p. diagnostik neuro-2.ppt [read-only]ocw.usu.ac.id/.../bms166_slide_prosedur_diagnostik.pdf ·...
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PROSEDUR DIAGNOSTIKDIAGNOSTIK
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PROSEDUR DIAGNOSTIKPROSEDUR DIAGNOSTIK• PEM. LABORATORIUM• FOTO RONTGEN
SCHEDULE FOTOSERVIKAL : AP, LAT, OBLIQTHORAKAL: AP, LAT,LUMBOSAKRAL: AP, LAT, OBLIQ
• CT SCAN, MRI, MRA, PET, SPECT, DLL, , , , ,• LUMBAL PUNGSI• EEG, EMG. EVOKE POTENSIAL,DLL, ,
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NEURO IMAGINGNEURO IMAGING
• STRUKTURAL / ANATOMIS CT SCANSTRUKTURAL / ANATOMIS CT SCAN, MRI, MYELOGRAFI, DLL
• FUNGSIONAL EEG EMG EVOKE• FUNGSIONAL EEG, EMG, EVOKEPOTENSIALMETABOLISME PET SPECT• METABOLISME PET, SPECT
• BLOOD VASCULATURE ANGIOGRAFIMR ANGIOGRAFI
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LUMBAL PUNGSILUMBAL PUNGSI• INDIKASI
Diagnosis meningitis, ensefalitis & inflamasipada
pada cairan spinal lainnyaPerdarahan sub arachnoid, intra serebralM i l k i t iMeningeal karsinomatosisMengukur tekanan intra kranialPemberian kemoterapi intrathecalPemberian kemoterapi intrathecalDrainase / reduksi cairan likuor, seperti padahidrosefalus commonicanhidrosefalus commonicanMengetahui respon terapi meningitis / lainnya
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Kontra indikasi lumbal pungsiKontra indikasi lumbal pungsi
• Diduga peninggian intra kranial ok SOLDiduga peninggian intra kranial ok SOL Trantentorial herniasi
• Infeksi lokal dekubitus• Infeksi lokal dekubitus• Kadar trombosit < 40.000• Protrombin time < 50 %• Penyakit /gang. jantung, pernafasan yg y g g j g p yg
berat• Diduga ada lesi massa pada spinal kord,Diduga ada lesi massa pada spinal kord,
untuk ini perlu LP yang diikuti myelografi
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Komplikasi lumbal pungsiKomplikasi lumbal pungsi
S kit k l ( t l b l tSakit kepala (post lumbal puncture headache) Hematoma epidural / subduralInfeksiHerniasiTraumatic tapTraumatic tap
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CARA LUMBAL PUNGSI• Pasien dibaringkan rata pada piggir
tempat tidur dgn posisi miring leher –tempat tidur dgn posisi miring, leher badan – badan – paha – lutut FLEKSI
• Lokasi LP L4-L5 (setentang SIAS )Lokasi LP L4 L5 (setentang SIAS ), boleh juga pada L2-L3
• Kulit dibersihkan dgn jodium bilasKulit dibersihkan dgn jodium bilas dengan alkohol, sebelumnya beri anastesi lokal
• Jarum sejajar dgn garis tlg belakang dengan sudut 10 – 200 arah kepala, g p ,tusukkan sampai menembus duramater
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ELEKTRO ENSEFALOGRAFI( EEG )
• EEG gambaran aktivitas listrik otak /potensial listrik otakpotensial listrik otak
• Grafik yang menggambarkan perobahan potensial listrik otak Elektroensefalogrampotensial listrik otak Elektroensefalogram
• Prosedur pembuatan grafik Elektroensefalografi
• Sumber gelombang EEG Kortek, talamus dan formatio retikularis dapat mempengaruhinya
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EEGEEG
• Singkatan dari:• Singkatan dari:–Electroencephalogramp g–Electroencephalographic–Electroencephalography
CAA/FEB/09
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ELECTROENCEPHALOGRAMELECTROENCEPHALOGRAMElectro- listrikE h l t kEncephalo-otakGram(ma)-gambar
Definisi:R k li t ik t k di kRekaman listrik otak yang direkam oleh elektroda yang ditempatkan pada kulit kepala
CAA/FEB/09
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ELECTROENCEPHALOGRAPHICELECTROENCEPHALOGRAPHICDefinisi : Rekaman Bioelektrik
ELECTROENCEPHALOGRAPHYELECTROENCEPHALOGRAPHYDefinisi:• Ilmu yang mempelajari aktivitas listrik otak • Tehnik melakukan rekaman & e e a u a e a a &
menginterpretasi -kan suatu electroencephalogram
CAA/FEB/09
p g
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ELECTROENCEPHALOGRAMELECTROENCEPHALOGRAMNeuron pada Perubahan potensial
Gelombang
ALPHA (8 13 Hz) korteks otakp
listrikALPHA (8 -13 Hz) BETA (>13Hz) THETA (4 -7 Hz) DELTA(<4Hz)
