Groups

Cantika 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 old Paraparesis since 6 month was last 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 Body temperature of subfebris

Organization of nerves
Brain SSP Korda spinalis

Aferen

SST

Eferen

System of nerve somatik

System of nerve otonom

Stimulate sensorik

Stimulate viseral

System of nerve simpatis

Nerve motorik
Muscle contruct 1. 2. 3.

System of nerve parasimpatis

Artless mucle Heart muscle Gland

Organ organ efektor (consisted of muscle network and gland

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

Upper motor neuron

Lower motor neuron

Upper Motorneuron [UMN]

Is all associative neurons channelling impulse motorik to lower motorneuron [lmn] Consist of : Formation piramidal Formation ekstrapiramidal : Consist of input and output

Formation Piramidal

Lower Motorneuron [LMN]

Neuron channelling impulse motorik to muscle skelet. Consist of Core 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

Trouble UMN and LMN

Characteristics UMN Lesi at brain : distribusi piramidalis,that is part distal especially hand muscles; exstensor arm and flexsor feebler leg. LMN Depend that is segment, radiks, or which nerve.

Kind and weakness distribution lesi at brain

Lesi at medula spinalis: vary to depend on location lesi.

Tonus Mass Muscle Spastisitas: real in fleksor arm and ekstensor leg. Only a little experience disuse atrophy muscle. Increase;Babinski (+) No Oftentimes Flaksid Atrofi can very clear Decrease or no; Babinski (-) Yes No

Reflex
Fasiculation Klonus

Regional UMN
Core of motorik from cortex motorik gyrus presentralis Traktus piramidalis - Traktus kortikobulber - Traktus kortikospinalis Traktus 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 motorik Nerve spinalis

Form of paralysis
Form of paralysis depended level of damage/lession : Lession area kortikal and subkortikal Hemiparesis kontalateral Lession 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 not get enough O2 from vessels

Nerve bind

Paraparesis

Medula Spinalis

Radix

Mechanism circle dorsal bone pain to stomach

Trauma

Reaction of body
Pain
Pain to Stomach

T7-L1

N.Isciadicus (L4-S3)

PARAPHARESE AND SUBFEBRIS

SUBFEBRI S

INFECTION

PARAPHARESES

Relation Pain With Paraparesis

Spastic weakness
Compression in medula spinalis caused tumor

pain

Lost function of medula spinalis

Without decompression

paraparesis

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 gender

Work 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 dont 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.

 Definition Is a chronic and destructive granulomatosa inflamation that caused by micobaterium tuberculose.

Spondilitis 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

Sarcoma
Definition: 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 Tumor

Schwannoma
Definition is a kind of tumor originating from the Schwann cells Causes The cause of schwannoma is unknown. These tumors sometimes occur in patients with von Recklinghausen disease (neurofibromatosis). Epidemiology They can occur in children but more commonly affect young adults. Symptoms a. 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.

 Diagnose
a. X-ray b. Ultrasound c. MRI d. Biopsy of the tumor

Treatment
Surgery 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

DEFINISI
Trauma 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

EPIDEMIOLOGY
AS 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 discus Secunder abnormality in bone marrow Infection and tumor Abnormality 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 sensation Paresis in some day or week

Examination
Anamnenis Physic examination Support examination Laboratoryum examination CT Scan MRI Biopsy Angiography Mielogram

Theraphy
Therapy depend of cause Infection antibiotic. Happened abses throw pussh Kortikosteroid. Surgery

Yes, I want to ask

Any Question ?

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