Case CIDP Elva Gabriella

8/19/2019 Case CIDP Elva Gabriella

1/17

RSUD ARIFIN ACHMAD

Fakultas Kedokteran UNRI

SMF/ BAGIAN SARAFSekretariat : SMF Saraf – Irna Medikal Lantai 4

Jl. Diponegoro No. 2 Telp. (0761) 7026225

P K A N ! A R U

S"A"US PASIN

Na#a Koass :l!" G"#riell" Dep"ri

N I M $ N U K :0$0%11&6'0

Pe#%i#%in& :r. Rii S*i"nr"+ Sp.S

I' IDN"I"AS PASIN

N"," N-. M

,*r && "*n

Jeni el",in ere,p*"n

Al"," "ir "ng"r"-"n

Ag"," Il",

S"* per"3in"n 4"3in

eer""n IRT

T"ngg"l M"* RS 7 J*li 201'

T"ngg"l e,eri""n 10 J*li 201'

Mei"l Reor %5 %7 7$

II' ANAMNSIS ("*o"n",ne")

Kelu(an Uta#a

e," p"" "nggo" ger" #"3"

1


2/17

Ri)a*at Pen*akit Sekaran&

8 2 "*n SMRS p"ien ,engel*"n le," p"" "nggo" ger" #"3".

e," er"i e"r" i#"8i#" "" p"ien #"r* "" #"ng*n p"gi+ p"ien i"

"p" ,engger""n "in-". G"ngg*"n BAB "n BA4 i"ng"l p"ien.

8 1 ,ingg* SMRS p"ien ,engel*"n e,", inggi eng"n #oro -"ng

,el*" i"re" p*ngg*ng "n #oong. "ien e,p" ir"3" i RS "ir

"ng"r"-"n el"," & "ri+ l"l* e,*i"n i r** e RSD AA.

Ri)a*at Pen*akit Da(ulu

8 "ien #el*, pern" ,eneri" el*"n eperi ini e#el*,n-".

8 Ri3"-" r"*," (8)

8 Ri3"-" DM (8)

8 Ri3"-" ipereni (8)

8 Ri3"-" #"* l"," (8)

Ri)a*at Pen*akit Keluar&a

Ti" "" el*"rg" -"ng ,eneri" pen-"i -"ng er*p".

RSUM ANAMNSIS

8 "ien N-. M && "*n+ ,"* RSD AA eng"n el*"n ele,""n p""

"nggo" ger" #"3" e" 2 "*n SMRS. 1 ,ingg* SMRS+ p"ien e,",

ier"i #oro -"ng ,el*" i"re" p*ngg*ng "n #oong.

III' PMRIKSAAN

A' KADAAN UMUM

Te"n"n "r" 9 "n"n 9 110/70 ,,:g+ iri 9 110/70 ,,:g

Den-* n"i 9 "n"n 9 7 ; /,n+ er"*r

iri 9 %0 ; /,n+ er"*r

J"n*ng 9 :R 9 %0 ; /,n+ ir"," 9 er"*r

"r* 9 Repir"i 9 2' ;/,n ipe 9 "#o,inoor""l

S"* Gi


3/17

2. N'II -+0ti.us/

4"n"n 4iri 4eer"ng"n

D"-" pengli""n

"p"ng p"n"ng

engen"l"n 3"rn"

N

N

N

N

N

N

Ti" "" el"in"n

&. N'III -+.ulo#otorius/


oi

*pil Ben*

*r"n

Ger" #ol" ,""

Re?le p*pil

"ng*ng

Ti" l"ng*ng

(8)

B*l"

& ,,

N

(@)

(@)

(8)

B*l"

& ,,

N

(@)

(@)

Ti" "" el"in"n

'. N' I1 -"rok(learis/


Ger" #ol" ,"" N N Ti" "" el"in"n

5. N' 1 -"ri&e#inus/


Moori

Seni#ili"

Re?le orne"

N

N

(@)

N

N

(@)

Ti" "" el"in"n

6. N' 1I -A%dus.ens/

4"n"n 4iri 4eer"ng"nGer" #ol" ,""

Sr"#i,*

De!i"i

N

(8)

(8)

N

(8)

(8)

Ti" "" el"in"n

7. N' 1II -Fa.ialis/


Ti

Moori

D"-" per""

T"n" !oe

(8)

N

N

(8)

(8)

N

N

(8)

Ti" "" el"in"n

&


4/17

%. N' 1III -Akustikus/


eneng"r"n N N Ti" "" el"in"n

$. N' I2 -,lossofarin&eus/


Ar* ?"ring

D"-" per""

Re?le ,*n"

