Highlight:ABSTRACTIntroduction: Dyke-Davidoff-Masson syndrome (DDMS) could be a rare neurological disorder characterized by cerebral hemiatrophy and an engine shortfall on the contralateral side of the body. Furthermore, facial asymmetry and seizures are common symptoms. Classic imaging findings in individuals with DDMS are ventriculomegaly, cerebral hypoplasia, paranasal sinus hyperpneumatization, and compensatory osseous broadening. The relationship between symptoms and imaging findings is used to determine DDMS. Case: A 46-year-old female patient arrived at the hospital with an inability to speak three days before admission, refused to eat or drink, and had a fever. She also had a slanted mouth and right-sided hemiparesis with a history of seizures. A firm boundary consolidation on the right pericardium was found on the chest X-ray, suggesting pulmonary TB. On a non-contrast head CT scan, thickening of the left hemicalvaria was found, accompanied by a widening of the left frontal-ethmoidal sinus, hyperpneumatization of the left mastoid air cell, and left cerebral hemiatrophy, all accompanied by left lateral ventricular dilatation. Conclusion: The proper diagnosis and early causative treatment significantly improve the outcome of the disease.

Highlight:ABSTRACTIntroduction: Glioblastoma multiforme (GBM) is a primary neoplasm of the central nervous system with a low survival rate, requiring more effective treatment to improve long-term survival. Dendritic cell (DC) therapy is expected to reduce tumor progressivity. Obective: The purpose of this meta-analysis was to analyze the administration of DC in reducing mortality in GBM patients. Methods: A systematic literature search was conducted using the PRISMA method through the Embase database, PubMed, and the Cochrane Controlled Trials Register for relevant studies between giving DC to GBM patients with conventional therapy on the number of living patients compared to controls. Article quality was assessed using the Newcastle-Ottawa Scale and statistically analyzed using RevMan 5.4. Results: Of the 14 articles, the rates of reduction in the probability of death during the first three years after initiation of therapy were 26%, 36%, and 38%, respectively [1st-y HR: 0.74 (0.57-0.95), I²: 15%, p=0.02; 2nd-y HR: 0.64 (0.51-0.81), I²: 14%, p=0.0002; 3rd-y HR: 0.62 (0.48-0.81), I²: 0%, p=0.0004]. However, there was no difference after 5 years [HR 0.81 (0.62-1.06), I²: 0%, p=0.13]. Conclusion: The DC vaccine reduces the likelihood of death in the early years of therapy but has not been proven for long-term therapy.

Highlight:ABSTRACTIntroduction: Wallenberg syndrome is a rare syndrome involving the medulla oblongata, an uncommon hemorrhage site. It is also known as lateral medullary syndrome or posterior inferior cerebellar artery syndrome. Wallenberg syndrome has several symptoms that can be divided into vestibulo-cerebellar, bulbar, autonomic, sensory, and atypical. Case: A 27-year-old man came to the emergency unit complaining of dizziness and swinging, as well as a left eyelid that did not open completely, a lack of sweat on the left side of the face, a hoarse voice, swallowing disturbances, hiccups, decreased hearing in the left ear, and a lack of sensation on the left side of the face and the right side of the body. The patient tended to fall to the left and was unsteady when standing. Physical examination revealed Horner syndrome, bidirectional nystagmus, left dysdiadochokinesia, and left ataxia. A CT scan of the head showed a left-sided medulla oblongata hemorrhage. The patient was given conservative therapy, feeding through a nasogastric tube, and medical rehabilitation. A repeat CT scan of the head was done one week later, and it was discovered that the hemorrhage in the medulla oblongata had begun to absorb. Conclusion: Wallenberg syndrome, with a manifestation of hemorrhagic stroke in the medulla oblongata, can occur at a young age with various clinical symptoms. The diagnosis of Wallenberg syndrome is made based on clinical symptoms and imaging findings. Conservative therapy using medicines and medical rehabilitation can provide a speedy recovery. An incorrect diagnosis is a major hazard to patient safety and can have serious consequences, including permanent disability or death.

Highlight:ABSTRACTIntroduction: Glioma grading is crucial to know its prognosis. Magnetic resonance imaging (MRI) is used as a preoperative examination that contains diffusion-weighted imaging (DWI) sequences confirmed by an apparent diffusion coefficient (ADC) value that helps assess tissue based on water diffusion. Objective: To prove the relationship between DWI and ADC values with cerebral glioma grading in patients at Dr. Soetomo General Academic Hospital in 2016—2020. Methods: This retrospective study collected medical records and MRI files in DICOM (Digital Imaging and Communications in Medicine) format. Gender, age, tumor histopathology, and glioma grading were collected. DWI and ADC values were obtained using the RadiAnt DICOM Viewer application. The data were analyzed using descriptive and analytical statistics. The chi-square test was used to analyze the relationship of DWI with glioma grading, and the spearman rank test was used to analyze the relationship of ADC value with glioma grading. Results: The majority of 35 patients were male (54.3%), aged 31–40 years old (22.9%), and the most common histopathology was glioblastoma (37.1%), WHO grade IV. On DWI, most low-grade glioma (LGG) patients showed unrestricted diffusion, and most high-grade glioma (HGG) patients showed restricted diffusion. The ADC value of HGG was lower than the ADC value of LGG. Statistical tests showed a relationship between DWI and glioma grading (p<0.05) and a relationship between the ADC value and glioma grading (p<0.05). Conclusion: There was a relationship between DWI and ADC with glioma grading in Dr. Soetomo General Academic Hospital patients for the period 2016—2020

Highlight:ABSTRACT Stent-assisted coiling (SAC) in wide-neck aneurysm treatment is associated with antiplatelet use. Dual antiplatelet therapy (DAPT) has been the gold standard for protecting against thrombosis events and is widely accepted for endovascular embolization treatment with a stent-assisted or flow diverter. Some patients experience vascular events due to the reduced efficacy of antiplatelet agents despite taking DAPT. The reported thrombosis rates during stent-assisted coiling embolization range from 2% to 20%. Thromboembolic complications, such as in-stent thrombosis, can manifest in 4.6% of cases. The correlation between platelet reactivity during treatment and bleeding events remains unclear. However, the association between High Residual Platelet Reactivity (HRPR) or hyporesponsiveness and ischemic events is well established. Based on various laboratory definitions, hyperresponsiveness in patients with clopidogrel occurs in about 14–30% of patients due to major and minor bleeding. Therefore, the optimization of antiplatelet therapy has developed significantly in the neurointerventional community.  

Highlight:ABSTRACT A wide-neck aneurysm, described as an aneurysm with a neck of 4 mm or a dome-to-neck ratio of <2, requires more advanced endovascular treatment than a narrow-neck aneurysm. Stent-assisted coiling (SAC) was the sole endovascular approach for wide-neck cerebral aneurysms, which were difficult to treat surgically or by embolization. More advanced endovascular approaches have since been developed in recent years, namely the flow diverter (FD) as an endovascular treatment for wide-neck cerebral aneurysms with an endoluminal reconstruction approach. Both techniques have advantages and disadvantages that must be studied further to develop a wide-neck cerebral aneurysm therapy. Therefore, based on the current literature, this article intends to review the differences in the efficacy and complications of SAC and FD for wide-neck aneurysm therapy.

