PRESENTASI POLI

SUSP HNP LUMBAL

Fathi Tsamara Ghufroon Rifai
G4A022052

Pembimbing :
dr. Prasetyo Tri Kuncoro, Sp.S

SMF ILMU PENYAKIT SARAF

RSUD PROF. DR. MARGONO SOEKARJO
IDENTITAS PASIEN

Nama : Ny. H
Usia : 55 tahun
Alamat : Ciamis
Pekerjaan : Ibu Rumah Tangga
Agama : Islam
No. CM : 02214XXX
Tanggal Pemeriksaan : 10 Juni 2023
ANAMNESIS
Keluhan Utama
Nyeri punggung bawah kanan menjalar sampai kaki kanan

Riwayat Penyakit Sekarang

Pasien baru rujukan dari RSDK Ciamis datang ke poli saraf RSMS pada tanggal 10
Juni 2023 dengan keluhan nyeri punggung bwah kanan menjalar sampai 4 jari kaki
kecuali ibu jari kanan, nyeri dirasakan tajam. Pasien mengaku nyeri pertama kali
dirasakan sejak 2020 dengan lokasi sama yaitu pada pinggang yang menjalar ke
kaki sebelah kanan. Pasien sudah berobat ke dokter saraf tetapi tidak ada
perbaikan. Nyeri memberat 2 minggu yang lalu dirasakan seperti terbakar
terus-menerus sepanjang hari sehingga mengganggu akvitias pasien. Nyeri
bertambah apabila pasien duduk terlalu lama dan membungkuk ketika hendak
mengambil/mengangkat barang. Nyeri berkurang jika pasien tidur terlentang.
Keluhan lain dirasakan kesemutan pada telapak kaki kanan. Pasien tidak
mengalami keluhan BAK maupun BAB
ANAMNESIS
Riwayat Penyakit Dahulu
• Riwayat keluhan serupa : (+) 2020
• Riwayat trauma : (-)
• Riwayat penyakit saraf lainnya : (-)
• Riwayat hiperetensi : (-)
• Riwayat DM : (-)

Riwayat Penyakit Keluarga

• Riwayat keluhan serupa : (+) Ibu dan kakak pasien
• Riwayat penyakit saraf lainnya : (-)

Riwayat Sosial Ekonomi

Pasien merupakan seorang ibu rumah tangga. Setiap hari melalukan pekerjaan
rumah seperti mencuci, menggosok, menyapu dengan posisi kurang nyaman.
Suami pasien memiliki sakit stroke sejak 1 tahun yang lalu, pasien mengatakan
sering mengangkat suaminya dengan posisi membungkuk. Saat ini pasien memiliki
3 orang anak. Pasien memiliki kesan ekonomi menengah. Pasien berobat
menggunakan BPJS non-PBI
PEMERIKSAAN FISIK
KU/Kes
Tampak sakit sedang VAS 4/Composmentis E4 V5 M6

Tanda Vital
Tekanan Darah : 146/95 mmHg
Nadi : 81 x/menit
Laju nafas : 20 x/menit
Suhu : 36.6 C

Antopometri
BB : 73 kg
TB : 160 cm
IMT : 28,52 kg/m2 (Obesitas I)
ANAMNESIS
Hubungan Antar Keluarga
Kesan hubungan keluarga harmonis

Riwayat Gizi
Pasien mengaku makan 3x sehari dengan kombinasi nasi, sayur, dan lauk

