DISORDERS THAT CAN CAUSE INTERFERENCE IN cranial nerve
1) olfactory nerve. (N.I)
Abnormalities in nerve olfaktovius can lead to a situation and how disturbances of smell is often called anosmia, and can be unilatral or bilateral. In the unilateral anosmia patients are often not aware of any disturbance of smell.
The process starts from the olfactory cells in the nose olfakrorius the fibers penetrating the ethmoid bone kribiformis at the base of the skull base dn reach the olfactory center of the lesion or damage to the olfactory impulses along the way will result in anosmia.
Brochitis olfactory mucosal disease and nasal tumors. Rhinitis recovery means recovery of smell, but the chronic rhinitis, where the nasal mucosa becomes atrophic olfactory space could be lost beyond.
Destruction of olfactory phyla because feribrosa lamina fracture. And bulbus olfactory tract destruction caused kontusi "countre coup", is usually caused by a fall on the back of the head. Bilalteral unilateral anosmia or perhaps it is the only evidence of neurological vegio orbital trauma. Sinusitas etmoidalis, osteitis etmoid bone, and inflammation of the lining of the brain nearby.
Midline tumors of the anterior cranial fossa, especially the olfactory groove meningioma (etmoidalis fossa), which can result in a triad of anosmia, Foster Kennedy syndrome, and personality disorder type orbital lobe. Pituitary adenomas that also extends to the rostral olfactory damage.
Diseases that includes the anterior temporal lobes and the base (intrinsic or extrinsic tumor). Patients may not realize that the sense of smell is lost on the contrary, he may complain about the lost sense of taste, because of its ability to sense the aroma, an important tool for the taste is lost.
2) optic nerve (N.II)
Abnormalities of the optic nerve can cause visual impairment. Impaired vision can be divided into visual acuity impairment and visual field disturbance. Damage or breaking penglitan pathway can lead to impaired vision abnormalities can occur directly on the optic nevrus itself or along the visual pathway that is optikum chiasma, optic tract, radiatio optics, visual cortex. In the event of severe eating disorders can end up with blindness.
People who are blind do not have both sides of the visual field, the term for the blind is anopia or anopsia. If the visual field of both eyes missing sesisi, then such blind called hemiopropia. Abnormalities or lesions in the optic nerve can be caused by:
- Head Trauma
- Cerebral tumors (craniopharyngioma, hipfise tumor, meningioma, astrositoma)
- Abnormalities of blood vessels
- Infections.
3) Nerve Okulomotorius (N.III).
Abnormalities of nerve paralysis caused okulomatorius eyeball can not move to the medial, upward and lateral, down and out. Also lead to impaired parasympathetic function to kontriksi pupil and accommodation, so that the pupil reaction to change. N. III also menpersarafi eyelid muscles to open the eyes, so if paralyzed, the eyelids will fall (ptosis).
Provide a complete paralysis syndrome okulomotorius below:
A. Ptosis, levator muscle paralysis caused by palpebra and the absence of opposition from labor orbikularis ocular muscles supplied by the facial nerve.
2. Fixation eye position, with the pupil downward and laterally, because of the lack of resistance of the lateral rectus muscle work and superior oblique.
3. Pupils are dilated, not reacting to light and accommodation.
If all the muscles experiencing acute paralysis, damage usually occurs in the peripheral, muscle paralysis tunggalmenandakan that involve damage to the nucleus okulomotorius.
Diperifer causes of damage include:
a). Compressive lesions such as cerebral tumor, basal meningitis, nasopharyngeal carcinoma and orbital lesions.
b). Infarction as in arteritis and diabetes.
4) The nerve trochlear (N IV)
Trochlear nerve disorder causing paralysis of the eye can not move the ball down and kemedial. When the patient look straight ahead, the axis of the diseased eye is higher than the other eye. If the patient is looking down and to the medial, the eye rotates dipopia occur in every direction except gaze paralysis limited to the trochlear nerve is rare and often caused by trauma, usually due to falls on the forehead atu vertex.
5) Nerve Abdusens (N. VI)
Abnormalities in nerve paralysis caused abdusens eyeball can not move laterally, when the patient is looking straight up, eyes teradduksi sick and can not be moved laterally, while the patient is looking towards the nasal, eye paralysis moves medially and upward because predominannya inferior oblique muscle.
If all three motor nerves of the eye are all affected, the eyes seemed to see straight up and not be driven all directions and the pupils dilated and not reacting to light (oftalmoplegia totalis). Bilateral paralysis of the muscles of the eye is usually caused by nuclear damage. The most common cause of paralysis of the nucleus is ensefelaitis, neurosyphilis, mutiple sclerosis, hemorrhage and tumor.