Highlight:ABSTRACTIntroduction: Tetanus is a disease caused by Clostridium tetani, which produces an exotoxin. Tetanus can rapidly progress into life-threatening muscle spasms accompanied by respiratory insufficiency with or without autonomic dysfunction. Case: A 43-year-old male patient was referred from the public health center to Tora Belo Hospital with mouth stiffness and difficulty swallowing food. He also had stiffness and pain in the neck, abdomen, and lower back. Seven days prior, the patient received lacerations on his right forearm caused by a machete. The patient’s wound had been stitched up without an anti-tetanus injection at the public health center. The symptoms worsened on the second day of admission, and the patient died from respiratory failure. Conclusion: It is very important to enhance public awareness that tetanus is a preventable disease, with proper vaccination and sanitization potentially lowering mortality and morbidity.

Highlight:ABSTRACTIntroduction: Stroke is still a major cardiovascular disease in Indonesia. Locally published data regarding stroke risk factors is still rarely reported. This condition complicates the regulation, policy-making, and community empowerment efforts to reduce modifiable stroke risk factors. Thus, a study is necessary to provide an overview of stroke risk factors and risks in cities in Indonesia, such as Surabaya. Objective: This study aimed to describe stroke risk factors in an urban Indonesian community, such as the Mojo sub-district in Surabaya. Methods: This was a descriptive study to describe stroke risk factors like age, gender, history of comorbidities, and history of cardiovascular disease, as well as patient clinical data like neurological symptoms, cardiovascular symptoms, anthropometry, vital signs, simple laboratory values, and cardiovascular risk categorization in the next ten years based on the Cardiovascular Disease Risk Index chart, Indonesian version. Results: In this study, 33 participants were included. Risk factors showed that many participants had histories of active smoking (18.2%), hypertension (45.5%), and diabetes (24.2%). One-third of the participants had a history of dyslipidemia. Based on the risk chart for cardiovascular disease, 36.3% of participants were at >10% risk of developing cardiovascular disease in the next ten years. Conclusion: The risk index of cardiovascular disease in the Mojo sub-district, Surabaya, was still high. A combination of government policies, public awareness improvement, and community empowerment are urgently required to manage these risk factors epidemiologically.

Highlight:ABSTRACTIntroduction: Approximately 90 million traumatic brain injury (TBI) cases worldwide exist yearly. TBI pathophysiology varies, which may cause diverse complications. These complications may decrease the patients’ quality of life. Objective: Describing the quality of life of traumatic brain-injured patients after being treated at Dr. Soetomo General Academic Hospital Period 2018-2020. Methods: This research is a descriptive cross-sectional study using SF-36 questionnaire data from patients with post-severe brain injury at Dr. Soetomo General Academic Hospital in 2018-2020. Results: The value of the physical component (59.9) and mental component (68.6) in patients with severe brain injury at Dr. Soetomo General Academic Hospital showed a good quality of life, with values ​​in the SF-36 domains, namely physical function (58.2), physical limitations (46.7), body pain (73.6), general health (61.3), vitality (65.3), social functioning (72.5), emotional limitations (60), and mental health (76.5) is above the threshold value (50) except for physical limitations (46.7).Conclusion: Patients with severe brain injury had a good quality of life after receiving treatment in Dr. Soetomo General Academic Hospital.

Highlight:ABSTRACTIntroduction: An indirect carotid-cavernous fistula (CCF) is an abnormal connection between the internal or external carotid artery and the cavernous sinus. The optic, trochlear, abducens, and trigeminal nerves are located in the cavernous sinus. Head Computed Tomography (CT) scan, Magnetic Resonance Imaging (MRI), and Cerebral Angiography are some imaging modalities used to establish and diagnose carotid-cavernous fistula. Endovascular intervention can be performed with trans-arterial or trans-venous access. In some cases, complete embolization by endovascular treatment is not possible because of difficult angioarchitecture. Case: A 61-year-old female reported having pain in her left eye (numerical rating scale was 6). The left eye was bulging, reddish, ptosis, and unable to move. The patient felt double vision when opening both eyes, complained of intermittent stabbing headaches on the left side, and heard a bruit from the left side of the head. The cerebral angiography showed bilateral indirect CCF Barrow type D. The procedure involved partial transvenous embolization with coiling. The angiographic evaluation showed partial occlusion, and residual flow from the fistula was still visible on angiography. There was a significant clinical improvement several days after the procedure and a five-month follow-up. Conclusion: This case report showed that partial targeted transvenous embolization is quite effective in indirect CCF when complete embolization is impossible.

Highlight:ABSTRACTIntroduction: Low back pain (LBP) is musculoskeletal pain, tension, or stiffness that occurs below the costal margin and above the inferior gluteal folds, with or without sciatica. It has been found that healthcare professionals are more likely to experience LBP than other industrial workers. Many factors contribute to higher rates of LBP, including occupation, age, obesity, family history, lack of exercise, and psychosocial condition. Objective: To determine LBP’s prevalence and risk factors among healthcare professionals at John Piet Wanane General Hospital. Methods: This is a cross-sectional study that included 158 healthcare professionals. The data was collected using questionnaires and analyzed using univariate and multivariate logistic regression. Results: The overall prevalence of LBP in this study was 62.7%. Descriptive statistics showed that LBP was most common in the female group (71.7%), age group 35-50 years (52.5%), overweight group (61.6%), married group (80.8%), never or rarely exercise group (84.8%), non-smoking group (85.9%), non-drinkers group (84.8%), and moderate perceived stress group (63.6%). Multivariate logistic regression analysis showed that BMI was significantly associated with LBP. Compared with underweight participants, overweight participants were four times more likely to experience LBP (OR = 4.344, 95% CI: 1.297-14.552). Conclusion: This study demonstrates a high prevalence of LBP among healthcare professionals. High BMI, especially being overweight, increases the risk of developing LBP. Overweight and obesity among healthcare professionals may affect their credibility in providing patients with healthy nutrition and exercise advice. Healthcare professionals should maintain a healthy lifestyle to increase productivity and decrease mortality.

Highlight:ABSTRACT Coronavirus disease 2019 (COVID-19), despite being a respiratory infection, also causes neurological manifestations such as stroke due to thrombosis formation. Prior investigations have examined the correlation between COVID-19 and ischemic stroke, as well as COVID-19 and obesity. However, the mechanism of thrombosis in obese COVID-19 patients remains elusive. This review aims to examine the mechanism of thrombosis in COVID-19 patients with ischemic stroke and obesity. Chronic inflammation and impaired fibrinolysis are two major pathways responsible for thrombosis in people with obesity. Chronic inflammation activates prothrombic signaling pathways in vascular cells, resulting in procoagulant factors and adhesion molecules upregulation, anticoagulant proteins downregulation, platelet activation enhancement, and increased thrombin generation. SARS-CoV-2 enters human cells utilizing the angiotensin-converting enzyme 2 (ACE-2) receptors, which results in inflammation, which has been suggested as one of the factors contributing to thrombotic complications in COVID-19 patients. The infection also causes cytokine storm that induces atherosclerosis, plaque rupture, and superimposed thrombosis leading to brain damage. Together with endothelial injury, the cytokine storm might increase the expression of tissue factors and further promote a prothrombic state. In conclusion, the mechanisms of thrombosis in COVID-19 patients are related to direct infection of SARS-CoV-2 into the ACE-2 receptor and the cytokine storm that results in chronic inflammation and thrombosis formation. Obesity will further boost the inflammation process that leads to the formation of thrombosis and increase the risk of ischemic stroke among individuals with COVID-19 with obesity.