Perubahan fokal & perubahan sel otak di perubahan sel otak di bagian lain
CAA/FEB/09
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INDIKASI EEGINDIKASI EEG• Diagnosis & klasifikasi kejangDiagnosis & klasifikasi kejang• Ensefalopati, Ensefalitis
B i d th• Brain death• Pengukuran & prognosis kejang• Deteksi lesi otak struktural tumor
serebri ,trauma kapitis, p• Gangguan metabolik, fisiologik di otak• DLL• DLL
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PRINSIP PENILAIAN EEGPRINSIP PENILAIAN EEG
• EEG BUKAN ALAT DIAGNOSTIKEEG BUKAN ALAT DIAGNOSTIK YANG MUTLAK
• DAPAT DIJUMPAI• DAPAT DIJUMPAIEEG normal --- Klinis abnormalEEG abnormal --- Klinis normal
• YANG PENTING KORELASI DENGAN KLINIS
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DASAR INTERPRETASIDASAR INTERPRETASIDASAR-DASAR ANALISA EEG
U k d kli i k i b tUmur, keadaan klinis, pemakaian obat, indikasi EEG K i i l b EEG &Komposisi gelombang EEG &topografinyaG b EEG i t i / i t iGambaran EEG simetris / asimetrisPerubahan aktivitas EEG selama
k d d ti l &rekaman dengan adanya stimulus &perubahan kesadaran (mengantuk, tidur, PS HV)PS, HV)Adanya gelombang abnormal spt, spike, dll
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Gelombang – gelombang EEGg g gParameter utama hubungan frekwensi/voltaseMacam-macam gelombang
Alfa : 8–13 spd, anak lanjut, dewasa, matatertutuptertutupBeta : > 14 spd, 25 uV, frontalTeta : 4 7 spd mengantuk tidurTeta : 4 – 7 spd, mengantuk, tidurDelta : < 4 spd, tidur, sadar abnormalSpike : 27 – 70 ms durationSpike : 27 – 70 ms durationSharp wave : 70 – 200 msSpike & sharp wave Epileptipform waveSpike & sharp wave Epileptipform wave
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Gambaran EEG AbnormalGAMBARAN ABNORMAL SPESIFIK
S ff &Spike komplek, 3 spd, diffuse bilateral, sinkron &simetris ( Petit mal )Spike wave bilateral sinkron & diffuse (GrandmalSpike wave, bilateral, sinkron & diffuse (Grandmal idiopatik )
GAMBARAN ABNORMAL NON SPESIFIKGAMBARAN ABNORMAL NON SPESIFIKTumor otak perlambatan fokal, DeltaT k iti l b t ltTrauma kapitis perlambatan, penurunan voltase diffuse, sesuai luasnya lesiMeningitis ensefalitis metabolik ensefalopatiMeningitis,ensefalitis,metabolik ensefalopati
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Tindakan provokasiTindakan provokasi
• Suatu tindakan untuk merangsangSuatu tindakan untuk merangsang timbulnya aktivitas EEG abnormal, dapat berupaberupa
Stimulus fotikHi til iHiperventilasiRekaman tidur
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Pemeriksaan Elektromiografig( EMG )
EMG P ik t t• EMG Pemeriksaan pencatatan aktivitas listrik otot dengan menusukkan
l kt d j d t telektroda jarum pada otot• Gambaran aktivitas listrik dalam otot
disebut Elektromyogram• Elektromyogram gambaran khas y g g
pada otot istirahat dan aktif dan memberikan gambaran abnormal gsesuai kelainan level motor unit
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Prinsip / Interpretasi EMGPrinsip / Interpretasi EMGPrinsip : membedakan lesiPrinsip : membedakan lesi• Saraf Motor neuron
AkAkson• Sambungan saraf otot• Otot
Hasil interpretasi tidak memberikanHasil interpretasi tidak memberikan diagnosa klinis spesifik, tetapi membantu menegakkan diagnosa, bersamamenegakkan diagnosa, bersama pemeriksaan klinis,dll
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INDIKASI EMG• Motor neuron disease• Gangguan saraf tepi & akson (
neuropati )p )• Gangguan pada neuromuskular –
junction (miastenia gravis)junction (miastenia gravis)• Penyakit otot primer ( DMP )
M b t kk di i• Membantu menegakkan diagnosis seperti Bells Palsy
• DLL
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Nerve Conduction Studies• Motor nerve conduction studies mencatat
l kt i d i t t t h d ti l irespon elektris dari otot terhadap stimulasi saraf motoriknya pada 2/lebih, sehingga dapat ditentukan kecepatan penghantarandapat ditentukan kecepatan penghantaran serabut motorik pd 2 tempat stimulasi ( MCV ).).
