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All Journal Indonesian Journal of Biomedicine and Clinical Sciences Berkala Ilmiah Kedokteran dan Kesehatan Masyarakat
Khairani, Atitya Fithri
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Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience

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Differences in the clinical presentations of anti-NMDAR (anti-N-methyl-D-aspartate receptor) encephalitis with status epilepticus: a retrospective case series Sejahtera, Desin Pambudi; Satiti, Sekar; Mukhtar, Ishana Nafeeza; Andatu, Roshynta Linggar; Khairani, Atitya Fithri
Indonesian Journal of Biomedicine and Clinical Sciences Vol 56 No 3 (2024)
Publisher : Published by Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/inajbcs.v56i3.15917

Abstract

Literature on anti-NMDAR (anti-N-methyl-D-aspartate receptor) encephalitis is limited in developing countries, including Indonesia. This retrospective observational case series explored the impact of early diagnosis and treatment on patient outcomes in four distinct cases of anti-NMDAR encephalitis with status epilepticus, and other related conditions, of patients referred to Dr. Sardjito General Hospital, Yogyakarta. Clinical data from May 2021 to August 2023 were collected through the review of medical records, encompassing demographic information, clinical presentation, history, laboratory results, imaging studies, EEG reports, interventions, and the progression of the disease. Four cases were reported, three of whom were diagnosed with anti-NMDAR and one with bacterial encephalitis, each presenting a variety of neuropsychiatric clinical symptoms, leading to hospitalization, extensive testing, and interventions to establish the definitive diagnosis. Cases 1 and 4 have a childhood history of seizures. The cases analyzed factors including the impact of childhood versus adulthood onset and the adherence to taking medicine regularly leading to exacerbation symptoms and relapses. Distinguishing anti-NMDAR encephalitis from related conditions, such as bacterial encephalitis, was further complicated in patients with varied neuropsychiatric presentations (seizures, hallucinations, irritable behavior, headaches) and responses to the treatment. Supporting investigation finds positive NMDAR testing and abnormal CT, MRI, and EEG results, contributed to definitive diagnoses. It could be concluded that comprehensive diagnostic investigations are important for prompt recognition of clinical characteristics, and early initiation of immunomodulatory therapy in managing anti-NMDAR encephalitis and related conditions in Yogyakarta, Indonesia.
Epilepsi Terkait Tumor Otak Pada Suspek Tumor Sinonasal Dengan Infiltrasi Serebral: Sebuah Laporan Kasus Darumurti, Rissito Centricia; Setyana, Michael Kevin Robby; Khairani, Atitya Fithri; Taufiqurrohman, Agus
Berkala Ilmiah Kedokteran dan Kesehatan Masyarakat Vol. 1 No. 2 (2023)
Publisher : Fakultas Kedokteran, Universitas Islam Indonesia

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Abstract

Epilepsi adalah gangguan otak yang ditandai dengan kecenderungan terjadinya kejang atau bangkitan epileptik. Epilepsi yang ditimbulkan oleh tumor otak disebut epilepsi terkait tumor otak. Patofisiologi yang mendasarinya masih belum banyak dipahami tetapi telah terbukti bersifat multifaktorial. Tujuan penulisan artikel ini adalah untuk melaporkan kasus dari seorang pasien perempuan berusia 50 tahun datang dengan keluhan utama kejang disertai benjolan di mata kanan yang terus membesar selama 6 bulan terakhir. Pemeriksaan fisik menunjukkan proptosis, gangguan visus dan papilatrofi pada mata kanan, paresis nervus kranialis III, IV, dan VI dekstra, lesi nervus kranialis V sensoris cabang I dan II dekstra, refleks primitif glabela positif, dan gangguan kognitif berat dengan ketergantungan ringan-sedang. Hasil radiologi menunjukkan suspek tumor sinonasal dekstra dengan infitrasi serebral. Hasil elektroensefalografi menunjukkan gambaran abnormal dengan frontal bilateral epileptiform discharges (L>R) disertai focal slowing regio frontalis dan frontal intermittent rhythmic delta activity (FIRDA) yang konsisten dengan klinis focal seizures disorder dapat sesuai dengan epilepsi lobus frontalis. Pasien mendapatkan terapi steroid deksametason intravena, fenitoin, asam valproat, asam folat, kalium aspartat, dan haloperidol. Pasien dipulangkan setelah perawatan hari kesepuluh dalam kondisi bebas kejang selama tujuh hari. Kondisi tumor pada kasus telah mencapai stadium lanjut, sebagaimana ditunjukkan oleh invasi tumor ke struktur tulang di sekitarnya dan struktur intrakranial sehingga memicu terjadinya epilepsi. Epilepsi dapat terkontrol dengan terapi steroid intravena serta obat anti epilepsi kombinasi.  KATA KUNCI: epilepsi; tumor otak; tumor sinonasal.
Co-Authors Andatu, Roshynta Linggar Darumurti, Rissito Centricia Mukhtar, Ishana Nafeeza Satiti, Sekar Sejahtera, Desin Pambudi Setyana, Michael Kevin Robby Taufiqurrohman, Agus