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All Journal Jurnal Ilmu Kedokteran (Journal of Medical Science) Majalah Kedokteran Bandung Bioscientia Medicina : Journal of Biomedicine and Translational Research International Archives of Medical Sciences and Public Health Journal of International Surgery and Clinical Medicine Journal of Medicine and Health
Valentino, Andrea
KJFD/KSM Bedah Divisi Bedah Saraf Fakultas Kedokteran Universitas Riau / RSUD Arifin Achmad Provinsi Riau, Indonesia
Religion Biochemistry, Genetics & Molecular Biology Dentistry Environmental Science Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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Hyponatremia After Intracranial Hemorrhage: Cerebral Salt Wasting Syndrome (CSWS) or The Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)? Wan Novriza Wijaya; Novita Anggraeni; Sony; Andrea Valentino
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 1 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i1.1174

Abstract

Background: Hyponatremia is a common electrolyte disorder encountered in neurosurgical patients, often associated with significant morbidity and mortality. This case report highlights the importance of recognizing and appropriately managing cerebral salt wasting syndrome (CSWS), a rare but important cause of hyponatremia in neurosurgical patients, often following intracranial hemorrhage (ICH). Distinguishing CSWS from the syndrome of inappropriate antidiuretic hormone secretion (SIADH) is crucial for appropriate management. Case presentation: A 56-year-old male with a history of hypertension and diabetes mellitus presented with sudden-onset left-sided weakness and decreased consciousness following an ICH. He underwent a ventriculoperitoneal (VP) shunt placement for hydrocephalus. Post-operatively, he developed hyponatremia with elevated urine sodium levels and hypovolemia, suggestive of CSWS. The patient was treated with fluid replacement therapy, including hypertonic saline, and desmopressin, resulting in improvement in his hyponatremia. Conclusion: CSWS is an important cause of hyponatremia in neurosurgical patients. Prompt diagnosis and appropriate management, including fluid replacement and potentially desmopressin, can improve patient outcomes. This case underscores the need for a high index of suspicion for CSWS in neurosurgical patients presenting with hyponatremia and highlights the importance of careful monitoring and individualized treatment strategies.
Effects of Propofol and Thiopental on Brain Relaxation and Hemodynamic Response to Craniotomy Supratentorial Tumors Removal Valentino, Andrea; Wijaya, Wan Novriza; Anggraeni, Novita; Sony, Sony
Majalah Kedokteran Bandung Vol 57, No 4 (2025)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15395/mkb.v57.4283

Abstract

Surgical procedures for brain tumors, particularly supratentorial tumor removal via craniotomy, present challenges related to brain relaxation and maintaining hemodynamic stability. The choice of intravenous anesthetics, such as Propofol and Thiopental, is crucial due to their distinct effects on intracranial pressure (ICP), cerebral blood flow (CBF), and hemodynamic parameters. This study aimed to compare the effects of Propofol and Thiopental on brain relaxation and hemodynamic responses during supratentorial tumor removal. A randomized experimental study was conducted at Arifin Achmad General Hospital, Riau, Indonesia, from May to September 2024 involving patients undergoing elective craniotomy for supratentorial tumors. Patients were divided into two groups: the Propofol group (1-3 mg/kg body weight, with maintenance of 50-100 µg/kg/min) and the Thiopental group (4-6 mg/kg body weight, with maintenance of 100-200 µg/kg/min), both receiving continuous infusion until a bispectral index of 40-60 was achieved. Hemodynamic parameters, including systolic blood pressure, diastolic blood pressure, mean arterial pressure (MAP), and heart rate, were measured at various stages: before induction, during surgery, and at multiple intervals. Brain relaxation was subjectively assessed by a neurosurgeon using a four-point scale. Results showed that 90% of subjects receiving Thiopental experienced good brain relaxation during duramater opening, compared to 70% in the Propofol group, though this difference was not statistically significant (p=0.118). Hemodynamically, the Thiopental group exhibited higher diastolic blood pressure and MAP at induction (p<0.05). In conclusion, Thiopental demonstrated superior hemodynamic stability, albeit both agents provided equally effective brain relaxation.
SURGICAL MANAGEMENT OF SUPRASELLAR GERMINOMA: INSIGHTS FROM A CRANIOTOMY CASE Halim, Monica; Valentino, Andrea; Agustiawan, Agustiawan
International Archives of Medical Sciences and Public Health Vol. 7 No. 1 (2026): International Archives of Medical Sciences and Public Health
Publisher : Pena Cendekia Insani

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53806/iamsph.v7i1.1415

Abstract

Intracranial germinoma is a rare midline CNS tumor, most commonly arising in the suprasellar or pineal regions. Suprasellar lesions frequently cause hypothalamic–pituitary dysfunction, resulting in diabetes insipidus, endocrine abnormalities, and visual impairment. We report a 21-year-old man with a two-year history of progressive visual blurring and polyuria polydipsia that culminated in acute loss of consciousness. Imaging revealed a suprasellar mass, and clinical deterioration required intensive care admission. Craniotomy was performed for tumor decompression and histopathological diagnosis, confirming germinoma. Postoperative radiotherapy led to recovery of consciousness after the third session and marked tumor regression to approximately 1 cm, demonstrating the tumor’s high radiosensitivity. Despite favorable oncologic response, residual deficits persisted, including left-sided visual blurring, complete right-eye blindness, severe hypocortisolemia, and low prolactin levels requiring hormone replacement therapy. This case emphasizes the importance of early diagnosis, individualized treatment, and multidisciplinary management to achieve tumor control while addressing long term neurological and endocrine sequelae. Survivorship-focused care integrating endocrinology, rehabilitation, psychosocial support, and adherence monitoring is essential, particularly in resource-limited settings, to improve treatment continuity, reduce complications, and enhance quality of life among young brain tumor survivors.
Co-Authors Ade Wirdayanto Adri Yandra Hidayat Agustiawan, Agustiawan Aji Prihartomo, Gatot Arip Heru Tripana Aslam, Filza RA Filza Rifqi Aufa Aslam Fitria Ameini Gebby Puspita Angraini Hadisi, Anthar Halim, Monica Huriatul Masdar Indra Jaya Indrajaya Ismar , Ibrahim Ismar Ibrahim Mardhiyah, Farah Maspian Tjili, Tondi Novita Anggraeni Novita Anggraeni Prastya Pardede, Jeremia Rangkuti, Ina Farida Rijalun Arridho Rita Endriani Rohman Sungkono Sabrina, Viona Salamullah Salamullah, Salamullah Sony Sony Sony, Sony Syntha Novianti Rahmad TB Odih Rhomdani Wahid Wahid, Tubagus OR WAHYUDI Wan Novriza Wijaya Wijaya, Wan Novriza Wirdayanto, Ade