NEUROSURGERY REPORT

Tuesday, January 11th, 2022

Chief on Call : dr. Mirza Aditya

Penanggung Jawab Mandiri

Chief on Site : dr. Muhamad Faisal Akbar Thamrin

Jaga 2 : dr. Muhammad Luqman Nul Hakim

Jaga 3 : dr. Samuel Wilyarto

Jaga 5 : dr. Brahma Putra

Jaga Stase : drg. Timotius (Bedah Dasar)

• New Patient :4
• Emergency Patient :-
• Urgent Consult :2
• Emergency Operation :-
• Pre Operative :2
• Post Operative :3
• Death Case :-
• Outpatient Clinic :9
• NCCU/ICU/PICU/NICU/HCU-RIK/HCU-KMG : - / 3 / - / - / -/ -
NEW PATIENT
 NP 1. Mr. Gilang / ♂ / 17 yo/ 0002010484/ Trauma / RS
CC: Decrease of consciousness
History:
± 5 hours prior to admission, when the patient was riding motorcycle at
Cipatat Area, suddenly he hit other motocycle from the opposite side, then he
fell down with his head hit the road. Helmet (-), History of alcohol
consumption (-), vomiting (-), seizure (-). Bleeding from nose (+), ear (-), and
mouth (+). Because of the complaint, he was brought to Neurosurgery
Emergency Unit of Hasan Sadikin Hospital.
Primary Survey:
A: Clear, C- Spine Control (+)
B: Symmetrical shape and movement, VBS right = left,
Rh -/-, Wh-/-, R: 20 x/min
C: BP: 120/70 Hg, HR: 89x/min, CRT < 2’’
D: GCS E3M6V4 = 13
pupil round equal 3mm/3mm, LR +/+
motoric: paresis -/-
Secondary Survey:
At Right superior orbital rim : lacerated wound 4x3x2 cm,
based on muscle, crepitation (+)
At Right Periorbita : hematome (+), ciliary injection (+)
At nostril: rhinorrhea (+), halo test (+), crepitation (+)
At right arm : deformity (+), swelling (+), bruising (+)
At right middle finger : lacerated wound size 1x0.5x0.5 cm
based on tendon, irregular edge, swelling (-)
 Laboratory Findings at Hasan Sadikin Hospital, Bandung
January 11th, 2022

Labs Results Labs Result Labs Result

Hb 13.8 Na/K 136/3.3 pH 7.413
Ht 40.2 Ur/Cr 23.0/0.76 pCO2 18.7
L 21.540 RBG 161 pO2 91.7
Tr 264.000 HCO3 17.9
PT/APTT/ 11.80/19.20/1.
INR 06 tCO2 18.7
BE -4.8
Sat o2 97.2

Labs Results
PCR TCM Covid-19 Negative
Cervical and Thorax X-Ray at Hasan Sadikin Hospital, Bandung
January 11th , 2022

Within Normal Limit

 Arm X-Ray at Hasan Sadikin Hospital, Bandung
January 11th , 2022
- Bone Discontinuity at Right Distal half third of radius
- Bone Discontinuity at Right middle finger
Non Contrast Head CT Scan at Hasan Sadikin Hospital, Bandung
January 11th, 2022
Non Contrast Head CT Scan at Hasan Sadikin Hospital, Bandung
January 11th, 2022
• Soft tissue swelling (+) at
bilateral frontal
• Bone Discontinuity (+) right
orbital rim and right
zygoma
• Sulci and gyri are
compressed
• Sylvian fissure not
compressed
• ventricle and cisterns are
not compressed
• salt and pepper
appearance at left
temporal
• Midline shift (-)
WD/ Moderate Head Injury + SBF Anterior Fossa + Cerebral Contusion at
Left Temporal + Closed Fracture at Right Radius Distal Third + Open
Fracture at Right Middle Finger + Fracture at Right Superior Orbital Rim
+ Fracture of Nasal Bone + Fracture of Right ZMC (frontozygoma, rima
orbita inferior, arcus zygoma)

