Makalah Hemiparesis Anwar Sholeh

MAKALAH

HEMIPARESIS

Disusun Oleh: Dian Primadia Putri (100100013) (100100013)

Pemimin!: DR" dr" RR" S#$% I&DHAR'% M"Kes S"*S

DEPAR'EME& ILM# *EDAH SARA+ RS#P HA,I ADAM MALIK MEDA& +AK#L'AS KEDOK'ERA& #&I-ERSI'AS S#MA'ERA S# MA'ERA #'ARA #'ARA .01/ DA+'AR ISI 1

DAFTAR ISI................................................................................................

2

BAB 1

PENDAHULUAN.........................................................................

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BAB 2

TINJAUAN PUSTAKA................................................................

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2.1. Definisi..................................................................................

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2.2. Fisiologi Jaras Moori!..........................................................

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2.". Eiologi..................................................................................

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2.#. Manifesasi Klinis..................................................................

12

KESIMPULAN............................................................................

1#

DAFTAR PUSTAKA...................................................................................

1$

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PE&DAH#L#A&

He&i'arese a(ala) !ele&a)an oo*oo lengan (an +ng!ai 'a(a sa+ sisi. Pa(a )e&i'arese er,a(i !ele&a)an se-agian anggoa +-+) (an le-i) ringan (ari'a(a )e&i'legi. Pene-a- ersering )e&i'aresis 'a(a orang (e/asa ai+ infar! sere-ral aa+ 'er(ara)an.1 Kaa 'aralisis -erasal (ari -a)asa 0+nani ai+ para ang -erari se'ar+) se-ela) se-agian (an lysis ang -erari !e)ilangan aa+ !er+sa!an. Dala& isila) !e(o!eran 'aralisis (iari!an se-agai !e)ilangan f+ngsi &oori! (ala& &enga+r   'ergera!an ol+ner a!i-a gangg+an (ari sala) sa+ -agian ,aras &oori! &+lai (ari 3ere-r+& )ingga !e sera-+ oo.Selain i+ sering ,+ga (ig+na!an !aa 'aresis ang (a'a (iari!an !e)ilangan se-agian f+ngsi &oori! -iasana -er+'a !ele&a)an -er-e(a (engan 'aralisis ang (iangga' !e)ilangan sel+r+) f+ngsi &oori!.1 Pene-a- )e&i'aresis -er&a3a&*&a3a& ergan+ng (ari lea! lesina. Lesi (a'a er,a(i 'a(a !ore!s s+-!ore!s -aang oa! &e(+lla s'inalis (an saraf 'erifer 2. Lea! lesi a!an &enen+!an !ara!erisi! )e&i'aresis ang er,a(i. Hal ini (a'a (i!elo&'o!!an &en,a(i lesi i'e upper motor neuron 4UMN5 (an lower motor neuron 4LMN5". Pa(a &a!ala) ini a!an (i,elas!an le-i) lan,+ &engenai )e&i'aresis ai+ (efinisi eiologi (an &anifesasi !linis ang er,a(i 'a(a )e&i'aresis.

*A* .

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'I&,A#A& P#S'AKA

2.1. Definisi  He&i'arese a(ala) !ele&a)an oo*oo lengan (an +ng!ai 'a(a sa+ sisi. Pa(a )e&i'arese er,a(i !ele&a)an se-agian anggoa +-+) (an le-i) ringan (ari'a(a )e&i'legi. Pene-a- ersering )e&i'aresis 'a(a orang (e/asa ai+ infar! sere-ral aa+ 'er(ara)an. He&i'arase ang er,a(i &e&-eri!an ga&-aran  -a)/a a(ana !elainan aa+ lesi se'an,ang ra!+s 'ira&i(alis. Lesi ini (a'a (ise-a-!an ole) -er!+rangna s+'lai (ara) !er+sa!an ,aringan ole) ra+&a aa+ infe!si aa+'+n 'ene!anan langs+ng (an i(a! langs+ng ole) &assa )e&ao&a a-ses (an +&or. Hal erse-+ selan,+na a!an &enga!i-a!an a(ana gangg+an  'a(a ra!+s !ori!os'inalis ang -erangg+ng ,a/a- 'a(a oo*oo anggoa gera!  aas (an -a/a).1 Kaa 'aralisis -erasal (ari -a)asa 0+nani ai+ para ang -erari se'ar+) se-ela) se-agian (an lysis ang -erari !e)ilangan aa+ !er+sa!an. Dala& isila) !e(o!eran 'aralisis (iari!an se-agai !e)ilangan f+ngsi &oori! (ala& &enga+r   'ergera!an ol+ner a!i-a gangg+an (ari sala) sa+ -agian ,aras &oori! &+lai (ari 3ere-r+& )ingga !e sera-+ oo. Isila) lain 'aralisis a(ala) 'legia. Selain i+ sering ,+ga (ig+na!an !aa 'aresis ang (a'a (iari!an !e)ilangan se-agian f+ngsi &oori! -iasana -er+'a !ele&a)an -er-e(a (engan 'aralisis ang (iangga' !e)ilangan sel+r+) f+ngsi &oori!.He&i'aresis a(ala) !ele&a)an se-agian aa+ se-ela) +-+) 1.

