RSUD ARIFIN ACHMAD Fakultas Kedokteran UR SMF/ BAGIAN SARAF Sekretariat : SMF Saraf – Irna Medikal Lantai 4 Jl.

Diponegoro No. 2 Telp. (0761) 7026225 P KAN!ARU S"A"US PASI N N ! "o ## NIM/N'" )e!*i!*ing I# ID N"I"AS PASI N N ! '!%r Jeni# 0el !in Al ! & Ag ! S& &%# per0 1in n )e0er2 n T ngg l M #%0 RS Me+i3 l Re3or+ N-. M 5. & /%n )ere!p% n Jl. )e!%+ , )e0 n* r% I#l ! " 1in I*% R%! / T ngg 12 J%ni 201. (.5624 $o#% B%& r B%& r 050(151221 +r. A!# r, Sp.S

II# ANAMN SIS (A%&o n !ne# ) Kelu$an Uta%a 5e! / 0e+% &%ng0 i * 1 / Ri&a'at Pen'akit Sekaran( • Se2 0 6 / ri SMRS p #ien !engel%/0 n 0e+% 0 0i &er # le! /, le! / &er2 +i #e3 r pel / n7l / n, + n +i 1 li + ri 0 0i #e*el / 0 n n. A1 ln- p #ien + p & *er2 l n +eng n +ip p / , n !%n #e&el / *e*er p / ri p #ien &i+ 0 ! !p% *er+iri &e& pi ! #i/ + p & !engger 00 n 0 0i , ) #ien 2%g !engel%/0 n 0%r ngn#en# #i r # !%l i + ri per%& # !p i 0e &el p 0 0 0i. ) #ien 2%g #%# / %n&%0 !engon&rol *% ng ir 0e3il, BAB.l n3 r • 2 Mingg% SMRS p #ien #ering !engel%/0 n n-eri p + pingg ng # !p i 0e 0e+% 0 0i, n-eri +ir # #eper&i +i&%#%0 &%#%0 + n +iperp r / p *il #e+ ng *er 0&i8i& #, 1

p #ien 2%g #%+ / !engel%/0 n r # 0e* # p + 0e+% 0 0i, + n !%l i !er # le! / p + 0 0i 0 n n • "el%/ n pen%r%n n 0e# + r n (7), +e! ! (7). "e!%+i n p #ien +i* 1 0e RS'D AA. Ri&a'at Pen'akit Da$ulu • Ri1 - & /iper&en#i (7), DM (7) • Ri1 - & S&ro0e (7) • Ri1 - & * &%0 l ! &i+ 0 + . • Ri1 - & 0on#%!#i o* & 6 *%l n &i+ 0 + . Ri&a'at Pen'akit Keluar(a • Ti+ 0 + nggo& 0el% rg - ng !eng l !i 0el%/ n & % pen- 0i& - ng # ! .

R SUM ANAMN SIS N-. D, 6( & /%n, + & ng +eng n 0el%/ n 0e+% &%ng0 i * 1 / le! / #e2 0 6 / ri #e*el%! +il 0%0 n pe!eri0# n. Di 1 li ole/ 0 0i #e*el / 0 n n, + n +i& !* / ! &i r # + ri per%& # !p i 0e &el p 0 0 0i, BA" #%li& +i0on&rol. III# P M RIKSAAN A# K ADAAN UMUM Te0 n n + r / Den-%& n +i J n&%ng ) r% "e + n Gi<i 9 " n n 9 160/40 !!:g, "iri 9 160/40 !!:g 9 " n n 9 (6 ;/!n&, &er &%r "iri 9 (6 ;/!n&, &er &%r 9 :R 9 (6 ;/!n&, ir ! &er &%r 9 Re#pir #i 9 20;/!n&, &ipe &/or 0o *+o!in l 9 B i0

!# S"A"US N UR)L)*IK 1) K SADARAN 2) FUN*SI LUHUR .) KAKU KUDUK 9 "o!po#!en&i# 9 Nor! l 9 Ti+ 0 A+ 2 *CS 9 =6 M6 >5

per # T n+ 3/@o#&e0 " n n (7) N N (7) "iri (7) N N (7) "e&er ng n Ti+ 0 + 0el in n .ens+ Ger 0 *ol ! & S&r *i#!%# De@i #i " n n N " n n N N N " n n (7) B%l & 2 !! N (?) (?) " n n N " n n N N (?) " n n N (7) (7) "iri N "iri N N N "iri (7) B%l & 2 !! N (?) (?) "iri N "iri N N (?) "iri N (7) (7) "e&er ng n Ti+ 0 + 0el in n "e&er ng n Ti+ 0 + 0el in n "e&er ng n Ti+ 0 + 0el in n "e&er ng n Ti+ 0 + 0el in n "e&er ng n Ti+ 0 + 0el in n "e&er ng n Ti+ 0 + 0el in n 4# N# 1II -Fa.4+ SARAF KRANIAL .torius+ D .ulo%otorius+ )&o#i# )%pil Ben&%0 '0%r n Ger 0 *ol ! & Re8le0# p%pil 5 ng#%ng Ti+ 0 l ng#%ng 6.ialis+ Ti3 Mo&ori0 D .pengli/ & n 5 p ng p n+ ng )engen l n 1 rn 0# N#III -). N# I1 -"rok$learis+ Ger 0 *ol ! & 5.pe!* % 2.us+ D . N#II -)/ti. N# 1 -"ri(e%inus+ Mo&ori0 Sen#i*ili& # Re8le0# 0orne 2# N# 1I -A3dus. .# N# I -)lfa.

