Penurunan Kesadaran

KEDARURATAN
NEUROLOGI
(Level Of Conciousness)
Anwar Wardy W
Juni 2013
anwar wardy w
Dept.Neyrosain FKK.UMJ.2010
The General Principle For Managing

Neurologic Emergencies
Principle I: (Kaidah I)
Kerusakan sistem saraf tidak menyebabkan
kematian organ yang disarafi. Jaringan dan
fungsi diharapkan dapat diperbaiki.
anwar wardy w
Anwar Wardy W.FKK.UMJ
Emergency Symptoms
Confusion
Drowsiness
Difficulty
speaking clearly
Numbness in any part of the body
One pupil that is larger than the other
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Focal brain dysfunction

Brain tumour
Vascular events (CVA)
Demyelination
Infection, such as cerebral abcess
Focal head injury
Diffuse brain dysfunction
Infection, such as meningitis or encephalitis
Epilepsy
Hypoxia and hypercarbia
Drugs, poisoning and overdoses ( including alcohol)
Metabolic/endocrine causes, such as diabetic coma,
Hepatic or renal failure,
Hypothyroidism, severe electrolyte disturbances
Hypotension, or hypertensive crisis
Diffuse head injury
Subarachnoid haemorrhage
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Hypothermia,
hyperthermia
Primary Events:
Cell, Axonal
atau Myelin (Transmisi terganggu)

Penyebabnya:
1. Anoxia
7. Toxin/Infeksi
2. Intracranial Hemorrhage.
8. Metabolic
3. Ischemia
4. TRAUMA
5. Hypoglicemia
6. Tumors
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TRAUMA
Concussion
Cerebral
contusion
Epidural hematoma
Subdural hematoma/effusion
Intracerebral hematoma
Diffuse axonal injury
anwar wardy
FKK UMJ
EPIDURAL HEMATOMA
anwar wardy
FKK UMJ
SUBDURAL HEMATOMA
anwar wardy
FKK UMJ
Secondary Events
Edema Cerebri
TIK
Obstruksi dari Liquor CS.
Vasospasme
Kegagalan Autoregulasi
Kegagalan Collateral supply
Gagal Jantung
Gagal Nafas.
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Anoxia
ICH
Ischemia
Tumors
Trauma
Principle II (Kaidah 2)
Selalu memerlukan intubasi
Agar pernapasan terjamin dan
oksigenasi ke otak terjamin baik.
Cegah terjadinya:
1. Coma hypoventilasi.
2. Hypoxia otak dan acidosis /
hypercarbia.
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Glasgow Coma Score
Eye Opening (E)

4=Spontaneous
3=To voice
2=To pain
1=None
Verbal Response (V)

5=Normal conversation
4=Disoriented conversation
3=Words, but not coherent
2=No words......only sounds
1=None
Total = E+V+M
Motor Response (M)

6=Normal
5=Localizes to pain
4=Withdraws to pain
3=Decorticate posture
2=Decerebrate
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1=None
Principle III (Kaidah 3)

Stop
perdarahan (Stop the Bleeding)
PRINCIPLE iv ( Kaidah 4)
Sirkulasi
peredaran daraf keotak

dipertahankan.
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Principle V (kaidah 5)
Penyakit tersebut Struktural atau NonStructural.

Biasanya dilakukan dengan pemeriksaan
Rontgen / CT.Scan atau
Suspect N-Struktural dengan LP.
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INFRATENTORIAL LESIONS
Brainstem
symptoms are often seen
initially
Sudden onset of coma
Cranial nerve abnormalities
Alteration of the respiratory pattern
anwar wardy
FKK UMJ
PROGRESSION OF MASS LESIONS
anwar wardy
FKK UMJ
TYPES OF BRAIN HERNIATIONS

1= subfalcine
2 = uncus
3 = caudal
displacement
4 = cerebellar
tonsils
anwar wardy
FKK UMJ
HERNIATION SYNDROMES
Tonsillar or Foramen Magnum Herniation
Displacement of brainstem and cerebellar tonsils into

the foramen magnum
Transtentorial herniation
Displacement of medial aspect of temporal lobe into

tentorial hiatus
Progressive ALOC, hypertension, bradycardia and irregular

respirations (Cushing Triad)
ALOC, ipsilaterial pupillary dilatation, contralateral

hemiparesis
Upward tentoral herniation
Cerebellar vermis moves into incisura

Produces brain stem compression
anwar wardy
FKK UMJ
Principle VI (Kaidah 6)
Diagnosis
cepat dan sederhana

(Simple & Spot Diagnosis) : yaitu
dengan menggunakan pengetahuan
Anatomi saraf (Topis Diagnostic) untuk
mengetahui letak lesi di Otak.
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Bleeding
or swelling in the brain can

cause pressure that forces the brain
downward in the skull.
Herniation: The Brain Under Pressure
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THE STATE OF CONSCIOUSNESS

