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All Journal Althea Medical Journal MNJ (Malang Neurology Journal) Universa Medicina Majalah Kedokteran Neurosains Biomolecular and Health Science Journal Indian Journal of Forensic Medicine & Toxicology AKSONA Magna Neurologica Journal of Neurointervention and Stroke (JNeViS)
Achmad Firdaus Sani, Achmad Firdaus
Departemen Neurologi, Fakultas Kedokteran, Universitas Airlangga; RSUD Dr. Soetomo, Surabaya, Indonesia
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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Cerebral Proliferative Angiopathy as the Cause of Symptomatic Epilepsy in a Young Adult Male: A First Case Report from Indonesia Swatan, Jovian Philip; Sani, Achmad Firdaus; Islamiyah, Wardah Rahmatul; Kurniawan, Dedy; Fatimah, Ersifa
Magna Neurologica Vol. 2 No. 1 (2024): 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.v2i1.895

Abstract

Background: Cerebral proliferative angiopathy (CPA) is a rare and distinct vascular malformation that was once considered a subset of cerebral arteriovenous malformation (AVM). Due to its relatively benign course with no distinctive clinical feature, CPA may often be overlooked and misdiagnosed with other diseases. We would like to report a case of CPA as the underlying cause of symptomatic epilepsy. Case: A 31-year-old male presented to the outpatient clinic with a history of focal to bilateral tonic-clonic seizure for 2 years. Following conservative management with an oral antiepileptic agent, the seizure frequency significantly decreased from once daily to once or twice monthly. The patient was lost to follow-up; however, he was incidentally referred back to our clinic two years later for further evaluation. A head Magnetic Resonance Imaging and Magnetic Resonance Angiography revealed a suspicion of giant AVM in the left hemisphere. Cerebral digital subtraction angiography (DSA) was performed and revealed a CPA in the left frontal area. The patient was managed conservatively, and during the 6-month follow-up period, the patient did not have any seizures. Discussion: In young adults, seizures may be caused by an underlying vascular abnormality. Cerebral DSA remained the gold standard for distinguishing various etiologies of vascular malformation, including CPA. Conclusion: Conservative treatment using oral antiepileptic agents was effective in controlling the seizure frequency in CPA. However, a complete diagnostic evaluation is still warranted to determine the most appropriate treatment while revealing some peculiar and unexpected etiologies in the process.
The Impact of Elevated Mean Arterial Pressure on Mortality in Spontaneous Subarachnoid Hemorrhage Sani, Achmad Firdaus; Laisari, Taurus; Yahya, Muh. Wildan; Rahmawati, Vita Kusuma; Hamdani, Faishol; Kurniawan, Dedy; Setyowatie, Sita
Journal of Neurointervention and Stroke Vol. 1 No. 1: MAY 2025
Publisher : Neurointervention Working Group of Indonesian Neurological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.63937/jnevis-2025.11.2

