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STEP 1

 Paralysis : (kelumpuhan) gangguan fungsi satu otot atau lebih yg tidak ada mobilitas atau
pergerakan, karena ada kerusakan di otak (intan), paralisis sama plegi sama.

STEP 2
1. What is the anatomy and fisiologi of the case?
2. What the relation the symptoms with using motorcyle without helmet?
3. Why the patient experiencing a weaknes of the facial on the left side, couldn’t
gargled, and found that her face was asymmetric and she was unable to tightly
close her left eye?
4. What the definition of bell’s spalsy
5. What the etiologi and risk factor of the case
6. What is the patofisiology and patogenesis from the case?
7. What is the diffrent between central nerve paralysis and perifer nerve paralysis?
8. What is DD and diagnose of the case?
9. What is physical examination and supporting examination?
10. What is the treatment, education, prognosis of the case?

STEP 3

1. What is the anatomy and fisiologi of the case?

Fisiologi: Traktus kortiko bulbarkapsula internaipsi lateral(pipi ke bawah),


kontralateral(dari dahi)jaras nya keluar lewat meatus akustikus internus (basis
cranii)foramen stylomastoideus. Ex lesi perifer  bisa ke dahi

Anatomi : sensorik, motorik, otonom

Sensorik2/3 anterior lidahbag.dasar palatum mulutkel.ludah mayor

Motorikotot2 wajah, kel.lakrima

n.7 keluar dr ponsmeatus akustikus interna dg n.8vestibulo dan koklearisganglion


genikulatumke bawah ke foramen stylomastoidmempersarafi otot2 wajah, kecuali
otot2 palpebra.

Nukleus salitorius: sensoris

Nukleus sensory trigeminus: somatu sensoris

2. What is the relation the symptoms with using motorcyle without helmet?

Bell’s palsy

Angin yg masuk ke dlm tengkorak kepalamembuat saraf di sekitar wajah


sembabmembesarsaraf terjepitkelumpuhanjd pasokan darah ke saraf
berhentikematian selfungsi hantar impuls tergangguperintah otak utk
menggerakan otot tdk dpt di teruskan.
Udara dinginlap.endotel rusaksebabkan transudasimempengaruhi
nervusmelewati foramen stylomastoidnervus terjepitbengkakproses hantar
listrik terganggu

Kena udara dingin, terpapar ac langsung, tiduran di lantai nervusnya bengkaktdk


bisa menggerakan otot.

Kenapa yg bengkak Cuma n.7 aja padahal daerah bengkaknya sama?

3. Why the patient experiencing a weaknes of the facial on the left side, couldn’t
gargled, and found that her face was asymmetric and she was unable to tightly close
her left eye?

Kelumpuhan otot yg di inervasikumur2 nyemoprot, tipe central lebih ringan dari


perifer.

Bell’s spalsy

Lakrima: air matanya jd terbendungtdk keluar

4. What the definition of bell’s spalsy

Paralisis nervus fascialis yg bersifat akut unilateral perifer dan mempengaruhi LMN dikenal
juga dgn nama paralisis fascialis idiopatik.

5. What the etiologi and risk factor of the case

Etiologi:

 kongenital: anomali kongenital (syndrome moebius), trauma lahir(fraktur tengkorak dan


pendarah intrakranial)
 didapat: trauma, penyakit osteomielitis, proses intrakranial (tumor, radang, pendarahan, infx
tmpt lain, ex: herpes zooster

Faktor2

Berkendaraan mlm hari tanpa pake helm, tidur di lantai, terpapar ac scr lgsg,

6. What is the patofisiology and patogenesis from the case?


7. What is the diffrent between central nerve paralysis and perifer nerve paralysis?

Central: kena kirisehat juga kiri. di supragenitiakum atau nukleusnya

Perifer: krna menyilang, jd kena di bawah persilangannya. suprastapedia, infrastapedia


(krna kumpulan dr serumen yg berasal dr bakteri stapylococcus), MAI, CA, SM (krna
pembengkakan nervus)

Central dan perifer : merotnya ke tmpt yg sehat, perbedaannya hanya di dahi

Cari otot2 yg berperan(central dan perifer) dan cara diagnosis central dan perifer nya.
8. What is DD and diagnose of the case?

DD : stroke lihat gejala klinisnya, dahinya bisa mengkerut lesi central. Gejala klinis: nyeri,
pegal, linu, dan tdk enak pada telinga, kelumpuhan di wajah dahi tdk bsa di kerutkan,
lagoftalmus, gg fungsi pengecap, hiperakusis, gg pada lakrimasinya. Penyakit miler viser
syndrome, trias gejalanya : optalmoplegi, ataksia, arefleksia. Akibat kerusakan
n.kranialis yg menyebabkan kelemahan otot2 mata, pd n.facialis kelemaha otot2 wajah
type perifer, infx hepes zooster pd ganglion genikulatum ruam pd wajah dan kelemahan
otot2 wajah

9. What is physical examination and supporting examination?

Pemeriksaan penunjang : ct-scan, memriksa struktur di dlm kepala ex. Otak, tulang,
sinusitis, EMG utk memastikan kerusakan saraf dan tipe keparahan

Pemeriksaan fisik: suruh meringis, mengerutkan dahi, menggerakan kelopak mata,


menutup mata, menggembungkan pipi, menjulurkan lidah.

10. What is the treatment, education, prognosis of the case?

MAPPING

Nervus fascialism.frontalis, m.orbicularis occuli (central dan perifer)etiologi