Assalamualikum wr wb….Good morning to Dr. Cahyono Kaelan PhD, Sp.PA(K), Sp.

S and my
colleagues. Thankyu for coming to beside teaching this morning. I will present case about dandy
walker syndrome.

Identity : Mr. W, Male, Twenty seven years old was referred from POLEWALI Hospital with
diagnose DOUBLE HEMIPARESE AND DANDY WALKER SYNDROME. This patient was transferd
from Neurosurgery department. The patient has rekuren seizure.

The first seizure happens when the patient is five years old, with the duration og less than five
minutes. The left hand was tonic and patient was still consecous. The last seizure happen at
three desember two thousand and eighteen (3 des 2018), three times, less than ten minutes,
accompanied by fever and inability to talk. 4 day layer, he brought to puskesmas, referred to POLEWALI
hospital head CT-Scan was done with the result of dandy walker syndrome with agenesis of corpus
collosum. Parents was them affered to Wahidin hospital for VP-Shuntr procedure. The poperation was
done at (26 des 2018) twentysix desember two thousand and eighteen.

History of delayed development is positive: When the patients sits, his head are tilted to the back.
Patient could walk when he is more than three years old. Ofthen has seizure when he 11 (eleven) years
old, so the parents stopped him from going to school anymore. Then he was brought to pediatrician and
was given anti epileptic drugs for three years, but he only took the drug in four months. If there was an
attack the parents let the seizure disappear by itself. Last years, the patients had febrile seizure, which
rendera him unable to walk.

Vital sign :BP : one hundred and twentieth / eighty, HR : Seventy three, RR : twenty two, Temps
:thirtysix point five celcius. Glascow coma scale :eye 4, motoric 6, verbal 5, high cortical function :
imparred. Meningeal sign : neck stiffness (neg, kernig sign neg/neg.

Cranial nerve : round, isocor pupil, diameter two point five millimeter. Direct light and indirect light
light reflex pos/pos. motoric : movement and strength lateralisasi to the left, tonus decrase to the left,
RF : decrese to the left. RP :Babinsky is positive on the left foot.

Sensory : cannot be evaluated, Autonomic : normal

A: generalized clonic seizure with aware impairness, Laboratorium result is normal

Plan :

1) Phenytoin one hundred milligram in paggy bag nacl zero point nine %
2) Glaucon two houndred fifty milligram every twelve hours oraly
3) Mecobalamin 1 ampul every twenty four hours intravenously
4) Pregabalin seventy five milligram every twenty four hous oraly
5) Meloxicam fifteen milligram every twenty four hours oraly
6) Valproate acid two hundred milligram every twelve hours oraly
7) Vitamin B6 1 tablet every twelve hours oraly.