pbl
DESCRIPTION
study caseTRANSCRIPT
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GroupsCantika Dini Waris ( 2007730027)Cynthia Fadhilla ( 2007730030)Dian Aulia ( 2007730036)Esha Perdana ( 2007730049)Eni Farkhaeni (2007730045)Farih Nahar Mubarok (2007730051)Fauziah Budi (2007730052)Herlan Boga Komarul Zaman (2007730065)Muh. Abbas Shiddiq (2007730082)Putri Seli (2007730098)Ridavianti nur Agami (2007730103) Imelda (2003730012)
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Scenario A man 40 year old is laboring of farmer,
experience paraparesis since 6 month was last. Early only at legs right, but 1 week then also at legs left. 1 month before he experience paraparesis he feel pain in bone at circle backbone to stomach. The time when checked by doctor is known that the body temperature of subfebris
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Difficult Words
Paraparesis : paralysis some of ekstermitities under
Subfebris : < 40oC between normal temperatures
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KEY WORDS
Farmer, a man 40 years oldParaparesis since 6 month was lastOnly at legs right, but 1 week then also at
legs left1 month before he experience paraparesis
he feel pain in bone at circle backbone to stomach
Body temperature of subfebris
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Organization of nerves
Brain SSP Korda spinalis
Aferen
Stimulate sensorik
Stimulate viseral
Eferen
System of nerve somatik
System of nerve otonom
Nerve motorik
System of nerve simpatis
System of nerve parasimpatis
Muscle contruct
1. Artless mucle
2. Heart muscle
3. Gland
Organ –organ efektor (consisted of muscle network and gland
SST
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Neuromuscular junction
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Neuromusculoskeletal
That is system managing and execute movement controlled by willingness
In anatomik consist of :Upper motorneuron[ UMN]Lowermotorneuron[ LMN]
Muscle nerve interface
Muscle skeletal
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Lower motor neuron
Upper motor neuron
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Upper Motorneuron [UMN]
Is all associative neurons channelling impulse motorik to lower motorneuron
[lmn]
Consist of :Formation piramidalFormation ekstrapiramidal :
Consist of input and output
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Formation Piramidal
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Lower Motorneuron [LMN]
Neuron channelling impulse motorik to
muscle skelet.
Consist ofCore of motorik nerve kranial and axon
[nerve root motorik cranial] Core of motorik cerebrospinal nerve and
axon [nerve root motorik is cerebrospinal] and also cerebrospinal nerve
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Characteristics UMN LMN
Kind and weakness distribution lesi at brain
Lesi at brain :“distribusi piramidalis”,that is part distal especially hand muscles; exstensor arm and flexsor feebler leg.
Lesi at medula spinalis: vary to depend on location lesi.
Depend that is segment, radiks, or which nerve.
TonusSpastisitas: real in fleksor arm and ekstensor leg.
Flaksid
Mass MuscleOnly a little experience disuse atrophy muscle.
Atrofi can very clear
Reflex Increase;Babinski (+) Decrease or no; Babinski (-)
Fasiculation No Yes
Klonus Oftentimes No
Trouble UMN and LMN
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Regional UMN
Core of motorik from cortex motorik gyrus presentralis
Traktus piramidalis
- Traktus kortikobulber
- Traktus kortikospinalisTraktus ektrapiramidalis
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Regional LMN
Core of motorik nerve kranial [ nervi kraniales] brain stem nerve kranial motorik
Core of motorik cerebrospinal nerve in medulla spinalis
Cerebrospinal nerve root motorikNerve spinalis
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Form of paralysis
Form of paralysis depended level ofdamage/lession :Lession area kortikal and subkortikal →
Hemiparesis kontalateralLession in brain stem → Hemiparese
kontralateral accompanied by trouble nervus kranialis is ipsilateral
Lession in medulla spinalis level of servikal→ Tetraparesis
Lession in medulla spinalis of level of torakal downwards → Paraparesis
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PATOMEKANISME PARAPARESIS
Lesion in medulla spinalis Effected to nerve
Nerve bindNerve not get enough O2
from vessels
Paraparesis
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Medula Spinalis
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Radix
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Mechanism circle dorsal bone pain to stomach
Trauma
Reaction of body
Pain
T7-L1
N.Isciadicus (L4-S3)
Pain to Stomach
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PARAPHARESE AND SUBFEBRIS
INFECTION
SUBFEBRIS
PARAPHARESES
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Relation Pain With Paraparesis
Compression in medula spinalis caused tumor
Lost function of medula spinalis
Spastic weakness
Without decompression
paraparesis
pain
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paralysis attack right side than left side
Infection
Attack right side
Spread with diffuse along medulla spinals for several time
Attack left side too
Paraparesis
(can cause tetraparesis too)
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Cause of paraparesis
- Micobacterium tubertculosa cause of spondilitis tuberculosa
- Varicella zoster cause of myelitis
- Injury medula spinalis cause of accident
- Grow tissue abnormal in medula spinalis cause of tumor medula spinalis
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Relation of Paraparesis with work, age and genderWork factor at paraparesis
Work which weight can cause continuous trauma which finally later result lesion available for becoming paraparesis.