N

N

N

N

N

N

Ti" "" el"in"n

10. N' 2 -1a&us/

4"n"n 4iri 4eer"ng"nAr* ?"ring

D-?oni"

N

(8)

N

(8)

Ti" "" el"in"n

11. N' 2I -Assesorius/


Moori

Tro?i

N

N

Ti" "" el"in"n

12. N' 2II -Hi0o&lossus/

4"n"n 4iri 4eer"ng"nMoori

Tro?i

Tre,or

Di"rri

N

(8)

(8)

N

(8)

(8)

Ti" "" el"in"n

I1' SIS"M M+"+RIK


re,i" ""

4e*""n

Di"l

roi,"l

Ton*

Tro?i

Ger.in!ol*ner

5

5

N

(8)

5

5

N

(8)

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re,i" #"3"

4e*""n

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roi,"l

Ton*

0

0

N

0

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"rei ere,i" #"3"

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5/17

Tro?i

Ger.in!ol*ner

(8)

(8)

B""n

Tro?i

Ger. in!ol*ner

Re?.ining per*

Re?le re,"er

(8)

Sn

(8)

Sn

Ti" "" el"in"n

1' SIS"M SNS+RIK


R"#"

N-eri

S**

ropioepi?

Men*r*n

Men*r*n

Men*r*n

Men*r*n

Men*r*n

Men*r*n

Men*r*n

Men*r*n

:ipoeei

1I' RFLKS


Fiiologi

Biep

Triep

4R

AR

(8)

(8)

(8)

(8)

(8)

(8)

(8)

(8)

Re?le ?iiologi (8)

"ologi

B"#ini

"o

:o??,"n Tro,er

Re?le pri,ii? 9

"l,o,en"l

Sno*

(8)

(8)

(8)

(8)

(8)

(8)

(8)

(8)

(8)

(8)

Re?le p"ologi (8)

1II' FUN,SI K+RDINASI


Te el*n* i*ngTe *,i l**

G"i

T"ne,

Ro,#erg

N N e,eri""n *,i l**g"i+ "ne, "n ro,#erg

i" "p" il"*"n.

1III' SIS"M +"+N+M

Mii 9 (@) nor,"l+ i" "" inonineni" "n reenio *rin

De?"e"i 9 (@) nor,"l i" "" inonineni" "l!i "n reenio "l!i

Ti" "" el"in"n #erering"

I2' PMRIKSAAN KHUSUS$LAIN

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#. 4ernig 9 i" er#""

. "ri 9 (8) / (8)

. 4onr"p"ri 9 (8) / (8)

e. >"l"!" e 9 (8)

?. Br*"l"!" e (8)+

Br*


7/17

Pe#eriksaan dara( rutin - 3uli 5674/

H% : 89 &$dl

: 9 2%+2

e*oi 9 7.%00 /El

"ro#%osit : 74;'666 $58>i"l Sign 9

• TD 9 120/70 ,,:g

• N"i 9 %0 ;/,eni

• RR 9 2% ;/,eni

S*. GBS 8 leroli "r"

8 Meilpreniolon

125 ,g / % ",

8 "l 2 ; 1

8 ipro?lo;"in

500 ,g 2 ; 1

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• T 9 &6+50

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• T 9 &6+70

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25/06/11

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• T 9 &6+50

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27/6/11

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;/,eni

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;/,eni

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• T 9 &6+50

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10/17

PM!AHASAN

PNDAHULUAN

Sinro," G*ill"in8B"rre (SGB) ""* -"ng ien"l eng"n Acute Inflammatory

Idiopathic Polyneuropathy (AII) ""* -"ng #i" *g" ie#* e#"g"i Acute Inflammatory

Demyelinating Polyneuropathy (AID) ""l" *"* pen-"i p"" **n"n "r"? -"ng

er"i e"r" "* "n ,en-el*r*+ er*"," ,engen"i r"i "n "r"? epi+ ""ng8

""ng ,engen"i "r"? o" -"ng i"*l*i ole in?ei.18&

M"ni?e"i lini *"," "ri SGB ""l" *"* el*,p*"n -"ng i,eri ipe

lower motor neuron "ri oo8oo ere,i"+ #""n "n ""ng8""ng *g" ,*".

en-"i ini ,er*p""n pen-"i i,"n" ie, i,*ni" *#* ,en-er"ng el "r"?.

