kuliah neuropati perifer

8/18/2019 Kuliah Neuropati Perifer

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Neuropati Perifer

Iwan setiawanBagian Penyakit Saraf

FK UMS


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Neuropati

Merupakan suatu penyakit ataucedera yang mengenai susunan saraftepi baik sensorik, motorik maupunotonom.

Neuropati dapat anya mengenaiserabut motorik sa!a, sensorik sa!a

ataupun campuran keduanya


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K"asi#kasi berdasarkan pato"ogi

Neurona" degeneration $akibatkerusakan pada se" bodi sarafsensorik maupun motorik%

&a""erian degeneration '(ona" degeneration $kerusakan a(on

yang difus% Segmenta" degeneration $kerusakan

se"ubung mie"in tanpa disertaikerusakan a(on%


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Faktor risiko Neuropati perifer

Nutritiona" de#ciencies, suc as B)*+ and fo"atede#ciency

Medications known to cause peripera"neuropaty, inc"ude seera" 'I-S drugs $-- and--I%, antibiotics $metronida/o"e, an antibiotic usedfor ron0s disease, isonia/id used for 1B%, go"dcompounds $used for reumatoid artritis%, somecemoterapy drugs $suc as incristine and

oters% and many oters. emica"s known to cause peripera"

neuropaty 2 a"coo", "ead, arsenic, mercury andorganopospate pesticides.


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3angguan pada Saraf2berdasarkan 4okasi

5adi( radiculopathy P"e(us plexopathy Sing"e nere mononeuropathy

Seera" neres multiplemononeuropathy,

mononeuritismultiplex

'"" neres, polyneuropathy "engt)dependent

'"" neres, polyradiculoneuropathy

not "engt)dependent


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5adi( Segmenta" "oss of

• motor atropy

weakness• re6e(es

• sensation Signs usua""y minima"7 symptoms

can be seere $pain%7 Usua""y on"y one "imb.


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P"e(us

Pain &eakness, atropy, ariab"e, but

usua""y more seere tanradicu"opaty

Usua""y restricted to one "imb 8tio"ogy2

• Bracia"2 trauma, neop"asm, idiopatic

• 4umbosacra"2 diabetes, neop"asm


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Sing"e nere $mononeuropaty%

5estricted distribution Pain, numbness or ting"ing,

atropy, weakness 8tio"ogy2

• entrapment

• trauma


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Seera" neres $mononeuritismu"tip"e(%

9ften painfu" at onset 9ften sudden -e#cits in te distribution of

seera" peripera" neres $one at atime%

8tio"ogy2 ascu"itis


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'"" neres2 4engt)dependent$po"yneuropaty%

4ower before upper e(tremity -ista" #rst $feet%

'tropy of intrinsic foot musc"es -ecreased ank"e !erks Stocking, ten g"oe sensory "oss -ista" motor and sensory #ndings

a"ways muc more seere tanpro(ima"


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auses of po"yneuropatyInfectious disease Leprosy

HIV , Lyme disease

Inflammatory Acue Inflammatory demyelinating polyneuropathy

CIDP, Multifocal motor neuropathy

Collagen vascular disease, vasculitis

Other systemicdisease

Diaetes mellitus, Chronic renal failure,

!hyroid dysfunction, Parathyroid dysfunction,Paraproteinemia, amyloidosis, Vitamin deficiency,critical illness neuropathy

"enetic disorde Hereditary motor sensory neuropathies,

Hereditary sensory and autonomic neuropathies

!o#ins !herapeutic drugs $chemotherapeutic agents,antiviral, statins%, Drugs ause $alcohol, aromatic

hydrocarons%, poisons $arsenic, n&he#ane%


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Insulin Deficiency

Hyperglycemia

Abnormal

Vasa

Nervorum

'bnorma"Fatty acidmetabo"ism

Nere

Iscemic

Po"yo" actiity

N9S

'ctiity

UptakeMyo)inosito"

3"ycosy"ationNeura" Proteins

NereMyoinosito"

'(ona" 1ransport

on#rmed"inica"

