406171057 - KEVIN TUMBEL

406181046 - CYNTHIA
406181054 - ANDI PANDU
NEUROLOGY BAGUS ALLAM
ROYAL TARUMA HOSPITAL

FACULTY OF MEDICINE
TARUMANAGARA UNIVERSITY
Case 1
Identity
 Name : Ms. B
 Age : 55 years old
 Adress : Kembangan, West Jakarta
 Weakness in both legs since 1 month ago
 Initially the patient has aching legs on
both legs since 6 months ago
 There is no history of trauma
 Patient have a hipertension
Physical examination
 Awareness :
 GCS = 15
 VitalSign  BP : 160/80mmhg RR : 20 ; HR :
72 ; T : 36,7 ; Weight : 65 kg
Physical examination
 Menigeal sign (-)
 N III, IV,VI : ocular alignment : symentic, pupil position in the
middle, direct light reflex (+), Indirect light reflex (+), ocular
movement to all direction
 Refleks Physiologist
 Refleks bicep +/+
 Patella ++/+
 Refleks Pathologist
Babinski : -/-
Chaddok : -/-
Gordon : -/-
Hoffman tromner : -/-
 Motoric :
 Strength : 5555/5555
 1111/1111
 Tonus : normotoni
 Trofy : normotrofy
 Sensory : no abnormality found
 Sensibility : no abnormality found
MRI
 Scoliosis to the right
 Signal intensity Vertebrae Thoracal to Lumbar 1 in
homogeneous especially L 1 dominant
hyperintense and tissue around edematous this is
a suspicious aspect of metastasis
 Sagittal cuts appear in disc bulging at L1, L2, to L5
S1 pressing on the spinal cord and causing
moderate canal stenosis
 Axial cuts appear on L4 L5 S1 bulging disks which
cause a slight narrowing of the neural foramen on
the left side and appear to be local radix irritation
 There is a picture of facet joint edema at L4 L5
and L5 L1 levels
Working diagnosis
 Paraplegia Inferior

Treatment
 Methlyprednisolone 3x125
 Ketorolac
1x30 mg
 Mecobalamin 1x500 mcg
Case 2
Low magnesium level

 Low magnesium level is a condition in which the amount of magnesium in the

blood is lower than normal. The medical name of this condition is
hypomagnesemia.

Causes
 Every organ in the body, especially the heart, muscles, and kidneys, needs the
mineral magnesium. It also contributes to the makeup of teeth and bones.
Magnesium is needed for many functions in the body, including the physical and
chemical processes in the body that convert or use energy (metabolism).
 When the level of magnesium in the body drops below normal, symptoms of low
magnesium may develop.
 Common causes of low magnesium include:
 Alcohol use
 Burns that affect a large area of the body
 Chronic diarrhea
 Excessive urination (polyuria), such as in uncontrolled diabetes and during recovery
from acute kidney failure
 High blood calcium level (hypercalcemia)
 Hyperaldosteronism (disorder in which the adrenal gland releases too much of the
hormone aldosterone into the blood)
 Malabsorption syndromes, such as inflammatory bowel disease
 Malnutrition
 Medicines : diuretics, proton pump inhibitors, and aminoglycoside antibiotics
Symptoms
 Convulsions
 Fatigue
 Muscle spasms or cramps
 Muscle weakness
 Numbness

Exams and Tests

 electrocardiogram (ECG).
 A blood test to check magnesium level. Normal range is 1.3 to 2.1 mEq/L (0.65 to
1.05 mmol/L).
 Calcium blood test
 Comprehensive metabolic panel
 Potassium blood test
 Urine magnesium test

Treatment
 Fluids given through a vein (IV)
 Magnesium by mouth or through a vein
 Medicines to relieve symptoms

Possible Complications
 Cardiac arrest
 Respiratory arrest
 Death