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Tuberculous MeningoencephalitisAdvisor : Dr. H. A. Rachman Toyo, Sp.S(K)

Departemen/Bagian NeurologiRSMH Palembang/Fakultas Kedokteran Universitas Sriwijaya2014Tanti Anggriyawati, S.Ked04124705035Rieska Yunika M, S.Ked 04124705101Case1Name: Mr. AMAge: 25 years oldSex: MaleAddress: SekayuReligion: IslamAdmission date: Oct 7th, 2014

Identification2The patient was admitted to Neurology ward Moh.Hoesin General Hospital because decreased of consciousness gradually.+ 4 monthspersistent headache, cough, mucous (+), blood (-). He had fever, loss of appetite, sweat in night, and loss of body weight, nausea and vomiting. + 3 monthsthe patient had admitted to Sekayu hospital because he had feel weakness of his body, and the doctor said that he got lung disease. Then he got the medicines and after around 1 week he feels better, then he stopped to drink medicine and he did not control to hospital. At home, he drunk drugs regularly, but he stopped + 2 days before admitted to the hospitalthe patient had decreased of consciousness gradually, such as anxious and disorientation.headache, nausea & vomiting, seizures (-), hemiparese(-). . no history of ear infections, no history of seizures, no history of diabetes, no head trauma.The patient suffered from this illness for the first time.

Anamnesis3PRESENT STATEInternal State Sense: E3M5V3Nutrition: SufficientTemperature : 38.9 oCPulse : 90 beats/minRespiratory rate: 20 times/minBlood pressure : 130/100 mmHgHeart : No abnormalityLungs Inspection : Static & Dinamis: left chest behind

Physical Examination4Palpation: stem fremitus of left chest >Thrombocyte: 547000/mm3 >>MCV: 74,8 fL Diff. Count: 0/0/0/91/5/4 18Blood Glucose: 113 mg/dLAlbumin: 3,5 g/dLCholesterol Total: 172 mg/dLCholesterol HDL: 18 mg/dL Cholesterol LDL: 114 mg/dL Ureum : 26 mg/dl Uric acid: 1,5 mg/dLCreatinin : 0,85 mg/dLNa: 132 mmol/LK: 3,4 mmol/LCa: 9,3 mg/dLPhospor: 3,5 mg/dLMg: 2,70 mEq/LCl: 93 mmol/LCRP Kualitative : positiveCRP Quantitative: 44 mg/L >>Contd19MacroscopicVolume: 3 ccColour: colorlessClarity: slightly cloudySmelly: no smellySpesific weight : 1.020Clot : negativepH: 9.0

Cerebro Spinal Fluid20MicroscopicLeukosit : 11,0 sel/lDiff.count PMN cell : 18%MN cell : 82% >>Nonne : negativePandy : positiveProtein: 0,3 g/dLGlucose: 41,7 gr/d