2.2. Fisiologi Jaras Moori! 6ol+ner  I&'+ls saraf +n+! 'ergera!an ol+ner -erasal (ari !ore!s 3ere-ri &en+,+ lower motor neuron 4LMN5 &ela+i ,aras &oori! ol+ner. Jaras &oori!  ol+ner (i!enal ,+ga se-agai ,aras 'ira&i(alis ang -erisi a!son ang +r+n (ari sel 'ira&i(al. Sel 'ira&i(al a(ala) upper motor neuron 4UMN5 (engan -a(an sel ang -er-en+! 'ira&i( erlea! 'a(a area &oori! 'ri&er (an area 're&oori!   'a(a !ore!s 3ere-ri 4area # (an 75. Jaras &oori! ol+ner er(iri (ari ,aras !ori!os'inal (an ,aras !ori!o-+l-ar #.

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8a&-ar 2.1. Pea Ho&+n3+l+s Area Moori! Pri&er 

Jaras !ori!os'inal &enganar!an i&'+ls +n+! &engonrol oo*oo 'a(a anggoa gera! (an -a(an. A!son UMN 'a(a !ore!s 3ere-ri &e&-en+! ,aras !ori!os'inal ang +r+n &elal+i !a's+la inerna 'a(a 3ere-r+& (an 'en(+n3+l+s 3ere-ri 'a(a &esensefalon. Di &e(+lla o-longaa a!son erse-+ &e&-en+!   'ira&i( (an %9: a!son erse-+ &enilang &en+,+ sisi !onralaeral &e(+lla o-longaa (an +r+n !e &e(+lla s'inalis -ersina's (engan LMN. 19: sisana ea' -era(a (isisi i'silaeral &e(+lla o-longaa !e&+(ian +r+n !e &e(+lla s'inalis (an &enilang 'a(a leel (i&ana ia a!an -ersina's (engan LMN.

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Se)ingga !ore!s sere-ri !anan &engonrol oo*oo (ise-ela) !iri +-+)  (an !ore!s sere-ri !iri &engonrol oo*oo (ise-ela) !anan +-+). A(a (+a i'e ,aras !ori!os'inal ai+ ,aras !ori!os'inal laeral (an ,aras !ori!os'inal anerior #.

•

Jaras Kori!os'inal Laeral A!son

!ori!os'inal

'a(a

&e(+lla

o-longaa

&e&-en+!

,aras

!ori!os'inal laeral 'a(a !ol+&na laeral &e(+lla s'inalis a!son ini -ersina's (engan LMN 'a(a !orn+ anerior &e(+lla s'inalis. A!son LMN ini !e&+(ian !el+ar &elal+i ra(i!s anerior saraf s'inal (an &en+,+ oo s!ele ang &engonrol  'ergera!an oo*oo (isal anggoa gera!. ;o*oo ini -erf+ngsi (ala& gera!an ang 'resisi ang!as (an sanga era&'il 'a(a angan (an !a!i &isalna gera!an ang (ila!+!an +n+! &engan3ing -a,+ (an &e&ai!an 'iano #.

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8a&-ar 2.2. Jaras Kori!os'inal Laeral

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Jaras Kori!os'inal Anerior  A!son !ori!os'inal ang i(a! &enilang (i &e(+lla o-longaa

&e&-e+! ,aras !ori!os'inal anerior 'a(a !ol+&na anerior &e(+lla s'inalis. Pa(a seia' leel &e(+lla s'inalis -e-era'a a!son a!an &enilang &elal+i !o&is+ra anerior. Ke&+(ian -ersina's (engan LMN 'a(a !orn+ anerior. A!son LMN ini !el+ar (ari &e(+lla s'inalis &elal+i ra(i!s anerior saraf s'inal (an &en+,+ oo s!ele ang &engonrol 'ergera!an oo*oo -a(an (an -agian  'ro!si&al anggoa gera! #.

