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All Journal Althea Medical Journal MNJ (Malang Neurology Journal) JUXTA: Jurnal Ilmiah Mahasiswa Kedokteran Universitas Airlangga Indian Journal of Forensic Medicine & Toxicology AKSONA

Ardhi, Mohammad Saiful

Department Of Neurology, Faculty Of Medicine, Universitas Airlangga; Dr. Soetomo General Academic Hospital, Surabaya, Indonesia

Author-ID : 1629810

Biochemistry, Genetics & Molecular Biology Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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Azathioptrine in Refractory Tolosa-Hunt Syndrome: Two Case Report Devi Ariani Sudibyo; Mohammad Saiful Ardhi
AKSONA Vol. 2 No. 1 (2022): JANUARY 2022
Publisher : Universitas Airlangga

Introduction: Tolosa-Hunt syndrome (THS) is an inflammatory disease with painful ophthalmoplegia and unilateral periorbital headache as detailed by the International Classification of Headache Disorders, 3rd edition (ICHD-3). Azathioprine has been suggested as a second-line treatment in refractory THS when oral corticosteroid only gives a partial response. Case: Two cases of THS, 45-year-old and 41-year-old women with unilateral headache, drooping of the left upper eyelid, and diplopia. They presented with complete ophthalmoplegia and ophthalmic division of trigeminal nerve disturbance. Magnetic resonance imaging (MRI) showed thickening of the left cavernous sinus, suggesting THS, while the other was normal. Corticosteroid (prednisone 1-1,5 mg/day) was given orally for the first two weeks, and according to the Numeric Pain Rating Scale (NPRS), pain intensity was reduced from severe to moderate. As a second-line treatment, azathioprine (2 mg/kg/day) was given afterward, with a significant reduction in pain intensity and remission of ophthalmoplegia within seven days. Azathioprine was used as an immunosuppressive agent and was continued for another three months without any deterioration in neurological deficits. The levels of complement 3, 4 (C3, C4), and C-reactive protein (CRP) were normal in both patients, with a slight increase in erythrocyte sedimentation rate (ESR) and equivocal values on antinuclear antibody (ANA) results. Other differentials of THS were eliminated from history-taking, physical examination, and proper investigations. Conclusion: Azathioprine as a second-line treatment can be used instead of an oral corticosteroid for refractory cases of THS with fewer side effects. Complete remission of ophthalmoplegia and a significant reduction in pain intensity was obtained.

Partial Transvenous Coil Embolization with Significant Clinical Improvement in Patient with Indirect Carotid Cavernous Fistula Muh. Wildan Yahya; Achmad Firdaus Sani; Dedy Kurniawan; Mohammad Saiful Ardhi
AKSONA Vol. 2 No. 2 (2022): JULY 2022
Publisher : Universitas Airlangga

Highlight: CCF is a rare vascular malformation with challenging management. Partial transvenous embolization is quite effective as an alternative therapy for indirect CCF type D. ABSTRACT Introduction: An indirect carotid-cavernous fistula (CCF) is an abnormal connection between the internal or external carotid artery and the cavernous sinus. The optic, trochlear, abducens, and trigeminal nerves are located in the cavernous sinus. Head Computed Tomography (CT) scan, Magnetic Resonance Imaging (MRI), and Cerebral Angiography are some imaging modalities used to establish and diagnose carotid-cavernous fistula. Endovascular intervention can be performed with trans-arterial or trans-venous access. In some cases, complete embolization by endovascular treatment is not possible because of difficult angioarchitecture. Case: A 61-year-old female reported having pain in her left eye (numerical rating scale was 6). The left eye was bulging, reddish, ptosis, and unable to move. The patient felt double vision when opening both eyes, complained of intermittent stabbing headaches on the left side, and heard a bruit from the left side of the head. The cerebral angiography showed bilateral indirect CCF Barrow type D. The procedure involved partial transvenous embolization with coiling. The angiographic evaluation showed partial occlusion, and residual flow from the fistula was still visible on angiography. There was a significant clinical improvement several days after the procedure and a five-month follow-up. Conclusion: This case report showed that partial targeted transvenous embolization is quite effective in indirect CCF when complete embolization is impossible.

Comparison of Recurrent Stroke in Patients with First Stroke Ischemic and Hemorrhagic in Soetomo General Academic Hospital Surabaya Sihotang, Marselia Febriyanti; Ardhi, Mohammad Saiful; Parenrengi, Muhammad Arifin
AKSONA Vol. 4 No. 1 (2024): JANUARY 2024
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/aksona.v4i1.50403

Highlight: The incidence of recurrent stroke in patients with the first stroke of ischemic type was 2.5-fold higher than that of hemorrhagic type, with the majority of recurrent strokes being the same type as the first stroke. Hypertension is the most common modifiable stroke risk factor in both stroke types, and in 5% of cases, secondary prevention is still not optimal. The average length of hospital stay for patients with the first stroke of hemorrhagic type was 3 days longer, along with a higher average NIHSS score on presentation than patients with ischemic stroke. ABSTRACT Introduction: Stroke is the leading cause of mortality and disability in Indonesia, as well as being the major cause of death and disability-adjusted life years (DALY) lost worldwide. Recurrent stroke is one of the most common complications of stroke after discharge, despite being highly preventable. Objective: This study aimed to compare the differences in recurrent stroke profiles between patients with first stroke ischemic and hemorrhagic strokes. Methods: The study was done by collecting secondary data from medical records and the stroke registry at Dr. Seotomo General Academic Hospital over a period of six months (January–July 2020). Result: This study examined 36 samples that met the inclusion criteria. The results revealed that patients who experienced their first stroke of the ischemic type had a 2.5-fold higher incidence of recurrent stroke than those who suffered a hemorrhagic type. Except for one case, the majority of patients had the same type of stroke as the first. The most frequent modifiable risk factors seen in these two types of strokes are hypertension and physical inactivity. It was found that there were still 5% of the risk factors for which secondary prevention had not been carried out optimally with antidyslipidemic, antidiabetic, or antihypertensive drugs. The most common acute treatment for ischemic stroke is antiplatelet therapy, either single or dual therapy. Up to 90% of hemorrhagic strokes were treated conservatively, and in one patient, extraventricular drainage was performed. Conclusion: There were more stroke patients with a first stroke of hemorrhagic type that presented with NIHSS scores in the severe to very severe range, and the average length of hospitalization in this group was longer.

