Protap Ilmu Penyakit Saraf

STANDAR PELA PEL AYANAN ANAN MEDIS MEDIS

SMF SARAF

RUMAH SAKIT UMUM DAERAH ULIN BANJARMASIN 2007 0

2007 RSUD ULIN Jl. A. Yani 43 Telp.257472 / 252180 Fax.252229 an!a"#a$in

%&NAN'ANAN %ASI&N

N(. D()*#en

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1 / 41

Tanal Te"i  %R-S&DUR

N(. Re+i$i

1 J*li 2003

Dieap)an Di"e)*" R*#a Sa)i U#*# Dae"a Ulin an!a"#a$in

Tanal Re+i$i  T&TA%

1. Diagnosis 2. ICD

/. Ki"ia

De$e#e" 200

D". ,. Ai#an* Sp%D6'&, %e#ina Ua#a *a NI%. 140 159 19

NYERI KEPALA A. Tgang !"o" #Tnsion "$% &a'a(&)* ++.2 1. E%iso'i(,"nsion,"$% &a'a(& #* ++.20-* ++.21) 2. C&oni(,"nsion,"$% &a'a(& #* ++.22- * ++.2/) B. Migain #* +/) 1. Tan%a aa #* +/.0) 2. Dngan aa #* +/.1) C. Pas(a Taa #* ++.) 1. A(" %os""aa"i( &a'a(& #* ++.0) 2. C&oni( %os""aa"i( &a'a(& #* ++./) D. Na3gia Tigina3 #* ++.+7) E. N$i K%a3a To !"a4 #* ++.22) A. Tgang !"o" 1. S4a S4ang, ng,4 4an angn$ gn$aa "'a% "'a%a" a" 10 %iso' %iso' sanga sangan n o n$i 4%a3a 4ang 'ai 10 &ai5"a&n o N$i 4%a3a 63angsng 'ai /0 ni" sa%ai 7 &ai S'i S'i4i 4i"n "n$a $a i i3i4 3i4ii 2 4aa 4aa4" 4" is" is"i4 i4 n$i n$i 4%a 4%a3a 3a o 6i4"  , 3o4asi 6i3a"a3 , n n4a 4an n a"a a"a n ngi gi4a 4a"" #"i' #"i'a4 a4 6 6' 'n$ n$") ") , In" In"ns nsi" i"as as ing ingan an a"a a"a s'a s'ang ng , Ti'a4 'i%6a" o3& a4"i8i"as " "in s% s%" "i 69a3an a"a nai4 "angga Ti'a4 'i9%ai  o , Ma3 Ma3 a"a a"a  n n"a "a& & #6is #6isaa ano ano4 4si sia) a) , L6i& 'ai sa" 43&an  :o"o:o6ia a"a :ono:o6ia Ti'a4 64ai"an 'ngan 43ainan 3ain o 2. o Ra"a,a"a Ra"a,a"a :4nsi :4nsi sangan sangan n$i n$i 4%a3a 36i& 6sa

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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(. ,ala#an

1 / 41


N(. Re+i$i

1 J*li 2003



1. Diagnosis 2. ICD

/. Ki"ia

De$e#e" 200


NYERI KEPALA A. Tgang !"o" #Tnsion "$% &a'a(&)* ++.2 1. E%iso'i(,"nsion,"$% &a'a(& #* ++.20-* ++.21) 2. C&oni(,"nsion,"$% &a'a(& #* ++.22- * ++.2/) B. Migain #* +/) 1. Tan%a aa #* +/.0) 2. Dngan aa #* +/.1) C. Pas(a Taa #* ++.) 1. A(" %os""aa"i( &a'a(& #* ++.0) 2. C&oni( %os""aa"i( &a'a(& #* ++./) D. Na3gia Tigina3 #* ++.+7) E. N$i K%a3a To !"a4 #* ++.22) A. Tgang !"o" 1. S4a S4ang, ng,4 4an angn$ gn$aa "'a% "'a%a" a" 10 %iso' %iso' sanga sangan n o n$i 4%a3a 4ang 'ai 10 &ai5"a&n o N$i 4%a3a 63angsng 'ai /0 ni" sa%ai 7 &ai S'i S'i4i 4i"n "n$a $a i i3i4 3i4ii 2 4aa 4aa4" 4" is" is"i4 i4 n$i n$i 4%a 4%a3a 3a o 6i4"  , 3o4asi 6i3a"a3 , n n4a 4an n a"a a"a n ngi gi4a 4a"" #"i' #"i'a4 a4 6 6' 'n$ n$") ") , In" In"ns nsi" i"as as ing ingan an a"a a"a s'a s'ang ng , Ti'a4 'i%6a" o3& a4"i8i"as " "in s% s%" "i 69a3an a"a nai4 "angga Ti'a4 'i9%ai  o , Ma3 Ma3 a"a a"a  n n"a "a& & #6is #6isaa ano ano4 4si sia) a) , L6i& 'ai sa" 43&an  :o"o:o6ia a"a :ono:o6ia Ti'a4 64ai"an 'ngan 43ainan 3ain o 2. o Ra"a,a"a Ra"a,a"a :4nsi :4nsi sangan sangan n$i n$i 4%a3a 36i& 6sa

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a"a saa 'ngan 1; &ai563an #10 &ai5"a&n) B. Migain 1. Mign "an%a aa o S4 S4a ang ng,4 ,4a ang ngn$ n$aa "9a "9a'i 'i ; san sanga gan n n$i n$i 4%a 4%a3a 3a 6 63a 3ang ng 'ng 'ngan an ani ani:s :s"as "asii san sanga gan n 63angsng +,72 9a- $ang %n$ai s'i4i"n$a 2 4aa4 4aa4" "is is"i4 "i4 6i 6i4 4""  ni3 ni3a" a"a a33- 6' 6'n n$ $""in" in"ns nsi"a i"ass s'an s'ang g a"a a"a 6a" 6a"-- 6" 6"a a6a 6a& & 6a" 6a" 'ngan a4"i8i"as :isi4 o S3aa n$i 4%a3a 'is"ai sa3a& sa" 6i4"  nasa 'an a"a n"a&- :o"o:o6ia 'an :ono:o6ia. o Sa Sang ngan an n$i n$i 4%a 4%a3a 3a "i'a "i'a4 4 64 64ai ai"a "an n 'ng 'ngan an 43ainan $ang 3ain 2. Mign 'ngan aa S4 S4a ang ng,4 ,4a ang ngn$ n$aa "9a "9a'i 'i 2 san sanga gan n n$i n$i o 4%a3a 4%a3a 63ang 63ang $ang 'i'a&3i 'i'a&3i g9a3a no3ogi no3ogi :o4a3 $ang 8si63 s(aa 6"a&a% ; < 20 ni" 'an 63angsng 4ang 'ai =0 ni". T'a% 'a%a" a" s'i4i s'i4i"n$ "n$aa sa" aa aa 6i4 6i4"" ini $ang $ang o 8 8si si6 633 s%" s%"ii gang gangg gan an 8is 8isa3 a3-- gang gangg gan an snsois- ganggan 6i(aa 'is:asia. o Pa3ing s'i4i" 2 'ai 4aa4"is"i4 6i4"  , *9a3 *9a3aa 8isa 8isa33 &oo &ooni ni 'an 'an5a 5a"a "a  g9a3 g9a3aa snso snsois is ni3a"a3 , Pa3i Pa3ing ng "i'a "i'a4 4 "i "i63 63 sa" sa" a(a a(a  aa aa s(a s(aa a ga'a3 > ; ni" 'an 5 a"a 9nis aa 3ainn$a > ; ni". , Tia% g9 g9a3 a3aa 63 63an ang gsn sng > ; ni ni"" 'an ? =0 ni". o Ti'a4 64ai"an 'ngan 43ainan 3ain. C. Pas(a Taa 1. A(" Pos""aa"i( &a'a(& K3inis  N$i 4%a3a- "i'a4 4&as  o T'a% 'a%a" a" "a "aa a 4%a 4%a3a3a- 'ia 'iana na n$i n$i 4%a 4%a3a 3a "9a'i "9a'i 'a3a 7 &ai &ai s"3a& s"3a& "aa "aa 4%a3a 4%a3a a"a ss'a& 4sa'aan %n'i"a %3i& 46a3i. T'a%a" T'a%a" sa" a"a 36i& 4a'aan 'i 6a@a& ini  o , N$ N$ii 4%a3a a3a &i3ang 'a3a / 63an s" "3a& "aa 4%a3a. , N$ N$ii 4%a3a n"a% "a%- ""a%i "i'a4 36i& / 63an s9a4 "aa 4%a3a. 2. C&oni( Pos""aa"i( &a'a(& o N$i 4%a3a- "i'a4 4&as o T'a% 'a%a" a" "a "aa a 4%a 4%a3a3a- 'ia 'iana na n$i n$i 4%a 4%a3a 3a "9a'i "9a'i 'a3a 7 &ai &ai s"3a& s"3a& "aa "aa 4%a3a 4%a3a a"a ss'a& 4sa'aan %n'i"a %3i& 46a3i. o N$i 4%a3a 63angsng 36i& 'ai / 63an s"3a& "aa 4%a3a.