Highlight:ABSTRACTIntroduction: The first unprovoked seizure is defined as a series of seizures that occur within 24 hours and are followed by recovery of consciousness with unknown triggering causes such as head trauma, central nervous system infections, tumors, or hypoglycemia. The first unprovoked seizure is a thing that cannot be underestimated. According to a previous study, less than half of those who experience their first unprovoked seizure will have another. An electroencephalogram (EEG) is one of the supporting examinations for the first unprovoked seizure. Objective: This study aims to determine the EEG as the first unprovoked seizure supporting examination. Methods: This is a retrospective, descriptive, observational study with sampling from the patient's medical record at Dr. Soetomo General Hospital Surabaya from January 2017 to December 2018 based on predetermined inclusion and exclusion criteria. Results: The EEG results in children who experienced their first unprovoked seizure were more abnormal (52.9%) than normal (47.1%), with an abnormal EEG breakdown of abnormal II (17.6%) and abnormal III (35.3%). There were no patients in this study who had EEG abnormal I. All patients with EEG abnormal II (17.6%) had an intermittent slow EEG waveform, while all patients with EEG abnormal III (35.3%) had a sharp waveform. The most common location of EEG wave abnormalities was temporal (55.6%). Conclusion: In the first unprovoked seizure, an EEG examination can assist clinicians as a seizure diagnostic assistant tool. It is hoped that the results of the EEG can provide better management of the first unprovoked seizure.

Highlight:ABSTRACTIntroduction: Smoking is a habit of Indonesian society and can be found in many places. Smoking increases the risk of cardiovascular problems, which can lead to stroke. Objective: Provides an overview of stroke patients who smoke from January to December 2020. Methods: This retrospective, descriptive research used medical records and extra data from telephone interviews with patients. A non-probability purposive sampling strategy with a total sampling method is used in this investigation. The observed variables include age, gender, number of cigarettes consumed per day, length of smoking history, type of stroke, and comorbidity. Results: The sample consisted of 33 participants chosen among 579 stroke patients. The age range of 56–65 (39.4%) was found to be the most prevalent in the 33 samples, and the sex group was dominated by men (100%). Then, for the smoking habit, the highest number of cigarettes consumed per day was dominated by the group of 9-16 cigarettes per day (45.46%). The group dominates the long smoking history with a smoking history of 30-50 years (42.43%). Ischemic stroke, also known as cerebral infarction, was the most common type (78.79%) among the samples. Of the 33 samples of stroke patients who smoked, 4 (12.12%) experienced comorbidities, including coronary heart disease, diabetes mellitus, and essential thrombocytosis. Conclusion: Several factors describe the tendency of stroke patients with a smoking history.

Highlight:ABSTRACTIntroduction: Fusiform aneurysms are uncommon, accounting for 1% of all intracranial aneurysms. Dissection and atherosclerosis are the main causes of this vasculopathy, but connective tissue disease is a very uncommon cause. Ehlers-Danlos Syndrome is the most common connective tissue disease, accounting for 11% of all cases. Symptoms depend on the location and size of the aneurysm, including headaches, blurred or double vision, and focal neurological deficits. Case: A 36-year-old man suddenly experienced blurred vision in both eyes on the right, starting with a chronic left-sided headache and no history of cardiovascular disease. In the confrontation test, Humphrey gave the right homonymous hemianopia. A head CT scan showed a lobulated lesion which showed enhancement in the left suprasellar region, and cerebral digital subtraction angiography (DSA) gave the impression of a long fusiform aneurysm L PCA. Clinically, the patient’s skin on the left side of his face was darker than on the right, his skin was more elastic, and his blood vessels were wider and more prominent on the side of the fusiform aneurysm. Conclusion: Posterior circulation involvement is only 3-13% of cases of intracranial aneurysms. Many cases of intracranial aneurysms are not detected before rupture, resulting in delays in treatment. Surgical or endovascular surgery can be performed if the size is >10 mm and causes clinical symptoms. Symptoms of ischemia are managed with antiplatelets or anticoagulants. Incidentally detected unruptured aneurysms are generally managed conservatively because of the highly friable nature of the blood vessels in patients with connective tissue diseases.

Highlight:ABSTRACTIntroduction: Migraine is the second most common primary headache after tension-type headache. Stress is one of the factors that can contribute to migraine occurrence. Medical students are subjected to a high-stress level due to their educational program, which increases their risk of migraine. Objective: To measure the relationship between stress levels and migraine occurrence in medical students of Duta Wacana Christian University, batch 2020. Methods: This study used an observational analytical design with a cross-sectional method and involved 61 respondents from the medical students of Duta Wacana Christian University, batch 2020, who met the inclusion and exclusion criteria. Respondents were required to approve informed consent and complete the Perceived Stress Scale and Migraine Screen Questionnaire before conducting the research. Results: The Chi-Square for Trend statistical analysis for trends showed that stress levels were related to migraine (p < 0.05), age variables revealed no association with migraine (p > 0.05), and gender revealed that the sexes had a relationship with migraine (p < 0.05). Using Fisher's statistical technique, this study found that menstrual status has no association with migraine (p > 0.05). Conclusion: Stress levels and migraine frequency were significantly correlated, meaning that high-stress levels can trigger migraines.

Vestibular symptoms are symptoms that interfere with daily activities. Diagnosing these symptoms often relies on radiologic examinations that lead to a false negative. Proper clinical approach and study showed higher accuracy than radiologic examination on vestibular disease. These clinical approaches are based on time, triggers, and targeted analysis. The new vestibular symptoms will be classified into acute vestibular syndrome, episodic vestibular syndrome, and chronic vestibular syndrome. An acute vestibular syndrome is a vestibular symptom that lasts for days up to weeks. The episodic vestibular syndrome is vestibular symptoms that periodically appear. The chronic vestibular syndrome is a vestibular symptom that appears from months to years. Diagnosing vestibular symptoms must be precisely made. The proper termination is the best way to facilitate doctors in communicating with each other. Using this classification is a precise and easy way to detect vestibular etiology. This review is made for clinicians to determine and differentiate the etiology of the vestibular syndrome and gives information in uniforming nomenclature of vestibular symptoms.

Introduction: Tolosa-Hunt syndrome (THS) is an inflammatory disease with painful ophthalmoplegia and unilateral periorbital headache as detailed by the International Classification of Headache Disorders, 3^rd edition (ICHD-3). Azathioprine has been suggested as a second-line treatment in refractory THS when oral corticosteroid only gives a partial response. Case: Two cases of THS, 45-year-old and 41-year-old women with unilateral headache, drooping of the left upper eyelid, and diplopia. They presented with complete ophthalmoplegia and ophthalmic division of trigeminal nerve disturbance. Magnetic resonance imaging (MRI) showed thickening of the left cavernous sinus, suggesting THS, while the other was normal. Corticosteroid (prednisone 1-1,5 mg/day) was given orally for the first two weeks, and according to the Numeric Pain Rating Scale (NPRS), pain intensity was reduced from severe to moderate. As a second-line treatment, azathioprine (2 mg/kg/day) was given afterward, with a significant reduction in pain intensity and remission of ophthalmoplegia within seven days. Azathioprine was used as an immunosuppressive agent and was continued for another three months without any deterioration in neurological deficits. The levels of complement 3, 4 (C3, C4), and C-reactive protein (CRP) were normal in both patients, with a slight increase in erythrocyte sedimentation rate (ESR) and equivocal values on antinuclear antibody (ANA) results. Other differentials of THS were eliminated from history-taking, physical examination, and proper investigations. Conclusion: Azathioprine as a second-line treatment can be used instead of an oral corticosteroid for refractory cases of THS with fewer side effects. Complete remission of ophthalmoplegia and a significant reduction in pain intensity was obtained.

