Protap Ilmu Penyakit Saraf
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Transcript of Protap Ilmu Penyakit Saraf
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8/12/2019 Protap Ilmu Penyakit Saraf
1/44
STANDAR
PELAYANAN MEDIS
SMF SARAF
RUMAH SAKIT UMUM DAERAH ULIN
BANJARMASIN
2007
0
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2007
RSUD ULIN
Jl. A. Yani 43
Telp.257472 /
252180 Fax.252229
an!a"#a$in
%&NAN'ANAN %ASI&N
N(. D()*#en N(. Re+i$i N(. ,ala#an
1 / 41
%R-S&DUR
T&TA%
Tanal Te"i
1 J*li 2003
Dieap)an
Di"e)*" R*#a Sa)i U#*#
Dae"a Ulin an!a"#a$in
D". ,. Ai#an* Sp%D6'&,
%e#ina Ua#a *aNI%. 140 159 19
Tanal Re+i$i
De$e#e" 200
1. Diagnosis NYERI KEPALA
2. ICD A. Tgang !"o" #Tnsion "$% &a'a(&)* ++.2
1. E%iso'i(,"nsion,"$% &a'a(& #* ++.20-* ++.21)
2. C&oni(,"nsion,"$% &a'a(& #* ++.22- * ++.2/)
B. Migain #* +/)
1. Tan%a aa #* +/.0)
2. Dngan aa #* +/.1)
C. Pas(a Taa #* ++.)
1. A(" %os""aa"i( &a'a(& #* ++.0)2. C&oni( %os""aa"i( &a'a(& #* ++./)
D. Na3gia Tigina3 #* ++.+7)
E. N$i K%a3a To !"a4 #* ++.22)
/. Ki"ia A. Tgang !"o"
1.
o S4ang,4angn$a "'a%a" 10 %iso' sangan
n$i 4%a3a 4ang 'ai 10 &ai5"a&n
o N$i 4%a3a 63angsng 'ai /0 ni" sa%ai 7 &ai
o S'i4i"n$a i3i4i 2 4aa4"is"i4 n$i 4%a3a
6i4"
, 3o4asi 6i3a"a3
, n4an a"a ngi4a" #"i'a4 6'n$")
, In"nsi"as ingan a"a s'ang
, Ti'a4 'i%6a" o3& a4"i8i"as "in s%"i
69a3an a"a nai4 "angga
o Ti'a4 'i9%ai
, Ma3 a"a n"a& #6isa ano4sia)
, L6i& 'ai sa" 43&an :o"o:o6ia a"a
:ono:o6ia
o Ti'a4 64ai"an 'ngan 43ainan 3ain
2.o Ra"a,a"a :4nsi sangan n$i 4%a3a 36i& 6sa
1
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a"a saa 'ngan 1; &ai563an #10 &ai5"a&n)
B. Migain
1. Mign "an%a aa
o S4ang,4angn$a "9a'i ; sangan n$i
4%a3a 63ang 'ngan ani:s"asi sangan63angsng +,72 9a- $ang %n$ai s'i4i"n$a
2 4aa4"is"i4 6i4" ni3a"a3- 6'n$"-
in"nsi"as s'ang a"a 6a"- 6"a6a& 6a"
'ngan a4"i8i"as :isi4
o S3aa n$i 4%a3a 'is"ai sa3a& sa" 6i4"
nasa 'an a"a n"a&- :o"o:o6ia 'an :ono:o6ia.
o Sangan n$i 4%a3a "i'a4 64ai"an 'ngan
43ainan $ang 3ain
2. Mign 'ngan aa
o S4ang,4angn$a "9a'i 2 sangan n$i
4%a3a 63ang $ang 'i'a&3i g9a3a no3ogi
:o4a3 $ang 8si63 s(aa 6"a&a% ; < 20 ni"
'an 63angsng 4ang 'ai =0 ni".
o T'a%a" s'i4i"n$a sa" aa 6i4" ini $ang
8si63 s%"i ganggan 8isa3- ganggan
snsois- ganggan 6i(aa 'is:asia.
o Pa3ing s'i4i" 2 'ai 4aa4"is"i4 6i4"
, *9a3a 8isa3 &ooni 'an5a"a g9a3a snsois
ni3a"a3
, Pa3ing "i'a4 "i63 sa" a(a aa s(aa
ga'a3 > ; ni" 'an 5 a"a 9nis aa 3ainn$a> ; ni".
, Tia% g9a3a 63angsng > ; ni" 'an ? =0
ni".
o Ti'a4 64ai"an 'ngan 43ainan 3ain.
C. Pas(a Taa
1. A(" Pos""aa"i( &a'a(&
K3inis N$i 4%a3a- "i'a4 4&as
o T'a%a" "aa 4%a3a- 'iana n$i 4%a3a
"9a'i 'a3a 7 &ai s"3a& "aa 4%a3a a"a
ss'a& 4sa'aan %n'i"a %3i& 46a3i.
o T'a%a" sa" a"a 36i& 4a'aan 'i 6a@a& ini
, N$i 4%a3a &i3ang 'a3a / 63an s"3a&
"aa 4%a3a.
, N$i 4%a3a n"a%- ""a%i "i'a4 36i& /
63an s9a4 "aa 4%a3a.
2. C&oni( Pos""aa"i( &a'a(&
o N$i 4%a3a- "i'a4 4&as
o T'a%a" "aa 4%a3a- 'iana n$i 4%a3a
"9a'i 'a3a 7 &ai s"3a& "aa 4%a3a a"a
ss'a& 4sa'aan %n'i"a %3i& 46a3i.
o
N$i 4%a3a 63angsng 36i& 'ai / 63an s"3a&"aa 4%a3a.
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D. Na3gia Tigina3
o Sangan n$i %ao4sisa3- s%on"an- "i6a,"i6a- n$i
"a9a- s%:isia3- s%"i 'i "s4- "s"- "6a4a
%a'a @a9a& a"a :on"a3 #n$a ni3a"a3)
66a%a '"i4 sa%ai 2 ni"- 63ang- "6a"as%a'a > 1 (a6ang N. Tigins #N. ). N$i
n$a isi 'a3a 9ang4a @a4" 68aiasi.
In"nsi"as n$i 6a" %si%i"asi 'a%a" 'ai "igg
aa #%3i4a naso3a6ia3is 'an 5 %i%i) a"a %a'a a4"i8i"as
&aian s%"i 6i(aa- 6as& 4a- n(4
9nggo"- goso4 gigi #trigger factors). Bn"4 sangan
asing,asing %asin saa. Dian"aa sangan
n$a asi"oa"is. Un$a "i'a4 a'a ':isi"
no3ogi4.
E. N$i 4%a3a "o o"a4
o N$i 'a%a" 6%a 6a" s%"i 'i"s4- 6'n$"
$ang :4nsi sangan 'an in"nsi"asn$a a4in
3aa a4in &6a" 'an 4a'ang,4a'ang 'ii4"i n"a&
%o$4"i3. Bgan"ng 3o4asin$a 'i o"a4- g9a3a
no3ogis 'a%a" "i63 a"a "i'a4. *9a3a
no3ogis 49ang :o4a3- ono%as- ganggan
snsi6i3i"as- ganggan %ng3i&a"an- ganggan n"a3-
%3%a - 'an 3ain,3ain.
+. Diagnosis
Ban'ing
o N$i 4%a3a %n$a4i" 3ain THT- gigi 3"- a"a-
&i%"nsi- %n$a4i" 'ngan 'a
o
*anggan %si4osoa"is;. Pi4saan
Pnn9ang
A.N$i 4%a3a "gang o"o"- 4a3a ag,ag 'a%a" 'i3a44an
%i4saan EM*)
B. N$i 4%a3a 8as43- 4a3a &6a" sangann$a EE*-
:o"o "ng4oa4- Mign 43asi4 'ngan sangan &6a" 'an
ign 4o%3i4a"a 'a%a" 'i%"i6ang4an a"ioga:i
a"a CT,S(an o"a4 'ngan 4on"as
C. N$i 4%a3a %as(a"aa 'a%a" 'i%"i6ang4an EE*
n"4 8a3asi 4a9an
D. Na3gia Tigina3 "i'a4 34an %i4saan
%nn9ang- 4(a3i a'a ':isi" no3ogis $ang ngaa&
%a'a 43ainan no3ogis :ngsi s4n' %3 'i3a44an%i4saan a'io3ogi #:o"o "ng4oa4- CT,S(an a"a
MRI)
E. N$i 4%a3a "o o"a4 &as 'i3a44an %i4saan
on"gn "ng4oa4- EE* 'an a"ioga:i a"a 3angsng
CT,S(an o"a4.
=. Kons3"asi o Bgan"ng 4ass Pn$a4i" Da3a- THT- Ma"a- gigi,
3"- 6'a& saa:- %si4osoa"is- 4a3a 'i%34an n"4
n(ai %n$6a6 4s"a4ania3 a"a %ngo6a"an 3an9".
7. Pa@a"an RS o Ra@a" 9a3an %a'a n$i 4%a3a "gang o"o"- n$i
4%a3a %as(a "aa a"a na3gia "igina3
o Ra@a" ina% %a'a n$i 4%a3a 8as43 'i%34an
/
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%a@a"an &an$a %a'a s"a"s igns #o6a" "i'a4
no3ong) %a'a ign 4o%3i4asi
o N$i 4%a3a "o o"a4 &as 'ia@a" n"4
4s%3oasi 'an o%asi.
. Ta%i A. N$i 4%a3a "gang o"o"o Ana3g"i4 'an %3as o"o" #%nnang) 'ia%a-
%o6aa" Psi4o"a%i s%o"i: 4a3a 'i%34an.
o Fisio"a%i %anasan 'an asas o"o" 4'4
#4%a3a) 4a3a 'i%34an.
B. N$i 4%a3a 8as43
o Is"ia&a"- ana3g"i4 'an %nnang
o aso4ons"i4si 4a:go" / ,1 "a63" #"i'a4 6o3&
%a'a @ani"a &ai3 'an %n'i"a 4a'io8as43)
o Sa"i%"an 1 "a63"
o
F3naiin 1 ;,20 go Ka3a sangan sing si%o&%"a'in- %o%ano3o3
a"a %o"i:n- n"4 %n(ga&an
o Hin'ai :a4"o %n("s
C. N$i %as(a "aa
o Ana3g"i4
o Mino "ansi3i
o An"i "igo #%o43o%ain- 'i:n&i'ain-
6"a&is"in) 6i3a a'a 8"igo
o Psi4o"a%i #4a3a %3)
D. Na3gia "igina3
o Ana3g"i4 'an %nnang
o Di:n&i'an"oin / 100 g
o Ka6aa%in / ,1 "a63" G 200 g #o6a"
%i3i&an)
. S"an'a RS o Sa RS. K(a3i %a'a 4ass $ang 34an
"in'a4an in8asi: o%asi &as RS "i% A5B $ang
%n$ai Do4" S%sia3is B'a& Saa:
10. Pn$3i" o Han$a %a'a "o o"a4 $ang 6si:a" ganas a"a $ang
3"a4n$a 'a3a '4a" 6a"ang o"a4
11. In:o'
Consn"
o P3 ""3is- &an$a %a'a 4ass $ang 34an
"in'a4an in8asi: 'an o%asi12. Tnaga S"an'a o Do4"
o Bi3a 43&an "i'a4 &i3ang- a%a3agi 6"a6a& 6a"
a"a 'i'a%a"i 43ainan no3ogis #ign 4o%3i4a"a-
"o o"a4) &as 'i94 4 Do4" A&3i Saa:
1/. Laa
Pa@a"an
o Bo6a" 9a3an- 4(a3i %a'a s"a"s ign 4o%3i4a"a
'an "o o"a4 &as 'ia@a" $ang 3aan$a 6gan"ng
%a'a 6a" a"a s3i" 4ass "s6"
1+. Masa
P3i&an
o Bgan"ng 4a'aan asing,asing
1;. Hasi3 o Pa'a n$i 4%a3a "gang 'an %as(a "aa %a'an$a s6& "o"a3
+
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RSUD ULIN
Jl. A. Yani 43
Telp.257472 /
252180 Fax.252229
an!a"#a$in
%&NAN'ANAN %ASI&N
N(. D()*#en N(. Re+i$i N(. ,ala#an
5 /41
%R-S&DUR
T&TA%
Tanal Te"i
1 J*li 2003
Dieap)an
Di"e)*" R*#a Sa)i U#*#Dae"a Ulin an!a"#a$in
D". ,. Ai#an* Sp%D6'&,
%e#ina Ua#a *a
NI%. 140 159 19
1. Diagnosis EPILEPSI
2. ICD *.+0
A. Mn" 6n"4 sangan
o E%i3%si #gan' a3 No. ICD *.+1.0 P"i"
a3 No. ICD *.+1.1 io43ons 'an 3ain,3ain).o E%i3%si 8o4a3 #o"ois- snsi6i3i"as- %asia3 4o%34s
'an 3ain,3ain). No. ICD *.+1.2
o S"a"s 4on83sis 5 s"a"s %i3%"i4is *.+1
B. Mn" %n$6a6
o I'io%a"is
o Si%"oa"is
/. Ki"ia K3inis
Sa" 4a'aan no3ogi4 $ang 'i"an'ai o3& 6ang4i"an
%i3%si $ang 63ang- $ang "i63 "an%a %o8o4asi.
