ManagemenL ln

18 nervous SysLem
8lwanu Lsuasarl
neurology ueparLmenL lkul-8SCM
!" $%& '()*
+%,-. *( /%01- '()* 23-14 56-7 8%04-39 :%;%0-%
kasus
WanlLa 21 Lahun, penurunan kesadaran
se[ak 3 harl sebelum masuk 8S
1 bulan
- nyerl kepala, seperu
dllkaL, sepan[ang
harl. 1ldak membalk
dengan analgeuk
2 mlnggu
- uemam
udak unggl
- MunLah
- 1ungkal
kanan
dlsereL
1 mlnggu
- MenganLuk
- Semakln
lemah
emerlksaan llslk
8honkl basah kasar dl kedua lapang paru
CCS: L2M3v2
kaku kuduk posluf
aresls n. vll deksLra senLral
lnlLraL dl kedua lapang paru
<%,30%-306.=
Pb: 8,39
Leu: 16.900
na: 121
Plv: non reakuf
Pldrosefalus komunlkan
Anallsa Calran Serebrosplnal
1ldak berwarna
!ernlh
PlLung sel: 11
Mn/Mn: 4/7
roLeln: 760
Clukosa CSS: 74
Clukosa serum: 93
1ldak dlLemukan basll Lahan asam
C8 18 negauf
enegakan dlagnosls
ersenLase keluhan awal Menlnglus 18

>1?%4%@-%9A% B10C19-%C1
SaklL kepala 30-80
uemam 60-93
MunLah 30-60
loLofobla 3-10
Anoreksla 60-80
kaku kuduk 40-80
uellrlum 10-330
1hwalLes CL, 1ran 1P. 1uberculous menlnglus: many quesuons, Loo few answers. LanceL neurology. 2003,4(3):160-70
1hwalLes CL, Chau 11, SLepnlewska k, hu nP, Chuong Lv, Slnh ux, eL al. ulagnosls of adulL Luberculous menlnglus by use of cllnlcal and laboraLory
feaLures. LanceL. 2002,360(9342):1287-92
1hwalLes CL, Chau 11, SLepnlewska k, hu nP, Chuong Lv, Slnh ux, eL al. ulagnosls of adulL Luberculous menlnglus by use of cllnlcal and laboraLory
feaLures. LanceL. 2002,360(9342):1287-92
(
D
EF
(
(
Skor < 4 - Menlnglus 18, Skor >4 - Menlnglus 8akLerlalls
1hwalLes CL, Chau 11, SLepnlewska k, hu nP, Chuong Lv, Slnh ux, eL al. ulagnosls of adulL Luberculous menlnglus by use of cllnlcal and laboraLory
feaLures. LanceL. 2002,360(9342):1287-92
8adlologl
?asar k, eL al. Lvaluauon of radlologlcal ndlngs ln 16o adulLs pauenLs wlLh Luberculous menlnglus. 1urk ! Med Scl, 2012
SLadlum
+-%A6.= G
CCS 13 Lanpa deslL neurologls fokal

+-%A6.= GG
CCS 13 dengan declL neurologls fokal
CCS 10-14 dengan aLau Lanpa deslL neurologls fokal

+-%A6.= GGG
CCS kurang darl 10 dengan aLau Lanpa deslL neurologls fokal
8rancusl l, larrar !, Peemskerk u. 1uberculous menlnglus ln adulLs: a revlew of a decade of developmenLs focuslng on prognosuc facLors for
ouLcome. luLure mlcroblology. 2012,7(9):1101-16
1aLalaksana
CA1 uosls harlan
8uLe
pemberlan
uurasl
Anak uewasa
8rlush 1horaslc SocleLy guldellnes,1998
lsonlazld
8lfamplcln
yrazlnamld
LLhambuLhol
SLrepLomlcln
3 mg/kg
10 mg/kg
33 mg/kg
13 mg/kg
13 mg/kg
300 mg
430 mg (<30 kg)
600 mg (>30 kg)
1-3 gram (<30 kg)
2 gram (>30 kg)
13 mg/kg
13 mg/kg
Cral
Cral
Cral
Cral
lnLramuscular
9-12 bulan
9-12 bulan
2 bulan
2 bulan
2 bulan
Culdellnes of !olnL commluee of A1S,luSA dan CuC 2003
lsonlazld
8lfamplcln
yrazlnamld
LLhambuLhol
10-13 mg/kg (Mu 300 mg)
10-20 mg/kg (Mu 600 mg)
13-30 mg/kg (Mu 2000 mg)
13-20 mg/kg (Mu 1000 mg)
3 mg/kg (Mu 300 mg)
10 mg/kg (Mu 600 mg)
40-33 kg :1000 mg
36-73 kg : 1300 mg
76-90 kg : 2000 mg
40-33 kg : 800 mg
36-73 kg : 1200 mg
76-90 kg : 1600 mg
Cral
Cral
Cral
Cral
9-12 bulan
9-12 bulan
2 bulan
2 bulan
1hwalLes CL, 1ran 1P. 1uberculous menlnglus: many quesuons, Loo few answers. LanceL neurology. 2003,4(3):160-70
korukosLerold
uexameLhason
Memperbalkl survlval
1hwalLes CL eL al. uexameLhasone for Lhe LreaLmenL of Luberculous menlnglus ln adolescenLs and adulLs. nL!M 2004, 331: 1741-31
uosls ueksameLason
+-%A6.= G +-%A6.= GG A%9 GGGG
Mlnggu l 0.3 mg/kg/harl (lv) 0.4 mg/kg/ harl (lv)
Mlnggu ll 0.2 mg/kg/harl (lv) 0.3 mg/kg/harl (lv)
Mlnggu lll 0.1 mg/kg/harl (C) 0.2 mg/kg/harl (lv)
Mlnggu lv 3 mg LoLal/harl (C) 0.1 mg/kg/harl (lv)
Mlnggu v 1urunkan 1 mg uap mlnggu selama
2 mlnggu
4mg LoLal/harl (C)
1urunkan 1 mg uap mlngggu
selama 3 mlnggu
1hwalLes C, llsher M, Pemlngway C, Scou C, Solomon 1, lnnes !. 8rlush lnfecuon SocleLy guldellnes for Lhe dlagnosls and LreaLmenL of
Luberculosls of Lhe cenLral nervous sysLem ln adulLs and chlldren. 1he !ournal of lnfecuon. 2009,39(3):167-87
Pldrosefalus
Pldrosefalus obsLrukuf/ non komunlkans
v shunL
Pldrosefalus komunlkan
v shunL blla medlkamenLosa gagal
8lsa dlberlkan Lerapl awal
AceLazolamlde 10-20 mg/kg

1hwalLes C, llsher M, Pemlngway C, Scou C, Solomon 1, lnnes !. 8rlush lnfecuon SocleLy guldellnes for Lhe dlagnosls and LreaLmenL of
Luberculosls of Lhe cenLral nervous sysLem ln adulLs and chlldren. 1he !ournal of lnfecuon. 2009,39(3):167-87
1erlmakaslh