Riwayat Psikologis
Baik

Riwayat Spiritual
Baik
PEMERIKSAAN FISIK
Status Generalis
Kepala : Mesochepal, rambut tidak mudah rontok
Mata : Konjungtiva anemis (-/-), sklera ikterik (- /- ), ptosis (-/-),
eksoftalmus (-/-)
Hidung : Simetris, deviasi septum (-), sekret (-/-), discharge (-/-)
Telinga : Simetris, sekret (-/-)
Mulut : Sianosis (-), mukosa mulut basah (+),
Leher : Pembesaran tiroid (-), nyeri tekan (-), pembesaran KGB (-)
Thorax : Simetris, retraksi intercostal (-/-), pigeon chest (-), barrel chest (-)
Jantung : S1>S2, regular, gallop (-), murmur (-),
Paru : Suara dasar vesikuler (+/+), ronkhi basah halus (-/-), wheezing
(-/-), ronkhi basah kasar (-/-), fremitus sama, sonor seluruh lapang paru
Abdomen : Datar, supel, timpani, BU (+) normal, NT(-), pembesaran hepar (-)
Ekstremitas : Akral hangat (+/+ +/+), edema (-/- -/-), sianosis (-/-/-/-)
PEMERIKSAAN FISIK
Status Neurologis
Kesadaran : E4M6V5
Kualitatif : Tingkah laku normoaktif
Orientasi : OTWS baik
Jalan pikiran : Baik
Daya ingat kejadian : Baik
Kemampuan bicara : Baik
Sikap tubuh : Baik
Cara berjalan : Sulit berjalan
Gerakan abnormal : Korea (-) tremor (-)
PEMERIKSAAN FISIK
Pemeriksaan Saraf Kranialis
N.I Olfaktori : Penciuman baik
N. II Optikus : Lapang pandang baik
N. III Okulomotoris : Bentuk bulat, isokor, ukuran pupil 3mm/3mm, RC +/+, gerak
bola mata bebas
N.IV Troklearis : Gerak bola mata ke kanan bebas
N. V Trigeminus : Baik
N. VI Abducen : Gerak bola mata ke kanan bebas
N.VII Fasialis : Parese (-), Gerakan involunter (-)
N. VIII Vestibulokoklearis : Baik
N. IX Glosofaringeus : Baik
N. X Vagus : Baik
N. XI Asesorius : Sikap bahu kanan kiri baik, otot bahu eutrofi
N. XII Hipoglosus : Atrofi (-), deviasi (-)
PEMERIKSAAN FISIK
Motorik Superior Inferior
Gerak B/B B/B
Kekuatan Motorik 5/5/5//5/5/5 5/5/5//5/5/5
Tonus N/N N/N
PEMERIKSAAN IRITASI RADIX
VERTEBRAE Trofi Eu/Eu Eu/Eu

Patrick : (+/-) RF +2/+2 +2/+2

Kontrapatrick : (+/-) RP -/- -/-

Laseque : (+/-) Klonus -/-

Bragard : (+/-) Sensorik Superior Inferior

Sicard : (+/-) Nyeri +/+ +/+
Taktil ++/++ +/++
Termis +/+ +/+
Diskriminasi tdl/tdl tdl/tdl
Posisi dbn/dbn dbn/dbn
USULAN PEMERIKSAAN PENUNJANG

• MRI Lumbosacral
 RESUME
Ny. S / 55 tahun KU/Kes
Keluhan utama: nyeri punggung bawah kanan menjalar Tampak sakit ringan/Composmentis
sampai ke kaki kanan
TTV Antopometri
TD: 146/95 mmHg BB: 73 kg
RPS
HR: 81x/menit TB: 160 cm
❑ Onset: 2 minggu RR: 20x/menit IMT: 28,52 kg/m2
❑ Lokasi: punggung bawah kanan menjalar ke jari-jari T: 36.6 C
kaki kanan
❑ Kualitas: Menggganggu aktivitas Status Generalis
❑ Kuantitas: Terus menerus Dbn
❑ F. memperberat: Mengangkat barang, membungkuk
❑ F. memperingan: Tidur terlentang Status Neurologi
❑ Kel. Penyerta: Kesemutan ❑ Meningeal sign (-)
❑ N. cranialis dbn
❑ KM 5/5/5//5/5/5///5/5/5//5/5/5
RPD dan RPK
❑ Refleks Fisiologis +2/+2//+2/+2
❑ Riwayat keluhan serupa: (+) 2020, Ibu dan kakak pasien ❑ Refleks Patologis -/-//-/-
❑ Riwayat penyakit saraf lainnya: (-) ❑ Sensorik : Hipoestesi Ekstremitas Inferior Dekstra Setinggi
❑ Riwayat trauma: (-) VL5-S1, Parestesi Plantar Pedis Dekstra
❑ Trofi EU/EU//EU/EU
RSosEk ❑ Tonus N/N//N/N
❑ Pasien merupakan ibu rumah tangga sering melakukan ❑ Patrick +/-
pekerjaan rumah dengan posisi tidak nyaman dan ❑ Kontra-Patrick +/-
sering mengangkat beban berat posisi membungkuk ❑ Laseque +/-
❑ Pasien berobat menggunakan BPJS non-PBI ❑ Bragard +/-
❑ Sicard +/-
ASSESMENT
o Diagnosis Klinis
Ischialgia, hipoestesia ektremitas inferior dekstra setinggi VL5-S1,
parestesia plantar pedis dekstra
o Diagnosis Topis
VL5-S1
o Diagnosis Etiologi
Susp. HNP Lumbal
o Diagnosis Sekunder
Hipertensi, Obesitas
o Diagnosis Banding
Susp. Spinal Stenosis
PLANNING
Medikamentosa Non-medikamentosa

