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Long-COVID neurological symptoms are associated with D-dimer levels in COVID-19 patients Diah Kurnia Mirawati; Pepi Budianto; Rivan Danuaji; Subandi Subandi; Ira Ristinawati; Hanindia Riani Prabaningtyas
Universa Medicina Vol. 41 No. 2 (2022)
Publisher : Faculty of Medicine, Universitas Trisakti

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18051/UnivMed.2022.v41.169-175

Abstract

Background Coronavirus disease 2019 (COVID-19) is a disease designated as a global pandemic by the WHO that can manifest clinically as neurological disorders that can occur in the acute phase or after the acute phase (long COVID-19), such as headache, myalgia, anosmia, and cognitive impairment. These neurological disorders as symptoms of long COVID-19 are presumably caused by hypercoagulable conditions characterized by an increase in D-dimer level. This study aims to determine the correlation of long COVID-19 neurological symptoms with hypercoagulable conditions and the role of D-dimer as a biomarker of long COVID-19 neurological symptoms. MethodsThis was a cross-sectional study involving 31 patients with long COVID-19 symptoms. Admitted long COVID-19 cases with recorded D-dimer levels and definitive outcomes were included consecutively. Long COVID-19 neurological symptoms were collected. D-dimer level was measured using immunofluorescence assay and reported in fibrinogen equivalent units (ìg/mL). The correlation between D-dimer levels and neurological clinical manifestations was assessed by using ordinal regression analysis. The p-value of <0.05 was considered statistically significant. ResultsThe mean age of the subjects was 38.81 ± 11.58 years and 18 (58.06%) were female. Long COVID neurological symptoms comprised myalgia, anosmia and cephalgia, and most subjects complained of myalgia (80.65%). On multivariable analysis, long-COVID-19 neurological symptoms were significantly correlated with D-dimer [odds ratio (OR) = 1.05; p=0.020]. ConclusionThe number of neurological long COVID symptoms were significantly correlated with level of D-Dimer. Ultimately, more clarity is needed on the neurological impact of COVID-19, its diagnosis, and its treatment.
Hematomyelia Akibat Traumatic Lumbar yang Menyebabkan Syok Spinal: Sebuah Laporan Kasus Raden Andi Ario Tedjo; Lawly Arrel Dionnie Greatalya; Vivienne Tjung; Muhammad Hafizhan; Stefanus Erdana Putra; Suroto Suroto; Diah Kurnia Mirawati; Subandi Subandi; Rivan Danuaji; Pepi Budianto; Yetty Hambarsari; Baarid Luqman Hamidi; Hanindia Riani Prabaningtyas; Ervina Arta Jayanti Hutabarat; Ira Ristinawati; Teddy Tejomukti
Jurnal Keperawatan Padjadjaran Vol. 11 No. 3 (2023): Jurnal Keperawatan Padjadjaran
Publisher : Faculty of Nursing Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24198/jkp.v11i3.2352

Abstract

Background: Spinal cord hemorrhage or hematomyelia can arise from trauma or non-trauma causes, adverse effect of anticoagulation therapy and ruptured vascular malformation. Bleeding in epidural space is common and complications such as acute spinal cord syndrome can arise due to the compression and destruction of the spinal cord. Symptoms of hematomyelia might be varied depending on location of the lesion, often accompanied with acute radicular pain. In this case study, we reported a case of spinal shock after traumatic lumbar hematomyelia. Case: A 13-year-old girl presented to Dr. Moewardi General Hospital with inferior paraparesis, bladder and bowel incontinence, a day after falling on her gluteus. Physical examination revealed reduced motoric and sensory function below 12th thoracal dermatome, with no patellar and reduced Achilles reflexes. Conventional X-ray was unremarkable and further investigation with MRI showed a hematoma on thoracal 10 to 12 vertebrae. Motor and sensory functions were improved after 12 days administration of corticosteroids and further improvement was seen almost immediately after decompression surgery. Objective: To describe a case of spinal shock caused by traumatic lumbar hematomyelia Method: This is a case report study describing spinal shock which improved after administration of corticosteroid and decompression surgery. Conclusion: Spinal shock could be caused by traumatic lumbar hematomyelia, which is characterized by loss of motor, sensory, and bladder function, and decompression surgery improved the prognosis.
Correlation between Neutrophil/Lymphocyte Ratio (NLR), lipid profile, lesion location and vascular cognitive impairment in acute ischemic stroke patients Ira Ristinawati; Kenneth Tan; Benedictus Benedictus; Muhammad Hafizhan; Stefanus Erdana Putra; Suroto Suroto; Diah Kurnia Mirawati; Subandi Subandi; Rivan Danuaji; Pepi Budianto; Yetty Hambarsari; Baarid Luqman Hamidi; Hanindia Riani Prabaningtyas; Ervina Arta Jayanti Hutabarat; Teddy Tejomukti; Raden Andi Ario Tedjo
Jurnal Keperawatan Padjadjaran Vol. 12 No. 2 (2024): Jurnal Keperawatan Padjadjaran
Publisher : Faculty of Nursing Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24198/jkp.v12i2.2526