ICD 10: Concussion (S06.0); Fracture of base of skull; (S02.2); Fracture of lower
end of radius, closed (S52.50 ), Contusion and laceration of cerebrum,
unspecified, with loss of consciousness of unspecified duration, initial
encounter (S06); for Nondisplaced fracture of middle phalanx
(S62.657); Fracture of orbit, unspecified, initial encounter for closed
fracture. (S02. 85XA); Fracture of nasal bones (S02.2XXA);

TH/ NC(Leader) : Closed Observation

Plastic Surgery : Primary Suture and ORIF Elective
Ortopedic Surgery : ORIF Elective

ICD 9: Observation for unspecified suspected condition (V71.9);

GCS this morning: E3M6V5 = 14 Emergency Ward

 NP 2. Mr. M. Aldi / L / 23 th/ 0002010548 / Trauma / RS
CC: Headache
History:
± 3 days prior to admission, when the patient was walk on stairs of his
house at Cianjur Area, suddenly he slipped, then fell down from 1,5 m of
height with his head hit the floor. History of alcohol consumption (-),
unsconciousness (+), vomiting (+), seizure (-). Bleeding from nose (-), ear (-),
and mouth (-). Because of the complaint, he was brought to Sayang Hospital,
Cianjur, hospitalized for 3 days by neurosurgeon and referred to Neurosurgery
Emergency Unit of Hasan Sadikin Hospital.
Primary Survey:
A: Clear,
B: Symmetrical shape and movement, VBS right = left,
Rh -/-, Wh-/-, R: 20 x/min
C: BP: 120/80 Hg, HR: 80x/min, CRT < 2’’
D: GCS 15
pupil round equal 3mm/3mm, LR +/+
motoric: paresis -/-
Secondary Survey:
At Bilateral temporal: Hematome (+)
At Occipital : Hematome (+), Crepitation (-)
Laboratory Findings at Hasan Sadikin Hospital, Bandung
January 11th, 2022

Labs Results
Hb 15.0
Ht 42.8
L 12.990
Tr 309.000
Thorax X-Ray at Hasan Sadikin Hospital, Bandung
January 11th , 2022

Within Normal Limit

Non Contrast Head CT Scan at Sayang Hospital, Cianjur
January 07th, 2022
Non Contrast Head CT Scan at Sayang Hospital, Cianjur
January 07th, 2022
• Soft tissue swelling (+) at
bilateral temporal et right
occipital
• Bone Discontinuity (+) at right
occipital
• Sulci and gyri are not
compressed
• Sylvian fissure are not
compressed
• ventricle and cisterns are not
compressed
• Hyperdense Lesion at Left
lateral Ventricle, ventricle III,
IV
• Hyperdense Lesion at left
frontal with volume 16 cc
• Hyperdense Lesion bikonveks
at right occipital with volume
20 cc et right cerebellum with
volume +- 8cc
• Midline shift (-)
WD/ Mild Head Injury + EDH at Right Occipital et Right Cerebellum
Traumatic IVH + ICH at Left Frontal + Closed Linear Fracture at Right
Occipital

ICD 10: Concussion (S06.0); Fracture of lower end of radius, closed (S52.50 ),
Epidural hemorrhage (S064); for Traumatic hemorrhage of cerebrum,
unspecified (S06.36); Fractures of other skull and facial bones, closed
(S02.80)

TH/ Closed Observation

ICD 9: Observation for unspecified suspected condition (V71.9);

GCS this morning: 15 Emergency Ward

 NP 2. Mrs. Dwi Diana / ♀ / 49 yo / 0001945915 / Skullbase / AB
CC: Blindness of the left eye