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+. Diagnosis Ban'ing ;. Pi4saan Pnn9ang

=. Kons3"asi

7. Pa@a"an RS

D. Na3gia Tigina3 o Sangan n$i %ao4sisa3- s%on"an- "i6a,"i6a- n$i "a9a- s%:isia3- s%"i 'i "s4- "s"- "6a4a %a'a @a9a& a"a :on"a3 #n$a ni3a"a3) 66a%a '"i4 sa%ai  2 ni"- 63ang- "6a"as %a'a > 1 (a6ang N. Tigins Tigins #N. ). N$i n n$a $a isi isi 'a3a 'a3a 9ang4a 9ang4a @a4" @a4" 68a 68aiasi iasi.. In"ns In"nsi"a i"ass n$i n$i 6a" 6a" %si% %si%i"as i"asii 'a%a" 'a%a" 'ai 'ai "igg "igg  aa #%3i4a naso3a6ia3is 'an 5 %i%i) a"a %a'a a4"i8i"as &aian &aian s%"i s%"i 6i(aa6i(aa- 6as 6as& & 4a4a- n(4 n(4  9nggo"- goso4 gigi #trigger #trigger factors). factors). Bn"4 sangan asin asing, g,asi asing ng %asi %asin n saa saa.. Dian Dian"a "aaa sa sang ngan an n$a n$a asi"oa"is. asi"oa"is. Un$a Un$a "i'a4 a'a ':isi" ':isi" no3ogi4. E. N$i 4%a3a "o o"a4 o N$i 'a%a" 6%a 6a" s%"i 'i"s4- 6'n$" $ang $ang :4n :4nsi si sanga sangan n 'an in"ns in"nsi"a i"asn$ sn$aa a4in a4in 3aa a4in &6a" 'an 4a'ang,4a'ang 'ii4"i n"a& %o$4"i3. Bgan"ng 3o4asin$a 'i o"a4- g9a3a no3 o3ogis 'a%a" "i63 a"a "i'a4. *9a3a a3a no3 no3ogi ogiss  49ang 49ang :o4a3:o4a3- ono% ono%a ass- gangg ganggan an snsi6i3i"as- ganggan %ng3i&a"an- ganggan n"a3 %3%a - 'an 3ain,3ain. o N$i 4%a3a %n$a4i" 3ain  THTTHT- gigi 3"- a"a&i%"nsi- %n$a4i" 'ngan 'a o *anggan %si4osoa"is A.N$i 4%a3a "gang o"o"- 4a3a ag,ag 'a%a" 'i3a44an %i4saan EM*) B. N$i 4%a3a 8as43- 4a3a &6a" sangann$a  EE*:o"o "ng4oa4- Mign 43asi4 'ngan sangan &6a" 'an ign ign 4o%3i 4o%3i4a" 4a"aa 'a%a" 'a%a" 'i%"i 'i%"i6a 6ang4 ng4an an a"io a"ioga ga:i :i a"a CT,S(an CT,S(an o"a4 'ngan 4on"as C. N$i 4%a3a %as(a"aa %as(a"aa 'a%a" 'i%"i6an 'i%"i6ang4an g4an EE* n"4 8a3asi 4a9an D. Na3g Na3gia ia Tig Tigin ina3 a3 "i'a4 "i'a4 3 34an 4an %i %i4sa 4saan an %nn9ang- 4(a3i  a'a ':isi" no3ogis $ang ngaa& %a'a 43ainan no3ogis :ngsi s4n' %3 'i3a44an %i4saan a'io3ogi #:o"o "ng4oa4- CT,S(an CT,S(an a"a MRI) E. N$i 4%a3a "o o"a4  &as 'i3a44an %i4saan on"g on"gn n "ng4o "ng4oa4 a4-- EE* 'an a"io a"ioga ga:i :i a"a a"a 3angs 3angsng ng CT,S(an o"a4. o Bgan"ng 4ass  Pn$a4i" Da3a- THTTHT- Ma"a- gigi, 3"3"- 6'a& saa:- %si4osoa"i %si4osoa"iss- 4a3a 'i%34an 'i%34an n"4 n"4 n(ai %n$6a6 4s"a4ania3 a"a %ngo6a"an 3an9". Ra@a Ra@a"" 9a3an 9a3an %a'a %a'a n$i n$i 4%a 4%a3a 3a "ga "gang ng o"o" o"o"-- n$i n$i o 4%a3a %as(a "aa a"a na3gia "igina3 o Ra@a" Ra@a" ina% ina% %a'a %a'a n$i n$i 4%a3a 4%a3a 8as4 8as43 3 'i%3 'i%34a 4an n

/

%a@a"an &an$a %a'a s"a"s igns #o6a" "i'a4 no3ong) %a'a ign 4o%3i4asi N$i 4%a3a "o o"a4 &as 'ia@a" n"4 o 4s%3oasi 'an o%asi. . Ta%i A. N$i 4%a3a "gang o"o" Ana3g"i4 'an %3as o"o" #%nnang)  'ia%ao %o6aa" Psi4o"a%i s%o"i: 4a3a 'i%34an. Fisio"a%i  %anasan 'an asas o"o" 4'4 o #4%a3a) 4a3a 'i%34an. B. N$i 4%a3a 8as43 o Is"ia&a"- ana3g"i4 'an %nnang o aso4ons"i4si  4a:go" /  ,1 "a63" #"i'a4 6o3& %a'a @ani"a &ai3 'an %n'i"a 4a'io8as43) o Sa"i%"an 1 "a63" o F3naiin 1  ;,20 g o Ka3a sangan sing  si%o&%"a'in- %o%ano3o3 a"a %o"i:n- n"4 %n(ga&an o Hin'ai :a4"o %n("s C. N$i %as(a "aa Ana3g"i4 o o Mino "ansi3i o An"i "igo #%o43o%ain'i:n&i'ain 6"a&is"in) 6i3a a'a 8"igo o Psi4o"a%i #4a3a %3) D. Na3gia "igina3 Ana3g"i4 'an %nnang o o Di:n&i'an"oin /  100 g o Ka6aa%in /  ,1 "a63" G 200 g #o6a" %i3i&an) . S"an'a RS Sa RS. K(a3i %a'a 4ass $ang 34an o "in'a4an in8asi: o%asi &as RS "i% A5B $ang %n$ai Do4" S%sia3is B'a& Saa: o 10. Pn$3i" Han$a %a'a "o o"a4 $ang 6si:a" ganas a"a $ang 3"a4n$a 'a3a '4a" 6a"ang o"a4 o 11. In:o' P3 ""3is- &an$a %a'a 4ass $ang 34an Consn" "in'a4an in8asi: 'an o%asi 12. Tnaga S"an'a o Do4"  o Bi3a 43&an "i'a4 &i3ang- a%a3agi 6"a6a& 6a" a"a 'i'a%a"i 43ainan no3ogis #ign 4o%3i4a"a"o o"a4) &as 'i94 4 Do4" A&3i Saa: o 1/. Laa Bo6a" 9a3an- 4(a3i %a'a s"a"s ign 4o%3i4a"a Pa@a"an 'an "o o"a4 &as 'ia@a" $ang 3aan$a 6gan"ng %a'a 6a" a"a s3i" 4ass "s6" 1+. Masa Bgan"ng 4a'aan asing,asing o P3i&an 1;. Hasi3 Pa'a n$i 4%a3a "gang 'an %as(a "aa %a'a o n$a s6& "o"a3

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1 J*li 2003



1. Diagnosis 2. ICD

/. Ki"ia

EPILEPSI *.+0 A. Mn" 6n"4 sangan E%i3%si  #gan' a3 No. ICD *.+1.0  P"i" o a3 No. ICD *.+1.1  io43ons 'an 3ain,3ain). o E%i3%si 8o4a3 #o"ois- snsi6i3i"as- %asia3 4o%34s 'an 3ain,3ain). No. ICD *.+1.2 o S"a"s 4on83sis 5 s"a"s %i3%"i4is *.+1 B. Mn" %n$6a6  o I'io%a"is o Si%"oa"is K3inis  Sa" 4a'aan no3ogi4 $ang 'i"an'ai o3& 6ang4i"an %i3%si $ang 63ang- $ang "i63 "an%a %o8o4asi. S'ang4an 6ang4i"an %i3%si sn'ii a'a3a& sa" ani:s"asi 43ini4 $ang 'is6a64an o3& 3%asn$a a"an 3is"i4 $ang a6noa3- 636i& 'an sin4on- 'ai non $ang #""aa) "3"a4 %a'a 4o"4s s6i. A4"i8i"as %ao4sisa3 a6noa3 ini n$a "i63 in"i""n 'an  self- limited’. Sin'oa %i3%si a'a3a& %n$a4i" %i3%si $ang 'i"an'ai o3& s4%3an g9a3a $ang "i63 6saaan #"as4 "i% 6ang4i"an- "io3ogi- ana"oi- :a4"o %si%i"an sia saa" a@i"an- 6a"n$a %n$a4i"- si43s &aian 'an %ognosa). A. Ki"ia Diagnosis o *9a3a s6i :o4a3 a"a  #%nnan ganggan

;