4el*,p*"n i,*l"i p"" #"gi"n i"l ere,i" #"3" "n "p" n"i e "r" r"ni"l

( Ascending Paralysis) eng"n "r"erii ""n-" ele,""n "re?lei" -"ng #eri?"

progrei? "n per*#""n en"i enori. Ge"l" enori ,*n*l eel" ""n-"

ele,""n ,oori.'87

SGB ering e"li #er*#*ng"n eng"n in?ei "* non pei?i. Inieni "*

SGB -"ng #er"i"n eng"n in?ei ini ei"r "n"r" 56 8 %0+ -"i* 1 ",p"i ' ,ingg*

e#el*, ge"l" ne*rologi i,#*l eperi in?ei "l*r"n pern"?""n "" ""* in?ei

g"roinein"l. 2+%

4el"in"n ini *g" "p" ,en-e#"#"n e,"i"n+ p"" & p"ien+ -"ng ie#"#"n

ole g"g"l n"p" "n "ri,i". Ge"l" -"ng er"in-" #i""n-" il"ng & ,ingg* eel"

ge"l" per"," "li i,#*l. Sei"r &0 peneri" ,e,ilii ge"l" i" ele,""n eel" &

"*n. Tig" peren p"ien eng"n SGB "p" ,eng"l",i rel"p -"ng le#i ring"n #e#er"p"

"*n eel" one per",". Bil" er"i e",#*"n ""* i" "" per#"i"n p"" "ir

,ingg* I> ,"" er,"* Chronic Inflammantory Demyelinating Polyradiculoneuropathy

(ID). S",p"i "" ini #el*, "" er"pi pei?i *n* SGB. engo#""n e"r"i,o,"i "n per"3""n -"ng #"i "p" ,e,per#"ii prognoin-".2+7

DFINISI

Parry ,eng"""n #"3"+ Sinro," G*ill"in B"rre (SGB) ""l" *"*

poline*rop"i -"ng #eri?" ascending "n "* -"ng ering er"i eel" 1 ",p"i &

,ingg* eel" in?ei "*. Men*r* Bosch+ SGB ,er*p""n *"* inro," lini

-"ng i"n"i ""n-" p"r"lii ?l"i -"ng er"i e"r" "* #er*#*ng"n eng"n

proe "*oi,*n i,"n" "rgen-" ""l" "r"? peri?er+ r"i+ "n ner!* r"ni"li.7

Be#er"p" n"," ie#* ole #e#er"p" "li *n* pen-"i ini+ -"i* Idiopathic

polyneuritis Acute !ebrile Polyneuritis Infective Polyneuritis Post Infectious

Polyneuritis Acute Inflammatory Demyelinating Polyradiculoneuropathy "uillain Barre Strohl Syndrome #andry Ascending paralysis dan #andry "uillain Barre

Syndrome.7

KLASIFIKASI

Beri* er"p" l"i?i"i "ri SGB+ -"i*9&+5+$

$% Acute &otor'Sensory A(onal )europathy (AMSAN) Sering ,*n*l ep" "n

,eng"l",i p"r"lii -"ng #er" eng"n per#"i"n -"ng l",#" "n #*r*. Seperi

ipe AMAN -"ng #er*#*ng"n eng"n in?ei "l*r"n ern" C jejuni. "ologi -"ng

ie,*"n ""l" egener"i "on "ri er"#* "r"? enori "n ,oori -"ng

#er" eng"n eii e,ielini"i.

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11/17

*% Acute &otor'A(onal )europa- (AMAN) Ber*#*ng"n eng"n in?ei "l*r"n

ern" C jejuni "n ier "ni#o- g"nglioi ,ening" (eperi+ GM1+ GD1"+

GD1#). eneri" ipe ini ,e,ilii ge"l" lini ,oori "n e"r" lini "

*n* ipe e,ielini"i eng"n "ening "n p"r"l-i i,eri. AMAN i#e""n

eng"n "il *i eleroi"gnoi i,"n" i"p""n ""n-" "onop"i ,oori."" #iop- ,en*n*"n egener"i +wallerian li,e- "np" in?l","i li,?oii.

er#"i"nn-" ep"+ i"#ili" -"ng i"l",i peneri" el"," le#i *r"ng 1 "*n.

.% &iller !isher Syndrome >"ri"i "ri SGB -"ng *,*, "n ,er*p""n 5 "ri

e,*" "* SGB. Sinro," ini eriri "ri ""i"+ op"l,oplegi" "n "re?lei".

A"i" erli" p"" g"-" "l"n "n p"" #""ng *#* "n "r"ng -"ng ,elip*i

ere,i". Moori #i""n-" i" eren". er#"i"n e,p*rn" er"i "l",

i*ng"n ,ingg* ""* #*l"n.

