RSUD. Dr.
Soetomo Surabaya
SMF Ilmu Penyakit Saraf Jl. Mayjen Prof. Dr. Moestopo No. 6 8 Telp. ( 031 ) 5501674, 5501670, 5501672 SURABAYA
Test Date: 10/14/2011
Patient: Ali Wafa, Tn Sex: Male ID#: Patient Complaints:
DOB: 6/19/1965 Height: 165 cm Weight: 56 kg
Physician: Ref Phys: Technician:
dr. Mudjiani Basuki ,Sp.S Poli Saraf dr.Devi/dr.Aziz
KU: Nyeri punggung kanan menjalar sampai lutut dan kaki kanan, terasa panas (-), gringgingan (-), rasa tebal (-), memberat bila berjalan, namun tidak memberat dgn mengejan, nyeri pinggang kiri kadang2, tidak menjalar. RPD: DM (-), HT (-) DP: Mot : bawah 5555/5555 Sens: dbn RF: KPR/APR +1/+1 Tes profokasi iskiadikus -/EMG & NCV Findings : CMAP : N. Peroneal kanan dan kiri : prolonged distal latency, low amplitude N. Tibialis kanan dan kiri : prolonged distal latency SNAP : N. Suralis kanan dan kiri : normal response F Wave N. Tibialis posterior kanan dan kiri : prolonged F latency H Reflex M. Gastrocnemius kanan dan kiri : no response Needle EMG : M. Tibialis anterior kanan dan kiri : aktivitas spontan (-), neurogenic MUAP M. Gastrocnemius kanan dan kiri : aktivitas spontan (-), neurogenic MUAP M. Rectus femoris kanan dan kiri : aktivitas spontan (-), neurogenic MUAP Impression : Nerve root irritation pre ganglioner setinggi L4,L5,S1 bilateral tanpa tanda denervasi otot Recommendations: MRI Lumbosacral Terimakasih atas rujukannya,
__________________________ dr. Mudjiani Basuki ,Sp.S
Patient: Ali Wafa, Tn,
Test Date: 10/14/2011
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Nerve Conduction Studies
Ortho Sensory Summary Table Sit NR Onset Norm Onset e (ms) (ms) Left Sural Ortho Sensory (Lat Mall) Calf 1.7 <4 Right Sural Ortho Sensory (Lat Mall) Calf 2.4 <4 Motor Summary Table Onset Norm Onset (ms) (ms) Left Peroneal Motor (Ext Dig Brev) Ankle 5.9 <4 B Fib 12.0 Poplt 14.5 Right Peroneal Motor (Ext Dig Brev) Ankle 4.6 <4 B Fib 12.2 Poplt 14.1 Left Tibial Motor (Abd Hall Brev) Ankle 4.8 <4 Knee 14.2 Right Tibial Motor (Abd Hall Brev) Ankle 5.2 <4 Knee 14.5 Site NR O-P Amp (mV) 1.1 1.0 1.2 1.6 2.1 3.6 7.8 5.6 7.9 4.7 Norm O-P Amp >2 Site1 B Fib Poplt B Fib Poplt Knee Knee Site2 Ankle B Fib Ankle B Fib Ankle Ankle Dist (cm) 0.0 0.0 30.0 10.0 40.0 0.0 39 53 43 Vel (m/s) Norm Vel (m/s) >40 >40 >40 >40 >40 >40 O-P Amp (V) 14.5 12.2 Norm O-P Amp >10 >10 Site 1 Calf Calf Site2 Lat Mall Lat Mall Delta-P (ms) 2.6 3.6 Dist (cm) 14.0 14.0 Vel (m/s) 54 39 Norm Vel (m/s) >40 >40
>2
>2 >2
F Wave Studies
F-Lat Lat Norm (ms) (ms) Left Tibial (Mrkrs) (Abd Hallucis) 51.47 <61 Right Tibial (Mrkrs) (Abd Hallucis) 51.94 <61 NR L-R F-Lat (ms) 0.47 0.47 L-R Lat Norm <5.7 <5.7 M-Lat (ms) 5.18 5.33 FLat-MLat (ms) 46.29 46.61
H Reflex Studies
H-Lat L-R H-Lat (ms) (ms) Left Tibial (Gastroc) NR Right Tibial (Gastroc) NR NR L-R Lat Norm <2.0 <2.0
EMG
Side Left Left Left Right Right Right Muscle AntTibialis Gastroc RectFemoris RectFemoris AntTibialis Gastroc Nerve Dp Br Peron Tibial Femoral Femoral Dp Br Peron Tibial Roo t L4-5 S1-2 L2-4 L2-4 L4-5 S1-2 Ins Act Nml Nml Nml Nml Nml Nml Fibs Nml Nml Nml Nml Nml Nml Psw Nml Nml Nml Nml Nml Nml Amp Nml Nml Nml Nml Nml Nml Dur Nml Nml Nml Nml Nml Nml Pol y 0 0 0 0 0 0 Recrt Reduced Reduced Reduced Reduced Reduced Reduced Int Pat Nml Nml Nml Nml Nml Nml Comment neurogenicMUAP neurogenicMUAP neurogenicMUAP neurogenicMUAP neurogenicMUAP neurogenicMUAP
Patient: Ali Wafa, Tn,
Test Date: 10/14/2011
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Waveforms:
Patient: Ali Wafa, Tn,
Test Date: 10/14/2011
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