The most common cause of paralysis of the peripheral eye muscles are meningitis, sinusistis, cavernosal sinus thrombosis, carotid artery anevrisma komunikantes interva or posterior artery, cranial base fractures.
6) trigeminal nerve (N. V)
Abnormalities that may cause trigeminal perpetual, among others: tumors in the posterior fossa may cause loss of corneal reflexes, and numbness of the face as the early signs.
Disorder of the trigeminal nerve is the most obvious is trigeminal neuralgia or tic douloureux that led to a brief and intense pain throughout the maxillary and mandibular nerve branches of the trigeminal nerve. Janeta (1981) found that the most common cause of trigeminal neurolgia triggered by blood vessels. Most often by superior serebelaris artery encircling the proximal nerve roots that are still not bermielin.
How abnormalities in the pons lesion of acute encephalitis can cause interference in the form of trismus, tonic spasm of the muscles of mastication. Due to the strong abnormal stress on the muscles of patients may not be able to open his mouth.
7) facial nerve (N. VII)
Abnormalities that can cause facial nerve paralis include:
- The cause of the pons, including tumors, vascular lesions and siringobulbia.
- In the posterior fossa, including acoustic neuroma, meningioma, and chronic meningitis.
- In the petrous portion of temporal os may occur Bell's palsy, fracture, Rumsay hunt syndrome, and otitis media.
Causes of bilateral facial paralysis of Guillain Barre Syndrome, among others, mononeuritis multiplex, and bilateral parotid malignancy. Cause of unilateral loss of taste soy sauce without other abnormalities can occur in lesions of the middle ear or tympanic covering Korda lingual nerve, but this is very rare.
Facial nerve disorders can lead to paralysis of the facial muscles, can not be closed eyelids, tear and salivary disorders, impaired sense of taste in the back of the tongue and hearing loss (hiperakusis).
Facial nerve paralysis of motor function resulting in the facial muscles of the hand does not work, characterized by loss of lip nasal folds, corners of the mouth down, lips drawn kesisi healthy. Patients will have difficulty chewing and swallowing.Saliva would come out of the corners of the mouth down. Eyelid could not close on the affected side, there is a collection of tears in the lower eyelid (epifora).Corneal reflex on the side of the hurt does not exist.
8) vestibulocochlear nerve
Abnormalities of the vestibulocochlear nerve may cause hearing loss and balance (vertigo). Abnormalities that may cause nerve VIII include hearing loss, such as:
A. Nerve deafness
Can be caused by tumors, such as acoustic neuroma. Degeneration such as in presbiakusis or caused trauma, ie the pars fracture of petrous temporal os, for example by aspirin toxicity, streptomycin or alcohol, for example infection, congenital rubella syndrome and congenital syphilis.
2. Conductive deafness
Can be caused by cerumen, otitis media, and disease otoskleroris Paget.Gangguan balance with the causes of vestibular disorders. In the labyrinth include Meniere's disease, acute labirinitis, motion sickness, intoxication streptomisin.Pada covers all causes of deafness vestibular nerve vestibular neuronitis added. In the brain stem include vascular lesions, tumors of the cerebellum or fourth ventricle tumor demyelination. Temporal lobe epilepsy and ischemia include.
9) Glosofaringeus nerve (N. IX) and vagus nerve (N. X)
Disturbances in sensory and motor components of N. IX and N. X can lead to loss of swallowing reflex is at risk of pulmonary aspiration. Loss of this reflex in patients will lead to aspiration pneumonia, sepsis and adult respiratory distress syndome (ARDS) such conditions can result in death. IX nerve disorders and N. X causes neurological swallowing muscles become weak and paralyzed. Liquids or foods can not be swallowed up into the esophagus to the trachea but can go directly to the lungs.
Abnormalities that may be the cause, among others: the brain stem lesions (lesion N N. IX and X), syringobulbig (fluid gathered in the medulla oblongata), cerebellum trepansi postoperative, postoperative kranioservikal area.
10) accessory nerve (N. XI)
Disorders N. XI resulting in weakness of the shoulder muscles (trapezius muscle) and the neck muscles (muscles sterokleidomastoideus). Patients will suffer a drop side and shoulder weakness when rotating the neck to the contralateral side.Abnormalities of the accessory nerve may be torn nerve fibers, neural tumors and ischemia result to the trapezius muscle and the muscle distracted stemokleidomastoideus.