History:
Since 3 years prior to admission, the patient complained of blurred
vision of her left eye that getting worse overtime until blind in the last 2 years.
The complain accompanied with blurred vision of the right eye since 7 months
ago and intermittent headache since 3 years ago which could still be relieved
with oral medication. History of unconsciousness (-), seizure (-), vomiting (-),
fever (-) and trauma (-). Because of the complaints, she was brought to
Ophtalmologist Outpatint Clinic of Cicendo Hospital, underwent contrast head
CT scan (July 09th, 2021), then referred to The Neurosurgery Outpatient Clinic
of Hasan Sadikin Hospital, underwent Contrast Head MRI (August 10th, 2021)
diagnosed with brain tumor, performed Craniotomy Tumor Removal (Septemer
6th, 2021), with histopatologhical result of Meningothelial Meningioma (WHO
grade I), hospitalized for 7 days, and sent home with improvement. Now she
come for second operation.
History of behavioral changes (-), Double vision (-), smelling disturbance
(-). History of hormonal contraceptive use (+) for 10 years, but has been
stopped since the last 5 years. History of lump on another parts of body (-).
History of progressive weight loss (-).
 Mrs. Dwi Diana / ♀ / 49 yo / 0001945915 / Skullbase / AB
CC: blindness of left eye

3 years ago

blurred vision Underwent

of her left 4 months ago control contrast
2 year ago head CT scan
eye, getting 7 months ago
worse over (September
time Complete Referred to Hasan 13rd, 2021), then
Blurred vision of her right Sadikin hospital, scheduled for
blindness of her
eye underwent surgery re-craniotomy
left eye
Intermittent (September 6th, 2021) tumor removal
headache and cranioplasty

History of double vision (-), numbness of her left face (-), lump on other part of
body (-), History of hormonal contraceptive use (+) for 10 years, but already
stopped since the last 5 years.
 Physical Examination
(August 30th, 2021)
General State:
BP: 110/80 mmHg HR: 84 x/min RR: 20 x/min T: 36.5 0 C

Local State:
At Thorax: VBS left = right, Rh -/-, Wh -/-

Neurological State:
GCS 15, nuchal rigidity (-)
Pupils : Round, unequal Ø RLO 3 mm/5 mm, LR +/-
Visus : OD : 1/60 OS : NLP
Funduscopy : Not performed
Eye ball movement : RO good to all direction, LO limited to all direction
Other cranial nerves : Paresis of left CN 3
Motoric : Paresis -/-
Sensoric : Within normal limit
Physiologic reflex : +/ +
Pathologic reflex : Babinski -/-
Contrast Head CT Scan at Cicendo Hospital, Bandung
July 09th , 2021
Contrast Head CT Scan at Cicendo Hospital, Bandung
July 09th , 2021
Contrast Head CT Scan at Cicendo Hospital, Bandung
July 09th , 2021

• Sulci and gyri are compressed

• Sylvian fissure are compressed
• Ventricle and Cisterns are

compressed
• Hyperdense Lesion at Left Clinoid

extend to Suprasellar
• Perifocal edema (+)
• Midline shift > 5mm to the right
Contrast Head MRI at Hasan Sadikin Hospital, Bandung
August 10th , 2021
Contrast Head MRI at Hasan Sadikin Hospital, Bandung
August 10th , 2021
Contrast Head MRI at Hasan Sadikin Hospital, Bandung
August 10th , 2021
 Contrast Head MRI at Hasan Sadikin Hospital, Bandung
August 10th , 2021

T1 : Isointense mass at left clinoid extend to suprasellar that

enhanced homegenously with contrast administration,
dural tail (+)
T2 : Isointense mass at left clinoid extend to suprasellar
Mrs. Dwi Diana / ♀ / 49 yo / 0001945915 / Skullbase / AB
INTRAOPERATIVE FINDING (06/09/2021)

