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Clinical Manifestation, Surveillance, and Complication in Tuberous Sclerosis Complex in Dr. Moewardi Hospital Hamidi, Baarid Luqman; Mirawati, Diah Kurnia; Danuaji, Rivan; Subandi, Subandi; Budianto, Pepi; Hambarsari, Yetty; Prabaningtyas, Hanindya
Indonesian Journal of Medicine Vol 5, No 1 (2020)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (600.779 KB)

Abstract

Background: Tuberous Sclerosis Complex (Bour­neville’s disease) is genetic disorder with autosomal pattern of heritence that affecting differentiation sellular in many organ such as brain, lungs, cardiac with varible severity. Birth incidence is estimated to be 1:6000. The purpose of this study was to reported a case of patients with Bourneville’s disease (tuberous sclerosis complex) in Moewardi Hospital. Also reported surveillance and complication in this patient.Case Presentation: A male, 18 yearsold, with seizures, onset from infancy, tonic secondary generalized seizure pattern simultaneously throug­h­out the body. Neurologic status exami­nation found right hemiparese and mental re­tarda­tion, Encountered in patients with skin disorders such as butterfly appearance with facial angiofibroma, forehead fibrous plaque dan shar­green patch. Abnormalities also appeared in the oral mucosa as multiple papules. When psych­ological tests patient had difficulty following instructions. Psychiatric examination showed mode­rate lower intelegence. EEG results slow waves at left parietal, there is severe electro­fisio­logic abnormality considered structural lesi­on in left parietal. CT showed multiple calci­fied nodul­es in subependymal right and left lateral ventri­cle. MRI showed  atrophy and left sclerotic hip­po­campus with glosis in sub cortex occipito left parietal. To overcome the seizure patients given Carbamazepine. There was in­creas­ing of trans­aminase enzim, liver suspect liver angio­myo­lipoma.Conclusion: Based on clinical criteria for definite tuberous sclerosis complex patients met the criteria. The patients responded positively to carbamazepine that reduced seizure frequency. But somehow, patient's prognosis is worst. Pre­sence of intellectual impairment and neuro­psy­chiatric problems is a potential poor epilepsy control, and liver disfunction so that the necessa­ry comprehensive management and surveillance involves other disciplines.Keywords:Tuberous sclerosis complex, con­genital disorder, epilepsy, mental retardationCorrespondence: Baarid Luqman Hamidi.Department of Neuro­logy, Dr. Moewardi Hospital/Faculty of Medi­cine, Universitas Sebelas Maret. Email: ba­arid@­staff.uns.ac.idIndonesian Journal of Medicine (2020), 05(01): 47-51https://doi.org/10.26911/theijmed.2020.05.01.07
ANGIOPLASTIC STENOSIS IN SPONTANEOUS BILATERAL CAROTIC ARTERY DISSECTION: A CASE REPORT Subandi, Subandi; Danuaji, Rivan; Suroto, Suroto; Mirawati, Diah Kurnia; Budianto, Pepi; Hambarsari, Yetty; Hamidi, Baarid Luqman; Prabaningtyas, Hanindia Riani; Hutabarat, Ervina Arta Jayanti; Ristinawati, Ira; Tejomukti, Teddy; Tedjo, Raden Andi Ario; Santosa, Novian Anindito; Putra, Stefanus Erdana; Hafizhan, Muhammad
MNJ (Malang Neurology Journal) Vol. 10 No. 1 (2024): 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.2024.010.01.20

Abstract

Case: A 28-years-old woman presented with sudden right extremities weakness, right sided facial droop, and not being able to speak. On examination, the patient had upper motor neuron (UMN) hemiplegia and motor aphasia. On blood laboratory, we found D-dimer level of 1068 ng/dl. A non-contrast head CT-scan and CT-angiography showed left cerebral hemisphere infarction, and bilateral carotid artery stenosis. Further investigation with transcranial Doppler demonstrated partial stenosis of internal carotid artery (ICA). On cerebral digital subtraction angiography (DSA), we observed pseudoaneurysm on the right ICA and flame-shaped appearance on the left ICA, both are common radiological finding of ICA dissection. Then we performed stenting angioplasty on bilateral ICA to provide recanalization, and aspirin 80mg q.d. and clopidogrel 75mg q.d. was initiated. Conclusion: Spontaneous dissection of the carotid artery can occur on young adults. DSA is considered as the gold standard for vascular examination, and stenting with angioplasty was performed for recanalization to prevent the progression to severe stroke.
Morse Fall Scale As Clinical Predictor Of 3-Month Neurologic Function Recovery On Ischemic Stroke Patients: A Prospective Cohort Study Sakti, Triono Agung; Hamidi, Baarid Luqman; Prabaningtyas, Hanindia Riani
Magna Neurologica Vol. 1 No. 1 (2023): January
Publisher : Department of Neurology Faculty of Medicine Universitas Sebelas Maret

