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All Journal MNJ (Malang Neurology Journal)
Alwahdy, Ahmad Sulaiman
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Neuroscience

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CLINICAL AND RADIOLOGIC APPROACH TO PROBABLE MIXED DEMENTIA (VASCULAR DEMENTIA AND PROGRESSIVE SUPRANUCLEAR PALSY) Lastri, Diatri Nari; Alwahdy, Ahmad Sulaiman
Malang Neurology Journal Vol 6, No 1 (2020): January
Publisher : Malang Neurology Journal

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mnj.2020.006.01.10

Abstract

Dementia as a global burden neurodegenerative disease need to be diagnosed as earlier as possible then treated accordingly. The varying aetiologies of dementia render specific diagnosis of dementia challenging. Other than clinical syndromes, cognitive function examination and neuroimaging are also important to determine the correct dementia diagnosis. This paper aims to provide a dementia case where the working diagnosis could not be decided at once and to show how cognitive function examination and neuroimaging are essential to determine the diagnosis. This paper reports an 80-year old male with dementia symptoms that was followed and regularly examined for one year. With time, additional neurological symptoms were observed thus the working diagnosis was established. The patient was diagnosed with mixed dementia that consisted of probable vascular cognitive impairment and probable progressive supranuclear palsy.
INDIRECT CEREBRAL REVASCULARIZATION ON OPTHALMIC ARTERY BY USING A DRUG-ELUTING BALLON FOR SUSPECTED MOYAMOYA DISEASE Alwahdy, Ahmad Sulaiman; Usman, Fritz Sumantri
MNJ (Malang Neurology Journal) Vol. 8 No. 1 (2022): January
Publisher : PERDOSSI (Perhimpunan Dokter Spesialis Saraf Indonesia Cabang Malang) - Indonesian Neurological Association Branch of Malang cooperated with Neurology Residency Program, Faculty of Medicine Brawijaya University, Malang, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mnj.2022.008.01.15

Abstract

Moyamoya disease (MMD) is a rare idiopathic progressive vaso-occlusive disease causing multiple occlusion of cerebral vessels lead to ischemic stroke. Asian population is the most common race to be affected. We present a male patient 33-years old with suspected MMD with right hemiparesis and neurocognitive changes. On digital substraction angiography (DSA) there was appearance of ‘puff of smoke’ on his right hemisphere, stenosis middle cerebral arteries M1 bilaterally, stenosis of right opthalmic artery (OA), stenosis of left anterior cerebral artery (ACA) and aplasia of right ACA. Ballon angioplasty was performed on right OA that supply the contralateral symptomatic stenosis area (left A1) indirectly through anterior ethmoidal artery and anterior falcine artery (OA-ACA collateral). While no guidelines for the management of MMD, cerebral revascularization by using drug-eluting ballon (DEB) in right opthalmica artery is potentially effective treatment  that could allow the brain to have good blood supply (gives good collateral to both ACA), reduces burden of the fragile moya-moya vessels to be ruptured followed by  improvement of clinical results. Patient’s selection by understanding the stage, its progressivity and collateral formation are crucial before decision is made.
Co-Authors Fritz Sumantri Usman, Fritz Sumantri Lastri, Diatri Nari