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Department of Neurology RSMH Palembang
Faculty of Medicine University of Sriwijaya
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By:
Ade Ramadhani, S.Ked
Rhonaz Putra Agung, S.KedAdvisor: Dr. H. A. R. Toyo, Sp.S (K)
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IDENTIFICATION
Mr.A/11 years old/Male/Islam/
Banyuasin/ August 28th 2010
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ANAMNESIS
The patient was admitted to Neurologyward RSMH because of the weakness onboth leg which happened gradually
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6 years before admitted to the hospital, patients was
experiencing hard to stand in foot. accompanied by
weakness in both legs, which becomes increasingly severe.
The weakness between right leg and left leg was felt same.
The patient can't move right leg and left leg was felt same at
all. He could express his mind by talking, writing, giving sign
and mentally health.
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ANAMNESIS
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3 years before admitted to thehospital, the symptoms still the same.The patient complained it is difficult to
stands for both legs felt weak.weakness becomes increasinglysevere. Patient cant run and jumparound like a child commonly. The
buttocks and thigh are weaker thanfoot and walking shouldguided.
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2 years before admitted patients can
only lying and sitting on the floor, and
both his knees hard to straightened.
Patients need to be assisted when goingto the bathroom.
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2 years before admitted bothshoulders and upper arms Start weak.
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ANAMNESIS
6 months before admitted patient
experiencing weaknes more severe and
felt his muscular leg tinier.
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There are history of the same
disease in family, getting common cold.
No fever before. There's no history
diabetes mellitus. And have delay ofdevelopment movement
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ANAMNESIS
This illness was the happened for the
first time for him.
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Growth History
The patient was born spontaneously, aterm, andburst into tears.
Patients started on his stomach four months of age,sitting at seven months, and is not accompaniedcrawl first, patients direct running at the age of 18
months, ran at the age of two years, but frequentstops.
When patients want to stand from a seated positionhave trouble standing straight with both handsholding the knee to climb his own legs.
At the age of seven years unable to jump. Patientseasily dropped, if runs slow, Mental status and goodcommunication.
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pedigree
PATIENT
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Physical Examination
Generalis Status
Sens : compos mentis
(GCS=E4M6V5)
Temp. : 36,8C
Pulse : 100 x/minuteRespiratory rate : 20 x/minute
Blood Pressure : 120/70 mmHg
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Physical Examination
Neurological Status
Nn. Craniales
No abnormality
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Physical Examination
Motorik Fungtion Arm Leg
Right Left Right Left
Motion Decrease Decrease Decrease Decrease
Power 4 4 3 3
Tonus Decrease Decrease Decrease Decrease
Klonus - -
Physiological R. Decrease Decrease Decrease Decrease
Patological R. - - - -
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Physical Examination
Sensorik function : no abnormality
Vegetatif function : no abnormality
Limbic function : no abnormalityMES : no
Abnormal Movement : no
Gait & Stability : not assesed yet
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Laboratory Findings
Blood ( August 28th 2010 )
Hb, Ht, Leukosit, LED, Trombosit, Diff.count, BSS, HDL,
LDL, Trigliserida, Cholestrol total, SGOT, SGPT,, Ureum,
Creatinin, Protein Total, Albumin, Globulin, Na, K, Ca :
normal.
Uric Acid : 9,6 mg/dl( 3,5=7,1 ) increase.
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Laboratory Findings
Urine ( August 28th 2010): Normal
Rontgen Thorax (August 28th 2010): normal
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DIAGNOSIS
Clinical diagnosis :Duchenne Muscular
Dystrophy
DD : - Gullian Barre Syndrome
- Bekker Muscular Dysthrophy Topic diagnosis : Muscle
Etiology diagnosis : X-linked genetik
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MANAGEMENT Medicine :
- IVFD NACl 0,9 % gtt xx/M- Vit B1B6B12 3x1 tab
- Metilprednisolone 3x4 mg
- diet porridge
Planning: EMGmuscle biopsy
Physiotherapy:- Bed positioning- Infra Red Radiation left side extremity
- Bobath therapy
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PROGNOSIS
Quo ad vitam : dubia ad
malam
Quo ad functionam : dubia ad
malam
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CASE ANALYSIS
Clinical diagnosis
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Clinical diagnosis
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1. Gullian Barre Syndrome,
signs:
In the patient, signs :
- motoric deficit - motoric deficit
- symptoms was found after
infection- No infection was found
- Happen in female and male- Only happen in male
- No family history of same
disease
-Family history of same
disease is present
So, the possibility of Gullian Barre Syndrome can be excluded
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1. Bekker Muscular Distrophy
, signs:
In the patient, signs :
- motoric deficit - motoric deficit
- begin after age 5- begin after age 5
- progressivity is slow- Progressive
So, the possibility of Bekker Muscular Distrophy can be excluded.
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1. Duchenne Muscular
Distrophy, signs:
In the patient, signs :
- motoric deficit - motoric deficit
- progressive- progressive
- begin before age 5- begin before age 5
- Onset gradually- Onset gradually
- Family history of same
disease is present
- Family history of same
disease is present
So, the possibility of Duchenne Muscular Distrophy can be made
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Clinical Diagnosis
Duchenne Muscular Distrophy
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THANKS