pembelajaran untuk pendewasaankitakitai.pptx

pembelajaran untuk pendewasaankitakitai.pptx

1. The patient was consulted from Neurology Department CC: Swallowing Disorder History UC 2. Mrs Sarmini / ♀ / 42 Yo 0002318765 / Skullbase Division / AB Admission Time : 11.21 AM Decision Time : 11.35 AM October, 10th 2024 June 2024 History of using hormonal birth control (+), for 20 years, has stopped for 3 years prior. Family history of tumors (+) in older siblings. History of lumps in other parts of the body (-), History of progressive weight loss (-), History of high blood pressure (-) and DM (-)

2. The patient was consulted from Neurology Department CC: Swallowing Disorder History: Since 4 months prior to admission, the patient has complained of swallowing disorder until the patient often chokes since 1 month prior. Complaints began with intermittent headaches which still improved with oral medication since 10 months prior. Complaints accompanied by nasal speech (+), balance problems (+), ringing in the right ear (+), and weakness in the right limbs since 4 months prior, which has worsened until the patient has had difficulty walking since 1 month prior. History of slurred speech (-), asymmetrical face (-), double vision (-), decreased consciousness (-), seizures (-), fever (-), and trauma (-). Because of his complaint, the patient was brought to the Neurology Outpatient clinic , underwent a contrast cervical MRI (October, 11 th 2024), diagnosed as a brain tumor , treated for 1 day in the Azalea ward by Neurology, then the patient was consulted to the Neurosurgery Department for further management. History of using hormonal birth control (+), for 20 years, has stopped for 3 years prior. Family history of tumors (+) in older siblings. History of lumps in other parts of the body (-), History of progressive weight loss (-), History of high blood pressure (-) and DM (-) UC 2. Mrs Sarmini / ♀ / 42 Yo 0002318765 / Skullbase Division / AB Admission Time : 11.21 AM Decision Time : 11.35 AM

3. Clinical Picture

4. General State : BP:121/81 mmHg HR : 79 x/ min R R : 20 x/m in T: 36.6 o C VAS: 2/10 Local Stat e : At Thorax: VBS Left=right, Rh-/-, Wh -/- Neurological Stat e : GCS 15 , Nuc hal Rigidity (-) Pupil : RLO r ound equal , Ø RLO 3 mm/ 3 mm , LR -/- Visual Acuity : >6/60 Funduscopy : RLO papil defined border Eyeball Movement : good to all directions Other Cranial Nerve : within normal limit CN VII : within normal limit CN VIII : AD: Tinnitus (+), AS: within normal limit CN X : Disturbed CN XI : Disturbed CN XII : Disturbed Motoric : parese +/- Sensory : within normal limit Physiological Reflex : ++/+ Babinski : -/- Rinne : AC > BC Weber : lateralisation (-) Scwabach : not disturbed Disdiadochokinesia : disturbed Romberg test : disturbed Finger to nose : disturbed Propioseptif : disturbed Physical Examination

5. Laboratory Findings at Hasan Sadikin Hospital, Bandung October 11 th 2024 Labs Result Hb 13.6 Ht 40.1 L 11.130 Tr 272.000 OT/ PT 27/23 Ur / Cr 22.7/0.53 Na/ K 137 / 3.5

6. Thorax X-Ray at Hasan Sadikin Hospital , Bandung October,11 th 2024 Cardiomegaly

7. Contrast Cervical MRI at Hasan Sadikin October , 11 th 2024

8. Contrast Cervical MRI at Hasan Sadikin October , 11 th 2024

9. Contrast Cervical MRI at Hasan Sadikin October , 11 th 2024

10. Contrast Cervical MRI at Hasan Sadikin October , 11 th 2024

11. Contrast Cervical MRI at Hasan Sadikin October , 11 th 2024 T1 - Isointense lesion at foramen magnum extend to medulla oblongata and cerebellar tonsil - Dural tail (+) T2: - Isointense lesion at foramen magnum extend to medulla oblongata and cerebellar tonsil