● PO Ketorolak tab 10 mg 1x1 ● Rujuk ke Sp.S/Sp.N

● PO Mecobalamin kaps 500 mcg ● MRI VLS
1x1 ● Fisioterapi
● PO Eperisone tab 50 mg 1x1
● PO Omeprazole kaps 20 mg 1x1
EDUKASI
• Edukasi pasien posisi ergonomis dalam melakukan pekerjaan
rumah-
• Edukasi pasien untuk menghindari membungkukkan badan terlalu
sering dan mengangkat barang-barang berat.
• Segera beristirahat jika merasakan nyeri
• Edukasi keluarga untuk membantu pasien melakukan aktivitas
sehari-hari guna mencegah pasien melakukan aktivitas yang terlalu
berat.
PROGNOSIS
Quo ad vitam : Bonam
Quo ad functionam : Dubia ad bonam
Quo ad sanationam : Dubia ad bonam
TINJAUAN
PUSTAKA
DEFINISI
Kondisi di mana bagian dalam (nukleus
pulposus) dari cakram intervertebralis
keluar melalui cincin fibrosus yang
melindunginya. Ini dapat menyebabkan
tekanan pada saraf di sekitarnya dan
menyebabkan gejala seperti nyeri,
kelemahan otot, dan kesemutan.

National Institute of Neurological

Disorders and Stroke (NINDS)
 EPIDEMIOLOGI
AMERIKA
HNP adalah salah satu penyakit muskuloskeletal
paling umum di Amerika Serikat. Diperkirakan
sekitar 1 hingga 3 persen penduduk Amerika Serikat
menderita HNP setiap tahun.

EROPA
Prevalensi HNP di negara-negara Eropa juga
cukup signifikan. Penelitian menunjukkan
bahwa prevalensi HNP bervariasi antara 1
hingga 5 persen di negara-negara Eropa Barat.

INDONESIA
diperkirakan 40% penduduk berusia diatas 65
tahun pernah menderita nyeri pinggang,
dengan prevalensi pada laki-laki 18,2% dan
pada perempuan 13,6%
ETIOLOGI

● Degeneratif
● Traumatik
● Faktor Genetik
● Faktor Lingkungan dan Gaya Hidup
 FAKTOR RISIKO

GENETIK USIA Trauma Postur Tubuh

Cedera, Aktivitas > Obesitas, Posisi
> Riwayat Keluarga > Usia lanjut
berlebih tubuh yang kurang
baik
PATOFISIOLOGI
 GEJALA KLINIS

● Nyeri punggung
● Nyeri menjalar
● Kesemutan / Kebas
● Kelemahan otot
 PENEGAKKAN DIAGNOSIS

Anamnesis - Nyeri radikuler, punggung bawah

- Abnormalitas sensorik, motoric, dan otonom
- Nyeri mengejan, batuk, bersin, dan meningkat pada posisi
duduk
- Riwayat pengobatan sebelumnya
Pemeriksaan - Uji kekuatan motoric, sensosik, dan laseque serta tes
Fisik provokasi lainnya
Pemeriksaan - MRI (Gold Standard)
Penunjang
 TATALAKSANA
● FARMAKOLOGI
❖ Obat Antiinflamasi Nonsteroid (NSAID)
❖ Analgesik
❖ Obat Penghilang Nyeri Opioid
❖ Relaksan Otot
❖ Steroid
● NON FARMAKOLOGI
❖ Fisioterapi
❖ Modifikasi Gaya Hidup
KOMPLIKASI
● Sindrom Cauda Equina
● Radikulopati
● Kelemahan Otot dan Gangguan
Sensorik
● Kehilangan Fungsi Kandung Kemih
PROGNOSIS
Bervariasi tergantung pada beberapa
faktor
● tingkat keparahan gejala
● respons terhadap pengobatan
● tindakan pengelolaan yang
diambil
TERIMA
KASIH
TABLE OF CONTENTS
01. 02.
OBJECTIVES METHODOLOGY
You can describe the topic You can describe the topic
of the section here of the section here

03. 04.
RESULTS ANALYSIS CONCLUSIONS
You can describe the topic You can describe the topic
of the section here of the section here
“This is a quote, words full of wisdom
that someone important said and
can make the reader get inspired”

— SOMEONE FAMOUS
LUMBAR SPINAL
STENOSIS
You can give a brief description of the
topic you want to talk about here. For
example, if you want to talk about Mercury,
you can say that it’s the smallest planet in
the entire Solar System
 MEDICAL BACKGROUND