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/magnaneurologica.v1i1.431

Abstract

Background: Stroke is a leading cause of death in developing countries. The Morse Fall Scale (MFS)'s use in predicting stroke clinical outcomes has not been extensively studied. This study aims to assess MFS's ability to predict neurological recovery in acute ischemic stroke patients within 3 months using the National Institutes of Health Stroke Scale (NIHSS). Methods: This prospective cohort study enrolled all individuals with acute ischemic stroke between September and November 2021. Patients' baseline data included their MFS and NIHSS scores, as well as their age, gender, weight, stroke location, and comorbidities. The NIHSS score was reassessed three months later. To identify NIHSS predictors, all baseline data will be analyzed. SPSS 22 was used to analyze the data. The local ethics committee approved the study. Results: Of the 164 patients who met the criteria, only 105 (mean age 59.09 [±11.65], male [58.1%], anterior location [88.6%]) reached the study end point. The average NIHSS score decreased from 9.14 (±1.70) to 6.27 (±1.92). Multiple linear regression showed only the MFS score (p = 0.000) accurately predicted the NIHSS by 0.059 (95% CI: 0.032–0.085, p = 0.000) at the study's conclusion. Discussion: Our investigation revealed that the baseline MFS score accurately predicted neurological improvement in patients who had suffered an ischemic stroke over a three-month period. It is considered that the greater risk of falling results in a delay in the patient's rehabilitation. Investigation with larger sample sizes and longer monitoring intervals are required to corroborate our findings.
The Effectiveness of Transcranial Magnetic Stimulation in Post Stroke Dysphagia: A Case Report Ginting, Suska Lara; Hambarsari, Yetty; Danuaji, Rivan; Hamidi, Baarid Luqman
Magna Neurologica Vol. 2 No. 1 (2024): January
Publisher : Department of Neurology Faculty of Medicine Universitas Sebelas Maret

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/magnaneurologica.v2i1.942

Abstract

Background: A 72-year-old male, experiencing dysphagia and left-sided weakness for six months post-stroke, encountered challenges such as coughing and choking during the consumption of liquids and soft foods, along with a prolonged meal-swallowing process. Magnetic Resonance Imaging (MRI) revealed bilateral thrombotic infarction and left lateralization. Case: The Gugging Swallowing Screening Scale (GUSS) assessment demonstrated severe impairment with a total score of 7, persisting despite conventional physiotherapy attempts to improve swallowing function. Subsequently, repetitive transcranial magnetic stimulation (rTMS) was implemented, involving high-intensity stimulation in the ipsilesional hemisphere and low-intensity stimulation in the contralesional hemisphere. Remarkably, one-month post-rTMS, the patient displayed significant progress, evidenced by an improved GUSS score of 15, indicating enhanced swallowing function. Discussion: This case emphasizes the positive impact of bilateral rTMS hemispheric stimulation on post-stroke dysphagia. The strategic application of high-intensity ipsilesional and low-intensity contralesional stimulation emerged as an effective intervention for alleviating swallowing difficulties. Conclusion: These findings highlight the potential of rTMS as an innovative therapeutic approach for persistent dysphagia following a stroke. Repetitive transcranial magnetic stimulation (rTMS) has shown significant potential as an innovative and effective therapeutic approach for managing persistent post-stroke dysphagia. This case highlights the role of tailored rTMS protocols in improving swallowing function, with recovery influenced by factors such as stroke severity, dysphagia severity, age, nutritional status, timing of intervention, and lesion location.
Association between vaspin rs2236242 gene polymorphism and atherosclerosis in ischemic stroke patients with diabetes mellitus in the Indonesian population Danuaji, Rivan; Suroto; Purwanto, Bambang; Indarto, Dono; Muhammad, Faizal; Mirawati, Diah Kurnia; Widyaningsih, Vitri; Soetrisno; Subandi; Budianto, Pepi; Hambarsari, Yetty; Hamidi, Baarid Luqman; Prabaningtyas, Hanindia Riani; Hutabarat, Ervina Arta Jayanti; Ristinawati, Ira; Tejomukti, Teddy; Tedjo, Raden Andi Ario
Medical Journal of Indonesia Vol. 33 No. 4 (2024): December
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.13181/mji.oa.247566