(AROUSAL)
The
ascending RAS, from the lower border

of the pons to the ventromedial thalamus
The cells of origin of this system occupy a
paramedian area in the brainstem
n
ai
M
gn
a
Di
tic
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S
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Part I. Neurological Examination

and Neurodiagnostic Testing
1. Neurological examination;
2. Neuroradiology;
3. Electroencephalography;
4. Lumbar puncture;
5. Electromyography;
6. Electronystagmography;
7. Evoked potentials;
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Part II. Common Neurological

Presentations
8. Altered level of consciousness;
9. Headache;
10. Weakness;
11. Dizziness;
12. Seizures;
13. Gait disturbance;
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Part III. Specific Neurological

Conditions:
14. CNS infections in adults;
22. Dementia;
15. Viral encephalitis;
23. Neurooncology;
16. Vascular disease; 24. Neuropsychiatric
17. Movement disorders;
25.Neuroanesthesiology;
18. Neuromuscular disorders; 26. TIK
19. Musculoskeletal and neurogenic pain;
20. Neuroophthalmological disorders;
21. Multiple sclerosis; 28. Sleep disorders;
27. Normal pressure hydrocephalus;
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Part IV. Neurological Trauma and

Environmental Emergencies
29. Traumatic brain injury;
30. Spinal cord injury;
31. Peripheral nerve injury;
32. Neurological complications of
environmental emergencies
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Part V. Pediatric Neurology

33. Hydrocephalus and shunts in
children;
34. Pediatric CNS infections;
35. Pediatric stroke;
36. Pediatric seizures;
37. The hypotonic infant;
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Part VI. Neurological Emergencies

of Pregnancy:
38. Neurological emergencies of
pregnancy;
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Part VII. Brain Resuscitation and

Neurotoxicology:
39. General neurotoxicology;
40. Neurotoxicology of alcohol and
substances of abuse;
41. Brain resuscitation.
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Evaluation
ICP monitoring is most often used in head trauma in
the following situations:
1) GCS less than 8
2) Drowsy with CT findings (operative or non
operative)
3) Post op hematoma evacuation
4) High risk patients (a) Above 40 yrs. (b) Low BP
(c) Those who require ventilation.
There is nothing to achieve in monitoring ICP in
the patients with GCS of less than 3.
anwar wardy w
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anwar wardy w
Bahan Bacaan:
Gilroy John, Textbook Medical Neurology, MacMillan Publ. co.Inc. 5th Edition
London, 2009.
Surgery, and Internal Medicine, Neuroscience Intensive Care Unit, 2006.
Epstein, Owen, Clinical Examination on Neurology Emergency, Mosby 2005
TERIMA KASIH,
.Wassalam..//
a2w@telkom.net
FKK.UMJ.Juni 2008

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KEDARURATAN

The General Principle For Managing

Anwar Wardy W.FKK.UMJ

Anwar Wardy W.FKK.UMJ

Focal brain dysfunction

atau Myelin (Transmisi terganggu)

Anwar Wardy W.FKK.UMJ

Anwar Wardy W.FKK.UMJ

Anwar Wardy W.FKK.UMJ

Glasgow Coma Score

Eye Opening (E)

Verbal Response (V)

Motor Response (M)

Anwar Wardy W.FKK.UMJ

Principle III (Kaidah 3)

perdarahan (Stop the Bleeding)

peredaran daraf keotak

Anwar Wardy W.FKK.UMJ

Penyakit tersebut Struktural atau NonStructural.

Anwar Wardy W.FKK.UMJ

symptoms are often seen

PROGRESSION OF MASS LESIONS

TYPES OF BRAIN HERNIATIONS

Tonsillar or Foramen Magnum Herniation

Displacement of brainstem and cerebellar tonsils into

Displacement of medial aspect of temporal lobe into

Progressive ALOC, hypertension, bradycardia and irregular

ALOC, ipsilaterial pupillary dilatation, contralateral

Upward tentoral herniation

Cerebellar vermis moves into incisura

cepat dan sederhana

Anwar Wardy W.FKK.UMJ

or swelling in the brain can

Herniation: The Brain Under Pressure

Anwar Wardy W.FKK.UMJ

THE STATE OF CONSCIOUSNESS

ascending RAS, from the lower border

Anwar Wardy W.FKK.UMJ

Part I. Neurological Examination

Anwar Wardy W.FKK.UMJ

Part II. Common Neurological

Anwar Wardy W.FKK.UMJ

Part III. Specific Neurological

Anwar Wardy W.FKK.UMJ

Part IV. Neurological Trauma and

Anwar Wardy W.FKK.UMJ

Part V. Pediatric Neurology

Anwar Wardy W.FKK.UMJ

Part VI. Neurological Emergencies

Anwar Wardy W.FKK.UMJ

Part VII. Brain Resuscitation and

Anwar Wardy W.FKK.UMJ

Anwar Wardy W.FKK.UMJ

Anwar Wardy W.FKK.UMJ

Anwar Wardy W.FKK.UMJ

Anwar Wardy W.FKK.UMJ

Anwar Wardy W.FKK.UMJ

Anwar Wardy W.FKK.UMJ

Anwar Wardy W.FKK.UMJ

Anwar Wardy W.FKK.UMJ

Anwar Wardy W.FKK.UMJ

Anwar Wardy W.FKK.UMJ

Anwar Wardy W.FKK.UMJ