Anwar Wardy W.FKK.

UMJ
FKK.UMJ.2006
KEDARURATAN NEUROLOGI
(Coma, tik)

Anwar Wardy W
Mei 2006
Anwar Wardy W.FKK.UMJ
FKK.UMJ.2006
The General Principle For
Managing Neurologic Emergencies



Principle I: (Kaidah I)
Kerusakan sistem saraf tidak menyebabkan
kematian organ yang disarafi. Jaringan dan
fungsi diharapkan dapat diperbaiki.
Anwar Wardy W.FKK.UMJ
FKK.UMJ.2006
Emergency Symptoms
Confusion
Drowsiness
Difficulty speaking clearly
Numbness in any part of the body
One pupil that is larger than the other

Anwar Wardy W.FKK.UMJ
FKK.UMJ.2006
Focal brain dysfunction

Brain tumour
Vascular events (CVA)
Demyelination
Infection, such as cerebral abcess
Focal head injury
Diffuse brain dysfunction
Infection, such as meningitis or encephalitis
Epilepsy
Hypoxia and hypercarbia
Drugs, poisoning and overdoses ( including alcohol)
Metabolic/endocrine causes, such as diabetic coma,
Hepatic or renal failure,
Hypothyroidism, severe electrolyte disturbances
Hypotension, or hypertensive crisis
Diffuse head injury
Subarachnoid haemorrhage
Hypothermia, hyperthermia
Anwar Wardy W.FKK.UMJ
FKK.UMJ.2006
Primary Events:
Cell, Axonal atau Myelin (Transmisi terganggu)
Penyebabnya:
1. Anoxia 7. Toxin/Infeksi
2. Intracranial Hemorrhage. 8. Metabolic
3. Ischemia
4. Trauma
5. Hypoglicemia
6. Tumors
Anwar Wardy W.FKK.UMJ
FKK.UMJ.2006
Tumors
Anwar Wardy W.FKK.UMJ
FKK.UMJ.2006
Brain Abscess
Anwar Wardy W.FKK.UMJ
FKK.UMJ.2006
Symptoms of Brain Tumors?
nausea - impaired sense of smell
Vomiting - memory loss
headaches - seizures
behavioral and emotional changes - muscle weakness
impaired judgment -paralysis on one side of the body
loss of hearing -reduced mental capacity
vision loss





Anwar Wardy W.FKK.UMJ
FKK.UMJ.2006
Secondary Events
Edema Cerebri
TIK
Obstruksi dari Liquor CS.
Vasospasme
Kegagalan Autoregulasi
Kegagalan Collateral supply
Gagal Jantung
Gagal Nafas.

Anoxia
ICH
Ischemia
Tumors
Trauma
Anwar Wardy W.FKK.UMJ
FKK.UMJ.2006
Anwar Wardy W.FKK.UMJ
FKK.UMJ.2006
Principle II (Kaidah 2)
Selalu memerlukan intubasi
Agar pernapasan terjamin dan
oksigenasi ke otak terjamin baik.
Cegah terjadinya:
1. Coma hypoventilasi.
2. Hypoxia otak dan acidosis /
hypercarbia.

Anwar Wardy W.FKK.UMJ
FKK.UMJ.2006
Glasgow Coma Score
Eye Opening (E) 4=Spontaneous
3=To voice
2=To pain
1=None
Verbal Response (V)
5=Normal conversation
4=Disoriented conversation
3=Words, but not coherent Total = E+V+M
2=No words......only sounds
1=None
Motor Response (M)
6=Normal
5=Localizes to pain
4=Withdraws to pain
3=Decorticate posture
2=Decerebrate
1=None
Anwar Wardy W.FKK.UMJ
FKK.UMJ.2006
Principle III (Kaidah 3)
Stop perdarahan (Stop the Bleeding)



PRINCIPLE iv ( Kaidah 4)

Sirkulasi peredaran daraf keotak
dipertahankan.
Anwar Wardy W.FKK.UMJ
FKK.UMJ.2006
Anwar Wardy W.FKK.UMJ
FKK.UMJ.2006
Principle V (kaidah 5)
Penyakit tersebut Struktural atau Non-
Structural.

