case miastenia gravis

8/18/2019 case miastenia gravis

1/35

Case Report Session

MIASTENIA GRAVIS

OLEH:

MAHMUDAH

NO.BP: 1010313027

PRESEPTOR:

1. dr. Hj. Meiti rid!" S#.S $%&2. dr. He'dr! Per(!'!" S#.S. M.Bi)(ed

PERIODE:

7 MARET 201*+7 APRIL 201*

BAGIAN ILMU PEN,A%IT SARARSUP DR.M.D-AMIL PADANG

A%ULTAS %EDO%TERAN

UNIVERSITAS ANDALAS

PADANG

201*


2/35

DAFTAR ISI

KATA PENGANTAR ...................................................................................... ii

DAFTAR ISI.................................................................................................... iiiBAB 1 TINJAUAN PUSTAKA................................................................

1.1 A'!t)(i Neuromuscular Junction..................................................

1.2 ii)/)i d!' Bi)i(i! Neuromuscular Junction...........................1.3 Mi!te'i! Gr!i.............................................................................

1.3.1 Dei'ii Mi!te'i! Gr!i...........................................................

1.3.2 %/!ii!i Mi!te'i! Gr!i......................................................1.3.3 E#ide(i)/)i..............................................................................

1.3.4 Eti)/)i.......................................................................................

1.3.5 P!t)ii)/)i...............................................................................

1.3.* M!'iet!i %/i'i...................................................................... 11

1.3.7 Di!')i.................................................................................... 121.3.6 Di!')i B!'di'..................................................................... 15

1.3. Pe'!t!/!!'!!'......................................................................... 1*1.3.10 %)(#/i!i d!' Pr)')i.......................................................... 21

BAB 2 LAPORAN KASUS ..................................................................... 22

2.1 Ide'tit! P!ie' .............................................................................. 222.2 A'!('ei ...................................................................................... 22

2.3 Pe(eri!!' ii........................................................................... 23

2.4 Pe(eri!!' L!8)r!t)ri9(............................................................. 2

2.5 Pe(eri!!' Pe'9'j!' ................................................................. 22.* Di!')i........................................................................................ 30

2.7 Pe'!t!/!!'!!'............................................................................... 302.6 Pr)')i......................................................................................... 30

BAB 3 DISKUSI ....................................................................................... 31

DAFTAR PUSTAKA

3


3/35

BAB 1

TINJAUAN PUSTAKA

1.1. Anatomi Neuromuscular Junction

Se8e/9( (e(!!(i te't!' (i!te'i! r!i" #e'et!9!' te't!'

!'!t)(i d!' 9'i ')r(!/ d!ri neuromuscular junction !'!t/! #e'ti'.

Ti!#+ti!# er!t !r! e;!r! ')r(!/ 8er;!8!' 8e8er!#! !/i d!' (er!'!'

ti! i'! 8e8er!#! r!t9 er!t )t)t r!'!. Uj9'+9j9' !r! (e(89!t

9!t9 !(89'!'

B!i!' ter(i'!/ d!ri !r! ()t)ri (e/e8!r #!d! 8!i!' !ir'

e#!'j!' er!t !r!. Me(8r!' #rei'!#ti $(e(8r!' !r!&" (e(8r!' #)t

i'!#ti $(e(8r!' )t)t&" d!' ;e/! i'!# (er9#!!' 8!i!'+8!i!'

#e(8e't9 neuromuscular junction.1

G!(8!r 1 'e9r)(9;9/!r j9';ti)' ')r(!/ *

1


4/35

G!(8!r 2 Ree#t)r !eti/)/i' *

1.2. Fisiologi an Bio!imia Neuromuscular Junction

=e/! i'!# (er9#!!' j!r! !'t!r! (e(8r!' #rei'!#ti d!'

(e(8r!' #)t i'!#ti. Le8!r'

)/e 9!t9 /!(i'! 8!!/i"

!eti/)/i' $A=&. Aeti/)/i' dii'tei d!/!( it)#/!(! 8!i!' ter(i'!/

'!(9' de'!' ;e#!t di!8)r#i e d!/!( ej9(/! eie/ i'!#


5/35

d!' 8eri!t!' de'!' ree#t)r !eti/)/i' $A=R& #!d! (e(8r!' #)t

i'!#ti.1"2

Se;!r! 8i)i(i!>i ee/9r9!' #r)e #!d! neuromuscular junction

di!'!# 8er/!'9' d!/!( * t!!#"

1. Si'tei !eti/ )/i' terj!di d!/!( it))/ ter(i'!/ !r! de'!'

(e'9'!!' e'?i( )/i' !eti/tr!'er!e

8eri9t i'i:

2. Aeti/)/i' e(9di!' di!t9!' e d!/!( #!rtie/ e;i/ teri!t+(e(8r!'

! i'i terj!di (e/!/9i e)it)i

eie/ de'!' (e(8r!' #rei'!#ti. D!/!( e!d!!' itir!!t" 9!'t!

t9'!/ $eit!r 10.000 ()/e9/ tr!'(itter

ei'! (e(9'i'!' !/ir!' (!9 =!2@ d!ri r9!' i'!# e ter(i'!/

!r!. I)' =!2@ i'i (e(er!'!' #er!'!'

r)'! i'!#.4. Aeti/)/i'

i'!# e d!/!( ree#t)r di d!/!( /i#!t!' t!9t $j9';ti)'!/ )/d&"

(er9#!!' 8!i!'

