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Penyakit Stroke dan Infeksi Corona Virus Disease 2019 (COVID-19): Sebuah Tinjauan Literatur Kurnianto, Aditya; Tugasworo, Dodik; Retnaningsih, Retnaningsih; Andhitara, Yovita; Ardhini, Rahmi; Tamad, Fatiha Sri Utami; Agung, Locoporta; Budiman, Jethro
Medica Hospitalia : Journal of Clinical Medicine Vol. 7 No. 1A (2020): Med Hosp
Publisher : RSUP Dr. Kariadi

Latar belakang: Corona virus disease 2019 (COVID-19) adalah suatu penyakit yang disebabkan oleh virus severe acute resporatory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 awalnya diketahui menyerang saluran pernapasan, namun sekarang ini manifestasi klinisnya beragam termasuk manifestasi kelainan saraf/neurologis. Kelainan neurologis yang perlu mendapat perhatian khusus karena morbiditas dan mortalitasnya yang dapat ditekan bila ditangani secara tepat waktu adalah kasus penyakit serebrovaskular/stroke. Tujuan dari tinjauan literatur ini adalah mengkaji secara teori berdasarkan literatur tentang hubungan infeksi COVID-19 dan stroke. Metode: Review literatur Pembahasan: Stroke pada COVID-19 berhubungan dengan koagulopati, antibodi antifosfolipid, dan vaskulitis. Manifestasi klinis, pemeriksaan penunjang, dan penanganan pada kasus stroke dengan COVID-19 butuh mendapat perhatian khusus. Penanganan pada stroke dengan COVID-19 difokuskan kepada keselamatan pasien dan keamanan tenaga kesehatan. Simpulan: Vasokontriksi serebral, peradangan saraf, stres oksidatif, dan trombogenesis dapat berkontribusi terhadap patofisiologi stroke selama infeksi COVID-19. Protokol perawatan di rumah sakit harus dimodifikasi untuk memberikan perawatan individual yang lebih baik untuk pasien stroke disertai COVID-19 dan keamanan bagi tenaga kesehatan.

Glioblastoma dengan Deep Vein Thrombosis pada pasien COVID-19: Sebuah Laporan Kasus Tugasworo, Dodik; Kurnianto, Aditya; Retnaningsih, Retnaningsih; Andhitara, Yovita; Ardhini, Rahmi; Priambada, Dody; Daynuri, Daynuri
Medica Hospitalia : Journal of Clinical Medicine Vol. 7 No. 1A (2020): Med Hosp
Publisher : RSUP Dr. Kariadi