/% Chronic Inflammatory Demyelinative Polyneuropathy (ID) ID ,e,ilii

g",#"r"n lini eperi AID+ e"pi pere,#"ng"n ge"l" ne*rologin-" #eri?"roni. "" e#"gi"n "n"+ el"in"n ,oori le#i o,in"n "n ele,""n oo

le#i #er" p"" #"gi"n i"l.

0% Acute pandysautonomia T"np" enori "n ,oori ,er*p""n ipe SGB -"ng

"r"ng er"i. Di?*ngi "ri ie, i,p"i "n p"r"i,p"i -"ng #er"

,eng"i#""n er"in-" ipoeni po*r"l+ reeni "l*r"n e,i "n "l*r"n

ern"+ "niroi+ pen*r*n"n "l!i" "n l"ri,"i "n "#nor,"li" "ri p*pil.

"I+L+,I

en-e#"# SGB i" ie"*i+ e"pi ering i*#*ng"n eng"n pen-"i

in?ei+ eperi in?ei "l*r"n n"?" "n "l*r"n ern". >ir* -"ng p"ling ering

,en-e#"#"n pen-"i ini ""l" Cytomegalovirus (M>)+ :I>+ &easles "n :erpe

Si,ple; >ir*. Se"ng"n *n* pen-e#"# #"eri p"ling ering ole Campylobacter

jejuni.7+10

PA"+,NSIS

Me"ni,e #"g"i,"n" in?ei+ !"in"i+ r"*,"+ ""* ?"or l"in -"ng

,e,preipi"i er"in-" e,ielini"i "* p"" SGB ,"i #el*, ie"*i eng"n

p"i. B"n-" "li ,e,#*" ei,p*l"n #"3" er*""n "r"? -"ng er"i p""

inro," ini ""l" ,el"l*i ,e"ni,e i,*nlogi. B*i8#*i #"3" i,*nop"ogene"

,er*p""n ,e"ni,e -"ng ,eni,#*l"n e" "r"? epi p"" inro," ini ""l"9

7

$% Di"p""nn-" "ni#oi ""* ""n-" repon ee#"l"n el*ler (cell mediated

immunity) er""p "gen in?ei* p"" "r"? epi.

*% A"n-" "*o "ni#oi er""p ie, "r"? epi.

.% Di"p""nn-" peni,#*n"n o,ple "nigen "ni#oi "ri pere"r"n p""

pe,#*l* "r" "r"? epi -"ng ,eni,#*l"n proe e,ielini"i "r"? epi.

roe e,ielini"i "r"? epi p"" SGB ipeng"r*i ole repon i,*ni"

el*ler "n i,*ni" *,or"l -"ng ipi* ole #er#"g"i perii3" e#el*,n-".'+7

"" SGB+ g"nglioi ,er*p""n "rge "ri "ni#oi. I""n "ni#o- "l",

ie, i,*n *#* ,eng"i!"i er"in-" er*""n p"" ,-elin. Al""n ,eng"p"

o,ponen nor,"l "ri er"#* ,ielin ini ,en"i "rge "ri -e, i,*n #el*,

ie"*i+ e"pi in?ei ole !ir* "n #"eri i*g" e#"g"i pen-e#"# ""n-" repon

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12/17

"ri "ni#oi ie, i,*n *#*. :"l ini i"p""n "ri ""n-" l"pi"n lipopoli""ri"

-"ng ,irip eng"n g"nglioi "ri *#* ,"n*i". Campylobacter jejuni+ #"eri

p"ogen -"ng ,en-e#"#"n er"in-" i"re+ ,eng"n*ng proein ,e,#r"n -"ng

,er*p""n ir*"n "ri g"nglioi GM1. "" "* in?ei ole Campylobacter jejuni+

er*""n er*"," er"i p"" egener"i "on. er*#""n p"" "on ini,en-e#"#"n ""n-" cross'reacting "ni#oi e #en* g"nglioi GM1 *n*

,erepon ""n-" epiop -"ng ",". '+7+10

Ber""r"n ""n-" in-"l in?ei -"ng ,enginii"i i,*ni" *,or"l ,""

el8T ,erepon eng"n ""n-" in?ilr"i li,?oi e pin"l "n "r"? peri?er. Ter#en*

,"ro?"g i "er" er*""n "n ,en-e#"#"n ""n-" proe e,ielini"i "n

",#""n peng"n"r"n i,p*l "r"?.'+7

PA"+L+,I

"" pe,eri""n ,"roopi i" ",p" el" g",#"r"n pe,#eng""n

"r"? epi. Deng"n ,iroop in"r ",p" per*#""n p"" "r"? epi. er*#""n

per"," #er*p" ee," -"ng er"i p"" "ri e8ig" ""* ee,p"+ e,*i"n i,#*l pe,#eng""n "n ireg*l"ri" el*#*ng ,ielin p"""ri e8li,"+ erli" #e#er"p"