(e(89! !/9r!' d!/!( ree#t)r

(e/i't!i (e(8r!'. M!9'

(e(8r!' )t)t ei'! ter8e't9 #)te'i!/ e'd #/!te. %e!d!!' i'i

3

Aeti/+%)A @ %)/i' Aeti/)/i' @ %)A


6/35

e/!'j9t'

terj!di #)te'i!/ !i

E'?i(

8!!/i r)'! i'!#.

*. %)/i' did!9r 9/!' e d!/!( ter(i'!/ !r! (e/!/9i (e!'i(e tr!'#)rt

!ti di (!'! #r)tei' tere89t d!#!t di9'!!' e(8!/i 8!i i'tei

!eti/)/i'.

Seti!# ree#t)r !eti/)/i' (er9#!!' )(#/e #r)tei' 8e!r de'!'

!/9r!'

i'i terdiri d!ri 5 #r)tei' 989'it"

#r)tei' 8et!" de/t!" d!' !((!. Me/e!t'

'!tri9( d!#!t 8erer! e;!r! (9d! (e/e>!ti !/9r!' tere89t" ei'!

!!' terj!di de#)/!ri!i #!ri!/ d!ri (e(8r!' #)t i'!#ti. Periti>! i'i

!!' (e'

9!t9 #)te'i!/ !i #!d! (e(8r!' )t)t

1.3 "iast#nia G$a%is

1.3.1 D#&inisi "iast#nia G$a%is

Mi!te'i! r!i $MG& !d!/! #e'

#!d! tr!'(ii 'e9r)(9;9/!r


7/35

!!' #9/i e9!t!''

(e'9'!!' iti/! (i!te'i! r!i d!' i! j9!

Re(e' $132& d!' !/er $134& (e'

1.3.2 Klasi&i!asi "iast#nia G$a%isMi!te'i! Gr!i )9'd!ti)' ) A(eri;! =/i'i;!/ (e'/!ii!i!'

(i!te'i! r!i (e'j!di 5

T!8e/ 1 %/!ii!i (i!te'i! r!i (e'9r9t Mi!te'i! Gr!i )9'd!ti)' )

A(eri;! =/i'i;!/.*

D#$a'at G#'ala

I Ad!'

(e'9t9# (!t!" d!' e9!t!' )t)t+)t)t /!i' ')r(!/

II Terd!#!t e/e(!!' )t)t )9/!r

III Terd!#!t e/e(!!'

e/e(!!' ti'!t ed!'

III! Me(#e'!r9i )t)t+)t)t !')t! t989" )t)t+)t)t !i!/" !t!9ed9!'


8/35

IV Ot)t+)t)t /!i' e/!i' )t)t+)t)t )9/!r (e'!/!(i e/e(!!'

d!/!( der!j!t

U't9 (e'e't9!' #r)')i d!' #e')8!t!''

P!d! e/)(#) i'i terd!#!t !'9!' #!d! !t9 !t!9 8e8er!#! )t)t

)9/!r

#t)i 9'i/!ter!/. Be't9 i'i 8i!!'

Ot)t+ )t)t re#ir!i 8i!!'

6


9/35

H!/ i'i (er9#!!' e!d!!' d!r9r!t (edi. %rii (i!te'i! d!#!t terj!di #!d!

#e'derit! )/)'!' III

#!d! !!t

(e'j!di e/9(#9!' )t)t+)t)t #er'!!!' !d!/! die8!8!' )/e 8!'!'it! !!' terj!di #e'i'!t!' e/e(!!' #!d! !!t

(e'tr9!i.4

1.3.3 E-i#miologiDi A(eri! eri!t" (i!te'i! r!i j!r!' dite(9!'. %ej!di!''

eit!r 2 d!ri 1.000.000 #e'd9d9 #er t!9'. Pre!/e'i'

#!ie' (i!te'i! r!i d!' !re'! di!')i (i!te'i! r!i

/e8i !>!/.*"7

Ti'!t e#!r!!' #e'

14"3F #!d! #!ie'

(e'e'!i e!/! 9(9r. P9';! ej!di!' #!d! #ere(#9!' #!d! 9i! de!de e

3 eid9#!'" ed!'!' #!d! /!i+/!i #!d! 9i! * 7 de!de eid9#!'. Ui!

r!t!+r!t! !d!/! 26 t!9' #!d! #ere(#9!' d!' 42 t!9' #!d! /!i+/!i.*

D!#!t terj!di tr!'ie't 'e)'!t!/ (i!te'i! r!i #!d! 8!

!'ti8)di ter!d!# A;R


10/35

Mi!te'i! r!i !d!/! 9!t9 #e'

!9t)i(9'. Pe'

(i!te'i! r!i !d!/! er9!!' ree#t)r !eti/)/i' 'e9r)(9;9/!r j9';ti)'

!i8!t #e'

e8!!i !'ti!;et

ti(9 d!' 10F di!'t!r!'

i!'