DO: at Left Clinoid

- Ditemukan massa tumor putih
keabuan berkapsul berbatas tegas,
konsistensi kenyal rubbery, mudah
berdarah, tidak mudah disuction
- Tumor terangkat +- 70%, disisakan
tumor di batas medial dan superior
Histopathological Result at Hasan Sadikin Hospital
September 14th, 2021

Meningothelial Meningioma
(WHO Grade I)
 Physical Examination
(January 11th, 2022)
General State:
BP: 110/80 mmHg HR: 84 x/min RR: 20 x/min T: 36.5 0 C

Local State:
At Left Frontal: Bone Defect (+), bulging (+), not tense, scar post Op (+)
At Thorax: VBS left = right, Rh -/-, Wh -/-

Neurological State:
GCS 15, nuchal rigidity (-)
Pupils : Round, unequal Ø RLO 3 mm/5 mm, LR +/-
Visus : OD : 1/60 OS : NLP
Funduscopy : Not performed
Eye ball movement : RO good to all direction, LO limited to all direction
Other cranial nerves : Paresis of left CN 3
Motoric : Paresis -/-
Sensoric : Within normal limit
Physiologic reflex : +/ +
Pathologic reflex : Babinski -/-
Laboratory Findings at Hasan Sadikin Hospital, Bandung
November 11th, 2021

Labs Result Labs Result

Hb 12.3 Na/K 145/3.7
Ht 39.5 Ur/Cr 18.9/0.74
L 9.360 SGOT/SGPT 19/33
Tr 383.000 GDS 178
PT/APTT/INR 14.2/26.60/0.98

January 11th , 2021

Labs Result
PCR TCM SARSCOV 2 Negative
Thorax X-Ray at Hasan Sadikin Hospital, Bandung
November 10th , 2021

Susp. Right Broncopneumonia

Contrast Head CT Scan at Hasan Sadikin Hospital, Bandung
September 13th , 2021
Contrast Head CT Scan at Hasan Sadikin Hospital, Bandung
September 13th , 2021
Contrast Head CT Scan at Hasan Sadikin Hospital, Bandung
September 13th , 2021

• Sulci and gyri are compressed

• Sylvian fissure are

compressed

• Ventricle and Cisterns are

compressed

• Hyperdense Lesion at Left

Clinoid extend to Suprasellar

• Hypodense mass at Left

frontal that not enhance with

contrast administration

• Midline shift (-)

 WD/ Post Craniectomy Tumor Removal due to SOL Supratentorial at Left
Clinoid extend to Suprasellar due to Suspect Clinoidal Meningioma
dd/ Tuberculum Sella Meningioma

ICD 10: Benign neoplasm of brain (C71.9);

Th/ Re-Craniotomy Tumor Removal + Cranioplasty

ICD 9: Craniotomy (01.24); Cranioplasty (02.0)

GCS this morning: 15 RIK 4th Ward

 NP 3. Mr. Maman Abdurrhoman/ ♂ / 42 yo / 0001839288/ AD
CC: Headache

History:
Since 2 months prior to admission. The patient complained of headache
that getting worse overtime and could be relieved with oral medication.
History of unconsciousness (-), seizure (-), History of weakness of extremities
(-), facial asymmetry (-), slurred speech (-), fever (-), and trauma (-). Because of
the complaint, she was brought to Al Islam Hospital, underwent Non Contrast
Head CT Scan at Al Islam Hospital (November 14th , 2021), diagnosed with
Arteriovenous malformation by Neurosurgeon, hospitalized 3 days and then
sent home with improvement. Then she referred to The Neurosurgery
Outpatient Clinic of Hasan Sadikin Hospital and plan for DSA Procedure.
1,5 years ago, He complained sudden headache when activity that getting
worse overtime and could not be relieved with oral medication. History
vomiting (+), Seizure (-). Because of the complaint, she was brought to Al Islam
Hospital, underwent Non Contrast Head CT Scan at Al Islam Hospital (June 06 th,
2020), diagnosed with Arteriovenous malformation by Neurosurgeon,
hospitalized 4 days and then sent home with improvement.
 NP 3. Mr. Maman Abdurrhoman/ ♂ / 42 yo / 0001839288/ AD
3 years ago, He complained of headache that getting worse overtime but
still could be relieved with oral medication. Because of the complaint, she was
brought to Al Islam Hospital, underwent Head Angiography at Al Islam Hospital
(March 03th, 2018), diagnosed with Arteriovenous malformation by
Neurosurgeon, hospitalized 3 days and then sent home with improvement.
History of Hypertension (-). History of DM (-). History of previous stroke (-),
History of anticoagulant consumption (-), history of smoking (-), and history of
alcohol consumption (-).
 Physical Examination
General State:
BP: 120/80 mmHg HR: 92x/min RR: 18 x/min T: 36.40 C