+. Diagnosis

;. Pi4saan Pnn9ang

=. Pa@a"an RS

7. Ta%i

4sa'aan- 49ang- %as"si 'an 3ain,3ain) $ang "i63 63ang B. E%i3%si Fo4a3 o Mani:s"asi 43inis :o4a3 a"a ani:s"asi 43inis 3ain $ang 'i"n9ang 'ngan 43ainan EE* :o4a3 #(on"o&  %i3%si %asia3 4o%34s 5 %i3%si 3o6s "%oa3is%i3%si :o4a3 s'&ana 'an 3ain,3ain). C. E%i3%si Si"oa"is E%i3%si "s6" %a4an g9a3a 'ai sa" o %n$a4i" #"o- CD 'an 3ain,3ain). P3 'i(igai %i3%si si"oa"is 6i3a  6n"4 sangann$a :o4a3%i3%si 3ai %a'a sia 36i& 'ai 20 "a&n- %i3%si %ogsi:- %i3%si $ang s3i" 'i"angg3angi 'ngan o6a". D. S"a"s Kon83sis Sangan 49ang  $ang 63angsng 3aa #36i& o 'ai /0 ni") a"a sangan 49ang "an%a %3i&an 4sa'aan K9ang 'a o o Sin4o% o Na4o3%si o Mign Ba"& Ho3'ing S%33s o His"ia o EE*- :o"o %o3os 4%a3a  'i3a44an 6i3a a3a" "s'ia o CT,S(an 4%a3a- %ngsi 36a3  'i3a44an a"as o in'i4asi #6i3a 'i%i4i4an %i3%si si%"oa"is) Un"4 'a%a" 3i&a" :4 sa%ng o6a" 'an %n$6a6 o 49ang 'a%a" 'i%i4sa o Daa& %i: 3ng4a% #DPL)- :ngsi &a"i- :ngsi gin9a3 #n"4 4on"a'is4si o6a")- 34"o3i" #Na- K- Ca- C3)g3a 'aa&- 4a'a o6a" #4a3a %3) Ra@a" 9a3an o Ra@a" ina% 6i3a %i3%si si%"oa"is 'an %3 o 4s%3oasi Ra@a" ina%  6i3a s"a"s 4on83si o %"in$ip  o Sga s"3a& 'iagnosis- gna4an sa" 9nis o6a" 4o6inasi o6a" 'igna4an 6i3a "i'a4 ""angg3angi 'ngan sa" 9nis o6a". Pa'a @ani"a $ang asi& ng4in &ai3 gna4an Ka6aa%in- @ani"a &ai3 $ang "3a& nggna4an o6a" 3ain 3an9"4an %ngo6a"an. Dosis 'inai44an 6"a&a% sa%ai sangan 6&n"io 3a3 %"a&an4an 2,+ "a&n 66as sangan- 4'ian 'i"n4an 6"a&a%. -a an i*na)an  Fno6a6i"a3  1,; g54gBB o Fni"oin  ;,10 g54gBB 'osis 6iasa 3ai 'ngan o =

. S"an'a RS . Pn$3i"

10. In:o' Consn" 11. Tnaga S"an'a 12. 3aa Pa@a"an

/00 g5&ai o K3ona%a 0-0;,0-2 g54gBB- 3ai 'ngan 'osis 4(i3 ""aa 'igna4an %a'a %i3%si Mio43oni4 'an P"i" Ma3 %enaala)$anaan S"a"s Kon83si o T9an ng&i3ang4an 49ang "'4 36i& 'ai =0 ni" "'ii a"as  Taap I E8a3asi %n'i"a 0,1; ni" o o P6ai4i sis" 4a'ios%iasi o !4sign 6i3a %3 o Ba" 'iagnosis Pasang in:s o La44an %i4saan 3a6oa"oi  DPL- 34"o3i"o - 4a"inin- 4a'a o6a" an"i%i3%si- Drug Sreen Metabolic Sreeen o *34osa 2; g i8 Taap II Mng&n"i4an 49ang 'a3a 20,/0 ni"- 4'ian o Dia%a I 2 g5ni" 'ngan 'osis 10,+0 g #&a"i,&a"i '%si %na:asan). Bsaaan 'ngan Dia%a 6i4an in:s Fni"oin 20 g54gBB 'a3a NaCL :isio3ogis 'ngan 4(%a"an "i'a4 36i& 'ai ;0 g5ni" #a@asi EK*) 'an "4anan 'aa&) Taap III S"3a& /0 ni" s3an9"n$a  o , In"6asi- %asang EE*- %"i6angan ans"si - sn"aa i" 'i3a44an  , In:s Fni"oin "a6a&an 10 g54gBB a"a Fno6a6i"a3 'ngan 4(%a"an "i'a4 36i& 'ai 100 g5ni" #%&a"i4an &i%o"nsi) Bo3s Li'o4ain 2 g54gBB I 'i i4"i 'ngan in:s o /,10 g54gBB59a Taap I: o La44an anas"si  %a'a $ang :a4" o Ps4sas5sa RS #n"4 s"a"s 4on83si 36i& 6ai4 6i3a a'a 'iang ICU) Ra4si a3gi #(on"o&  Sin'o S"8n Jo&nson) o o E' s6i 4ana ganggan %na:asan a4i6a" 49ang,49ang "s,ns %a'a s"a"s 4on83si A3a" 4a'ios%"o $ang "i'a4 sia% %a4ai a"a o "3a6a" 6"in'a4 o P3 ""3is o o

Do4" - 6i3a "i'a4 a'a Do4" A&3i saa: Pa'a s"a"s 4on83si  sa%a 49ang "a"asi4sa'aan %3i& 'an 4a'aan  "3a& ng4in4an 7

o

1/. Masa P3i&an 1+. Pa"o3ogi 1;. A"o%si

o

o o

n"4 6o6a" 9a3an Pn'i"a 6o6a" 9a3an s4ang,4angn$a 2,; "a&n 66as sangan Pa'a s"a"s 4on83si 36i& 4ang 1 ingg Jaang- 6i3a 4asan$a 'i o%asi #isa3 "o) Bi3a 'i%34an


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1. DIA*N!SIS 2. ICD /. Ki"ia


De$e#e" 200


*AN**UAN PEREDARAN DARAH !TAK #STR!KE) *.+;- *.+=- I. =0- I.=1 o S"o4 a'a3a& ani:s"asi 43ni4 'ai ganggan :ngsi s6a3- 6ai4 :o4a3 a%n n$3& #g3o6a3)- $ang 63angsng 'ngan (%a" 36i& 'ai 2+ 9a- a"a 6a4&i 'ngan a"- "an%a 'i"4ann$a %n$6a6 s3ain 'ai %a'a ganggan 8as43a Jeni$ S"()e a. S"o4 Non Hoagis , Tansin" Is4i( A""a(4 #TIA)- R8si63 Is4i( No3ogi( ':isi" #RIND) #*.+;) , To6osis s6i , E6o3i s6i 6. S"o4 Hoagis , P'aa&an In"as6a3 #I.=1) , P'aa&an S6aa4&noi' #I.=0) Taaa 4a%i"is o o Ens:a3i"is o To !"a4 o La6oa"oi  H6- H"- L4osi"- LED- To6osi"Aggasi "o6osi",8is4osi"as %3asa #6i3a ng4in)3i%i'- g3a- asa a"- - 4a"inin- &oosis"in-



=. Kons3"asi

7. Pa@a"an RS . Ta%i

@a4" %'aa&an- @a4" %64anas"%- 34"o3i"in "in Pngsi 36a3 #a"as in'i4asi) o EK* o o Ra'io3ogis  :o"o "&oa4s- "ng4oa4- 3&- CT,s(anMRI- Do%3 U3"ason'- a"ioga:i #6i3a a'a) Pn$a4i" Da3a #*in9a3- Hi%"nsi- En'o4ino Ka'io3ogi) n"4 4on:iasi 43ainan ogan "4ai" o B'a& s$aa:- n"4 4ass &oagis $ang %3 'i o%asi #anisa- AM- 8a4asi &a"o) o B'a& 8as43- s34"i: n"4 4ass "o6osis- a"i 4s"a4ania3 #"o6on'a"4"oi) Pn'i"a 6a #4ang 'ai s%3& &ai) o Pn'i"a 'ngan g9a3a 43inis $ang %ogsi: o a. Se;a"a U#*# 1. U Di"94an "&a'a% :ngsi 8i"a3  %a,%a- 9an"nggin9a3- 4si6angan 34"o3i" 'an (aian gii- &igin 2. K&ss Pn(ga&an 'an %ngo6a"an 4o%3i4asi R&a6i3i"asi Pn(ga&an s"o4  "in'a4an %oo"i:- %i 'an s4n' . Se;a"a 6*$*$ 1. S"o4 Is4i45In:a4 o An"i aggasi %3a"3" as%iin- "i43o%i'in43o%i'og3- 'i%ii'ao3 o To6o3i"i4  ",PA #&as n&i 4i"ia in43si) o An"i4oag3an  &%ain- LMH- &%ainoi' #n"4 so4 6o3i) #*i'3in s S"o4 200+) o No%o"4"an 2. P'aa&an S6aa4&noi' o An"i s%aso8as o No%o"4"an /. P'aa&an In"as6a3 6(n$e"+ai< o M%6ai4i :aa3 &os"asis #6i3a a'a ganggan :aa3 &os"asis) o Mn(ga&5nga"asi 8asos%as o"a4 a4i6a" %'aa&an  Nio'i%in o No%o"4"an -pe"ai<  'i3a44an %a'a 4ass $ang in'i4a"i:5ng4in4an o o3 %'aa&an 36i& 'ai / (( a"a 'ia" / ( %a'a :ossa %os"io o L"a4 3o6a 'an 4o"i4a3 'ngan "an'a,"an'a %ninggian TIK a4" 'an an(aan &niasi o"a4 o P'aa&an s633 

&i'os:a3s a4i6a" %'aa&an in"a8n"i43 a"a s633 o *CS  7 Te"api 6(#pli)a$i  , An"i'a  3a"an ani"o3 20 , An"i6io"i4a- an"i'%san- an"i4on83san a"as in'i4asi , An"i"o6osis 8na 'a3a 'an 6o3i %a o

. S"an'a Rs

10. Pn$3i"

11. In:o' Con(n" 12. Tnaga S"an'a

1/. Laa Pa@a"an 1+. Masa P3i&an 1;. Hasi3

%enaala)$anaan Fa)(" Ri$i)(   An"i&i%"nsi  :as a4" s"o4 'ngan %s$aa"an ""n" #*i'3ins S"o4 200+) , An"i6io"i4a  :as a4" s"o4 'ngan %s$aa"an ""n" #*i'3ins S"o4 200+) , An"i'is3i%i'ia a"as in'i4asi Te"api N(n
10