Be8er!#! )8!t

(i!te'i! r!i !'t!r! /!i':*

1. A'ti8i)ti" (i!/: )/)'!' !(i')/i)id!" #)/i(ii'" ;i#r)/)!;i'"

eritr)(ii' d!' !(#ii/i'.

2. Pe'ii/!(i'. O8!t i'i d!#!t (e'i'd9i terj!di'

)8!t e/!(! 8e8er!#! (i'9 i'! 8e8er!#! 89/!'.

3. Bet! 8/)er" (i!/: #r)#r!')/)/.

4. Liti9("5. M!'ei9("

*. Pr);!i'!(id"

7. Ver!#!(i/6. 9i'idi'e

. %/)r)9i'

10. Pred'i)'

8


11/35

11. Ti()/)/ $8et! 8/)er t)#i!/

1.3./ Pato&isiologi

%e/e(!!' )t)t #!d! (i!te'i! r!i d!' (e'i'!t'!t9

9't9 ei!t!' ii /e8i /!(! di8!'di'!' >!t9

#e'!';9r!' !9t)!'ti8)di ter!d!# A=R

%eti! e89! #)te'i!/ !i 8erer! e ()t)r 'e9r)' d!' (e';!#!i

()t)r e'd #/!te" ()/e9/ !eti/)/i' $A;& di/e#!!' d!ri eie/ #rei'!#ti"

(e/!/9i 'e9r)(9;9/!r j9';ti)' d!' e(9di!' !!' 8eri'ter!i de'!'

ree#t)r A; $A;R& di (e(8r!' #)ti'!#ti. %!'!/+!'!/ di A;R

ter89!" (e(9'i'!' N!@ d!' !ti)' /!i' 9't9 (!9 e d!/!( er!t )t)t

d!' (e'i(89/!' de#)/!ri!i. De#)/!ri!i

9


12/35

(!! !!' (e(i;9 ti(89/'

)t)t 9't9 (e'!i/!' )'tr!i.10

P!d! (i!te'i! r!i" !d! #e'9r!'!' j9(/! A;R

(e'

!'ti8)di (e'%)'e'tr!i !'ti8)di A=R tid! 8er)/er!i ter!d!# ti'!t

e#!r!!' MG. Mi)#!ti i'/!((!t)r< d!#!t terj!di #!d! #!ie' (i!te'i!

r!i d!' di!9(i die8!8!' )/e #)/i(i)iti.11 A'ti8)di #)/i/)'!/ IG

ter!d!# A=R di#r)d9i )/e e/ #/!(! di )r!' /i()id #erier" 9(+9(

t9/!' d!' ti(9.*11"12 Se/ i'i 8er!!/ d!ri e/ B

8eri!t!' de'!' 9r9t!' #e#tide !'tie' A=R $e#it)#&

1.3.0 "anistasi Klinis

G!(8!r!' /i'i (i!te'i! r!i !'!t je/!

e/e(!!' )t)t /!i''

e/e(!!' )t)t );9/!r j!r!' terj!di" !'


13/35

Gej!/! e/e(!!' (i!te'i! r!i !'!t ! di(!'! e/e(!!'

tere89t 8eri!t /9t9!ti. %e/e(!!' !!' (e'i'!t !#!8i/! ed!'

8er!tiit!. Pe'derit! !!' (er!! )t)t'

A'!('ei !t9 #!i !ri'

#!d! )t)t e/)#! (!t!. Bi/! )t)t+)t)t 89/8!r tere'!" 9!r!'!t9 (e'9'

!d!/! !d!'

G!(8!r 1 #!ie' (i!te'i! r!i

1.3. Diagnosis

Di!')i dite!!' 8erd!!r!' !'!('ei

#e(eri!!' ii eder!'! 9't9 (e'i/!i 8er9r!''


14/35

1. A'!('ei

Per/9 dit!'

#!d! #!ie' (i!te'i! r!i ti#e );9/!r

d!' (e'i/!' #!d! #!i !ri. Sert! #t)i d!' 9!r!

e(!i' (e'e;i/ ji! #!ie' 8er8i;!r! d!/!( >!t9

Pe(eri!!' ii di/!9!' 8erd!!r!' #!d! e/e/!!' )t)t+)t)t

tere'!.;. P!d! !9+!9 89/8!r" #!ie' di(i't! 9't9 (e'it9' d!ri !'! 1

!(#!i 100" (!! )/9(e 9!r! !!' (e'i/!' !t!9 ti(89/ di!rtri!.

d. S9/it (e'e/!' 8!ri9( 8i/! terd!#!t ej!/! di!i!.3. Pe(eri!!' !r(!)/)i

Pe(eri!!' !r(!)/)i


15/35

8. Uji Pr)ti(i' $'e)ti(i'&

P!d! te i'i" di9'ti!' 3 ;; !t!9 1"5 ( #r)ti(i' (et

(. 3 j!( e(9di!' di8eri!' 3 t!8/et /!i $(!i'+(!i' 200 ( #er

t!8/et&. Bi/! e/e(!!' it9 8e'!r die8!8!' )/e (i!te'i! r!i" (!!

ej!/! e#erti #t)i" tr!8i(9" d!' /!i'+/!i' !!' 8ert!(8! 8er!t.

