kasus saraf 2

7/25/2019 KASUS SARAF 2

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KASUS SARAF 2

PARKINSON, GANGGUAN PSIKIS, NYERI SARAF

1. K.J. is a 73-year-old a! "i#$ a $is#ory o% &od'(i! ly)$oa. &e is i! reissio! a%#er

*$eo#$era)y a!d radia#io! #rea#e!#. &e is see! i! *o!s+l# %or P&N a##ri+#ale #o a *ase o%

s$i!'les d+ri!' *$eo#$era)y. $e os#er e)isode "as a%#er $is /rs# *$eo#$era)y *y*le 2 years

a'o. $e lesio!s *o0ered a! area aro+!d $is ri'$# lo"er adoe! elo" #$e +ili*+s i! a 1- #o

1-* s#ri) aro+!d #$e lo"er a*( a!d +##o*(. Si##i!' +ie#ly, $is )ai! is a 1 #o 2 o% 1. A# i#s

"ors# i# is 7 #o 4 o% 1. Pai! is a''ra0a#ed y li'$# #o+*$ or a!y 5arri!' o#io! 6s+*$ as ridi!' i!

a *ar or r+i!' o% *lo#$es o! #$e lo*a#io! o% #$e os#er. &e $as #"o areas #$a# $a0e 'rea#er )ai!,

o!e lo*a#ed i! #$e lo"er ri'$# as)e*# o% $is a*( a!d #$e o#$er i! #$e ri'$# lo"er adoi!al

+adra!#. &e des*ries #$e )ai! as a +r!i!' se!sa#io!. &e 'e#s ild relie% %ro #o)i*al

a+a)$ili* oi!#e!#. I% $e s#ays +sy, i# soe#ies #a(es $is i!d o%% #$e )ai!. &e $as !o# ee!slee)i!' "ell e*a+se o% #$e )ai!. &is )as# edi*al $is#ory i!*l+des &od'(i! ly)$oa, i!

reissio!, lo" a*( )ai!, a!d e!i'! )ros#a#i* $y)er#ro)$y 68P&. &e *+rre!#ly #a(es a*y*lo0ir

9 ' daily, al)raola .2 ' :&S as !eeded 6PRN %or slee), do*+sa#e 1 ' 8I; PRN

%or *o!s#i)a#io!, +l#i0i#ai! o!e daily, #as+losi! .9 ' :&S, a!d ol)ide ' :&S. K.J.

is arried, $as !e0er so(ed, a!d de!ies al*o$ol a!d illi*i# dr+' +se. &is )$ysi*al e

Ser+ *rea#i!i!e, 1.2 '?d=

Ele*#roly#es, "i#$i! !oral lii#s

8lood )ress+re, 137?4 &'&ear# ra#e, 77 ea#s?i!+#e

@ei'$#, 4 ('

@$i*$ edi*a#io! is #$e os# a))ro)ria#e o)#io! %or #rea#i!' K.J.s P&N )ai!B @$a# %a*#ors !eed

#o e *o!sidered "$e! *$oosi!' a edi*a#io! %or K.J.B

2. =.C. la(i-la(i #a$+!, seora!' asis#e! a(#or, da#a!' (e (li!i( sara% de!'a! (el+$a!

e!'alai (es+li#a! el+(is (are!a #a!'a! (a!a!!ya #ida( isa #e!a!' 6se)er#i #reor. ;ia

5+'a e!'el+$(a! sea(i! s+li# erdiri dari (+rsi se#ela$ laa d+d+( (are!a ada!ya rasa!ya

(e(e#a#a! )ada #a!'a! da! (a(i. Selai! i#+ ia 5+'a e!'alai )e!+r+!a! i!dera )e!*i+a!!ya

da! erli+r erlei$a!, #er+#aa )ada ala $ari. ;ari (e#era!'a! is#ri!ya, )asie! se(ara!'

e!5adi )el+)a, )asie! )+! 5+'a e!yadari!ya. Ri"aya# )e!ya(i# )asie! adala$ de)resi selaa

se#a$+! #era($ir, 'o+# 6ya!' #ida( )erl+ di#era)i, (o!s#i)asi, 8P& 68e!i'! )ros#a#i*

$y)er#ro)$y, da! aor#i* s#e!osis. Pasie! #ida( ero(o(, #e#a)i (ada!'-(ada!' i!+ al*o$ol di


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ala $ari. Ce!da)a# #era)i *i#alo)ra 1'?$ari. ;ari $asil )eeri(saa! %isi(, )er(ea!'a!