S'ang4an 6ang4i"an %i3%si sn'ii a'a3a& sa"
ani:s"asi 43ini4 $ang 'is6a64an o3& 3%asn$a a"an
3is"i4 $ang a6noa3- 636i& 'an sin4on- 'ai non
$ang #""aa) "3"a4 %a'a 4o"4s s6i. A4"i8i"as
%ao4sisa3 a6noa3 ini n$a "i63 in"i""n
'an self- limited.
Sin'oa %i3%si a'a3a& %n$a4i" %i3%si $ang 'i"an'ai
o3& s4%3an g9a3a $ang "i63 6saaan #"as4
"i% 6ang4i"an- "io3ogi- ana"oi- :a4"o %si%i"an sia
saa" a@i"an- 6a"n$a %n$a4i"- si43s &aian 'an
%ognosa).
A. Ki"ia Diagnosiso *9a3a s6i :o4a3 a"a #%nnan ganggan
;
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4sa'aan- 49ang- %as"si 'an 3ain,3ain) $ang
"i63 63ang
B. E%i3%si Fo4a3
o Mani:s"asi 43inis :o4a3 a"a ani:s"asi 43inis 3ain
$ang 'i"n9ang 'ngan 43ainan EE* :o4a3 #(on"o& %i3%si %asia3 4o%34s 5 %i3%si 3o6s "%oa3is-
%i3%si :o4a3 s'&ana 'an 3ain,3ain).
C. E%i3%si Si"oa"is
o E%i3%si "s6" %a4an g9a3a 'ai sa"
%n$a4i" #"o- CD 'an 3ain,3ain). P3 'i(igai
%i3%si si"oa"is 6i3a 6n"4 sangann$a :o4a3-
%i3%si 3ai %a'a sia 36i& 'ai 20 "a&n- %i3%si
%ogsi:- %i3%si $ang s3i" 'i"angg3angi 'ngan
o6a".
D. S"a"s Kon83sis
o Sangan 49ang $ang 63angsng 3aa #36i&
'ai /0 ni") a"a sangan 49ang "an%a %3i&an
4sa'aan
+. Diagnosis o K9ang 'a
o Sin4o%
o Na4o3%si
o Mign
o Ba"& Ho3'ing S%33s
o His"ia
;. Pi4saan
Pnn9ang
o EE*- :o"o %o3os 4%a3a 'i3a44an 6i3a a3a" "s'ia
o CT,S(an 4%a3a- %ngsi 36a3 'i3a44an a"asin'i4asi #6i3a 'i%i4i4an %i3%si si%"oa"is)
o Un"4 'a%a" 3i&a" :4 sa%ng o6a" 'an %n$6a6
49ang 'a%a" 'i%i4sa
o Daa& %i: 3ng4a% #DPL)- :ngsi &a"i- :ngsi
gin9a3 #n"4 4on"a'is4si o6a")- 34"o3i" #Na- K- Ca- C3)-
g3a 'aa&- 4a'a o6a" #4a3a %3)
=. Pa@a"an RS o Ra@a" 9a3an
o Ra@a" ina% 6i3a %i3%si si%"oa"is 'an %3
4s%3oasi
o Ra@a" ina% 6i3a s"a"s 4on83si7. Ta%i %"in$ip
o Sga s"3a& 'iagnosis- gna4an sa" 9nis o6a"
4o6inasi o6a" 'igna4an 6i3a "i'a4 ""angg3angi
'ngan sa" 9nis o6a". Pa'a @ani"a $ang asi&
ng4in &ai3 gna4an Ka6aa%in- @ani"a &ai3
$ang "3a& nggna4an o6a" 3ain 3an9"4an %ngo6a"an.
o Dosis 'inai44an 6"a&a% sa%ai sangan 6&n"i-
3a3 %"a&an4an 2,+ "a&n 66as sangan- 4'ian
'i"n4an 6"a&a%.
-a an i*na)an
o Fno6a6i"a3 1,; g54gBB
o Fni"oin ;,10 g54gBB 'osis 6iasa 3ai 'ngan
=
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/00 g5&ai
o K3ona%a 0-0;,0-2 g54gBB- 3ai 'ngan 'osis
4(i3 ""aa 'igna4an %a'a %i3%si Mio43oni4 'an
P"i" Ma3
%enaala)$anaanS"a"s Kon83si
o T9an ng&i3ang4an 49ang "'4 36i& 'ai =0 ni"
"'ii a"as
Taap I
o E8a3asi %n'i"a 0,1; ni"
o P6ai4i sis" 4a'ios%iasi
o !4sign 6i3a %3
o Ba" 'iagnosis
o Pasang in:s
o La44an %i4saan 3a6oa"oi DPL- 34"o3i"-- 4a"inin- 4a'a o6a" an"i%i3%si-Drug Sreen-
Metabolic Sreeen
o *34osa 2; g i8
Taap II
o Mng&n"i4an 49ang 'a3a 20,/0 ni"- 4'ian
Dia%a I 2 g5ni" 'ngan 'osis 10,+0 g
#&a"i,&a"i '%si %na:asan). Bsaaan 'ngan
Dia%a 6i4an in:s Fni"oin 20 g54gBB 'a3a
NaCL :isio3ogis 'ngan 4(%a"an "i'a4 36i& 'ai ;0
g5ni" #a@asi EK*) 'an "4anan 'aa&)
Taap IIIo S"3a& /0 ni" s3an9"n$a
, In"6asi- %asang EE*- %"i6angan ans"si
- sn"aa i" 'i3a44an
, In:s Fni"oin "a6a&an 10 g54gBB a"a
Fno6a6i"a3 'ngan 4(%a"an "i'a4 36i& 'ai 100
g5ni" #%&a"i4an &i%o"nsi)
o Bo3s Li'o4ain 2 g54gBB I 'i i4"i 'ngan in:s
/,10 g54gBB59a
Taap I:
o
La44an anas"si %a'a $ang :a4". S"an'a RS o Ps4sas5sa RS #n"4 s"a"s 4on83si 36i&
6ai4 6i3a a'a 'iang ICU)
. Pn$3i" o Ra4si a3gi #(on"o& Sin'o S"8n Jo&nson)
o E' s6i 4ana ganggan %na:asan a4i6a"
49ang,49ang "s,ns %a'a s"a"s 4on83si
o A3a" 4a'ios%"o $ang "i'a4 sia% %a4ai a"a
"3a6a" 6"in'a4
10. In:o'
Consn"
o P3 ""3is
11. Tnaga S"an'a o Do4" - 6i3a "i'a4 a'a Do4" A&3i saa:
12. 3aa Pa@a"an o Pa'a s"a"s 4on83si sa%a 49ang "a"asi-
4sa'aan %3i& 'an 4a'aan "3a& ng4in4an
7
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n"4 6o6a" 9a3an
o Pn'i"a 6o6a" 9a3an s4ang,4angn$a 2,;
"a&n 66as sangan
1/. Masa
P3i&an
o Pa'a s"a"s 4on83si 36i& 4ang 1 ingg
1+. Pa"o3ogi o Jaang- 6i3a 4asan$a 'i o%asi #isa3 "o)
1;. A"o%si o Bi3a 'i%34an
RSUD ULIN
Jl. A. Yani 43
Telp.257472 /252180 Fax.252229
an!a"#a$in
%&NAN'ANAN %ASI&N
N(. D()*#en N(. Re+i$i N(. ,ala#an
8 / 41
%R-S&DUR
T&TA%
Tanal Te"i
1 J*li 2003
Dieap)an
Di"e)*" R*#a Sa)i U#*#
Dae"a Ulin an!a"#a$in
D". ,. Ai#an* Sp%D6'&,
%e#ina Ua#a *a
NI%. 140 159 19
Tanal Re+i$i
De$e#e" 200
1. DIA*N!SIS *AN**UAN PEREDARAN DARAH !TAK #STR!KE)
2. ICD *.+;- *.+=- I. =0- I.=1
/. Ki"ia o S"o4 a'a3a& ani:s"asi 43ni4 'ai ganggan :ngsi
s6a3- 6ai4 :o4a3 a%n n$3& #g3o6a3)- $ang
63angsng 'ngan (%a" 36i& 'ai 2+ 9a- a"a 6a4&i
'ngan a"- "an%a 'i"4ann$a %n$6a6 s3ain 'ai
%a'a ganggan 8as43a
Jeni$ S"()e
a. S"o4 Non Hoagis
, Tansin" Is4i( A""a(4 #TIA)- R8si63 Is4i(
No3ogi( ':isi" #RIND) #*.+;) , To6osis s6i
, E6o3i s6i
6. S"o4 Hoagis
, P'aa&an In"as6a3 #I.=1)
, P'aa&an S6aa4&noi' #I.=0)
+. Diagnosis
Ban'ing
o Taaa 4a%i"is
o Ens:a3i"is
o To !"a4
;. Pi4saan
Pnn9ang
o La6oa"oi H6- H"- L4osi"- LED- To6osi"-
Aggasi "o6osi",8is4osi"as %3asa #6i3a ng4in)-3i%i'- g3a- asa a"- - 4a"inin- &oosis"in-
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@a4" %'aa&an- @a4" %64an- as"%- 34"o3i"-
in "in
o Pngsi 36a3 #a"as in'i4asi)
o EK*
o Ra'io3ogis :o"o "&oa4s- "ng4oa4- 3&- CT,s(an-MRI- Do%3 U3"ason'- a"ioga:i #6i3a a'a)
=. Kons3"asi o Pn$a4i" Da3a #*in9a3- Hi%"nsi- En'o4in-
Ka'io3ogi) n"4 4on:iasi 43ainan ogan "4ai"
o B'a& s$aa:- n"4 4ass &oagis $ang %3 'i
o%asi #anisa- AM- 8a4asi &a"o)
o B'a& 8as43- s34"i: n"4 4ass "o6osis- a"i
4s"a4ania3 #"o6on'a"4"oi)
7. Pa@a"an RS o Pn'i"a 6a #4ang 'ai s%3& &ai)
o Pn'i"a 'ngan g9a3a 43inis $ang %ogsi:
. Ta%i a. Se;a"a U#*#1. U
Di"94an "&a'a% :ngsi 8i"a3 %a,%a- 9an"ng-
gin9a3- 4si6angan 34"o3i" 'an (aian gii- &igin
2. K&ss
Pn(ga&an 'an %ngo6a"an 4o%3i4asi
R&a6i3i"asi
Pn(ga&an s"o4 "in'a4an %oo"i:- %i 'an
s4n'
. Se;a"a 6*$*$
1. S"o4 Is4i45In:a4
o An"i aggasi %3a"3" as%iin- "i43o%i'in-43o%i'og3- 'i%ii'ao3
o To6o3i"i4 ",PA #&as n&i 4i"ia in43si)
o An"i4oag3an &%ain- LMH- &%ainoi' #n"4
so4 6o3i) #*i'3in s S"o4 200+)
o No%o"4"an
2. P'aa&an S6aa4&noi'
o An"i s%aso8as
o No%o"4"an
/. P'aa&an In"as6a3
6(n$e"+ai
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8/12/2019 Protap Ilmu Penyakit Saraf
11/44
o &i'os:a3s a4i6a" %'aa&an in"a8n"i43 a"a
s633
o *CS 7
Te"api 6(#pli)a$i
, An"i'a 3a"an ani"o3 20, An"i6io"i4a- an"i'%san- an"i4on83san a"as in'i4asi
, An"i"o6osis 8na 'a3a 'an 6o3i %a
%enaala)$anaan Fa)(" Ri$i)(
An"i&i%"nsi :as a4" s"o4 'ngan %s$aa"an
""n" #*i'3ins S"o4 200+)
, An"i6io"i4a :as a4" s"o4 'ngan %s$aa"an ""n"
#*i'3ins S"o4 200+)
, An"i'is3i%i'ia a"as in'i4asi
Te"api N(n
