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Neuropathy
Darwin Amir
Bgn Neurologi
Fakultas Kedokteran
Universitas Andalas
http://www.apsu.edu/thompsonj/Anatomy%20&%20Physiology/2010/2010%20Exam%20
Reviews/Exam%204%20Review/CH%2013%20Peripheral%20Nerve%20Histology.htm
• Neuropati perifer
Objectives
• The students will recognize major
peripheral sensory and motor neuropathies
including diabetic neuropathy and Guillain-
Barre syndrome and others
• Student will recognize difference between
mono and polyneuropathies.
• Approach to evaluating patients will be
recalled given a case presentation
2/7/2018 3
• Tujuan
Para siswa akan mengenali neuropati
sensorik dan motorik utama termasuk
neuropati diabetes dan sindrom Guillain-
Barre dan lainnya.
Siswa akan mengenali perbedaan antara
mono dan polyneuropathies.
Pendekatan untuk mengevaluasi pasien
akan diingat mengingat presentasi kasus
Definitions
• Generalized term including disorders of
any cause
• May involve sensory nerves, motor
nerves, or both
• May affect one nerve (mononeuropathy),
several nerves together (polyneuropathy)
or several nerves not contiguous
(Mononeuropathy multiplex)
• May have demyelination or axonal
degeneration
2/7/2018 5
• Definisi
Istilah umum termasuk gangguan
penyebab apapun
Mungkin melibatkan saraf sensorik, saraf
motorik, atau keduanya
Dapat mempengaruhi satu saraf
(mononeuropati), beberapa saraf bersama
(polyneuropathy) atau beberapa saraf
tidak bersebelahan (Mononeuropathy
multiplex)
The Motor Unit
www.ama-assn.org/ ama/pub/category/7172.html
# 1. Dimana lesi itu?
# 2. Apa etiologi itu?
# 3. Apa pengobatannya?
The patterns of peripheral
neuropathy…
• Mononeuropathy?
• Polyneuropathy?
multiple nerves
contiguous
typically length dependent
(“stocking-glove”)
Polyneuropathy is common!
2.4% (8% over 55 yr)
www.ama-assn.org/ ama/pub/category/7172.html
• Pola neuropati perifer ...?
Mononeuropati
Polineuropati?
beberapa saraf
berdekatan
Biasanya tergantung panjang ("stocking-
glove")
# 3. Apa pengobatannya?
Bergantung pada membalikkan penyebab yang mendasarinya.
2/7/2018 14
• Ujian fisik
Carilah penebalan saraf (Neurofibroma)
Turunkan pinprick, sensasi, atau suhu
Berkurangnya refleks
Kelemahan motor
Pengujian Tinnel
http://fulton.edzone.net/cites/winkler-science/team1/chap8.html http://www.neuro.wustl.edu/neuromuscular/pathol/nervenl.htm
The clinical effect of a polyneuropathy
depends on
1) what modalities involved
2) what fibers are effected
3) whether the injury is axonal or demyelinating.
Tinnel’s testing
• Tapping over nerve creates tingling
• Examples
– Wrist (Carpal tunnel syndrome)
– Elbow (Funny bone)
2/7/2018 24
• Ujian fisik
Carilah penebalan saraf (Neurofibroma)
Turunkan pinprick, sensasi, atau suhu
Berkurangnya refleks
Kelemahan motor
Pengujian Tinnel
Mengetuk saraf membuat kesemutan
Contoh
Pergelangan tangan (Carpal tunnel syndrome)
Siku (tulang yang lucu)
Lab evaluation
• Might included CBC,
• Erythrocyte sedimentation rate,
• Urinalysis,
• Glucose serum,
• Serum protein electrophoresis,
• Thyroid function testing
2/7/2018 26
• Evaluasi lab
Mungkin termasuk CBC,
Tingkat sedimentasi eritrosit,
Urinalisis,
Glukosa serum,
Elektroforesis protein serum,
Pengujian fungsi tiroid
The two types of peripheral neuropathies:
axonopathies and myelinopathies
Electrical diagnosis
• Demyelination
– Slows nerve conduction velocity
– Conduction block possible
• Axonal degeneration
– Decreases amplitude of action potentials
Degenerasi aksonal
Mengurangi amplitudo potensial aksi
= Low!
= Slow!
= Slow!