U't9 9ji i'i" e8!i'

4. Pe(eri!!' L!8)r!t)ri9(!. A'ti+!eti/)/i' ree#t)r !'ti8)di

H!i/ d!ri #e(eri!!' i'i d!#!t di9'!!' 9't9

(e'di!')i 9!t9 (i!te'i! r!i" di(!'! terd!#!t !i/

e'er!/i!t! d!' 50F d!ri #e'derit! de'!' (i!te'i! )9/!r (9r'i

(e'9'j9!' !i/ te !'ti+!eti/)/i'ree#t)r !'ti8)di

!(#!i!' #!d! t!8e/ 8eri9t: *

T!8e/ 2. Pre!/e'i d!' Titer A'ti+A=R A8 #!d! P!ie' Mi!te'i! Gr!i.*

13

sserman Class !ean antibodi "iter #ercent #ositive

R 0.7 24

I 2.17 55

IIA 4.6 60

IIB 57. 100

III 76.5 100

IV 205.3 6


16/35

%eter!'!': R K remission" I K ocular only" IIA K mild generali$ed "

IIB K moderate generali$ed "III K acute severe" IV Kchronic severe

P!d! t!8e/ 2 d!#!t di/i!t 8!>! titer !'ti8)di /e8i ti'i #!d! #e'derit! (i!te'i! r!i d!/!( )'dii

tere89t tid! d!#!t di9'!!' 9't9 (e(#redii!' der!j!t #e'

(i!te'i! r!i.*

8. A'ti tri!ted (9;/e $!'ti+SM& !'ti8)di

Mer9#!!' !/! !t9 te

(i!te'i! r!i. Te i'i (e'9'j9!'!i/ #)iti #!d! eit!r 64F

#!ie'

#!ie' t!'#! t!i/ !'ti+A=R A8 'e!ti $(i!te'i! r!i er)'e!ri&"

(e'9'j9!' !i/

D!/!( er9( 8e8er!#! #!ie' de'!' (i!te'i! r!i

(e'9'j9!' !d!'

#!ie'(9d! de'!' (i!te'i! r!i.*

5. I(!i'

!. =et +r!<

)t) r)'te' t)r! d!#!t di/!9!' d!/!( #)ii

!'ter)#)teri)r d!' /!ter!/. P!d! r)'te' t)r!" ti()(! d!#!t

diide'tii!i e8!!i 9!t9 (!! #!d! 8!i!' !'teri)r (edi!ti'9(.10

H!i/ r)'te'


17/35

t)r! 9't9 (e'ide'tii!i ti()(! #!d! e(9! !9 (i!te'i!

r!i" ter9t!(! #!d! #e'derit! de'!' 9i! t9!. *"10

8. MRI

P!d! )t! d!' )r8it! e8!i'

r!i tid! d!#!t dite!!' de'!' #e(eri!!' #e'9'j!' /!i''

d!' 9't9 (e';!ri #e'


18/35

G!(8!r 4 A/9r #e'!t!/!!'!!' Mi!te'i! Gr!i.10

D!!r #e')8!t!' !d!/! de'!' (e'9'!!' )8!t+)8!t

!'ti)/i'eter!e (i!/'

!/i #er!ri" e(9di!' d)i'

#e'derit!. O8!t+)8!t !'ti)/i'eter!e i'i (e(#9'

di/!9!' ti(et)(i. %!re'! ter!#i ter)id d!#!t (e'i(89/!' ee !(#i'

16


19/35

e/!( 2 (i'9 #e')8!t!'" (!! #er/9 #er!>!t!' di r9(! !it" ter9t!(!

8i/! ti(89/ ej!/!+ej!/! 89/8!r. O8!t !'ti)/i'eter!e !r9 diter9!' d!'

#red'i)' di8eri!' ert! diti'!t!' #er/!!'+/!!' d!ri d)i i'ii!/ 25 (

!(#!i 100 ( #er!ri d!' di8eri!' e/!' !t9 !ri" ter!'t9' #!d! re!i

#e'derit!. Sete/! !d! #er8!i!'" d)i 'e)ti(i' d!' #irid)ti(i' d!#!t

dit9r9'!' #er/!!'+/!!'. %)(8i'!i 8!i #irid)ti(i' d!' #red'i)'

de'!' ti()(!1.D!/!( #e'!t!/!!'!!' #!d! (i!te'i! r!i d!#!t di8eri!' ter!#i

e8!!i 8eri9t :

1. Ne)ti(i' 8r)(ide $#r)ti(i'& 15 ( #er t!8.$#er )&. Bi!!'

di8eri!' 31 t!8 e!ri & d!#!t diti'!t!' (e'j!di 32 t!8&. U't9

(e'i'd!ri ti(89/'

!t!9 et. Be//!d)''!e.

