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)

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

Difficult Words

Paraparesis : paralysis some of ekstermitities under

Subfebris : < 40oC between normal temperatures

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

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

Neuromuscular junction

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

Lower motor neuron

Upper motor neuron

Upper Motorneuron [UMN]

Is all associative neurons channelling impulse motorik to lower motorneuron

[lmn]

Consist of :Formation piramidalFormation ekstrapiramidal :

Consist of input and output

Formation Piramidal

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

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

Regional UMN

Core of motorik from cortex motorik gyrus presentralis

Traktus piramidalis

- Traktus kortikobulber

- Traktus kortikospinalisTraktus ektrapiramidalis

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

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

PATOMEKANISME PARAPARESIS

Lesion in medulla spinalis Effected to nerve

Nerve bindNerve not get enough O2

from vessels

Paraparesis

Medula Spinalis

Radix

Mechanism circle dorsal bone pain to stomach

Trauma

Reaction of body

Pain

T7-L1

N.Isciadicus (L4-S3)

Pain to Stomach

PARAPHARESE AND SUBFEBRIS

INFECTION

SUBFEBRIS

PARAPHARESES

Relation Pain With Paraparesis

Compression in medula spinalis caused tumor

Lost function of medula spinalis

Spastic weakness

Without decompression

paraparesis

pain

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)

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

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

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

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.

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

Therapy

- Anti tuberculose medicine

- Spinal cord decompression

- Blotting out infection

- Vertebra stabilization

- Operative

Spinal Cord Tumor

SarcomaDefinition:Sarcoma is a cancer of the connective

tissues, such as nerves, muscles, joints, bone, or blood vessels.

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

Treatment

Treatments include surgery to remove the tumor, radiation therapy, chemotherapy or a combination.

Glioma

Brain Cancer also called:

1. Glioma

2. Meningioma

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

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..

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.

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.

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.

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 )

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

SIGN AND SYMPTOMS

Symptoms depend of location Weakness and loss of sensationParesis in some day or week

ExaminationAnamnenisPhysic examinationSupport examinationLaboratoryum examinationCT ScanMRIBiopsyAngiographyMielogram

Theraphy

Therapy depend of cause Infection antibiotic.Happened abses throw pusshKortikosteroid.Surgery

Any Question

?Yes, I

want to ask

No

!!??