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8a&-ar 2.". Jaras Kori!os'inal Anerior

Jaras !ori!o-+l-ar &enganar!an i&'+ls +n+! &engonrol 'ergera!an oo s!ele (i !e'ala. A!son UMN (ari !ore!s 3ere-ri &e&-en+! ,aras !ori!o-+l-ar ang +r+n -ersa&a ,aras !ori!os'inal &elal+i !a's+la inerna  'a(a 3ere-r+& (an 'e(+n3+l+s 3ere-ri 'a(a &esensefalon. Be-era'a a!son 'a(a  ,aras !ori!o-+l-ar &enilang se-agian lagi i(a!. A!son*a!son ini -era!)ir (i ini &oori! se&-ilan saraf !ranial 'a(a -aang oa!< o!+lo&oori+s 4III5 ro!learis 4I65 rige&in+s 465 a-(+sens 46I5 fasialis 46II5 glosofaringe+s 4I=5 ag+s 4=5 a!sesori+s 4=I5 (an )i'oglos+s 4=II5. LMN saraf !ranial

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&ena&'ai!an i&'+ls ang &enga+r 'resisi gera!an ol+ner -ola &aa li(a) (an le)er (ia&-a) (engan &eng+na) e!s'resi /a,a) (an -er-i3ara #.

8a&-ar 2.#. Jaras Kori!o-+l-ar 

2.". Eiologi Ker+sa!an saraf ang (a'a &ene-a-!an 'aralisis &+ng!in (i (ala& oa!  aa+ -aang oa! 4'+sa sise& saraf5 aa+ &+ng!in (i l+ar -aang oa! 4sise& saraf 'erifer5. Le-i) sering 'ene-a- !er+sa!an 'a(a oa! a(ala) < sro!e +&or r+&a 4(ise-a-!an ,a+) aa+ '+!+lan5 &+li'le s3lerosis 4'ena!i ang &er+sa!   -+ng!+s 'elin(+ng ang &en++'i sel saraf5 sere-ral 'als 4!ea(aan ang (ise-a-!an in,+ri 'a(a oa! ang er,a(i sesaa seela) la)ir5 gangg+an &ea-oli! 

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4gangg+an

(ala&

'eng)a&-aan

!e&a&'+an

+-+)

+n+!  

&e&'era)an!anna5.2" S+a+ lesi ang &eli-a!an !ore!s sere-ri se'eri 'a(a +&or infar! aa+ 3e(era ra+&ai3 &ene-a-!an !ele&a)an se-agian +-+) sisi !onralaeral. He&i'aresis ang erli)a 'a(a /a,a) (an angan (kelemahan brakhiofasial) le-i) sering er,a(i (i-an(ing!an (i (aera) lain !arena -agian +-+) erse-+ &e&ili!i area re'resenasi !ori!al ang l+as.2$ Lesi seing!a 'e(+n!+l+s sere-ri se'eri 'roses as!+lar 'er(ara)an aa+ +&or &eni&-+l!an hemiparesis spastik !onralaeral ang (a'a (iserai ole) !el+&'+)an ner+s o!+lo&oori+s i'silaeral. Lesi 'ons ang &eli-a!an ra!+s 'ira&i(alis 4+&or is!e&ia -aang oa! 'er(ara)an5 &ene-a-!an hemiparesis kontralateral aa+ &+ng!in bilateral . Lesi 'a(a 'ra&i( &e(+lla 4-iasana a!i-a +&or5 (a'a &er+sa! sera-+*sera-+ ra!+s 'ira&i(alis se3ara erisolasi !arena sera-+*sera-+ non'ira&i(al erlea! le-i) !e (orsal 'a(a ing!a ini. A!i-ana (a'a er,a(i hemiparesis flasid kontralateral . Kele&a)an i(a! -ersifa oal 4'aresis -+!an 'legia5 !arena ,aras (esen(ens lain i(a!  ergangg+.2$ Eiologi )e&i'aresis -er(asar!an lea! lesi (an !ara!erisi! )e&i'aresis (a'a (ili)a 'a(a a-el -eri!+ 2<

Ta-el 2.1. Eiologi He&i'aresis Ber(asar!an Lea! Lesi 2 Lea! Lesi Lesi Kori!al •

•

Infar! 

