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All Journal Damianus Journal of Medicine Magna Neurologica Indonesian Journal of Biomedicine and Clinical Sciences Acta Neurologica Indonesia
Vania, Aurelia
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Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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Profile of HIV/AIDS Patients with Neurological Manifestations in The Tertiary Referral Hospital in Bali Suryapraba, Anak Agung Ayu; Vania, Aurelia; Sudewi, Anak Agung Raka; Sukmawati, Ni Made Dewi Dian; Susilawathi, Ni Made
Magna Neurologica Vol. 2 No. 2 (2024): July
Publisher : Department of Neurology Faculty of Medicine Universitas Sebelas Maret

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/magnaneurologica.v2i2.1097

Abstract

Background: Neurological manifestations in approximately half of Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) patients are related to high morbidity and mortality worldwide. Therefore, there is a need for epidemiological data on HIV/AIDS patients with neurological manifestations in Bali, as an international tourism destination.  Objective: This study aimed to describe the clinical profile of neurological manifestations among patients with HIV/AIDS in the tertiary referral hospital for Bali and Nusa Tenggara region. Methods: A descriptive-retrospective study was conducted on HIV/AIDS patients presenting with neurological manifestations hospitalized in the Neurology Department of Prof. Dr. I.G.N.G Ngoerah Hospital Denpasar from January 2018 to December 2021. Results: Among the 227 subjects included in this study, the majority were male (69.9%) and HIV positive newly diagnosed (69.2%). Furthermore, out of 126 subjects who had CD4 data, the majority were with CD4 <200 cells/mm3 (85.7%) and 53.1% were <50 cells/mm3, with ages ranging from 18 to 67 years old, at a median of 36 years old. The most common neurological signs and symptoms found were paresis/paralysis (61.7%), headache (54.6%), decreased consciousness (52.9%), and cranial nerve palsy (52%). Cerebral toxoplasmosis (67.4%) and tuberculous meningoencephalitis (20.3%) were the prevalent opportunistic infections, while the mortality rate was 39.6% with sepsis as the major cause. Conclusions: Neurological manifestations are common initial symptoms in diagnosing HIV infection. Therefore, better awareness and earlier detection are required among people with risk factors of HIV transmission, particularly in groups of young and productive age with signs of immunocompromised condition as well as neurological manifestations.
Toxoplasma encephalitis in HIV/AIDS patients in Prof. Dr. I.G.N.G. Ngoerah General Hospital, Bali, Indonesia Suryapraba, Anak Agung Ayu; Sintarani, Cokorda Istri Dyah; Vania, Aurelia; Ni Made Susilawathi; Anak Agung Raka Sudewi
Indonesian Journal of Biomedicine and Clinical Sciences Vol 56 No 4 (2024)
Publisher : Published by Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/inajbcs.v56i4.16763

Abstract

Toxoplasma gondii, an opportunistic infection in HIV/AIDS patients, is an obligate intracellular parasite that causes toxoplasma encephalitis (TE). The symptoms of TE range from subacute focal or global neurologic impairments to neuropsychiatric disorder, and infectious mass lesions. In clinical practice, presumptive diagnosis, including clinical syndrome, finding single or multiple brain lesions on neuroimaging evaluation are preferred. This study aimed to identify neurologic and radiologic characteristics of HIV/AIDS patients with TE in Prof. Dr. I.G.N.G Ngoerah Hospital, Denpasar, Bali. It was a retrospective study using medical records of patients with TE from January 2018 to December 2021. Of 122 subjects, 66.4% were male and 33.6% were female, age ranged from 19-59 y.o. with a median of age 33 y.o., and the CD4 count median was 29.5 cell/mm3. Decreased consciousness was the most prevalent clinical symptom in 40.2% of subjects followed by headache in 18.9% of subjects. A structural lesion in neuroimaging was primarily found in the basal ganglia area of the brain (44.3%). The fatality rate (30.3%) was significantly associated with decreased consciousness, higher leukocyte levels, and a higher neutrophil-to-lymphocyte ratio (p<0.05). Diagnosis of TE should be considered in immunocompromised young adults with subacute onset of focal and/or global neurological deficit and neuroimaging results showing hypodense lesion, particularly with ring-like enhancement, in thebasal ganglia and corticomedullary junction area of the brain. An altered state of consciousness and NLR can indicate poor outcomes in HIV/AIDS patients with TE.
Prediktor Klinis dan Pencitraan Hematoma Subdural Kronik pada Pasien Lanjut Usia di Instalasi Gawat Darurat Vania, Aurelia; Arimbawa, I Komang; Laksmidewi, Anak Agung Ayu Putri; Putra, Ida Bagus Kusuma; Widyantara, I Wayan
Bahasa Indonesia Vol 23 No 3 (2024): Damianus Journal of Medicine
Publisher : Atma Jaya Catholic University of Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.25170/djm.v23i3.5416