• Sensory nerve conduction studiesmengukur kecepatan hantaran saraf &litudo action potensial pada serabut
ik ( KHS )sensorik ( KHS )
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MYELOGRAPHY• By injecting 5‐25ml of radiopaque dye (iopamidol/ isovue) through a lumbar puncture needle.
• The entire spinal subarachnoid space can be visualized.
• Useful in visualizing small areas within the spinal canalcanal.
• CT body scan :
d ll f h l l &‐ provides excellent images of the spinal canal & intervertebral foramina visualizing spinal &
posterior fossa lesions
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• MRI has largerly replaced contrast myelography because:because:
‐ does not require lumbar puncture
‐ provides sharper visualization of the spinal canal
& its contents.
‐ image lesion greater clarity
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EVOKED POTENTIALS
• Visual evoked potentials• Visual evoked potentials
• Brainstem auditory evoked potentials
• Somatosensory evoked potentials
• Transcranial motor cortex stimmulation
• Endogenous event‐related evoked potentials
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POSITRON EMISSION TOMOGRAPHY (PET)
M d th b l t ti f• Measured the cerebral concentration of systematically administered radioactive tracers.
• Measured local patterns of cerebral blood flow, oxygen uptake, & glucose utilization.
• Noninvasively
• Tomographic images are constructed byTomographic images are constructed by techniques similar to those used in CT & MRI.
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• Proved to be of value in:
‐ grading primary brain tumors
‐ distinguishing tumor tissue from radiationdistinguishing tumor tissue from radiation
necrosis
l li i il ti f i‐ localizing epileptic foci
‐ differentiating types of dementing diseases.
• Has ability to quantitate neurotransmitter & their receptors importance in the study of parkinsonreceptors importance in the study of parkinson disease & other degenerative diseases.
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• PET not available for routine diagnosis because:• PET not available for routine diagnosis because:
‐ found in relatively few medical centers
‐ requires costly facilities & support staff.
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Single Photon Emission Computed Tomography (SPECT)(SPECT)
• Emit only a single photon.
• Allows the study of regional blood flow under conditions of cerebral ischaemia or during intense tissue metabolism.
• Helping to:Helping to:
‐ distinguish between alzheimer dementia & a
b f f l b l (l b ) t hinumber of focal cerebral (lobar) atrophies
‐ localization of epileptic foci in patients who
are candidates for cortical resection
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ANGIOGRAPHY
• Has evolved over the last 50 years
• Relatively safe & an extremely valuable method• Relatively safe & an extremely valuable method for the diagnosis of :
aneurysms‐ aneurysms
‐ vascular malformations
‐ narrowed or occluded arteries & veins
‐ arteria dissections
‐ angiitis
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• The great advantages of this procedure are:
‐ The vessels can be visualized with relativelysmall amounts of dye & that this can besmall amounts of dye & that this can be accomplished with the smaller catheters thanthose used in standard angiographythose used in standard angiography.
‐ The arterial route is now used exclusively for dye injection in preference to the venous route.