pp refrat anita 06123
DESCRIPTION
neurologiTRANSCRIPT
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CEPHALGIA
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Definisi
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Etiologi
• Idiopatik
• Intrakranium
• Ekstrakranium
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Struktur Jaringan Kepala yang Peka Nyeri
• Intrakranial :Sinus cranial dan vena aferenArteri dari duramaterArteri dari dasar otak dan cabang utamanya.Bagian dari duramater (sekitar pembuluh darah besar)
• Ekstrakranial : Kulit, kulit kepala, fasia, otot mukosa
Arteri (vena kurang peka)Saraf-saraf : N. trigeminus, N. vagus, saraf servikal kedua dan ketiga.
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Struktur Jaringan Kepala Tidak Peka Nyeri
• Parenkim otak
• Ependima, pleksus khoroideus
• Pia mater, araknoid
• Tengkorak (periost: sedikit peka)
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Skala verbal derajat Keparahan Nyeri Kepala
0 : No headach
1 : Mild headach
2 : Moderate headach
3 : Severe headach,
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KLASIFIKASI
• PRIMER
• SEKUNDER
• NEURALGIA KRANIAL, SENTRAL ATAUNYERI FACIAL
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MIGRAINMIGRAIN
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AURA• Aura visual :
- fenomena positive dan negative (scotoma)- fortification spectra scotoma)- fotopsia
• Aura sensorik - parestesia hemisensorik- kebas - rasa panas
• Aura motorik- hemiparesis- disfagia- sulit bicara
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Gejala prodromal• hiperaktif• hipoaktif• depresi• menginginkan jenis makan tertentu• gerakan mengunyah-ngunyah,• perasaan lemah lesu,• kurang nafsu makan,• perasaan sensitive pada sentuhan, suara,
bau maupun cahaya• sering kencing
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Migrain tanpa aura
• Sekurang- kurang 5 kali serangan• Berlangsung antara 4-72 jam • Sifat nyeri
• lokasi unilateral biasanya pada frontotemporal• sifatnya mendenyut • intensitas sedang sampai berat• diperberat oleh kegiatan fisik
• sekurang- kurangnya ada satu dari yang tersebut di bawah ini :- mual dan atau muntah - fotofobia dan fonofobia
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Migrain dengan aura
Adanya aura paling sedikit satu Paling sedikit 2 dari 3 dibawah ini : - Gejala visual homonim dan/ gejala sensoris
unilateral. - Aura timbul >5 menit - gejala berlangsung 5 – 60 mnt
Nyeri Kepala memenuhi kriteri migran tanpa aura
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TERAPI
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Obat NSAIDs
• Ibuprofen : dosis 400-800mg/6 jam, dosis maksimal 4 gr/hari
• Ketorolac , dosis : 60 mg IM/15-30 menit, dosis maksimal 120 mg/hari. Tidak lebih dari 5 hari
• Naproxen sodium , dosis : 275-550 mg/ 2-6 jam/hari, dosis maksimal 1,5 gr/hari
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TRIPTANS
• Sumatripan, dosis : 25-100 mg oral/2 jam, dosis maksimal 200 mg/hari
• Rizatriptin , dosis: 5-20 mg oral /2 jam, dosis maksimal 30 mg per hari
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Tension type headache
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stres fisik atau emosi
hiperventilasi
CO2 turun
alkalosis
kalsium masuk kedalam sel kontraksi otot
otot kaku dan tegang
nyeri kepala
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kriteria
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ANTIDEPRESSAN
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Cluster Headache
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KLASIFIKASI
• Tipe episodik, (80%) - 1-3 serangan / hari selama 2-12 minggu - Masa bebas serangan 3 bulan - 3 tahun
• Tipe kronik (20%) - tidak ada remisi selama lebih dari 1 tahun atau remisi singkat kurang dari 14 hari
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TERAPITerapi Akut
• Inhalasi oksigen 100% 7 L/menit selama 15 menit
• Dihydroergotamin (DHE) 0,5 -1,5 mg i.v akan mengurangi nyeri dalam 10 menit
• Sumatriptan injeksi subkutan 6 mg akan mengurangi nyeri dalam 5 – 15 menit dapat diulang dalam setelah 24 jam
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TERAPI NKK KRONIK
• Ergotamine• Metylsergide• Lithium carbonate, dosis : 360-600 mg/hari
beberapa minggu ditingkatkan menjadi 900 mg/hari
• Veraparamil 120-200mg/hari
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TERAPI PREVENTIF• Hidup dan istirahat teratur
• Hindari tidur sore
• Hindari alkohol
• Hindari produk Tobacco
• Hindari sinar terang dan suara gaduh