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8/12/2019 Protap Ilmu Penyakit Saraf
12/44
o Kana 6iasan$a 'is"ai %n$a4i" 3ain #gin9a3-
9an"ng- &i%"nsi- DM) 4o%3i4asi 9a'i "%ang "in'i&
1=. Pa"o3ogi o Bi3a 'i3a44an "in'a4an 6'a& #"i'a4 6gi" %n"ing)
17. A"o%si o Bi3a %3- a"as %in"aan %o3isi- %nga'i3an 'ngan
siin 43aga
RSUD ULIN
Jl. A. Yani 43
Telp.257472 /
252180 Fax.252229
an!a"#a$in
%&NAN'ANAN %ASI&N
N(. D()*#en N(. Re+i$i N(. ,ala#an
11 / 41
%R-S&DUR
T&TA%
Tanal Te"i
1 J*li 2003
Dieap)an
Di"e)*" R*#a Sa)i U#*#
Dae"a Ulin an!a"#a$in
D". ,. Ai#an* Sp%D6'&,
%e#ina Ua#a *a
NI%. 140 159 19
Tanal Re+i$i
De$e#e" 200
1. Diagnosis TRAUMA SUSUNAN SARAF
2. ICD S.0=
A . Saa: Psa"
o Taa Ka%i"is no.S.0=
1. Koosio s6i #C'a !"a4 Ringan)
no.S.0= 0
2. Kon"sio s6i #C'a !"a4 S'angBa") no.ICD. ; I
/. P'aa&an %i'a3 no.s.0=.+
+. P'aa&an s6'a3 no.S.0=.;
;. Taa 4a%i"is $ang 'is"ai :a4" """%
'an :a4" "64a
o Taa M'33a s%ina3is
1. Koosio '3a s%ina3is
2. Kon"sio '3a s%ina3is
/. Dis"ai 34sasi a"a :a4" 8"6a
B. Saa: Pi:
o A83si a'i4s
o Lsi %34ss
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o Lsi saa: %i: #3ngan 'an "ng4ai)
/. Ki"ia
Diagnosis
A. Saa: %sa"
1. Minia3 O Si%3 Ha' In9$ #SHI)
, Ni3ai S4a3a Coa *3asgo@ 1; #noa3)
, Ksa'aan 6ai4, Ti'a4 ansia
2. C'a !"a4 Ringan #C!R)
, Ni3ai S4a3a Coa *3asgo@ 1+ a"a
, Ni3ai S4a3a Coa *3asgo@ 1;- 'ngan
, Ansia %as(a ('a 2+ 9a- a"a
, Hi3angn$a 4sa'aan 10 ni"
, Da%a" 'is"ai g9a3a 43ini4 3ainn$a- isa3n$a a3-
n"a&- sa4i" 4%a3a a"a 8"igo
/. C'a !"a4 S'ang #C!S)
, Ni3ai S4a3a Coa *3asgo@ ,1/
, Hi3angn$a 4sa'aan 10 ni" ""a%i 4ang 'ai =9a
, Da%a" a"a "i'a4 'i"4an a'an$a ':isi" no3ogis
, Ansia %as(a ('a s3aa 4ang 36i& 7 &ai
#6isa %osi"i: a"a nga"i:)
+. C'a !"a4 Ba" #C!B)
, Ni3ai S4a3a Coa *3asgo@ ;,
, Hi3angn$a 4sa'aan = 9a
, Di"4an ':isi" no3ogis
, Ansia %as(a ('a 7 &ai
;. Kon'isi Ki"is, Ni3ai S4a3a Koa *3asgo@ /+
, Hi3angn$a 4sa'aan = 9a
, Di"4ann$a ':isi" no3ogis
Pendarahan epidural
o Da%a" "9a'i n$"ai 4oosio a"a%n 4on"osio
s6i
o Biasan$a "9a'i 'a3a 2 2+ 9a
o Da%a" 'i'a&3i in"8a3 3si'- 4'ian 4sa'aan
64
o Di'a%a"i 3a"a3isasi #1 %%i3 i'iasis) 'is"ai
43%&an a"a :34s %a"o3ogis anggo"a ga4 sisi$ang 3ain
o 70 4ass 'i'a%a"i 9ga :a4" "%oa3is
Pendarahan subdural
o Da%a" "9a'i n$"ai 4oosio a"a%n 4on"sio
s6i.46an$a4an s6a4" a"a 4onis.
o T9a'in$a 36i& 3aa- 66a%a &ai sa%ai 66a%a
63an ss'a& "aa.
o Pa'a $ang a4" "9a'i (%a" s%"i %n'aa&an
%i'a3
o Sa4i" 4%a3a $ang "i'a4 &i3ang- 4a'ang,4a'ang a3a&
ng&6a".
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o Di'a%a"i 'a %a%i3- 3a"asasi- 4a3a 36i& 3aa 3agi
'a%a" "9a'i %nnan 4sa'aan.
Trauma kapitis dengan disertai fraktur
o Dngan 6an"an a3a" on"gn "a%a4 :a4" a"a
%a'a ins%4si "a%a4 3angsng 'aa" a"a9aingan
Trauma medula spinalis
o A'an$a "aa %a'a 'aa& s%an9ang "3ang
63a4ang
Komosio medula spinaIis
o A'an$a n$i s"%a" $ang 4a'ang,4a'ang 'a%a"
'is"aiganggan no3ogi- s"inggi "aa- sanga"
ingan 'an sn"aa.
Kontusio medulla spinalis
o A'an8a n$i s"%a" $ang 'is"ai ganggan
no3ogi s"inggi "aa- ganggan o"ois-
snsi6i3i"as 'an a"ono.
Disertai luksasi atau fraktur vertebra
o K3inis sana 'ngan 4on"sio '3a
o Dngan 6an"an on"gn "a%a4 34sasi aa :a4"
8"6a
B Saa: Pi:
o A'an$a "ai4an $ang 636i&an a"a "aa 3angsng
%a'a %o4sia3 anggo"a ga4.
vulsi radikso N$i s"%a" anggo"a ga4 6agian %o4sia3 %a'a
saa" 49a'ian 'ii4"i 43%&an "o"a3 %ann
!esi Pleksus
o K9a'ian saa "a%i 43%&an 'a%a" "o"a3 a"a
s6agian
!esi saraf perifer
o A'an$a "aa s"%a". 'i'a%a" 43%&an 'an
ganggan snsi6i3i"as 66a%a o"o" $ang 'i%saa:i
saa: $ang 6sang4"an.'i'a%a"i gangan %ga4an
"i'a4 "o"a3
+. Diagnosis
Ban'ing
A. Saa: %sa"
"l"rauma kapitis
o Pn'aa&an o"a4 #s"o4)
o !8'osis #in"o4si4asi) !6a" %nnang 'an a34o&o3
o Ra4si 4on8si
Trauma medula spinalis
o Ta4 a'a 'iagnosis 6an'ing
B. Saa: %i:
Monono%a"i a4"
;. Pi4saan
Pnn9ang
Trauma kapitis
o Ron"gn %o3os "ng4oa4 AP53a"o Fngsi 36a3 4a3a 'iagnosis ag4an 'an "a4 a'a
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4on"ain'i4asi.
o EE* 'an a"ioga:i a"a 3angsng CT,S(an o"a4 %a'a
%n'aa&an %i'a3 'an s6'a3.
Trauma medula spinalis
o Ron"gn 8"6a 6sang4ano Fngsi 36a3 4a3a "a4 a'a 4on"ain'i4asi
o Po"nsia3 E8o4 #SSEPSoa"osnso$ E8o4' Po"nsia3)
Saraf perifer
o Pi4saan EM* #3("o$oga%&$ )
=. Kons3"asi o Bgan"ng in'i4asi 6'a& saa: a"a 6'a& "3ang
7. Ta%i Tgan"ng 'a9a" 6a"n$a ('a
3 . Minia3
, Tia& 6aing- 4%a3a 'i"inggi4an s4i"a /0 'a9a"
, Is"ia&a" 'i a&
, Di6i nas&a" aga 46a3i 4 Ra& Sa4i" 6i3a a'a"an'a,"an'a %'aa&an %i'a3- s%"i oangn$a 3ai
"3i&a" ngan"4 #4sa'aan 3ai "n,gia3a 3(i'
in"8a3)
2.C'a !"a4 Ringan #Koosio S6i)
, Tia& 6aing- 4%a3a 'i"inggi4an s4i"a /0 'a9a"
, !6s8asi 'i Ra& Sa4i" 2 &ai
, K3&an &i3ang- o6i3isasi
, Si%"oa"is an"i 8"igo- an"i "i4- ana3g"i4a
, An"i6io"i4a #a"as in'i4asi)
/. C'a !"a4 S'ang 'an Ba" #Kon"sio S6i)
a. Ta%i UUn"4 4sa'aan nn
, La44an ssi"asi
, B6as4an 9a3an na:as #Ai@a$)- 9aga :ngsi %na:asan
#Ba"&ing)- Ci(3a"ion #"i'a4 6o3& "9a'i &i%o"nsi-
sis"o3i4 Saa 'ngan a"a 36i& 'ai 0 nHg)- na'i-
s& #"i'a4 6o3& sa%ai "9a'i %i4sia)
, Ksi6angan (aian 'an 34"o3i" 'an n"isi $ang
(4%- 'ngan 4a3oi ;0 36i& 'ai noa3
, Jaga 4si6angan gas 'aa&
, Jaga 46si&an 4an'ng 4i&- 4a3a %3 %asang
4a"", Jaga 46si&an 'an 43an(aan 9a3 in"a8na , R6a&
%osisi n"4 (ga& '46i"s , Posisi 4%a3a
'i"inggi4an /0 'a9a"
, Pasang s3ang nasogas"i4 %a'a &ai 4'a- 4(a3i
4on"a in'i4asi $ai" %a'a :a4" 6asis 4anii
, In:s (aian iso"onis
, Bi4an o4sign ssai in'i4asi
6. Ta%i K&ss
1. M'i4an"osa
, Mnga"asi "4anan "inggi in"a4ania3- 6i4an
Mani"o3 20
1+
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, Si%"oa"is ana3g"i4- an"i"i4- an"i%i"i4
, An"i%i3%si 'i6i4an 6i3a "9a'i 6ang4i"an %i3%si
%as(a ('a
, An"i6io"i4a 'i6i4an a"as in'i4asi
, An"i s"ss 3( 'i6i4an 6i3a a'a %'aa&an3a6ng
2. !%asi 6i3a "'a%a" in'i4asi
(. R&a6i3i"asi
, Mo6i3isasi 6"a&a% 'i3a44an s(%a"n$a s"3a&
4a'aan 43ini4 s"a6i3
, Nos"oasi 'an No&a6i3i"asi 'i6i4an ssai
Trauma Kapitis dengan fraktur tertutup
o Ti'a4 'i3a44an "in'a4an 4&ss- 4(a3i %a'a :a4"
i%si: 'ngan 4'a3aan 36i& 'ai 0-; (. !%asi si"o
'i49a4an 4a3a "4anan in"a4ania3 ninggi sa4i"4%a3a &6a" 'an n"a&.
Trauma Kapitis dengan fraktur tertutup
o Di6i4an an"i6io"i4 'osis "inggi n"4 n(ga& in:4si
o"a4 'an 4ons3"asi 4 6agian 6'a& saa: n"4
%n6si&an 'an %n9a&i"an s3a%" o"a4.
Komosio medula spinalis
o Is"ia&a" 'an o6oansia5no"o%i4
o Fisio"a%i
Kontusio medula spinalis
o
Is"ia&a" 'an o6oansia5"io"oni4o D4sa"ason $ang 'i6i4an 'a3a ang4aian 'is"ai
%6ian an"asi' a"a si"i'in.