per # N Re8le0# !%n& / (?) .in@ol%n&er "iri "e&er ng n "iri N "iri N N (?) "iri N (7) "iri N =%&ro8i "iri N =%&ro8i 7 7 "e&er ng n Ti+ 0 + 0el in n "e&er ng n Ti+ 0 + 0el in n "e&er ng n Ti+ 0 + 0el in n "e&er ng n Ti+ 0 + 0el in n "e&er ng n Ti+ 0 + 0el in n 5 5 Nor! l =%&ro8i (7) 5 5 Nor! l =%&ro8i (7) Ti+ 0 + 0el in n 2 2 Nor! l =%&ro8i (7) 2 2 Nor! l =%&ro8i (7) ) r p re#e 'MN 6 . N# 1III -Akustikus+ " n n )en+eng r n N 4.# N# 5I -Assesorius+ " n n Mo&ori0 N Tro8i =%&ro8i 12.(. N# 5II -Hi/o(lossus+ " n n Mo&ori0 N Tro8i =%&ro8i Tre!or 7 Di# r&ri 7 I1# SIS" M M)")RIK " n n =0#&re!i& # & # "e0% & n Di#& l )ro0#i! l Ton%# Tro8i Ger.in@ol%n&er =0#&re!i& # * 1 / "e0% & n Di#& l )ro0#i! l Ton%# Tro8i Ger.6# N# 5 -1a(us+ " n n Ar0%# 8 ring# N D-#8oni (7) .. N# I5 -*lossofarin(eus+ " n n Ar0%# 8 ring# N D .

g i&. In@ol%n&er Re8. & n+e! + n ro!*erg &i+ 0 + p & +il 0%0 n 5 .B + n Tro8i Ger. Din+ing per%& 1# SIS" M S NS)RIK R * N-eri S%/% )ropio#ep&i8 1I# R FL KS =%&ro8i (7) (?) =%&ro8i (7) (?) Ti+ 0 + 0el in n " n n 7 7 7 DBN "iri 7 7 7 DBN "e&er ng n :ipe#&e#i #e&inggi T 11 " n n Fi#iologi# Bi#ep# Tri#ep# ")R A)R ) &ologi# B *in#0i A/ ++o30 :o88! n Tro!er Re8le0 pri!i&i8 ) l!o!en& l Sno%& 1II#FUN*SI K))RDINASI Te# &el%n2%0 /i+%ng Te# &%!i& l%&%& G i& T n+e! Ro!*erg 1III# SIS" M )")N)M Mi0#i De8e0 #i 9 Terp # ng 0 &e&er 9 SDN " n n N SDN SDN SDN SDN "iri "e&er ng n Re8le0# 8i#iologi# (?) Mening0 & (?) (?) (?) (?) (?) (?) Mening0 & Mening0 & (?) (?) (7) (7) (7) (7) (7) (7) (7) (7) (7) (7) Re8le0# p &ologi# (7) Re8le0# pri!i&i8 (7) "iri N SDN SDN SDN SDN "e&er ng n )e!eri0# n &%!i& l%&%&.

"ernig (7). Br%+<in#0i 9 Ti+ 0 &er* & # 9 Ti+ 0 &er* & # 9 7/7 9 SDN 9 7/7 +. "on&r p &ri30 9 7/7 5# R SUM P M RIKSAAN "e + n %!%! "e# + r n Te0 n n + r / )ern 8 # n F%ng#i l%/%r S r 8 0r ni l Mo&ori0 Sen#ori0 "oor+in #i C&ono! Re8le0# 8i#iologi# Re8le0# p &ologi# )e!eri0# n l in 9 "o!po#!en&i# 9 160/40 !!:g 9 20 ./!n&.I5# P M RIKSAAN KHUSUS7LAIN . 5 #eB%e *. ) &ri30 e. "on&r p &ri30 (7) R ng# ng !eninge l 9 (7) C# DIA*N)SIS K R8A DIA*N)SIS KLINIS DIA*N)SIS ")PIK DIA*N)SA !ANDIN* : Mielop &i T/or 0 l : Me+%ll #pin li# #eg!en T 11 : In8e0#i !e+%l #pin li# DIA*N)SIS "I)L)*IK : S%#p. > l# @ &e#& 8. T%!or !e+%l #pin li# 6 . ) &ri30 (7). &ipe &/or 0o *+o!in l 9 Nor! l 9 D l ! * & # nor! l 9 ) r p re#e 'MN 9 :ipe#&e#i #e&inggi T 11 9 S%li& +inil i 9 S%li& +inil i 9 Mening0 & p + e0#&re!i& # * 1 / 9 (7) 9 5 #eB%e (7). "ernig 3.

( I'/5 9 27 I'/5 9 10. bladder training "on&rol & n+ @i& l )e!*eri n n%&ri#i peror l #e#% i 0e*%&%/ n 0 lori 3# K$usus 7 I>FD R5 20 g&&/i 7 In2.0 !g/+5 9 27.1 F# HASIL P M RIKSAAN P NUN8AN* Pe%eriksaan ki%ia dara$ -9: 8uni 96. 125 !g..11 !g/+5 9 .10. A5T. gr/+l 7 .5 !g/+5 9 . I> 7 In2.1.0+ • Gl%0o# • B'N • 're%! • AR7S • 'ri3 • AST • A5T • 5e%0o#i& • :B 9 42 !g/+l 9 16.( . R ni&i+in 1 gr 2. )A Ron&gen @er&e*r e &/or 0ol%!* l A)7l &er l MRI &/or 3ol%!* l # USULAN " RAPI a# U%u% 7 7 7 7 I!!o*ili# #i Fi#io&er pi.D# USULAN P M RIKSAAN P NUN8AN* • • • • • )e!eri0# n l *or &ori%! + r / r%&in9 :*. 5e%0o#i&. :&. /'l 9 11. Tro!*o#i& )e!eri0# n l *or &ori%! 0i!i + r /9 AST. 're%!70re &inin Ron&gen &/or .0 !g/+5 9 1. Me&ilpre+ni#olon . .1.