Local State:
At thorax : VBS right = left, Rh -/-, Wh -/-

Neurological State:
GCS 15, nuchal rigidity (-)
Pupils : RLO: round, equal, Ø RLO 3mm/3mm, LR +/+
Visus : RLO: > 6/60
Funduscopy : RLO: not examined
Eye ball movement : Good to all direction
Other cranial nerves : Within normal limit
Motoric : Parese -/-
Sensoric : Within normal limit
Physiologic reflex : +/+
Pathologic reflex : Babinski -/-
Laboratory Findings at Hasan Sadikin Hospital, Bandung
December 31st, 2021

Labs Result Labs Result

Hb 15.7 RBG 98
Ht 46.5 Na/K 140/4.2
L 4190 Ur/Cr 18/0.79
Tr 211.000 OT/PT 18/23
PT/APTT/INR 13.6/30.80/0.96

Labs Result
PCR TCM SARSCOV 2 Negative
(January 11th, 2022)
Thorax X-Ray at Hasan Sadikin Hospital, Bandung
November 26th, 2021

Within normal limit

Contrast Head CT Scan at Al Islam Hospital, Bandung
March 13th , 2018
Contrast Head CT Scan at Hasan Sadikin Hospital, Bandung
March 13th , 2018

- Found AVM with feeding artery from branch medial cerebral

artery and draining vein to superficial Middle Cerebral Vein and
Vein of Labbe
- Bag of Worm (+)
- Spetzler Martin Grade : 4
Contrast Head CT Scan at Al Islam Hospital, Bandung
June 20th , 2021
• Sulcus and gyrus are not
compressed
• Sylvian fissure are not
compressed
• Ventricle and cistern are not
compressed
• isohipodense lesion at
temporal lobe, calcification
(+)
• Perifocal Edema (-)
• Midline shift (-)
Contrast Head CT Scan at Al Islam Hospital, Bandung
November 14th , 2021

• Sulcus and gyrus are not

compressed
• Sylvian fissure are not
compressed
• Ventricle and cistern are not
compressed
• isohiperdense lesion at
temporal lobe, calcification
(+)
• Perifocal Edema (-)
• Midline shift (-)
WD/ Arteriovenous Malformation at Left Temporal

ICD 10: Cerebral Arteriovenous malformation of cerebral vessels (Q28.2)

Th/ Plan for DSA Elective

ICD 9: Arteriography of cerebral arteries(88.41); Digital Subtraction

Angiography (220.9)

GCS this morning: 15 Kana Ward

URGENT CONSULT
 UC 1 . Mr. Iin Solihin / ♂ / 57 yo / 0002008869/ Oncology / FM
Patient was consulted from Neurology department
CC: Weakness of extremity