2. Ne)ti(i' (et

Ter!#i i(9')9#rei d!' i(9')()d9/!i


20/35

terj!di'

r!i. Pe')8!t!' i'i d!#!t di)/)'!' (e'j!di ter!#i

/!(8!t tet!#i (e(i/ii ee

eeti. Re#)' d!ri ter!#i i'i !d!/! (e'9r9''

eeti di9'!!' #!d! it9!i di(!'! ter!#i j!'! #e'de

(e(!i(!/!' te'!! #!ie'

)/9(e #/!(! ti!# !/i ter!#i 9't9 5 !t!9 * !/i ter!#i eti!# !ri. A/89(i'

$5F& de'!' /!r9t!' !/i'

'!tri9( d!#!t di9'!!' 9't9 replacement .

Ee PE !!' (9';9/ #!d! 24 j!( #ert!(! d!' d!#!t 8ert!!' i'!/e8i d!ri 10 (i'9. Ee !(#i' 9t!(! d!ri ter!#i PE !d!/! terj!di'

#ereer!' ;!ir!' e/!(! #ert9!r!' 8er/!'9'. Terj!di rete'i !/i9("

(!'ei9(" d!' '!tri9(

di#erir!!' (!(#9 (e()d9/!i re#)' i(9'. Red9i d!ri titer !'ti8)di

tid! d!#!t di89ti!' e;!r! /i'i" !re'! #!d! e8!i!' 8e!r #!ie' tid!

terd!#!t #e'9r9'!' d!ri titer !'ti8)di. Ee d!ri ter!#i de'!' IVIG d!#!t

18


21/35

(9';9/ eit!r 3+4 !ri ete/! (e(9/!i ter!#i. IVIG dii'di!i!' #!d!

#!ie'

di/!'j9t!' 1 r!(88!ri e/!(! 2 !ri. IVIG di/!#)r!' (e(i/ii

e9't9'!' /i'i 8er9#! #e'9r9'!' /ee/ !'ti+!eti/)/i' ree#t)r

!(#i' d!ri ter!#i de'!' (e'9'!!' IVIG !d!/! '

1. %)rti)ter)id

Re#)' ter!d!# #e')8!t!' )rti)ter)id (9/!i t!(#! d!/!(

>!t9 2+3 (i'9 ete/! i'ii!i ter!#i. D9r!i erj! )rti)ter)id d!#!t

8er/!'9' i'! 16 89/!'" de'!' r!t!+r!t! e/!(! 3 89/!'. %)rti)ter)id

(e(i/ii ee

#!ti ter!d!# (i!te'i! r!i (!i 8e/9( diet!9i. %)rti)ter)id

di#erir!!' (e(i/ii ee #!d! !ti!i e/ T e/#er d!' #!d! !e

#r)/ier!i d!ri e/ B.

Se/ T ert! antigen-presenting cell

(e(i/ii #er!'

te(#!t e/!i'!' i(9' #!d! (i!te'i! r!i. P!ie'

)rti)ter)id !!' (e'!/!(i #e'9r9'!' d!ri titer !'ti8)di'

%)rti)ter)id dii'di!i!' #!d! #e'derit! de'!' ej!/! /i'i


22/35

di/!9!' t!#eri' ) #!d! #e(8eri!''

di!8ete" d!' )(#/i!i )8eit! ert! i#erte'i.

2. A?!ti)#ri'e

A?!ti)#ri'e di9'!!' #!d! #!ie' (i!te'i! r!i

A?!ti)#ri'e d!#!t di)'eri (e'j!di (er!#t)#9ri'" 9!t9 !'!/) d!ri

#9ri'

#e(e/i!r!!' 2+3 (88!ri. P!ie' di8eri!' d)i !>!/ e8e!r 25+50

(!ri i'! d)i )#ti(!/ ter;!#!i.

A?!ti)#ri'e (er9#!!' )8!t

de'!' 8!i )/e t989 d!' e;!r! 9(9( (e(i/ii ee !(#i'

A?!ti)#ri'e !'!'t /!(8!t" de'!' re#)' (!i(!/ did!#!t!' d!/!( 12+

3* 89/!'. %e!(89!' di/!#)r!' terj!di #!d! eit!r 50F !9" e;9!/i

#e'9'!!''

=


23/35

>!'it! (9d! de'!' ri>!!'it! (9d! t!'#!

ti()(! ir!+ir! 60F+0F #e'derit! !!' (e(8!i !t!9 !!' terj!di re(ii

e8e/9( ti'd!!' ti(et)(i !'t!r! /!i':

1. Ter!#i !'ti)/i'eter!e de'!' 'e)ti(i' !t!9 #irid)ti(i'

!r9 di/!9! tr!e)t)(i #!d! !!t di/!9!' ti(et)(i 9#!

re#ir!i d!#!t di8eri!' #!d! !!t #!;!8ed!.

3. P!d! #!;!8ed!" ter!#i !'ti)/i'eter!e di(9/!i de'!' (e(8eri!'d)i re'd! d' die9!i!' d'e!' e89t9!' #e'derit!.

Se;!r! 9(9(" e8!'

>!t9 !t9 t!9' ete/! t

!/i #er;!

ter!'t9' d!ri je'i t

re(ii

1.3.14 Kom-li!asi an P$ognosis

T!'#! #e')8!t!' !'! e(!ti!' (i!te'i! r!i !d!/! 25+31F.