70.4 5D 9 .9 8uli 96.• :T • )5T 9 . 0e#e!%& n (?) C9 "e# + r n 0o!po#!en&i# GAS 9 =6>5M6 TD 9 1.6. /%l Ront(en .erte3rae t$ora.o<lu%3al Kesan : Seg!en &or 0ol%!* l & 0 & !p 0 0el in n *# F)LL)= UP "an((al .10.0 S 9 le! / p + 0e+% 0 0i.0/(0 !!:g ( .

R ni&i+in 1gr 2. 125 !g.> Foli3 A3i+ 2 . N 5 ./!eni&.6. Me&ilpre+ni#olon .1 I. 9 BA" 9 &erp # ng 0 &e&er BAB 9 Bel%! + Re8le0#  Fi#iologi# 9 Mening0 &  ) &ologi# 9 7 A9 Mielop &i& )9 I>FD R5 20 g&&/i In2.N +i 9 (6.7EA F%ng#i l%/%r 9 Nor! l S r 8 0r ni l 9 D l ! B & # Nor! l Sen#ori0 Mo&ori0 C&ono! 9 N 9 5 . &er &%r N 8 # 9 1(. I> In2.1 P M!AHASAN I# Para/arese 1.2 a# Definisi 4 . ./!eni& S%/% 9 .

A0i* & &erp%&%#nlin& # n #o! &o#en#ori# + n lin& # n %&ono! ne%ro@ege& &i8 #en+en# + n +e#en+en#.ng &er2 +i p + + er / #er@i0 l .ng !e!o&ong !e+%ll #pin li# p + &ing0 & &or 0 l & % &ing0 & l%!* l & # !eng 0i* &0 n 0el%!p%/ n .) r p re#e + l / 0ele! / n o&o& 0e+% e0#&re!i& # * 1 / p + 8%ng#i !o&ori0 + n #en#ori0 p + #eg!en &or 0 l.ng &er2 +i &i+ 0 *egi&% 2el # &erli/ & +i0 ren 0 n per n n + ri o&o&7o&o& &er#e*%& 0%r ng !enon2ol. pen+eri& &i+ 0 + p & !el 0%0 n *% ng ir *e# r + n 0e3il.ng !engen i lower motor neuron (5MN). 0e+% leng n .  ) r p re#e 8l 0#i+  ) r p re#e 8l 0#i+ &er2 +i 0 ren &on%# o&o& & % /ipo&on%#.ng &erle& 0 +i* 1 / &ing0 & le#i.ng *er # l + ri !io&o! A6 # !p i !io&o! A(. l l% o&o&7o&o& &or 0# + n *+o!en #er& #el%r%/ o&o&7o&o& 0e+% e0#&re!i& #. ! 0 + ri &ing0 & le#i 0e* 1 /. #er& &i+ 0 !e!perli/ &0 n re 0#i ne%ro@ege& &i8.# Pato(enesis1. D n +i* 1 / &ing0 & le#i + p & &er2 +i g ngg% n !o&ori0 *er%p #eg!en &/or 0 l &erp%&%#. 10 0el%!p%/ n 'MN 0 ren 2 r # 0or&i0o#pin l l &er l 0er%# 0 n . & % # 3r l !e+%ll #pin li#. #e/ingg !en-e* *0 n pening0 & n . l%!* l.ng p + + # rn. n !%n 0el%!p%/ n . 5e#i &r n#@er# l . : l ini +i0 ren 0 n le#i + p & !engen i 0orn% n&erior !e+%l #pin li#.ng !en+e# 0 !e+%ll #pin li# #e/ingg !er%# 0 + er / 2 r # 0or&i0o#pin li# l &er l + p & !eni!*%l0 n 0el%!p%/ n 'MN p + o&o&7o&o& * gi n &%*%/ . #e/ingg !en-e* *0 n pen%r%n n 0er%# 0 n . 1.ng !engen i upper motor neuron ('MN). !i# ln.i&% p + &ing0 & le#i &er2 +i g ngg% n !o&ori0 *er%p 0el%!p%/ n 5MN p + o&o&7o&o& . 5e#i &r n#@er# l !e+%ll #pin li# p + &ing0 & #er@i0 l.2 5e#i .#er%p +eng n le#i .2 .A5 + p & !eng 0i* &0 n 0el%!p%/ n 'MN p + o&o&7o&o&.ng !er%p 0 n #e* gi n 0e3il + ri o&o&7o&o& &or 0# + n *+o!en. 3# Klasifikasi  ) r p re#e #p #&i0  p r p re#e #p #&i0 &er2 +i 0 ren &on%# o&o& & % /iper&on%#.

pen2 l r n o#&eo!ieli&i#.ng !en-e* *0 n 3e+er !e+%ll #pin li#. ) r p re#e + p & +i#e* *0 n ole/ #% &% in8e0#i.2  :iper&on%#  :iper8le0#i  Re8le0 p &ologi# (?)  "lon%#  A&ro8i o&o& &i+ 0 +  Re8le0# %&o! &i#!e #pin l e# Dia(nosis1. r ng# ng n-eri. # &% /ingg +% #eg!en + ri !e+%l #pin li# + p & r%# 0 #e3 r #e0 lig%#.2  R -7#pine 11 .i /%*%ng n +eng n in8e0#i. Di* 1 / * & # &er#e*%&. G ngg% n 8%ng#i o&ono! + p & &er2 +i 0 ren &erp%&%#n. In8e0#i l ng#%ng + p & &er2 +i !el l%i e!*oli #ep&i0.ng !e!p%n.ng !engen i 0orn% po#&erior !e+%l #pin li# ! 0 0 n &er2 +i pen%r%n n 8%ng#i #en#i*ili& # +i* 1 / le#i. l%0 &er*%0 + ri &%l ng *el 0 ng. Se/ingg pen+eri& *er0%r ng !er # 0 n + n. Ting0 & le#i &r n#@er# l +i !e+%l #pin li# !%+ / &er%ng0 p ole/ * & # +e8i#i& #en#ori0. r ng# ng &/er! l. I#&il / !ieli&i# &i+ 0 # 2 +ig%n 0 n %n&%0 pro#e# per + ng n p + !e+%ll #pin li# n !%n 2%g +ig%n 0 n p *il le#in!en-er%p i pro#e# per + ng n + n +i#e* *0 n ole/ pro#e# p &ologi . r ng# ng +i#3ri! + n r ng# ng lo0 li#.r ng# ng & 0&il. & % perl% # n + ri pro#e# !eningi&i# piogeni0. & n+ 7& n+ 'MN + p & +i&e!%0 n p + 0e+% &%ng0 i #e3 r leng0 p. + n&%!or * i0 &%!or e0#&r !e+%l r ! %p%n in&r !e+%l r #er& &r %! .2 r # #3en+en #pino&/ l !i3%# #e/ingg in0o&inen#i %rin + n in0o&inen#i l@i. d# Manifestasi klinis1.G ngg% n 8%ng#i #en#ori0 + p & &er2 +i 0 ren le#i .

