By Advisors

Rahmawati dr. Jecky Chandra

C 111 07 200 dr. Moh. Fadli

Supervisor
dr. Karya Triko Biakto, Sp.OT (K) Spine

Orthopaedic and Traumatology Department

Hasanuddin University
Makassar
2011
 PATIENT IDENTITY
• Name : R
• Age : 48 years old
• Sex : Female
• RM : 521345
• Date of admission: 5/12/2011
 GENERAL STATUS

• Good nourished/consciouss

Vital Sign
• BP : 140/90 mmHg
• HR : 86 bpm, regular
• RR : 20 tpm
• Temp. : 36.9C
 HISTORY TAKING
• Chief complaint: paraparese at both leg and arm.
• History taking: suffered since  2 years before admitted to the
hospital. Patient complain pain at back neck and her chin. 1 year ago
patient start complaining tinggling sensation at right leg and then
after 1 month move to the left leg. Since 3 month ago patient can’t
walk far and since 1 month ago, patient totally can’t walk and cannot
stand by her own.

• History:
• History of trauma is denied
• History of chronic cough (-)
• History of weight loss (+)
• History of night sweating (-)
• History of pregnancy controlling medications (+) since 24 years
old.
• History of dexamethason medication (+) for 2-4 years
• History of menarche at 14 years old, regular until now
 LOCAL STATUS
Bone Region :
• I: deformity (-), wound (-), hematoma (-),
swelling (-) , gibbus (-)

• P: tenderness (+)
CLINICAL PICTURE
 5 5
5 5
5 0
5
5 5
5 5

Motoric
Examination

4 4
4 4
4 4
4 4
4 4

yes
2 2 2 2
2 2 2 2
2 2 2 2
2 2 2 2
2 2 2 2
2 2 2 2
2 2 2 2
2 2 2 2
2 2 2 2
1 1 2 2
1 1 2 2
1 1 2 2 Any anal sensation
1 1 2 2 Y
0 → Absent
1 1 2 2 1 → Impaired
1 1 2 2 2 → Normal
1 1 2 2 NT → Not testable
1 1 2 2
1 1 2 2
1 1 2 2
1 1 2 2
1 1 2 2
1 1 2 2
1 1 2 2
1 1 2 2
1 1 2 2
1 1 2 2
1 1 2 2
1 1 2 2
 Reflex

Physiologic Reflex Pathologic Reflex

R L R L
• Biceps (++) (++) • Babinski (+) (+)
• Triceps (++) (++) • Chadock (+) (+)
• Achilles (++) (++) • Openheim (+) (+)
• Patellar (++) (++) • Hoffman ( ) ( )
• Tromner ( ) ( )
 LABORATORY FINDING
WBC 8.600 /uL
RBC 8.22.000 /uL
HGB 15 ,1 gr/dl
HCT 42,8%
PLT 317.000/uL
Ureum 17 mg/dl
Creatinin 0,84 mg/dl
GDS 98 mg/dl
SGOT 13 U/L
SGPT 10U/L
HBsAg(rapid) negative
CT 8,00”
BT 3,00”
LED I 36 mm
LED II 59 mm
Radiology Findings
 DIAGNOSIS

paraparese due to tomor intra dural

extramedullarry verthebra C6 – Th2
 TREATMENT

• Surgery Planning
 RESUME
• A 48 years old woman with Chief complaint
paraparese at both leg and arm, suffered since  2
years before admitted to the hospital. Patient
complain pain at back neck and her chin. 1 year ago
patient start complaining tinggling sensation at
right leg and then after 1 month move to the left
leg. Since 3 month ago patient can’t walk far and
since 1 month ago, patient totally can’t walk and
cannot stand by her own.
 History of trauma is denied, history of weight loss
(+), history of pregnancy controlling (+) since 24
years old, history of dexamethason medication (+)
for 2-4 years, history of menarche at 14 years old,
regular until now

• Physical examination found ….

Sensoric : hipostesi T3--S4-5, motoric : L2-S1 = 4,
and reflex fisiologis are hiperreflexia, reflex
patologis (+)
 RESUME

• Radiography shows
Discussion
TUMOR INTRA DURAL EXTRA
MEDULLARRY
ANATOMI OF SPINAL CORD
Arteries & veins spinal cord
DESCRIPTION

• spine tumors can be classified by the relation to the

spinal canal and its coverings. Tumors can arise from
the different tissue type around the spinal column,
such as neural tissue, menigeal tissue, bone and
cartilage.
CONT…
• Spine tumors can occur
inside the spinal cord.
These are termed
intramedullary tumors.
They may occur within
the meninges and are
termed intradural
extramedullary tumors .
They can also arise
between the meninges
and the bony confines of
the spine and are termed
extradural
Intradural extramedularry tumors
• Intradural extramedularry tumors masses arise
from inside the duramater, but outside the
spinal cord. The most common
intraduraextramedullary tumors are
meningiomas and nerves sheath tumors
(Schwannomas and neurofibromas )

• Tumors that arise from within the duramater are

rarely metastasic and usually slow growing.
• Meningiomas, which arise from arachnoid
cluster cells located at exit zones of nerve roots,
are usually benign, but may be malignant. These
tumors are more common in middle aged and
erderly woman, nerve sheath tumors arise from
the nerve roots.

• This type of tumor is usually benign and slow

growing and well sircumsribed.

• In fact, it may be years before any neurological

sign present.
Symptoms
• Pain unilateral unilateral radicular
symptoms
• Occipital headaches caused by tumors
located high in the cervical region
• Focal back or neck pain, especially meningioma
• Sphincter dysfunction when the tumors
involves the conus medullaris
 Habitual (Postural
scoliosis)

Pain & muscle

Non Structural
spasm

Lower limb length

discrepency

Infantil
Idiopathic Juvenil
Adolescent

Congenital
Osteopathic
Acquired
Structural
Congenital
Neuropathic Acquired

Congenital
Myopathic
Acquired
Initial Evaluation

Patient
History

Physical
Examination

Radiographic
Assesment
Physical Examination
IMAGING
Treatment
Complications
Prognosis
Thank You