CASE ANALYSIS

3.1 CLINICAL DIAGNOSIS

Based on anamnesis, patient complaint of recurrent generalized tonic-clonic seizures. Patient
also suffered from weakness on the left side of her body. From physical examination, there
were increased physiological reflexes and increased tones on her left side, and hemiplegic
gait. These findings showed that the patient suffered from spastic hemiparesis sinistra. Patient
also complaint of diplopia which was caused by her strabismus. From cranial nerve
examination, paresis of the sixth and seventh nerve were found. History of vomiting and
findings of papilledema and sixth nerve paresis indicated that there was increased intracranial
pressure. In conclusion, this patient suffered from spastic hemiparesis sinistra and multiple
cranial nerve palsies.
3.2 TOPICAL DIFFERENTIAL DIAGNOSIS
1. Cerebral cortex
2. Subcortical
3. Internal Capsule
1. Cerebral cortex lesion
- Motoric deficit
- Sensoric deficit
- Focal sign
-

Irritative sign

Patients clinical findings

- Spastic hemiparesis sinistra
- No sensoric deficit was found
- Left side weaknesses of upper and
lower limb
- Tonic-clonic seizures

2. Subcortical lesion
Patients clinical findings
- Motoric deficit
- Spastic hemiparesis sinistra
- Motoric aphasia if lesion on the
- No aphasia
dominant hemispherium
3. Internal capsule lesion
Patients clinical findings
- Typical hemiplegia
- Spastic hemiparesis sinistra
- Paresis of central N.VII
- Yes
- Paresis of central N. XII
- None
- Weaknesses of upper and lower limb
- Left side weaknesses of upper and
of the limp side is equal
lower limb
Topical diagnosis for this case is cerebral cortex lesion.

3.3 ETIOLOGICAL DIFFERENTIAL DIAGNOSIS

1. Subdural Empyema
2. Bacterial Meningitis
3. Brain Abscess
1. Subdural Empyema
Patients clinical findings
- Headache
- Present
- Fever
- Present
- Focal neurologic signs
- Spastic hemiparesis sinistra
- Seizure begin as partial motor
- Generalized tonic-clonic seizures
seizures then become secondarily
generalized seizure
- Altered level of consciousness
- Present
- Nuchal rigidity
- Not found
2. Bacterial Meningitis
Patients clinical findings
- Headache
- Present
- Nuchal rigidity
- Not found
- Fever
- Present
- Decreased level of consciousness
- Present
- Photophobia
- Not found
- Nausea and/or vomiting
- Vomiting without nausea
- Seizures
(focal/generalized/status
- Generalized tonic-clonic seizures
epilepticus)
3. Brain Abscess
- Fever
- Headache
- Nausea and/or vomiting
- Decreased level of consciousness
- Focal neurologic deficit

Patients clinical findings

- Present
- Present
- Vomiting without nausea
- Present
- Seizures, spastic hemiparesis sinistra

From clinical findings, etiological diagnosis for this case is brain abscess.