Case Hemiplegi 3.ppt

8/18/2019 Case Hemiplegi 3.ppt

1/22

Presentasi KasusPresentasi Kasus

HEMIPARESE DEXTRAHEMIPARESE DEXTRASPASTIK+PARESE N.VII DEXTRASPASTIK+PARESE N.VII DEXTRA

SENTRAL+PARESE N.XII DEXTRASENTRAL+PARESE N.XII DEXTRA

SENTRALSENTRALOleh: Anton Purnomo, S.Ked.Oleh: Anton Purnomo, S.Ked.

Pem!m!n": Dr. M#r"ono, S$. S %K&Pem!m!n": Dr. M#r"ono, S$. S %K&


2/22

IDENTI'IKASIIDENTI'IKASI

( TN.)* t#hun*l#-!

l#-!*men!-#h*I/l#m* -el#/ I LP P#-0o *1 O-toer 2331 * Medre4. 56786


3/22

An#mne/!/ %Auto#n#mne/!/& An#mne/!/ %Auto#n#mne/!/&Pender!t# d!r#9#t d! #"!#n /#r#; RSMH

-#ren# t!d#- d#$#t 0#l#n #n" d!/e#-#n oleh-elem#h#n $#d# len"#n -#n#n d#n tun"-#!

-#n#n #n" ter0#d! /e4#r# t!#t!#.

Kur#n" le!h 1 0#m SMRS, /##t $ender!t#

men"#m!l 9udhu %9#-tu /hol#t /uuh& t!#

t!# $ender!t# men"#l#m! -elem#h#n $#d#

len"#n -#n#n d#n tun"-#! -#n#n t#n$# d!/ert#!

-eh!l#n"#n -e/#d#r#n. S##t /er#n"#n $ender!t#t!d#- men"#l#m! /#-!t -e$#l# #n" d!/ert#! mu#l

d#n munt#h, t#n$# -e0#n", t#n$# "#n""u#n

/en/!!l!t#/ $#d# /!/! #n" lem#h. Kelem#h#n

$#d# tun"-#! -#n#n len"#n -#n#n /#m# er#t.


4/22

An#mne/!/ %Auto#n#mne/!/& An#mne/!/ %Auto#n#mne/!/&

Seh#r!h#r! $ender!t# e-er0# den"#nmen""un#-#n t#n"#n -!r!. Pender!t#m#/!h d#$#t men"un"-#$-#n !/!

$!-!r#nn# /e4#r# l!/#n, tul!/#n d#n!/#r#t. Pender!t# m#/!h d#$#t men"ert!!/! $!-!r#n or#n" l#!n #n" d!un"-#$-#nden"#n l!/#n, tul!/#n d#n !/#r#t. S##t!4#r# mulut $ender!t# men"ot -e -!r!d#n !4#r# $elo.


5/22


S##t /er#n"#n $ender!t# t!d#- men"#l#m! 0#ntun"erde#rde#r d!/ert#! /e/#- n#$#/. Pender!t#/er!n" /#-!t -e$#l# #"!#n el#-#n". Se0#- 2 t#hun#n" l#lu $ender!t# m#-#n o#t d#r#h t!n""! d#r!

do-ter den"#n ter#tur. Pender!t# t!d#- $ern#hmen"#l#m! -oren" d! -em#lu#n #n" t!d#- "#t#l,t!d#- ner!, d#n /emuh /end!r!. Pender!t# t!d#-$ern#h men"#l#m! er4#- mer#h d! -ul!t #n" t!d#-

ner!, t!d#- "#t#l d#n /emuh /end!r!. Pender!t#t!d#- $ern#h men"#l#m! ner! $#d# tul#n" $#n0#n".Pender!t# t!d#- $ern#h men"#l#m! -e"u"ur#n $#d#u/!# -eh#m!l#n le!h d#r! 51 m!n""u.


6/22


Pen#-!t !n! d!der!t# untu- #n" -et!"#

-#l!n#, #n" I 5 )un! 233 d#n #n" -e II

Se$temer 2331 den"#n -eluh#n #n"

/#m#.


7/22

Pemer!-/##n '!/!-Pemer!-/##n '!/!-

Status Generalis:K< : /#-!t /ed#n"

Sen/ : 4om$o/ ment!/

=!>! : 4u-u$Suhu : 1,?@

N#d! : ?? B*men!t

Pern#$#/#n : 5? B*men!t

Te-#n#n D#r#h :

563*533 mmH"

)#ntun" : HR: ??B*men!t

murmur%&, "#llo$%&

P#ru$#ru : Ce/!-uler%+&norm#l, ron-h! %&,9hee>!n"%&

He$#r : t!d#- ter##

L!en : t!d#- ter##

E-/trem!t#/ : l!h#t/t#tu/ neurolo"!-u/


8/22

Pemer!-/##n '!/!-Pemer!-/##n '!/!-

Status Neurologikus:

Nn. r#n!#le/ :

( N.VII : -erut#n d#h! /!metr!/

l#"o;t#lmu/ %&

/udut mulut -#n#n tert!n""#l

l!$#t#n n#/ol#!#l!/ -#n#n

tert!n""#l

( N.XII : deC!#/! l!d#h -e -#n#n

;#/!-ul#/! %&

#tro;! $#$! %&

d!/#rthr!# %+&


9/22

Pemer!-/##n '!/!-Pemer!-/##n '!/!-Status NeurologikusStatus Neurologikus

FungsiMotorik

Lengan Tungkai

Kanan Kiri Kanan Kiri

=er#-#n -ur#n" 4u-u$ -ur#n" 4u-u$

Ke-u#t#n 2 2

Tonu/ Norm#l Norm#l

Klonu/ + R. '!/!olo"!/ Norm#l Norm#l

R. P#tolo"! + %+& ,


10/22

Pemer!-/##n '!/!-Pemer!-/##n '!/!-

Status Neurologikus'un"/! /en/or!- : t!d#- #d# -el#!n#n

'un"/! Ce"et#t!; : t!d#- #d# -el#!n#n

'un"/! luhur : t!d#- #d# -el#!n#n

=er#-#n #norm#l : t!d#- #d#

=#!t -e/e!m#n"#n: elum d#$#t

d!n!l#!