Introduction: Cerebral sinus venous thrombosis (CSVT) is a major cause of stroke in young patients. The incidence of CSVT ranging from 1-12 cases per 1 million adults per year. Autoimmune diseases such as Systemic Lupus Erythematosus (SLE) can cause CSVT. The incidence of CSVT involvement in SLE is 1%. It is characterized by thrombosis in the sinuses and veins, which causes various symptoms, such as headache, seizures, motor weakness, and decreased consciousness. Cases: We report a case of a 20-year-old woman with SLE who complained of seizures accompanied by weakness on both sides of the body and a history of headaches. There is an increase in D-dimer, with positive ANA and anti-ds-DNA tests. A non-contrast CT scan of the head showed a lobar venous infarct with hyperdense lesions, a head non-contrast MRI/MRV revealed a dural sinus thrombosis with a deep cortical/subcortical venous infarct, no bleeding was seen. Patients were given Fondaparinux sodium therapy for 5 days, followed by Warfarin sodium for 3-12 months with a target INR of 2.0-3.0, and control SLE by administering immunosuppressants gave better outcomes for patients. Conclusion: The diagnosis of CSVT in this patient was based on clinical suspicion and imaging confirmation, and elevation of D-dimer. Non-contrast CT of the head as an initial examination often shows normal imaging. Still, there is also an image of a hyperdense lesion that usually causes an incorrect diagnosis, resulting in delays in therapy. Anticoagulation in CSVT should still be given even if there is bleeding.

Introduction: Sleep disorder commonly happens to teenagers and adults because of light exposure during sleep that affects sleep quality, but the relation of lamp light exposure during sleep and sleep quality of medical students hasn’t been determined previously. Objective: This research aimed to determine the relation of lamp light exposure and sleep quality of Universitas Airlangga’s medical students and to give further information about the right adjustment of lamp light exposure to improve the sleep quality of medical student. Methods: Variables in this cross-sectional designed research were lamp light exposure (on or off) as the independent variable and sleep quality as a dependent variable. The research used the PSQI questionnaire to decide the sleep quality of 115 subjects once a week in a month. The collected data were analyzed by chi-square and fisher’s exact test. Results: Based on the chi-square test, the p-value for lamp light exposure and sleep quality was more than 0.05 (p = 0.863). The results also showed that 74.8% of medical students had bad quality sleep. Conclusion : In conclusion, there was no relation between lamp light exposure and sleep quality. This research also indicated that most of the subjects had a bad sleep quality so that student should increase their needs for better sleep quality to maintain performance.

Pendahuluan: Chorea merupakan gangguan gerak involunter hiperkinetik. Chorea dapat disebabkan lesi vaskular serebral iskemik atau perdarahan. Gejala klinis melibatkan satu sisi tubuh dan lesi terletak di hemisfer otak kontralateral. Gangguan gerak pasca stroke paling sering dikaitkan dengan lesi di basal ganglia (44%) dan thalamus (37%). Laporan ini bertujuan untuk menyampaikan kasus hemichorea, gangguan gerak pascastroke perdarahan yang meliputi diagnosis, terapi dan prognosis. Kasus: Seorang laki-laki 59 tahun menderita tekanan darah tinggi, dislipidemia dan mengalami stroke perdarahan dengan kelemahan tubuh di sisi kiri. 5 bulan paca stroke pasien datang ke poliklinik rawat jalan saraf dengan keluhan lengan bawah kiri bergerak seperti menghentak. Pasien mengaku gerakan mulai muncul pada jemari tangan, terasa tertarik tarik otomatis menyentak, gerakannya tidak dapat dikendalikan. Pemeriksaan fisik dalam batas normal, pemeriksaan neurologis menunjukkan hemiparese sisi kiri dan gerakan otot berlangsung cepat, tanpa ritme, melibatkan satu anggota badan yaitu lengan kiri dan tes laboratorium menunjukkan dislipidemia. Pencitraan otak menunjukkan area hipointens pada thalamus kanan. Gejala dapat terkontrol dengan pemberian obat antidopaminergik (haloperidol) dan agonis GABA (klonazepam). Kesimpulan: Gangguan gerak dapat terjadi pascastroke sehingga penting untuk mengetahui dan mempertimbangkan terapi serta prognosis untuk kualitas hidup pasien pascastroke. Pemberian haloperidol dan klonazepam pada kasus hemichorea mengurangi klinis gerakan involunter.

Pendahuluan: Trigeminal neuralgia (TN) merupakan kondisi yang digambarkan sebagai nyeri hebat seperti tersilet pada satu sisi wajah pada distribusi area saraf ke lima. Nyeri ini dapat mengganggu aktivitas sehari-hari pasien. Rasa nyeri merupakan fenomena subjektif yang dapat dipengaruhi oleh banyak faktor, seperti usia dan jenis kelamin. Tujuan: Mengetahui pengaruh usia dan jenis kelamin terhadap skala nyeri pasien Trigeminal Neuralgia. Metode: Data diambil dari rekam medik pasien pada periode Januari 2017 hingga Juni 2019 di RSUD Dr. Soetomo Surabaya, RS PHC Surabaya, dan RSUD Bangil Pasuruan berdasarkan kriteria inklusi dan eksklusi yang telah ditetapkan. Hasil: TN banyak ditemukan pada kelompok usia 36-64 tahun (55,55%) dan jenis kelamin perempuan (66,67%). Tidak didapatkan hubungan pengaruh usia dan jenis kelamin terhadap skala nyeri pasien (p > 0.05). Kesimpulan: Usia dan jenis kelamin merupakan faktor yang tidak dapat diubah dalam mempengaruhi nyeri. Usia dan jenis kelamin mempengaruhi nyeri melalui perubahan anatomi, hormonal, dan psikologis. Tidak ada hubungan antara usia dan jenis kelamin pada skala nyeri pasien dengan TN.  

Pendahuluan: Abses otak merupakan penyebab morbiditas yang signifikan pada pasien dengan penyakit jantung kongenital sianotik seperti sindrom Eisenmenger. Sindrom Eisenmenger ditandai oleh hipertensi paru ireversibel yang berat dan shunting darah dari kanan ke kiri yang merupakan predisposisi terjadinya abses otak. Tulisan ini melaporkan kasus sindrom Eisenmenger dengan komplikasi abses otak. Kasus: Seorang laki-laki 29 tahun datang dengan keluhan kelemahan pada setengah tubuh bagian kanan yang progresif dan pelo yang dirasakan sejak 8 minggu sebelum masuk rumah sakit. Tidak didapatkan keluhan demam, nyeri kepala, muntah, riwayat cedera kepala dan kejang sebelumnya. Pasien ini baru mengetahui memiliki penyakit jantung bawaan sejak usia 16 tahun dan tidak pernah mendapatkan pengobatan. Tanda vital berada dalam batas normal. Saturasi oksigen pada pasien ini antara 88-92%. Pemeriksaan fisik didapatkan hemiparese kanan, kelumpuhan saraf fasial kanan tipe sentral, disartria, murmur sistolik derajat III/VI di intercostal IV parasternal kiri dan didapatkan jari tabuh. Pemeriksaan laboratorium didapatkan peningkatan hemoglobin (Hb 17,2 g/ dL) namun tidak ada peningkatan jumlah darah putih (WBC). Kultur darah dan sensitivitas bakteri negatif. Foto thorax didapatkan gambaran dextrocardia. Echocardiografi menunjukkan gambaran defek septum ventrikel dengan hipertensi paru aliran bidirectional dominan kanan ke kiri. CT scan kepala didapatkan lesi dengan cincin yang menyerap kontras di daerah parietal kiri dengan perivokal edema. MRI kepala didapatkan lesi multipel berkapsul, bentuk oval dengan batas tegas, tepi ireguler, disertai vasogenik edema disekitarnya, tampak cincin menyerap kontras di regio parietal kiri. Pasien ini membaik signifikan secara neurologis setelah pemberian antibiotik Ceftriaxon dan Metronidazol intravena selama 8 minggu. Kesimpulan: Abses otak multipel dapat merupakan penyulit dari sindrom Eisenmenger pada pasien dewasa dengan penyakit jantung bawaan yang tidak dikoreksi.  