Trauma medula spinalis disertai Iuksasi atau fraktur
o D4sa"ason $ang 'i6i4an 'a3a ang4aian
o Kons3"asi 6'a& saa: n"4 4ng4inan o%asi
vulsi radiks# lesi pleksus dan lesi saraf perifer
o No"o%i4 'an :isio"a%i. Ka3a "'a%a" 3si "o"a35%"s
4ons3"asi 4 6'a& saa: n"4 4ng4inan
%n$a6ngan
. Pa@a"an RS o Taa saa: %sa" &as 'ia@a"
o Taa saa: %i: 6iasan$a "i'a4 'ia@a" 4(a3i
'is"ai :a4" "3ang a"a ganggan 4&i'%an s&ai,
&ai
. S"an'a RS o Pa'a 4oosio s6i sa RS
o Yang 3ainn$a. RS $ang %n$ai 'o4" S%sia3is Saa:-
$ang a& sa4i" "i% C-B-A
10. Pn$3i" o Kana "i'a4 'i4"a&i %"o3ongan %a'a saa" "aa
'a%a" %6a" 4a'aan %a'a 4ass 'ngan :a4"
s8i4a3.
o Kana "9a'in$a (%a". 4a"ian 'a%a" "i63 s63
'a%a" 'i3a44an o%asi %a'a %'aa&an %i'a3o Kana "6a"asn8a "naga a&3i B'a& saa:. %n'i"a
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'a%a" ningga3 s63 'i4ii 4 RS 8ang 36i& Bsa
o Kon"sio 6a" 'ngan ganggan 9i@a oganis
o Kana 'a$a gnasi s3 saa: sanga" s'i4i"-
4"3a6a"an 'a%a" n$6a64an 4a"ian "o"a3 s3 saa:
11. In:o'Consn"
o T"3is- n"4 $ang 6si4o a"a 34an "in'a4anin8asi:5o%asi
12. Tnaga S"an'a o Do4" S%sia3is Saa:
o Do4" 'i "%a" $ang "i'a4 a'a 'o4" s%sia3is-
"a%i 4a3a 'a%a" &as 'i4ii 4 RS $ang a'a 'o4"
s%sia3is
o Do4" s%sia3is 6'a& saa: 'an 6'a& "3ang 4ass $ang
34an.
1/. Laa
Pa@a"an
o Un"4 $ang ingan /, = &ai 'an $ang 6a" 36i& 'ai =
&ai
1+. Hasi3 o Koosio 'an Kon"sio ingan s6& "o"a3o Kon"sio $ang 36i& 6a" sing a'a 43&an #g9a3a) sisa
o Kon"sio '33a. 3si "o"a3 a'i4s- %34ss 'an saa:
%i: sing 'i'a%a"i 43%&an %ann
1;. Pa"o3ogi o Bi3a a'a "in'a4an o%asi
1=.A"o%si o Sing 'i%34an %a'a 4ass,4ass 44asan n"4-
4%n"ingan 'i4o3ga3 #%nga'i3an)
1=
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RSUD ULIN
Jl. A. Yani 43
Telp.257472 / 252180
Fax.252229an!a"#a$in
%&NAN'ANAN %ASI&N
N(. D()*#en N(. Re+i$i N(.
,ala#an
17 / 41
%R-S&DUR
T&TA%
Tanal Te"i
1 J*li 2003
Dieap)an
Di"e)*" R*#a Sa)i U#*#
Dae"a Ulin an!a"#a$in
D". ,. Ai#an* Sp%D6'&,
%e#ina Ua#a *a
NI%. 140 159 19
Tanal Re+i$i
De$e#e" 200
1. Diagnosis NEUR!PATI #*anggan Saa: T%i O %i:a3 No%a"&$)
2. ICD *.=0
/. Ki"ia A'a3a& sa" %n$a4i" 'ngan g9a3a 43ini4 $ang "i63
4ana 43ainan saa: %i:- n$a 6%a 'gnasi
non,in:3aasi $ang 3as 'ngan g9a3a $ang 3i%"i
43a&an o"oi4- ganggan snsoi4- ganggan a"ono
'an 3a&n$a :34s "n'on. Saa: %i: $ang "4na
3i%"i sa a4a saa: s%ia3is- s3 gang3ion a'i4s
'osa3is- sa a4a saa: %i: 'ngan sa (a6ang
"ina3n$a- ssnan saa: a"ono- 'an saa: o"a4 4(a3i
saa: o%"i4s 'an o3:a4"ois.+. Diagnosis o Po3ioi3i"is
17
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Ban'ing o A"o:i o"o" s%ina3 #spinal muscular atroph$)
o Mias"nia ga8is
o M3"i%3 s43osis
o ALS 'an 3ain,3ain
;. Pi4saanPnn9ang
o Pi4saan 3io #(aian s6os%ina3) n"4 s3-
%o"in- g34osa- NaC3- ino3ogi #6i3a %3)
o Daa& "%i "in- g34osa- 4o3s"o3- .
Ka"inin- 34"o3i"- 3oga 6a"- ino3ogi- 6asi3 "a&an
asa- %i4saan 4a'a 8i"ain B1- B=- B12 'an 3ain,
3ain.
o Bi3a a'a "an'a,"an'a ania %nisiosa- %i4sa
&a"o3ogi 3ng4a%
o Uin "in
o Pi4saan 34"oioga:i #EM*)
o Pi4saan %o"nsia3 ("san Soa"osnsoisSoa"osnsois
o EK*
o Bio%si saa: o"o" #a"as in'i4asi)
=. Kons3"asi o Pn$a4i" 'a3a #n'o4ino3ogi- ino3ogi-
&a"o3ogi- "o4si4o3ogi 'an 3ain,3ain 6gan"ng 4asa).
B'a& Saa: 5B'a& #6i3a %3)
o K3i" #6i3a 4asa 3%a- &%s 'an 3ain,3ain).
7. Pa@a"an RS o No%a"i a4" sga ina%. Bi3a "i63 gangan
%na%asan #%a'a sin'o Lan'$)- 'i%34an %a@a"an
in"nsi: 'i ICUo Pa'a B33s %a3s$- no%a"i 4ana "4anan #Sa"'a$
nig&" %a3s$) 'an no%a"i ingan- 'a%a" 6o6a" 9a3an.
o No%a"i 4onis- 6gan"ng 4a'aan - 6i3a 6a"
a@a" ina%- 6i3a ingan (4% 6o6a" 9a3an.
. Ta%i o Bi3a 4asan$a 'i4"a&i- 4assn$a 'i"angg3angi
, n'o4in #Dia6"s 33i"s- i- &i%"ioi'- 'an 3ain,
3ain)- o6a"i %n$a4i" 'asan$a
, H%s# A($(3o8i- si%"oa"is)
, L%a #Ri:a%isin- DDS 'an 3ain,3ain. !%asi %a'a
4ass ""n")
,Taa #ng4in %3 "in'a4an o%a"i:)o No"o%i4 #4o6iansi 8i"ain B1- B=- B125
siano4o6a3ain 'an 3ain,3ain)
o Pa'a ':isinsi gii 'an :ngsi %n$a%an
'i%6ai4i
o Si%"oa"is #n"4 n$i sa3isi3a"- 4a6aa%in-
'an 3ain,3ain)
o Pa'a sin'oa *i33an Ba,S"o&3- 3an'$ 'an
8aiann$a
, Ko"i4os"oi' ACTH- Ko"ison- P'nison #asi&
6an$a4 %6'aan %n'a%a" "n"ang o6a" ini). Pa'a$ang 63ang 5 3a%s 4o"i4os"oi' 6an$a4
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an:aa"n$a. !6a",o6a" ino%san Aa"io%in
, P3asa%asis
, Inog3o63in #+00 g54g5&ai n"4 ; &ai)
, An"i8ia3 6o3& 'i(o6a
, An"iin:3aasi 6o3& 'i(o6a. S"an'a RS o Sa RS. Bi3a 'i(igai a4an "i63 ganggan
%na%asan- sga 94 4 RS $ang 36i& 3ng4a%
#i3i4i ICU)
10. Pn$3i" o Kana %n$a4i"
, T9a'i %ogsi:i"as- ganggan %na%asan
o Kana "in'a4an
o Pa@a"an 'an :isio"a%i $ang 4ang (a" 'a%a"
'a&4an "9a'in$a in:4si "a4"s inais-
'46i"s- 4on"a4".
11. In:o'Consn"
o
P3 ""3is- %3 ""aa 6agi $ang 'i(igai 6a"%ogsi:
12. Tnaga S"an'a o Do4" - 6i3a a'a Do4" S%sia3is Saa:
1/. Laa Pa@a"an o Ra"a,a"a 2 ingg sa%ai 1 63an
1+. Masa P3i&an o Bgan"ng 4a'aan- a'a $ang (%a" "a%i a'a %3a
$ang "i'a4 'a%a" 649a n"4 s3aan$a
1;. Hasi3 o Un$a s6& 'ngan "an%a g9a3a sisa
o Jnis s"o4 3ain n$a s6& 'ngan g9a3a sisa
'ai $ang ingan sa%ai $ang 6a"
o Kana 6iasan$a 'is"ai %n$a4i" 3ain #gin9a3-
9an"ng- &i%"nsi- 'ia6"s 33i"s) 4o%3i4asi 9a'i
"%ang "in'i&
1=. Pa"o3ogi o Pa'a 4ass ""n" n"4 as"i4an 'iagnosis
'i%34an 6io%si saa: 4a'ang,4a'ang o"o",o"o" #9aang)
17. A"o%si o Bi3a 'i%34an #9aang)
1
-
8/12/2019 Protap Ilmu Penyakit Saraf
21/44
RSUD ULIN
Jl. A. Yani 43
Telp.257472 / 252180
Fax.252229
an!a"#a$in
%&NAN'ANAN %ASI&N
N(. D()*#en N(. Re+i$i N(.
,ala#an
20 / 41
%R-S&DUR
T&TA%
Tanal Te"i
1 J*li 2003
Dieap)an
Di"e)*" R*#a Sa)i U#*#
Dae"a Ulin an!a"#a$in
D". ,. Ai#an* Sp%D6'&,
%e#ina Ua#a *a
NI%. 140 159 19
Tanal Re+i$i
De$e#e" 200
1. Diagnosis MIASTENIA *RAIS
2. ICD *.70.0
/. Ki"ia o A'a3a& sa" %n$a4i" a"oin $ang "9a'i 4ana
sangan %a'a as"i34o3in s%"o 'ai nos43a
9n("ion o"o" 6gais o3& sa" an"i6o'i- a'a + "i%
1. !(3a $as"nia2. Mi3' gna3i' $as"&nia
20
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8/12/2019 Protap Ilmu Penyakit Saraf
22/44
/. S8 gna3i' $as"&nia
+. M$as"&nia (isis
+. Diagnosis
Ban'ing
o No%a"i
o Sin'oa La6",Ea"n
o *anggan 'i 6i'ang THT #'is:oni- 'is:agi)o *anggan 'i 6i'ang a"a #%"osis- o:"a3o%3gi)
;. Pi4saan
Pnn9ang
o Pi4saan EM* #Ts Yo33$- "s Ha8$ Mas3an'-
Pi4saan EM* sa6" "ngga3- sing3 :i6 EM*).
