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LESION?
Why,. Sign and
Symptom!!!
Neuroscience Core Lecture
Anwar Wardy, MD.Neu
Department of Neurology
FKK UMJ
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Neuromuscula
r Junction
Muscle
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Ketidakseimbangan=Cerebellum
Pneumonia=batang
otak(dysphagiaterkait)
KehilanganDexterity=SarafPeriphe
ral
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Neurologic Examination
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Pemeriksaan neurologis
FungsikortikalTinggi
Sarafkranial
CerebellarFungsi
Motor
Indrawi
DeepTendonRefleks
Reflekspatologis
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UjianNeuroHarusMengevalua
siSeluruhNeuraxis
CorticalTinggiFungsi:korteks
Sarafkranial:subcortex,batang otak
CerebellarFungsi:otak kecil
Motor:motorhomonculous,saluranpira
midalsubkortikal,BS,kabel,radikula,PN,
otot
Sensorik:ascendingtraktat,talamus,sal
uransubkortikal,sensorikhononculous
DeepTendonRefleks:PNaferen,radikula,
kabel,PNeferen,otot
Reflekspatologis
fkk umj 2011
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SO WHERES THE
LESION?
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Goals of MD Testing
Localization
Muscle
Fiber type
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Severity
NMJ
Nerve
Pathology
Anterior Horn
Temporal course
Brain component
Cerebral cortex
Cerebral cortex
Basal nuclei
(lateral to thalamus)
Basal nuclei
Thalamus
(medial)
Thalamus
Hypothalamus
Hypothalamus
Cerebellum
Cerebellum
Midbrain
Brain stem
Brain stem
(midbrain, pons,
and medulla)
Pons
Medulla
Spinal cord
BRAIN COMPONENT
Cerebral cortex
MAJOR FUNCTIONS
1. Sensory perception
2. Voluntary control of movement
3. Language
4. Personality traits
5. Sophisticated mental events, such as thinking memory,
decision making, creativity, and self-consciousness
Basal nuclei
Thalamus
Hypothalamus
Cerebellum
1. Maintenance of balance
2. Enhancement of muscle tone
3. Coordination and planning of skilled voluntary muscle activity
Brain stem
(midbrain, pons,
and medulla)
Cortical Brain
Depends upon hemispheric dominance
Non-neurologists generalize:
right: visual/spatial, perception and memory
left: language and language dependent
memory
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Neurologic examination
cortical brain is lesioned
CorticalTinggiFungsi:aphasia,apraxia,agno
sia
Sarafkranial:normal
CerebellarFungsi:normal
Motor:Kelemahanjikaanda
menekanmotorhomonculous
Sensorik:kelainansensorikjikaanda
menekansensorikhomonculous
DeepTendonRefleks:hemi-hiper-reflexia
Reflekspatologis:mungkintandatandarefleksataufrontalBabinskirilis
fkk umj 2011
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Somatosensory
homunculus caricature
of relative amounts of
cortical tissue devoted
to each sensory function
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Cerebellar Function
Some people believe that one can not test
specifically for cerebellar abnormalities
no one test on examination reliably evaluates the cerebellum
H:
A:
N:
D:
S:
T:
hypotonia
assynergy of (ant)agonist muscles
nystagmus
dysmetria, dysarthria
stance and gait
tremor
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Motor:
hemi-hypotonia
intention > positional tremor
axial instability with dysmetria
Sensory: normal
Deep Tendon Reflexes: normal
Pathologic Reflexes: none
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Spinal Cord
Sensory level (horizontal)
Weakness below the lesion (paraparesis) =
Kelemahanbawah(paraparesis)lesi
UMN signs below the lesion (UMNtandatandadi bawahlesi )
Bowel and bladder incontinence
(Inkontinensiausus dankandung kemih)
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Root/Radiculopathy
Pain is the hallmark of a radiculopathy
(nyeriadalahciri
khassebuahradikulopati)
Sensory abnormalities in a dermatome
provocative maneuvres exacerbate the pain
(manuverprovokatifmemperburukrasa sakit)
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Peripheral Nerve
(presuming nonfocality)
Weakness: distal predominant
Sensory Dysesthesias: distal
predominant
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Neuromuscular Junction
Fatiguability is the hallmark
Weakness: proximal and symmetric
exacerbated with use, recovers with
rest(diperburukdenganpenggunaan,sem
buhdenganistirahat)
often affects facial muscles (ptosis,
dysconjugate gaze, slack jaw) =
seringmempengaruhiototototwajah(ptosis,dysconjugatetatapan,rahangslack
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Neurologic Examination in
Disorders of the NMJ
Higher Cortical Function: normal
Cranial Nerves: fatiguabile ptosis, dysconjugate
gaze, slack jaw
Cerebellar Function: normal
Motor: fatiguable proximal weakness in both UEs
and LEs
Sensory: normal
Deep Tendon Reflexes: normal
Pathologic Reflexes: none
fkk umj 2011
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Muscle
Weakness of proximal arm and leg
muscles
symmetric
Sensation is normal
though patients complain of cramping
and aching
(meskipunpasienmengeluhkramdans
akit)
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Neurologic Examination in
Disorders of Muscle
Higher Cortical Function: normal
Cranial Nerves: ptosis, dysconjugate gaze,
dysphagia, dysphonia, (dysarthria)
Cerebellar Function: normal
Motor: proximal weakness in both UEs and LEs,
atrophy and fasiculations, hypotonia
Sensory: normal
Deep Tendon Reflexes: preserved until late in the
disease
Pathologic Reflexes: none
fkk umj 2011
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