Pendahuluan: Sindrom Guillain-Barre (SGB) merupakan sindroma klinis yang ditandai dengan kelumpuhan tipe flaksid akut secara asenden dengan tingkat keparahan berbeda-beda dari ringan hingga berat yang sifatnya mengancam jiwa. Hingga saat ini penyebab SGB masih belum diketahui. Kasus: Pasien laki-laki usia 34 tahun dirujuk dari RS S ke RSUD Prof Dr. W. Z. Johannes dengan SGB untuk tindakan plasmafaresis. Tiga minggu sebelum masuk rumah sakit pasien mengalami diare setelahnya kesemutan di kedua kaki dan mulai susah digerakkan. Kesemutan kemudian menjalar ke kedua tangan dan lalu kedua tangan juga susah digerakkan. Pasien mengalami gagal napas sehingga membutuhkan perawatan intensif dan ventilasi mekanik. Pasien mendapatkan terapi berupa plasmaferesis ,kortikosteroid dan imunosupresan. Selama perawatan, pasien awalnya menunjukkan perbaikan, namun pada akhirnya pasien meninggal karena mengalami komplikasi (gagal nafas, henti jantung dan sepsis). Kesimpulan : Komplikasi SGB tersering adalah gagal napas, gangguan fungsi otonom yang berat dan infeksi. Prognosis pasien SGB tergantung klinis pasien serta komplikasi yang ditemukan   

Pendahuluan: Spastisitas adalah gangguan motorik yang sering dijumpai dan muncul setelah stroke. Spastisitas dapat menyebabkan nyeri dan disabililitas pada bagian tubuh yang mengalaminya. Tujuan: mencari hubungan antara rasio H/M yang diukur dengan elektromiografi dengan derajad spastisitas yang terjadi setelah fase akut stroke. Metode: Penelitian ini adalah studi analisis korelatif observasional, dengan 26 sampel. Pasien diukur rasio H/M pada saat stroke akut dan diukur derajad spastisitasnya dengan menggunakan Modified Ashworth Scale setelah 3 bulan. Hasil yang didapatkan dilakukan analisa statistik dengan menggunakan tes korelatif kategorik dari Spearman. Hasil: Pasien yang mengikuti penelitian ini sebanyak 26 orang. Terdapat perbedaaan antara nilai H/M rasio antara sisi parese dengan sisi sehat dan tidak didapatkan hubungan yang bermakna antara nilai rasio H/M yang diukur saat fase akut stroke dengan derajad spastisitas yang diukur dengan Modified Ashworth Scale (MAS) setelah 3 bulan (p = 0,06 ; r = 0, 37). Kesimpulan: Rasio H/M pada pasien stroke akut meningkat pada sisi parese dibanding pada sisi sehat, namun peningkatan ini tidak memiliki hubungan yang signifikan dengan derajad spastisitas pasca stroke yang diukur dengan MAS, sehingga rasio H/M tidak dapat digunakan sebagai prediktor munculnya spastisitas pasca stroke

Penyakit Parkinson (PP) adalah penyakit neurodegeneratif paling umum ke dua yang melibatkan hilangnya neuron dopaminergik di otak tengah yang menyebabkan gejala motorik dan nonmotorik pada pasien yang mengalaminya. Gejala motorik ini dapat dikelola dan dikendalikan dalam jangka waktu tertentu dengan menggunakan obat-obatan seperti levodopa. PP mempengaruhi jutaan orang di seluruh dunia, oleh karena itu tinjauan pustaka tinjauan pustaka tentang PP menjadi penting dan kami akan menyampaikan berbagai hal penting dari PP mulai dari patofisiologi hingga tindakan pengobatan baik medikamentosa maupun tindakan intervensi.

Pendahuluan: Proloterapi juga dikenal sebagai terapi injeksi regeneratif atau skleroterapi adalah terapi yang menggunakan zat kimia atau biologi untuk kondisi nyeri muskuloskeletal kronis, termasuk osteoartritis lutut. Osteoartritis(OA) lutut adalah bentuk paling umum dari osteoarthritis kronis di seluruh dunia serta merupakan penyebab utama nyeri dan kecacatan dalam beberapa tahun terakhir, hasilbeberapa uji klinis yang dipublikasikan telah menunjukkan efek positif proloterapi pada osteoartritis lutut. Kasus: Wanita,51 tahun dengan nyeri lutut kanan sejak 1 tahun lalu, semakin memberat dalam 3 bulan. Numeric Rating Scale (NRS) adalah 7. Didapatkan tenderness, krepitasi, dan range of movement (ROM) normal tanpa adanya deformitaslutut kanan. Dari pemeriksaan radiologis didapatkan osteoarthritis femorotibial joint grade 1 dan osteoarthritis femoropatellar joint kanan. Injeksi dekstrosa hipertonik 25% dilakukan setiap 2 minggu. Sebelumnya pasien mendapat injeksi steroid intraartikuler (triamsinolon) namun nyeri kembali muncul setelah tiga minggu. Nilai Numeric Rating Scale (NRS) menurun menjadi 4 setelah dilakukan injeksi dekstrosa hipertonik yang keempat. Kesimpulan: Injeksi dekstrosa hipertonik (proloterapi) dapat dijadikan sebagai modalitas terapi alternatif yang menghasilkan perubahan klinis pada osteoarthritis lutut dengan resiko minimal, biaya terjangkau dan penggunaan yang mudah. 

Pendahuluan: Tuberkuloma serebral merupakan suatu bentuk tuberkulosis (TB) yang jarang dan serius karena penyebaran hematogen Mycobacterium tuberkulosis (MT). Tuberkuloma serebral ditemukan paling sedikit dibandingkan tuberkulosis intrakranial lainnya, yaitu sekitar 1%. Tuberkuloma serebral yang multipel hanya 15–33% kasus. Obat anti TB penting untuk keberhasilan pengobatan tuberkuloma serebral tapi belum ada kesepakatan mengenai durasi terapi. Kasus: Kasus 1: Laki- laki usia 33 tahun dengan keluhan penurunan kesadaran, kejang, sakit kepala, kelemahan tubuh sisi kanan. Gambaran MRI kepala dan biopsi menunjukan tuberkuloma. Penderita mendapat obat anti tuberkulosis rifampisin, INH, pirazinamid, dan injeksi streptomisin. Setelah pengobatan selama 13 bulan, penderita mengalami perbaikan secara klinis maupun radiologis. Kasus 2: Laki-laki usia 33 tahun dengan keluhan nyeri kepala kronik, demam tidak tinggi, muntah, dan dismetria kanan. Penderita juga diketahui menderita TB paru yang sedang dalam pengobatan selama 1 minggu. MRI kepala dengan kontras menyokong gambaran tuberkuloma serebral dan Gene Xpert MTB positif. Penderita mendapat pengobatan anti tuberkulosis berupa rifampisin, INH, pirazinamid, etambutol, dan injeksi streptomisin. Keluhan penderita membaik dimana tidak ada nyeri kepala dan dismetria setelah pengobatan selama 1 bulan. Kesimpulan: Tuberkuloma serebral dapat diterapi dengan obat antituberkulosis (OAT), minimal 9 bulan pengobatan. Pada beberapa kasus, masa pengobatan dapat ditambah sesuai dengan kondisi klinis dan radiologis penderita. Sedangkan pada kasus yang berat, tindakan eksisi tuberkuloma mungkin diperlukan.