li,?oi p"" "ri e8e,#il"n "n ,"ro?"g p"" "ri e8e#el"+ poli?er"i el 3"n

p"" "ri e8ig" #el". er*#""n p"" ,ielin+ "on+ "n el*#*ng 3"n #er"l"n

e"r" progrei?+ eingg" p"" "ri e8en", p*l* en",+ e#"gi"n r"i "n "r"? epi

el" "n*r.'+7

A#*r- ,enge,*""n #"3" per*#""n per"," -"ng er"i ""l"

in?ilr"i el li,?oi -"ng er"!""i "ri pe,#*l* "r" eil p"" eno "n

epine*r"l. 4e"""n ini eger" ii*i e,ielini"i eg,en"l. Bil" per""ng"nn-" #er"

""n #ere,#"ng ,en"i egener"i 1allerian. 4er*""n ,-elin ie#"#"n

,"ro?"g -"ng ,ene,#* ,e,#r"n #""li "n ,elep""n el*#*ng ,ielin "ri el

3"n "n "on.'+7

DIA,N+SIS

Di"gnoi SGB er*"," ieg""n e"r" lini. SBG i"n"i eng"n

i,#*ln-" *"* el*,p*"n "* -"ng ier"i il"ngn-" re?le8re?le enon "n

i"*l*i p"reei *" ""* ig" ,ingg* eel" ,eng"l",i e,", ier"i ioi"i

io"l#*,in p"" li*or "n g"ngg*"n enori "n ,oori peri?er.5

,e>ala Klinik

SGB ,er*p""n pen-e#"# p"r"lii "* -"ng i,*l"i eng"n r"" #""l+

p"reei" p"" #"gi"n i"l "n ii*i e"r" ep" ole p"r"lii e8e,p" ere,i"-"ng #eri?" "enen. "reei" ini #i""n-" #eri?" #il"er"l. Re?le ?iiologi ""n

,en*r*n "n e,*i"n ,engil"ng "," e"li.6+7

4er*""n "r"? ,oori #i""n-" i,*l"i "ri ere,i" #"3" "n ,en-e#"r

e"r" progrei? e ere,i" ""+ *#* "n "r"? p*". 4er*""n "r"? ,oori ini

#er!"ri"i ,*l"i "ri ele,""n ",p"i p"" -"ng ,eni,#*l"n 2uadriplegia flacid .

4eerli#""n "r"? p*"+ ,*n*l p"" 50 "*+ #i""n-" #er*p" facial diplegia.

4ele,""n oo pern"p""n "p" i,#*l e"r" igni?i"n "n #""n 20 p"ien

,e,erl*"n #"n*"n !enil"or "l", #ern"?". 7+10+11

4er*""n "r"? enori -"ng er"i *r"ng igni?i"n i#"ning"n eng"n

ele,""n p"" oo. R"" "i "n r", *g" "p" ,en-er"i ele,""n oo -"ng

er"i er*"," p"" "n"8"n".&+ 12

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13/17

4el"in"n "r"? oono, i" "r"ng er"i "n "p" ,eni,#*l"n e,"i"n.

4el"in"n ini "p" ,eni,#*l"n "i"ri+ ipoeni ""* ipereni+ "ri,i" #""n

cardiac arrest + facial flushing + ?inger -"ng i" eronrol+ "n el"in"n "l",

#erering". 4er*""n p"" **n"n "r"? p*" "p" ,eni,#*l"n ge"l" #er*p"

i?"gi"+ e*li"n "l", #er#i"r"+ "n -"ng p"ling ering (50) ""l" bilateral facial palsy%&+7+10+11

Ge"l"8ge"l" ",#""n -"ng #i""n-" ,en-er"i SGB ""l" e*li"n *n*

,*l"i BA4+ inonineni" *rin "n "l!i+ onip"i+ e*li"n ,enel"n "n #ern"p"+

per"""n i" "p" ,en"ri n"p" "l",+ "n pengli""n "#*r 3blurred visions4%&+12+1&

Pe#eriksaan Fisik

"" pe,eri""n ne*rologi ie,*"n ""n-" ele,""n oo -"ng #eri?"

i?* "n p"r"lii. Re?le enon ""n ,en*r*n ""* #""n ,engil"ng. B"* -"ng

le," "n "pir"i ,engini"i"n ""n-" ele,""n p"" oo8oo inero"l. T"n"

r"ng"ng ,eninge"l eperi per"" ernig "n "* ** ,*ngin ie,*"n. Re?le

p"ologi eperi re?le B"#in- i" ie,*"n.&

Pe#eriksaan Penun>an&

1. e,eri""n S D"ri pe,eri""n S i"p""n ""n-" en"i"n ""r

proein ( 1 1+5 g/l ) "np" ii*i en"i"n *,l" el. 4e"""n ini ole

G*ill"in (1$61) ie#* e#"g"i ioi"i "l#*,in iologi. e,eri""n "ir"n

ere#ropin"l p"" '% ", per"," pen-"i i" ,e,#eri"n "il "p"p*n

*g". 4en"i"n ""r proein #i""n-" er"i p"" ,ingg* per"," ""* e*".

