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406171057 - KEVIN TUMBEL

406181046 - CYNTHIA
406181054 - ANDI PANDU
NEUROLOGY BAGUS ALLAM
ROYAL TARUMA HOSPITAL

FACULTY OF MEDICINE
TARUMANAGARA UNIVERSITY
Case 1
 Ms. SH
 82 years old
 Bisma st. block B
 Patient presents with symptoms of
forgetfulness. She has trouble
remembering the date and keep asking
the same question repeatedly.
 The patient seems to have a word-finding
difficulty.
 There is no any head trauma injury, no
motoric and sensoric impairment
Physical examination
 Awareness : GSC = 15
 VS  BP : 154/79mmhg RR : 20 ; HR : 72 ; T
: 36,7 ; Weight : 58.5 kg

Other examination
 Orientation : impaired
 Clock drawing test : impaired
 Impaired short term memory
Working diagnosis
 Demensia Alzheimer Type

Terapi
 Donepezil
Case 2
 An. D
 4 years old
 Dadap
Identification :
 10 days ago -> fever -> recovery
 8 days ago -> she walk by dragged her
legs, fall frequently, worse by the day and
fell pain on her leg
 6 day ago -> she get traditional massage,
heavily walk (she must holding the wall)
 Now -> she can’t even squad
 Still can write
Physical examination
 Awareness : GSC = 15
 VS : RR : 22 ; HR : 110 ; T : 36,5
 Menigeal sign (-)
 N III, IV,VI : ocular alignment : symentic, pupil
position in the middle, direct light reflex (+),
Indirect light reflex (+), ocular movement to all
direction
 Babinski (+/-)
 Motoric :
 Strength : 5555/5555
 3333/3333
 Tonus : normotoni
 Trofy : normotrofy
 Sensory : no abnormality found
 Sensibility : no abnormality found
Laboratory :
Monosit 9 1-6
MCHC 35 26-34
KREATININ 0,36 0,60-1,00
CSF
Glucosa 84
Pandy +1
Working diagnose :
 guillain barre syndrome
 Poliradiculopathy

Treatment
 IVIG 0,4 gram/Kg/day --> 5 days
CASE 3
Identity
 Name = Ms L
 Age = 18 Yo
 Address = Rawa Buaya
Anamnesis
 Patients come with headache complaints
since 1 month ago.
 There is fever, nausea and vomiting
 Patients have a history of TB, diagnosed at
siloam hospital (29/01/19)
Physical Examination
 Awareness = CM
 Bp = 140/ 80 Pulse = 99, RR = 20, T = 37, weight = 44 kg

 Menigeal sign
 Neck Stifness : (+)
 Brudzinsky I : (-)
 Brudzinsky II : (+)
 Brudzinsky III : (-)
 Brudzinsky IV : (+)
 Laseq : (-)
 Kernig : (-)

 N II : normal visus
 N III, IV,VI : ocular alignment : symentic, pupil position in the middle, direct light reflex (+),
Indirect light reflex (+), ocular movement to all direction
 Physiologic Reflex : bicep (+/+), Tricep (+/+), Patella (+/+)
 Babinski (-)
 Motoric :
 Strength : 5/5
5/5
 Tonus : normotony
 Trofi : normotrofy
 Sensory : Normal
 Sensibility : No abnormality found
Laboratorium
Makroskopic
Colour No Colour
Appereance Cloudy Clear
Clot (-) (-)
Mikroskopic
Amount of cell 100 <5
PMN 85 15-39
MN 15 0.60-1.00
Nonne (-) (-)
Pandy (-) (-)
Glucose 24 50-80
Protein 132 <50
Laboratorium
Hemoglobin 11.3 12.0-16.0

ESR 31 2-30

Eosinofil 0 1-3

Segment 83 50-70

Limfosit 12 21-40

Ureum 12 15-39

Creatinine 0.47 0.60-1.00

Natrium 135 137-145


X Foto Thoraks
 Thereis no abnormal in Cor
 Pulmo suggest KP appearance with
seconder inffection
Working Diagnosis
 Meningitis Bakterial ec TB

Treatment :
 Isoniazid 300 mg 1x1
 Rifampizin 600 mg 1x1
 Pyrazinamide 500 mg 3x1
 Ethambutol 500 mg 2x1