Abstract

Highlight: Elevated MAP is associated with increased in-hospital mortality in SAH patients High MAP increases the risk of rebleeding, cerebral edema, and vasospasm MAP, age, infection, and hydrocephalus are independent predictors of mortality ABSTRACT Introduction: Subarachnoid hemorrhage (SAH) remains a critical neurological emergency with high mortality and morbidity. Mean arterial pressure (MAP) plays an importance role in cerebral perfusion and hemodynamic stability in SAH patients. However, excessive MAP elevation potentially worsening clinical outcomes. This study investigates the impact of elevated MAP on in-hospital mortality among SAH patients. Objective: This study investigates the impact of elevated MAP on in-hospital mortality among SAH patients.  Method: A retrospective cross-sectional study was conducted using medical records of SAH patients admitted to Dr. Soetomo Academic Medical Center Hospital from 2013 to 2021. A total of 360 patients met the inclusion criteria. MAP was calculated upon admission and categorized as ≥125 mmHg or <125 mmHg. The primary outcome was in-hospital mortality. Logistic regression analysis was performed to assess the association between MAP and mortality while adjusting for confounders. Result: Among 360 SAH patients, 44.8% did not survive hospitalization. The mean age was 54 years, with an initial mean MAP of 117.45±21.6 mmHg. Bivariate analysis showed that MAP ≥125 mmHg significantly increased mortality risk (OR = 1.93; 95% CI: 1.24–2.98; p = 0.002). Multivariate logistic regression identified MAP ≥125 mmHg as an independent predictor of mortality (Adjusted OR = 1.795; p = 0.012), alongside age (Adjusted OR = 2.043; p = 0.004), infection (Adjusted OR = 2.442; p = 0.001), and hydrocephalus (Adjusted OR = 2.174; p = 0.003). Conclusion: Elevated MAP (≥125 mmHg) is significantly associated with increased in-hospital mortality in SAH patients. These findings highlight the importance of early hemodynamic management in SAH to improve patient survival.
Indonesian Stroke Management Neurointerventional Services Challenges Usman, Fritz Sumantri; Sani, Achmad Firdaus; Octaviana, Fitri; Kastilong, Merlin Prisilia; Kurnia, Leny; Hendartono, Theodorus K; Atmadja, Andika S; Tambunan, Yan Leo; Syahrul, Syahrul; Pramukarso, Dodik Tugasworo
Journal of Neurointervention and Stroke Vol. 1 No. 1: MAY 2025
Publisher : Neurointervention Working Group of Indonesian Neurological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.63937/jnevis-2025.11.3

Abstract

Highlight: Stroke burden in Indonesia Challenges for Indonesian neurointerventionst ABSTRACT Introduction: Stroke is a leading cause of death and disability in Indonesia. Currently, stroke management has become more aggressive, and neurointerventionists are required to optimize acute stroke management. Objective: To determine the distribution of neurointerventionists in Indonesia and identify the obstacles faced in neurointervention services. Method: This cross-sectional study used an online questionnaire distributed to neurointerventionists in Indonesia between October and November 2024. Result: A total of 105 neurointerventionists completed the questionnaires. The distribution of neurointerventionists remains concentrated in Java, especially in Jakarta. The highest ratio of neurointerventionists to stroke cases was observed in Jakarta, while the lowest was in Lampung. West Java identified the largest gap in the number of neurointerventionists compared to Jakarta. Notably, 20.9% of neurointerventionists had not performed any neurointerventional procedures, and 46.8% reported challenges related to the funding of neurointerventional procedures through government insurance. Conclusion: Despite the increasing number of neurointerventionists in Indonesia, their distribution remains concentrated in Java. The main barrier was the funding of neurointerventional procedures through government insurance.
Deferring Angioplasty and Stenting based on Natural Progression in Severe Middle Cerebral Artery Stenosis: An Observation of Two Cases Rahmawati, Vita Kusuma; Sani, Achmad Firdaus; Kurniawan, Dedy; Yahya, Muh. Wildan; Hamdani, Faishol
Journal of Neurointervention and Stroke Vol. 1 No. 1: MAY 2025
Publisher : Neurointervention Working Group of Indonesian Neurological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.63937/jnevis-2025.11.5