9  F7R .Dil 0%0 n F7R .2  Ter pi %& ! +i+ # r0 n + n +i#e#% i0 n +eng n pen.#i8ili#  IgA & % IgG l*%!in %n&%0 !en+i gno# + ri #0lero#i# !%l&iple  Te# + r / r%&in  )e!eri0# n %rin f# Ko%/likasi1. T n+ +egener #i + ri #pine + l / 9 • Re+%0#i + ri r% ng in&e@er&e*r li# • )en-e!pi& n 8or !en in&e@er&e*r li# • For! #i o#&eo8i& • )ele* r n 2 r 0 n& r pe+%n0%l r +i&e!%0 n p + le#i in&r +%r l  Mielogr !  AT S3 n  An li#i# ASF )e!eri0# n pen%n2 ng l inn.ng 0 n !e!perli/ &0 n #% &% 0eg n # n. 12 .Tor 0# .0i& pen-e* * p r p re#e #p #&i0.#pine +eng n per!in& n l &er l + n o*liB%e.  Te# #erologi %n&%0 !en+e&e0#i + n.2  5%0 +e0%*i&%#  "on&r 0&%r  In8e0#i &r 0&%# %rin ri%#  =!*oli p r%  Deep vein thrombosis  ) r li#i# o&o&7o&o& pern p # n (# Penatalaksanaan 1.

+ & 55 p #ien 3e+er !e+%l #pin li#G 2( 0o!ple&..ng +i&i!*%l0 n ole/ pen-e* * + ri !ielop &i &erg n&%ng lo0 #i + n n &o!i + ri !e+%l #pin li#.ng . nor! l (15D) 1. 27 in0o!ple&) Lesi Inko%/let Sering (?) Sering (?) Sering (?) po#i&i8 Sering nor! l =+e! (62D).8%ng#i .6 Karakteristik Mo&ori0 )ro&op &i0 (n-eri. @er&e*r MRI (R !on. II# Mielo/ati Mielop &i + l / g ngg% n 8%ng#i p + !e+%l #pin li# . "on&%#i (26D).ng *i # n. )en ng n n #p #&i#i& # Fi#io&er pi &er+iri + ri 9 • • • • • Prolonged passive stretching Hydrotherapy Refl ex inhibiting postures Standing and walking Ice therapy  F r! 0ologi • • • An&i#p #!o+i0 In2 in&r &e3/ l * 3lo8en / !orp/ine Blo0 # r 8 lo0 l #e!en& r #pe#i8i0. "o!pre#i (25D). G !* r n & % 3iri . in8e0#i p + !e+%l #pin li#. #%/%) )ropio#ep&i0 (joint position.ng +iper& / n0 n +i * 1 / le#i.ng + p & !en-e* *0 n in8 r0 + ri !e+%l #pin li#. +gn &o0#in *o&%lin%! p + o&o& . g ngg% n @ #0%l r . @i*r #i) Sacral sparing Ro. 1447.#ering +i/%*%ng0 n +eng n &r %! @er&e*r . &%!or p + !e+%l #pin li#. & % li#&e#i# :e!or gi (56D). Klasifikasi Ae+er !e+%l #pin li# + p & +i* gi !en2 +i 0o!ple& + n Lesi Ko%/let :il ng +i * 1 / le#i :il ng +i * 1 / le#i :il ng +i * 1 / le#i neg &i8 Sering 8r 0&%r. "on&%#i (11D) &i+ 0 0o!ple& *er+ # r0 n + /&i+ 0n. l%0# #i.

(.& + n 3ep &G 0/ # 0ele! / n & ng n + n 2 ri !ene& p )er* i0 n ) ling *%r%0 +i n& r l inn- NA 16 .i&%9 (1) !entral !ord Syndrome.%&%/ !ro&n Se>uard S'ndro%e J r ng )ene&r #i "ele! / n nggo& ger 0 ip#il &er l le#iG ggn &r 0&%# +e#en+en (?) Sering /il ng &o& l (ggn &r 3&%# #3en+en) 0on&r l &er l :il ng &o& l ip#il &er lG ggn &r 3&%# #3en+en F%ng#i *%r%0. (2) nterior !ord Syndrome. + n (5) !onus &edullaris Syndrome Karakteristi k klinik "e2 +i n Bio!e0 ni0 Mo&ori0 Central Cord S'ndro%e Sering :ipere0#&en#i G ngg% n *er@ ri #i G 2 r ng p r li#i# 0o!ple& Anterior Cord S'ndro%e J r ng :iper8le0#i Sering p r li#i# 0o!ple& (ggn &r 3&%# +e#en+en)G *i # n*il &er l Sering /il ng &o& l (ggn &r 3&%# #3en+en)G *il &er l Bi # n. ggn &r 3&%# +e#3en+en ring n )ro&op &i0 G ngg% n *er@ ri #i &i+ 0 0/ # G ngg% n *er@ ri #i. *i # nring n Terg ngg% )ropio#ep&i0 J r ng #e0 li &erg ngg% Sering n. n !%n in+epen+en#i p ling * i0 Posterior Cord S'ndro%e S ng & 2 r ng :ipere0#&en#i G ngg% n *er@ ri #i.Ter+ p & 5 #in+ro! %& ! 3e+er !e+%l #pin li# in0o!ple& !en%r%& merican Spinal !ord Injury ssociation .) "rown Se#uard Syndrome$ (6) !auda %#uina Syndrome.