Mi!te'i! r!i

#)'t!' 10F. Seit!r 15+17F #!ie' !!' tet!# (e'!/!(i ej!/! )9/!r

e/!(! (!! ti'd! /!'j9t r!t!+r!t! i'! 17 t!9'. P!ie'+#!ie' i'i die89t

e8!!i (i!te'i! r!i )9/!r. Si!'

d!' die89t e8!!i (i!te'i! r!i e'er!/i!t!. Se89! t9di d!ri 37 #!ie'

(i!te'i! r!i de'!' ti()(! (e(i/ii ej!/!


24/35

BAB 2

LAPORAN KASUS

2.1 IDENTITAS PASIEN

N!(! : N/9'! e#erti 8989r" '!(9' (!i d!#!t (e'e/!' (!!'!' ;!ir. %e/9!'

dir!!!' /9t9!ti. %e/9!' (9';9/ ji! #!ie' (er!! e/e/!!' d!'

8!'

ter9t!(! ji! #!ie' 8!'

+ %e/)#! (!t! dir!!!' e(!i' 8ert!(8! 8er!t d!' t!(#! j!t9 di

)re !ri. Ai8!t e/9!' i'i #!ie' /e8i 8!'

+ Se! '!! tid! !d!.

+ P!'d!'!' !'d! tid! !d!.

+ De(!( tid! !d!.+ %e/e(!!' #!d! !')t! er! tid! !d!.

Ri6a+at P#n+a!it Da5)l) (

22


25/35

+ %e/9!' i'i 9d! dir!!!' ej! 3 t!9'

(9';9/ /!i ji! #!ie' 8er!tiit! 8er!t. %e/9!' !t di I=U RSUP

Dr.M.Dj!(i/ P!d!' d!' di/!9!' tr!e)t)(i. S!!t it9 #!ie' r9ti'

(i'9( (eti')' 4*0 (.

+ Ri>!

e8e/9('

Ri6a+at P#!#$'aan7 Sosial7 E!onomi7 K#'i6aan7 an K#*iasaan (

+ P!ie' !d!/! e)r!' i89 r9(! t!'!" !tiit! ii ri'!'+ed!'.

2.3 PE"ERIKSAAN FISIK

Stat)s g#n#$alis(

%e!d!!' U(9( : S!it ed!'

%e!d!r!' : Compos mentis cooperative

Te!'!' D!r! : 12060 ((H

N!di : Ter!8! 9!t" re9e'i 76 !/i(e'it" re9/!r.

N!! : A8d)(i') t)r!!/" re9e'i 22 !/i(e'it.

S99 : 3*"6 )=

%e!d!!' i?i : 8!i

Ti'i B!d!' : 156 ;(

Ber!t B!d!' : 54

Stat)s Int#$n)s(

R!(89t : it!(" /9r9" tid! (9d! di;!89t.

%9/it d!' 99 : tid! !d! e/!i'!'

%e/e'jer Get! Be'i' :

23


26/35

+ Leer : tid! dite(9!' #e(8e!r!' %GB.

+ Ai/! : tid! dite(9!' #e(8e!r!' %GB.+ I'9i'!/ : tid! dite(9!' #e(8e!r!' %GB.

%e#!/! : tid! dite(9!' e/!i'!'.

M!t! : )'j9'ti! tid! !'e(i" /er! tid! iteri

Hid9' : tid! dite(9!' e/!i'!'.

Te/i'! : tid! dite(9!' e/!i'!'.

Leer : -VP 5+2 ;(H2O

P!r9

I'#ei : i(etri" iri K !'!' !!t t!ti d!' di'!(i.

P!/#!i : re(it9 ')r(!/" iri K !'!'.

Per9i : )')r.

A99/t!i : ei9/er" rhonki ++" whee$ing ++.

-!'t9'

I'#ei : it9 )rdi tid! ter/i!t.

P!/#!i : it9 )rdi ter!8! 1 j!ri (edi!/ /i'e! (id ;/!i;9/! i'itr!

RI= VI.

Per9i : 8!t! j!'t9' d!/!( 8!t! ')r(!/.

A99/t!i : ir!(! ter!t9r" HR: *1!/i(e'it" re9/!r" 8ii' tid! !d!.

A8d)(e'

I'#ei : dite'i tid! !d!.

P!/#!i : 9#e/" e#!r d!' /ie' tid! ter!8! (e(8e!r.

Per9i : ti(#!'i.

A99/t!i : 8ii' 99 $@& ')r(!/.

Stat)s N#)$ologis

%e!d!r!' : G=S 15 $E4 M* V5&.

1. T!'d! R!'!'!' Se/!#9t Ot!:

%!9 %9d9 : $+& T!'d! %er'i : $+&

Br9d?i'i I : $+& T!'d! L!e9e : $+&

Br9d?i'i II : $+&

2. T!'d! Pe'i'!t!' Te!'!' I'tr!r!'i!/: tid! !d!

24


27/35

+ P9#i/ : i))r" di!(eter 3((3(( )9/i detr! i'itr!"

re/e ;!!

N.II $O#ti9&

P#ngli5atan Kanan Ki$i

T!j!( Pe'/i!t!' 55 55

L!#!'!' P!'d!' 8!i 8!i

Me/i!t >!r'! 8!i 8!i 9'd9)#i Tid! di/!9!' #e(eri!!'