Neuropati perifer merupakan salah satu alasan paling sering pasien dirujuk ke klinik neurologi. Neuropati diabetik, salah satu neuropati perifer, merupakan penyebab neuropati tersering di dunia sehingga masih merupakan masalah besar dunia. Nyeri neuropati diabetik (NND) merupakan komplikasi umum dari diabetes baik diabetes tipe 1 maupun tipe 2. NND mempengaruhi kualitas hidup pasien secara substansial akibat dari kurang tidur, kelelahan konstan, kesulitan mempertahankan konsentrasi secara penuh, gangguan melakukan aktivitas harian, gangguan mood, depresi dan ansietas. Karbamazepin merupakan salah satu terapi nyeri neuropati. Artikel ini menjelaskan efikasi dan tolerabilitas karbamazepin untuk nyeri neuropati diabetik.

Pendahuluan: Demensia merupakan proses hilangnya fungsi kognitif seperti berpikir, mengingat, dan bernalar sehingga penderita demensia terganggu dalam melakukan kehidupan dan aktivitas sehari-hari pada seseorang. WHO menyebutkan bahwa jumlah pasien demensia di dunia terus meningkat. Pada tahun 2015, pasien demensia diprediksi mencapai 47,47 juta pasien dan dapat mencapai 75,63 juta pada 2030. Semakin meningkat usia lansia, faktor komorbiditas yang menyerang lansia juga semakin meningkat. Faktor komorbiditas dapat berupa penyakit kronik seperti stroke, hipertensi, DM, juga penyakit jantung. Tujuan: Untuk mengetahui prevalensi komorbiditas pada pasien lansia demensia di RSUD Dr. Soetomo Surabaya. Metode: Data diambil dari rekam medis pasien pada periode Januari hingga Desember 2017 di RSUD Dr. Soetomo Surabaya berdasarkan kriteria inklusi dan eksklusi yang telah ditetapkan. Hasil: Faktor komorbiditas yang paling banyak terjadi pada pasien demensia adalah stroke (57,3%), diikuti oleh hipertensi (50,6%), DM (30,3%), penyakit Parkinson (24,7%), dan penyakit Jantung (19,1%). Kesimpulan: Stroke merupakan komorbiditas paling banyak terjadi pada pasien dengan demensia. Hipertensi berada di tempat kedua paling banyak diderita lansia demensia. Pengendalian komorbiditas pada lansia sangat penting untuk dilaksanakan untuk mengendalikan risiko terjadinya penurunan fungsi kognitif.

Pendahuluan: High mobility group box 1 (HMGB1), akhir-akhir ini diketahui sebagai salah satu mediator yang memicu proses inflamasi setelah terjadi iskemia di otak. Saat ini telah dikenal beberapa reseptor HMGB1 yang memerantarai proses inflamasi diotak yaitu RAGE, TLR2 dan TLR4. Ikatan HMGB1 dengan reseptornya akan menyebabkan kerusakan neuron otak yang memberikan konstribusi perburukan defisit neurologi klinis. Beberapa studi menunjukkan bahwa kadar HMGB1 meningkat secara signifikan pada pasien stroke dibandingkan kelompok kontrol. Studi lain menunjukkan bahwa kadar HMGB1 yang tinggi setelah iskemia otak akan memperluas area infark. Tujuan: untuk mengetahui adanya korelasi antara kadar HMBG1 dalam serum dengan derajat fungsional neurologik yang diukur dengan NIHSS pada pasien stroke trombotik akut. Metode: Telah diukur kadar HMGB1 pada 43 pasien stroke trombotik akut yang di rawat di ruang saraf RSUD Dr. Soetomo Surabaya periode September 2012 sampai Januari 2013 diukur kadar HMGB1 dengan metode ELISA - Sandwich menggunakan Indirect Capture Re Capture dan diukur derajat fungsional neurologik dengan NIHSS. Hasil: Rerata usia subyek penelitian ini 60.40 ± 9.346 tahun. Subyek penelitian terdiri dari 24 wanita dan 19 pria. Rerata kadar HMGB1 serum adalah 62.57± 54.164 ng/ml. Rerata nilai NIHSS adalah 6.47 ± 3.261. Terdapat korelasi positif dengan kekuatan lemah antara kadar HMGB1 serum dengan nilai NIHSS pada pasien stroke trombotik akut yang bermakna secara statistik (r = 0.353 dan p = 0.02) Kesimpulan: Terdapat korelasi positif antara kadar HMGB1 dalam serum dengan derajat fungsional neurologik yang diukur

Pendahuluan: Mioklonus didefinisikan sebagai gerakan involunter yang mendadak dan singkat akibat kontraksi otot aktif atau hambatan aktivitas otot. Letak kelainan bisa berasal dari kortikal, subkortikal, atau spinal. Prevalensi mioklonus berdasarkan penelitian di Olmsted County, Minnesota, Amerika Serikat sejumlah 8,6 kasus dalam 100.000 populasi. Di Indonesia masih sedikit laporan mengenai kasus mioklonus terutama pada wanita hamil dan pasca persalinan. Perlu dilakukan pemeriksaan klinis dan pemeriksaan penunjang yang tepat untuk mengetahui klasifikasi dan etiologi mioklonus. Hal tersebut akan menentukan pemilihan terapi simptomatis dan terapi penyebab yang tepat. Perlu pengkajian lebih dalam mengenai standar diagnosis dan terapi khususnya pada pasien mioklonus dengan kehamilan dan pasca persalinan. Kasus: Dilaporkan dua kasus mioklonus pada otot abdomen pada pasien wanita dengan investigasi dan penatalaksanaan yang berbeda. Kasus pertama, wanita usia 25 tahun dengan usia kehamilan 20 minggu didiagnosis mioklonus pada abdomen tanpa pemberian terapi medikamentosa. Pada kasus kedua, wanita usia 24 tahun dengan 8 hari pasca persalinan didiagnosis mioklonus pada abdomen dengan pemberian terapi medikamentosa, yaitu fenitoin, triheksifenidil, dan diazepam. Kesimpulan: Pasien wanita usia 25 tahun, usia kehamilan 20 minggu dengan mioklonus pada abdomen mengalami perbaikan klinis setelah 3 bulan dengan tanpa pemberian terapi medikamentosa, sedangkan kasus lainnya, wanita usia 24 tahun, 8 hari pasca persalinan dengan mioklonus pada abdomen mengalami perbaikan klinis setelah 2 hari dengan pemberian terapi medikamentosa.

