PENGANTAR NEUROLOGI

Dr FUAD HANIF SpS M.KES

SMF NEUROLOGI RSUD
BANJAR

BATASAN
NEUROLOGI ADALAH ILMU YANG
MEMPELAJARI TENTANG
PERSARAFAN, BAIK
YANGFISIOLOGIS MAUPUN
PATOLOGIS.

SKEMA PEMERIKSAAN
PENYAKIT SARAF
1.

SKEMA
ANAMNESA

GEJALA
TUMPANG
TINDIH

PEMERIKSAAN
FISIK

DIAGNOSA KLINIS
DIAGNOSA LOKALISASI
DIAGNOSA ETIOLOGI
DIAGNOSA BANDING

PEMERIKSAAN
PENUNJANG

CARA PEMERIKSAAN
SSP (SUSUNAN SARAF PUSAT)
TERLETAK DIDALAM TULANG SEHINGGA
TIDAK DAPAT DI INSPEKSI, PALPASI, DAN
AUKULTASI SECARA LANGSUNG,
MELAINKAN DENGAN PEMERIKSAAN
KHUSUS (TEKNIK STIMULUS RESPONS)

URUTAN PEMERIKSAAN
1. ANAMNESA

ALLO-ANAMNESA
HETERO-ANAMNESA

2. PEMERIKSAAN FISIK

STATUS PRAESENSI : vital sign

STATUS INTERNA

ETIOLOGY IN NEUROLOGIC DISORDERS :

TRAUMA : HEAD / SPINE TRAUMA
VASCULAR : STROKE
INFECTION : ENCEPHALITIS, MENINGITIS
TUMOUR
DEGENRATIVE PROCESS : PARKINSON,
DEMENTIA
IDIOPATHIC : EPILEPSY

 STATUS NEUROLOGI

RANGSANG MENINGEAL
SARAF OTAK
PEMERIKSAAN MOTORIK
PEMERIKSAAN SENSORIK
PEMERIKSAAN REFLEKS
PEMERIKSAAN KOORDINASI
PEMERIKSAAN FUNGSI LUHUR

ANAMNESA
1.
2.
3.

KELUHAN UTAMA
RIWAYAT PENYAKIT SEKARANG
RIWAYAT PENYAKIT DAHULU

PEMERIKSAAN FISIK
1.
2.
3.
4.
5.

KESADARAN
TEKANAN DARAH
NADI
RESPIRASI
TEMPERATUR

PEMERIKSAAN NEUROLOGIS
1.

DIPERIKSA RANGSANGAN MENINGEAL

PEMERIKSAAN MELIPUTI :
TANDA KAKU KUDUK
TANDA KERNIG
TANDA LASEQUE
TANDA BRUDZINSKI

2.

PEMERIKSAAN SARAF OTAK

SARAF YANG DIPERIKSA

NERVUS I (OLFAKTORIUS)
NERVUS II (OPTIKUS)
NERVUS III, IV, VI
NERVUS V (TRIGEMINUS)
NERVUS VII (FASIALIS)
NERVUS VIII (VESTIBULOCOCHLEARIS)
NERVUS IX (GLOSSOFARINGEUS)
NERVUS X (VAGUS)
NERVUS XI (ASESORIUS)
NERVUS XII (HIPOGLOSUS)

Cranial
Nerves

Nuclei of
Cranial
Nerves

Motoric
Cranial
Nerves
Nuclei

Sensoric
Cranial
Nerves
Nuclei

CN V (TRIGEMINAL)

SENSATION OF FACE, OPEN/CLOSE JAW,

MASTICATION, CORNEAL REFLEX)