2/7/2018 36
• Biopsi saraf
http://missinglink.ucsf.edu/lm/ids_104_musclenerve_path/student_musclenerve/nervepath.html
From Kumar: Robbins and Cotran: Pathologic Basis of Disease, 7th ed.
Wallerian Degeneration
http://missinglink.ucsf.edu/lm/ids_104_musclenerve_path/student_musclenerve/nervepath.html
Segmental Demyelination
Normal
Demyelination
Normal
Demyelination
http://www.neuro.wustl.edu/neuromuscular/pathol
Question #2. What is the etiology?
• Asymmetry
1. Mononeuropathy
2. Mononeuritis multiplex – e.g. vasculitis
2/7/2018 50
• Mononeuropati
Ulnar neuropati
Sindrom terowongan karpal
Sindrom terowongan tarsal
Suara yang rendah
Ulnar neuropathy
• Just distal to the elbow cubital tunnel
entrapped
• Results in a claw hand if severe
2/7/2018 52
• Ulnar neuropati
Hanya distal ke terowongan cubital siku
yang terperangkap
Hasil di tangan cakar jika parah
Carpal tunnel syndrome
• Perhaps the most common
mononeuropathy
• Entrapment of median nerve in the wrist
• Results in paresthesias of thumb, index,
and middle finger; Weakness of the
abductor pollicus brevis
• Tingling fingers, weak thumb, loss of
“meat” of the APB muscle (atrophy)
2/7/2018 54
• Sindrom terowongan karpal
Mungkin mononeuropati yang paling
umum
Meraba saraf median di pergelangan
tangan
Hasil di parestesia pasak, indeks, dan jari
tengah; Kelemahan penculik pollicus
brevis
Kesemutan jari, jempol lemah, kehilangan
"daging" otot APB (atrofi)
Carpal tunnel syndrome-Causes
• Usually due to overuse
– Typing probably okay (argued)
• Other causes
– Arthritis
• Osteoarthritis
• Rheumatoid arthritis
– Infiltrative diseases
– Hypothyroidism
– Diabetes
– Pregnancy
2/7/2018 56
• Sindrom terowongan karpal-penyebabnya
Biasanya karena terlalu sering digunakan
Mengetik mungkin oke (diperdebatkan)
Penyebab lainnya
Radang sendi
Osteoarthritis
Radang sendi
Penyakit infiltrasi
Hipotiroidisme
Diabetes
Kehamilan
Carpal tunnel syndrome-Treatment
• Treatment is usually surgical resection of carpal
ligament
• Other treatments may help, too
– Stretches
– Splints
• Cock-up wrist splints
• Night time use only ?
– Anti-inflammatory medications
• Oral (non-steroidal)
• Injections
2/7/2018 58
• Sindrom terowongan karpal - perawatan
Pengobatannya biasanya reseksi bedah ligamen karpal
Perawatan lainnya juga bisa membantu
Peregangan
Belat
Cock-up pergelangan tangan splints
Penggunaan waktu malam saja?
Obat anti-inflamasi
Oral (non-steroid)
Suntikan
2. What is the duration?
• Acute polyneuropathies
e.g. Guillain Barre syndrome
Vasculitis
Polineuropati akut
misalnya Sindrom Guillain Barre
Vaskulitis
Demyelinating Axonal
e.g. e.g.
Glue sniffing Cancer drugs like vincristine
Arsenic and paclitaxel
Antibiotics like chloroquine,
ethambutol, isoniazid and
metronidazole
Cardiac medications like
amiodarone
• 6. Paparan obat atau toksin?
Demyelinating
misalnya
Lem mengendus
Arsenik
Axonal
misalnya
Obat kanker seperti vincristine dan paclitaxel
Antibiotik seperti klorokuin, etambutol, isoniazid dan metronidazol
Obat jantung seperti amiodarone
History of drug use
• Amiodarone
• Chemotherapeutics
– Cisplatin
– Taxol
• Antibiotics
– Metronidazole
– INH
– Anti-retrovirals
• Heavy metals
2/7/2018 70
• Sejarah penggunaan narkoba
Amiodarone
Kemoterapi
Cisplatin
Taxol
Antibiotik
Metronidazol
INH
Anti-retroviral
Logam berat
Polyneuropathy Example #1
3. Pemeriksaan, NCS / EMG & biopsi dapat membedakan aksonopati dari mielinopati
m.
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