11) Neural Hypoglosus (N. XII)
This neurological disorder causes defisiasi skewed towards the weak from the tongue, nerve disorders also showed the occurrence disphagia or swallowing disorders.
ACTIVITIES reflex
Inspection activities with a tap on the tendon reflex using a reflex hammer. Scale for ranking the reflex that is:
0 = No response
1 = hypoactive / decreased responsiveness, weakness (+)
2 = Normal (+ +)
3 = Faster than average, not necessarily
abnormal (+ + +)
4 = hyperactive, with klonus (+ + + +)
Reflexes are checked are:
A. Patellar reflex
Patient lying on your back, knees raised up to approximately 300 of flexion.Patellar tendon (in the middle of the patella and tuberosity tibiae) was hit with a reflex hammer. The response of the quadriceps femoris muscle contraction that is an extension of the knee.
2. Biceps reflex
Arm to the elbow flexed at an angle of 900, supination and the forearm supported on a particular base (check table). Finger probe was placed on the tendon m.biceps (above the elbow crease), then hit with a reflex hammer. Normal if there is contraction of the muscle biceps, a slight increase in the event of partial flexion and pronation movement. When hyperactive it will spread to the arms and flexion movement of the fingers or shoulder joint.
3. Triceps reflex
Sustained arm and flexed at an angle of 900, and triceps tendon with a reflex hammer diketok (triceps tendon is at a distance of 1-2 cm above olekranon).Normal response is contraction of the triceps muscle, a slight increase when the extension is light and hyperactive when elbow extension was spread upward to the muscles of the shoulder, or there might be a temporary klonus.
4. Achilles reflex
The position of the foot is dorsiflexed, to facilitate the examination of this reflex can be placed under investigation foot / lower leg crossed over the contralateral.Achilles tendon reflex was beaten with a hammer, the normal response of plantar flexion of foot movement.
5. Abdominal reflexes
Performed by scraping the abdomen above and below the umbilicus. If scratched like that, the umbilicus will move up and toward the scratched area.
6. Babinski reflex
Reflex is the most important. He only found in kortikospinal tract disease. To perform this test, firmly goreslah lateral part of the heel of your foot towards the little finger and then across the heart of the leg. Babinski response occurs if the mother did dorsifleksi toes and other fingers are spread. Normal response is plantar flexion of all toes.
SPECIAL INVESTIGATION the nervous system
To find out the lining of the brain stimulation (eg meningitis) conducted the examination:
A. Stiff neck
When the neck is passively bent detainees there, so it can not stick your chin on the chest - neck stiffness, positive (+).
2. Brudzinski sign I
Put one hand under the head examiner other hand the client and the client chest to prevent the body is not lifted. Then head kedada clients passively flexed. I Brudzinski positive (+) when the second leg will be flexed at the hip joint and knee joint.
3. Brudzinski sign II
Brudzinski sign II positive (+) when the limb flexion in the hip joint clients will be followed by passive flexion of the other leg in the hip joint and knee.
4. Kernig sign
Flexion of the upper leg straight, and then try to straighten the leg at the knee joint.Normal, when the lower leg form an angle of 1350 to the upper limbs. Kernig + if passive knee extension would cause pain to the barriers.
5. Test Laseque
Flexion of the hip joint with a straight knee joint will cause pain along the m.ischiadicus.
Assessing abnormal posture by observing:
- Decorticate posturing, occurs when there are lesions in the corticospinal tract.Appears on the cover aside arms, elbows, both wrists and finger flexion, extension legs by turning into
and foot plantar flexion.
- Decerebrate posturing, occurs when there are lesions in the midbrain, pons or diencephalon. Neck extension, with a clenched jaw, arms pronation, extension and close the side, legs straight out and foot plantar flexion.
DIAGNOSTIC TEST
Five diagnostic procedure that is commonly performed lumbar puncture, angiography, Elekto Encephalografi, Electromyography, Computerized Axial Tomography Scan (CT Scan) Brain
A.Lumbal puncture
1.Pengertian
Is a way of making the cerebrospinal fluid via lumbar puncture in the area
2.Tujuan
Taking cauran cerebrospinaluntuk interests examination / diagnostic and therapy interests
3.Indikasi
a. For diagnostic
- Suspicion of meningitis
- Suspicion of sub arachnoid haemorrhage
- Provision of contrast media in examination myelografi
- Evaluation of treatment outcome
b. For Therapy
- Provision of anti-neoplastic or anti-microbial intra tekal
- Provision of spinal anesthetics
- Reduce or decrease CSF pressure
4. Preparation
a. Preparation of patients
- Provides counseling to patients and families about the lumbar puncture include objectives, procedures, position,
long action, sensations will be experienced and the things that may happen following the effort needed to reduce these things
- Ask permission from the patient / family with a signed form to the willingness of action of lumbar puncture.