Latar belakang: Glioblastoma (GBM) berhubungan dengan peningkatan hiperkoagulabilitas dan peningkatan risiko dari venous thromboembolism (VTE) (termasuk Deep Vein Thrombosis (DVT)). VTE merupakan komplikasi kardiovaskular atau respirasi yang sering ditemukan pada pasien-pasien yang dirawat inap karena COVID-19. Hubungan mengenai VTE pada kasus GBM dan COVID-19 belum pernah dibahas sebelumnya. Laporan kasus ini akan membahas tentang seorang wanita usia 55 tahun dengan GBM dan DVT dengan hasil PCR SARS-CoV-2 positif yang dirawat di RSUP Dr. Kariadi. Laporan kasus: Wanita 55 tahun datang ke rumah sakit dengan nyeri kepala dan nyeri serta bengkak pada tungkai kanan. Pada pemeriksaan laboratorium didapatkan INR 0.92, D-Dimer kuantitatif 46540 ug/L, dan titer fibrinogen kuantitatif 234 mg/dL. Dari USG vena doppler tungkai kanan didapatkan gambaran DVT sepanjang vena tungkai kanan, pada pemeriksaan MRI kepala dan biopsi tumor sesuai dengan gambaran GBM, hasil pemeriksaan foto rontgen thoraks terjadi perburukan gambaran paru, serta pemeriksaan PCR SARS-CoV-2 positif. Pembahasan: Pada pasien ini, kondisi GBM dapat menyebabkan adanya kondisi hiperkoagulabilitas akibat neoangiogenesis, mutase onkogenik, dan aktivitas kronik kaskade koagulasi. Selain itu, infeksi dan inflamasi yang berat berkontribusi dalam berkembangnya DVT, seperti yang ditemukan pada pasien dengan COVID-19 yang parah. Pada pasien rawat inap dengan COVID-19, prevalensi DVT tinggi dan biasanya memiliki outcome yang buruk. Istilah COVID-19 associated coagulopathy (CAC) digunakan untuk menggambarkan perubahan koagulasi pada pasien yang terinfeksi COVID. Simpulan: Peningkatan risiko DVT pada pasien dengan glioblastoma dan infeksi COVID-19 disebabkan hiperkoagulabilitas dan koagulopati akibat sel tumor dan virus SARS-CoV-2. Kata Kunci: glioblastoma, DVT, COVID-19 Introduction: GBM is associated with increased of hypercoagulability and the risk of venous thromboembolism (VTE) (include Deep Vein Thrombosis (DVT)). VTE is a cardiovascular or respiratory complication that is often found in patients with COVID-19. The relationship of VTE in GBM and COVID-19 has not been discussed before. This case report will discuss a 55-year-old woman with GBM and DVT with a positive SARS-CoV-2 treated at Dr. Kariadi Hospital. Case presentation: A 55-year-old woman came to the hospital with cephalgia, pain and redness in the right leg. On laboratory examination, it was obtained INR 0.92, quantitative D-Dimer 46540 ug/L, and quantitative fibrinogen titer 234 mg/dL. Venous doppler USG of right leg showed the imaging of DVT along the venous system in right leg. Head MRI and tumor biopsy showed the imaging of GBM, on the chest X-ray examination showed the deterioration of the lung damage, and positive SARS-CoV-2 with PCR examination. Discusssion: GBM can cause hypercoagulability due to neoangiogenesis, oncogenic mutation, and chronic coagulation cascade activity. In addition, severe infection and inflammation contribute to the development of DVT, as found in patients with severe COVID-19. In hospitalized patients with COVID-19, the prevalence of DVT is high and usually has a poor outcome. The term COVID-19 associated coagulopathy (CAC) is used to describe changes in coagulation in patients infected with COVID-19. Conclusion: Increased risk of DVT in GBM and COVID-19 is because of hypercoagulability and coagulopathy due to tumor cells and SARS-CoV-2 virus. Keywords: glioblastoma, DVT, COVID-19

Ensefalitis pada Infeksi Corona Virus Disease 2019 (COVID-19): Sebuah Tinjauan Literatur Retnaningsih, Retnaningsih; Kurnianto, Aditya; Tugasworo, Dodik `; Andhitara, Yovita; Ardhini, Rahmi; Satrioaji, Hari Wahono; Budiman, Jethro
Medica Hospitalia : Journal of Clinical Medicine Vol. 7 No. 1A (2020): Med Hosp
Publisher : RSUP Dr. Kariadi

Latar belakang: Infeksi Corona Virus Disesase 2019 (COVID-19) pertama kali terdeteksi pada Desember 2019 di Cina dan telah menyebar dengan cepat ke seluruh dunia. World Health Organization (WHO) baru-baru ini mengumumkan COVID-19 merupakan pandemi dunia dengan lebih dari 180.000 kasus dilaporkan hingga saat ini. Manifestasi neurologis dari COVID-19 berkaitan dengan penyakit serebrovaskular akut, gangguan kesadaran, dan kasus ensefalopati nekrotik hemoragik akut. Tujuan dari tinjauan literatur ini adalah mengkaji secara teori berdasarkan literatur tentang hubungan ensefalitis dan infeksi COVID-19. Metode: Review literatur Pembahasan: Ensefalitis dapat menyertai penyakit virus, seperti pada infeksi COVID-19. Ensefalitis virus mempengaruhi anak-anak, dewasa muda, atau pasien lanjut usia. Virus severe acute resporatory syndrome coronavirus 2 (SARS-CoV-2) dapat masuk ke sistem saraf pusat melalui nervus olfaktorius. Simpulan: Diagnosis ensefalitis COVID-19 dapat ditegakkan dengan anamnesis; pemeriksaan fisik; dan pemeriksaan penunjang berupa laboratorium darah, CT scan kepala, MRI serebral, EEG, analisa cairan serebrospinal, dan pemeriksaan PCR SARS-CoV-2 dari cairan serebrospinal. Kata Kunci: COVID-19, ensefalitis, neurologi Background: Corona Virus Disease 2019 (COVID-19) infection was first detected in December 2019 in China and has spread rapidly throughout the world. World Health Organization recently announced COVID-19 is a world pandemic with more than 180,000 reported cases. Neurological manifestations of COVID-19 were an acute cerebrovascular disease, impaired consciousness, and acute hemorrhagic necrotic encephalopathy. The aim of this literature review is to analyse theoretically based on literature about encephalitis in COVID-19.Methods: A literature reviewDiscussion: Encephalitis can accompany viral diseases, such as COVID-19. Viral encephalitis affects children, young adults, or elderly patients. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) enters the central nervous system via the olfactory nerve.Conclusion: Covid-19 encephalitis can be detected by anamnesis, physical examination, and supporting examination: blood laboratory finding, head CT scan, cerebral MRI, EEG, cerebrospinal fluid (CSF) analysis, and PCR test of SARS-CoV-2 by CSF. Keywords: COVID-19, encephalitis, neurology