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o o

Kana 6iasan$a 'is"ai %n$a4i" 3ain #gin9a3 9an"ng- &i%"nsi- DM) 4o%3i4asi 9a'i "%ang "in'i& Bi3a 'i3a44an "in'a4an 6'a& #"i'a4 6gi" %n"ing) Bi3a %3- a"as %in"aan %o3isi- %nga'i3an 'ngan siin 43aga


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1. Diagnosis 2. ICD

De$e#e" 200


TRAUMA SUSUNAN SARAF S.0= A . Saa: Psa" o Taa Ka%i"is no.S.0= 1. Koosio s6i #C'a !"a4 Ringan) no.S.0= 0 2. Kon"sio s6i #C'a ! "a4 S'ang Ba") no.ICD. ; I /. P'aa&an %i'a3 no.s.0=.+ +. P'aa&an s6'a3 no.S.0=.; ;. Taa 4a%i"is $ang 'is"ai :a4" """% 'an :a4" "64a o Taa M'33a s%ina3is 1. Koosio '3a s%ina3is 2. Kon"sio '3a s%ina3is /. Dis"ai 34sasi a"a :a4" 8"6a B. Saa: Pi: o A83si a'i4s o Lsi %34ss 11

Lsi saa: %i: #3ngan 'an "ng4ai) A. Saa: %sa" 1. Minia3 O Si%3 Ha' In9$ #SHI) , Ni3ai S4a3a Coa *3asgo@ 1; #noa3) , Ksa'aan 6ai4 , Ti'a4 ansia 2. C'a !"a4 Ringan #C!R) , Ni3ai S4a3a Coa *3asgo@ 1+ a"a , Ni3ai S4a3a Coa *3asgo@ 1;- 'ngan , Ansia %as(a ('a  2+ 9a- a"a , Hi3angn$a 4sa'aan  10 ni" , Da%a" 'is"ai g9a3a 43ini4 3ainn$a- isa3n$a  a3n"a&- sa4i" 4%a3a a"a 8"igo /. C'a !"a4 S'ang #C!S) , Ni3ai S4a3a Coa *3asgo@ ,1/ , Hi3angn$a 4sa'aan 10 ni" ""a%i 4ang 'ai = 9a , Da%a" a"a "i'a4 'i"4an a'an$a ':isi" no3ogis , Ansia %as(a ('a s3aa 4ang 36i& 7 &ai #6isa %osi"i: a"a nga"i:) +. C'a !"a4 Ba" #C!B) , Ni3ai S4a3a Coa *3asgo@ ;, , Hi3angn$a 4sa'aan = 9a , Di"4an ':isi" no3ogis , Ansia %as(a ('a  7 &ai ;. Kon'isi Ki"is , Ni3ai S4a3a Koa *3asgo@ /+ , Hi3angn$a 4sa'aan  = 9a , Di"4ann$a ':isi" no3ogis Pendarahan epidural Da%a" "9a'i n$"ai 4oosio a"a%n 4on"osio o s6i Biasan$a "9a'i 'a3a 2  2+ 9a o Da%a" 'i'a&3i in"8a3 3si'- 4'ian 4sa'aan o 64 Di'a%a"i 3a"a3isasi #1 %%i3 i'iasis) 'is"ai o 43%&an a"a :34s %a"o3ogis anggo"a ga4 sisi $ang 3ain o 70 4ass 'i'a%a"i 9ga :a4" "%oa3is o

/. Ki"ia Diagnosis

Pendarahan subdural o Da%a" "9a'i n$"ai 4oosio a"a%n 4on"sio s6i.46an$a4an s6a4" a"a 4onis. o T9a'in$a 36i& 3aa- 66a%a &ai sa%ai 66a%a 63an ss'a& "aa. o Pa'a $ang a4" "9a'i (%a" s%"i %n'aa&an %i'a3 o Sa4i" 4%a3a $ang "i'a4 &i3ang- 4a'ang,4a'ang a3a& ng&6a". 12

Di'a%a"i 'a %a%i3- 3a"asasi- 4a3a 36i& 3aa 3agi 'a%a" "9a'i %nnan 4sa'aan. Trauma kapitis dengan disertai fraktur Dngan 6an"an a3a" on"gn "a%a4 :a4" a"a o %a'a ins%4si "a%a4 3angsng 'aa" a"a 9aingan Trauma medula spinalis A'an$a "aa %a'a 'aa& s%an9ang "3ang o 63a4ang Komosio medula spinaIis o A'an$a n$i s"%a" $ang 4a'ang,4a'ang 'a%a" 'is"aiganggan no3ogi- s"inggi "aa- sanga" ingan 'an sn"aa. Kontusio medulla spinalis o A'an8a n$i s"%a" $ang 'is"ai ganggan no3ogi s"inggi "aa- ganggan o"oissnsi6i3i"as 'an a"ono. Disertai luksasi atau fraktur vertebra o K3inis sana 'ngan 4on"sio '3a o Dngan 6an"an on"gn "a%a4 34sasi aa :a4" 8"6a o

+. Diagnosis Ban'ing


B Saa: Pi: o A'an$a "ai4an $ang 636i&an a"a "aa 3angsng %a'a %o4sia3 anggo"a ga4. vulsi radiks N$i s"%a" anggo"a ga4 6agian %o4sia3 %a'a o saa" 49a'ian 'ii4"i 43%&an "o"a3 %ann !esi Pleksus o K9a'ian saa "a%i 43%&an 'a%a" "o"a3 a"a s6agian !esi saraf perifer o A'an$a "aa s"%a". 'i'a%a" 43%&an 'an ganggan snsi6i3i"as 66a%a o"o" $ang 'i%saa:i saa: $ang 6sang4"an.'i'a%a"i gangan %ga4an "i'a4 "o"a3 A. Saa: %sa" "l"rauma kapitis o Pn'aa&an o"a4 #s"o4) !8'osis #in"o4si4asi) !6a" %nnang 'an a34o&o3 o Ra4si 4on8si o Trauma medula spinalis Ta4 a'a 'iagnosis 6an'ing o B. Saa: %i: Monono%a"i a4" Trauma kapitis o Ron"gn %o3os "ng4oa4 AP53a" o Fngsi 36a3 4a3a 'iagnosis ag4an 'an "a4 a'a

1/

=. Kons3"asi 7. Ta%i

4on"ain'i4asi. o EE* 'an a"ioga:i a"a 3angsng CT,S(an o"a4 %a'a %n'aa&an %i'a3 'an s6'a3. Trauma medula spinalis o Ron"gn 8"6a 6sang4an o Fngsi 36a3 4a3a "a4 a'a 4on"ain'i4asi o Po"nsia3 E8o4 #SSEPSoa"osnso$ E8o4' Po"nsia3) Saraf perifer o Pi4saan EM* #3("o$oga%&$ ) o Bgan"ng in'i4asi 6'a& saa: a"a 6'a& "3ang Tgan"ng 'a9a" 6a"n$a ('a 3 . Minia3 , Tia& 6aing- 4%a3a 'i"inggi4an s4i"a /0 'a9a" , Is"ia&a" 'i a& , Di6i nas&a" aga 46a3i 4 Ra& Sa4i" 6i3a a'a "an'a,"an'a %'aa&an %i'a3- s%"i oangn$a 3ai "3i&a" ngan"4 #4sa'aan 3ai "n,gia3a 3(i' in"8a3) 2.C'a !"a4 Ringan #Koosio S6i) , Tia& 6aing- 4%a3a 'i"inggi4an s4i"a /0 'a9a" , !6s8asi 'i Ra& Sa4i" 2 &ai , K3&an &i3ang- o6i3isasi , Si%"oa"is an"i 8"igo- an"i "i4- ana3g"i4a , An"i6io"i4a #a"as in'i4asi) /. C'a !"a4 S'ang 'an Ba" #Kon"sio S6i) a. Ta%i U Un"4 4sa'aan nn , La44an ssi"asi , B6as4an 9a3an na:as #Ai@a$)- 9aga :ngsi %na:asan #Ba"&ing)- Ci(3a"ion #"i'a4 6o3& "9a'i &i%o"nsisis"o3i4 Saa 'ngan a"a 36i& 'ai 0 nHg)- na'is& #"i'a4 6o3& sa%ai "9a'i %i4sia) , Ksi6angan (aian 'an 34"o3i" 'an n"isi $ang (4%- 'ngan 4a3oi ;0 36i& 'ai noa3 , Jaga 4si6angan gas 'aa& , Jaga 46si&an 4an'ng 4i&- 4a3a %3 %asang 4a"" , Jaga 46si&an 'an 43an(aan 9a3 in"a8na , R6a& %osisi n"4 (ga& '46i"s , Posisi 4%a3a 'i"inggi4an /0 'a9a" , Pasang s3ang nasogas"i4 %a'a &ai 4'a- 4(a3i 4on"a in'i4asi $ai" %a'a :a4" 6asis 4anii , In:s (aian iso"onis , Bi4an o4sign ssai in'i4asi 6. Ta%i K&ss 1. M'i4an"osa , Mnga"asi "4anan "inggi in"a4ania3- 6i4an Mani"o3 20

1+

, Si%"oa"is  ana3g"i4- an"i"i4- an"i%i"i4 , An"i%i3%si 'i6i4an 6i3a "9a'i 6ang4i"an %i3%si %as(a ('a , An"i6io"i4a 'i6i4an a"as in'i4asi , An"i s"ss 3( 'i6i4an 6i3a a'a %'aa&an 3a6ng 2. !%asi 6i3a "'a%a" in'i4asi

