UTOYO SUNARYO

Assessment

 Anamnesis  Test diagnostik penunjang.

 Pemeriksaan fisik
 Tanda – tanda vital
 Fungsi luhur
 Derajat kesadaran
 Rangsang meningeal.
 Saraf kranialis
 Fungsi motorik
 Fungsi sensorik
 Refleks fisiologis dan patologis
 Tanda serebelum dan koordinasi
 Gait /cara berjalan and bicara
 Gerakan involunter
 Laboratorium darah,urine
 CT Scan/M.R.I
 TCD ( transcranial doppler)
 PET
 Lumbal pungsi
 Electroencephalogram /EEG
 Electromyography/EMG
 Echoencephalography.
 Foto rontgen.
 Alat yang diperlukan

 Stethoscope, gloves, tongue spatel.

 Ophthalmoscope,
 Reflex hammer
 Garpu tala
 Kapas
 Tabung
 Benda tajam
dan tumpul
PEMERIKSAAN FUNGSI LUHUR
 Fungsi luhur

 Status mental

 MINI MENTAL STATUS EXAMINATION

( MMSE)
 Status Mental
 Derajat kewaspadaan , perhatian : nama – nama
bulan , forward and backward.
 Orientasi: nama lengkap , tanggal bulan tahun ,
lokasi .
 Memori : mengulang 3 kata sesdh 3-5 menit
 Bahasa : Bicara spontan, pengertian bahasa ,
penamaan, pengulangan, membaca dan menulis
Comprehension
 Status Mental
 Calculation, R-L confusion, Finger agnosia,
agraphia
 Apraxia
 Neglect and Construction
 Sequencing tasks and Frontal release signs
Apraxia
Neglect and Constructions

Constructions
 Status Mental

 Logic and abstraction

 Apa persamaan apel dengan pisang ?
 Apa persamaan mobil dengan perahu ?
 Bila Jane lebih tinggi dibandingkan Marry, dan
Mary lebih tinggi dibandingkan Anne. Siapakah
yang tertinggi diantara mereka ?
 Delusi dan halusinasi.
 Mood
 Status Mental

 Memori
 Orientasi waktu, tempat dan orang
 Intelligensi Vocabulary, fund of knowledge, calculations (eg,
serial-7 calculations), abstraction (eg, use of proverbs), and judgment
(eg, what to do with a found wallet)

 Gangguan psikologis proses berpikir ( circumstantiality) ;

persepsi (cth, illusi dan halusiniasi) ; arus dan isi berpikir.
Mini mental status examination
Tanda – tanda vital
GLASGOW COMA SCALE
Tanda rangsang meningeal
 Tanda rangsang meningeal

 Kaku kuduk
 Brudzinski sign
 Brudzinski tanda leher
 Brudzinski tanda pipi
 Brudzinski tanda simphisis.
 Brudzinski tanda tungkai kontra lateral.
 Kernig sign
PEMERIKSAAN SARAF KRANIALIS
 Saraf kranialis

 Nervus olfaktorius.
N. I
 N. II

 Nervus optikus.
 Acuity, by using the Snellen chart (near and
distant vision)
 Visual fields, by means of confrontation or
perimetry if indicated
 Color, with use of an Ishihara chart or by using
common objects
 Funduscopi dng memakai optalmoskope
Visual Acuity/lapang pandang
Test Lapangan Pandang (Tes
Konfrontasi)
Anatomy of Visual Pathway
1. Optic nerve
2. Optic chiasma
3. Optic tract
4. Lateral geniculate body
5. Optic radiation
6. Visual cortex
7. Superior colliculus of the midbrain
8. Putamen
9. Long association bundle - inferior
occipitofrontal fasciculus
10. Pulvinar of the thalamus
11. Calcarine fissure
12. Posteroinferior horn of the lateral
ventricle
Funduscopi
 Nervus III - IV - VI
 Oculomotor nerve - CN III
 pupillary constrictors;
 the levator palpebrae superioris;
 the superior, inferior, and medial recti; and
 the inferior oblique muscles.
 Trochlear nerve - CN IV
 superior oblique muscle
 Abducens nerve - CN VI
 the lateral rectus
Tes Ocular Motility
 Nervus V

 Nervus trigeminal
 ophthalmic; V1
 maxillary; V2
 Mandibular; V3
Sensoris
Motorik
 Nervus VII

 Motorik otot-otot wajah

 Kelenjar Lakrimalis
 Kelenjar Saliva
 Pengecapan 2/3 depan lidah
 N. Stapedius -> Hyperakusis
Motorik N. VII
Parese N. VII perifer
 Nervus VIII

 Fungsi pendengaran dan vestibular

 Fungsi pendengaran:
 Weber Test
 Rinne Test
 Schwabach Test
 Fungsi vestibular
 Romberg Test
Tes Pendengaran
Weber Test
Rinne Test
 Nervus IX
 Sensory innervation of the posterior third of
the tongue and the pharynx.
 Loss of taste in the posterior third of the
tongue and loss of pain and touch sensations
in the same area, soft palate, and pharyngeal
walls
 Pharyngeal musculature, particularly the
stylopharyngeus, in concert with the vagus
nerve.
 Nervus IX – X
 The pharyngeal gag reflex : tongue retraction
and elevation and constriction of the
pharyngeal musculature in response to
touching the posterior wall of the pharynx,
tonsillar area, or base of the tongue
 The palatal reflex : elevation of the soft palate
and ipsilateral deviation of the uvula on
stimulation of the soft palate
Anatomi
Parese N.IX yang mana ?
Parese N. IX yang mana ?
 Nervus XI