4e#"n-""n pe,eri""n S p"" p"ien ""n ,en*n*"n *,l" el -"ng

*r"ng "ri 10/,,& (albuminocytologic dissociation).1+%

2. e,eri""n MG G",#"r"n MG p"" "3"l pen-"i ,"i "l", #""

nor,"l+ el*,p*"n er"i p"" ,ingg* per"," "n p*n"n-" p"" "ir

,ingg* e*" "n p"" "ir ,ingg* e ig" ,*l"i ,en*n*"n ""n-"

per#"i"n. "" pe,eri""n MG ,ingg* per"," "p" ili" ""n-"

eerl",#""n ""* #""n #lo "l", peng"n"r"n i,p*l+ gelo,#"ng F -"ng

,e,"n"ng "n l"eni i"l -"ng ,e,"n"ng. Bil" pe,eri""n il"*"n

p"" ,ingg* e 2+ ""n erli" ""n-" pen*r*n"n poeni"l "i (MA) "ri

#e#er"p" oo+ "n ,en*r*nn-" eep""n on*i "r"? ,oori.%

&. e,eri""n MRI e,eri""n MRI ""n ,e,#eri"n "il -"ng #er,"n" i"

il"*"n ir"8ir" p"" "ri e81& eel" i,#*ln-" ge"l". MRI ""n

,e,perli""n g",#"r"n "*" e*in" -"ng #er",#" #e"r. :"l ini "p"

erli" p"" $5 "* SGB.

7

". e,eri""n er*, 4 #i""n-" nor,"l ""* ,ening" eii.1

#. Biopi oo i" iperl*"n "n #i""n-" nor,"l p"" "i*, "3"l. ""

"i*, l"n* erli" ""n-" denervation atrophy.1

KRI"RIA DIA,N+S"IK

4rieri" i"gnoi SGB ,en*r* 5he )ational Institute of )eurological and

Communicative Disorders and Stro,e ( NINDS).6

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,e>ala uta#a :

1. 4ele,""n -"ng #eri?" progrei? p"" "* ""* le#i ere,i" eng"n ""*

"np" ier"i "";i"

2. Are?lei" ""* ipore?lei" -"ng #eri?" gener"l

,e>ala ta#%a(an :

1. rogrei?i"9 ge"l" ele,""n ,oori #erl"ng*ng ep"+ ,"i,"l "l", '

,ingg*+ 50 ,en"p"i p*n" "l", 2 ,ingg*+ %0 "l", & ,ingg*+ "n

$0 "l", ' ,ingg*.

2. Rel"i? i,eri.

&. Ge"l" g"ngg*"n eni#ili" ring"n.

'. Ge"l" "r"? r"ni"l+ 50 er"i p"ree N >II "n ering #il"er"l. S"r"? o"

l"in "p" eren" **n-" -"ng ,e,per"r"?i li" "n oo8oo ,enel"n+

""ng H 5 "* ne*rop"i i,*l"i "ri oo er"o*ler ""* "r"? o" l"in.

5. e,*li"n9 i,*l"i 28' ,ingg* eel" progrei?i" #ereni+ "p" ,e,"n"ng",p"i #e#er"p" #*l"n.

6. Di?*ngi oono,. T"i"ri "n "ri,i"+ ipoeni po*r"l+ ipereni "n

ge"l" !"o,oor.

7. Ti" "" e,", "" one ge"l" ne*rologi

Pe#eriksaan LCS :

1. ening""n proein

2. Sel MN H 10 /*l

Pe#eriksaan elektrodia&nostik 9 erli" ""n-" perl",#""n ""* #lo p""

on*i i,p*l "r"?