o Pi4saan an"i6o'i an"i ACHR 'an an"i o"o" 3i4 'i
'aa& #6i3a a'a)
o Pi4saan ino3ogi
o Fo"o ong"n "oa4s PA53a"5o63i4 1; 'a9a" #n"4
3i&a" a'an$a %6saan "is)
o CT,S(an "oa4s #6i3a a'a)
o Ts Pos"igin 5 "s "nsi3on=. Kons3"asi o Ino3ogi #6i3a a'a in'i4asi)
o P3ono3ogi #6i3a a'a "ioa)
o B'a& "oa4s #6i3a a'a "ioa)
7. Pa@a"an RS o Ra@a" ina% sga %a'a 4ass 6a"
o Bi3a 'i(igai a4an "i63 4isis ias"nia- %3
'ia@a" s(aa in"nsi: 'i ang ICU
. Ta%i o An"i4o3ins"as #A(&E) nos"igin 6oi'
#Pos"igin) 7-;,+; g "ia%2,= 9a 'an a"a %ii'os"igin
#s"inon) /0,120 g "ia% +,= 9a #'issai4an
46"&an)o Ko"i4os"oi'
o Inos%san nons"oi'
o Aa"ioin a"a si43os:ai' # 6i3a 'ngan ACHE "i'a4
6&asi3)
o Ti4"oi
o P3asa:osis %a'a ias"nia ga8is $ang 6a" a"a
4isis ias"nia
. S"an'a RS o Sa RS. Bi3a 4a'aan ng4in4an 94 4 RS
$ang %n$ai %a@a"an 3ng4a% #ICU)
10. Pn$3i" o Kana %n$a4i"
, Kisis ias"nia
, 4isis 4o3ingi4
o Kana "in'a4an
, 9aang
11. In:o'
Consn"
o P3 ""3is
12. Tnaga S"an'a o Do4" - 6i3a a'a Do4" S%sia3is Saa:
1/. Laa Pa@a"an o Bgan"ng 4a'aan
1+. Masa P3i&an o 1 Mingg. Pn'i"a &as ""a% 4on"o3 s"3a& 43inis
s6&
1;. Hasi3 o T4on"o3
o Kng4inan 3%as
21
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8/12/2019 Protap Ilmu Penyakit Saraf
23/44
1=. Pa"o3ogi o Bi3a 'i3a44an "i4"oi
17. A"o%si o Jaang
RSUD ULIN
Jl. A. Yani 43
Telp.257472 / 252180
Fax.252229
an!a"#a$in
%&NAN'ANAN %ASI&N
N(. D()*#en N(. Re+i$i N(. ,ala#an
22 / 41
%R-S&DUR
T&TA%
Tanal Te"i
1 J*li 2003
Dieap)an
Di"e)*" R*#a Sa)i U#*#
Dae"a Ulin an!a"#a$in
D". ,. Ai#an* Sp%D6'&,
%e#ina Ua#a *a
NI%. 140 159 19
Tanal Re+i$i
De$e#e" 200
1. Diagnosis *AN**UAN !T!T #MI!PATI)
2. ICD *. 71- *. 72 #Ms(3a D$s"o%&asis an' o"& M$o%a"i()
/. Ki"ia o Sa" 43ainan $ang 'i"an'ai o3& a6noa3n$a
:ngsi o"o" #%a4an %6a&an %a"o3ogi %i) "an%a
a'an$a 'n8asi %a'a %i4saan 43ini4- &is"o3ogi4 a"ano:isio3ogi
22
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8/12/2019 Protap Ilmu Penyakit Saraf
24/44
o *9a3a s%si:i4 Bi3a a4an 6angn56'ii "an%a
ganggan- %n'i"a 6sa&a ngang4a" 'an n'oong
6a'ann$a 4 a"as s'i4i" 'i s'i4i" so3a&,o3a&
an9a" 4 a"as "&a'a% 'iin$a sn'ii $ang 'is6"
*o@s signo *o3ongan 'is"o:i o"o"
, Pogsi: 'an &'i"
Jnis D(&nn #'is"o:i Ms(3o Pogsi:) $ang
ganas 'an 9nis 'is"o:i 'ngan 3o4a3isasi 'an
"i4a" %a'a 9nis 43ain %ia #se%-linked). Dis"o:i
Ms(3o Pogsi: "i63 6angs,angs %a'a
sia /,; "a&n 'an 6iasan$a ningga3 s63 sia
20 "a&n.
o *o3ongan io"oni
, Bi3a 4on"a4si a4"i: o"o"- ""a% 6"a&an 66a%a @a4"
'a3a 4a'aan 4on"a4si #3a4sasi "3a6a")
@a3a%n angsang inisia3 s'a& 6&n"i. Misa3n$a
6i3a "angan gang ssa" 'ngan a" %n'i"a
"i'a4 6isa 3%as4an %gangann$a 'ngan (%a"-
4ana o"o",o"o" "angan asi& ""a% 'a3a 4a'aan
4on"a4si
o *o3ongan %o3ioiosi"is
, Dis"o:i o"o" $ang 'is"ai asa n$i 3o4a3 'an "an'a
angsang 'ngan @ana 4a&,a&an %a'a 43i"
4a 'an 'a'a #skin rash)
o *o3ongan Mio%a"i 4ana ganggan n'o4in 'an"a6o3i4 isa3n$a Dia6"s 33i"s
o *o3ongan Mias"nia *a8is #s'a& 'i6a&as sn'ii)
+. Diagnosis
Ban'ing
o No%a"i
o Po3ioi3i"is
;. Pi4saan
Pnn9ang
o Pi4saan ni s 'aa& S*!T- S*PT- LDH
'an CPK
o Pi4saan g3a 'aa&- :ngsi "ioi' #a"as in'i4asi)
o Pi4saan E34"oioga:i #EM*)
o Pi4saan Ron"gn "3ang
o
EK*o Bio%si o"o" #6i3a ng4in)
=. Kons3"asi o Pn$a4i" Da3a #6i3a 4asan$a ganggan
En'o4in5"a6o3i4
7. Pa@a"an RS o Ra@a" ina%
o Bi3a a'a %n$3i" 54a'aan 3a& a"a n"4
nga44an 'iagnosis %as"i 'an n(ai 4asan$a
. Ta%i o Pa'a $ang &'i"
o Di"aa4an %n(ga&an #aiag (ons33ing)
isa3n$a oang "an$a i4" 43aga 6n(ana
o S%o"i:
o Fisio"a%i
2/
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8/12/2019 Protap Ilmu Penyakit Saraf
25/44
o Bi3a 4asa 'i4"a&i sga "angg3angi #isa3n$a
ganggan n'o4in)
o Ta%i S%o"i: P6ian %'nison
, Dis"o:i s43 1 g5KgBB5& s3aa = 63an
, Po3ioiosi"is 1 g5KgBB5& s3aa / 63an , Da%a" 'i6i4an continousl$ a"a alternating
, i"ain E 6o3& (o6a
. S"an'a RS o Un"4 nga44an 'iagnosis %as"i- %3 RS $ang
%n$ai EM*- Pa"o3ogi K3ini4 'an Pa"o3ogi Ana"oi
10. Pn$3i" o Kana %n$a4i"
, Pa'a 9nis D(&nn #Dis"o:i Ms43o Pogsi:)
%n$a4i" a4an 64 s(aa 6"a&a% 'an 6iasan$a
ningga3 s63 sia 20 "a&n
o Kana "in'a4an
, Jaang11. In:o'
Consn"
o P3 ""3is
12. Tnaga S"an'a o Do4" U- 6i3a "i'a4 a'a Do4" S%sia3is Saa:
1/. Laa Pa@a"an o S"3a& 'iagnosis %as"i- %n$3i" a"a 4asa s'a&
'i"angg3angi %n'i"a 'a%a" 6o6a" 9a3an ""aa n"4
:isio"a%i.
1+. Masa P3i&an o Bgan"ng 4a'aan- %n$a4i"n$a (n'ng
64 %a'a "i% '(&nn
1;. Hasi3 o Dngan %a@a"an 'an :isio"a%i %n'i"a asa
6ai4 #s6& %asia3). Jnis 3ainn$a n$a
s6& 'ngan g9a3a sisa 'ai ingan sa%ai 6a".
o Kana 6iasan$a 'is"ai %n$a4i" 3ain #gin9a3-
9an"ng- &i%"nsi- 'ia6"s 33i"s) 4o%3i4asi 9a'i
"%ang "in'i&.
1=. Pa"o3ogi o Bio%si o"o" n"4 'iagnosis
17. A"o%si o Bi3a %3 #9aang)
2+
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8/12/2019 Protap Ilmu Penyakit Saraf
26/44
RSUD ULIN
Jl. A. Yani 43
Telp.257472 / 252180
Fax.252229
an!a"#a$in
%&NAN'ANAN %ASI&N
N(. D()*#en N(. Re+i$i N(. ,ala#an
25 / 41
%R-S&DUR
T&TA%
Tanal Te"i
1 J*li 2003
Dieap)an
Di"e)*" R*#a Sa)i U#*#
Dae"a Ulin an!a"#a$in
D". ,. Ai#an* Sp%D6'&,
%e#ina Ua#a *a
NI%. 140 159 19
Tanal Re+i$i
De$e#e" 200
1. Diagnosis RA6IAL'IA DAN IS6IAL'IA
Kasa o Pn$6a6n$a 6an$a4- nan $ang %a3ing
2;
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8/12/2019 Protap Ilmu Penyakit Saraf
27/44
a'a3a& sa" 'is4s in"8"6a3is $ang nga3ai
%" a"a 'gnasi 'ngan "9a'in$a 4s"si
s6agian an3s 'ngan &niasi n43s %3%oss.
Po"si 'a%a" "9a'i 4 aa& %os"o3a"a3 a"a 4
"nga& #i'3in)o Pa'a n$a a'a "aa $ang 'iss3 o3&
"i63n$a n$i a'i43
o Hniasi a"a %o"si n43s %3%oss n$6a64an
%n4anan %a'a a'i4s 'an n$6a64an g9a3a. Ha3 ini
6iasan$a "9a'i 'i 'aa& 36a3- nan 6isa 9ga
"9a'i 'i 'aa& s8i4a3 - 9aang 'i 'aa& "oa4a3.
o Ba4ia3gia 'an is4ia3gia %a4an g9a3a- 64an sa"
%n$a4i". S&ingga &as 'i%a$a4an n(ai
%n$6a6n$a. Pn$6a6 n$i a'a3a& 4o%34s- 4ana
3i%"i 4"3i6a"an o"o" 'an s43" 'an s"4" $ang
6&6ngan 'ngann$a s%"i %n$a4i" %38is 'an
a6'on- 9ga 43ainan %os"a3 'an 9ga :a4"o,:a4"o
%si4ogni4.
o N$i %nggng 6a@a& #NPB) a'a3a& n$i $ang
'iasa4an 'aa& %nggng 6a@a&- 'a%a" %a4an
n$i 3o4a3 a%n n$i a'i43 a"a 4'an$a. N$i
ini "asa 'ian"aa s'" iga "6a@a& 'an 3i%a" 6o4ong
6a@a& $ai" 'i'aa& 36a3 a"a 36o sa4a3 'an
sing 'is"ai 'ngan %n9a3aan n$i 4 aa& "ng4ai
'an 4a4i. N$i $ang 6asa3 'ai 'aa& %nggng
6a@a& 'a%a" 'i94 4 'aa& 3ain a"a s6a3i4n$a n$i$ang 6asa3 'ai 'aa& 3ain 'iasa4an 'i 'aa&
%nggng 6a@a& #:' %ain).
2. ICD *. 71- *.72 #Ms43a D$s"o%&asis an' !"& M$o%a"i()
/. Ki"ia "a)ialia
o N$i a'i43 'ai 3& $ang n9a3a 4 3ngan-
$ang 6"a6a& 6i3a 6a"4- ng9an
o P3 'i%i4sa s3& "3ang %nggng ""aa
s8i4a3 'ngan %&a"i4an a'a "i'a4n$a 43ainan
%os"- ':oi"as- n$i "4an 'an 4"o4 s"a s%as
o"o".
o Da%a" "9a'i ganggan o"ois 6%a %asis 6i3a"'a%a" sa" 4o%si a'i4s.
o Bi3a 43ainan &an$a 6%a ii"asi a'i4s- "a4 'i9%ai
ganggan o"oi45%asis. *anggan snsi6i3i"as $ang
"9a'i ssai 'a"o $ang "4na
o R:34s :isio3ogis %a'a sgn $ang "4na nn
#(on"o&n$a :34s 6is% 'an 6a4ioa'ia3is %a'a
sin'oa C;5= a"a :34si "is% %a'a sin'oa C=57)
I$)ialia
o N$i a'i43 'ai 'aa& 36a3 $ang n9a3a 4
'aa& is4ia'i4s- "s n9a3a 4 "ng4ai 6a@a& 'an6gan"ng 3"a4 3si- 6isa 4 9ai,9ai 4a4i. #(on"o&
2=
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n9a3a 4 9%o3 4a4i %a'a sin'o S1)
o P3 'i%i4sa s3& "3ang %nggng ""aa
36osa4a3 'ngan %&a"i4an a'a "i'a4n$a
43ainan %os"- ':oi"as- n$i "4an 'an 4"o4 s"a
s%as o"o". Dngan a'an$a n$i a'iasi 4 is4ia'i4sa"a%n 4 aa& 36o sa4a3- a4a 6iasan$a 3o'osis
36a3 a4an 64ang 4ana s%as in8o3n" 'ai
o"o",o"o" %nggng. Biasan$a 9ga 6isa 'i9%ai
s4o3iosis 36a3- 'ngan s4o3iosis "oa4a3 $ang
4o%nsa"oa.
o Pasin a4an 6asa&a n"4 3"a44an 6a"
6a'ann$a %a'a sisi $ang 4on"a3a"a3 'an %osisi 6a'an
aga4 6ng44 'an aga4 iing 4 %osisi $ang sa4i"-
n"4 ng&in'ai %gangan saa: $ang "4na.
o Pa'a n$i $ang &6a"- a4a %n'i"a a4an
ngangi 4s"nsi 3""- 'an &an$a 3"a44an 9ai,
9ai 'i 3an"ai n"4 ng&in'ai 'oso:34si $ang a4an
na6a& n$in$a.
o Tan'a %angsangan ninga3 'a%a" "i63- 6%a
3as %a'a sisi "4na a"a%n Coss Las %a'a
sisi 4on"a3a"a3.
o Mo'i:i4asi "an'a 3as a'a3a& "an'a Bagga' $a4ni
'ngan 3a44an 'oso:34si 4a4i- a"a%n "an'a
Si(a' 'ngan 3a44an 'oso:34si 9%o3 4a4i- a4a
n$i a'i43 a4an 6"a6a&.
o Tan'a Na::iig ni634an n$i a'i43 $ang6"a6a& 6i3a 6a"4- 6sin- a"a%n %a'a %n4anan
8na 9g3ais. Ka'ang,4a'ang n$i 9s" 6"a6a&-
%a'a %3%asan %n4anan. Pi4saan ini 9ga 'a%a"
'i3a44an 'ngan "s 8asa38a. Tan'a n$i s@a4"
'is& 6ng44- a4a %asin a4an 3a44an
:34si %a'a 3"" n"4 n(ga& "gangn$a N.
