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Neurologic examination
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Alat-alat
Ophthalmoscope
Senter
Pecussion hammer / hammer reflex
Pin
Stetoskop
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Anamnesis
Umur Mendasari jenis penyakit
Keluhan utama Yg menyebabkan ps masuk RS
Riwayat penyakit sekarang Onset (akut, kronis)
Progresivitas gejala
Kronologis
Riwayat penyakit dahulu Faktor risiko/faktor pencetus
Riwayat penyakit keluarga Faktor genetik
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First impressions
Ps saat berjalan
Parkinsonian, ataxia gait, hemiparetic gait, scissor gait
Postur tubuh
Limb ataxia, terpaksa/tidak
Ps saat duduk
Raut wajah
Tanpa ekspresi, kesakitan, ptosis, hemifacialparesis
Suara
Pelo, sengau, serak
Ps saat tiduran
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Pemeriksaan umum
Status mental Kooperatif, orientasi, memori, emosional, halusinasi
Kepala dan leher kaku kuduk, ukuran kepala
Kulit (alergi, sianosis, herpes)
Jantung (fibrilasi, aritmia, bising)
Tekanan darah (hipertensi, hipotensi)
Paru (TBC, Ca) dan dada (Ca)
Abdomen (Ca gaster, colon dll.)
Pelvis (Ca prostat, kehamilan)
Limfonodi (NHL, TBC)
Tiroid (tirotoksikosis: eksoptalmos, weakness)
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Kesadaran
Kualitatif
Composmentis: sadar penuh
Somnolen/drowsiness:
• Dg stimulasi bisa sadar penuh
Stupor:
• Dg stimulasi hanya bisa respon sesaat
Coma:
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Confusion & disorientation: • Pemahaman yg keliru
• Waktu
• Tempat
• Orang
Delirium: • Mental confusion, exitement, illusions, hallucination
Akinetic mutism: • Apparently awake, lies immobile, no speech/sound,
follow with his eyes
Catatonia: • Lies mute, immobile, unresponsive, not follow with
eyes, plastic rigidity of the limbs
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Kuantitatif dg Glasgow Coma Scale
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Saraf Kranial
Saraf perifer
12 macam
Bisa menunjukkan letak lesi
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Midbrain & cranial nerves
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N. Olfactorius (I)
Sensation of smell
Cara: Kooperatif
Mata terpejam
Hidung bebas hambatan
Dg kopi, tembakau, teh
Lubang dites satu persatu
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N. Opticus (II)
Visus:
Snellen card (6/6)
Jari (../60)
Lambaian tangan (…/300)
Cahaya (…/~)
Warna (Ishihara)
Visual fields
Tes konfrontasi
Tes perimetri
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Tes konfrontasi
perimetri
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Pem fundus:
Discus (papil edema,
atrofi)
Arteri & vena
Retina (perdrhan,
eksudat, tuberkel, phakomata)
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N. Oculomotorius (III)
Ptosis (klp mata jatuh)
Gerakan bola mata Ke medial, atas, bawah
Refleks cahaya (+/-)
Ukuran pupil (mm): Cahaya dari seb lateral
mata
Bentuk pupil (isokor/anisokor)
Diplopia (pandangan dobel)
Nistagmus (gangg balans tonus otot bola mata)
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N. Trochlearis (IV)
Gerak bola mata ke lateral bawah
Diplopia (pandangan dobel)
Nistagmus (gangg balans tonus otot bola mata)
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N. Abducens (VI)
Gerak bola mata ke lateral
Diplopia (pandangan dobel)
Nistagmus (gangg balans tonus otot bola mata)
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N. Trigeminus (V)
Fungsi:
Sensasi wajah
Gerakan mengunyah
Refleks cornea
Sentuhan kapas basah pd limbus cornea
Bilateral blink (+)
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Gerakan mengunyah:
Palpasi otot masseter
Buka mulut
Jaw jerk (sulit)
Saraf peka nyeri
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N. Facialis (VII)
Fungsi:
Gerakan wajah
Pengecap 2/3 lidah depan
Sekresi gld lacrimalis & gld salivarius
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Gerakan wajah: Meringis
Tutup mata
Kerutkan dahi
Pengecap: Gula, garam, cuka,
kinina
Disentuh dg cottonbuds
Sekresi: Inhalasi amonia
(lakrimal)
Bumbu yg keras (saliva)
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N. Auditorius (VIII)
Fungsi: Pendengaran (cochlear
nerve)
Keseimbangan (vestibular nerve)
Pendengaran: Masking noise
Garputala • Rinne’s test:
udara/tulang
• Weber’s test: tulang
• Schwabach’s test: pt/examiner
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Keseimbangan:
Rotational test:
• Diputar di kursi 10x selama 20 detik
Caloric test:
• Irigasi dg air 250 ml selama 40 dtk, suhu 30ºC & 44ºC
Romberg test:
• Berdiri kaki rapat, buka & tutup mata
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N. Glossopharyngeus (IX)
Fungsi: Mengatur otot
palatum & pharynx
Sensasi di pharynx, tonsil, palatum, lidah blkg • Refleks muntah
Pengecap 1/3 blkg lidah
Saraf peka nyeri
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N. Vagus (X)
Fungsi:
Mengatur otot palatum & pharynx
• Refleks menelan
• Disfagia
Sensasi di pharynx, tonsil, palatum, lidah blkg
Mengatur otot pita suara
Saraf peka nyeri
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N. Accessorius (XI)
Otot-otot leher
Otot-otot bahu
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N. Hypoglossus (XII)
Otot lidah
Disartria (gangg artikulasi)
Menjulurkan lidah: mencong
Fasikulasi, tremor, atrofi (tanda perifer)
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Ekstremitas
Gerakan
Kekuatan
Tonus
Trofi
R. fisiologis
R. patologis
Clonus
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Kekuatan otot
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Tonus otot
Cara pemeriksaan:
Gerakkan otot ps secara pasif, raba tahanan otot yang diperiksa
Trofi otot Cara pemeriksaan:
palpasi masa otot yg diperiksa
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Refleks fisiologis
Refleks patella Refleks achilles
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Refleks patologis
Babinski
Hoffmann
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Clonus
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Tanda2 lesi UMN
Hipertonus
Hiperrefleksi/refleks fisiologis Reaksi asimetris
Perluasan refleks
Refleks silang
Refleks patologis +
Clonus +
Eutrofi otot
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Tanda2 lesi LMN
Hipotonus
Hiporefleksi/arefleksi
Hipotrofi/atrofi otot
Fasikulasi (kedutan)
R patologis –
Clonus -
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Meningeal sign
Kernig’s sign Neck rigidity/Brudzinski 1
Brudzinski 2
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Meningeal sign
Brudzinski 3
Penekanan pd os zygomaticus : fleksi pd sendi siku
Brudzinski 4
Penekanan pd simfisis pubis : fleksi genu + coxae
Guillain
Pemijatan pd paha : fleksi gen
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Iritasi n. ischiadicus
Lasegue O’Connell Gaenslen
Patrick Contra Patrick
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Koordinasi, keseimbangan
Romberg
Disdiadokhokinesis
Dismetri
disdiadokhokinesis
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Fungsi vegetatif
Defekasi
Retensi alvi, inkontinensia alvi
Miksi
Retensi urin, inkontinensia urin
Sexual
Lokal, fungsional
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Sensibility
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Dermatome