responsi brainstem lesions
DESCRIPTION
brain lesionTRANSCRIPT
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Brainstem LesionsMyelopathy
Laili Candrawati
Ali Ridho Al Haddar
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Brainstem
MesensefalonPons Medulla Oblongata
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Anatomi Brainstem
Mesensefalon Basis
Krus posterior Substansia nigra
Tegmentum Seluruh jaras ascenden + Sebagian jaras descenden Nukleus Ruber Inti NC. III dan IV
Tektum 2 pasang Kolikulu
Pedunkulus Serebelli Superior (Brakhium Konjungtivum)
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Anatomi Brainstem
Pons Basis
Jaras kortikospinal Inti-inti pons Serabut pontoserebelaris
Tegmentum Inti NC. 6 dan 7 Jaras spinotalamikus tegmentalis sentralis tektospinalis, dan fasikulus longitudinal medialis
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Anatomi Brainstem
Medulla Oblongata Jaras-jaras ascenden Jaras-jaras descenden Inti NC. 4,7,8,9,10 dan 12 Pedunkulus serebelaris inferior
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Brainstem lesion Mesensefalon
Sindroma Weber Sindroma benedik
Pons Sindroma basis pontis (Tengah) Sindroma basis pontis (Kaudal) / sindroma Millard-
Gubler Sindroma tegmentum pontis (rostral) Sindroma tegmentum pontis (kaudal)
Medulla oblongata Sindroma Med-Ob medial/ sindroma Dejerine Sindroma Med-Ob Lateral/ sindroma Wallenberg
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1.a) Sindroma WeberParalisis nc.
3
Paralisis nc. 7
dan12
Paralisis Spatik
Rigid, tremor,
parkinsonism
Substansia Nigra Akinesia (Parkinsonism)KShemiplegi spastik kontralateralKN Parese nc.7, 12 kontralateral KP distaksia kontralateralNC3paralisis nc.3 ipsilateral
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1.b) Sindroma Benedik
Hilang rasa raba, posisi, getar
Hiperkinesia
Lemnikus medialis hilang rasa raba, posisi, getar (kontralateral)Nukleus ruber hiperkinesia kontralateral (korea, atetosis)Substansia nigra akinesia kontralateral (parkinsonisme)N C 3 paralisis N 3 ipsilateral
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2.a) Sindroma Basis Pontis (bag. tengah)
Distaksia
Paralisis Spastik
AnestesiaParali
sis Flaksi
d
NC5Hemifasial anestesia ipsilateral, paralisis flaksid otot kunyah ipsilateral Pedunkulus hemiataksia, asinergia ipsilateralKS hemiparesis spastik kontralateral Inti-inti pontis Distaksia ipsilateral
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2.b) Sindroma basis pontis (bag. Kaudal)/ Sindroma Millard-Gubler
Paralisis Flaksid
Analgesia, termaneste
sia
Lemnikus medialis anestesia (raba, posisi, getar)Lemnikus lateral hipakusiaInti N C 7 paralisis fasial perifer ipsilateralSpinotalamikus lateralis termanistesia tubuh kontralateral, analgesiaTr piramidalis hemiplegi spastik kontralateralN C 5 paralisis N 6 perifer ipsilateral
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2.c) Sindroma Tegmentum Pontis (bag.rostral)
Analgesia, Termaneste
sia
Anestesia (raba, posisi, getar)
Paralisis Flaksid
Tr spinotalamikus lateral analgesia dan termanestesia tubuh kontralateralN C 5 anestesia hemifasial (prinsipalis), analgesia termanestesia (tr spinal), paralisis flaksid otot kunyah ipsilateral (morius)Lemnikus medial anestesia (raba, posisi, getar)
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2.d) Sindroma Tegmentum Pontis (bag.kaudal)
Paralisis
Flaksid
Analgesia, termaneste
siaAsinerg
ia
NC 6 dan 7 paralisis ipsilateralSpinotalamikus lateral analgesia dan termanestesia kontralateralLemnikus medialis anestesia kontralateral (raba, posisi, getar)Tr spinoserebelaris asinergi dan termanestesia kontralateral
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3.a) Sindroma medular medial/ Sindroma Dejerine
Anestesia(raba, posisi,
getar)
Paralisis Non
Spastik
Paralisis N XII
Tr piramidalis hemiplegi kontralateral non spaticLemnikus medialis anestesia (raba, posisi, getar)N C 12 paralisis perifer ipsilateral
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3.b) Sindroma medular lateral / SindromaWallenberg
Ataksia & Asinergia
Analgesia, termaneste
sia
Tr spinotalamikus lateral analgesia dan termanistesia kontralateralTr spinoserebelaris anterior ataksia, hipotonia ipsilateralLintasan simpatik sentral sindroma horner vasodilatasi ipsilateral hipohidrosisNistagmus, gangguan bicara, dan menelan
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Myelopathy
Laili Candrawati
Ali Ridho Al Haddar
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Definisi
Setiap setiap gangguan fungsional atau perubahan patologis dalam medulla spinalis
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Etiologi V = Vascular I = Infeksi T = Trauma A = Autoimun M = Metabolic electrolic / Endokrin I = Iatrogenik / Idiopathic N = Neoplasma S = Seizure / Struktural / Sikiatris D = Degeneratif
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Patofisiologi
Mielopati paling sering disebabkan stenosis dari tulang belakang terjadi penyempitan progresif dari kanal vertebrae tempat beradanya medulla spinalis medulla spinalis dapat terjepit di dalam kanal yang mengecil.
Sebagai efeknya spinal cord dan nerve root akan mengalami kompresi dan terganggu fungsi normalnya.
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Gejala Klinis
1. Gejala motorik - setinggi segmen kelumpuhan LMN - dibawah segmen kelumpuhan UMN - servikal tetraparese/plegi - torakal/lumbal paraparese/plegi - sakral gangguan miksi dan defekasi, tanpa paraparese/plegi
2. Gejala sensorik Hipo/anestesi mulai setingi segmen yang terganggu kebawah
3. Gejala otonom Retensi urin dan inkontinensia alvi
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Diagnosis 1. Klinisa. Keluhan sensibilitas:
- bandingkan daerah yang (N) dengan yang sakit- tentukan batas atas lesi menentukan letak lesi
b. Keluhan motoris: gangguan tr piramidalis kelumpuhan spastik
c. Keluhan otonom
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Diagnosis
2. Pemeriksaan Penunjang a. Foto X-ray kolumna vertebrae b. MRI c. Lab : - Hb, eritrosit
- alkali & acid fosfoterase - px spektrum protein
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Terapi Pada penderita mielopati dengan bukti
kompresi pada spinal cord dan nerve root
dilakukan operasi (dekompresi) dengan hati-hati untuk membebaskan dari
kompresi.
Analgesic untuk nyeri yang dialami.
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TERIMA KASIH