N.III $O9/)()t)ri9&

Kanan Ki$i

B)/! M!t! B9/!t B9/!t

Pt)i Tid! !d! Tid! !d!

Ger!!' B9/89 Be8! Be8!

Str!8i(9 Tid! !d! Tid! !d!

Nit!(9 Tid! !d! Tid! !d!

E)E'd)#t!/(9 Tid! !d! Tid! !d!

P9#i/+ Be't9 B9/!t B9/!t

+ Re/e =!!

+ Re/e A)()d!i $@& $@&

+ Re/e %)'ere'i $@& $@&

N. IV $Tr)/e!ri&

Kanan Ki$i

Ger!!' (!t! e 8!>! @ @

Si!# 89/89 Ort) Ort)

Di#/)#i! Tid! !d! Tid! !d!

N. VI $A8d9e'&

Kanan Ki$i

Ger!!' (!t! e /!ter!/ @ @

25


28/35

Si!# 89/89 Ort) Ort)

Di#/)#i! Tid! !d! Tid! !d!

N. V $Trie(i'9&Kanan Ki$i

M)t)ri D!/!( 8!t! ')r(!/

Me(89! (9/9t @ @

Me'er!!' r!!' @ @

Me'iit @ @

Me'9'

Se')ri B!i B!i

+ Diii O#t!/(i! D!/!( 8!t! ')r(!/

Re/e %)r'e! @ @

Se'i8i/it! @ @

+ Diii M!i/! D!/!( 8!t! ')r(!/Re/e M!eter @ @

Se'i8i/it! @ @

+ Diii M!'di89/! D!/!( 8!t! ')r(!/

Se'i8i/it! @ @

N. VII $!i!/i&

Kanan Ki$i

R!9t >!j! P/i! '!)/!8i!/i i(etri P/i! '!)/!8i!/i i(etri

Serei !ir (!t! @ @

i9r! #!/#e8r! @ @

Me'er!!' d!i Si(etri Si(etri

Me'9t9# (!t! @ @

Me';i8ir8eri9/ @ @

Me(#er/i!t!' ii @ @

Se'!i /id! 23 de#!' B!i B!i

Hi#er!9i Tid! !d! Tid! !d!

N. VIII $Veti89/!ri&

Kanan Ki$i

S9!r! 8er8ii @ @

Deti Ar/)ji @ @Ri''e tet N)r(!/ N)r(!/

e8er tet N)r(!/ N)r(!/

S;>!8!; S!(! de'!' #e(eri! S!(! de'!' #e(eri!

+ Me(!'j!' + +

+ Me(e'de + +

Nit!(9 Tid! !d! Tid! !d!

26


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+ Pe'd9/!r + +

+ Verti!/ + +

+ Si/i!/ + +

Pe'!r9 #)ii e#!/! Tid! !d! Tid! !d!

N.I $G/))!ri'e9&

Kanan Ki$i

Se'!i Lid! 13 8e/!!' B!i 8!i

Re/e (9't! ! re/e @ @

N. $V!9&

Kanan Ki$i

Ar9 !ri' Si(etri Si(etri

U9/! Di te'!

Me'e/!' @" (e'9r9' @" (e'9r9'

Arti9/!i -e/!S9!r! @

N!di Ter!8! 9!t" ter!t9r

N. I $Ae)ri9&

%!'!' %iri

Me')/e e !'!' @ @

Me')/e e iri @ @

Me'!'!t 8!9 e !'!' @ @

Me'!'!t 8!9 e iri @ @

N. II $Hi#)/)9&

Kanan Ki$i

%ed9d9!' /id! d!/!( Dite'!

%ed9d9!' /id! dij9/9r!' Dite'!

Tre()r Tid! !d! Tid! !d!

!i9/!i Tid! !d! Tid! !d!

Atr)#i Tid! !d! Tid! !d!

4. Pe(eri!!' %))rdi'!i

=!r! Berj!/!' N)r()!it Di!rti! +

R)(8er tet + Dir!i! +At!i! + S9#i'!i+#r)'!i Tid! ter!'9

Re8)9'd Pe')(e' + Tet j!ri id9' Tid! ter!'9

Te T9(it L9t9t + Tet id9' j!ri Tid! ter!'9

5. Pe(eri!!' 9'i M)t)ri

27


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A. B!d!' Re#ir!i T)r!)!8d)(i'!/

D9d9 @

B.Berdiri d!' 8erj!/!' Ger!!' #)'t!' @ @

Tre()r Tid! !d! Tid! !d!

Atet)i Tid! !d! Tid! !d!Mi)/)'i Tid! !d! Tid! !d!

%)re! Tid! !d! Tid! !d!

=.Eter(it! S9#eri)r I'eri)r

%!'!' %iri %!'!' %iri

Ger!!' Ati Ati !ti Ati

%e9!t!' 555 555 555 555

Tr)#i E9tr)#i E9tr)#i E9tr)#i E9tr)#i

T)'9 E9t)'9 E9t)'9 E9t)'9 E9t)'9

*. Pe(eri!!' Se'i8i/it!