History:
Since ± 10 day prior to admission, the patient suddenly complaint
weakness of his right extremity. The complaint was preceded with headache
since 1 years before that can be relieved by oral medication. History of
unconsciousness (-), vomiting (-), slurred speech (-), facial asymmetry (-),
seizure (-), fever (-), and trauma (-). Because of the complaint he was brought
to emergency unit at Boromeus Hospital, underwent contrast head CT Scan
(December 29th, 2021) by Internist, diagnosed with Bleeding Brain Tumor
hospitalized for 3 days but the complaint didn’t relieve and the patient
referred to Emergency unit of Hasan Sadikin Hospital and hospitalized for 5
days by Neurologist and then consulted to Neurosurgery Department.
History of hypertension (+) 3 years ago, uncontrolled with highest systolic
pressure 220, Diabetes mellitus (+), previous stroke (-) lump at another part of
bodies (-), progressive body weight loss (+) 10 kgs in 1 months, behavioral
change (-)
 Physical Examination
General State:
BP: 160/92 mmHg HR: 81 x/min RR: 22 x/min T: 37.0 0 C

Local State:
At Thorax : Symetrical shape and movement, VBS right = left, Rh -/-, Wh -/-

Neurological State:
GCS 15, nuchal rigidity (-)
Pupils : RLO: round, equal, Ø RLO 3mm/3mm, LR +/ +
Visus : RLO: difficult to be examined
Funduscopy : RLO: not examined
Eye ball movement : Good to all direction
Other cranial nerves : Within normal limit
Motoric : Right Hemiparesis
45
45
Sensoric : Within normal limit
Physiologic reflex : ++/+
Pathologic reflex : babinski +/-
 Laboratory Finding at Hasan Sadikin Hospital, Bandung
January 10th, 2022
Lab (11/01/2022)
Labs Result Labs Result Labs Result Labs Result
Hb 11.8 Na/K 123/3.1 Na/K 131 / 3.7 pH 7.496

Ht 33.1 Ur/Cr 78 / 1,10 Ur/Cr 74.0 / 0.91 pCO2 24.8

L 14.310 Alb 2.04
Hba1c 11.8 pO2 95.5
Tr 265.000 RBG 494
RBG 101 HCO3 19.3
tCO2 20.1
Be- -1.9
SaO2 98.1 
 Urinary Finding at Hasan Sadikin Hospital, Bandung
January 08th, 2022
Urine Culture (08/01/2022) Labs (07/01/2022) Result
Isolate Enterobacter Cloaceae Color Yelowish
Ceftriaxone, Purity Cloudy
Gentamycin, Amikacin, BJ 1.009
Piperacilin,
pH 5.5
Sensitive Cefotaxime,
Ceftazidime, Cepefime, Nitrit Negative
Aztreonam, Protein +1
Ertapenem, GLucosa +2 
Meropenem
Urobilinogen Normal
Leukosit Esterase +4
Microscopic (07/01/2022)
Eritrosit +2
Eritrosit 31.6
Bilirubin Negative
Leukosit 163
Negative
Epitel 0 Keton
Bakteri Negative
Negative
Kristal
Silinder Positive
Thorax X-Ray at Hasan Sadikin Hospital, Bandung
January 6th, 2022

Within normal limit

Contrast Head CT Scan at Borromeus Hospital, Bandung
Decemmber 29th, 2021
• Sulci and gyri are not compressed
• Sylvian fissure are not compressed
• Ventricle and Cistern are
compressed
• Hyperdense at left temporal with
volume +-10cc
• Isohypodens at left temporal
• Perifocal edema (+)
• Midline shift (-)
• ICH Score :0
WD/ SOL Supratentorial at Left Temporal due to Suspect High Grade
Glioma DD/ Metastasis + Suspect Tumor Apoplexy + Urinary Tract
Infection + DM type 2 + Hypertension stage II + AKI stage III dd/ AKI
superimposed CKD + Hyponatremia + Hypoalbuminemia

ICD 10: Malignant Neoplasm of Brain (C71.9); Nontraumatic intracerebral

hemorrhage (I61.0); Urinary tract infection, site not specified
(N39.0); Hypertension (I10.1); Diabetes mellitus (E10-E14); Acute
kidney failure, unspecified (N17.9); Hypo-osmolality and
hyponatremia (E87. 1); Hypoalbuminemia (E88.09)