=e0#l# r#n"/#n" men!n"e#l: t!d#- #d#


11/22

Pemer!-/##n Penun0#n"Pemer!-/##n Penun0#n"

L#or#tor!umL#or#tor!umDarah Rutin:H : 51, "*dl

Leu-o/!t : 55.133*mm+

D!;;. ount: 3*3*5*?3*5?*5

Kimia Klinik:

Kole/terol tot#l:5? m"*dl

Kole/terol HDL:6m"*dl

Kole/terol LDL:551 m"*dl

Tr!"l!/er!d: 523 m"*dl

A/#m ur#t: ,5 m"*dl


12/22

D!#"no/!/D!#"no/!/Diagnosis Banding Topik:

orteB hem!/;er!um 4erer! /!n!/tr#

Le/! d! 4orteB 4erer!, P#d# $ender!t# d!temu-#n

"e0#l#n#: "e0#l#n#:

de;!/!t motor!- hem!$#re/e deBtr# /$#/t!-

"e0#l# !r!t#t!; t!d#- #d# -e0#n" "e0#l# ;o-#l -elem#h#n tun"-#! -#n#n

d#n len"#n -#n#n /#m#

er#t

de;!/!t /en/or!- "#n""u#n /en/!!l!t#/ $#d# tuuh /eel#h -#n#n %&

)#d! le/! d! 4orteB 4erer! d#$#t d!/!n"-!r-#n


13/22

Diagnosis Banding Topik:Diagnosis Banding Topik:

( Su4orteB hem!/;er!um 4erer! /!n!/tr#

Le/! d! /u4orteB P#d# $ender!t# d!temu-#n

hem!/;er!um 4erer! "e0#l#n#:

/!n!/tr#, "e0#l#n#:

de;!/!t motor!- hem!$le"! deBtr# A;#/!# motor!- !l# t!d#- #d# #;#/!# motor!-

ter-en# hem!/$her!um

dom!n#n)#d! le/! d! /u4orteB hem!/;er!um 4erer! de-/tr#

elum d#$#t d!/!n"-!r-#n


14/22

Diagnosis Banding Topik:Diagnosis Banding Topik:

#$/ul# !ntern# hem!/;er!um 4erer! /!n!/tr#

Le/! d! 4#$/ul# !ntern#, P#d# $ender!t#

"e0#l#n#: d!temu-#n,"e0#l#n#: hem!$#re/e*hem!$le"! hem!$#re/e deBtr#

/!n!/tr# t$!4# /$#/t!- $#re/e N.VII deBtr#

/entr#l

$#re/e N.XII deBtr#

/entr#l)#d! le/! d! #$/ul# !ntern# hem!/;er!um 4erer! /!n!/tr#

elum d#$#t d!/!n"-!r-#n.


15/22

Diagnosis Banding EtiologiDiagnosis Banding Etiologi

Hemor#"! 4erer!,

"e0#l#n#:

-eh!l#n"#n -e/#d#r#n

F3G

ter0#d! /##t #-t!C!t#/

Ad# h!$erten/!

)#d! hemor#"! 4erer!

d#$#t d!/!n"-!r-#n

P#d# $ender!t# d!temu-

"e0#l#:

-eh!l#n"#n -e/#d#r#n %

ter0#d! /##t !/tr!r#h#t

TD: 563*533mmH"


16/22


Emol! 4erer!,

"e0#l#n#:

-eh!l#n"#n-e/#d#r#n 3G

Ad# #tr!#l ;!r!l#/!

)#d! emol! 4erer!

d#$#t d!/!n"-!r-#n

P#d# $ender!t#

d!temu-#n "e0#l#:

-eh!l#n"#n

-e/#d#r#n%&

HR: ??B*men!t,

murmur%&,"#llo$%&,

0#ntun"erde#r

de#r%&


17/22


Tromo/!/ 4erer!"e0#l#n#:

-eh!l#n"#n -e/#d#r#n

%&

Ter0#d! /##t !/tr!r#h#t

Atero/-lero/!/

)#d! tromo/!/ 4erer!

elum d#$#t d!/!n"-!r-#n

P#d# $ender!t#d!temu-#n "e0#l#:

-eh!l#n"#n -e/#d#r#n %&

Ter0#d! /##t !/tr!r#h#t


18/22

Ren4#n# Pemer!-/##nRen4#n# Pemer!-/##n

( TS4#n Ke$#l#


19/22

D!#"no/!/D!#"no/!/( D!#"no/!/ Kl!n!/ :

Hem!$#re/e deBtr# /$#/t!-

P#re/e N.VII deBtr# /entr#l

P#re/e N.XII deBtr# /entr#l

( D!#"no/!/ To$!- :

#$/ul# !ntern# Hem!/;er!um

erer! S!n!/tr#

( D!#"no/!/ Et!olo"! :

Tromo/!/ erer!


20/22


21/22

Pro"no/!/Pro"no/!/

uo #d C!t#m: du!# #d on#mPert!m#n"#n:

t!d#- #d# -eh!l#n"#n -e/#d#r#n

-#d#r -ole/terol norm#l

uo #d ;un4t!on#m: du!# #d m#l#m

Pert!m#n"#n:

/er#n"#n untu- #n" -et!"# -#l!


22/22

Case Hemiplegi 3.ppt

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