Biasanya dilakukan dengan pemeriksaan
Rontgen / CT.Scan atau
Suspect N-Struktural dengan LP.
Anwar Wardy W.FKK.UMJ
FKK.UMJ.2006
Anwar Wardy W.FKK.UMJ
FKK.UMJ.2006
Principle VI (Kaidah 6)

Diagnosis cepat dan sederhana
(Simple & Spot Diagnosis) : yaitu
dengan menggunakan pengetahuan
Anatomi saraf (Topis Diagnostic) untuk
mengetahui letak lesi di Otak.
Anwar Wardy W.FKK.UMJ
FKK.UMJ.2006





Herniation: The Brain Under Pressure





Bleeding or swelling in the brain can
cause pressure that forces the brain
downward in the skull.
Anwar Wardy W.FKK.UMJ
FKK.UMJ.2006
When Specific Areas of the Brain
Are Damaged
Anwar Wardy W.FKK.UMJ
FKK.UMJ.2006
Emboli (Perifer)
Anwar Wardy W.FKK.UMJ
FKK.UMJ.2006
Part I. Neurological Examination
and Neurodiagnostic Testing
1. Neurological examination;
2. Neuroradiology;
3. Electroencephalography;
4. Lumbar puncture;
5. Electromyography;
6. Electronystagmography;
7. Evoked potentials;
Anwar Wardy W.FKK.UMJ
FKK.UMJ.2006
Part II. Common Neurological
Presentations
8. Altered level of consciousness;
9. Headache;
10. Weakness;
11. Dizziness;
12. Seizures;
13. Gait disturbance;
Anwar Wardy W.FKK.UMJ
FKK.UMJ.2006
Part III. Specific Neurological
Conditions:
14. CNS infections in adults; 22. Dementia;
15. Viral encephalitis; 23. Neurooncology;
16. Vascular disease; 24. Neuropsychiatric
17. Movement disorders;
25.Neuroanesthesiology;
18. Neuromuscular disorders; 26. TIK
19. Musculoskeletal and neurogenic pain;
20. Neuroophthalmological disorders;
21. Multiple sclerosis; 28. Sleep disorders;
27. Normal pressure hydrocephalus;
Anwar Wardy W.FKK.UMJ
FKK.UMJ.2006
Part IV. Neurological Trauma and
Environmental Emergencies
29. Traumatic brain injury;
30. Spinal cord injury;
31. Peripheral nerve injury;
32. Neurological complications of
environmental emergencies
Anwar Wardy W.FKK.UMJ
FKK.UMJ.2006
Part V. Pediatric Neurology
33. Hydrocephalus and shunts in children;
34. Pediatric CNS infections;
35. Pediatric stroke;
36. Pediatric seizures;
37. The hypotonic infant;
Anwar Wardy W.FKK.UMJ
FKK.UMJ.2006
Part VI. Neurological
Emergencies of Pregnancy:

38. Neurological emergencies of
pregnancy;
Anwar Wardy W.FKK.UMJ
FKK.UMJ.2006
Part VII. Brain Resuscitation and
Neurotoxicology:
39. General neurotoxicology;
40. Neurotoxicology of alcohol and
substances of abuse;
41. Brain resuscitation.
Anwar Wardy W.FKK.UMJ
FKK.UMJ.2006
Anwar Wardy W.FKK.UMJ
FKK.UMJ.2006
Anwar Wardy W.FKK.UMJ
FKK.UMJ.2006
Anwar Wardy W.FKK.UMJ
FKK.UMJ.2006
Anwar Wardy W.FKK.UMJ
FKK.UMJ.2006
Anwar Wardy W.FKK.UMJ
FKK.UMJ.2006
Anwar Wardy W.FKK.UMJ
FKK.UMJ.2006
Anwar Wardy W.FKK.UMJ
FKK.UMJ.2006
Evaluation
ICP monitoring is most often used in head trauma in
the following situations:
1) GCS less than 8
2) Drowsy with CT findings (operative or non
operative)
3) Post op hematoma evacuation
4) High risk patients (a) Above 40 yrs. (b) Low BP
(c) Those who require ventilation.
There is nothing to achieve in monitoring ICP in
the patients with GCS of less than 3.
Anwar Wardy W.FKK.UMJ
FKK.UMJ.2006