. Pa@a"an RS

. S"an'a RS

10. Pn$3i"

(. R&a6i3i"asi , Mo6i3isasi 6"a&a% 'i3a44an s(%a"n$a s"3a& 4a'aan 43ini4 s"a6i3 , Nos"oasi 'an No&a6i3i"asi 'i6i4an ssai Trauma Kapitis dengan fraktur tertutup o Ti'a4 'i3a44an "in'a4an 4&ss- 4(a3i %a'a :a4" i%si: 'ngan 4'a3aan 36i& 'ai 0-; (. !%asi si"o 'i49a4an 4a3a "4anan in"a4ania3 ninggi sa4i" 4%a3a &6a" 'an n"a&. Trauma Kapitis dengan fraktur tertutup o Di6i4an an"i6io"i4 'osis "inggi n"4 n(ga& in:4si o"a4 'an 4ons3"asi 4 6agian 6'a& saa: n"4 %n6si&an 'an %n9a&i"an s3a%" o"a4. Komosio medula spinalis Is"ia&a" 'an o6oansia5no"o%i4 o Fisio"a%i o Kontusio medula spinalis Is"ia&a" 'an o6oansia5"io"oni4 o D4sa"ason $ang 'i6i4an 'a3a ang4aian 'is"ai o %6ian an"asi' a"a si"i'in. Trauma medula spinalis disertai Iuksasi atau fraktur o D4sa"ason $ang 'i6i4an 'a3a ang4aian o Kons3"asi 6'a& saa: n"4 4ng4inan o%asi vulsi radiks# lesi pleksus dan lesi saraf perifer o No"o%i4 'an :isio"a%i. Ka3a "'a%a" 3si "o"a35%"s 4ons3"asi 4 6'a& saa: n"4 4ng4inan %n$a6ngan o Taa saa: %sa" &as 'ia@a" Taa saa: %i: 6iasan$a "i'a4 'ia@a" 4(a3i o 'is"ai :a4" "3ang a"a ganggan 4&i'%an s&ai, &ai o Pa'a 4oosio s6i  sa RS o Yang 3ainn$a. RS $ang %n$ai 'o4" S%sia3is Saa:$ang a& sa4i" "i% C-B-A o Kana "i'a4 'i4"a&i  %"o3ongan %a'a saa" "aa 'a%a" %6a" 4a'aan %a'a 4ass 'ngan :a4" s8i4a3. o Kana "9a'in$a (%a". 4a"ian 'a%a" "i63 s63 'a%a" 'i3a44an o%asi %a'a %'aa&an %i'a3 o Kana "6a"asn8a "naga a&3i B'a& saa:. %n'i"a

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'a%a" ningga3 s63 'i4ii 4 RS 8ang 36i& Bsa Kon"sio 6a" 'ngan ganggan 9i@a oganis Kana 'a$a gnasi s3 saa: sanga" s'i4i"4"3a6a"an 'a%a" n$6a64an 4a"ian "o"a3 s3 saa: T"3is- n"4 $ang 6si4o a"a 34an "in'a4an in8asi:5o%asi Do4" S%sia3is Saa: Do4"  'i "%a" $ang "i'a4 a'a 'o4" s%sia3is"a%i 4a3a 'a%a" &as 'i4ii 4 RS $ang a'a 'o4" s%sia3is Do4" s%sia3is 6'a& saa: 'an 6'a& "3ang 4ass $ang 34an. Un"4 $ang ingan /, = &ai 'an $ang 6a" 36i& 'ai = &ai Koosio 'an Kon"sio ingan s6& "o"a3 Kon"sio $ang 36i& 6a" sing a'a 43&an #g9a3a) sisa Kon"sio '33a. 3si "o"a3 a'i4s- %34ss 'an saa: %i:  sing 'i'a%a"i 43%&an %ann Bi3a a'a "in'a4an o%asi Sing 'i%34an %a'a 4ass,4ass 44asan n"44%n"ingan 'i4o3ga3 #%nga'i3an)

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NEUR!PATI #*anggan Saa: T%i O %i:a3 No%a"&$) *.=0 A'a3a& sa" %n$a4i" 'ngan g9a3a 43ini4 $ang "i63 4ana 43ainan saa: %i:- n$a 6%a 'gnasi non,in:3aasi $ang 3as 'ngan g9a3a $ang 3i%"i 43a&an o"oi4- ganggan snsoi4- ganggan a"ono 'an 3a&n$a :34s "n'on. Saa: %i: $ang "4na 3i%"i sa a4a saa: s%ia3is- s3 gang3ion a'i4s 'osa3is- sa a4a saa: %i: 'ngan sa (a6ang "ina3n$a- ssnan saa: a"ono- 'an saa: o"a4 4(a3i saa: o%"i4s 'an o3:a4"ois. Po3ioi3i"is o

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A"o:i o"o" s%ina3 # spinal muscular atroph$) Mias"nia ga8is M3"i%3 s43osis ALS 'an 3ain,3ain Pi4saan 3io #(aian s6os%ina3) n"4  s3 %o"in- g34osa- NaC3- ino3ogi #6i3a %3) Daa& "%i "in- g34osa- 4o3s"o3- . Ka"inin- 34"o3i"- 3oga 6a"- ino3ogi- 6asi3 "a&an asa- %i4saan 4a'a 8i"ain B1- B=- B12 'an 3ain, 3ain. Bi3a a'a "an'a,"an'a ania %nisiosa- %i4sa &a"o3ogi 3ng4a% Uin "in Pi4saan 34"oioga:i #EM*) Pi4saan %o"nsia3 ("san Soa"osnsois Soa"osnsois EK* Bio%si saa: o"o" #a"as in'i4asi) Pn$a4i" 'a3a #n'o4ino3ogiino3ogi&a"o3ogi- "o4si4o3ogi 'an 3ain,3ain 6gan"ng 4asa). B'a& Saa: 5B'a& #6i3a %3) K3i" #6i3a 4asa 3%a- &%s 'an 3ain,3ain). No%a"i a4"  sga ina%. Bi3a "i63 gangan %na%asan #%a'a sin'o Lan'$)- 'i%34an %a@a"an in"nsi: 'i ICU Pa'a B33s %a3s$- no%a"i 4ana "4anan #Sa"'a$ nig&" %a3s$) 'an no%a"i ingan- 'a%a" 6o6a" 9a3an. No%a"i 4onis- 6gan"ng 4a'aan - 6i3a 6a"  a@a" ina%- 6i3a ingan (4% 6o6a" 9a3an. Bi3a 4asan$a 'i4"a&i- 4assn$a 'i"angg3angi  , n'o4in #Dia6"s 33i"s- i- &i%"ioi'- 'an 3ain, 3ain)- o6a"i %n$a4i" 'asan$a , H%s# A($(3o8i- si%"oa"is) , L%a #Ri:a%isin- DDS 'an 3ain,3ain. !%asi %a'a 4ass ""n") ,Taa #ng4in %3 "in'a4an o%a"i:) No"o%i4 #4o6iansi 8i"ain B1- B=- B125 siano4o6a3ain 'an 3ain,3ain) Pa'a ':isinsi  gii 'an :ngsi %n$a%an 'i%6ai4i Si%"oa"is #n"4 n$i  sa3isi3a"- 4a6aa%in'an 3ain,3ain) Pa'a sin'oa *i33an Ba,S"o&3- 3an'$ 'an 8aiann$a , Ko"i4os"oi'  ACTH- Ko"ison- P'nison #asi& 6an$a4 %6'aan %n'a%a" "n"ang o6a" ini). Pa'a $ang 63ang 5 3a%s 4o"i4os"oi' 6an$a4

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an:aa"n$a. !6a",o6a" ino%san  Aa"io%in , P3asa%asis , Inog3o63in #+00 g54g5&ai n"4 ; &ai) , An"i8ia3  6o3& 'i(o6a , An"iin:3aasi  6o3& 'i(o6a Sa RS. Bi3a 'i(igai a4an "i63 ganggan %na%asan- sga 94 4 RS $ang 36i& 3ng4a% #i3i4i ICU) Kana %n$a4i" , T9a'i %ogsi:i"as- ganggan %na%asan Kana "in'a4an Pa@a"an 'an :isio"a%i $ang 4ang (a" 'a%a" 'a&4an "9a'in$a in:4si "a4"s inais'46i"s- 4on"a4". P3 ""3is- %3 ""aa 6agi $ang 'i(igai 6a" %ogsi: Do4" - 6i3a a'a Do4" S%sia3is Saa: Ra"a,a"a 2 ingg sa%ai 1 63an Bgan"ng 4a'aan- a'a $ang (%a" "a%i a'a %3a $ang "i'a4 'a%a" 649a n"4 s3aan$a Un$a s6& 'ngan "an%a g9a3a sisa Jnis s"o4 3ain n$a s6& 'ngan g9a3a sisa 'ai $ang ingan sa%ai $ang 6a" Kana 6iasan$a 'is"ai %n$a4i" 3ain #gin9a3 9an"ng- &i%"nsi- 'ia6"s 33i"s) 4o%3i4asi 9a'i "%ang "in'i& Pa'a 4ass ""n" n"4 as"i4an 'iagnosis 'i%34an 6io%si saa: 4a'ang,4a'ang o"o",o"o" #9aang) Bi3a 'i%34an #9aang)

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MIASTENIA *RAIS *.70.0 A'a3a& sa" %n$a4i" a"oin $ang "9a'i 4ana o sangan %a'a as"i34o3in s%"o 'ai nos43a 9n("ion o"o" 6gais o3& sa" an"i6o'i- a'a + "i%  1. !(3a $as"nia 2. Mi3' gna3i' $as"&nia