Th/ NC : Head Contrast MRI

Internal Medicine (Leader) : Antibiotic Therapy, Blood glucose
regulation, Blood Pressure regulation,
natrium correction and albumin
Correction
Neurology : Improve general condition

ICD 9: Observation for unspecified suspected condition (V71.9)

GCS this morning 15 NIC Azalea Ward

 UC 2. Mrs. Curiah / ♀ / 69 yo / 1802618 / Oncology / FM
The patient was consulted from Internal Medicine Department
CC: Headache
History:
Since 2 weeks ago, the patient complaint intermittent headache that’s
getting worse overtime. The complaint accompanied with anorexia since 1
weeks ago, History of fever (+) since 2 days ago, unconsciousness(-), seizure(-),
blurred vision (-), weakness of extremity (-). Because of the complaint patient
was brought to Emergency unit of Hasan Sadikin Hospital, diagnosed with
Dengue Syok Syndrome + malnutrition + brain tumor + papillary carcinoma
thyroid+ AKI Stage II and consulted to neurosurgery department.
Since 4 years ago, the patient complaint intermittent headache that’s
getting worse overtime. The complaint accompanied with lump in her head, at
first as big as marble and now as big as egg, and preceded with lump on her
neck (+) since 5 year before, at first as big as marble and now as big tennis ball.
Because of the complaint was worsening, she was brought to Neurology
Emergency Unit at Hasan Sadikin Hospital, hospitalized 3 weeks, performed
USG at Regio Coli (November 18th, 2019), FNAB (November 21th, 2019) with
histopathologic result Papillary carcinoma Thyroid, and underwent Contrast
Head CT Scan (November 24th, 2019), then consulted to Neurosurgery
Department, diagnosed with Skull Tumor and planned for Craniotomy Tumor
Removal but The patient was refused and the patient sent home with
improvement.
History of another lump on body (-). Weigh loss (-), tremor (+), Behavioural
change(-)
 Mrs. Curiah / ♀ / 69 yo / 1802618 / Oncology / FM
CC: Headache 3 years ago

brought to Neurology
Emergency Unit at Hasan
Sadikin Hospital,
4 year ago hospitalized 3 weeks,
5 years ago 2 weeks ago
performed USG at Regio Now
Coli (November 18th, 2019), brought to
intermittent Emergency unit of
Lump on her FNAB (November 21th, intermittent
headache that’s Hasan Sadikin
neck (+) since 2019) with headache that’s Hospital, diagnosed
getting worse
5 year before, histopathological result getting worse with Dengue Syok
overtime. The
at first as big Papillary carcinoma overtime. The Syndrome +
complaint malnutrition + brain
as marble and Thyroid, and underwent complaint
accompanied tumor + papillary
now as big Contrast Head CT Scan accompanied with carcinoma thyroid+
with lump in her
tennis ball. (November 24th, 2019), anorexia since 1 AKI Stage II and
head, at first as consulted to
then consulted to weeks ago, History of
big as marble neurosurgery
Neurosurgery Department, fever (+) since 2 days
and now as big department.
diagnosed with Skull Tumor ago
as egg
and planned for
Craniotomy Tumor
Removal but The patient
was refused and the
patient sent home with
improvement.

History of another lump on body (-). Weigh loss (-), tremor (+), Behavioural
change(-)
 Physical Examination
November 26th, 2019
General state :
BP: 120/100 mmHg HR: 80 x/m RR : 12 x/mnt T : 36,5 oC

Local State :
At Right Frontoparietal : Solid Mass (+), fixated, immobile, with size 5x3cm
At Coli : Multiple Solid Mass (+), fixated, mobile, with size 4x3x2cm