Kara!erisi!   Kele&a)an er,a(i (i se-ela) -agian +-+) na&+n -ersifa le-i) fo!al (i-an(ing!an

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(engan lesi s+-!ori!al Pa(a infar! 3ere-ri a!i-a 'en+&-aan aa+  'e3a)na  -ergan+ng

Lesi S+-!ori!al • •

Infar!  Pena!i (e&elinisasi

•

'e&-+l+) 'a(a

(ara) (aera)

!ele&a)an oa!

ang

(i'er(ara)i 'e&-+l+) (ara) erse-+. Lesi s+-!ori!al &eng)asil!an !ele&a)an (engan inensias ang sa&a anara /a,a) lengan (an +ng!ai 'a(a sisi !onralaeral 10

• • •

S!lerosis &+li'el Migrain T+&or 

•

+-+). ;nse er,a(ina )e&i'aresis -er-e(a*-e(a ergan+ng 'ene-a-. Pa(a sro!e onse a!+  'a(a 'ena!i (e&elinisasi onse s+-a!+

Lesi Baang ;a! 

•

•

Lesi

&esensefalon

•

4sin(ro&a >e-er5 Lesi 'ons 4sin(ro&a

•

Millar(*8+-ler5 Lesi &e(+lla o-longaa 4sin(ro&a

&e(+lla

(an 'a(a +&or onse la&-a. Sin(ro&a >e-er (ian(ai (engan 'aralisis ner+s

•

i'silaeral

(an

)e&i'aresis

!onralaeral Sin(ro&a Millar(*8+-ler (ian(ai (engan  'aralisis ner+s 6I (an 6II (an )e&i'aresis

•

&e(ial5

!onralaeral Sin(ro&a &e(+lla &e(ial (ian(ai (engan )ilangna sensasi 'osisi (an gearan 'aresis li(a)

Lesi Me(+lla S'inalis •

Sin(ro&a

•

s'inal T+&or  Infar! 

•

III

•

)e&ise!si

i'silaeral

(an

)e&i'aresis

!onralaeral. Lesi &e(+lla s'inalis 'a(a sa+ sisina (a'a &ene-a-!an )e&i'legia an'a &eli-a!an

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 -agian /a,a). Sin(ro&a )e&ise!si s'inal (ian(ai (engan !ele&a)an +-+) i'silaeral )ingga !e -a/a) lesi (an )ilangna sensasi neri (an s+)+  'a(a +-+) !onralaeral )ingga !e -a/a)

Lesi Saraf Perifer 

•

lesi. Lesi

saraf

'erifer

se)ar+sna

i(a! 

&ene-a-!an )e&i'aresis er!e3+ali ,i!a lesi er,a(i (i 'ersarafan lengan (an +ng!ai se!alig+s 'a(a sisi ang sa&a &+ng!in (a'a &ener+'ai )e&i'aresis. Ta-el 2.2. Eiologi He&i'aresis Ber(asar!an Lea! Lesi $

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2.#. Manifesasi Klinis Disri-+si 'aralisis &e&-eri!an sara ang 'ening +n+! -agian saraf  ang r+sa!. He&i'legia (ise-a-!an !er+sa!an oa! 'a(a sisi -erla/anan (engan  'aralsis -iasana (ari sro!e. Para'legia er, a(i seela) in,+ri 'a(a -agian -a/a)  -aang oa!  (an ?+a(ri'legia er,a(i seela) !er+sa!an -agian aas -aang oa!   'a(a ing!a -a)+ aa+ le-i) inggi 4 saraf ang &engonrol lengan se,a,ar +lang  -ela!ang 5. Di'legia -iasana &engin(i!asi!an !er+sa!an oa! le-i) sering !arena sere-ral 'als. Mono'legia &+ng!in (ise-a-!an 'e&isa)an !er+sa!an (ianara sse& saraf '+sa aa+ saraf 'erifer. Kele&a)an aa+ 'aralsis )ana (a'a er,a(i 'a(a lengan (an !a!i (a'a &engin(i!asi!an 'ena!i (ie&elinisasi. 8e,ala -erfl+!+asi (ala& &e&-e(a!an -agian +-+) &+ng!in (ise-a-!an &+li'le s3lerosis. Ke,a(ian 'aralsis le-i) sering (ise-a-!an in,+ri aa+ sro!e. Pen,alaran 'aralsis &engin(i!asi!an 'ena!i (egeneraif 'ena!i infes!i se'eri < 8BS aa+ @IDP gangg+an &ea-olis&e. 1" 8e,ala lain ang sering &enerai 'aralisis er&as+! &ai rasa (an  'erasaan !ese&+an neri 'er+-a)an 'engli)aan  !es+lian -er-i3araaa+