%!'!' %iriSe'i8i/it! t!ti/ T!'!' d!' !i 8er9r!' T!'!' d!' !i 8er9r!'

Se'i8i/it! '


31/35

+ Mii : $@& >!r'! d!' j9(/! 8i!!.

+ Dee!i : $@& >!r'! d!' )'ite'i 8i!!.+ Ot)')( : U'i'i8ited 8/!dder $+&

. 9'i L99r

%e!d!r!' T!'d! De(e'i!Re!i 8i;!r! @ Re/e /!8e/! +

re!i i'te/e @ Re/e S')9t +

Re!i e()i @ Re/e Me'i!# +

Re/e Me(e!' +

Re/e #!/()(e't!/ +

Te >!ter'8er: ter!'9

Te 8erit9': ter!'9

2. PE"ERIKSAAN LABORATORIU" (

D!r! r9ti':

+ He()/)8i': 11 rd/+ He(!t)rit: 33F

+ Le9)it : 12.700((3

+ Tr)(8)it : 205.000((3

%e!': /e9)it)i

%i(i! /i'i:

+ Ure9(: 25 (d/

+ %re!ti'i': 0"6 (d/

+ N!tri9(: 136 (()/L+ %!/i9(:3"6 (()/L

+ =/)rid!: 105 (()/L

+ %!/i9(: "7 (d/.

%e!': d!/!( 8!t! ')r(!/

2./ PE"ERIKSAAN PENUNJANG (

!. E%G

8. EMG

2.0 DIAGNOSIS

Diagnosa Klinis ( Mi!te'i! Gr!i r!de II8

Diagnosa To-i! ( Ne9r)(9;9/!r j9';ti)'

Diagnosa Etiologi ( !9t)i(9'

2. PENATALAKSANAAN (

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!. Ter!#i 9(9(:

+ IVD Ri'er L!t!t 12 j!()/.+ NGT

8. Ter!#i 99:

+ Meti')' 4*0 ( $#.)&+ Meti/ #red'i)/)'e 4125 ( $i.& t!# ).

+ R!'itidi' 250 ( $i.&

2. PROGNOSIS

+ 9) !d it!(: 8)'!(.+ 9) !d !'!ti)'!(: d98i! !d 8)'!(

+ 9) !d 9';ti)'!(: d98i! !d 8)'!(.

BAB 3

DISKUSI

Se)r!' #!ie' #ere(#9!'" 9(9r 31 t!9'" dir!>!t di8!'!/ !r! RSUP

Dr.M.Dj!(i/ P!d!' de'!' di!')i (i!te'i! r!i r!de II8. D!ri !'!('ei

did!#!t!' e/9!' 9t!(! 9/it (e'e/!'. Ri>!! 9! (e'e/!' 9d! dir!!!' ej! 1 (i'9

30


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9/it (e'e/!' (!!'!' /9'! e#erti 8989r" '!(9' (!i d!#!t (e'e/!' (!!'!'

;!ir. %e/9!' dir!!!' /9t9!ti. %e/9!' (9';9/ ji! #!ie' (er!! e/e/!!' d!'

8!'

8ert!(8! 8er!t d!' t!(#! j!t9 di )re !ri. Ai8!t e/9!' i'i #!ie' /e8i 8!'

8eritir!!t.

Gej!/! !t9 #!i !ri'

8i/! #er;!!#!' 8er/!'9' ter9. P!d! !9

Gej!/! e/e(!!' (i!te'i! r!i !'!t ! di(!'! e/e(!!' tere89t

8eri!t /9t9!ti. %e/e(!!' !!' (e'i'!t !#!8i/! ed!' 8er!tiit!. Pe'derit!

!!' (er!! )t)t'

D!ri #e(eri!!' ii dite(9!' #!d! te >!te'8er ter!'9 d!' te

8erit9' j9! ter!'9. P!d! #e(eri!!' 'er9 r!'i!/i dite(9!' !d!'

#!ree N.I d!' di(!'! re/e (e'e/!' (e'9r9'. O/e !re'! it9 #!ie' !r9

di#!!' NGT 9't9 (e';e! terj!di'

#red'i)/)' 4125 ( $i.& t!# ) d!' r!'itidi' 250 ( $i.&. Meti')' !d!/!

)8!t

31


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(eti')' !re'! >!t9 #!r9'

ee !(#i' ter!d!# !/9r!' ;er'!'

di!re'!!' #!ie' i'i tid! (e(8eri!' re#)' #er8!i!'


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DAFTAR PUSTAKA

1. S'e//" Ri;!rd S." 2007. Neuro 'natomi (linik ed) *) EG=. -!!rt!.

2. M9rr!

Ne9r)(9;9/!r -9';ti)' %!#er. D!/!( Br!9'>!/d" !9;i" H!9er" L)')"

-!(e)'. H!rri)'Q. Pri';i#/e ) I'ter'!/ Medi;i'e edii 1*. M;Gr!>

Hi// 2005.

11. S!'der D.B." Ge'er!/i?ed (

13. H)>!rd" -.. M

di)rder(

#!d!: 2* M!ret 201*].

14. N)er! Gd. N. Gt. I" D!!r+D!!r I/(9 Pe'

case miastenia gravis

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