Is&ia'i4s. *anggan o"ois %asis 'a%a" "9a'i 6i3a
"'a%a" 4o%si a'i4s #(on"o&n$a %asis
'oso:34si 'an %3an"a:34si 4a4i %a'a sin'o L;,S1)
o *anggan snsi6i3i"as 'a%a" "9a'i %a'a 'a"o
$ang "4na. R:34s :isio3ogis nn %a'a sin'oL2,+ #:34s 3"") 'an %a'a sin'o S1 #:34s "i")
o Has 'i6'a4an an"aa ii"asi a'i4s 'an 4o%si
a'i4s.
o Diagnosis 4o%si a'i4s 'i"ga44an 6i3a a'a
, Pasis o"ois
, *anggan i4si ':4asi
o Tan'a,"an'a :i6i3asi %a'a sgn "4na %a'a
%i4saan EM*
+. Diagnosis
Ban'ing
o Ba4ia3gia
, To a'i4s , A83asi a'i4s "aa"is
27
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29/44
, P34ss ni"is
, Sin'oa Ca%a3,Tnn3
, Sin'oa S4a3ns
, No3ogis a"o3ogis
o Is4ia3gia , To
, Fa4"
, Pasis %34ss
, Pasis N. Pons
, No%a"i4 'ia6"i4
, *anggan 8as43 %a'a a. I3ia4a 'an (a6ang,
(a6angn$a
, S%on'i3i"is 36a3is
, N. Is4ia'i4s ni"is %i- %ini"is- ninoa-
"aa %a'a saa:n$a a"a sn"i4an
;. Pi4saanPnn9ang
o Ba4ia3gia
, Fo"o on"gn s8i4a3 'ngan %osisi AP 53a"5o63i4
o Is4ia3gia
, Fo"o on"gn 36osa4a3 AP53a"
, LP 6gan"ng 4ass 'a%a" 'i%"i6ang4an- 6i3a
'i'ga a'a 4o%si a'i4s $ang 'is"ai 6n'ngan
a"a%n 'i'ga a'a "o '3a s%ina3is
, Pi4saan EM* n"4 %nn"an 3o4a3isasi-
6'a4an ii"asi a'i4s 'ngan 4o%si a'i4s-
8a3asi %ngo6a"an. Bi3a 'i'ga 4o%si a'i4s-
a4a- s"3a& %i4saan EM* 'i3a44ani3oga:i5CT,i3oga:i a"a%n MRI
=. Kons3"asi o Do4" S%sia3is Pn$a4i" Da3a. Bi3a a'a %n$a4i"
sis"a"is s6agai %n$6a6 a"a%n %n$"a %n$a4i"
o Do4" S%sia3is Psi4osoa"i4 6i3a "i'a4 'i"4an
43ainan 3ain
o Fisio"a%i n"4 "a4si s8i4a3 a%n 36a3-
asas 'an UK* a"a 3"ason'
7. Pa@a"an RS o Ra@a" ina% %a'a ii"asi a'i4s- 6i3a a'a 43ainan
no3ogis.
o N$i a'i43 "a4 ""a&an4an #o6a" "i'a4
no3ong)- "a4 'a%a" is"ia&a" 'i a&- 'i'ga a'a
%n$6a6 3ain $ang &as 'i 4s%3oasi
o Pa'a 4o%si a'i4s "3a4 %3 'ia@a" 4ana
"in'a4an o%a"i: "3a4 'i%34an
. Ta%i o Pa'a ii"asi a'i4s ""a%i n$a 4ons8a"i:
"36i& 'a&3- $ai"
, Tia& 6aing 'ngan %osisi $ang a"a 'ngan a3as
4as
, P6ian 6an"a3 %anas
, Sn"i4an an"si s(aa 3o4a3
, !6a" 3a4san o"o" - ana3gsi4 'an o6a" AINS, S3ain i" 'a%a" 'i3a44an "a4si s8i4a3 a%n
2
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8/12/2019 Protap Ilmu Penyakit Saraf
30/44
36a3 'an 9ga :isio"a%i 3ain
o !%a"i:
, In'i4asi o%asi
, In'i4asi o%asi si"o ia3a& "i63n$a %o3a%s 'ngan
%aa%asis #4o%si a'i4s). Pa'a 4o%sio a'i4s"in'a4an o%a"i: &as 'i3a44an s(%a"n$a s"3a&
'iagnosis 'i"ga44an n"4 n(ga& %asis 'an
a"o:i 36i& 3an9".
, *anggan i4si
, Pa'a %asis o"ois $ang "i63n$a a4" 'an
38an.
, Bi3a s'a& =, ingg "a%i 4ons8a"i: asi&
"'a%a" 43&an 'an g9a3a $ang 38an.
, Pa'a si'i: $ang 64a3i,4a3i 'ngan g9a3a $ang
4&as.
, Bi3a 'ngan %i4saan EM* 'ai o"o",o"o" sgn$ang 6sang4"an a"a o"o",o"o" %aas%ina3 a"a %aa
8"6a3 'i"4an a'an$a 'n8asi5:i6i3asi $ang
nn944an 4o%si a'i4s.
. S"an'a RS o Sa RS- 4(a3i %a'a 4ass $ang 34an
"in'a4an in8asi:5o%a"i: &as RS "i% A5B $ang
%n$ai a&3i 6'a& saa: 5 o"o%'i
10. Pn$3i" o Han$a a'a %a'a 4ass $ang "3a& 'io%asi- 4a'ang,
4a'ang n$i asi& a'a.
11. In:o'
Consn"
o S(aa 3isan %a'a %i4saan EM*
o P3 ""3is %a'a %i4saan LP- M$3oga:i-MRI 'an %a'a "in'a4an o%asi
12. Tnaga S"an'a o Do4" U
o Do4" S%sia3is Saa: 6i3a 43&an "i'a4 &i3ang-
a%a3agi 4a3a 6"a6a& 6a" a"a%n 'i'a%a"i 43ainan
no3ogis.
o Do4" S%sia3is B'a& Saa:5o"o%'i n"4 4ass
4o%si a'i4s $ang %3 o%asi
1/. Masa P3i&an o Bgan"ng %a'a asing,asing 4ass- nan
n$a %a'a ii"asi a'i4s 'i%34an @a4" +,=
ingg
1+. Hasi3 o Pa'a ii"asi a'i4s
o Biasan$a %ognosis 6ai4- 6i3a 'i3a44an "a%i 'an
:isio"a%i $ang 6ai4 'ngan is"ia&a" $ang (4%.
o Pa'a &nia 'is4s $ang 'io%asi
o Pa'a 25/ 4ass %ognosis 6ai4 'an %a'a 10 &asi3
"a4 as4an
o Taa %a'a %49aan
o Yang 93as %ognosisn$a s%"i %a'a n$a
"aa %a'a %49aan 'an 6i3a %o%a"i: g9a3a s'a&
a'a 36i& 'ai 1 "a&n 'ngan %6a&an a"o"is $ang
93as- isa3n$a anoa3i 36osa4a31;. Pa"o3ogi o Han$a 'i%34an %a'a 4ass $ang 'io%asi
2
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1=. A"o%si o Sanga" 'ian94an - 6i3a "9a'i 4a"ian $ang &a%i
"a4 %na& "9a'i
RSUD ULIN
Jl. A. Yani 43
Telp.257472 / 252180
Fax.252229
an!a"#a$in
%&NAN'ANAN %ASI&N
N(. D()*#en N(. Re+i$i N(. ,ala#an
30 / 41
Tanal Te"i
1 J*li 2003
Dieap)an
Di"e)*" R*#a Sa)i U#*#
Dae"a Ulin an!a"#a$in
/0
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%R-S&DUR
T&TA% D". ,. Ai#an* Sp%D6'&,
%e#ina Ua#a *a
NI%. 140 159 19
Tanal Re+i$i
De$e#e" 200
1. Diagnosis TETANUS
2. ICD Q.2.0
/. Ki"ia Diagnosis o Pn$a4i" sis" saa: $ang %3angsngann$a a4" 'ngan
4aa4"is"i4 s%as "oni4 %sis"n 'an 4sas6asi
sing4a"
o Tiss,a&ang "4n(i
o Riss Sa'oni4s,"a4si s'" 3" 'ii4"i 'nan
n$i 'an 4a4 o"o"
o Paas%ina3 'an o"o" %" "9a'i s%as %a'a o"o",o"o"
agonis 'an an"agonis $ang sanga" &6a" sa%ai "9a'i
n$i 'an 44a4an $ang sanga" 6a" $ang 6isa
ni634an :a4"
o "6a 'osa3is "9a'i s%as %a'a o"o" %na%asan
$ang %a4an %n$6a6 4a"ian 6i3a "i'a4 (%a"
'i"o3ong
o *9a3a a"ono 6%a 6an$a4 4inga" 'an 3'a&. Jga
s4si :aing. "a4i4a'i 'an &i%o"nsi
o T9a'i 9ga a6'oio3isis $ang nga4i6a"4an
iog3o6ini 'an gaga3 gin9a3
+. Diagnosis
Ban'ing
o K9ang 4ana &i%o4a3sia
o Sin'oa &i%8n"i3asi5a4si &is"io E%i3%si
o Pa'angan 'aa& 3"
;. Pi4saan
Pnn9ang
o Pi4saan i4ooganis 6a4 n"4 n4an
&.tetani
o Pi4saan To4si4o3ogi n"4 n4an
""anos%asin
=. Kons3"asi o Do4" S%sia3is Ana4 Pina"o3ogi
o Do4" *igi
o Do4" S%sia3is B'a&
7. Pa@a"an RS o Ra@a" ina% sga- 6i3a %3 'i ang ICU. Ta%i o E4sisi 34a $ang (4% 36a
o Pn6ian "ono'ao3 7.; g4gBB"ia% = 9a oa3
a"a I !6a" ini 36i& 6ai4 %a'a %ni(i3in
o To4sis $ang asi& 'a3a si43asi 'in"a34an 'ngan
inisasi %asi: # 'uman Imunoglobulin ()))-*)))) +I
intramuskular,
o K9ang 'i6i 'ia%a ; g54gBB5&ai- 'a%a" 9ga
'ngan 'an'"o3n so'i = g54gBB53i" 3@a" N*T
o Pa'a 4ass $ang 6a" 'i6i4an o6a" 63o4a'
nos43a 'an 8n"i3asi 'ngan "4anan $ang %osi"i:s"a %&a"i4an 6a3ans (aian
/1
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. S"an'a RS o RS 'ngan :asi3i"as ICU
10. Pn$3i" o *anggan n3an 'an %na%asan $ang 34an
"in'a4an 4&ss
11. In:o'
Consn" o
P3 ""3is- ""aa $ang 'i(igai 6a"
12. Tnaga S"an'a
o Do4" U
o Bi3a 'i(igai a4an "9a'i 4s3i"an %na%asan 94 4
RS $ang 3ng4a%
1/. Laa Pa@a"an o 2 ingg < 1 63an.