Profile Patients based on Risk Factors for Ischemic Stroke in the Neurology Inpatient Ward of Dr. Soetomo General Academic Hospital Surabaya during the Period of January to June 2022 Kusuma, Nabila Divandra; Ardhi, Mohammad Saiful; Widodo, Widodo; Setyowatie, Sita
AKSONA Vol. 4 No. 2 (2024): JULY 2024
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/aksona.v4i2.52354

Highlight: Some risk factors exhibited incongruent outcomes and went against existing theories. The age group under 65 years old was the most prevalent modifiable risk factor. Stage 2 hypertension was the most dominant non-modifiable risk factor. ABSTRACT Introduction: Stroke is a major cause of disability and death worldwide. Among the three types of strokes, the ischemic stroke is the most prevalent. Controlling risk factors is a key approach to preventing ischemic stroke. Due to the limited data availability in Indonesia, it is important to research patient profiles focusing on risk factors for ischemic stroke. Objective: To record the patient profiles based on the risk factors for ischemic stroke in the neurology inpatient ward of Dr. Soetomo General Academic Hospital Surabaya for the period of January–June 2022. Methods: This was a descriptive observational study with a retrospective design. This study examined secondary data from ischemic stroke patients’ medical records at the Dr. Soetomo General Academic Hospital’s neurology inpatient ward in Surabaya between January and June 2022. Results: Out of 176 patients, 108 were under the age of 65. Of these, 97 were male. There were 63 patients with a history of ischemic stroke, 58 with diabetes mellitus, 84 with stage 2 hypertension, 77 with dyslipidemia, 59 with impaired kidney function, 52 with diabetes mellitus by lab tests, and 23 who smoked. Conclusion: In this study, some risk factors exhibited discrepancies and contradicted existing theories. The two dominant variables in the patient population were a combination of risk factors that occur more frequently at a certain age and a combination of risk factors in patients with recurrent strokes.

Epidemiologic Profile of Ischemic Stroke Patients with Dyslipidemia in Dr. Soetomo General Academic Hospital Patient Prakoso, Raditya Ardra Putra; Ardhi, Mohammad Saiful; Thamrin, Husin; Setyowatie, Sita
AKSONA Vol. 5 No. 1 (2025): JANUARY 2025
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/aksona.v5i1.64275

Highlight: This study provides insights into the epidemiologic profile of ischemic stroke patients with dyslipidemia in Dr. Soetomo General Academic Hospital. The majority of patients had hypertension, the most common comorbidity with low HDL-C levels Most patients showed moderate stroke severity and high levels of consciousness, with a majority proportion demonstrating recovery. ABSTRACT Introduction: Ischemic stroke is a major medical issue, especially in individuals with dyslipidemia, as it can elevate both the likelihood and severity of stroke incidents. This study is essential due to the rising prevalence of stroke and limited data regarding ischemic stroke patients with dyslipidemia in Indonesia. Understanding these traits is important for enhancing preventative and treatment strategies. Objective: This study intended to assess the epidemiologic profile of ischemic stroke patients with dyslipidemia in a tertiary hospital in Indonesia. Methods: This descriptive study assessed 116 medical records of ischemic stroke patients with dyslipidemia admitted to Dr. Soetomo General Academic Hospital in Surabaya, Indonesia, from January to June 2023. The collected data encompassed demographics, comorbidities, lipid profiles, and clinical outcomes. Dyslipidemia was defined based on the PERKENI guidelines, and stroke severity was assessed using the GCS and NIHSS scales. Results: The majority of ischemic stroke patients with dyslipidemia (77.6%) had low HDL-C levels. There were 64 males and 52 females; most of them were between the ages of 56 and 65. Hypertension was the most common comorbidity (64.7%), followed by diabetes (39.7%), heart disease (12.9%), and obesity (11.2%). Of 40 NIHSS-assessed patients, 26 had moderate, 8 mild, 2 moderate-to-severe, and 4 severe strokes. The majority of patients (70.7%) recovered. Conclusion:The majority of dyslipidemia-related ischemic stroke patients, aged 56 to 65, had low HDL-C levels. Hypertension was the main comorbidity, with many experiencing their first stroke. Most patients had high consciousness, moderate stroke severity, and showed improvements.

Co-Authors Achmad Firdaus Sani, Achmad Firdaus Aisyah Rizki Ramadhani Asra Al Fauzi Citra Amaniah Anhar Dedy Kurniawan Divastuti, Kedyatasya Rae Fahirah Fikriyah, Lathifatul Hermawan Susanto Kusuma, Nabila Divandra Mohammad Pratama Jauhar Putra Muh. Wildan Yahya Parenrengi, Muhammad Arifin Perdana, Philips Carel Prakoso, Raditya Ardra Putra Puji Lestari Puspa Wardhani, Soebagijo Adi Sihotang, Marselia Febriyanti Sita Setyowatie Subur Prajitno Sudibyo, Devi Ariani Surdji, Almuta'Aaliyati Nur Suryantoro, Satriyo Dwi Thamrin, Husin Triagung Arif Pratama Widodo Widodo Yetti Hernaningsih

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