Pendahuluan: Meningioma merupakan tumor otak primer yang berasal dari jaringan arakhnoid. Angka kejadian meningioma di Indonesia menunjukkan peningkatan dari tahun ke tahun. Selain mutasi gen supresor tumor, meningioma dapat dipengaruhi oleh faktor eksternal diantaranya usia dan jenis kelamin. Tujuan: Mengetahui hubungan antara usia dan jenis kelamin dengan angka kejadian meningioma pada pasien di RSUD Dr. Soetomo, Surabaya, Indonesia tahun 2018 berdasarkan derajat keganasannya. Metode: Penelitian ini merupakan studi observasional analitik cross-sectional retrospektif dari data sekunder lembar hasil pemeriksaan patologi anatomi pasien yang dirawat inap melalui SMF. Ilmu Bedah Saraf, RSUD Dr. Soetomo tahun 2018; data yang tidak lengkap akan dieksklusi. Analisis data dilakukan menggunakan uji Chi squre (SPSS 25) dengan tingkat signifikansi p <0,05. Hasil: Didapatkan 45 pasien meningioma yang sesuai dengan kriteria inklusi, dengan mayoritas perempuan (71%) pada kelompok usia 45 – 49 tahun (22,2%), WHO grade I (82%) dengan tipe histopatologi transisional (49%). Terdapat hubungan yang signifikan antara angka kejadian meningioma dengan kelompok usia tertentu (r = 0,718, p = 0,025), dan dengan jenis kelamin (r = 0,441, p = 0,002). Rasio perempuan dibanding laki- laki sebesar 1:2,36. Kesimpulan: Usia dan jenis kelamin berkorelasi erat dengan angka kejadianmeningioma.

Pendahuluan: Neuropati diabetik perifer merupakan salah satu komplikasi mikroangiopati pada penderita diabetes mellitus. Manifestasi neuropati diabetik perifer paling banyak adalah polineuropati simetris distal, yang menunjukkan gangguan sensorik, motorik, serta penurunan refleks tendon dengan pola length-dependent. Diabetes Mellitus tipe 1 terbanyak diderita pada penderita usia muda, dimana saraf tepi memiliki amplitudo yang relatif masih tinggi, sehingga penurunan amplitudo yang relatif kecil, masih dianggap normal. Perbandingan amplitudo saraf sural dan radial dapat mendeteksi adanya neuropati subklinis. Penderita diabetes mellitus tipe 1 dengan kadar glukosa darah yang tidak teregulasi dengan baik mempunyai risiko 25.6% terkena neuropati diabetik perifer. Tujuan: untuk mengetahui hubungan antara kadar HbA1C dengan kejadian neuropati diabetik perifer pada penderita Diabetes Mellitus tipe 1. Metode: Penelitian ini merupakan penelitian observasional analitik dengan rancangan cross sectional dengan teknik pengambilan subjek penelitian menggunakan consecutive sampling admission yang memenuhi kriteria inklusi dan eksklusi. Subjek penelitian dilakukan pengukuran terhadap kadar HbA1C, amplitudo saraf sural dan radial dan dihitung perbandingan diantara keduanya. Hasil: Pada 38 subjek penelitian didapatkan 31 subjek penelitian dengan Sural Radial Amplitude Ratio (SRAR) rendah dan 7 subjek penelitian dengan nilai SRAR normal. Hasil analisis penelitian didapatkan bahwa pada subjek dengan nilai SRAR rendah lebih besar pada kelompok HbA1C tinggi yaitu 26 subjek (83.87%) dibandingkan dengan kelompok HbA1C normal yaitu 5 subjek (16.13%). Perbedaan tersebut bermakna secara statistik dengan p= 0.021, rasio odd 6.933 (IK 95% 1.173-40.981). Kesimpulan: Terdapat hubungan negatif antara kadar HbA1C dengan kejadian neuropati diabetik perifer pada penderita Diabetes Mellitus Tipe 1.

Pendahuluan: Tension Type Headache (TTH) dapat dipengaruhi banyak faktor, beberapa di antaranya adalah stres dan kadar hormon kortisol. Beberapa penelitian telah menganalisa hubungan nyeri kepala terhadap kortisol, dan stres. Namun, jarang ada penelitian yang menghubungkan ketiganya. Tujuan: Membuktikan adanya hubungan antara intensitas nyeri kepala, stres psikologis dan kadar kortisol serum pada penderita TTH. Metode: Jenis penelitian adalah analitik observasional dengan rancangan cross sectional dengan uji korelasi. Hasil: Pada penelitian ini didapatkan 42 subyek penelitian. Dari pengolahan data, didapatkan p= 0,594. Yang berarti tidak ada korelasi signifikan antara intensitas nyeri kepala dengan stres psikologis. Sementara itu, pada intentistas nyeri kepala dengan kadar kortisol didapatkan korelasi signifikan dengan p= 0,04. Pada stres dan kadar kortisol tidak ditemukan korelasi signifikan dengan p= 0,154. Kesimpulan: Ada hubungan yang signifikan antara intensitas nyeri kepala dengan kadar kortisol serum. Sebaliknya, pada intensitas nyeri kepala dengan stres psikologis dan stres psikologis dengan kadar kortisol serum, tidak memiliki hubungan yang signifikan.

Pendahuluan: Multiple sistem atrophy adalah penyakit degeneratif yang dapat menyebabkan kecacatan bahkan kematian. Sedikit jurnal yang yang membahas tentang diagnosis dan penanganan multiple system atrophy secara menyeluruh. Kasus: Seorang laki-laki berusia 44 tahun datang ke poli saraf dengan keluhan kelemahan pada keempat ekstremitas dengan disertai gejala parkinsonisme yang khas. Pada pemeriksaan neurologis didapatkan gangguan fungsi serebelum. Pada pemeriksaan MRI kepala dengan kontras didapatkan gambaran khas suatu multipel system atrophy tipe cerebellar. Kesimpulan: Multipel system atrophy adalah kasus degeneratif yang bersifat jarang namun seringkali dapat menyebabkan kematian. Dibutuhkan diagnosis yang cepat dan penanganan yang memadai secara multidisiplin untuk mencegah beratnya gejala multiple system atrophy. Terapi simptomatik dan suportif sangat dibutuhkan untuk meningatkan kualitas hidup pasien.

Acute ischemic stroke (AIS) is a life-threatening complication of COVID-19. This study aims to compare anticoagulant or antiplatelet administration on mortality cases in patients with COVID-19 and AIS. To know the mortality rate in COVID-19 patients with AIS after anticoagulants or antiplatelets therapies. We searched PubMed, ScienceDirect, and Google Scholar for a retrospective cohort study of anticoagulant or antiplatelet effects on mortality cases in COVID-19 and AIS patients. The retrospective cohort was screened using our eligibility criteria, and quality was assessed using the Newcastle Ottawa Scale. Heterogeneity was assessed using the I² test, and publication bias was evaluated using a funnel plot. All analyses were performed using Review Manager 5.4. Seven retrospective cohort studies involving 58 patients (38 of whom received anticoagulant therapy) met the inclusion criteria. Our combined analysis showed that anticoagulation versus antiplatelet therapy in COVID-19 patients with AIS on the forest plot chart did not significantly affect mortality (OR: 0.9 95% CI 0.42-1.91 I²=0 %). The study showed no significant difference in the incidence of death between anticoagulants or antiplatelet agents to COVID-19 patients with AIS.