1+. Masa P3i&an o Sa%ai "a4 "9a'i 4s3i"an %na%asan
o Pa'a :a4" 8"6a is"ia&a" 6aing 4ang 36i& 2 63an
1;. Hasi3
o Pa'a ana4,ana4 ;0 ningga3
o Ang4a 4a"ian "inggi 6i3a
a. "9a'i s%as $ang "i'a4 (%a" 'i"o3ong
6. Bi3a 9aa4 an"aa "9a'in$a 34a 'an a@i"an "9a'i ""ans %n'4
1=. Pa"o3ogi o Ti'a4 %3
17.A"o%si o Bi3a 'i%34an
RSUD ULIN
Jl. A. Yani 43
Telp.257472 / 252180
Fax.252229
an!a"#a$in
%&NAN'ANAN %ASI&N
N(. D()*#en N(. Re+i$i N(. ,ala#an
32 / 41
/2
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8/12/2019 Protap Ilmu Penyakit Saraf
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%R-S&DUR
T&TA%
Tanal Te"i
1 J*li 2003
Dieap)an
Di"e)*" R*#a Sa)i U#*#
Dae"a Ulin an!a"#a$in
D". ,. Ai#an* Sp%D6'&,
%e#ina Ua#a *a
NI%. 140 159 19
Tanal Re+i$i De$e#e" 200
1. Diagnosis MENIN*ITIS
, Mningi"is Ba4"ia3is A4"
, Mningi"is T643osis #A.17.0)
, Mningi"is ia3
2. ICD *.00
/. Ki"ia Diagnosis o A'a3a& sa" in:4si ssnan saa: %sa" $ang 6a" 'an
'a%a" ni634an g9a3a sisa $ang %ann. Pn$6a6
in:4si a'a3a& 6a4"i-8is a"a oganis $ang 3ain.
o M%a4an sa3a& sa" 4o%3i4asi 'ai %n$a4i"
"6(3osis- %n$ai o6i'i"as 'an o"a3i"as $ang
"inggi 'ngan %ognosis 64
o Da- a3ais- sa4i" 4%a3a- n"a&- sing "a%a4
ngan"4 'an (on:s' #4sa'aan nn)
o Bi3a "a4 'io6a"i- ngan"4 ng6ang4an n9a'i
so%o 'an 4oa
o *9a3a 43inis $ang 4&as 'i"4an "an'a angsangan
ninga3 6%a 4a4 4'4- "an'a 4nig
o P"4ia 'i9%ai %a'a ningo4o4 @a3a%n 'a%a" 9ga%a'a in:4si %no4o4- s"a:i3o3o4o4- 'an 66a%a
in:4si 8is. Ka'ang,4a'ang 'i9%ai 49ang a4i6a"
ning4a"n$a a"a in:4si 8na 3o4a3
o E' %a%i3 'i9%ai %a'a s6i"is 'i:s 'an ' o"a4
$ang . Ma3ais- sa4i" 4%a3a- ii"a63- %6a&an
"ing4a& 3a4 $ang 63angsng s3aa 2,= ingg.
Di9%ai 'a ingan 'an "an'a %angsangan s3a%"
o"a4
o Pa%i3 'a sing "9a'i. Ji4a "a4 'io6a"i 4a'aan so%o
6"a6a& 'an 'ii4"i 4a"ian. Ma3ais- sa4i" 4%a3a-
'a ingan- ngan"4 'an n"a&.
o Pi4saan %&a"i4an %n'i"a "a%a4 sa4i"
s'ang- 66a%a "'a%a" 4a4 4'4- ""a%i "i'a4 s93as
%a'a ningi"is 6a4"ia3is a4".
+. Diagnosis
Ban'ing
o In:4si 9a5%aasi" #&r$ptococcus neoformans a"a
To%oplasma gondii, sarkoid meningitis.
o T4anan %a'a s3a%" o"a4 $ang 'i:s o3& s3 ganas-
"as4 4asinoa- 3i:oa- 34ia- g3ioa-
3anoa 'an '3o63as"oa.
o Pa'a %aaninga3 a6ss ni634an a4si 3i:osi"i4
%a'a (aian o"a4.;. Pi4saan
I
o Pngsi 36a3 #6i3a "a4 a'a "an'a,"an'a %ninggian
//
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Pnn9ang "4anan in"a4ania3)
o CT s(an a"a MRI 'i6a" s63 'i3a44an :ngsi
36a3 6i3a 'i9%ai %ninggian "4anan in"a4ania3.
o K3" 'aa& 'an (aian o"a4.
o P@anaan ga (aian o"a4- 9ga %@anaan i&3,Ni3sn
o Ka'a g34osa 'aa&- %i4saan 4an"i"a"i: (aian o"a4
n"4 93a& s3- &i"ng 9nis s3.
o Ka'a g34osa- %o"in- NaCL- 4a'a asa aino- 'an
n"4 n'a%a"4an an"ign 6a4"i 'i%i4sa
counterimmunoelectrophoresis radioimmunoassa$ a"a
"4ni4ELISA.
o C,a("i8 %o"in ning4a" 36i& 'ai 20 g53 in'i4asi
4ng4inan "ia'in$a ningi"is 6a4"ia3is.
=. Kons3"asi o
Do4" S%sia3is Pn$a4i" Da3ao Do4" S%sia3is Pa
o Do4" S%sia3is !n4o3ogi
o Do4" S%sia3is THT
o Do4" *igi
o Do4" S%sia3is Ra'io3ogi
o Do4" S%sia3is B'a& saa:
o Do4" A&3i La6oa"oi K3ini4
o Do4" A&3i Mi4o6io3ogi
o Do4" A&3i Paasi"o3ogi
7. Ta%i o
Ra@a" ina% n"4 sa %n'i"a $ang 'i(igain'i"a ningi"is
. Pa@a"an RS Pa'a oang '@asa
o L6i& 6ai4 'i'"4si 'a&3 'ngan %@ana ga a"a
"4ni4 n'a%a"4an an"ign $ang (%a".
o Kan %n$6a6 46an$a4an eisseria meningitidis
#Meningococcus, 'an Streptococcuspneumoni s&ingga
$ang 'i%a4ai a'a3a& 6n$3 %nisi3in s4a 'i9%ai 'i
In'onsia)
o Pi3i&an 3ain- %nisi3in 'ngan 'osis /00 g54gBB
in"a8na 'i6agi / 'osis 'i4o6inasi4an 'ngan
43oa:ni4o3 7; , 100 g54gBB %&ai,in"a8nao S:o"a4si ;0 g 4g BB "ia% = 9a I a'a3a& o6a"
"%i3i&
Pa'a ana4,ana4
o P6ian 'ini '4sa"ason 6i3a %n$6a6'.influenae
ngangi insi'n s3 "3i 'an 43ainan no3ogi
3ain.
o Pngo6a"an 'an &asi3n$a 6gan"ng (%a"n$a
%n(o6a"an.
o Pngo6a"an sga 6i3a 'i9%ai %3iosi"osis 3i:osi"i4
'an 4a'a g34osa (aian o"a4 $ang n'a&.o INH 20 g4g BB5&ai s3aa 1 63an #a4s =00 g &ai)
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3a3 'osis 'i"n4an 30 g54gBB5&ai
o Ri:a%isin 30 g54g BB5&ai- s3aa 2 63an
o Piainai' /0 g54gBB5&ai- s3aa 2 63an
K"iga o6a" ini 'i6i4an s&an s4a3i
o INH 'an i:a%isin 'i6i4an 30 63ano Pa'a 4a'aan $ang 6a" 'i"a6a& s"%"oisin 20 g5 4g
5BB5&ai- s3aa 2 ingg
o Ko"i4os"oi' 'a%a" 'i6i4an @a3a%n asi&
4on"o8sia3
o Pngo6a"an %a'a in:4si 8is "a4 a'a %ngo6a"an $ang
s%si:i4 4(a3i %ngo6a"an s%o"i: 'an "ia& 6aing
. S"an'a RS o Sa RS- 6i3a a'a %n$3i" a"a in'i4asi 94 4 RS
$ang 36i& 3ng4a% :asi3i"asn$a.
10. Pn$3i" Meningococcal septicaenia
o T3i snsoi,na3o K3%&an saa: 4ania3
o Hi'os:a3s
o E%i3%si
o Higoa s6'a3
o R"a'asi nn"a3
o A"o:i n.o%"i4s
11. In:o'
Consn"
o P3 'iin"a %a'a saa" a4an 'i %ngsi 36a3
12. Tnaga S"an'a o Do4" S%sia3is Saa:
o
Do4" S%sia3is Pn$a4i" Da3ao Do4" S%sia3is Pa
o Do4" S%sia3is !n4o3ogi
o Do4" S%sia3is THT
o Do4" *igi
o Do4" S%sia3is Ra'io3ogi
o Do4" S%sia3is B'a& saa:
o Do4" A&3i La6oa"oi K3ini4
o Do4" A&3i Mi4o6io3ogi
o Do4" A&3i Paasi"o3ogi
o
Do4" 6i3a "a4 a'a 'o4" s%sia3is "s6"1/. Laa Pa@a"an o 1,2 63an n"4 ningi"is 6a4"ia3is 4"
o 2,= 63an n"4 ningi"is "643osis
o 1 63an n"4 ningi"is 8ia3
1+. Masa P3i&an o 1,2 63an n"4 ningi"is 6a4"ia3is a4"
o Ss'a& = 63an- 'ngan s3 no3ogis n$a
n"4 ningi"is "643osis
1;. Hasi3 o ningi"is 6a4"ia3 'a%a" (%a" s6& "o"a3 6i3a (%a"
'io6a"i 'an 4sa'aann$a 63 "gangg
o ningi"is "643osis s6& 3a6a" 'an n$a
ningga34an s3 no3ogiso ningi"is 8ia3 a'a $ang s6& "o"a3- a'a $ang n9a'i
/;
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(a(a"5%i3%si
1=.Pa"o3ogi o Bi3a 'i9%ai %n$3i"
%&NAN'ANAN %ASI&N
/=
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RSUD ULIN
Jl. A. Yani 43
Telp.257472 / 252180
Fax.252229an!a"#a$in
N(. D()*#en N(. Re+i$i N(. ,ala#an
3 / 41
%R-S&DUR
T&TA%
Tanal Te"i
1 J*li 2003
Dieap)an
Di"e)*" R*#a Sa)i U#*#
Dae"a Ulin an!a"#a$in
D". ,. Ai#an* Sp%D6'&,
%e#ina Ua#a *a
NI%. 140 159 19
Tanal Re+i$i
De$e#e" 200
1. Diagnosis ENSEFALITIS IRAL
2. ICD A./. A.;- A./. Ki"ia Diagnosis o Sa" %n$a4i" 'a a4" 'ngan 4sa4an 9aingan
%an4i sis" saa: %sa" $ang ni634an 49ang-
4sa'aan nn- a"a "an'a,"an'a no3ogis :o4a3.
o Skin rash# :aingi"is- 3i:a'ni"is- %3i"is- 4a'i"is-
i4"s- oganoga3i- 'ia 'an o4i"is
o Po'oa3 63angsng 1,+ &ai 6%a 'a- nggigi3-
sa4i" 4%a3a- a3ais- sa4i" "nggoo4an- 4on9ng"i8i"is-
n$i %a'a 4s"i"as 'an a6'on.
o Bi3a 646ang 9a'i ningi"is- 'i9%ai 4a4 4'4-
:o"o:o6ia. n8i %a'a %ga4an 6o3a a"a. Ksa'aan
nn.
o A'an$a nsn:a3i"is 'i"an'ai o3& a"a4sia. "o.
ganggan n"a3- ganggan 6i(aa- 43%&an
4s"ii"as- 49ang %ninggian "4anan in"a4ania3.