*er & + n per* i0 n / n+ p & +i/ r p0 n &er2 +i + l ! 1 0&% . "on&%#io !e+%l #pin li# "e + n ini + p & +i#e* *0 n ole/ &r %! l ng#%ng ! %p%n &i+ 0 l ng#%ng p + 0ol%!n @er&e*r li#.6.69 1. Cle/ 0 ren p ren0i! !e+%l #pin li# %!%!n.ng &er2 +i l ng#%ng &e& pi / n.6 & % +i#lo0 #i. 5e#i @ #0%ler 6. "o!o#io !e+%l #pin li# "e + n ini +i#e* *0 n ole/ #% &% &r %! &i+ 0 l ng#%ng p + !e+%ll #pin li# .ng &i+ 0 !en-e* *0 n 8r 0&%r g ngg% n 8%ng#i !e+%l / ri5. Ge2 l g ngg% n 8%ng#i %!%!n. 5 in7l in .ng !e! + i5. 5e#i &r %! &i0 2. ! 3 ! #in+ro!. 5e#i in8l ! #i 5.ire@er#i*el. Ge2 l g ngg% n !e+%l #pin li# ini + p & !e!* i0 + l ! 26 2 !716 . !en-e* *0 n &er2 +i g ngg% n 8%ng#i !e+%l #pin li#.6. "o!pre#i !e+%l #pin li# ) + 0e + n ini #el l% +i#er& i 0el in n p + 0ol%!n @er&e*r li# .i&%5.Pen'e3a3 Lesi Medula S/inalis De $o%ng (1474) !enggolong0 n pen-e* * le#i !e+%l #pin li# + l !5. *.69 .ng l ! + n %!%!n. Neopl #! . 15 . .# Lesi "rau%atik G%&&! nn !e!* gi &r %! !e+%l #pin li# + l ! .ng le#i +i 5. ) + 0e + n ini &er+ p & #pin li# .&i+ 0 #e!p%rn 3.*er#i8 & #e!en& r . )ro#e# +egener &i8 + n pen..0i& #i#&e!i0 6. g ngg% n 8%ng#i +i #ini *er#i8 & !ene& p + n 2 r ng &er+ p & per* i0 n .

5e#i +i &or 0 l i.+ l ! 267 6( 2 ! p #3 &r %! !e+%l #pin li#. "e + n ini &i!*%l 6712 !ingg% #e&el / .ng +i#er& i +i#lo0 #i #ering !en-e* *0 n &er2 +in.ng + & ng &i* 7&i* . #eper&i per%* / n !or8ologi#.i&%5.ng *erpeng r%/ p + &r %! !e+%l #pin li#.i&% per%* / n7per%* / n . Tr n#e0#i 0o!pli& !e+%l #pin li# +. '!%!n. 8 0&or . :e! &o!ieli 8.ng &er2 +i p + !e+%l #pin li# 0i* & &r %! . Ge2 l 0lini# &r %! !e+%l #pin li# + l /9 . *. 5e#i p + 0 %+ eB%ine 16 ini + l / &i!*%lnre8le0# +i * 1 / le#i #eper&i re8le0# *%l*o0 @erno#%# + n Hanal winkI.ng + p & !en-e* *0 n 0e + n ne%rologi0 progre#i8 !e!*%r%0. 5e#i +i &eng / + n * 1 / #er@i0 l /. @ #0%ler + n !e& *oli#! & % 0i!i .ng !en-e* *0 n 0e!%ng0in n &er2 +i 0o!pre#i p + !e+%l #pin li# #eper&i 8r 0&%r + n +i#lo0 #i. F 0&or =0#&rin#i0. :e!i#e0#i !e+%l #pin li# e. . F 0&or In&rin#i0.ng &i!*%l %!%!n. "o!pre#i !e+%l #pin li# 3. T n+ per& ! /il ngn0e + n &r %! (.69 1. 5e#i +i & # #er@i0 l g. 8r 0&%r # 2 & % +i#lo0 #i # 2 . 2.i&% +e8i#i& ne%rologi #e!en& r . S/o30 #pin l. Sel ! perio+e ini +i&e!%0 n p r li#i# 8l 0#i+ + n 0e/il ng n #el%r%/ re8le0# +i* 1 / le#i. 5e#i p + 0on%# !e+%l ri# 2. S% &% 8r 0&%r .0e + n &i+ 0 #& *il . . .&er+ p & ro*e0 n lig !en& n&erior ! %p%n po#&erior.Green (14(2) !en-e*%&0 n * /1 #e3 r p &o8i#iologi &er+ p & 2 8 0&or .