Serial Case: Infarct Stroke In Covid 19 Patients Retnaningsih, Retnaningsih; Tamad, Fatiha Sri Utami; Tugasworo, Dodik; Andhitara, Yovita; Ardhini, Rahmi; Kurnianto, Aditya
Medica Hospitalia : Journal of Clinical Medicine Vol. 10 No. 1 (2023): Med Hosp
Publisher : RSUP Dr. Kariadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36408/mhjcm.v10i1.744

Introduction: SARS-CoV-2 has been reported to cause various neurological symptoms including stroke. SARS-CoV-2 infection causes the release of cytokines, proinflammatory chemokines, immune system activation, coagulopathy, endothelium, vasculitis, hypoxia, renin-angiotensin system imbalance, and cardiovascular complications, all of which can contribute to stroke. Purpose: Describe the incidence of stroke with different conditions in COVID 19 Cases: There were two cases of stroke infarct in a COVID-19 patient who was admitted to our hospital. Both were treated with a diagnosis of stroke infarct with previous COVID-19 symptoms, the results of laboratory examinations revealed an increase in inflammatory markers in both patients and had been given appropriate treatment according to each patient's condition. But at the end of the treatment one patient died and the other patient went home with clinical improvement. Discussion: The incidence of stroke infarct in this case is thought to be due to several factors, namely the presence of comorbidities in the patient, microvascular thrombus due to the formation of neutrophil extracellular traps (NET), activation of complement which causes thrombogenesis and vasculopathy, formation of antiphospholipid antibodies so that protein c is reduced, the formation of microparticles causes platelet hyperactivation. and increased tissue factor (TF) resulting in hypercoagulation. Adequate therapy in controlling inflammation due to COVID 19 has shown clinical improvement in stroke infarct patients. Conclusion: There are 2 cases of stroke infarction in patients with covid 19 who have comorbidities. The first case with COVID advanced stages experienced a worsening of the condition despite being given appropriate therapy. The second case with COVID middle stages experienced an improvement in the condition after the viral inflammatory factors were controlled and the comorbidity was well controlled.

Case Series Report: Subarachnoid Hemorrhage and ICU Management Retnaningsih; Tugasworo, Dodik; Andhitara, Yovita; Ardhini, Rahmi; Kurnianto, Aditya; Daynuri; Harianto, Erlangga Pradipta
Medica Hospitalia : Journal of Clinical Medicine Vol. 10 No. 3 (2023): Med Hosp
Publisher : RSUP Dr. Kariadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36408/mhjcm.v10i3.745

Background: Subarachnoid hemorrhage is a neurological syndrome with complex systemic complications. Rupture of an intracranial aneurysm causes acute extravasation of arterial blood under high pressure into the subarachnoid space and often into the brain parenchyma and ventricles. Bleeding triggers a complex series of events, which can ultimately lead to early brain injury, delayed cerebral ischemia, and systemic complications. Cases: There were six cases of subarachnoid hemorrhage. Some patients come clinically with severe headache and loss of consciousness. The patient has been treated quickly and aggressively and even put on a ventilator for complications of respiratory failure, support for shock and management of aneurysm clipping and EVD. Rapid and precise diagnosis in the management of patients with SAH is of paramount importance, within the first few hours after the onset of SAH. The risk for early neurologic damage and high rates of severe long-term complications necessitated aggressive early management. Conclusion: Rapid diagnosis and attentive management of patients with SAH are essential, as early deterioration is possible within the first few hours after the onset of SAH. The risk for early neurologic damage and high rates of severe long-term complications necessitated aggressive early management. Prevention and Management of Complications. The most common complications were pneumonia, aspiration, respiratory failure/distress, sepsis and imbalance electrolyte (hyponatremia). Approximately 50% of deaths after SAH are due to medical complications.