VENUS JUPITER MARS SATURN

Venus is the second It’s the biggest planet Despite being red, Saturn is a gas giant
planet from the Sun of them all Mars is a cold place with rings
 OUR GOALS

MARS
It’s actually a cold place. It’s
full of iron oxide dust
VENUS MERCURY
Venus is the second planet It’s the closest planet to the
from the Sun Sun and the smallest one
A PICTURE IS
WORTH A
THOUSAND
WORDS
 OUR METHODS

IDENTIFY ANALYSIS RESEARCH

Venus is the second Mercury is the closest Despite being red, Mars is
planet from the Sun planet to the Sun a cold place

PREVENTION EVALUATION TREATMENT

Jupiter is the biggest Saturn is composed of Neptune is the farthest
planet of them all hydrogen and helium planet from the Sun
AWESOME
WORDS
RESEARCH AND PUBLICATIONS

Mercury is the closest planet to the Sun and

the smallest one in the Solar System—it’s only
a bit larger than the Moon

INTERNATIONAL MEDICINE JOURNAL

Venus has a beautiful name and is the second

planet from the Sun. It’s hot and has a
poisonous atmosphere

JOURNAL OF RHEUMATOLOGY PRACTICE

RESEARCH RESOURCES

● You can list your reference websites or

publications here
● You can list your reference websites or
publications here
● You can list your reference websites or
publications here
● You can list your reference websites or
publications here
● You can list your reference websites or
publications here
 FACTORS TO CONSIDER

MARS SATURN
Despite being red, Saturn is a gas giant
Mars is a cold place and has rings

MERCURY NEPTUNE
Mercury is the closest It’s the farthest planet
planet to the Sun from the Sun
 CLINICAL TRIAL

PHASE 1 PHASE 2 PHASE 3

Human safety Expanded safety Efficacy & safety

PRECLINICAL
Mercury is the Saturn is the Venus has a
Lab studies smallest planet ringed planet beautiful name
Neptune is far away
from Earth

20% 60% 40%

 TRIAL TIMELINE
RESEARCH EXPERIMENTATION CONCLUSION
Mercury is the Neptune is far away Venus is the second
smallest planet from Earth planet from the Sun

1 2 3 4 5

PRECLINICAL RESULTS
Jupiter is the biggest Earth is the third
planet of them all planet from the Sun
 PHASE 1
SAMPLE GROUP SUCCESS TEST TIME

95% 18 MONTHS
521 518 Success rate of treatment

SIDE EFFECTS RESULTS GOALS

Jupiter is a gas Venus is the
giant and the second planet
biggest planet in from the Sun. It’s
20% 10% 55% 4% the Solar System hot there
 THIS IS A GRAPH

GROUP 1
Mercury is the closest
planet to the Sun

GROUP 2
Jupiter is the biggest
planet of them all

Follow the link in the graph to modify its data and then paste the new one here. For more info, click here
1,650,352
Incidence of degenerative spine disease
in the world
 RESULTS TABLE

EXPERIMENT A EXPERIMENT B

OUTCOME OUTCOME
TREATMENT Test 1 Test 2 Test 3 TREATMENT Test 1 Test 2 Test 3

Group 1 315 285 600 Group 1 189 285 474

Group 2 210 390 600 Group 2 210 234 444

Group 3 240 165 580 Group 3 367 123 396

 RESULTS MAP

MARS
Despite being red, Mars
is a very cold planet

VENUS
Venus is the second
planet from the Sun
 RESULTS ANALYSIS

MERCURY
Mercury is very small

VENUS 75% 20%

Venus has a beautiful name Venus Mercury

MARS
Mars is a red and cold planet

NEPTUNE 35% 55%

Neptune is far away from us Mars Jupiter
 SUCCESS RATE

85% 33%
JUPITER SATURN
It’s the biggest planet Saturn is a gas giant
in the Solar System and has rings
3,100
Patients who did not need to be hospitalized

1,234,876
Patients who were not prescribed any medication

7,773,143
Patients who participated in this final study
A PICTURE ALWAYS
REINFORCES THE
CONCEPT
Images reveal large amounts of data,
so remember: use an image instead
of long texts
 DESKTOP
MOCKUP
You can replace the image on
the screen with your own work.
Just right-click on it and select
“Replace image”
CONCLUSIONS

CONCLUSION 1
Mercury is the closest planet to
the Sun and the smallest one

CONCLUSION 2
Venus has a beautiful name, but
its atmosphere is poisonous
 THANKS!
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