4sa'aan $ang a4in nn sa%ai 4oa 'an 'a%a"
6a4& 'ngan 4a"ian- 9aang 'i9%ai %"osis 'an
%asis 6o3a a"a.
o Bi3a g9a3a %angsangan s3a%" o"a4 'is"ai 'is:ngsi
o"a4 'is6" ningons:a3i"is
+. Diagnosis
Ban'ing
o In:4si 6a4"i
o In:4si i4o6a4"io In:4si 9a
o 3n:4si %o"ooa
;. Pi4saan
Pnn9ang
o Pngsi 36ai 6i3a "a4 a'a "an'a %ninggian "4anan
in"a4ania3
Di8a3asi
, S3 n8a 4ang 'ai 100053-
3i:oonosi"i4
, Di9%ai i"osi" %a'a &%s si%34s
ns:a3i"is
, Po"in noa3 a"a s'i4i" ninggi #0,200g5'3)
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39/44
, *34osa 6iasan$a noa3
, P@anaan ga 'an 43" n"4 6a4"i
a. Ja
6. BTA
o Bi3a ng4in4an iso3asi 8is- "i" an"i6o'i n"4n(ai 'iagnosis "io3ogi
o Pi4saan 'aa&
, L4osi" noa3 a"a 34o%ni a"a
3i4osi"osis ingan
, Ai3as s sing ning4a" %a'a %ao"i"is
, Fngsi &a"i $ang a6noa3 'i9n%ai %a'a
&%a"i"is 8is 'an onon43osis in:4siosa.
o Pi4saan EE*
, Un$a 'i9%ai %3an6a"an
, A'an$a 4o%34s slo/ /ave$ang %io'i4 4
'aa& 3o6s "%oa3is ssisi a"a 'a sisi
n(iga4an sa" in:4si &%s si%3s 8is
#HS). Pa'a AIDS ns:a3i"is 9ga &an$a 'i9%ai
%3a6a"an
o Pi4saan CT s(an 'an MRI
, Pi4saan ini s6nan$a %n"ing ""a%i
a&a3. Bgna n"4 '"4si 'ini HS ns:a3i"is
o Bio%si 9aingan o"a4
, S%sin n"4 isoiasi 8is- %i4saan
&is"o%a"o3ogis- %i4saan 'ngan i4os4o%
34"on 'an ino:3osns. Bio%si o"a4 6gnan"4 nga44an 'iagnosis HS ns:a3i"is
o Pi4saan an"i6o'i an"ign s%si:i4 n"4 HS 'an HI
=. Kons3"asi o Do4" S%sia3is Saa:
o Do4" A&3i io3ogi
o Do4" A&3i Pa"o3ogi K3ini4
o Do4" A&3i Pa"o3ogi Ana"oi
o Do4" S%sia3is Ra'io3ogi
o Do4" S%sia3is B'a& Saa:
o Do4" S%sia3is Ans"si
o
Fisio"a%is7. Pa@a"an RS o Ra@a" ina% sga n"4 sa %n'i"a $ang 'i(igai
'i"a ns:a3i"is
. Ta%i o Bsi:a" s%o"i:
o Bi3a 'i(igai %n$6a6n$a HS 'i6i4an A($(3o8i /0
g54gBB5&ai in"a8na- 'i6agi / 'osis s3aa 10 &ai.
. S"an'a RS o Un"4 %a@a"an s%o"i: sa RS
o Bi3a a'a %n$3i" a"a in'i4asi 94 4 RS $ang 36i&
3ng4a%
10. Pn$3i" o In:4si sa3an na%as 'an sa3an 4i&
o
K9ang $ang "s ns %a'a :asi3i"as ICU n"4na4os
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11. In:o'
Consn"
o P3 ""3is 6i3a 'i%34an n"4 %n4si 36a3- 6io%si
o"a4
12. Tnaga S"an'a o Do4" n"4 "a%i s%o"i:
o Do4" S%sia3is Saa:- 'o4" S%sia3is Ans"si- 6i3a
49ang,49ang n9 4a a& s"a"s 4on83si1/. Laa Pa@a"an o Sa" 63an 6i3a "i'a4 "9a'i s3 no3ogis5%n$3i"
3ain. S3 no3ogis %3 'i3a"i& a&3i Fisio"a%i
o Pngo6a"an s &i'% 6i3a "9a'i %i3%si
1+. Masa P3i&an o 1,/ 63an- s6agian ningga34an (a(a" ""a%
1;. Hasi3 o Ens:a3i"is 8is "i'a4 a'a o6a"n$a- A($(3o8i 'a%a" 'i(o6a
'i6i4an %a'a HS ns:a3i"is 'ngan o"a3i"as 1,2
1=.Pa"o3ogi o Bi3a 'i3a44an 6io%si o"a4
17. A"o%si o Dngan %s"9an 43aga- n"4 visum et repertum
/
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RSUD ULIN
Jl. A. Yani 43
Telp.257472 / 252180
Fax.252229
an!a"#a$in
%&NAN'ANAN %ASI&N
N(. D()*#en N(. Re+i$i N(. ,ala#an
39 / 41
%R-S&DUR
T&TA%
Tanal Te"i
1 J*li 2003
Dieap)an
Di"e)*" R*#a Sa)i U#*#
Dae"a Ulin an!a"#a$in
D". ,. Ai#an* Sp%D6'&,
%e#ina Ua#a *a
NI%. 140 159 19
Tanal Re+i$i
De$e#e" 200
1. Diagnosis PENYAKIT PARKINS!N
2. ICD *. 20
/. Ki"ia Diagnosis o Pn$a4i" Pa4inson a'a3a& 6agian 'ai %a4insonis $ang
%a"o3ogis 'i"an'ai 'ngan 'gnasi gang3ia 6asa3is
""aa %as (o%a("a s6s"an"ia niga 'is"ai 'ngan
in43si si"o%3asi4 osino:i3i4 #!e/$s bodies,
o Pa4insonis a'a3a& sin'oa $ang 'i"an'ai 'ngan
"o @a4" is"ia&a"- igi'i"as- 6a'i4insia 'an
&i3angn$a :34s %os"a3 a4i6a" %nnan 'o%ain
4ana 66a%a s6a6
o To %a4an g9a3a $ang "i63 a4i6a" 3"%an
i"is "&a'a% "a4"s %iai'a3is. Dis6" 9ga resting
tremor 'ngan :4nsi +,; H a"a pill rolling tremor.
Da3a 4a'aan s"ss "o a4an 6"a6a&
+. Pi4saan Fisi4 o Da3a %i4saan 'a%a" 'i"4an "ias Pa4inson $ai"
:nona o'a 6gigi. 6a'i4insia 'an igi'i"as.Ba'i4insia
o Mnnn$a 4a%an n"4 3a44an ga4an @a9a&
'is"ai 6"a6a&n$a @a4" $ang 'i%34an n"4
3ai a"a ng6a& ga4an a4i6a"n$a 4s3&an
ga4an %n'i"a 6i 4san 3a6a".
o Da3a %i4saan 'a%a" 'i"4an %n'i"a 69a3an
'ngan 3ang4a& 4(i3,4(i3 s%"i 'is" #Marche petit
Pas, "an%a 3nggang- sa3i8a "i'a4 'i"3an. 4a "o%ng
$ang is4in ii4- :4nsi a"a 64'i% nn 'an
"3isan 66a& n9a'i 4(i3,4(i3.
Rigi'i"as
o Tons o"o" ninggi 4ana ning4a"n$a a4"i8i"as o"o
+0
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nogaa ""aa %a'a o"o" :34so. Ka'aan ini
nnga4i6a"4an si4a% %n'i"a s%"i 6ong4o4
'ngan 4a4i ""44 #S"oo%ing).
o Disa%ing g9a3a 'i a"as 'a%a" 'i"4an &i%&i'osis-
&i%o"nsi %os"a3- ganggan i4si- 'nsia- '%si-%na%asan $ang 'ang4a3 'an "i'a4 6a"an s"a (aa
6i(aa $an ono"on.
o P9a3anan 43inis %n$a4i" Pa4inson 'i3i&a" 6'asa
"a&a%an n" Ho&n 'an Ya&
o S"a'i I
, *9a3a 'an "an'a %a'a sa" sisi
, *9a3a ingan
, *9a3a $ang "i63 nggangg "a%i "i'a4 ni634an
(a(a"
, To %a'a sa" anggo"a ga4
, *9a3a a@a3 'a%a" 'i4na3i oang "'4a"
o S"a'i II
, *9a3a 6i3a"a3
, T9a'i 4(a(a"an inia3
, Si4a%5(aa 69a3an "gangg
o S"a'i III
, *a44an "6& n$a"a 3a6a" 'ii
, *anggan 4si6angan saa" 69a3an56'ii
, Dis:ngsi s'ang
o S"a'i I
, *9a3a 36i& 6a", K"6a"asan 9aa4 69a3an
, Rigi'i"as 'an 6a'i4insia
, Ti'a4 a% an'ii
, To 64ang
o S"a'i
, S"a'i 4a4sia
, K(a(a"an 4o%34s
, Ti'a4 a% 6'ii 'an 69a3an
, M34an %a@a"an ""a%
;. Diagnosis
Ban'ing
o Sin'o Pa4inson S4n'
o Pas(ans:a3i"is 3"agi4a 8an (onoo. Da %3& "a&n
s"3a& 49a'ian in:4si 8is o"a4 "i63 g9a3a %a4inson.
o Ka'aan ia"ognis a4i6a" %6ian o6a" ""aa
:no"iain- &a3o%i'o3 'an 3i"i.
o A4i6a" 4a(nan C! a"a Mn
o Pn$a4i" saa: 3ain %n$a4i" s6o8as43a5
%a4insonis a"ios43osis
o A4i6a" 4a'aan 3ain s%"i "aa a"a "o o"a4.
=. Pi4saan
Pnn9ang
o Pa'a CT S(an a"a MRI- ng4in 'a%a" 'i"4an "an'a
'gnasi %a'a s6s"ansia niga.
o Da%a" 'i3a44an ana3isis (aa 69a3an ""aafoot print.7. Kons3"asi o Do4" S%sia3is Pn$a4i" Da3a
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o Do4" S%sia3is Ji@a
o Do4" A&3i Faa4o3ogi K3inis 6i3a 'i%34an
. Pa@a"an RS o Ra@a" ina% &an$a 'ian94an %a'a 4ass $ang 6a"
'ngan "9an n"4 ng"a&i 'i4an"osa $ang
(o(o4 'an 'osis $ang a'4a". Ta%i o M'i4an"osa
, Aan"a'in
, An"i4&o3ingi4 Bno"o%in si3a"- 6i%i'in-
"i&$%&ni'i3
, Do%aingi4 Ca6i'o%a 'an L8o'o%a Bnsai'
'an L8o'o%a
, Do%ain Aginis Boo4i%"in si3a"- %go3i'
si3a"- %ai%o3- %inio3- 3$si'
, C!MT In&i6i"o En"a(a%on- "o3(a%on
, MA!,Bin&i6i"o S3gi3in- Laa6i', , An"i !4si'an *3"aa" an"agonis- a3:a "o(o:o3- asa
As(o6a"- 6"a(ao"n
, Bo"3in "oin
, Po%ano3o3
o Non 'i4an"osa
, !%asi Ta3a"oi- %a3i'o"oi- "ans%3an"asi s6s"ansia
niga
, A63asi 'an s"i3asi o"a4
, R&a6i3i"asi 'i4
, Psi4o"a%i
10. S"an'a RS o Sa RS $ang %n$ai 'o4" S%sia3is Saa:11. Pn$3i" E:4 sa%ing 'a%a" 6%a
o F34"asi 4&asia" o6a" #on,o:: %&nonon)
o Hi%o"nsi %os"a3
o Nasa
o Dis4insia
o D%si n"a3
12. In:o'
Consn"
o Han$a %a'a 4ass o%a"i: $ang 63 %na& 'i49a4an
'i In'onsia
1/. Tnaga S"an'a o Do4" U- %a'a %n'i"a 'ngan 43&an $ang s'a&
"a"asi 'ngan %ngo6a"an $ang a'4a".o Do4" S%sia3is Saa:- 6i3a 4'ian "i63 :4 sa%ing
%6ian o6a" 9ang4a %an9ang
1+. Laa Pa@a"an o Bo6a" 9a3an- 4(a3i n"4 %n$saian o6a"- %n'i"a
'ngan :4 sa%ing %ngo6a"an $ang 6a" a"a '%si
n"a3 6a".
o Laa %a@a"an 6gan"ng %a'a 6a" a"a s3i"n$a 4ass
"s6"
1;. Masa P3i&an o Pn'i"a s3aan$a 6gan"ng %a'a 'i4an"osa
o Ha3 ini s3a$a4n$a n9a'i 6a&an %"i6angan 'a3a
i3i& 9nis o6a" 4ana %n'i"a a4an sanga" "66ani
o3& &aga o6a"
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1=.Hasi3 o Dngan "a%i $ang a'4a" %n'i"a 'a%a" 66as g9a3a
n"4 @a4" $ang 3aa a4an ""a%i 'osis a'4a" n"4
4n @a4" ""n" ng4in "i'a4 a'4a" 3agi n"4
@a4" s3an9"n$a s&ingga 'osis &as 'inai44an
17. Pa"o3ogi o Ti'a4 s3a3 %31. A"o%si o ,