Apolipoprotein E Polymorphism and Carotid Intima Medial Thickness Progression in Post Ischemic Stroke Patient: Apolipoprotein E Polymorphism and Carotid Intima Medial Thickness Progression in Post Ischemic Stroke Patient Kurnianto, Aditya; Retnaningsih, Retnaningsih; Tugasworo, Dodik; Andhitara, Yovita; Ardhini, Rahmi; Budiman, Jethro
Medica Hospitalia : Journal of Clinical Medicine Vol. 9 No. 2 (2022): Med Hosp
Publisher : RSUP Dr. Kariadi

Background : Apolipoprotein E (APOE) gene is believed to associate with cholesterol level, a risk factor of ischemic stroke. CIMT (carotid intima-media thickness) can be used to determine the degree of atherosclerosis. Increased CIMT may predict ischemic stroke recurrence. This study aimed to determine association between increased CIMT in post ischemic stroke patients and APOE genotype. Methods : This was an epidemiological prospective study involving 71 post ischemic stroke patients (1 month from onset), admitted from 2012 to 2013. CIMT was examined with carotid duplex ultrasound at 1st, 6th, and 12nd month after stroke onset. APOE gene polymorphism was examined using HRM (high-resolution melting) which is a simple method, accurate, and sensitive for genotyping. Results : We found 5 APOE gene variation categories, i.e. E2E3, E2E4, E3E3, E3E4, and E4E4. The most common allele was E3 and genotype groups E3E3 was the majority of the population. E2E4 allele had the highest CIMT level among others, in the 1st month, 6th month, and 12nd month after stroke, with no association with hypertension, diabetes, and hypercholesterolemia. E3E3 allele was most often associated with hypertension, diabetes mellitus, dyslipidemia, and hyperhomocysteinemia. Conclusion : The results showed that APOE genotype E2E4 may independently constitute risk factor for atherosclerosis progression (CIMT) in post ischemic stroke patients. While the E3E3 genotype was often associated with hypertension, diabetes mellitus, dyslipidemia, and hyperhomocysteinemia. Our results suggest that APOE E4 was not an important risk factor for carotid atherosclerosis in post ischemic stroke patient.

A 71-year Old Male Patient with 20 Hour Onset of Infarct Stroke that was Performed with Intra-Arterial Thrombolysis, Mechanical Thrombectomy, Balloon Angioplasty, and Carotid Stenting: A Case Report Kurnianto, Aditya; Andhitara, Yovita; Yudistira; Setiadi, Jeffri; Budiman, Jethro
Medica Hospitalia : Journal of Clinical Medicine Vol. 10 No. 2 (2023): Med Hosp
Publisher : RSUP Dr. Kariadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36408/mhjcm.v10i2.961

Introduction: For above 2 decades, the definitive management for acute ischemic stroke is intravenous or intra-arterial thrombolysis (IAT), using recombinant tissue-type plasminogen activator. Recently mechanical thrombectomy (MT) was developed to overcome the problem that intravenous thrombolysis is only effective in removing large artery occlusions in the range of 10-30%. Early treatment with intra-arterial thrombolysis, permanent stent insertion and clot extraction devices evolved into the stent-retriever device used in most of the important trials and, recently, emerged aspiration tool. This case report presented 71-year-old male patient with infarct stroke who performed with MT. Case presentation: This case report presented 71-year-old male patient with the main complaint of right limbs weakness. A non-contrast head CT scan found infarction in the cortical-subcortical left parietal lobe, posterior pericornu of the right lateral ventricle and right temporal cornu periventricular; lacunar infarction in the right and left paramedian pons; old lacunar infarction in the left and right centrum semiovale, left corona radiata, right internal capsule, right parietal lobe white matter, left lentiform nucleus, left posterior crus of the internal capsule-thalamus, right thalamus, right lateral ventricular pericornu and left paramedian pons. The patient underwent cerebral digital substraction angiography (DSA), as well as IAT, MT, balloon angioplasty, and carotid stenting with good clinical outcome. Conclusion: With the overwhelming positive results of studies evaluating the safety, efficiency, and efficacy of mechanical thrombectomy; the standard of care for the treatment of patients with anterior circulation vessel occlusion is becoming clear.

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