)asie! !oral, ra+# "a5a$ #er(esa! (a(+, 'aya i*ara ya!' le+#, #er(esa! o!o#o!, a+ ada!

ya!' (+a#. Peeri(saa! e(s#rei#as e!+!5+((a! ada (e(a(+a! di le!'a! da! (a(i, da! #reor

)ada #a!'a! (a!a!. Gaya er5ala!!ya laa# de!'a! )os#+r #++$ a'a( +!'(+(.

Keseia!'a!!!ya ai( #a!)a re#ro)+lsio! a#a+ $ila!'!ya re%le< el+r+s(a! (eali. &asil

)eeri(saa! 'e!i#o+ri!ary e!+!5+((a! ada!ya )eesara! )ros#a#. &asil )eeri(saa! la>

;> 11D? &' @8> 99 sel? =

&R> 71


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s+ai!ya, Car#ia!, e(er5a +!#+( )eeri!#a$a! selaa 2 #a$+! #era($ir da! ere(r+# a!a( ya!'

el+ dila$ir(a! +!#+( )ro'ra l+ar a!'(asa. ;ia 5+'a e!e+(a! a$"a aya$ da! #ea!

se(aar!ya i(+# #erlia# de!'a! (o!s)irasi i!i, se$i!''a dia #ida( )er*aya ere(a la'i. ;ia

e!'a#a(a! a$"a s+er i!%orasi ra$asia e!'irii!ya )esa! elal+i i(la! a5ala$ da! .

;ia e!ya(i!i i#+ adala$ s+ara i+!ya ya!' #ela$ a#i e!'a#a(a! +!#+( e!'a(ali )e!*+ri

ayi de!'a! *ara e+!+$ diri(+ se!diri.L J.R. #ida( eili(i ri"aya# )e!ya(i# )si(ia#ri(

seel+!ya da! #ida( )er!a$ dira"a# di RS. ;ia e!ya!'(al )e!ya(i# seel+!ya da! er(a#a

Ka+ e!''+!a(a! i!i +!#+( alasa! +!#+( e!'ail ayi(+ dari a(+.L J.R. #++$ de"asa

de!'a! aya$!ya, (are!a i+!ya seri!' dira"a# di r+a$ sa(i# a(ia# e)isode )si(osis. ea!

se(aar J.R. selaa 3 #a$+! #era($ir e!'a#a(a! a$"a #i!'(a$ la(+ J.R sea(i! a!e$ selaa

eera)a +la! #era($ir. J.R. e(er5a sea'ai )ro'raer *o)+#er, #e#a)i ar+-ar+ i!i, dia

seri!' #ida( as+( (er5a da! eili$ di r+a$, e!o!#o! , da! e!'$ais(a! +a!'!ya +!#+(

eeli )a(aia! ayi da! )o)o(. ;ia 5+'a #ida( la'i e!'i(+#i (e'ia#a! 'ere5a +!#+( er#e+

#ea! a+)+! (el+ar'a!ya. Pasie! 5+'a ero(o( 1 a#a!'?$ari da! ea!#a$ )ea(aia!

al*o$ol, a#a+ oa# #erlara!'.&asil )eeri(saa! !e+rolo'is da! %isi( iasa-iasa sa5a. 8CI )asie! 27,2 ('? 2. &asil #es#

laora#ori+ +!#+( 8 de!'a! di%ere!sial 6*o)le#e lood *o+!#, +ri!alisis, %+!'si li0er, da!

#$yroid dala (eadaa! !oral. &asil li)id ya!' a!oral> Koles#erol #o#al 294 '?d=M &;= 39

'?d=M G 17 '?d=M =;= 17D '?d=. &asil )eeri(saa! (e$aila! 6-. &asil EG> :* 9

ilise*o!d. U!#+( $asil )eeri(saa! e!#al, dari )e!a)ila! da! )erila(+!ya dida)a#(a! )asie!

eili(i (elei$a! era# ada!. ;ia 5+'a +da$ 'elisa$ ole$ eera)a )er#a!yaa!. Pasie! selal+

*+ri'a da! selal+ e!a!ya(a! U!#+( sia)a a!da e(er5aBL Pasie! see!#ara didia'!osa

s(io)re!ia #i)e )ara!oid. era)i %ara(olo'i da! !o!-%ara(olo'i a)a ya!' a!da sara!(a!B