Abstract

Pendahuluan: Subdural hematoma kronik (cSDH) merupakan salah kasus emergensi neurologi yang sering terjadi yang lebih sering terjadi pada lansia. Diagnosis cSDH memiliki kesulitan tersendiri pada pasien lansia. Studi ini bertujuan untuk mempelajari karakteristik klinis pasien lansia yang dapat menjadi prediktor adanya cSDH dan derajat keparahan gambaran cSDH yang ditemukan pada hasil CT-scan kepala. Metode: Penelitian ini merupakan studi kasus-kontrol yang dilakukan di Instalasi Gawat Darurat Neurologi RSUP Prof. dr. I.G.N.G. Ngoerah dalam periode 3 tahun. Studi melibatkan 85 pasien lansia cSDH dan 85 kontrol yang terbukti tidak ada perdarahan intrakranial dari data imaging. Pengumpulan dan pengolahan data yang dilakukan meliputi variabel karakteristik demografi, faktor risiko, presentasi klinis, dan karakteristik cSDH pada gambaran computed-tomography scan (CT-scan) kepala. Hasil: Studi ini menemukan pasien cSDH dengan rata-rata usia 72,9±8.1 tahun dan 75,3% laki-laki. Penurunan kesadaran dan defisit fokal merupakan presentasi klinis yang paling sering ditemukan dengan median onset 3 hari (rentang 1-30 hari). Usia lebih tua, laki-laki (RO=2,84, 95% IK 1,45-5,45, p=0,001), hipertensi (RO=3,66, 95% IK 1,89-7,06, p=0,000), dan gangguan ginjal kronik (RO=2,77, 95% IK 1,34-5,72, p=0,005) merupakan faktor risiko terjadinya cSDH yang signifikan. Efek massa dan Glasgow Coma Scale (GCS) yang rendah lebih sering terjadi pada cSDH dengan midline shift (MLS) >5mm. Simpulan: Adanya cSDH perlu dipertimbangkan pada pasien lansia yang datang dengan onset manifestasi neurologis akut-subakut terutama pasien laki-laki, mengalami penurunan kesadaran dengan atau tanpa defisit fokal, disertai adanya komorbid hipertensi dan gangguan ginjal. Penurunan GCS dan efek massa dapat memperkirakan adanya MLS pada CT-scan kepala.
Role of Visual Evoked Potential in Direct Traumatic Optic Neuropathy: A Case Report : VEP in Direct TON Vania, Aurelia; Arimbawa, I Komang; Pratiwi, Ni Made Dwita
Acta Neurologica Indonesia Vol. 2 No. 01 (2024): Acta Neurologica Indonesia
Publisher : Departemen Neurologi Fakultas Kedokteran Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.69868/ani.v2i01.16

Abstract

Traumatic optic neuropathy (TON) is a rare cause of visual impairment following blunt or sharp trauma and the diagnosis is established clinically. Lesions on the optic nerve may not always be visible in neuroimaging examinations. Studies on Visual Evoked Potential (VEP) in TON patients are still limited, despite being beneficial for objectively detecting optic nerve lesions. A 16-year-old male patient was referred to the neurology clinic with a sudden loss of vision in the left eye approximately 25 days after a head injury due to a motor vehicle accident. The patient had epidural bleeding and fractures in the orbital and facial bones, as revealed by a head CT scan. Neurological examination showed a visual acuity of 1/300 in the left eye, left midriasis, and a negative light reflex in the left eye. VEP examination of the left eye revealed prolonged P100 latency and a decrease in P100 amplitude (>50%), indicating a lesion in the left optic nerve. This visual impairment persisted for up to 6 months post-head trauma. TON is a vision-threatening disorder that should be considered in patients with ocular or head trauma and visual impairment. A decrease in amplitude ratio <50% and prolonged P100 latency >140 ms are associated with poor visual function recovery. VEP examination is an objective assessment of visual pathway integrity and serves as one modality for early TON diagnosis and a predictor of visual function prognosis in TON patients.   Keywords: diagnostic; prognostic; traumatic optic neuropathy; visual evoked potential
Co-Authors Anak Agung Ayu Putri Laksmidewi Anak Agung Raka Sudewi Arimbawa, I Komang I WAYAN WIDYANTARA Ni Made Susilawathi Pratiwi, Ni Made Dwita Putra, Ida Bagus Kusuma Raka-Sudewi A. A. Sintarani, Cokorda Istri Dyah Sukmawati, Ni Made Dewi Dian Suryapraba, Anak Agung Ayu Susilawathi, Ni Made