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All Journal Medicinus : Jurnal Kedokteran Indonesian Journal of Medicine
Sutanto, Ratna
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Medicine & Pharmacology 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.
Spinal Tuberculosis: Spectrum of MR Findings with Laboratory Evaluation Sutanto, Ratna; Pratama, Teodorus; Koesbandono, Koesbandono; Chandra, Yohanes
Indonesian Journal of Medicine Vol. 9 No. 3 (2024)
Publisher : Masters Program in Public Health, Sebelas Maret University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.26911/theijmed.2024.9.3.702

Abstract

Background: Tuberculosis infections are endemic diseases in Asian countries. Although the incidence is rare, tuberculous spondylitis manifests as a severe and life-threatening disease. This study aims to correlate the abnormal result of erythrocyte sedimentation rate (ESR) and magnetic resonance (MR) imaging findings. Subjects and Method: MR imaging of 60 patients with characteristics of spinal tuberculosis in 4-year 5 month period (January 2019 – May 2023) from Siloam Lippo Village is retrospectively analyzed and reviewed. Data were collected from Infinitt PACS and analyzed by SPSS. Dependent variables in this study are clinical suspicion for tuberculosis infection, erythrocyte sedimentation rate (ESR), and tuberculosis infection in different organs. Meanwhile, the independent variables in this study are multilevel vertebral involvement, multilevel disc involvement, abscess formation, and myelopathy. Results: Association with elevated ESR (erytrocyte sedymentation rate) are seen in 11 out of 31 patients aged >40 (OR=0.45; CI 95%= 0.16 to 1.26; p=0.120), 19 out of 37 patients with clinically suspected for tuberculosis infection (OR=1.98; CI 95% 0.68 to 5.78; p=0.210); 27 out of 55 patients with multilevel vertebral body involvement (OR=0.8; CI 95%= 0.12 to 5.17); p=1); 13 out of 30 patients with intervertebral disc involvement (OR=0.87; CI 95% 0.32 –to2.42); p=0.8); 20 out of 50 patients with abscess formation(OR=0.29; CI 95%=0.66 to 1.24; p=0.08); 5 out of 12 patients with tuberculosis infection on other organs(OR=0.84; CI 95%=0.24 – 3.04; p=0.8); and 5 out of 6 patients with myelopathy(OR=7.3; CI95%=0.79 TO 66.6; p=0.04). Conclusion: MR has an important role in detecting extrapulmonary tuberculosis lesions, especially in the spine. Elevated ESR results play important roles for physicians in identifying patients with the possibility of spondylitis TB.
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.
Co-Authors Koesbandono, Koesbandono Larope, Ekawaty Yasinta Yohana Pratama, Teodorus Situmeang, Rocksy Fransisca V Situmeang, Rocksy Fransisca V. Stevano, Reza Yohanes Chandra