. C.=. "a!i#a er+sia 24 #a$+! da#a!' (e (li!i( +!#+( )er#aa (ali!ya de!'a! (el+$a! (+ra!'#id+r, !yeri, da! (e(+ra!'a! e!er'i. ;ari $asil "a"a!*ara de!'a! do(#er, )asie! 5+'a

e!'el+$(a! seri!' e!a!'is da! #ida( la'i er'a+!' di (l+ o"li!', ya!' iasa dia la(+(a!

di a($ir )e(a!. ;ia 5+'a ($a"a#ir a(a! di)e*a# dari )e(er5aa!!ya a(ia# a($ir-a($ir i!i dia #erlal+

seri!' i5i! sa(i# da! (e#ida(a)+a! er(o!se!#rasi )ada #+'as sela dia (er5a. ;ia 5+'a

erasa(a! #e(a!a! a#a+ s#ress #er$ada) (e+a!'a! (el+ar'a!ya (are!a s+ai!ya ar+ sa5a di)e*a#

dari )e(er5aa!!ya se$i!''a dia erasa )+#+s asa da! %r+s#asi. ;ia e!'a(+ i!+ 3-9 'elas ir

#ia) ala +!#+( ersa!#ai da! a'ar isa #er#id+r. ;ari da#a re(a edis dida)a#(a!>

Ri"aya# )e!ya(i# #erda$+l+> *$ro!i* a*( )ai! se5a( (e*ela(aa! o#or 3 #a$+! ya!' lal+.

Ri"aya# (el+ar'a> i+ e!deri#a ;C da! C;; 6a5or de)ressi0e disorder, aya$ #ida( eili(i

ri"aya# )e!ya(i# a)a)+!, (a(a( la(i-la(i!ya se+$ dari (e*a!d+a! al*o$ol.

Ri"aya# sosial> e(er5a sea'ai se(re#aris di )er+sa$aa! (o!s#r+(si. 8eera)a +la! #era($ir

eili(i (eiasaa! i!+ 3-9 ir?ala. Ce!ya!'(al ero(o( a#a+ oa# #erlara!'.

Ri"aya# oa#> =o?O0ral 1 #ale#?$ariM O


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&asil )eeri(saa! s#a#+s> )erasaa! de)resi, )erasaa! #er#e(a!, )er!a$ er)i(ira! a#i #a)i #ida(

ada ide +!+$ diri.

&asil laora#ori+> !oral

;ia'!ose see!#ara> C;;

era)i %ara(olo'i da! !o!-%ara(olo'i a)a ya!' a!da sara!(a!B

. .&. la(i-la(i er+sia 3 #a$+! de!'a! ri"aya# $i)er#e!si, da#a!' (e (li!i( de!'a! (el+$a!

rasa (a!#+( di sia!' $ari, *ra"ly le'sL )ada "a(#+ #id+r, da! seri!' #era!'+! di ala $ari.

;ari $asil "a"a!*ara de!'a! )asie! dida)a#(a! a$"a )asie! )ada sa#+ 5a #era($ir a#a+ lei$

seel+ #id+r dia #ida( da)a# e!5a'a (a(i!ya +!#+( #e#a) dia. ;ia 5+'a e!'a#a(a! a$"a ia

5adi +da$ #er#id+r di sia!' $ari, 'e5ala i!i sea(i! )ara$ selaa #a$+! lal+ da! #er5adi )ada

ala $ari. Is#ri!ya e!'a(+i a$"a )ada s+a#+ ala (a(i s+ai!ya e!e!da!' diri!ya,

s+ai!ya e!5adi e!'oro(, da! (ada!'-(ada!' #erde!'ar #ere!'a$-e!'a$ se#ela$ 5eda

er!a)as. 8CI )asie! 3 ('?2, da! dia ar+-ar+ i!i e!'alai (e!ai(a! 88 da! e!'el+$

sa(i# (e)ala di )a'i $ari. ;ari da#a re(a edis dida)a#>Ri"aya# )e!ya(i# da$+l+> $i)er#e!si #ida( #er(o!#rol se5a( 1DDD

Ri"aya# (el+ar'a> aya$ e!i!''al se5a( +sia 7 #a$+! (are!a s#ro(e, i+ asi$ $id+) de!'a!

ri"aya# res#less le's da! $i)o#iroid.

Ri"aya# sosial> e!i(a$, e(er5a sea'ai a(+!#a!, #ida( ero(o(, i!+ 2 'elas?ala #ia)

"ee(e!ds.

Oa# ya!' di'+!a(a!> & 2 ' 1

kasus saraf 2

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