- Convincing the client about what to do
b. Preparation Tools
- Bak streil contains needle puncture, syringes and needles, gloves, gauze and cotton sticks, a small bottle (if bacteriological examination will be performed), and down hole.
- Test tube three
- Bent
- Pengalas
- Disinfectant (jodium and alcohol) in place
- Plaster and scissors
- Manometer
- Lidocaine / Xilocain
- Masks. Dress, headgear
5. Implementation Procedures
a. Lateral recumbent position with the patient's back on the bed. Knee flexion on the position attached to the abdomen, neck, chin menepel forward flexion of the chest (knee chest position)
b. Select the puncture site. Each slit below the L2 vertebral interspinosus can be used in adults, although it is recommended L4-L5 or L5-S1 (Krista iliaca was L4 spinous prosessus field). Interspinosus mark on a predetermined gap.
c. Doctors wearing masks, headgear, wearing sterile gloves and gown.
d. Skin disinfection degan desinfektans solution and form a sterile field with the cover down.
e. Anesthetics with lidocaine or Xylokain skin, tissue infiltration by more dapam longitudinal ligament and periosteum
f. Stick with a spinal needle into the inside stilet subcutaneous tissue. The needle should enter the cavity interspinosus perpendicular to the long axis vertebra.
g. Stick the needle into the subarachnoid cavity slowly, until it feels loose. This sign has penetrated the ligamentum flavum. Remove the stilet to check the flow of cerebrospinal fluid. When no
CSF fluid flow round the needle because the needle may be clogged. When the fluid remained not out. Enter again and tusukka stiletnya needle deeper. Unplug stiletnya at intervals of about 2 mm and check for fluid flow of CSF. Repeat this until the exit liquid.
h. When would know tekananCSF, connect the lumbar needle with the manometer pressure monitor, normally 60-180 mmHg with a lateral recumbent position berrbaring patients. Before measuring the pressure, and the head of the patient's legs should be straightened out. Help the patient to straighten his legs slowly.
i. Instruct patient to breath normally, avoid straining.
j. To find out whether the subarachnoid cavity is blocked or not, the officer may conduct a test
queckenstedt mengoklusi way one jugular vein for I \ 10 seconds. If there is obstruction of the spinal cord so that pressure does not rise, but if there is no obstruction in the spinal cord after 10 minutes of the jugular venous pressure, the pressure will go up and down within 30 seconds.
k. Capacity of the CSF fluid for examination. Enter tesbut fluid in sterile tube 3 and which already contains a reagent, each tube filled with 1 ml of CSF. These fluids are used for calculating the type and cell count, culture and gram staining, protein and glucose. For examination of the principle is none-Apelt globulin precipitate within 0.5 hours in a solution of sulfuric acid. Pemeriksaanya way is put into a test tube 0.7 ml reagent using a pipette, then enter the CSF fluid 0.5. let stand for 2-3 minutes note whether the white precipitate formed.
Penilainnya way is as follows:
(-) May not find a white ring
(+) Very thin white ring seen with a black background and white when it was shaken
(+ +) Is very clear and white rings when shaken liquid into opolecement (misty)
(+ + +) White rings clear and the liquid becomes turbid when shaken
(+ + + +) Is very clear and white rings when shaken liquid becomes very turbid
To test PANDI aims to determine whether there is an increase in globulin and albumin, the principle is the protein precipitated in a saturated solution of phenol in water. The trick is to fill in a watch glass tube with 1 cc of liquid reagent PANDI then drops 1 drop of CSF fluid, consider the reaction that occurs if there is turbidity.
l. When lumbar puncture is used to remove fluid in patients with hydrocepalus liquor then the maximum weight is 100 cc of fluid removed.
m. After all the action is completed, the input is released back stilet manometer needle puncture and remove the needle. Replace the bandage on the puncture marks.
6. After the Procedure
a. Clients terletang sleep without a pillow for 2-4 hours
b. Observation points to the possibility of lumbar CSF drainage
c. If the headaches occur, do the ice pack on his head, recommend relaxation techniques, if necessary, giving
analgesic and sleep until the headaches disappear.
7. Complication
a. Herniation Tonsiler
b. Meningitis and epidural or sub-dural empyema
c. Lumbago
d. Infection
e. Intraspinal epidermoid cyst
f. Damage to the intervertebral discs
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