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All Journal Cermin Dunia Kedokteran Journal of Neurointervention and Stroke (JNeViS)
Candrayuni, Ni Made Ayu
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Health Professions Medicine & Pharmacology Neuroscience

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Successful Management of Acute Ischemic Stroke with Intravenous Thrombolysis and Implementation of Prehospital Stroke Candrayuni, Ni Made Ayu; Andaka, Deddy
Journal of Neurointervention and Stroke Vol. 1 No. 1: MAY 2025
Publisher : Neurointervention Working Group of Indonesian Neurological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.63937/jnevis-2025.11.7

Abstract

Highlight: Timely thrombolysis led to major neurological improvement in stroke patient. Early recognition and prehospital care enabled rapid stroke intervention. Case shows value of prehospital stroke systems for thrombolysis success ABSTRACT Introduction: Acute ischemic stroke (AIS) is a leading cause of disability and death worldwide. Timely administration of intravenous thrombolysis (IVT) significantly improves patient outcomes when delivered within the therapeutic window. Prehospital stroke care encompass the period from symptom onset to hospital arrival and includes both patient-to-hospital and inter-hospital transfers. Delays in prehospital stroke care represent a significant barrier to effective treatment. Case: A 68-year-old male presented with sudden left-sided weakness and slurred speech. A CT scan performed one hour after symptom onset showed no acute abnormalities (ASPECTS 10). He was transferred to the hospital 3.5 hours post-onset and received alteplase (67.5 mg). His door-to-needle time was 20 minutes, with an onset-to-needle time of 3 hours and 50 minutes. The patient showed significant improvement, with his NIHSS score decreasing from 11 to 2 within 30 minutes. Conclusion: Integrating IVT with robust prehospital stroke services enhances treatment efficiency and improves functional outcomes, setting a benchmark for optimal stroke management.
Penyakit Moyamoya Tahap III menurut Klasifikasi Suzuki pada Orang Dewasa: Diagnosis dan Penatalaksanaan Konservatif — Laporan Kasus: Laporan Kasus Candrayuni, Ni Made Ayu; Riyadi, Marsya Julia; Wardhana, I Made Edwin Alberty
Cermin Dunia Kedokteran Vol 53 No 06 (2026): Juni 2026
Publisher : PT Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55175/cdk.v53i06.1980

Abstract

Introduction: Moyamoya disease (MMD) is a rare, progressive cerebrovascular condition, predisposing patients to ischemic or hemorrhagic strokes—particularly among Asian populations. Case: A 38-year-old male with a prior ischemic stroke in 2023 presented with acute left lower limb weakness lasting two days. MRI showed an acute and chronic ischemic lesion, and an acute lacunar infarct in the right superior frontal gyrus. MRA and cerebral angiography confirmed Suzuki stage III MMD, with A1 right anterior cerebral artery (ACA) occlusion and collateral flow from the left posterior cerebral artery (PCA). Cerebral angiography revealed occlusion of the proximal A1 segment of the right ACA and a characteristic “puff of smoke” appearance from abnormal collateral vessels in the distal branches of the right middle cerebral artery (MCA). The patient was managed conservatively with cilostazol, rosuvastatin, and antiplatelet therapy, alongside physical rehabilitation, resulting in functional improvement. Discussion: MMD is a progressive vasculopathy that may cause recurrent cerebrovascular events due to impaired cerebral perfusion. Cerebral angiography remains essential for diagnosis and Suzuki staging. Although revascularization surgery is the standard treatment to improve cerebral blood flow and reduce stroke risk, conservative management may be considered in selected patients based on clinical stability, collateral circulation, and treatment indications. In this case, conservative therapy combined with rehabilitation was associated with clinical improvement, although continuous monitoring is required due to the progressive nature of the disease. Conclusion: Early diagnosis of MMD through advanced neuroimaging is crucial for preventing recurrent stroke and guiding treatment decisions. This case highlights that individualized conservative management may provide clinical benefits in adult Suzuki stage III MMD when surgical intervention is not immediately performed, while long-term follow-up remains essential.
Co-Authors Andaka, Deddy Riyadi, Marsya Julia Wardhana, I Made Edwin Alberty