Introduction: Dementia screening provides numerous benefits to its users. However, current screening methods have several limitations regarding applicability and accuracy, making it difficult to accommodate the results. Objective: To describe whether the Abbreviated Mental Test (AMT) and Ascertain Dementia 8 Indonesia (AD8-INA) questionnaire is superior to Mini-Mental State Examination (MMSE) questionnaire as a dementia screening instrument for the elderly in rural areas. Methods: A cross-sectional study was conducted in February 2020 at Banyuwangi residence. Dementia screening was conducted among elderly respondents using MMSE, AMT, and AD8-INA questionnaires. Sensitivity and specificity of AMT, AD8-INA and combined AMT+AD8-INA were compared with the MMSE questionnaire using crosstabs. Comparison of time required to complete each questionnaire was analyzed using Wilcoxon Signed Rank Test. Results: Mean age among 59 respondents was 68.44 years. The average MMSE score was 24.54. Compared with MMSE, the AMT questionnaire had a sensitivity of 47.37% and specificity of 100% (X² = 22.36, p <0.001). Meanwhile, the AD8-INA questionnaire had a sensitivity of 63.16% and specificity of 45% (X² = 24.64, p <0.001). The average questionnaire completion time of AMT, AD8-INA, and combined AMT+AD8-INA each was significantly shorter than MMSE (122.59, 121.17, and 243.76 seconds vs 319.83 seconds, p<0.001, <0.001, and <0.001, respectively). Conclusion: This study found that the combined AMT+AD8-INA questionnaire could be used as a dementia screening instrument among the elderly in rural areas with considerable sensitivity and shorter administration time.

Introduction: Stroke is one of the leading causes of death and disability worldwide, and especially in Indonesia. Several studies showed the pleiotropic and neuroprotective effect of simvastatin in addition to lowering blood cholesterol levels. Objective: This trial was conducted to investigate if the administration of simvastatin in acute ischemic stroke management can improve functional outcomes. Methods: This randomized, double-blind, placebo-controlled trial of simvastatin was conducted in patients with acute ischemic stroke with an NIHSS score of 4-14. Participants were randomly assigned to receive 40 mg of simvastatin or placebo for seven days. The NIHSS scale was compared on admission day, 4th and 8th day after administration of simvastatin between the two groups. Results: 52 individuals were randomized: 28 to simvastatin and 24 to placebo. There was no significant improvement of functional outcome between the two groups (p > 0.05). Conclusion: Administration of simvastatin had no significant effect on outcome (measured by NIHSS) in patients with acute ischemic stroke.  

Introduction: As COVID-19 has rapidly spread worldwide, it is an urgent health problem. Some evidence suggests that SARS-CoV-2 also affects the central nervous system. Stroke is the most common disease of the central nervous system. In contrast to ischemic stroke, which can occur due to the hypercoagulation effect of COVID-19, the study of Intracerebral Hemorrhage (ICH) associated with COVID-19 is still unclear. Objective: This paper investigated the characteristics of an inflammatory biomarker and compared the outcomes of ICH patients with COVID-19 and ICH patients without COVID-19. Methods: We conducted a retrospective, observational analysis case-control of patients (n = 42) admitted with ICH with positive COVID-19 and ICH with negative COVID-19 at the National Brain Center Hospital Prof.Dr.dr. Mahar Mardjono from March 2020 to August 2021. We took blood samples and COVID-19 swab PCR on the first day of admission, and GOS was measured when the patients were discharged. Results: There were 21 ICH patients with positive COVID-19 who had a significantly procalcitonin (p < 0.05) compared to control patients. From Spearman’s correlational analysis, there is a significant value between early procalcitonin and the Barthel Index (r_s = -0,374, p < 0.05), early CRP and GOS (r_s =- 0.329, p < 0.05), which indicates weak-inverse correlation, and between early PCT and GOS (r_s = -0.438, p < 0.05) which indicates moderate-inverse correlation. Conclusion: The level of procalcitonin was increased in ICH patients with COVID-19. Maybe PCT could be a predictor of outcome in ICH patients with COVID-19.

Pendahuluan: Penyandang epilepsi sering mengalami cedera pada saat serangan. Tipe bangkitan tonik dan kontraksi kuat dari anggota gerak pada saat serangan seringkali menyebabkan cedera otot pada sendi dan tulang, sehingga menyebabkan dislokasi dan fraktur. Kontraksi hebat pada sekelompok otot dapat menyebabkan dislokasi dan instabilitas sendi bahu. Kejadian dislokasi sendi bahu bilateral patognomonis disebabkan oleh karena kejang. Akan tetapi pada umunya bentuk dislokasi pascakejang berupa dislokasi bahu posterior bilateral. Laporan kasus berikut akan menyampaikan kejadian dislokasi sendi bahu anterior bilateral berulang pada penyandang nocturnal epilepsy. Kasus ini jarang terjadi dan diharapkan meningkatkan kewaspadaan klinisi dalam merawat penyandang epilepsi. Kasus: Laki-laki 22 tahun dikonsulkan oleh spesialis bedah orthopedi dengan diagnosis dislokasi sendi bahu anterior berulang. Pasien sudah mengalami dislokasi sebanyak empat kali dalam satu tahun terakhir. Dislokasi bahu selalu terjadi setelah serangan kejang di malam hari ketika pasien tidur. Pasien rutin mengkonsumsi obat phenytoin dengan frekuensi serangan 3 – 4 bulan sekali setiap tidur malam. Pasien menginginkan kejadian ini tidak terulang lagi. Penggantian obat antiepilepsi yang tepat dan memiliki efek samping minimal pada tulang membantu mencegah terjadinya komplikasi dislokasi seperti ini. Kesimpulan: Dislokasi sendi bahu anterior bilateral berulang merupakan bentuk cedera pascabangkitan yang jarang terjadi. Pemilihan jenis antikejang yang tepat, upaya kontrol kejang yang baik dan penatalaksanaan multidisiplin dapat membantu mencegah terjadinya komplikasi berulang pada kasus serupa.

Pendahuluan: Nyeri kepala hemikrania dengan presentasi menyerupai nyeri kepala primer namun tidak membaik dengan medikamentosa (intractable headache), perlu dicurigai suatu nyeri kepala sekunder. Etiologi nyeri kepala sekunder, ditegakan dengan melakukan pemeriksaan penunjang diagnostik lebih lanjut. Adanya kelainan yang ditemukan, akan menuntun pada terapi definitif. Kami melaporkan seorang pasien dengan intractable headache dan ditemukan etiologi berupa fistula karotis kavernosus indirek dan membaik dengan tindakan embolisasi. Kasus: Laki-laki 29 tahun dengan nyeri kepala selama 2 bulan terakhir dan tidak membaik dengan medikamentosa. Nyeri kepala berdenyut pada sisi kiri menyerupai nyeri kepala primer dan makin lama makin memberat. Skala NRS 9-10. Keluhan disusul dengan pandangan mata dobel dan ptosis mata kiri. Dari MRI kepala sekuen TOF didapatkan gambaran hiperintensitas area sinus kavernosus. Dilakukan konfirmasi dengan serebral DSA didapatkan fistula indirek dari cabang arteri karotis eksterna dan intra bilateral menuju ke sinus kavernosus. Dilakukan embolisasi pada cabang arteri karotis eksterna kiri. Post embolisasi nyeri kepala menghilang tanpa obat-obatan. Kesimpulan: Adanya anomali vaskuler, pada kasus ini fistula karotis kavernosus, perlu dipertimbangkan pada kasus nyeri kepala intraktabel. Tindakan embolisasi merupakan terapi kuratif yang dapat menghilangkan keluhan nyeri kepala