 When the right sternocleidomastoid muscle

is weak, pushing to the opposite (ie, left) side
is impaired, and vice versa.
 Shrugging of the shoulder is impaired
ipsilaterally when the trapezius muscle is
weak.
Nervus XI
 nervus XII

 It provides motor innervation for all the

extrinsic and intrinsic muscles of the tongue
except the palatoglossus.
 To test the hypoglossal nerve, have the
patient protrude the tongue; when paralyzed
on 1 side, the tongue deviates to the side of
paralysis on protrusion
N. XII
N. XII
Parese N. XII kanan
PEMERIKSAAN MOTORIK
 Motor system

 Trophic state :
 3 Ss: size, shape, and symmetry
 Muscle tone
 Hypotonia
 Hypertonia : Clasp-knife, paratonia (gegenhalten),
cog-wheel, lead-pipe
 Paratonia (Gegenhalten)
 Inability to relax one’s limb manifesting as
resistance to movement
Size, Shape, Symetry
Size, Shape, Symetry
SKALA PEMERIKSAAN MOTORIK
 Hemiparese, Tetraparese, Paraparese
Kekuatan :
0 = tidak terlihat kontraksi
1 = terlihat kontraksi tetapi tidak ada
gerakan pada sendi
2= ada gerakan pada sendi, tidak dapat
melawan gaya gravitasi (bergeser)
3= bisa melawan gravitasi, tidak dapat
melawan tahanan
4= bisa bergerak melawan tahanan tetapi
berkurang kekuatannya
5= kekuatan normal
The deltoid muscle is innervated
by the C5 nerve root via the
axillary nerve
Pronator Drift, Lesi UMN
The biceps muscle is innervated by the C5
and C6 nerve roots via the musculocutaneous
nerve.
The triceps muscle is innervated by
the C6 and C7 nerve roots via the
radial nerve.
The wrist extensors are innervated by
C6 and C7 nerve roots via the radial
nerve
Finger flexion is innervated by
the C8 nerve root via the median
nerve.
Finger abduction or "fanning" is
innervated by the T1 nerve root via
the ulnar nerve
Thumb opposition is innervated by the
C8 and T1 nerve roots via the median
nerve
PEMERIKSAAN SENSORIK
 Sensory system
 Noncortical sensory system
 Light touch,
 pain,
 heat, cold, and
 vibration sensations
 Cortical sensory system
 Position sensation
 Stereognosis - AStereognosis
 Graphesthesia - AGraphesthesia
Pain, Light touch
Propioception
Vibration
Monofilament
PEMERIKSAAN REFLEKS
 Refleks

 Primitive reflexes
 glabellar tap,
 snout,
 sucking, and
 palmomental reflexes
 Refleks

 Superficial reflexes
 corneal, conjunctival,
 abdominal,
 cremasteric,
 anal wink, and
 plantar (Babinski) reflexes.
 Refleks fisiologis

 Deep tendon reflexes

 Refleks fisiologis

 Refleks biceps. ( BPR)

 Refleks triceps ( TPR)
 Refleks brachioradialis.
 Refleks patella ( KPR)
 Refleks achilles ( APR)
 Refleks patologis

 Babinsky Hoffman trommer

 Chaddock.
 Schaffer.
 Oppenheim.
 Gordon.
 Stransky
 Gonda
 Mendel bethreuw
 rossolimo
PEMERIKSAAN CEREBELLUM DAN
KOORDINASI
 Cerebellar signs

 Ataxia,
 Intention tremor
 Dyssynergia (incoordination)
 Dysmetria
 Dysrhythmia
 Dysdiadochokinesis
 Dysarthria (staccato or scanning speech)
 Coordination

 Finger to Nose
 Heel to Knee
 Rapid alternating movement
 Fine motor
 Romberg’s sign
PEMERIKSAAN CARA BERJALAN DAN
BICARA
 Gait

 Hemiparetic gait
 Ataxic gait
 Shuffling gait / parkinson gait
 Steppage gait
 Spastic or scissor gait
 Antalgic gait
 Waddling gait
 Speech

 Dysphonia or aphonia
 Dysarthria or anarthria
 Dysphasia or aphasia
PEMERIKSAAN GERAKAN INVOLUNTER
 Involuntary movements
 Fibrillations are not visible to the naked eye
except possibly those in the tongue.
 Fasciculations may be seen under the skin as
quivering of the muscle
 Asterixis
 Tics
 Myoclonus is a muscle jerk; it is a brief (<0.25
seconds), generalized body-jerk, which is
sometimes asymmetric
 Dystonias are muscle contractions that are
more prolonged than myoclonus and result in
spasms (blepharospasm, spasmodic
torticollis, oromandibular dystonia,
spasmodic dysphonia, and writer's cramp).
 Chorea-Athetosis
 Ballismus
TEST diagnostik penunjang
Spike, generalized. Note the high amplitude, and the aftergoing background
suppression and slow wave.
LUMBAL PUNGSI
TRANSCRANIAL DOPPLER
 Thank You for
your kind attention
9/9/2015 117