Abstract

BACKGROUND Stroke is the third leading cause of morbidity and second in mortality worldwide. Diabetes mellitus (DM) is a risk factor for stroke. Vaspin and single nucleotide polymorphism (SNP) rs2236242 involved DM pathogenesis. This study aimed to explore the correlation between SNP rs2236242, serum vaspin levels, and atherosclerosis in patients with ischemic stroke and DM. METHODS This study was conducted in Dr. Moewardi Hospital from 2022 to 2023. The case group included patients with ischemic stroke and DM, while the controls were those with ischemic stroke only. Tetra-primer amplification refractory mutation system-polymerase chain reaction was used to determine the genotypes. RESULTS There were 31 cases and 33 control. SNP rs2236242 showed that odds ratio (OR) (95% confidence interval [CI]) for AA-TT was 0.273 (0.241–0.305) and for TA-TT was 0.315 (0.298–0.341). The OR (95% CI) for allele A to T was 0.789 (0.373−1.669). The mean (standard deviation) serum vaspin level in the case group compared to the control was 1,570 (2,108) ng/ml versus 1,630 (1,428) ng/ml (p = 0.064). Higher vaspin levels were found in T allele of the TT (1,523 [2,269] ng/ml, p = 0.021) and TA (1,760 [1,349] ng/ml, p = 0.004) genotype groups than the A allele of the AA genotype group (0.914 [0.329] ng/ml). CONCLUSIONS Vaspin gene polymorphism AA genotype or A allele significantly reduces vaspin levels in patients with ischemic stroke with DM.
Posterior communicating artery aneurysm presenting as isolated oculomotor palsy: The role of rapid identification, intervention, and multidisciplinary care - A case study Tedjo, Raden Andi Ario; Subandi, Subandi; Tejomukti, Teddy; Hamidi, Baarid Luqman; Tristan, Christopher Daniel; Hamka, Muhammad Farid; Rahman, Awalil Rifqi Kurnia; Putra, Stefanus Erdana; Hafizhan, Muhammad
Jurnal Keperawatan Padjadjaran Vol. 13 No. 1 (2025): Jurnal Keperawatan Padjadjaran
Publisher : Faculty of Nursing Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24198/jkp.v13i1.2587

Abstract

Background: Posterior communicating artery (PCOM) aneurysms are the prevalent type of aneurysm with high rupture risks. Isolated oculomotor nerve (CN III) palsy is a key symptom warranting heightened awareness in primary care. Given the need for advanced imaging, early referral is paramount. This study highlights the significance of prompt identification, targeted intervention, and comprehensive management in optimizing patient outcomes. Case: A 58-year-old woman presented with isolated CN III palsy. The patient underwent rapid referral to tertiary care with magnetic resonance angiography (MRA) and digital subtraction angiography (DSA), revealing an aneurysm in the PCOM. Subsequently, coiling was performed to achieve complete occlusion. The procedure resulted in significant neurological recovery, with restoration of CN III function. Post-coiling, the patient receives close nurse monitoring, incorporating fall management and comprehensive education before discharge. CN III palsy is one of the unique-noticeable presentations of PCOM aneurysms, though symptoms may include facial pain, occasional headaches, and migraines. Coiling was chosen due to its less invasiveness and was recommended for posterior circulation aneurysms. Blood pressure control is essential to prevent aneurysm formation, rupture, and recurrence. Regular imaging follow-ups were needed to ensure long-term outcomes. Conclusion: PCOM aneurysm care involves a multidisciplinary approach. Rapid identification, early referral, immediate occlusion, and comprehensive rehabilitative programs were mandatory to improve patient outcomes.