DMD Case Ade Rhonaz 1

7/29/2019 DMD Case Ade Rhonaz 1

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Department of Neurology RSMH Palembang

Faculty of Medicine University of Sriwijaya

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By:

Ade Ramadhani, S.Ked

Rhonaz Putra Agung, S.KedAdvisor: Dr. H. A. R. Toyo, Sp.S (K)


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IDENTIFICATION

Mr.A/11 years old/Male/Islam/

Banyuasin/ August 28th 2010

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ANAMNESIS

The patient was admitted to Neurologyward RSMH because of the weakness onboth leg which happened gradually

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6 years before admitted to the hospital, patients was

experiencing hard to stand in foot. accompanied by

weakness in both legs, which becomes increasingly severe.

The weakness between right leg and left leg was felt same.

The patient can't move right leg and left leg was felt same at

all. He could express his mind by talking, writing, giving sign

and mentally health.

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ANAMNESIS


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3 years before admitted to thehospital, the symptoms still the same.The patient complained it is difficult to

stands for both legs felt weak.weakness becomes increasinglysevere. Patient cant run and jumparound like a child commonly. The

buttocks and thigh are weaker thanfoot and walking shouldguided.

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2 years before admitted patients can

only lying and sitting on the floor, and

both his knees hard to straightened.

Patients need to be assisted when goingto the bathroom.

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2 years before admitted bothshoulders and upper arms Start weak.

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ANAMNESIS

6 months before admitted patient

experiencing weaknes more severe and

felt his muscular leg tinier.

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There are history of the same

disease in family, getting common cold.

No fever before. There's no history

diabetes mellitus. And have delay ofdevelopment movement

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ANAMNESIS

This illness was the happened for the

first time for him.

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Growth History

The patient was born spontaneously, aterm, andburst into tears.

Patients started on his stomach four months of age,sitting at seven months, and is not accompaniedcrawl first, patients direct running at the age of 18

months, ran at the age of two years, but frequentstops.

When patients want to stand from a seated positionhave trouble standing straight with both handsholding the knee to climb his own legs.

At the age of seven years unable to jump. Patientseasily dropped, if runs slow, Mental status and goodcommunication.

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pedigree

PATIENT

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Physical Examination

Generalis Status

Sens : compos mentis

(GCS=E4M6V5)

Temp. : 36,8C

Pulse : 100 x/minuteRespiratory rate : 20 x/minute

Blood Pressure : 120/70 mmHg

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Neurological Status

Nn. Craniales

No abnormality

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Motorik Fungtion Arm Leg

Right Left Right Left

Motion Decrease Decrease Decrease Decrease

Power 4 4 3 3

Tonus Decrease Decrease Decrease Decrease

Klonus - -

Physiological R. Decrease Decrease Decrease Decrease

Patological R. - - - -

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Sensorik function : no abnormality

Vegetatif function : no abnormality

Limbic function : no abnormalityMES : no

Abnormal Movement : no

Gait & Stability : not assesed yet

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Laboratory Findings

Blood ( August 28th 2010 )

Hb, Ht, Leukosit, LED, Trombosit, Diff.count, BSS, HDL,

LDL, Trigliserida, Cholestrol total, SGOT, SGPT,, Ureum,

Creatinin, Protein Total, Albumin, Globulin, Na, K, Ca :

normal.

Uric Acid : 9,6 mg/dl( 3,5=7,1 ) increase.

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Laboratory Findings

Urine ( August 28th 2010): Normal

Rontgen Thorax (August 28th 2010): normal

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DIAGNOSIS

Clinical diagnosis :Duchenne Muscular

Dystrophy

DD : - Gullian Barre Syndrome

- Bekker Muscular Dysthrophy Topic diagnosis : Muscle

Etiology diagnosis : X-linked genetik

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MANAGEMENT Medicine :

- IVFD NACl 0,9 % gtt xx/M- Vit B1B6B12 3x1 tab

- Metilprednisolone 3x4 mg

- diet porridge

Planning: EMGmuscle biopsy

Physiotherapy:- Bed positioning- Infra Red Radiation left side extremity

- Bobath therapy

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PROGNOSIS

Quo ad vitam : dubia ad

malam

Quo ad functionam : dubia ad

malam

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CASE ANALYSIS

Clinical diagnosis

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Clinical diagnosis

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1. Gullian Barre Syndrome,

signs:

In the patient, signs :

- motoric deficit - motoric deficit

- symptoms was found after

infection- No infection was found

- Happen in female and male- Only happen in male

- No family history of same

disease

-Family history of same

disease is present

So, the possibility of Gullian Barre Syndrome can be excluded


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1. Bekker Muscular Distrophy

, signs:



- begin after age 5- begin after age 5

- progressivity is slow- Progressive

So, the possibility of Bekker Muscular Distrophy can be excluded.


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1. Duchenne Muscular

Distrophy, signs:



- progressive- progressive

- begin before age 5- begin before age 5

- Onset gradually- Onset gradually

- Family history of same

disease is present

- Family history of same

disease is present

So, the possibility of Duchenne Muscular Distrophy can be made


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Clinical Diagnosis

Duchenne Muscular Distrophy

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THANKS

DMD Case Ade Rhonaz 1

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