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S8 gna3i' $as"&nia M$as"&nia (isis No%a"i Sin'oa La6",Ea"n *anggan 'i 6i'ang THT #'is:oni- 'is:agi) *anggan 'i 6i'ang a"a #%"osis- o:"a3o%3gi) Pi4saan EM* #Ts Yo33$- "s Ha8$ Mas3an'Pi4saan EM* sa6" "ngga3- sing3 :i6 EM*). Pi4saan an"i6o'i an"i ACHR 'an an"i o"o" 3i4 'i 'aa& #6i3a a'a) Pi4saan ino3ogi Fo"o ong"n "oa4s PA53a"5o63i4 1; 'a9a" #n"4 3i&a" a'an$a %6saan "is) CT,S(an "oa4s #6i3a a'a) Ts Pos"igin 5 "s "nsi3on Ino3ogi #6i3a a'a in'i4asi) P3ono3ogi #6i3a a'a "ioa) B'a& "oa4s #6i3a a'a "ioa) Ra@a" ina% sga %a'a 4ass 6a" Bi3a 'i(igai a4an "i63 4isis ias"nia- %3 'ia@a" s(aa in"nsi: 'i ang ICU An"i4o3ins"as #A(&E)  nos"igin 6oi' #Pos"igin) 7-;,+; g "ia%2,= 9a 'an a"a %ii'os"igin #s"inon) /0,120 g "ia% +,= 9a #'issai4an 46"&an) Ko"i4os"oi' Inos%san nons"oi' Aa"ioin a"a si43os:ai' # 6i3a 'ngan ACHE "i'a4 6&asi3) Ti4"oi P3asa:osis  %a'a ias"nia ga8is $ang 6a" a"a 4isis ias"nia Sa RS. Bi3a 4a'aan ng4in4an 94 4 RS $ang %n$ai %a@a"an 3ng4a% #ICU) Kana %n$a4i" , Kisis ias"nia , 4isis 4o3ingi4 Kana "in'a4an , 9aang P3 ""3is Do4"  - 6i3a a'a Do4" S%sia3is Saa: Bgan"ng 4a'aan 1 Mingg. Pn'i"a &as ""a% 4on"o3 s"3a& 43inis s6& T4on"o3 Kng4inan 3%as 21


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Bi3a 4asa 'i4"a&i sga "angg3angi #isa3n$a ganggan n'o4in) Ta%i S%o"i:  P6ian %'nison , Dis"o:i s43  1 g5KgBB5& s3aa = 63an , Po3ioiosi"is  1 g5KgBB5& s3aa / 63an , Da%a" 'i6i4an continousl$ a"a alternating  , i"ain E 6o3& (o6a Un"4 nga44an 'iagnosis %as"i- %3 RS $ang %n$ai EM*- Pa"o3ogi K3ini4 'an Pa"o3ogi Ana"oi Kana %n$a4i" , Pa'a 9nis D(&nn #Dis"o:i Ms43o Pogsi:) %n$a4i" a4an 64 s(aa 6"a&a% 'an 6iasan$a ningga3 s63 sia 20 "a&n Kana "in'a4an , Jaang P3 ""3is Do4" U- 6i3a "i'a4 a'a Do4" S%sia3is Saa: S"3a& 'iagnosis %as"i- %n$3i" a"a 4asa s'a& 'i"angg3angi %n'i"a 'a%a" 6o6a" 9a3an ""aa n"4 :isio"a%i. Bgan"ng 4a'aan%n$a4i"n$a (n'ng 64 %a'a "i% '(&nn Dngan %a@a"an 'an :isio"a%i %n'i"a asa 6ai4 #s6& %asia3). Jnis 3ainn$a n$a s6& 'ngan g9a3a sisa 'ai ingan sa%ai 6a". Kana 6iasan$a 'is"ai %n$a4i" 3ain #gin9a3 9an"ng- &i%"nsi- 'ia6"s 33i"s) 4o%3i4asi 9a'i "%ang "in'i&. Bio%si o"o" n"4 'iagnosis Bi3a %3 #9aang)

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1 J*li 2003



1. Diagnosis

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RA6IAL'IA DAN IS6IAL'IA Kasa  Pn$6a6n$a 6an$a4- nan $ang %a3ing  o

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n9a3a 4 9%o3 4a4i %a'a sin'o S1) P3 'i%i4sa s3& "3ang %nggng ""aa 36osa4a3 'ngan %&a"i4an a'a "i'a4n$a 43ainan %os"- ':oi"as- n$i "4an 'an 4"o4 s"a s%as o"o". Dngan a'an$a n$i a'iasi 4 is4ia'i4s a"a%n 4 aa& 36o sa4a3- a4a 6iasan$a 3o'osis 36a3 a4an 64ang 4ana s%as in8o3n" 'ai o"o",o"o" %nggng. Biasan$a 9ga 6isa 'i9%ai s4o3iosis 36a3- 'ngan s4o3iosis "oa4a3 $ang 4o%nsa"oa. Pasin a4an 6asa&a n"4 3"a44an 6a" 6a'ann$a %a'a sisi $ang 4on"a3a"a3 'an %osisi 6a'an aga4 6ng44 'an aga4 iing 4 %osisi $ang sa4i"n"4 ng&in'ai %gangan saa: $ang "4na. Pa'a n$i $ang &6a"- a4a %n'i"a a4an ngangi 4s"nsi 3""- 'an &an$a 3"a44an 9ai, 9ai 'i 3an"ai n"4 ng&in'ai 'oso:34si $ang a4an na6a& n$in$a. Tan'a %angsangan ninga3 'a%a" "i63- 6%a 3as %a'a sisi "4na a"a%n Coss Las %a'a sisi 4on"a3a"a3. Mo'i:i4asi "an'a 3as a'a3a& "an'a Bagga' $a4ni 'ngan 3a44an 'oso:34si 4a4i- a"a%n "an'a Si(a' 'ngan 3a44an 'oso:34si 9%o3 4a4i- a4a n$i a'i43 a4an 6"a6a&. Tan'a Na::iig ni634an n$i a'i43 $ang 6"a6a& 6i3a 6a"4- 6sin- a"a%n %a'a %n4anan 8na 9g3ais. Ka'ang,4a'ang n$i 9s" 6"a6a& %a'a %3%asan %n4anan. Pi4saan ini 9ga 'a%a" 'i3a44an 'ngan "s 8asa38a. Tan'a n$i s@a4" 'is& 6ng44- a4a %asin a4an 3a44an :34si %a'a 3"" n"4 n(ga& "gangn$a N. Is&ia'i4s. *anggan o"ois %asis 'a%a" "9a'i 6i3a "'a%a" 4o%si a'i4s #(on"o&n$a  %asis 'oso:34si 'an %3an"a:34si 4a4i %a'a sin'o L;,S1) *anggan snsi6i3i"as 'a%a" "9a'i %a'a 'a"o $ang "4na. R:34s :isio3ogis nn %a'a sin'o L2,+ #:34s 3"") 'an %a'a sin'o S1 #:34s "i") Has 'i6'a4an an"aa ii"asi a'i4s 'an 4o%si a'i4s. Diagnosis 4o%si a'i4s 'i"ga44an 6i3a a'a , Pasis o"ois , *anggan i4si ':4asi Tan'a,"an'a :i6i3asi %a'a sgn "4na %a'a %i4saan EM* Ba4ia3gia , To a'i4s , A83asi a'i4s "aa"is

27


=. Kons3"asi

7. Pa@a"an RS

. Ta%i

, P34ss ni"is , Sin'oa Ca%a3,Tnn3 , Sin'oa S4a3ns , No3ogis a"o3ogis Is4ia3gia o , To , Fa4" , Pasis %34ss , Pasis N. Pons , No%a"i4 'ia6"i4 , *anggan 8as43 %a'a a. I3ia4a 'an (a6ang, (a6angn$a , S%on'i3i"is 36a3is , N. Is4ia'i4s  ni"is %i- %ini"is- ninoa"aa %a'a saa:n$a a"a sn"i4an Ba4ia3gia o , Fo"o on"gn s8i4a3 'ngan %osisi AP 53a"5o63i4 Is4ia3gia o , Fo"o on"gn 36osa4a3 AP53a" , LP 6gan"ng 4ass 'a%a" 'i%"i6ang4an- 6i3a 'i'ga a'a 4o%si a'i4s $ang 'is"ai 6n'ngan a"a%n 'i'ga a'a "o '3a s%ina3is , Pi4saan EM* n"4 %nn"an 3o4a3isasi6'a4an ii"asi a'i4s 'ngan 4o%si a'i4s8a3asi %ngo6a"an. Bi3a 'i'ga 4o%si a'i4sa4as"3a& %i4saan EM* 'i3a44an i3oga:i5CT,i3oga:i a"a%n MRI o Do4" S%sia3is Pn$a4i" Da3a. Bi3a a'a %n$a4i" sis"a"is s6agai %n$6a6 a"a%n %n$"a %n$a4i" Do4" S%sia3is Psi4osoa"i4 6i3a "i'a4 'i"4an o 43ainan 3ain Fisio"a%i n"4 "a4si s8i4a3 a%n 36a3o asas 'an UK* a"a 3"ason' o Ra@a" ina% %a'a ii"asi a'i4s- 6i3a a'a 43ainan no3ogis. o N$i a'i43 "a4 ""a&an4an #o6a" "i'a4 no3ong)- "a4 'a%a" is"ia&a" 'i a&- 'i'ga a'a %n$6a6 3ain $ang &as 'i 4s%3oasi o Pa'a 4o%si a'i4s "3a4 %3 'ia@a" 4ana "in'a4an o%a"i: "3a4 'i%34an Pa'a ii"asi a'i4s ""a%i n$a 4ons8a"i: o "36i& 'a&3- $ai"  , Tia& 6aing 'ngan %osisi $ang a"a 'ngan a3as 4as , P6ian 6an"a3 %anas , Sn"i4an an"si s(aa 3o4a3 , !6a" 3a4san o"o" - ana3gsi4 'an o6a" AINS , S3ain i" 'a%a" 'i3a44an "a4si s8i4a3 a%n