Abstract

Background: Stroke is the leading cause of long-term disability with significant clinical and socioeconomic impact worldwide. Hyperlipidemia and inflammation play major roles in ischemic stroke. This research focuses on the correlation of three factors, namely Neutrophil-Lymphocyte Ratio (NLR), lipid profile, and lesion location, with Vascular Cognitive Impairment (VCI). These factors may serve as potential predictors for VCI. Purpose: This research aims to study the correlation between NLR, lipid profile, and lesion location with vascular cognitive impairment. Besides, this research aims to explore those potential biomarkers as predictors of vascular cognitive impairment. Methods: This was a cross-sectional study which included 107 patients diagnosed with ischemic stroke from February 2022 to January 2023 with a history of admission to the hospital within 72 hours. After signed an informed consent form, every patient had history taking, physical exam, lipid profile, routine blood test, Mini Mental State Examination (MMSE) and Montreal Cognitive Assessment Indonesian Version (MoCA-Ina) on the first hospital day. Statistical tests were done with Spearman correlation method. Results: The data distribution was not normal for INR and MoCA-INA values (p<0.05).  Total cholesterol was insignificantly (p=0.092) correlated with MoCA-INA score with low correlation value (r=-0.293). HDL was significantly (p=0.035) correlated with MoCA-INA score with moderate correlation value (r=0.461). LDL was significantly (p=0.028) correlated with MoCA-INA score with low correlation value (r=-0.387). Triglycerides was insignificantly (p=0.440) correlated with MoCA-INA score with very weak correlation value (r=-0.137). NLR was significantly (p=0.015) correlated with MoCA-INA score with moderate correlation value (r=-0.412). Conclusions: Lipid profile is correlated with cognitive impairment in post stroke patients, with HDL being a protective factor, and LDL as risk factor. NLR was associated with worse cognitive function and LDL was directly proportional to NLR. Lesion location reporting was highly heterogeneous and more uniformed reporting is recommended for future research.
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.
Correlation of electrolytes with falling risk, cognitive function, and functional outcome in acute ischemic stroke patient Mirawati, Diah Kurnia; Ristinawati, Ira; Prabaningtyas, Hanindia Riani; Tedjo, Raden Andi Ario; Putra, Stefanus Erdana; Hafizhan, Muhammad; Ilhamsyah, Rudi
International Journal of Public Health Science (IJPHS) Vol 13, No 3: September 2024
Publisher : Intelektual Pustaka Media Utama

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.11591/ijphs.v13i3.23839

Abstract

Stroke outcome is determined on multiple factors. However, there are limited studies discussing the impact of electrolyte imbalance on stroke outcome. In this study, we analyzed sodium, calcium, and potassium level in acute ischemic stroke, and compare their risk of falling, cognitive function, and functional outcome. This was a cross-sectional study in Dr. Moewardi General Hospital, Indonesia between January and June 2023. Patient with acute ischemic stroke were enrolled in this study. Cognitive function was assessed with mini mental state examination (MMSE) and the Indonesian version of montreal cognitive assessment (MoCA-Ina). National Institutes of Health Stroke Scale (NIHSS), Modified Rankin Scale (MRS) and Morse Fall Score (MFS) were used to assessed stroke severity, disability, and risk of falling, respectively. Pearson correlation was then performed to evaluate the correlation of electrolytes level with MMSE, MoCA-Ina, NIHSS, MRS, and MFS. Furthermore, we also analyzed the odds ratio of increasing risk of falling, cognitive function deterioration, and worse functional outcome. A p-value of <0.05 is considered statistically significant. On univariate analysis, natrium is correlated with MMSE (r=0.174; p=0.042), NIHSS (r=-0.412; p=0.011), MRS (r=-0.174; p=0.042), and MFS (r=-0.304; p=0.042). Potassium is correlated with MMSE (r=0.344; p=0.044), MoCA-INA (r=0.341; p=0.048), NIHSS (r=-0.572; p=0.019), (MRS r=-0.376; p=0.017), and MFS (r=-0.612; p=0.031). Calcium is correlated with NIHSS r=-0.348 (p=0.018), MRS r=-0.256 (p=0.036). On odds ratio analysis, low natrium level increased the risk of deteriorating cognitive function, and low level of potassium increased the risk of falling. Electrolyte imbalances correlates with risk of falling and deteriorating cognitive function.
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.
Profile of Cognitive Impairement in Patients with Brain Tumors in Dr. Moewardi Hospital, Surakarta Hapsari, Maria Yosita Ayu; Ilyas, Muhana Fawwazy; Ristinawati, Ira; Stepvia, Stepvia; Novika, Revi Gama Hatta
Indonesian Journal of Medicine Vol. 7 No. 2 (2022)
Publisher : Masters Program in Public Health, Sebelas Maret University