Neurological States :
GCS 15, nuchal rigidity (-)
Pupil : RLO round, equal, 3mm/3mm, LR +/+
Visus : RLO > 6/60
Funduscopy: RLO : Papil defined border
Eye ball movement : RLO : Good to all direction
Other cranial nerve : Within normal limit
Motoric: No paresis
Sensoric : Within normal limit
Physiologic Reflex : +/+
Pathologic Reflex : -/-
Contrast Head CT Scan at Hasan Sadikin Hospital, Bandung
November 24 th, 2019
Contrast Head CT Scan at Hasan Sadikin Hospital, Bandung
November 24 th, 2019
Contrast Head CT Scan at Hasan Sadikin Hospital, Bandung
November 24 th, 2019
• Hyperostosis (+) at right
fronototemporoparietal and left
frontal
• Sulci and gyri are compressed
• Sylvian fissure are compressed
• Ventricles and cistern are not
compressed
• Mixed-density mass at left
temporoparietal enhanced
inhomogenously with contrast
administration
• Perifocal edema (+)
• Midline shift (-)
USG Coli at Hasan Sadikin Hospital, Bandung
November 18 th , 2019

Solid nodule inhomogenously

Histopatology at Hasan Sadikin Hospital, Bandung
November 21st , 2019

Papilary Carcinoma Thyroid

ar Coli Anterior (Bethesda
Kategori V)
 Physical Examination
January 11th, 2022
General state :
BP: 60/40 mmHg HR: 140 x/m RR : 20 x/mnt T : 38,8 oC

Local State :
At Right Frontoparietal : Solid Mass (+), fixated, immobile, with size 5x3cm
At Coli : Multiple Solid Mass (+), fixated, mobile, with size 4x3x2cm
At Extremity: CRT > 2”, Ptechiae (-)

Neurological States :
GCS 15, nuchal rigidity (-)
Pupil : RLO round, equal, 3mm/3mm, LR +/+
Visus : RLO > 6/60
Funduscopy: not examined
Eye ball movement : RLO : Good to all direction
Other cranial nerve : Within normal limit
Motoric: No paresis
Sensoric : Within normal limit
Physiologic Reflex : +/+
Pathologic Reflex : -/-
Laboratory Finding at Hasan Sadikin Hospital, Bandung
January 11th , 2022

Labs Result Labs Result

Hb 10.4 Ur/Cr 89.0/2.56
Ht 31.1 Na/K 130/3.3
L 12,400
Tr 4,000
Thorax X-Ray at Hasan Sadikin Hospital, Bandung
January 11th, 2022

Cardiomegaly
WD/ Suspect Dengue Shock Syndrome + Multiple Skull Tumor at Right
Frontotemporoparietal and Left Frontal + Supratentorial SOL at Left
Temporoparietal due to suspect Metastases Thyroid + Papillary
Carcinoma Thyroid at Coli anterior + Malnutrition + AKI Stage II +
Trombocytopenia + Hyponatremia

ICD 10: Malignant carcinoid tumor of unspecified site (C7A.010); Malignant

neoplasm of thyroid (C73); Dengue Haemorragic Fever DHF(X A91);
mild malnutrition (E44.1 ); Acute kidney failure, unspecified (N17.9);
Hypo-osmolality and hyponatremia (E87. 1); Thrombocytopenia,
unspecified (D69. 6)

Th/ NC : Closed
Observation, Improve General
Condition, and suggest to consult to
Oncology Surgery for primary tumor
Internal Medicine (Leader) : Improve General Condition

ICD 9: Craniotomy (01.24); Cranioplasty (02.0)

GCS this morning: 15 Emergency Ward
 THANK YOU

Chief on Call : dr. Mirza Aditya

Penanggung Jawab Mandiri
Chief on Site : dr. Muhamad Faisal Akbar Thamrin

Jaga 2 : dr. Muhammad Luqman Nul Hakim

Jaga 3 : dr. Samuel Wilyarto

Jaga 5 : dr. Brahma Putra

Jaga Stase : drg. Timotius (Bedah Dasar)