CN VII (FACIAL)
FACIAL MOVEMENT AND
EXPRESSION,
TASTE OF ANTERIOR
TWO THIRD OF
TONGUE,
BLINKING REFLEX

Central 7th palsy

Peripheral 7th palsy

CN VIII (VESTIBULO-COCHLEAR)
BALANCING
SENSE OF HEARING

CN IX (GLOSSOPHARYNGEAL) AND CN X
(VAGUS)
ELEVATION OF PALATE/UVULA, GAG REFLEX

CN XI (SPINAL
ACCESSORY)
HEAD MOVEMENT,
SHOULDER
SHRUG/ELEVATION

CN XII TONGUE
MOVEMENT

MOTOR SYSTEM
MUSCLE BULK
MUSCLE TONUS
MUSCLE POWER/STRENGTH
FASCICULATION

SENSORY SYSTEM
SUPERFICIAL SENSORY MODALITIES : PAIN
PERCEPTION, TEMPERATURE DISCRIMINATION, LIGHT
TOUCH
DEEP SENSORY MODALITIES : VIBRATION SENSE,
POSITION SENSE
CORTICAL FUNCTION : TWO-POINT DISCRIMINATION
(EXTINCTION), STEREOGNOSIS

REFLEXES
PHYSIOLOGIC REFLEX [MUSCLE STRETCH (DEEP)
REFLEX] : BICEPS, TRICEPS, BRACHIORADIAL, KNEE
JERK (KPR), ANKLE JERK (APR)
SUPERFICIAL REFLEX : ABDOMINAL SKIN REFLEX,
CRESMATERIC, ANAL, BULBOCAVERNOUS
PATOLOGIC REFLEX : BABINSKI, CHADDOCK,
HOFFMANN TROMMER, REGRESSION

SUBSPECIALTIES IN NEUROLOGY
NEUROPEDIATRIC OR
DEVELOPMENTAL NEUROLOGY
NEURO-RADIOLOGY
NEURO-PHYSIOLOGY
NEURO-PSYCHOLOGY
NEURO-ANATOMY
NEURO-REHABILITATION
CEREBRO-VASCULAR DISEASE (CVD)
CNS INFECTION
EPILEPSY
PERIPHERAL NERVE
NEURO-OPHTHALMOLOGY

SIGN AND SYMPTOMS IN

NEUROLOGICAL
DISEASES

Due to location
Hemisphere
Central Nerves System
Medulla
spinalis

Nucleus
Peripheral nerves system

Ganglion
Nerve root

Cerebral
Cerebellum
Brain section
Cervical
Thoracal
Lumbosacral

SYMPTOMS & SIGNS

Cardinal symptoms
General cerebral disorders
High intracranial pressure

Consciousness

Intoxication
Metabolic disorders
Focal cerebral disorders
Disturbances of ARAS /
brain stem

Causes of decreased LOC

Intra-cranial

Extra-cranial

Diffuse

Focal

Hepar

Meningitis,
Encephalitis

Stroke,
Tumour,
Abscess

Renal
Lungs
Diabetes
Intoxication

Lumbal
puncture

CT-Scan
Laboratory

Cardinal symptoms

Meningeal irritation : - Infection

- Haemorrhage
- Radix irritation

Motor dysfunction : - central

Cerebral : hemiparese, hemiplegy

- Vascular
- Infection
- SOL
- Degenerative process
Medullar : segmental paralytic

- Upper motor / central

Hypertonic / spastic
Hyperreflexia
Pathological reflex

Cranial nerve
- Perifer
Segmental : - Myotomal
- Radiculopathy
- Neuropathy
- Lower motor :
Hypotonic / flacid
Hypo / areflexia

Sensoric dysfunction :
Exteroceptive
Pain
Temperature
Touch
Proprioceptive
Vibration
Deep pain
Position
Cerebral
Cortical
Thalamic
Medullar
Radicular
Organic

Autonomic :
Symphatic
Parasymphatic

Regulation of blood pressure,

respiration, micturation, bowel
habit, sweating

Equilibrium :
Central :
Cerebellum
Posterior medulla spinalis
Peripheral :
Vestibular

Higher Cortical Dysfunction :

Cognitive dysfunction
Neurobehaviour
Memory
Immediate
Recent
Long term memory
Language
Verbal
Non verbal
Dyslexia
Dysgraphia
Orientation
Time
Place
Person

 Praxis
Calculation
Insight
Executive function
Visuospatial
Emotion

Higher Cortical Dysfunction :

Degenerative Dementia
Vascular Stroke
SOL Intracranial tumor
Neurotransmitter Psychiatric disorder

Symptoms :
Memory problem
Executive dysfunction
Language dysfunction, aphasia
Disorientation
Disinhibition
Behaviour disturbances
Dispraxia