neurology examination status...
TRANSCRIPT
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NEUROLOGY EXAMINATIONS TATUS WR ITTING
Diatri Nari LastriLyna S oertidewi
NEUROLOGY DEPARTMENTMEDIC INE FACULTY UNIVERS ITY OF
INDONES IACIPTO MANGUNKUS UMO HOS PITAL
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PATIENT INFORMATION
• Patient name• Address• Date of birth• Age• Education• Handedness• Occupation
• Date
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HIS TORY TAKING
• The most important part of the clinical assessment
• The time course of the symptoms give an insight into the pathological process
• The history should be used to construct and test hypotheses abolut the diagnosis
• Common neurological diagnoses made on the history, with the normal esamination:– Migraine, Tension headache– Epilepsy– Transiene Ischaemic Attack (TIA)
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HIS TORY
• Auto / Allo Anamnesis• Chief complaint• A 28 year old man was brought to the emergency
room with 1 day of worsening headache
• History of the present illness • Medication and Allergies
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History of the present illness
• History of the current medical problem include risk factor or other causes of the current illness
• Detailed chronological discription• Related medical problems • Illness in the present
Illness in the past with handicapIllness in the seizure form, inter seizure in normal condition
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HIS TORY• Past medical history (not related to the HPI)• The patient has a history of a mildly enlarged
prostate gland. He had a right inguinal hernia repair in 1978
• Family history• Patient’s mother died at 66 of stroke, had
hypertension. Father had myocardial infarction at 55.
• S ocial and enviromental history (occupation, family situation, lifestyle, habits)• Electrical engineer. Married with two children. No
recent travel. Denies ever smoking cigarettes or using drugs. Drinks 1-2 beers on S unday
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History
AN AM N E S IS Y G B A IK M E M B AWA K ITA M E N E M PU H S E TE N G AH JALAN K E AR AH D IAG N OS IS Y G TE PAT
D IAG N OS IS C linic Topic Pa tholog ic E tiolog y
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Taking H is tory
C ommunic ation
InformationC ons c ious nes s , a ttention,
motor s peed, lang uag e, memory, exec utive func tion
(menta l s ta tus )
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HIS TORY• Taking History:• Open question• Close question• Combination
• Pusing : headache or vertigo?• Kurang mendengar: • language/memory disturbances?
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Neurologic S ymptoms
• Headache• Vomitus• Vertigo
Cranial Nerve (I – X II)motorsensoryautonomy
• Consciousness• Neurobehavioral
problem• Motor dysfunction• S ensory dysfunction• Autonomy dysfunction
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Headache
1. Apakah anda menderita sakit kepala?2. Bagaimana sifatnya,dalam bentuk serangan atau terus
menerus?3. Dimana lokasinya? 4. Apakah progresif, makin lama makin berat atau makin
sering? 5. Apakah sampai mengganggu aktivitas sehari- hari ?6. Adakah faktor yg memperberat / memperingan?7. Adakah disertai gejala lainnya?
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Vomit
1. Apakah disertai rasa mual atau tidak ?2. Apakah muntah ini tiba,tiba, mendadak ,
seolah – olah isi perut dicampakkan keluar (proyektil)
3. Berapa kali? (frekuensi)4. Adakah hubungannya dg makanan, 5. Perubahan posisi, penglihatan?
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Vertigo
1. Pernahkah anda merasakan seolah sekeliling anda bergerak, berputar atau anda merasa diri anda yang bergerak atau berputar ?
2. Apakah rasa tersebut ada hubungannya dengan perubahan sikap ?
3. Apakah disertai tinitus (telinga berdenging, berdesis)?
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Visual
1. Apakah ketajaman penglihatan anda menurun pada satu atau kedua mata ?
2. Apakah anda melihat dobel (diplopia) ?3. Apakah jika berjalan sering menabrak pintu?
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Hearing
1. Adakah perubahan pada pendengaran anda ? 2. Adakah tinitus (bunyi berdenging /berdesis
pada telinga)?3. Halusinasi?
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Hearing
1. Adakah perubahan pada pendengaran anda ? 2. Adakah tinitus (bunyi berdenging /berdesis
pada telinga)?3. Halusinasi?
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Cranial Nerves
1. Adakah gangguan pada penciuman, pengecapan,2. Adakah masalah salivasi (pengeluaran air ludah),
lakrimasi (pengeluaran air mata), dan rasa baal di wajah?
3. Adakah wajah / mulut mencong (kelemahan pada otot wajah)?
4. Apakah bicara jadi cadel dan pelo (disartria)? 5. Apakah suara anda berubah, jadi serak, atau bindeng
(disfonia), atau jadi mengecil/ hilang (afonia)? 6. Apakah sulit/gangguan menelan /batuk atau tersedak
jika minum(disfagia)?