Age factor at paraparesis Paraparesis can be suffered bt person in advanced age
because of imunity complex don’t of inadecuat immunity complex and it can be suffered
Gender factor at paraparesis man and women ration 2,1 :1,5
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Supporting Examination for Neurology
1. Lumbal Pungsion
Is an activity for take cerebrospinal fluid from subarachnoid space to find out the presence or not some disorder of that fluid.
2. Radiology• X-ray
• CT scan
• MRI
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3. Electroensefalograph
Is a technique to record an electrical brain activity trough intact skull, the procedure is attach some electrode on the surface of the skull that potential for the record.
4. Electromiograph (EMG) & Electroneurograph (ENG)
EMG is an exam to gauge electrical skeletal muscle activity and ENG is to gauge velocity nerve conducting.
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Spondilitis Tuberculose• DefinitionIs a chronic and destructive granulomatosa inflamation that caused by micobaterium tuberculose.
• Sign and symptom -Localized back pain-Neurologic deficit sign especially paraparesis/paraplegi-Sign and symptom tuberculose desease
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Therapy
- Anti tuberculose medicine
- Spinal cord decompression
- Blotting out infection
- Vertebra stabilization
- Operative
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Spinal Cord Tumor
SarcomaDefinition:Sarcoma is a cancer of the connective
tissues, such as nerves, muscles, joints, bone, or blood vessels.
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Epidemiology
15-20% of all children's cancers are sarcomas.
However, it is more rare in adults and only 1% of adult cancers are sarcomas
Diagnose
To diagnose soft tissue sarcomas, doctors must remove and look at piece of the tumor under a microscope
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Treatment
Treatments include surgery to remove the tumor, radiation therapy, chemotherapy or a combination.
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Glioma
Brain Cancer also called:
1. Glioma
2. Meningioma
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Brain tumors can cause many symptoms. Some of the most common are
Headaches, usually worse in the morning Nausea and vomiting Changes in your ability to talk, hear or see Problems with balance or walking Problems with thinking or memory Muscle jerking or twitching Numbness or tingling in arms or legs
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Treatment
Treatment for a glioma — and survival odds — depends on the tumor type, size and location, and the patient's age and overall health. Gliomas can be complex, and a variety of techniques and procedures needed to treat them..
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Spinal Cord TumorSchwannomaDefinition
is a kind of tumor originating from the Schwann cellsCauses
The cause of schwannoma is unknown. These tumors sometimes occur in patients with von Recklinghausen disease (neurofibromatosis).
EpidemiologyThey can occur in children but more commonly affect young adults.
Symptomsa. Painless or painful mass that is slow-growing b. Electric like shock when affected area is felt (Tinel shock) c. Usually no neurological problems or loss unless the tumor involves a major motor or sensory nerve or is compressed between the tumor and a rigid structure.
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Diagnosea. X-ray
b. Ultrasound
c. MRI
d. Biopsy of the tumor
TreatmentSurgery to separate and remove the tumor from the nerve is usually the treatment of choice for schwannomas. Fortunately, this condition is curable and should not recur.
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SPINAL CORD TRAUMA
DEFINISITrauma medulla spinalis is trauma in vertebrae,there are fraktur in vertebrae ,ligamentum longitudainalis posterior and duramater can torn,and can stick canalis vertebralis, arteri and venous
EPIDEMIOLOGYAS Database report that happen 11 thousand case every
years.Trauma medulla spinalis in AS is 247 thousand people.
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ETIOLOGY
Fraktur vertebrae happened cause hiperflexion, hiperekstention, compression, or vertebrae rotation ,and accident
Ruptur in one of or some of vertebrae discusSecunder abnormality in bone marrow Infection and tumorAbnormality blood vessel (malformation arteriveniosa )
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PATOMECHANISM
In normal medulla spinalis protect by kolumna spinalis that have structure like bone but because something so that happened pressure to medulla spinalisand disturb normal function
Effect of medulla spinalis pressure ,motoric nerve corticospinal, ascending dorsal which bring sensation vibration and ipsilateral posision which crossing above medulla spinalis is disturb too. Spinothalamic which send temperature sensasion and touch sensasion from contralateral side body
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SIGN AND SYMPTOMS
Symptoms depend of location Weakness and loss of sensationParesis in some day or week
ExaminationAnamnenisPhysic examinationSupport examinationLaboratoryum examinationCT ScanMRIBiopsyAngiographyMielogram
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Theraphy
Therapy depend of cause Infection antibiotic.Happened abses throw pusshKortikosteroid.Surgery
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Any Question
?Yes, I
want to ask
No
!!??
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