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (31.798 KB) | DOI: 10.26911/theijmed.2022.7.2.532

Abstract

Background: Brain tumor is a disease that is difficult to treat and causes high morbidity and morta¬lity. One of the clinical manifestations of brain tumors is cognitive impairment which is the most common neurological problem. The aim of this study is to determine the profile of cognitive impairment in patients with brain tumors.Subjects and Method: The design of this study was a retrospective cross-sectional using secondary data from the Neurology Polyclinic of RSUD Dr. Moewardi in January 2021-March 2022. The subject was diagnosed with a brain tumor based on anamnesis, physical examination, and neuroimaging. Cognitive impairment was inferred through the MoCA-Ina test. The analysis used was univariate descriptive analysis, independent T test, Mann-Whitney test, and Pearson correlation test.Results: There were 29 subjects with a mean MoCA-Ina score (17.97). Primary brain tumors (79.3%), more than metastatic tumors. The majority of patients were diagnosed with meningioma (55.2%). This study showed that there were differences in abstraction scores (p=0.015) and total MoCA-Ina scores (p=0.042) between patients with tumors located in the temporal lobe and non- temporal lobe; differences in abstraction scores (p=0.034) and orientation scores (p=0.042) between patients with supratentorial and infratentorial tumors; and differences in memory scores (p=0.028) between patients with and without radiation history. In addition, this study also found an association between the number of lobes affected by brain tumors with attention score (p=0.027; r=-0.409), abstraction score (p=0.004; r=-0.524), orientation score (p=0.021; r=-0.426), and the total score of MoCA-Ina (p=0.018, r=-0.435).Conclusion: There is an association between brain tumors and cognitive impairment which is concluded through the MoCA-Ina test. The clinical manifestations of cognitive impairment in the patient are in accordance with the neuroanatomical function of the brain affected by the lesion.Keywords: Cognitive, Tumor, MoCA-InaCorrespondence: Maria Yosita Ayu Hapsari. Department of Neurology, Faculty of Medicine, Universitas Sebelas Maret/ Moewardi Hospital, Indonesia. Email: ayositahapsari@gmail.com. Phone: 0813 3155 5412.Indonesian Journal of Medicine (2022), 07(02): 242-250https://doi.org/10.26911/theijmed.2022.07.02.12
SYSTEMATIC REVIEW AND META-ANALYSIS ON THE RELATIONSHIP BETWEEN NEURODEGENERATIVE BIOMARKERS AND NEUROBEHAVIORAL CHANGES Ristinawati, Ira; Ilhamsyah, Rudi; Yang, Han; Pradana, Muhammad Yusuf Brilliant; Putra, Mohammad Sandhia Mahardhika
MNJ (Malang Neurology Journal) Vol. 12 No. 1 (2026): 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.2025.012.01.15

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Background: Neurodegenerative diseases represent a growing global health challenge, with early detection remaining elusive in clinical settings. Recent advances in fluid biomarkers have enabled the identification of molecular changes preceding clinical symptoms, thus offering promising avenues for early diagnosis and personalized management. This review synthesizes current findings on biomarker utility alongside neuroimaging in neurodegenerative disease detection and prognosis Objective: To evaluate the diagnostic accuracy and prognostic value of fluid biomarkers and neuroimaging in the early detection of neurodegenerative diseases, with a focus on Alzheimer’s disease. Methods: This systematic review and meta-analysis, registered in PROSPERO (CRD420251142436), followed PRISMA guidelines. Comprehensive searches across PubMed and Scopus identified peer-reviewed studies from 1985–2025 on neurodegenerative biomarkers and neurobehavioral changes. Standardized mean differences (SMD) along with 95% confidence intervals (CI) were calculated using a random-effects model to address study variability. The degree of heterogeneity was quantified by the I² statistic, while publication bias was assessed qualitatively due to the limited number of included studies. Results: This Meta-analysis reveals heterogeneity in biomarker-MRI correlations, biomarkers demonstrate remarkable accuracy in detecting Alzheimer’s at its earliest stages. This early detection capability for early intervention. No consistent overall effect emerged, underscoring standardization protocols remains a major challenge. Conclusion: Biomarker represent a promising approach for early detection and precise intervention in Alzheimer’s disease. Integrating fluid biomarkers, advanced neuroimaging, and standardized cerebrospinal fluid analysis enhances diagnostic accuracy and enables timely therapy during the prodromal stage. Future research should explore synergies between fluid biomarkers and digital cognitive tools to develop scalable, cost-effective screening protocols.
Comparison of Cognitive Function Examination Using Montreal Cognitive Assessment (MOCA-INA) with Telephone Moca (T-MOCA) Ristinawati, Ira; Fairuzya, Azmi Farah
Smart Medical Journal Vol 5, No 3 (2022): Smart Medical Journal
Publisher : Faculty of Medicine Universitas Sebelas Maret