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Neurobehavior/Mental S tatus
1. Bagaimana dengan memori : apakah anda jadi pelupa? S ering bertanya berulang dengan pertanyaan yang sama?
2. Apakah anda menjadi sukar mengemukakan isi pikiran anda (disfasia, afasia motorik) atau memahami pembicaraan orang lain (disfasia, afasia sensorik)?
3. Bagaimana dengan kemampuan membaca (aleksia)? • apakah menjadi sulit membaca, dan memahami
yang anda baca ? 4. Bagaimana dengan kemampuan menulis : • apakah kemampuan menulis berubah? • apakah bentuk tulisan berubah ?
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Conciousness
1. Pernahkah anda mendadak kehilangan kesadaran, tidak mengetahui apa yang terjadidi sekitar anda?
1. Pernahkah anda mendadak merasa lemah dan seperti mau pingsan (sinkop) ?
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Motoric dysfunction
1. Adakah bagian tubuh anda yang menjadi lemah,atau lumpuh (tangan,lengan, kaki, tungkai,)
2. Bagaimana sifatnya, hilang-timbul,menetap, bertambah berat atau berkurang?
1. Apakah timbulnya mendadak atau sedikit demi sedikit?
1. Adakah gangguan gerak? • Gemetar? S aat istirahat atau melakukan
gerakan/aktivitas?• Gerakan seperti menari?
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S ensory dysfunction
1. Adakah perubahan atau gangguan rasa pada bagian tubuh atau ektremitas?
2. Adakah rasa baal, semutan, seperti di tusuk,seperti dibakar, hilang rasa?
3. Di mana tempatnya? 4. Apakah rasa tersebut menjalar ?
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Autonomic dysfunction
1. Bagaimana buang air kecil (miksi), buangair besar (defekasi), dan nafsu seks (libido) anda?
2. Adakah kesulitan buang air kecil (harus mengedan? ) atau buang air besar? (retensio urin/alvi) atau buang air kecil dan buang air besar tidak terkontrol/ngompol? (inkontinensia urin atau alvi)
3. Adakah bagian badan atau wajah yang menjadi lebih kering (keringat berkurang/tidak berkeringat)?
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General Examination• K es adaran K ooperatif• N adi S uhu• Tens i R es piras i • B entuk tubuh• G i z i• S tikmata• K ulit – Topik– Turg or
• K uku• K elenjer G etah B ening • Pembuluh darah (puls as i, g etaran, bis ing , a .
karotis , a . tempora lis , la in-la in)
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Regional Examination• K epa la• K a lvarium• M ata• H idung • M ulut • Teling a • Oks iput• Leher
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Regional Examination
• Toraks• Jantung• Paru-Paru• Abdomen• Hepar• Limpa• Vesika Urinaria • Genitalia Eksterna
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Regional Examination
• Ekstremitas • S endi-sendi • Otot-otot (nyeri tekan) • Kolumna vertebralis • Gerakan leher • Gerakan tubuh • Nyeri ketok • Nyeri sumbu
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1. Consciousness
• Qualitative Compos mentis S omnolen Delirium S opor Coma
• Quantitative : Glasgow Coma S cale E..M..V..
Minimum: E1M1V1 = 3 (Coma)Maximum: E4M6V5 = 15 (Compos
mentis)
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Meningeal S ign
• Neck S tifness • Brudzinski I • Laseque• Kernig • Brudzinski II
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2. Cranial Nerves N I (K ua lita tif) : L.H. ka.
