KULIAH UMUM BLOK

SARAF
RINI ANDRIANI
BAGIAN ILMU PENYAKIT SARAF
FK UNTAR

UMN DAN LMN

KELAINAN UPPER MOTOR NEURON :
-Vaskular, tumor, infeksi, trauma,
degeneratif, metabolik
-Kejang
-Sakit kepala (cefalgia)

KELAINAN LOWER MOTOR

NEURON:
Vaskular, tumor, infeksi/inflamasi,
degeneratif, trauma, metabolik,
obat2an

GEJALA KLINIS
UPPER MOTOR NEURON

LOWER MOTOR NEURON

Kelumpuhan flacid

Kelumpuhan spastik

Normotrofi atau atrofi krn disuse

Hipertonus

Reflek fisiologis meningkat

Reflek patologis +
Fasikulasi dan fibrilasi +

Normotrofi atau atrofi

Reflek fisiologis menurun

Hipotonus

Reflek patologis -

Fasikulasi dan fibrilasi -

CEREBROVASCULAR DISEASE

Any abnormality of the brain resulting from

a pathologic process of blood vessels
arteries, arterioles, capillaries, veins, or
sinuses.
The pathologic change in the vessels takes
the form of occlusion by thrombus or
embolus, or of rupture.
The resulting abnormalities in the brain are
of two types: ischemia, with and without
infarction, and hemorrhage

CEREBROVASCULER DISEASE

Other forms of cerebrovascular disease

are those due to altered permeability of
the vascular wall, hypertension, and
increased viscosity or other changes in
the quality of blood.

ISCHEMIC STROKE

Transient Ischemic Attacks (TIAs) :

transitory neurologic defects due to
ischemia in a particular angioanatomic
territory, lasting for minutes to hours
and followed by complete restoration of
function.
Embolic infarction
Lacunar infarction

INTRACRANIAL HEMORRHAGE

Spontaneous Subarachnoid Hemorrhage

due to Ruptured Saccular Aneurysm
Primary Intracerebral Hemorrhage
Arteriovenous Malformation (AVM)

Craniocerebral Trauma

The basic problem is both simple &

complex
simple because there is usually no
question about the cause and complex
because of the abstruse nature of a
number of secondary and delayed
effects.

PRIMARY INJURY

Skull Fractures
Concussion and Contusion
Diffuse Axonal Injury
Acute Epidural Hemorrhage
Acute and Chronic Subdural Hematomas
Penetrating Injuries

SECONDARY INJURY

Hypoxia, hypotension
Elevated intracranial pressure
Hyperglicemia, Seizures
Deep Venous Thrombosis and Pulmonary
Embolism
Hyperthermia, infection

NEUROIMAGING

NEUROIMAGING

Intracranial Neoplasms

Benign or malignant
(1) primary tumors
(2) secondary tumors

Primary brain tumors

Pilocytic astrocytoma, grade I, Astrocytoma,

grade II
Anaplastic astrocytoma, grade III,
Glioblastoma multiforme, grade IV
Oligodendroglioma, Ependymoma
Choroid plexus papilloma, Neuronal tumors
or mixed tumors (e.g., ganglioglioma)
Embryonal tumors (medulloblastoma, PNET)
Pineal parenchymal tumors

Other intracranial tumors

Metastatic tumors (breast and lung most

common)
Meningeal tumors (meningioma), Vascular
tumors (hemangioblastomas), Pituitary
adenomas
Germ cell tumors (germinoma, teratoma)
Primary CNS lymphoma, Nerve sheath tumors
(vestibular schwannoma)
Developmental tumors (craniopharyngioma,
epidermoid, colloid cyst), Chondroid matrix
tumors (chondrosarcoma, chordoma)

INFECTIONS

Infections involving the nervous system carry

a high morbidity and mortality, particularly in
developing countries where the burden of
disease is great, diagnosis is difficult and
limited
resources mean that availability and access to
treatment is poor.
In the developed world, neurological infection
is less frequent but continues to cause signifi
cant problems of diagnosis and management.

INFECTIONS

Infections of the nervous system can be

caused by viruses, bacteria, fungi or
protozoa.
They may affect the lining of the brain,
CSF, brain parenchyma, spinal cord,
nerve roots, peripheral nerve or muscle.

INFECTIONS

meningitis : infl ammation involving the

pia and arachnoid mater and the
subarachnoid space.
Encephalitis is infection and
inflammation within the brain
parenchyma.
Focal infection causes abscess formation
within or immediately adjacent to the
brain or spinal cord.

INFECTIONS

These patterns may overlap and when

infection involves the meninges, brain,
spinal cord and nerve roots the
descriptive compound terms are used:
meningo-encephalitis, meningo-myelitis,
encephalo-myelitis, meningo-radiculitis
and meningo-encephalomyelitis.

EPILEPSY

epilepsy is as a disorder of brain characterized

by an ongoing liability to recurrent epileptic
seizures.
An epileptic seizure is transient clinical
manifestations that result from an episode of
epileptic neuronal activity.
The epileptic neuronal activity is a specific
dysfunction, characterized by abnormal
synchronization, excessive excitation and/or
inadequate inhibition, and can affect small or
large neuronal populations.

CLINICAL SIGNS

Sudden and usually brief, include motor,

psychic, autonomic and sensory
phenomenon, with or without alteration
in consciousness or awareness
the symptoms depend on the part of the
brain involved in the epileptic neuronal
discharge, and the intensity of the
discharge

Headache (CEPHALGIA)