Skenario 3

Blok Neurologi
 Unilateral facial weakness
• A healthy 50-year-old man notices that his face is drooping on the right side. He
denied any numbness, tingling, or weakness in his extremities. He denied recent
cold sores, ear discharge, or recent trauma; however, he noted flu-like symptoms
about 1-2 weeks ago. He also denied any changes in hearing or ear pain. The
patient noted no previous medical history, however had not seen a doctor in more
than 20 years. He denied any prior surgeries. He is a smoker but denied alcohol or
illicit drug use. He usually sleep on the floor with air conditioned room.
• On examination, the patient was in no acute distress and in no obvious discomfort.
He was hypertensive with an initial blood pressure of 142/96 mmhg. His speech
was slightly slurred. He was alert and oriented times . His skin was warm and dry
with no apparent rashes or lesions. Facial asymmetry was evident, and some saliva
had accumulated on the right side of the patient’s mouth. When the patient
attempted to close his eyes, his right eye could not close, although it rolled
upward, and he was unable to show his teeth or inflate his cheek on the right. His
pupils were 3 mm, equal, round, and reactive. Extraocular movements were intact.
No ulcerations were noted in his ears. The remainder of his exam including a
through neurologic exam was unremarkable.
• All diagnostic tests were essentially normal.
 Nervus Facialis
Komponen Asal Fungsi
Eferen brakhialis Nukleus nervus facialis Otot2 ekspresi wajah,
platisma,m.stilohioideus,
m.digastrikus
Eferen visceral Nukleus salivatorius supor Gld.nasalis, gld.lacrimalis,
saliva, gld sublingualis
Aferen viseral khusus Ganglion geniculatum Pengecapan 2/3 anterior
lidah
Aferen somatik Ganglion geniculatum Telinga luar, bagian kanalis
auditoris’, permukaan
external membran
timpanika
 Bell’s Palsy
• Kelumpuhan saraf fasialis perifer yang terjadi
secara akut
• Mononeuropati akut yang paling umum,
biasanya self-limiting
• Paralisis nervus facialis unilateral idiopatic
 Etiologi
The viruses that have been linked to the
development of Bell’s palsy include:
• herpes simplex, which causes cold sores and
genital herpes
• HIV, which damages the immune system
• sarcoidosis, which causes organ inflammation
• herpes zoster virus, which causes chickenpox and
shingles
• Epstein-Barr virus, which causes mononucleosis
 Faktor Risiko
 Semua kelompok umur dapat terkena
 Lebih sering terjadi pada wanita daripada pria
 sering menyerang wanita hamil (terutama pada trimester ke -3
kehamilan),
 penderita diabetes melitus ,
 infeksi saluran pernapasan atas ,
 kekebalan tubuh turun
 mereka yang terpapar langsung dengan AC dan kipas angin,
 sering terpapar angin malam,
 mengendarai motor tanpa helm,
 mandi di air dingin di malam hari,
 serta perokok juga bisa terkena penyakit ini
 Patofisiologi
• Patofisiologi Bell's palsy belum jelas,
• salah satu teori menyebutkan terjadi proses
inflamasi, penekanan atau pembengkakan akut pada
nervus fasialis.
• Peradangan, penekanan atau pembengkakan nervus
fasialis menyebabkan terjepitnya nervus ini pada
saat melalui tulang temporal sehingga terjadi
kelemahan (paralisis).
• Pembengkakan nervous fasialis ini juga
mengakibatkan pasokan darah ke saraf tersebut
terhenti  neuropati
 Terapi

 Istirahat terutama pada keadaan akut

 Medikamentosa
 Psikoterapi
 Fisioterapi : modalitas berupa infra red, electrical
stimulasi, massage, dan terapi latihan.
 Medikamentosa
(
).
Pemberian sebaiknya selekas-lekasnya terutama pada kasus bell's palsy yang secara
elektrik menunjukkan denervasi. Tujuannya untuk mengurangi udem dan
mempercepat reinervasi. Literatur lain menyebutkan dosis yang dianjurkan 3 mg/kg
BB/hari sampai ada perbaikan, kemudian dosis diturunkan bertahap selama 2 minggu.
. Penggunaan Acyclovir akan berguna jika
diberikan pada 3 hari pertama dari onset penyakit untuk mencegah replikasi virus.

– Terapi akibat lagoptalmus sangat diperlukan untuk melindungi mata dari kerusakan
lebih lanjut, misalnya dengan melindungi mata pada saat tidur dan pemberian tetes
mata metilselulosa. Bagian mata juga harus mendapatkan perhatian khusus dan harus
dijaga agar tetap lembab, hal tersebut dapat dilakukan dengan pemberian pelumas
mata setiap jam sepanjang hari dan salep mata harus digunakan setiap malam