ng #e* i0n+i0er2 0 n !elip%&i pe!eri0# n l *or &ori%! + r / + n pe!eri0# n r +iologi#. o+on&oi+) %n&%0 @er&e*r #er@i0 l. po#i#i #& n+ r ( n&eropo#&erior. Ae+er !e+%l #pin li# &i+ 0 0o!ple& 3en+er%ng !e!ili0i progno#i# . &er pi o0%p #i. &agnetic Resonance Imaging !er%p 0 n l & +i gno#&i0 .7 "atalaksana Ter pi p + 3e+er !e+%l #pin li# &er%& ! +i&%2%0 n %n&%0 !ening0 &0 n + n !e!per& / n0 n 8%ng#i #en#ori# + n !o&ori#. A9 %n&%0 le#i 0o!ple&. ) + 0 #%#70 #%# . Fi#io&er pi. pe!eri0# n l n2%& n +eng n !' Scan + n MRI # ng & +i n2%r0 n.ng le*i/ * i0. ) #ien +eng n 3e+er !e+%l #pin li# 0o!ple& / n. T%2% n %& ! 8i#io&er pi + l / %n&%0 17 . + n bladder training p + p #ien ini +i0er2 0 n #e 1 l !%ng0in.ng p ling %!%! +ig%n 0 n %n&%0 3e+er !e+%l #pin li# &r %! &i0 + n +ire0o!en+ #i0 n ole/ (ational Institute of Health +i A!eri0 Seri0 &. pe!eri0# n #& &%# ne%rologi lo0 l !er%p 0 n / l .ng p ling * i0 %n&%0 !en+e&e0#i le#i +i !e+%l #pin li# 0i* & 3e+er /&r %! . Me&ilpre+ni#olon !er%p 0 n &er pi .Pe%eriksaan neurolo(i ) + 0 #%#70 #%# !ielop &i. # !p i +eng n =9 %n&%0 0e + n nor! l. "l #i8i0 #i +i*% & *er+ # r0 n re0o!en+ #i ASIA. l &er l.*%r%0.ng &i+ 0 !en%n2%00 n per* i0 n + l ! 72 2 ! per& ! . + n po#i#i A) + n l &er l %n&%0 @er&e*r &/or 0 l + n l%!* l. 3en+er%ng !ene& p + n progno#i#n.!e!ili0i pel% ng 5D %n&%0 0e!* li nor! l.6 Pe%eriksaan /enun?an( )e!eri0# n pen%n2 ng . ! 0 0e!%ng0in n %n&%0 0e!* li *er2 l n + l / le*i/ + ri 50D . Ap *il 8%ng#i #en#ori# +i * 1 / le#i ! #i/ + . 5e#i !e+%l #pin li# 0o!ple& . Di n2%r0 n !el 0%0 n pe!eri0# n . )e!eri0# n #& &%# ne%rologi# lo0 li# p + p #ien 3e+er !e+%l #pin li# !eng 3% p + p n+% n + ri merican Spinal !ord Injury ssociation/ ASIA.ng &i+ 0 !en%n2%00 n 0el in n r +iologi#.ng # ng & pen&ing.( Tin+ 0 n re/ *ili& #i !e+i0 !er%p 0 n 0%n3i %& ! + l ! pen ng n n p #ien 3e+er !e+%l #pin li#.

0 !g/0gBB in&r @en perl / n #el ! 15 !eni&. )engg%n n l & * n&% +i#e#% i0 n +eng n pro8e#i + n / r p n p #ien. 1447) &er/ + p per* i0 n !eng/ !* & p n2 ng. p#i0o&er pi. pen & l 0# n n g ngg% n 0 n+%ng 0e!i/ + n # l%r n 3ern ) !ening0 &0 n #e3 r #igni8i0 n nil i #& &%# 8%ng#ion l p + pen+eri& 3e+er !e+%l #pin li#. & /%n !en%n2%00 n * /1 #% &% progr ! re/ *ili& #i . . 0e!%+i n 25!g #e&i p 6 2 ! #el ! 10 / ri o Tipe 2 J )e!*eri n 1000!g !e&ilpre+ni#olon #e3 r *ol%#. Tri l 0lini0 !en%n2%00 n / #il #& &i#&i0 .ng &erp +% (/i+ro&er pi. Te& pi 2i0 &er pin.+i*eri0 n .ng *er! 0n ne%rologi# 2 ng0 NASAIS III ('SA..ng + .ng * i0 #e/ingg + p & *er2 l n +eng n * n&% n & %p%n &i+ 0. 14(6) o Tipe 1 J )e!*eri n 100!g ! &ilpre+ni#olon #e3 r *ol%#. ele0&ro&er pi.!e!per& / n0 n RCM (Range of &ovement) + n 0e! !p% n !o*ili& #. )e!*en&%0 n 0on&r 0&%r / r%# +i3eg / #eop&i! l !%ng0in.7( 2 ! #e&el / 3e+er . Di#%#%l 65 !eni& 0e!%+i n in8%# 5. in8%# +i n2%r0 n *er 0/ir # !p i 6( 2 !.  1( . )eneli&i n pro#pe0&i8 #el ! . 2 !. Ter pi o0%p #ion l &er%& ! +i&%2%0 n %n&%0 !e!per0% & + n !e!per* i0i 8%ng#i e0#&re!i& # & #. ) #ien +eng n !entral !ord Syndrome ) ASS *i # n. 1440) o )e!*eri n #&eroi+ / r%# #e#eger !%ng0in.!eng l !i pe!%li/ n 0e0% & n o&o& e0#&re!i& # * 1 / . Bil 3e+er &er2 +i #e*el%! ( 2 !.6 !g/0gBB/2 ! #el ! 2.i&% 9  NASAIS I ('SA.6 Pe%3erian steroid 3erdasarkan National Acute Spinal Cord Injury Studies -NASCIS+ (ational cute Spinal !ord Injury Studies (NASAIS) +i* gi . 0e!%+i n 25!g #e&i p 6 2 ! #el ! 10 / ri  NASAIS II ('SA. !e!per& / n0 n 0e! !p% n 0&i@i& # /i+%p #e/ ri7/ ri/ activities of daily living (AD5). +i*eri0 n !e&ilpre+ni#olon +o#i# &inggi . +eng n !e!per0% & 8%ng#i o&o&7o&o& . Me&ilpre+ni#olon *e0er2 pero0#i+ #e + n #e0%n+er 0 n !ening0 &0 n # ! r 0i+on &.