Abstract

Highlight: MCA stenosis may remodel spontaneously or progress to complete occlusion Serial imaging observing progression spots high-risk cases, guiding intervention ABSTRACT Introduction: Severe middle cerebral artery (MCA) stenosis, as one of the intracranial atherosclerotic diseases, is a major cause of ischemic stroke. The role and optimal timing of interventions, such as angioplasty and stenting, remain subjects of debate, particularly due to the variable natural disease progression. While some cases improve spontaneously, others progress to total occlusion, necessitating comprehensive evaluation of individualized treatment approaches. Cases: This case series presents two patients with severe MCA stenosis, each of whom followed a distinct clinical courses. The first patient had 88% stenosis in the M1 segment of the right MCA (NIHSS 3, mRS 2), which spontaneously improved to 57% within days (NIHSS 2, mRS 2), with enhanced distal flow, leading to the decision to defer angioplasty and stenting. In contrast, the second patient initially had severe left MCA stenosis (NIHSS 10, mRS 4), which progressed to total occlusion within three months (NIHSS 10, mRS 4), also resulting in deferred intervention. Serial cerebral digital subtraction angiography (DSA) facilitated the observation of vascular evolution and collateral circulation, guiding decisions about intervention. Conclusion: The clinical outcomes of MCA stenosis range widely, from spontaneous resolution to progressive occlusion. Close serial imaging observation of collateral circulation and natural progression is essential for guiding decisions about angioplasty and stenting.  
Improvement of Hemifacial Spasm Following Palliative Embolization of an Unruptured Cerebellar Arteriovenous Malformation Kastilong, Merlin Prisilia; Usman, Fritz Sumantri; Sani, Achmad Firdaus; Saputra, Gilang Nispu; Darmawan, Octavianus; Muin, Rahmi; Kurnia, Leny; Keneddy, Erman
Journal of Neurointervention and Stroke Vol. 1 No. 1: MAY 2025
Publisher : Neurointervention Working Group of Indonesian Neurological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.63937/jnevis-2025.11.6

Abstract

Highlight: Cerebellar region's AVM and hemifascial spasm Embolization AVM and hemifacial spasm ABSTRACT Introduction: Posterior fossa arteriovenous malformations (AVMs) are uncommon, accounting for 7–15% of all intracranial AVMs. These malformations typically present with symptoms such as headaches, seizure, and intracerebral hemorrhage. Reports of hemifacial spasm–characterized by involuntary contractions of the facial muscles–as a presenting symptom of AVMs are extremely rare and usually occur only when the facial nerve is compressed. Case: A 35-year-old male presented with worsening left-sided hemifacial spasm, unresponsive to medication for around one year, followed by progressive headache and dizziness. T2-weighted MRI revealed contact between the facial nerve root and a tortuous posterior inferior cerebellar artery (PICA), along with an AVM in the left cerebellar hemisphere. Cerebral angiography demonstrated a left cerebellar AVM with feeding arteries from superior cerebellar artery (SCA) and PICA. The patient underwent successful embolization of the SCA using glue (n-BCA:lipiodol). An intraprocedural thrombus developed but was managed appropriately. Post-procedural cerebral angiography revealed recanalization of the basilar artery and left PICA, with a 30% reduction in nidus size. The hemifacial spasm improved significantly after embolization with an HFS-7 score reduction of six points in the first week post-procedure. Conclusion: Palliative embolization has shown potential in alleviating symptoms associated with hemifacial spasm and improving quality of life. Careful patient selection is essential to rule out secondary causes of hemifacial spasm and to identify underlying neurovascular contacts.
Co-Authors Adrianto, Yudhi Archangela Olivia Eugenia Ardhi, Mohammad Saiful Atmadja, Andika S Basuki, Mudjiani Chandrawati Widya Hartati Darmawan, Ahmad Faisal Darmawan, Octavianus Dedy Kurniawan Fadil Fadil Fatimah, Ersifa Fidiana Fidiana, Fidiana Fitri Octaviana Fritz Sumantri Usman, Fritz Sumantri Hamdani, Faishol Hendartono, Theodorus K Hermawan Susanto Islamiyah, Wardah Rahmatul Jongky Hendro Prajitno Kastilong, Merlin Prisilia Keneddy, Erman Kurnia, Leny Laisari, Taurus MARIA BINTANG Mohammad Pratama Jauhar Putra Muh. Wildan Yahya Muin, Rahmi Pramukarso, Dodik Tugasworo Puji Lestari Rahmawati, Vita Kusuma Ramadhania, Nadya Noor Rizky Hartono Rizky Hartono, Rizky Saputra, Gilang Nispu Shakir Husain, Shakir Siswahyudianto Sita Setyowatie Sita Setyowatie Swatan, Jovian Philip Syahrul Syahrul Tambunan, Yan Leo Taurus Laisari Yahya, Muh. Wildan Yusak Maryunianta