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.13057/smj.v5i3.66435

Abstract

Introduction: The prevalence of dementia tends to increase over time. MOCA assessment tool is a cognitive function screening test that has high sensitivity. Telephone-based MOCA assessment has potential of detection and monitoring dementia which can be widely applied.Methods: This is an observational study with cross-sectional approach in the Neurology Outpatient Department RSUD Dr. Moewardi. The aim of this study is to compare the effectiveness of MOCA-INA assessment tool with the T-MOCA.Results: There were 424 patients who underwent MOCA-INA examination during January-June 2022. After screening, 185 patients were able to complete the study. Subjects consisted of 67 males (36.2%) and 118 females (63.8%); aged 65-74 years (44.9%), 75-84 years (25.9%), and 85 years (29.2%). It was found that the conformity diagnosis of MOCA-INA to T-MOCA was 82.3% in the conversion test. There were significant differences between normal patients and MCI patients in age (p=0.000), education level (p=0.000), MOCA-INA score (p=0.000), and T-MOCA score (p=0.000). The relationship between MOCA-INA and T-MOCA has a strong positive correlation (p = 0.000; r = 0.789). Subsequent correlation test between MOCA-INA and T-MoCA showed a strong significant relationship in the direction of gender (p = 0.000; r = 0.438) and education level (p = 0.000; r = -0.323)Conclusion: Both MOCA-INA and T-MOCA could significantly determine the level of cognitive function with a strong correlation between the two assessments.
Intracranial and Extracranial Vertebrobasilar Artery Stenosis Patient Profile in Dr. Moewardi General Hospital Subandi, Subandi; Suroto, Suroto; Mirawati, Diah Kurnia; Danuaji, Rivan; Budianto, Pepi; Hambarsari, Yetty; Hamidi, Baarid Luqman; Prabaningtyas, Hanindia Riani; Hutabarat, Ervina Arta Jayanti; Tejomukti, Teddy; Ristinawati, Ira; Tedjo, Raden Andi Ario; Pretikasari, Zefania Yonisa; Hafizhan, Muhammad; Putra, Stefanus Erdana
Smart Medical Journal Vol 6, No 3 (2023): December
Publisher : Faculty of Medicine Universitas Sebelas Maret

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.13057/smj.v6i3.71299

Abstract

Introduction: Vertebrobasilar artery stenosis can be extracranial or intracranial, and accounts for up to 20% of posterior circulation ischemic strokes. The gold standard for diagnosing is Digital Subtraction Angiography (DSA), an invasive diagnostic method by injecting a contrast agent into the blood vessels leading to the brain through a catheter. This study aims to determine the profile of patients with intracranial and extracranial vertebrobasilar artery stenosis who underwent DSA procedures.Methods: This descriptive research was conducted in RSUD Dr. Moewardi in patients who underwent DSA procedures for the period January 2020 to March 2022 and found vertebrobasilar artery stenosis. The study samples were grouped based on the location of the stenosis; intracranial and extracranial. The data collected included age, gender, symptoms, risk factors, degree of stenosis, and angiographic findings.Results: Of 42 subjects, 33 (78.6%) patients were male. There are 23 (54.8%) patients with intracranial vertebrobasilar stenosis and 19 (45.2%) patients in extracranial. The main symptoms included hemiparesis, vertigo, hemiesthesia, loss of consiciousness, aphasia, dysartria, and dysphagia. The risk factors were 36 (85.7%) patients with hypertension, 18 (42.9%) patients with diabetes mellitus, 18 (42.9%) patients with a history of smoking, and 13 (31%) patients with hyperlipidemia. A total of 8 patients underwent stenting/angioplasty.Conclusion: The prevalence of vertebrobasilar artery stenosis increases with age, most commonly occurring at the age of 50-59 years..The most common risk factor for vertebrobasilar artery stenosis is hypertension. Management recommendations include a combination of antiplatelet and endovascular therapy.