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All Journal Medicinus : Jurnal Kedokteran Magna Neurologica Acta Neurologica Indonesia
Stevano, Reza
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Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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Reversible Bilateral Basal Ganglia and Brainstem Lesions in Neuropsychiatric Systemic Lupus Erythematosus: A Case Report Situmeang, Rocksy Fransisca V.; Stevano, Reza; Larope, Ekawaty Yasinta Yohana; Sutanto, Ratna
Medicinus Vol 9, No 3 (2021): October 2021-January 2022
Publisher : Fakultas Kedokteran Universitas Pelita Harapan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19166/med.v9i3.4939

Abstract

The pathophysiology behind neuropsychiatric SLE (NPSLE) remains poorly understood and its clinical and radiological manifestations are highly varied. In this report, we present a complex case of an adolescent female patient with a three-week history of systemic symptoms (fever, nausea, vomiting, weight loss, polyarticular joint pain), progressive motor weakness, tremor, and altered mental status. Physical examination was significant for oromandibular and cervical dystonia rigidity, and general weakness with imposed right-sided hemiparesis. A head MRI demonstrated bilateral hyperintense lesions of the basal ganglia and brainstem, without restricted diffusion. The patient was diagnosed with NPSLE, lupus nephritis, electrolyte imbalance, severe hypoalbuminemia, lupus cardiomyopathy, autoimmune hemolytic anemia, pulmonary tuberculosis, and sepsis. The patient was given treatment in the ICU with pulse dose corticosteroids, intravenous antibiotics, intravenous immunoglobulins (IVIg), and supportive treatment with correction of hematologic and electrolyte abnormalities. Her condition improved rapidly. Full alertness was regained, and symptoms of oromandibular dystonia, tremor, and weakness diminished significantly. A follow-up MRI three weeks later revealed the complete disappearance of lesions, which we attribute to the resolution of the inflammatory process in the brain.
Reversible Bilateral Basal Ganglia and Brainstem Lesions in Neuropsychiatric Systemic Lupus Erythematosus: A Case Report Situmeang, Rocksy Fransisca V; Stevano, Reza; Larope, Ekawaty Yasinta Yohana; Sutanto, Ratna
Medicinus Vol 11, No 2 (2022): February
Publisher : Fakultas Kedokteran Universitas Pelita Harapan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19166/med.v9i3.6976

Abstract

The pathophysiology behind neuropsychiatric SLE (NPSLE) remains poorly understood and its clinical and radiological manifestations are highly varied. In this report, we present a complex case of an adolescent female patient with a three-week history of systemic symptoms (fever, nausea, vomiting, weight-loss, polyarticular joint pain), progressive motor weakness, tremor, and altered mental status. Physical examination was significant for oromandibular and cervical dystonia rigidity, and general weakness with imposed right-sided hemiparesis. A head MRI demonstrated bilateral hyperintense lesions of the basal ganglia and brainstem, SS without restricted diffusion. The patient was diagnosed with NPSLE, lupus nephritis, electrolyte imbalance, severe hypoalbuminemia, lupus cardiomyopathy, autoimmune hemolytic anemia, pulmonary tuberculosis, and sepsis. The patient was given treatment in the ICU with pulse dose corticosteroids, intravenous antibiotics, intravenous immunoglobulins (IVIg), and supportive treatment with correction of hematologic and electrolyte abnormalities. Her condition improved rapidly. Full alertness was regained, and symptoms of oromandibular dystonia, tremor, and weakness diminished significantly. A follow-up MRI three weeks later revealed complete disappearance of lesions, which we attribute to resolution of the inflammatory process in the brain.
Clinical Profile And Risk Factors Of Stroke: A Comparative Analytical Study Between Young And Old Onset Stevano, Reza; Margono, Jacqueline Tasha; Sutanto, Anyeliria
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.v1i1.470

Abstract

Background: With ever-increasing incidence, young-onset stroke is responsible for significant psychosocial and economic burden, primarily due to post-stroke disability in the productive population. Objective: The aim of our study is to assess the profile and risk factors in young-onset stroke compared to those in older patients. Methods: This was a retrospective cross-sectional study. We included all patients with acute stroke, or transient ischemic attack (TIA) treated at Siloam Lippo Village Hospital between October 2021 and February 2022. An independent t-test was conducted for continuous variables with normal distribution and a Mann-Whitney U test for ordinal or continuous variables with non-normal distribution. Pearson's chi-square test was performed for categorical variables. Results: 153 patients with acute stroke and TIA were included. On univariate analysis comparing young and old-onset strokes, significant differences were found in diagnosis (p=0.039), Bamford classification (p=0.022), NIHSS (p=0.014), history of smoking (p=0.012), previous stroke (p=0.045), history of coronary artery disease (p=0.026), and routine antiplatelet use (p=0.018). Conclusion: We found a predominance of hemorrhagic stroke and TIA in the young-onset group, with more common involvement of the anterior circulation. Older onset was associated with a higher NIHSS score. Modifiable risk factors are more common in young-onset stroke, while non-modifiable risk factors are more common in the older population. However, hypertension remains an equally important risk factor in both groups. Our study provides an overview of the profile and risk factors for young-onset stroke. The information obtained can be useful as educational material for the community to prevent young-onset stroke.
Cases of Meige’s Syndrome Controlled Following Administration of Low-Dose Botulinum Toxin Type-A: A Serial Case Series Ketaren, Retno Jayantri; Margono, Jacqueline Tasha; Stevano, Reza
Magna Neurologica Vol. 1 No. 2 (2023): 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.v1i2.700