PNA"ALAKSANAAN

S",p"i "" ini #el*, "" pengo#""n pei?i *n* SGB+ pengo#""n er*","

e"r" i,po,"i. T**"n *"," pen""l""n""n ""l" ,eng*r"ngi ge"l"+

,engo#"i o,pli"i+ ,e,perep" pen-e,#*"n "n ,e,per#"ii prognoin-".

eneri" p"" "i*, "3"l perl* ir"3" i r*," "i *n* er* il"*"n

o#er!"i "n"8"n" !i"l. eneri" eng"n ge"l" #er" "r* eger" i r"3" i

r*," "i *n* ,e,"p""n #"n*"n pern"?""n+ pengo#""n "n ?iioer"pi. 7+12+1&

A"p*n pen""l""n""n -"ng "p" il"*"n ""l" 9

7' Fisiotera0i

Fiioer"pi "" e"r" er"*r *n* ,eneg" reeni p**, "n ol"p p"r*.

Ger""n p"i? p"" "i -"ng l*,p* ,eneg" e"*"n eni. Seger" eel"

pen-e,#*"n ,*l"i (?"e reon!"leen)+ ,"" ?iioer"pi "i? i,*l"i *n* ,el"i

"n ,ening""n e*""n oo.7

5' Plasma exchange therapy -P/

l","p"rei ""* plasma e(change #er**"n *n* ,engel*"r"n ?"or

"*o"ni#oi -"ng #ere"r. e,""i"n pl","p"rei p"" SGB ,e,perli""n "il

-"ng #"i+ #er*p" per#"i"n lini -"ng le#i ep"+ pengg*n""n "l" #"n* n"?" -"ng

le#i eii+ "n l"," per"3""n -"ng le#i pene. "* -"ng p"ling e?ei? *n*

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15/17

,el"*"n ""l" "l", 2 ,ingg* eel" ,*n*ln-" ge"l". J*,l" pl"," -"ng

iel*"r"n per e(change ""l" '0850 ,l/g "l", 3"* 7810 "ri il"*"n e,p"

",p"i li," "li e(change. 7

' I#uno&lo%ulin I1 Intravenous inffusion of human Immunoglobulin (I>Ig) "p" ,ener"li"i

"*o"ni#oi p"ologi -"ng "" ""* ,ene"n pro*i "*o "ni#oi ere#*. I>Ig

*g" "p" ,e,perep" ""#oli,e IgG+ -"ng e,*i"n ,ener"liir "nigen "ri

!ir* ""* #"eri eingg" T ell p"ologi i" er#en*.7

engo#""n eng"n g",," glo#*lin inr"!en" le#i ,eng*n*ng"n

i#"ning"n pl","p"rei "ren" e?e ",ping/o,pli"i le#i ring"n. e,#eri"n

I>Ig ini il"*"n "l", 2 ,ingg* eel" ge"l" ,*n*l eng"n oi 0+' g / gBB

/"ri el"," 5 "ri. e,#eri"n io,#in"i"n eng"n I>Ig i" ,e,#eri"n "il

-"ng le#i #"i i#"ning"n eng"n "n-" ,e,#eri"n ""* I>Ig.2+'

4. Kortikosteroid4e#"n-""n penelii"n ,eng"""n #"3" pengg*n""n prep"r" eroi i"

,e,p*n-"i nil"i/i" #er,"n?"" *n* er"pi SGB. Te"pi+ ig*n""n p"" SGB ipe

ID.%+11

K+MPLIKASI

4o,pli"i -"ng "p" er"i ""l" g"g"l n"p"+ "pir"i ,""n"n ""* "ir"n

e "l", p"r*+ pne*,oni"+ ,ening""n reio er"in-" in?ei+ ro,#oi !en"

"l",+ p"r"lii per,"nen p"" #"gi"n *#* eren*+ "n onr"*r p"" eni.7+12

PR+,N+SIS

"" *,*,n-" peneri" ,e,p*n-"i prognoi -"ng #"i+ e"pi p"" e#"gi"n

eil peneri" "p" ,eningg"l ""* ,e,p*n-"i ge"l" i". eneri" SGB "p"

e,#* e,p*rn" (758$0) ""* e,#* eng"n ge"l" i" #er*p" dropfoot ""*

re,or po*r"l (258&6).7

en-e,#*"n "p" ,e,""n 3"* #e#er"p" ,ingg* ","p"i #e#er"p" "*n.

