Beside Teaching

PARAPARESIS UPPER MOTOR NEURON CAUSED

BY EPENDYMOMA + MDR TB + HIV

Candra Arisandi
C155172007

Supervisor: dr. Ummu Atiah, Sp.S

 Patient’s identity

 Name : Mr. SM
 Sex : Male
 Date of Birth : September 25th, 1992
 Age : 27 years old
 Occupation : Employee
 Date of Admission : June 6th, 2019
 Chief complain

 Weakness of lower extremities since

one month.
 PRESENT HISTORY

 Worsen gradually since 4 days before admision. Pain

sensation (-), Tingling sensation (-), History of trauma (-),
history of fever (+) since last month.
 Body weight decrease 4 Kg in one month.
 History of pulmonary TB (+) at 2010, finished treatment.
 Physical examination

 BP 110/70 mmHg, HR 90, RR 22, Temp 36,2 C

 GCS : E4M6V5
 Higher cortical function: within normal limit
 Meningeal signs: no neck stiffness, kernig sign neg/neg
 Cranial nerves: round & isochoric pupil, Ø 2,5mm / 2,5mm, DLR
pos/pos, ILR pos/pos
 Physical examination

 Other cranial nerves: within normal limit

 Motor system :
Physiologic Pathologic
Movement Strength Tone
Reflex Reflex

N N 5 5 N N +2 +2 Neg Neg
↓ ↓ 3 3 ↓ ↓ +3 +3 Pos Pos
 Clonus -/-. Atrophy +/+
 Sensory system: within normal limit
 Proprioceptive test: within normal limit
 Autonomic system: normal micturition &
defecation
 Working diagnosis

 Clinical Diagnosis : Paraparesis Upper Motor Neuron

 Topical Diagnosis : Vertebral body at level Th - 10
 Etiological Diagnosis : Suspected Spondylitis TB
 Laboratory examination
Result Reference Unit
White Blood Cell 10,7 4.000 – 10.000 103/µL
Hemoglobin 10,7 12,0 – 16,0 gr/dL
Hematocrite 80.8 37 – 48 %
Platelet 497.000 150.000 – 400.000 /µL
Random Blood Glucose 95 140 mg/dL
Ureum 19 10 – 50 mg/dL
Creatinine 0,57 < 1,3 mg/dL
SGOT / AST 52,2 10-40 U/L
SGPT / ALT 29,2 10-55 U/L
BSR 92 0-10 mm/h
Anti – HIV Reactive Non-reactive
Chest X-ray

Interpretation: miliary TB
X-Ray of Thoracolumbar Vertebra
Thermoregulatory Sweat Test
MRI of Thoracolumbar Vertebra
 Interpretation:
Intramedullary tumor suggestive
ependymoma at the level of Th-10
 Final diagnosis

 Clinical Diagnosis : Paraparesis Upper motor Neuron

 Topical Diagnosis : Central Canal of spinal cord
 Etiological Diagnosis : Ependymoma
 Management

 IVFD RL 20 drips/minute
 Paracetamol 1 gr/8h/iv drips
 Lansoprazole 1 amp/12h/iv
 Dexamethasone 2 amp/loading dose/ iv
 1 amp/8h/iv
 Mecobalamin 1 tab/24h/oral

 Recommendation : MRI of Thoracolumbar Vertebra with contrast