!er%p 0 n &%!or !e& #& #e. S0or 1 l ASIA *er0orel #i +eng n pe!%li/ n 8%ng#i 0 n+%ng 0e!i/. Bil le#i progre#i8 / l ini 0 n +ii0%&i +eng n g ngg% n 8%ng#i 0ol%!n +or# li# + n 0e!%+i n g ngg% n 8%ng#i &r 0&%# n&erol &er l.ng + p & !%n3%l *er%p 59 14 . 2%!l /n. in8%# +i n2%r0 n *er 0/ir # !p i 6( 2 !. + n g g l gin2 l.ng !er%p 0 n 40D + ri #el%r%/ &%!or in&r +%r l. #ep&i0e!i . Ge2 l + n & n+ . 2 ! #e&el / 0e2 +i n. &er+iri + ri e0#&r !e+%l r . "l #i8i0 #i &%!or !e+%l #pin li# . '!%!n! ni8e#& #i +ini + ri 0o!pre#i !e+%l #pin li# + l / *er%p + l / &%!or in&r !e+%l r. )en%r%n n r & 7r & l ! / r p n /i+%p #e#% i +eng n *er &n. Bi # n.le*i/ #e+i0i& +i* n+ing0 n &%!or e0#&r !e+%ler. )en-e* * 0e! &i n %& ! + l / 0o!pli0 #i +i# *ili& # ne%rologi0 .ng +i*eri0 n # ! +eng n pro&o30ol NASAIS II n !%n +i*eri0 n #el ! 26 2 ! 2i0 &er pi +i*eri0 n K . *er # l + ri #el g ngg% n 8%ng#i &r 0&%# !o&ori0. r +i0# ne%r li#.i&% 9 pne%!oni .3e+er . *) T%!or in&r +%r l. #el epen+i! + n @ #0%ler. 2 ring n pen%n2 ng + n pe!*%l%/ + r /. Pro(nosis Se*% / peneli&i n pro#pe0&i8 #el ! 27 & /%n !en%n2%00 n * /1 r & 7r & / r p n /i+%p p #ien 3e+er !e+%l #pin li# le*i/ ren+ / +i* n+ing pop%l #i nor! l.7( 2 ! #e&el / 3e+er .4 9# Neo/las%a T%!or !e+%l #pin li# !er%p 0 n 20D + ri #e!% #%#%n n # r 8 p%# &. e!*oli !en%n2%00 n * /1 p r%. Te& pi 2i0 &er pin.*er # l + ri !eningen. 5 inngli . !e+%l #pin li#G / #iln- pe!%li/ n 8%ng#i 0 n+%ng 0e!i/ &er2 +i p + 27D p #ien p + 6 *%l n per& ! . !er%p 0 n 50D + ri #e!% &%!or in&r #pin l + n / !pir #e!% n.i&%59 ) T%!or e0#&r +%r l.o Do#i# !e&ilpre+ni#olon .+i*eri0 n .

*er& !* / *er & + n + 0o!pre#i + + .0i& gr n%lo! pri!er p + !eningen + n !e+%l #pin li# 3) Mieli&i# . &%!p%l.ng !eng l !i 0o!pre#i +) A& 0#i e) Re&en#io %rin + n 0on#&ip #i !er%p 0 n ge2 l l n2%& + ri +i#8%ng#i o&ono! 0# Lesi 1askuler S% &% g ngg% n 8%ng#i !e+%l #pin li# 0i* & le#i @ #0%ler 2%g +i#e*%& pen. "l #i8i0 #i le#i @ #0%ler &er+iri + ri in8 r0 + n per+ r / n5.0i& + l / progre#i8 l !* & 20 * gi n #i#&e! # r 8 .ng +i#e* *0 n 0 ren 0e!%n+%r n 8%ng#i #el # r 8 .i&%69 ) Mieli&i# . N-erin0on#& n.ng +i#e* *0 n ole/ @ir%# *) Mieli&i# . !er%p 0 n ge2 l &er#ering. @# Proses De(eneratif Dan Pen'akit Siste%ik Men%r%& A+ !# (14(1) pen.0i& +eng n in8l ! #i p + "l #i8i0 #i !ieli&i# !en%r%& A+ ! . '!%!. # !p i & % &ep & +i * 1 / +er! &o! #e&inggi per# r 8 n .ng +i#e* *0 n ole/ * 0&eri.) N-eri. Be*er p 0 r 0&eri#&i0 %!%! + ri pen.per2 l n n pen. *er& !* / 2i0 *erger 0 & % 2i0 *) "ele! / n. pol n.ng &er0en . p r #i& + n pen.*er8%ng#i nor! l *) '!%!n.ng +i#e* *0 n pro#e# in8l ! #i non in8e0#i%# !e+%l #pin li# +i#e*%& !ieli&i#.0i& #pino@ #0%ler.ng .0i& ini &i!*%l *er ng#%r7 ng#%r p + #e*el%!n.0i& +egener #i #i#&e! # r 8 + l / pen.0i& .0i& +egener &i8 + l /69 ) )en.upper motor neuron 3) Sen#ori# !en%r%n. 2 !%r.!%n3%l le*i/ +%l% + ri p + & n+ 7& n+ ne%rologi#. 4# Lesi Infla%asi S% &% pen.