Men*r* )ational Institute of )eurological Disorders and Stro,e ei"r &0 peneri"

,"i ,eng"l",i ge"l" i" eel" & "*n (ge"l" i" ring"n "p" ,ene"p p""

peneri"). 4el*"r"n peneri" ""n ,en"i "ng" #"i #il" ge"l"8ge"l" "p" il"ng

"l", 3"* & ,ingg* e" ,*n*l ge"l" ere#* ,*n*l.6

4el"in"n ini *g" "p" ,en-e#"#"n e,"i"n+ p"" & p"ien+ -"ng

ie#"#"n ole g"g"l n"p" "n "ri,i". Ge"l" -"ng er"in-" #i""n-" il"ng &,ingg* eel" ge"l" per"," "li i,#*l. Sei"r &0 peneri" ,e,ilii ge"l" i

ele,""n eel" & "*n. Tig" peren p"ien eng"n SGB "p" ,eng"l",i rel"p

-"ng le#i ring"n #e#er"p" "*n eel" one per",". 6+7+%

Bil" er"i e",#*"n ""* i" "" per#"i"n p"" "ir ,ingg* I> ,""

er,"* Chronic Inflammantory Demyelinating Polyradiculoneuropathy (ID).1+$

DAF"AR PUS"AKA

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16/17

1. Soll BJ+ 4lieg,"n RM. Behrman')elson Pediatric 5e(tboo, . enn-l!"ni"

9S"*ner in+ 200'.

2. A", RD+ >ior M+ Ropper A:. Principles of )eurology 6th 7d . SA 9 MGr"3:ill+ 2005.

&. D"!i :R. "uillain'Barre Syndrome' Available from 9 R 9

p9//e,eiine.,e"pe.o,/"rile/&156&28o!er!ie3. i"e "ngg"l 2& J*ni

2011K. #ast 8pdate L 2011.

'. Mene J:+ S"rn" :B+ Moer FG. Child )eurology 9 th 7d . onon 9 illi",

ilin+ 2000.

5. S"? eng""r F4 I. Il,* 4ee""n An". J""r" 9 F4 I+ 1$%5.

6. N"ion"l Ini*e o? Ne*rologi"l Diorer "n Sroe. "uillan'Barre Syndrome.

200$. Available from 9 R 9

p9//333.nin.ni.go!/iorer/g#/g#.,*#li"ion. i"e "ngg"l 22

J*ni 2011K. #ast update L 2011.7. J"p"ri I. Sinro," G*ill"n8B"rre. F4 S B"gi"n Be". Available from 9 R 9

p9//li#r"r-.**.".i/o3nlo"/?/#e"8i"n"r20"p"ri'6.p? . i"e

"ngg"l 22 J*ni 2011K. #ast update L 2002.

%. ilinon I+ enno; G. 7ssential )eurology /th 7d . 4 9 Bl"3ell *#liing+

2005.

$. R",""nr"n TS. Acute Inflammatory Demyelinating Polyradiculoneuropathy%

Available from 9 R 9 p9//e,eiine.,e"pe.o,/"rile/116$$5$8o!er!ie3.

i"e "ngg"l 22 J*ni 2011K. #ast update L 200$.

10. Miller A. "uillain'Barre Syndrome' Available from 9 R 9

p9//e,eiine.,e"pe.o,/"rile/7$200%8o!er!ie3. i"e "ngg"l &

Sepe,#er 200$K. #ast update L 200$.11. e3i RA. Chronic Inflammatory Demyelinating Polyradiculoneuropathy'

Available from 9 R 9 p9//e,eiine.,e"pe.o,/"rile/1172$658o!er!ie3.

i"e "ngg"l 2& J*ni 2011K. #ast update L 2010.

12. M"-o lini S"??. "uillain Barre Syndrome. Available from 9 R 9

p9//333.,"-olini.o,/e"l/g*ill"in#"rre-nro,e/DS00'1&/ i"e

"ngg"l 2& J*ni 2011K.

1&. ,eiine S"??. "uillan'Barre Syndrome. Available from 9 R 9

p9//333.e,eiinee"l.o,/g*ill"in8#"rreO-nro,e/"rileOe,.,. i"e

"ngg"l 2' J*ni 2011K.

Laporan Kasus

16

http://library.usu.ac.id/download/fk/bedah-iskandar%20japardi46.pdfhttp://emedicine.medscape.com/article/1169959-overviewhttp://emedicine.medscape.com/article/1172965-overviewhttp://www.emedicinehealth.com/guillain-barre_syndrome/article_em.htmhttp://emedicine.medscape.com/article/1169959-overviewhttp://emedicine.medscape.com/article/1172965-overviewhttp://www.emedicinehealth.com/guillain-barre_syndrome/article_em.htmhttp://library.usu.ac.id/download/fk/bedah-iskandar%20japardi46.pdf


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SINDR+M ,UILLAIN !ARR

Disusun ole( :

Mu(a##ad Sukri Dini(ar

6?6@777?4

Pe#%i#%in& : dr' Riki Sukiandra9 S0'S

Ke0aniteraan Klinik Senior -KKS/ – !a&ian Il#u Saraf

Fakultas Kedokteran Uniersitas Riau

RSUD Arifin A.(#ad

Pekan%aru

5677

17

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