NeuropatyFoot U"cer'mputatio

n

'bnorma"Morpometr

y

NereFunction

-ee"opment of Neura" 'utoantibodies


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U"nar neuropaty

Numbness 'tropy of #rst

dorsa" interosseous

&eakness ompression at

e"bow 8ntrapment in

cubita" tunne" -ista" in!ury


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5adia" nere2 Saturday nigt pa"sy

&eakness of wrist: #nger e(tensors,

bracioradia"is Pressure pa"sy 1rauma $umerus

fracture%


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Peronea" pa"sy

rossing "egs &eigt "oss

;ospita"i/ation

Surgery


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Po"yneuropaty $cont


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Po"yneuropaty $cont


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3ui""ain)Barre syndrome

Progresses oer days to => weeks 1ypica""y ascending weakness 5e6e(es "ost ear"y Motor symptoms predominate, but

can a?ect sensation and autonomicfunction

5espiratory fai"ure re@uires support


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3ui""ain)Barre syndrome $cont


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Neuropati otonom

Keringat berkurang ;ipotensi ortostatik Nokturna" diare Inkontinensia a"i, konstipasi Inkontinensia : retensio urine 3astroparesis

impotensi


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Table . Clinical Manifestations of Autonomic Neuropathy

Cardiovascular : Tachycardia, exercise intolerance - Heat intolerance• Cardiac denervation, painless myocardial infarction• Orthostatic hypotension - Alterations in skin blood flow

Gastrointestinal : Esophageal dysfnction - !astroparesis diabeticorm• "iarrhea - Constipation• #ecal incontinence

Genitourinary: Erectile dysfnction - $etrograde e%aclation• Cystopathy - &erogenic bladder

Seatin! disturbances: Areas of symmetrical anhydrosis• !statory sweating

Metabolic : Hypoglycemia nawareness• Hypoglycemia nresponsiveness

"upillary : "ecreased diameter of dark adapted ppil•

Argyll-$obertson type ppil


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Nyeri Musku"oske"eta"

Sistem musku"oske"eta" me"iputi otot,tendon, sendi, dan bursa.

Nyeri musku"oske"eta" merupakannyeri yang berasa" dari otot, tendon,sendi dan bursa.


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Fibromyalgia

Sindroma Fibromia"gia ada"a nyerikronik yang penyebabnya be"umdiketaui.

-itandai o"e nyeri musku"oske"eta"yang tersebar "uas, kekakuan danke"e"aan menye"uru.


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Fibromyalgia

Penyebab tidak diketaui,diperkirakan ada C pencetus potensia"

yaitu2 3angguan tidur D kurang tidur 'bnorma"itas neurobiocemica" ;i"angnya kontro" sistem saraf

simpatis Faktor !aringan setempat 1rauma #sik atau infeksi irus

Faktor Psiko"ogis


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Fibromyalgia

4ima 3e!a"a K"inis $*% nyeri, $+% kaku, $E% edema !aringan "unak, $>% titik nyeri dan $% spasme otot dan nodu". 3e!a"a

yang kas ada"a nyeri yang difus,menyebar atau nyeri yangber6uktuasi yang sering disertai

kekakuan yang menon!o".


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Fibromyalgia

&idespread pain ada"a nyeri yangme"iputi nyeri aksia", nyeri pada sisikiri dan kanan tubu, serta nyeri

pada segmen atas dan bawa tubu ronic widespread pain yang

ber"angsung sekurang)kurangnya

se"ama E bu"an merupakan k"inisutama pada #bromia"gia


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FibromyalgiaPenata"aksanaan 2 1idak ada obat yang spesi#k 8dukasi Farmakoterapi 2 'setaminofen, NS'I-s, 1ramado", musc"e

re"a(ant, antidepresan trisik"ik $amitripti"in *G)+ mg,

nortripti"in%, antidepresan SS5I $6uo(etine, sertra"in% In!eksi topika" "idokain dikombinasikan dengan kortikosteroiddi titik nyeri $tender points%

'kupuncture Cognitive Behaviour !herapy 4atian #sik 2 postura" e(ercise, passie stretcing,

bersepeda, berenang, !a"an)!a"an. 4atian di"akukan tiga ka"ida"am seminggu.

-isarankan mandi dengan air angat Nutrisi 2 indari kafein, a"koo" dan nikotin

kuliah neuropati perifer

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