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&asala) (engan !esei&-angan. @e(era 'a(a -aang oa! sering &ene-a-!an &en+r+nna f+ngsi !an(+ng !e&i) BAB (an organ se. In,+ri (iaas -aang oa!  (a'a &ene-a-!an !es+lian (ala& -ernafas. 1" Manifesasi !linis )e&i'aresis se3ara garis -esar ergan+ng (ari lea!  lesina. Lesi UMN (ian(ai (engan &anifesasi se-agai -eri!+ 1"< •

Kele&a)an s'asi! 4on+s oo &ening!a )ilangna !e!+aan &oori! 

•

!asar (an gangg+an !onrol &oori! )al+s5. Pening!aan refle!s oo inrinsi! 'erl+asan ona refle!s (an &+n3+lna refle!s 'aologis 4refle!s Ba-ins!i ;''en)ei& 8or(on Hoff&an (an Tro&ner5 (an )ilangna refle!s oo e!srinsi! 4&isalna refle!s !+li

•

a-(o&en5. Ti(a! a(a aro'i oo 4er!a(ang &+n3+l aro'i oo ringan a!i-a i(a! 

•

(ig+na!an (ala& /a!+ la&a5. Refle!s ang asi&eris ,i!a lesi +nilaeral. Se(ang!an lesi LMN (ian(ai (engan &anifesasi se-agai -eri!+ 1"<

• • •

Kele&a)an fla!si( 4)ilangna on+s oo (an !e!+aan &oori! !asar5. Ber!+rang aa+ )ilangna refle!s oo inrinsi!. Aro'i oo ang -iasana &+n3+l " &ingg+ seela) lesi er,a(i.

*A* 3 KESIMP#LA&

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He&i'arese a(ala) !ele&a)an oo*oo lengan (an +ng!ai 'a(a sa+ sisi. Pa(a )e&i'arese er,a(i !ele&a)an se-agian anggoa +-+) (an le-i) ringan (ari'a(a )e&i'legi. Pene-a- ersering )e&i'aresis 'a(a orang (e/asa ai+ infar! sere-ral aa+ 'er(ara)an. He&i'arase ang er,a(i &e&-eri!an ga&-aran  -a)/a a(ana !elainan aa+ lesi se'an,ang ra!+s 'ira&i(alis. Lesi ini (a'a (ise-a-!an ole) -er!+rangna s+'lai (ara) !er+sa!an ,aringan ole) ra+&a aa+ infe!si aa+'+n 'ene!anan langs+ng (an i(a! langs+ng ole) &assa )e&ao&a a-ses (an +&or. Pene-a- )e&i'aresis -er&a3a&*&a3a& ergan+ng (ari lea!  lesina. Lea! lesi ini a!an &enen+!an !ara!erisi! )e&i'aresis ang er,a(i.

DA+'AR P#S'AKA

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1. Ro''er AH Bro/n RH. A(a&s an( 6i3orCs Prin3i'les of Ne+rolog. ) e(.  Ne/ 0or!< M38ra/*Hill 299$. '. "%*#. 2. Mis+lis KE. He&i'legia an( Mono'legia. In< Bra(le >8 e(ior.Ne+rolog in @lini3al Pra3i3e Prin3i'les of Diagnosis an( Manage&en. #) e(. P)ila(el')ia< Elseier 299$. '. ""*"#". ". M+&en)aler M Male H. F+n(a&enals of Ne+rolog an Ill+srae( 8+i(e.  Ne/ 0or!< T)ie&e 2997. '. 77*9. #. Torora 8J Derri3!son B. Prin3i'les of Anao& an( P)siolog. 12) e(. USA< Jo)n >ille G Sons 299%. '. $"*$7. $. >a&an S8. @lini3al Ne+roanao&. 27) e(. Ne/ 0or!< M38ra/*Hill 2919. '. 1"*%".

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