2

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. S"an'a RS

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36a3 'an 9ga :isio"a%i 3ain !%a"i: , In'i4asi o%asi  , In'i4asi o%asi si"o ia3a& "i63n$a %o3a%s 'ngan %aa%asis #4o%si a'i4s). Pa'a 4o%sio a'i4s "in'a4an o%a"i: &as 'i3a44an s(%a"n$a s"3a& 'iagnosis 'i"ga44an n"4 n(ga& %asis 'an a"o:i 36i& 3an9". , *anggan i4si , Pa'a %asis o"ois $ang "i63n$a a4" 'an 38an. , Bi3a s'a& =, ingg "a%i 4ons8a"i: asi& "'a%a" 43&an 'an g9a3a $ang 38an. , Pa'a si'i: $ang 64a3i,4a3i 'ngan g9a3a $ang 4&as. , Bi3a 'ngan %i4saan EM* 'ai o"o",o"o" sgn $ang 6sang4"an a"a o"o",o"o" %aas%ina3 a"a %aa 8"6a3 'i"4an a'an$a 'n8asi5:i6i3asi $ang nn944an 4o%si a'i4s. Sa RS- 4(a3i %a'a 4ass $ang 34an "in'a4an in8asi:5o%a"i: &as RS "i% A5B $ang %n$ai a&3i 6'a& saa: 5 o"o%'i Han$a a'a %a'a 4ass $ang "3a& 'io%asi- 4a'ang, 4a'ang n$i asi& a'a. S(aa 3isan %a'a %i4saan EM* P3 ""3is %a'a %i4saan  LP- M$3oga:iMRI 'an %a'a "in'a4an o%asi Do4" U Do4" S%sia3is Saa: 6i3a 43&an "i'a4 &i3anga%a3agi 4a3a 6"a6a& 6a" a"a%n 'i'a%a"i 43ainan no3ogis. Do4" S%sia3is B'a& Saa:5o"o%'i n"4 4ass 4o%si a'i4s $ang %3 o%asi Bgan"ng %a'a asing,asing 4ass- nan n$a %a'a ii"asi a'i4s 'i%34an @a4" +,= ingg Pa'a ii"asi a'i4s Biasan$a %ognosis 6ai4- 6i3a 'i3a44an "a%i 'an :isio"a%i $ang 6ai4 'ngan is"ia&a" $ang (4%. Pa'a &nia 'is4s $ang 'io%asi Pa'a 25/ 4ass %ognosis 6ai4 'an %a'a 10  &asi3 "a4 as4an Taa %a'a %49aan Yang 93as %ognosisn$a s%"i %a'a n$a "aa %a'a %49aan 'an 6i3a %o%a"i: g9a3a s'a& a'a 36i& 'ai 1 "a&n 'ngan %6a&an a"o"is $ang 93as- isa3n$a anoa3i 36osa4a3 Han$a 'i%34an %a'a 4ass $ang 'io%asi

2

1=. A"o%si

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Sanga" 'ian94an - 6i3a "9a'i 4a"ian $ang &a%i "a4 %na& "9a'i


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30 / 41

Tanal Te"i  1 J*li 2003


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1. Diagnosis 2. ICD /. Ki"ia Diagnosis



=. Kons3"asi


TETANUS Q.2.0 o Pn$a4i" sis" saa: $ang %3angsngann$a a4" 'ngan 4aa4"is"i4 s%as "oni4 %sis"n 'an 4sas6asi sing4a" o Tiss,a&ang "4n(i s'" 3" 'ii4"i 'nan o Riss Sa'oni4s,"a4si n$i 'an 4a4 o"o" o Paas%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 44a4an $ang sanga" 6a" $ang 6isa ni634an :a4" o "6a 'osa3is "9a'i s%as %a'a o"o" %na%asan $ang %a4an %n$6a6 4a"ian 6i3a "i'a4 (%a" 'i"o3ong o *9a3a a"ono 6%a 6an$a4 4inga" 'an 3'a&. Jga s4si :aing. "a4i4a'i 'an &i%o"nsi 9ga a6'oio3isis $ang nga4i6a"4an o T9a'i iog3o6ini 'an gaga3 gin9a3 o K9ang 4ana &i%o4a3sia o Sin'oa &i%8n"i3asi5a4si &is"i E%i3%si o Pa'angan 'aa& 3" o Pi4saan i4ooganis 6a4 n"4 n4an o &.tetani Pi4saan To4si4o3ogi n"4 n4an o ""anos%asin o Do4" S%sia3is Ana4 Pina"o3ogi o Do4" *igi o Do4" S%sia3is B'a& o Ra@a" ina% sga- 6i3a %3 'i ang ICU o E4sisi 34a $ang (4% 36a Pn6ian "ono'ao3 7.; g4gBB"ia% = 9a oa3 o a"a I !6a" ini 36i& 6ai4 %a'a %ni(i3in o To4sis $ang asi& 'a3a si43asi 'in"a34an 'ngan inisasi %asi: # 'uman Imunoglobulin ()))-*)))) +I intramuskular, K9ang 'i6i 'ia%a ; g54gBB5&ai- 'a%a" 9ga o 'ngan 'an'"o3n so'i = g54gBB53i" 3@a" N*T Pa'a 4ass $ang 6a" 'i6i4an o6a" 63o4a' o nos43a 'an 8n"i3asi 'ngan "4anan $ang %osi"i: s"a %&a"i4an 6a3ans (aian

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. S"an'a RS 10. Pn$3i" 11. In:o' Consn"

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Tanal Te"i  1 J*li 2003

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1. Diagnosis

MENIN*ITIS , Mningi"is Ba4"ia3is A4" , Mningi"is T643osis #A.17.0) , Mningi"is ia3 2. ICD *.00 /. Ki"ia Diagnosis o A'a3a& sa" in:4si ssnan saa: %sa" $ang 6a" 'an 'a%a" ni634an g9a3a sisa $ang %ann. Pn$6a6 in:4si a'a3a& 6a4"i-8is a"a oganis $ang 3ain. M%a4an sa3a& sa" 4o%3i4asi 'ai %n$a4i" o "6(3osis- %n$ai o6i'i"as 'an o"a3i"as $ang "inggi 'ngan %ognosis 64 o Da- a3ais- sa4i" 4%a3a- n"a&- sing "a%a4 ngan"4 'an (on:s' #4sa'aan nn) o Bi3a "a4 'io6a"i- ngan"4 ng6ang4an n9a'i so%o 'an 4oa *9a3a 43inis $ang 4&as 'i"4an "an'a angsangan o ninga3 6%a 4a4 4'4- "an'a 4nig P"4ia 'i9%ai %a'a ningo4o4 @a3a%n 'a%a" 9ga o %a'a in:4si %no4o4- s"a:i3o3o4o4- 'an 66a%a in:4si 8is. Ka'ang,4a'ang 'i9%ai 49ang a4i6a" ning4a"n$a a"a in:4si 8na 3o4a3 E' %a%i3 'i9%ai %a'a s6i"is 'i:s 'an ' o"a4 o $ang . Ma3ais- sa4i" 4%a3a- ii"a63- %6a&an "ing4a& 3a4 $ang 63angsng s3aa 2,= ingg. Di9%ai 'a ingan 'an "an'a %angsangan s3a%" o"a4 o Pa%i3 'a sing "9a'i. Ji4a "a4 'io6a"i 4a'aan so%o 6"a6a& 'an 'ii4"i 4a"ian. Ma3ais- sa4i" 4%a3a'a ingan- ngan"4 'an n"a&. Pi4saan %&a"i4an %n'i"a "a%a4 sa4i" o s'ang- 66a%a "'a%a" 4a4 4'4- ""a%i "i'a4 s93as %a'a ningi"is 6a4"ia3is a4". +. Diagnosis 9a5%aasi" #&r$ptococcus neoformans a"a o In:4si Ban'ing To%oplasma gondii, sarkoid meningitis. o T4anan %a'a s3a%" o"a4 $ang 'i:s o3& s3 ganas"as4 4asinoa- 3i:oa- 34ia- g3ioa3anoa 'an '3o63as"oa. o Pa'a %aaninga3 a6ss ni634an a4si 3i:osi"i4 %a'a (aian o"a4. ;. Pi4saan o Pngsi 36a3 #6i3a "a4 a'a "an'a,"an'a %ninggian I

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1. Diagnosis 2. ICD /. Ki"ia Diagnosis