Abstract

Background: Meige syndrome is a form of cranial dystonia characterised by blepharospasm and oromandibular dystonia, with a twice-fold higher prevalence in women as compared to men. The definitive pathophysiology underlying Meige syndrome remains unknown, but some studies have postulated the role of striatal dopaminergic activity. Currently, no curative treatments are available for Meige syndrome, but non-specific modalities include oral agents such as anti-cholinergics, dopaminergics, and benzodiazepines. Botulinum toxin Type-A (BoNTA) constitutes an effective treatment option in cases of Meige syndrome refractory to oral management. Case: We report three cases of female patients, age 42, 57, and 61 years, presenting with complaints of blepharospasm and oromandibular dystonia. Discussion: Low-dose BoNTA injections were administered, 10 units total weekly divided into the orbicularis oculi, corrugator supercilii, frontalis, procerus, nasalis, zygomaticus, mentalis, dan risorius, and orbicularis oris areas. Following repeated administrations of BoNTA injections, the three patients no longer experience symptoms up till now. Conclusion: The authors report that low-dose BoNTA injections are effective in ameliorating dystonic symptoms associated with Meige syndrome, with low incidences of side effects.
Reversible Bilateral Basal Ganglia and Brainstem Lesions in Neuropsychiatric Systemic Lupus Erythematosus: A Case Report Situmeang, Rocksy Fransisca V; Stevano, Reza; Larope, Ekawaty Yasinta Yohana; Sutanto, Ratna
Medicinus Vol. 11 No. 2 (2022): February
Publisher : Fakultas Kedokteran Universitas Pelita Harapan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19166/med.v9i3.6976

Abstract

The pathophysiology behind neuropsychiatric SLE (NPSLE) remains poorly understood and its clinical and radiological manifestations are highly varied. In this report, we present a complex case of an adolescent female patient with a three-week history of systemic symptoms (fever, nausea, vomiting, weight-loss, polyarticular joint pain), progressive motor weakness, tremor, and altered mental status. Physical examination was significant for oromandibular and cervical dystonia rigidity, and general weakness with imposed right-sided hemiparesis. A head MRI demonstrated bilateral hyperintense lesions of the basal ganglia and brainstem, SS without restricted diffusion. The patient was diagnosed with NPSLE, lupus nephritis, electrolyte imbalance, severe hypoalbuminemia, lupus cardiomyopathy, autoimmune hemolytic anemia, pulmonary tuberculosis, and sepsis. The patient was given treatment in the ICU with pulse dose corticosteroids, intravenous antibiotics, intravenous immunoglobulins (IVIg), and supportive treatment with correction of hematologic and electrolyte abnormalities. Her condition improved rapidly. Full alertness was regained, and symptoms of oromandibular dystonia, tremor, and weakness diminished significantly. A follow-up MRI three weeks later revealed complete disappearance of lesions, which we attribute to resolution of the inflammatory process in the brain.
Factors Affecting Progonosis in Tuberculous Meningoencephalitis Puspitasari, Vivien; Sutanto, Anyeliria; Stevano, Reza; Djuanda, Gerald
Acta Neurologica Indonesia Vol. 1 No. 01 (2023): Acta Neurologica Indonesia
Publisher : Departemen Neurologi Fakultas Kedokteran Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.69868/ani.v1i01.7

Abstract

Introduction: Cases of tuberculosis is still highly prevalent in the world, including Indonesia.Tuberculous meningoencephalitis (TBME) is the most severe form of tuberculosis. This study aims to establish the factors affecting prognosis in TBME. Objective: To Identify the clinical factors that affect the prognosis of tuberculous meningoencephalitis patients. Material and Methods: This is cross-sectional study evaluating factors (clinical features, imaging, and treatment) affecting prognosis in TBME patients who underwent treatment in Siloam Hospitals Lippo Village. Univariate analyses was done, followed by bivariate analyses with logistic regression to compare factors between good (Glasgow outcome scale [GOS] 4-5) and poor (GOS 1-3) prognosis. Results and Discussion: 64 patients were included. On univariate analysis, significant differences was found between Glasgow coma scale (GCS) scores (p=0.012), clinical features of meningeal irritation (p=0.004), findings of hydrocephalus (p=0.023) and vasculitis/infarction (p=0.020) on imaging, antibiotic use (p=0.013), and MRC grading (p=0.008). On logistic regression, 4 factors were found to be significant: headache (OR 5.398 95% CI 1.165-25.008, p=0.031), meningeal irritation (OR 0.146 95% CI 0.026-0.813, p=0.028), hydrocephalus (OR 0.167 95% CI 0.032-0.881, p=0.035), and antibiotic use (OR 0.155 95% CI 0.034-0.717, p=0.017). Conclusion: Clinical manifestations of meningeal irritation and altered consciousness, imaging findings of hydrocephalus and vasculitis/infarction, and antibiotic usage is associated with poor prognosis, while presence of headache is associated with a better prognosis.
Co-Authors Djuanda, Gerald Ketaren, Retno Jayantri Larope, Ekawaty Yasinta Yohana Margono, Jacqueline Tasha Situmeang, Rocksy Fransisca V Situmeang, Rocksy Fransisca V. Sutanto, Anyeliria Sutanto, Ratna Vivien Puspitasari, Vivien