Dasar dia(nosis to/ik  Se(%en " @ %edulla s/inalis 21 . #eper&i 0i* & pen-%n&i0 n o* & & % < & 0on&r # in&r &e0 l & % 0i* & &er pi +) Mielop &i /ep &i0 + n 0i* & 0eg n # n p + 2 ring n e0#&r ne%r l DASAR DIA*N)SIS a# Dasar dia(nosis klinis  Mielo/ati t$orakal Mielop &i &/or 0 l +i&eg 00 n 0 ren + ri n !ne#i# +i+ p &0 n 0el%/ n p #ien *er%p r # le! / + n *er & p + 0e+% &%ng0 i . o#&eoporo#i# .0i& p + &%l ng @er&e*r #eper&i pen. + n + n.ng l in +) Be*er p 2eni# pen.0i& .p r p re#e 'MN.0i& #i#&e!i0. *.0i& po&&. pen.0i& ini + l / #i!e&ri# *il &er l #e/ingg 1 l %p%n ! ni8e#& #i 0lini#n.g ngg% n #en#ori0 #e&inggi T 5 !e+%l #pin li#. D ri pe!eri0# n 8i#i0 2%g +i&e!%0 n + n.ng /e* & + n l in7l in *) "el in n p + +i#0%# in&er@er&e*r li#. 0 n &e& pi 3ep & & % l !* & 0 n !engen i #i#i .ng &ergolong +i#ini !en-e* *0 n #e3 r #ele0&i8 #i#&e! # r 8 &er&en&% .3) 5e#i .0i& ini #ering 2%g +i#e*%& pen.ng #e3 r n &o!i + n 8i#iologi *er/%*%ng n.ng &er+ p & p + pen.!%ng0in +i+ /%l%i ole/ # l / # &% #i#i.0i& p ge&. #e/ingg pen.ng #e3 r progre#i8 3ep & !en-e* *0 n &%ng0 i &i+ 0 + p & +iger 00 n. J%g +i+ p 0 n + n.g ngg% n o&ono!. 2# Lain<Lain "el in n +i l% r 0 n li# #pin li# + p & !en-e* *0 n g ngg% n 8%ng#i !e+%l #pin li#. #eper&i59 ) )en. + p & *er%p r%p&%re #pon+ilo#i# + n #pon+ili&i# 3) I &rogeni0.

e# MRI t$ora. /iper&on%# + n &i+ 0 + n0e&%ng0 i T 5 .& &r %! 2 &%/ &er+%+%0. BA" + n BAB &erg ngg%. ! &i r # .olu%3al -3ila /erlu den(an kontras+ 9 'n&%0 !en+%0%ng 0e3%rig n e&iologi pen. .# Ront(en t$oraks PA 9 %n&%0 !en+%0%ng 0e3%rig n e&iologi0 pen.3 #%#pe0 &r %! !e+%ll #pin li# &ro8i o&o&. n !%n #%+ / !%l i &er # le! # p + 0 0i.ng +i*%0&i0 n +eng n + n/ipere8le0 p + p &ell + n A3/ille#. e# Dia(nosa ak$ir Mielop i &or 0 l e.olu%3al AP<lateral 9 'n&%0 !en+%0%ng 0e3%rig n e&iologi 22 .ri1 .in8e0#i !e+%l #pin li#. "e!%+i n 0e+% &%ng0 i !eng l !i 0%r ng #en# #i r # + n p #ien &i+ 0 *i# *er2 l n l gi. J%g &er+ p & g ngg% n #en#ori0 #e&inggi * & # * 1 / lip & n ! !! e # !p i DASAR AN8URAN P M RIKSAAN P NUN8AN* a# Pe%eriksaan la3oratoriu% dara$ rutin 9 'n&%0 !enge& /%i 0e + n %!%! p #ien + n 0e!%ng0in n l in pen-e* * 0el in n. #eper&i in8e0#i +eng n !eli/ & 0en i0 n 2%!l / le%0o#i& 3# Pe%eriksaan la3oratoriu% ki%ia dara$ 9 'n&%0 !enil i 8%ng#i org n7org n l in.# Dasar dia(nosa etiolo(ik  "rau%a %edulla s/inalis ) + n !ne#i# +i+ p &0 n + n. in0on&inen#i %ri p + p #ien 2%g + p & +i#e* *0 n ole/ + n.0i& p + p #ien. d# Dasar dia(nosis 3andin( M ni8e#& #i 0lini# p r p re#e. ) #ien ! #i/ *i# *er2 l n +eng n +i* n&%.) + p #ien +i&e!%0 n p r p re#e 'MN . d# Ront(en t$ora.0i& p + p #ien + n !enil i #&r%0&%r &%l ng #eg!en &/or 3ol%!* l.

2. .

*uide for Physiotherapists . 2000. Spin l Aor+ In2%r. T/ie!e S&%&&g r&. April. 4. A/! + A.DAF"AR PUS"AKA 1. 'etraplegia and Paraplegia$ A/in 9 =l#e@ier. A+ !# RD. 2001. FSI). 2001. 2. 5. (2006).17 12(. G. "oe#oe! 1 &i :. $og. >i3&or M.. Bro!le-. "ee0 Aen&re 8or Aoll *or &i@e Ne%ro#3ien#e. Ropper A:. 6. A/%##i+. 14(5. Di#e #e o8 Spin l Aor+ in )rin3iple# o8 Ne%rolog-. J. B e/r M. =+i#i 24. A re n+ A%re. Spin l Aor+ In%rie#. B gi n "e+% . " !%# "e+o0&er n Dorl n+. $o%ng M. . G +2 / M + 'ni@er#i&.F 3&# 9 S& &i#&i3#. eMe+i3ine Jo%rn l. Fo%n+ &ion 8or Spin l Aor+ In2%r)re@en&ion. S3/rei*er D. 2002. 2005. 6.0i& S r 8 R%! / S 0i& Dr : # n S +i0in B n+%ng )erio+e 14(1714(6.5e@el# n+ Al ##i8i3 &ion. +00 e+i&or. J 0 r& 9 =GA. . M3Gr 17:ill.)re##. I. 1614. Spin l Aor+ In2%r. Fro#&3/er M. Ne1 $or0.0i& Me+%l Spin li# +i 5 */')F Il!% )en. 2002. B n+%ng. (. Ne1 $or0. 7T/ e+. 26 . "orel #i Ne%ro n &o!i + n Ne%rologi F%ng#ion l. A re A%re Ao!!%ni&-. 7.0 r& . )ol )en. (1440). D%%#L Topi3 l Di gno#i# In Ne%rolog-.

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