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*34osa 6iasan$a noa3 P@anaan ga 'an 43" n"4 6a4"i a. Ja 6. BTA Bi3a ng4in4an iso3asi 8is- "i" an"i6o'i n"4 n(ai 'iagnosis "io3ogi Pi4saan 'aa& , L4osi"  noa3 a"a 34o%ni a"a 3i4osi"osis ingan , Ai3as s sing ning4a" %a'a %ao"i"is , Fngsi &a"i $ang a6noa3 'i9n%ai %a'a &%a"i"is 8is 'an onon43osis in:4siosa. Pi4saan EE* , Un$a 'i9%ai %3an6a"an  , A'an$a 4o%34s slo/ /ave $ang %io'i4 4 'aa& 3o6s "%oa3is ssisi a"a 'a sisi n(iga4an sa" in:4si &%s si%3s 8is #HS). Pa'a AIDS ns:a3i"is 9ga &an$a 'i9%ai %3a6a"an Pi4saan CT s(an 'an MRI , Pi4saan ini s6nan$a %n"ing ""a%i a&a3. Bgna n"4 '"4si 'ini HS ns:a3i"is Bio%si 9aingan o"a4 , S%sin n"4 isoiasi 8is- %i4saan &is"o%a"o3ogis%i4saan 'ngan i4os4o% 34"on 'an ino:3osns. Bio%si o"a4 6gna n"4 nga44an 'iagnosis HS ns:a3i"is Pi4saan an"i6o'i an"ign s%si:i4 n"4 HS 'an HI Do4" S%sia3is Saa: Do4" A&3i io3ogi Do4" A&3i Pa"o3ogi K3ini4 Do4" A&3i Pa"o3ogi Ana"oi Do4" S%sia3is Ra'io3ogi Do4" S%sia3is B'a& Saa: Do4" S%sia3is Ans"si Fisio"a%is Ra@a" ina% sga n"4 sa %n'i"a $ang 'i(igai 'i"a ns:a3i"is Bsi:a" s%o"i: Bi3a 'i(igai %n$6a6n$a HS 'i6i4an A($(3o8i /0 g54gBB5&ai in"a8na- 'i6agi / 'osis s3aa 10 &ai. Un"4 %a@a"an s%o"i: sa RS Bi3a a'a %n$3i" a"a in'i4asi 94 4 RS $ang 36i& 3ng4a% In:4si sa3an na%as 'an sa3an 4i& K9ang $ang "s ns %a'a :asi3i"as ICU n"4 na4os 

/


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P3 ""3is 6i3a 'i%34an n"4 %n4si 36a3- 6io%si o"a4 Do4"  n"4 "a%i s%o"i: Do4" S%sia3is Saa:- 'o4" S%sia3is Ans"si- 6i3a 49ang,49ang n9 4a a& s"a"s 4on83si Sa" 63an 6i3a "i'a4 "9a'i s3 no3ogis5%n$3i" 3ain. S3 no3ogis %3 'i3a"i& a&3i Fisio"a%i Pngo6a"an s &i'% 6i3a "9a'i %i3%si 1,/ 63an- s6agian ningga34an (a(a" ""a% Ens:a3i"is 8is "i'a4 a'a o6a"n$a- A($(3o8i 'a%a" 'i(o6a 'i6i4an %a'a HS ns:a3i"is 'ngan o"a3i"as 1,2 Bi3a 'i3a44an 6io%si o"a4 Dngan %s"9an 43aga- n"4 visum et repertum

/


N(. D()*#en

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39 / 41


N(. Re+i$i

1 J*li 2003



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1. Diagnosis 2. ICD /. Ki"ia Diagnosis

PENYAKIT PARKINS!N *. 20 o Pn$a4i" Pa4inson a'a3a&  6agian 'ai %a4insonis $ang %a"o3ogis 'i"an'ai 'ngan 'gnasi gang3ia 6asa3is ""aa %as (o%a("a s6s"an"ia niga 'is"ai 'ngan in43si si"o%3asi4 osino:i3i4 # !e/$’s bodies, o Pa4insonis  a'a3a& sin'oa $ang 'i"an'ai 'ngan "o @a4" is"ia&a"- igi'i"as- 6a'i4insia 'an &i3angn$a :34s %os"a3 a4i6a" %nnan 'o%ain 4ana 66a%a s6a6 o To %a4an g9a3a $ang "i63 a4i6a" 3"%an i"is "&a'a% "a4"s %iai'a3is. Dis6" 9ga resting tremor 'ngan :4nsi +,; H a"a pill rolling tremor. Da3a 4a'aan s"ss "o a4an 6"a6a& +. Pi4saan Fisi4 o Da3a %i4saan 'a%a" 'i"4an "ias Pa4inson $ai" :nona o'a 6gigi. 6a'i4insia 'an igi'i"as. Ba'i4insia o Mnnn$a 4a%an n"4 3a44an ga4an @a9a& 'is"ai 6"a6a&n$a @a4" $ang 'i%34an n"4 3ai a"a ng6a& ga4an a4i6a"n$a 4s3&an ga4an %n'i"a 6i 4san 3a6a". o Da3a %i4saan 'a%a" 'i"4an %n'i"a 69a3an 'ngan 3ang4a& 4(i3,4(i3 s%"i 'is" # Marche petit Pas, "an%a 3nggang- sa3i8a "i'a4 'i"3an. 4a "o%ng $ang is4in ii4- :4nsi a"a 64'i% nn 'an "3isan 66a& n9a'i 4(i3,4(i3. Rigi'i"as o Tons o"o" ninggi 4ana ning4a"n$a a4"i8i"as o"o

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nogaa ""aa %a'a o"o" :34so. Ka'aan ini nnga4i6a"4an si4a% %n'i"a s%"i 6ong4o4 'ngan 4a4i ""44 #S"oo%ing). Disa%ing g9a3a 'i a"as 'a%a" 'i"4an &i%&i'osis&i%o"nsi %os"a3- ganggan i4si- 'nsia- '%si %na%asan $ang 'ang4a3 'an "i'a4 6a"an s"a (aa 6i(aa $an ono"on. P9a3anan 43inis %n$a4i" Pa4inson 'i3i&a" 6'asa "a&a%an n" Ho&n 'an Ya& S"a'i I , *9a3a 'an "an'a %a'a sa" sisi , *9a3a ingan , *9a3a $ang "i63 nggangg "a%i "i'a4 ni634an (a(a" , To %a'a sa" anggo"a ga4 , *9a3a a@a3 'a%a" 'i4na3i oang "'4a" S"a'i II , *9a3a 6i3a"a3 , T9a'i 4(a(a"an inia3 , Si4a%5(aa 69a3an "gangg S"a'i III , *a44an "6& n$a"a 3a6a" 'ii , *anggan 4si6angan saa" 69a3an56'ii , Dis:ngsi  s'ang S"a'i I , *9a3a 36i& 6a" , K"6a"asan 9aa4 69a3an , Rigi'i"as 'an 6a'i4insia , Ti'a4 a% an'ii , To 64ang S"a'i  , S"a'i 4a4sia , K(a(a"an 4o%34s , Ti'a4 a% 6'ii 'an 69a3an , M34an %a@a"an ""a% Sin'o Pa4inson S4n' Pas(ans:a3i"is 3"agi4a 8an (onoo. Da %3& "a&n s"3a& 49a'ian in:4si 8is o"a4 "i63 g9a3a %a4inson. Ka'aan ia"ognis a4i6a" %6ian o6a" ""aa :no"iain- &a3o%i'o3 'an 3i"i. A4i6a" 4a(nan C! a"a Mn Pn$a4i" saa: 3ain  %n$a4i" s6o8as43a5 %a4insonis a"ios43osis A4i6a" 4a'aan 3ain s%"i "aa a"a "o o"a4. Pa'a CT S(an a"a MRI- ng4in 'a%a" 'i"4an "an'a 'gnasi %a'a s6s"ansia niga. Da%a" 'i3a44an ana3isis (aa 69a3an ""aa foot print. Do4" S%sia3is Pn$a4i" Da3a

+1

Do4" S%sia3is Ji@a o Do4" A&3i Faa4o3ogi K3inis 6i3a 'i%34an 'ian94an %a'a 4ass $ang 6a" o Ra@a" ina% &an$a 'ngan "9an n"4 ng"a&i 'i4an"osa $ang (o(o4 'an 'osis $ang a'4a" o M'i4an"osa  , Aan"a'in , An"i4&o3ingi4  Bno"o%in si3a"- 6i%i'in"i&$%&ni'i3 , Do%aingi4  Ca6i'o%a 'an L8o'o%a Bnsai' 'an L8o'o%a , Do%ain Aginis  Boo4i%"in si3a"- %go3i' si3a"- %ai%o3- %inio3- 3$si' , C!MT In&i6i"o  En"a(a%on- "o3(a%on , MA!,Bin&i6i"o  S3gi3in- Laa6i' , , An"i !4si'an  *3"aa" an"agonis- a3:a "o(o:o3- asa As(o6a"- 6"a(ao"n , Bo"3in "oin , Po%ano3o3 o Non 'i4an"osa  , !%asi  Ta3a"oi- %a3i'o"oi- "ans%3an"asi s6s"ansia niga , A63asi 'an s"i3asi o"a4 , R&a6i3i"asi 'i4 , Psi4o"a%i Sa RS $ang %n$ai 'o4" S%sia3is Saa: o E:4 sa%ing 'a%a" 6%a  o F34"asi 4&asia" o6a" #on,o:: %&nonon) o Hi%o"nsi %os"a3 o Nasa Dis4insia o o D%si n"a3 o Han$a %a'a 4ass o%a"i: $ang 63 %na& 'i49a4an 'i In'onsia o Do4" U- %a'a %n'i"a 'ngan 43&an $ang s'a& "a"asi 'ngan %ngo6a"an $ang a'4a". o Do4" S%sia3is Saa:- 6i3a 4'ian "i63 :4 sa%ing %6ian o6a" 9ang4a %an9ang o Bo6a" 9a3an- 4(a3i n"4 %n$saian o6a"- %n'i"a 'ngan :4 sa%ing %ngo6a"an $ang 6a" a"a '%si n"a3 6a". o Laa %a@a"an 6gan"ng %a'a 6a" a"a s3i"n$a 4ass "s6" o Pn'i"a s3aan$a 6gan"ng %a'a 'i4an"osa o Ha3 ini s3a$a4n$a n9a'i 6a&an %"i6angan 'a3a i3i& 9nis o6a" 4ana %n'i"a a4an sanga" "66ani o3& &aga o6a" o

. Pa@a"an RS

. Ta%i

10. S"an'a RS 11. Pn$3i"

12. In:o' Consn" 1/. Tnaga S"an'a

1+. Laa Pa@a"an

1;. Masa P3i&an

+2

Protap Ilmu Penyakit Saraf

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