L.H. ki. Penciuman
N I I : OD OS• Visus (snellen chart)• Lihat warna • Refleks ancam • Kampus (konfrontasi, kampimeter) • Fundus
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N I I I , IV , V I
S ikap B ola M ata• Ptosis • S trabismus
• Nistagmus
• Eksoftalmus • Enoftalmus • Diplopia
Perg erakan bola mata• Lateral kanan • Lateral kiri • Lateral Atas kanan• Lateral Atas Kiri• Lateral Bawah Kanan• Lateral bawah Kiri• Deviasi konjugat• Berputar
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PU P IL K ananK iri
• Besar :• Bentuk :• Isokori :• Reaksi cahaya langsung :• Reaksi cahaya konsensual :• Reaksi pada konvergensi dan akomodasi :
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N V (M otorik) • Gerakan rahang
• Menggigit (palpasi otot-otot maseter, temporalis)
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N .V (S ens ibilita s )
• Rasa nyeri :• Rasa suhu :• Rasa raba : • Rasa permukaan lidah :• Rasa selaput lendir mulut :• Noktah nyeri foramen supra orbita :• Noktah nyeri foramen infraorbita :• Noktah nyeri foramen mental :
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N .V (R efleks )
• Refleks nasopalpebra• Refleks kornea• Refleks maseter
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N V I IM otorik• S ikap mulut da lam is tirahat • M imik • Ang kat a lis• K erut dahi • Tutup mata deng an kuat • Ters enyum/memperliha tkan g ig i• K embung pipi • M enyering a iPeng ec apan• R as a kec ap lidah 2/3 depan R efleks • R efleks c hvos tek
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N . V I I I
N . V es tibularis • N is tag mus• S a lah tunjuk • K es eimbang an • V ertig o
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N . V I I I N . K oklearis K anan
K iri• S uara bisik • Gesekan jari • R inne • Weber • S chwabach
N .V I I I (R efleks ) • Refleks auriculo palpebra
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N . IX , X
• Arkus faring s • Pa la tum mole • S eng au • Parau • Dis fag i • B atuk • S a lah telan • M eng ejan
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N .X I
• M enoleh (kanan, k iri, baw ah) • Ang kat bahu (kanan, k iri) • M . S terno k leidomas toideus
(tropik : kanan dan k iri) • M . Trapezius bag ian a tas (tropik : kanan dan k iri)
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N . X I I
• S ikap lidah da lam mulut • Julur lidah • G erakan lidah (devia s i) • Tremor • Fas ikula s i • Artikulas i (dis artria )
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3. Motor 1. S treng ht ( 0 – 5) : Kanan
Kiri• Ekstremitas atas : lengan atas
lengan bawah tangan jari
• Ekstremitas bawah : Tungkai atas tungaki bawah
kaki jari
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3. Motor2. B erdiri • Jong kok berdiri• Ja lan :
lang kah leng g ang leng an
dia tas tumit jinjit
3. Tonus Otot (hiper, normo, hipo, a toni) K anan K iri
Lengan
EkstensorFleksor
TungkaiEkstensor Fleksor
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3. Motor4. Trofik Otot (hiper, normo, hipo, atrofi)
5. Koordinasi
S tatis Duduk B erdiri R omberg
Dinamis Telunjuk – hidung :
Jari-Jari (finger to finger finger to nose) :
Lutut tumit :Tremor intensi :Rebound Phenomen :Disdiadokokinesis :Deviasi dan past Pointing :
* B ic a ra (dis artri-s c anning s peec h) :
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3. Motor6. Abnorma l S pontaneous M ovement• Convulsion :• Tetanus :• Tremor :• Chorea :• Atetosis :• Balismus :• Diskinesia :• Myoclonic :• Tick :
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3. Motor 7. R eflex (hiper, normo, hipo, a refleks i)
K anan K iri
• A. Tendon : Biseps:Triseps:Radius:Ulna:Lutut:Tumit:
• B. S uperficial :Telapak kaki (strumpel):Kulit perut :Kremaster :
S fingter ani : Normal: ++Hypo reflex: +/-Hyper Reflex: +++, ++++ Ex: Biseps: ++/+++
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3. Motor K anan K iri
C . Abnorma l/Patholog yc R efleks• Babinski :• Chaddock :• Oppenhein :• Gordon :• S chafer :• Rossolimo :• Mendel-Bechterew :• Hoffman-Trommer :• Klonus patela :• Klonus achiles : Normal : -
Pathology : +
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4. S ensory dysfunctionE ks teroc eptive • Pain• Temperature• Tactile
Proprioc eptive :• Position • Posture • Vibration • 2 point discrimination
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5. Autonomy Dysfunction
• M iksi • S ekresi keringat • Defekasi • S ekresi air mata • S alivasi • Gangguan vasomotor
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6. Neurobehavior/Mental S tatus• Neuropsychiatry
(emotion, delusion, hallucination)
• Attention and Concentration
• Language• Fluency• Comprehension• Repetition• Naming• Reading and
Writting• Memory
• Immediate• Recent• Remote
• Visuospatial• Executive Function
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7. Tanda regresi
• Refleks menghisap :• Refleks genggam :
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8. Palpasi S araf PeriferN . ulnaris
N . aurikularis N . fibularis
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Anjuran Pemeriksaan
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Resume
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Diagnosis
• K linis :• Topis :• Patolog is :• E tiolog is :
D iff. D iag nos is (DD)
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Therapy
K omunikas i, Informas i, E dukas i (K IE )
S uportif D ietetik M edikamentos a Fis ioterapi La in-la in (operas i, radioterapi)
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Prognosis
• Ad V itam • Ad Fung s ionam • Ad S anas ionam
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