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All Journal Jurnal Sinaps Majalah Kedokteran Neurosains Cermin Dunia Kedokteran Magna Neurologica Neurona
Riwanti Estiasari
Departemen Neurologi Fakultas Kedokteran Universitas Indonesia, RSUPN Dr. Cipto Mangunkusumo Jakarta
Education Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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Sklerosis Multipel Riwanti Estiasari
Cermin Dunia Kedokteran Vol 41, No 6 (2014): Bedah
Publisher : PT. Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55175/cdk.v41i6.1130

Abstract

Sklerosis Multipel (MS) adalah penyakit autoimun yang terutama menyerang perempuan usia muda, tergolong penyakit langka di Indonesia. Meskipun demikian, penyakit ini dapat mengakibatkan kecacatan dan menurunkan kualitas hidup. Penegakan diagnosis yang akurat sangat diperlukan agar pasien MS bisa mendapatkan pengobatan yang adekuat sedini mungkin. Tata laksana pasien MS perlu memperhatikan tipe MS dan gejala yang menyertai.Multiple sclerosis (MS) is an autoimmune disease that mostly affected young women; this disease is rare in Indonesia. Nevertheless, MS can result in severe disability and decreased quality of life. Accurate diagnosis is needed as early as possible to initiate proper treatment. In MS management it is important to classify the disease and also treat the accompanying symptoms.
Diagnosis dan Tatalaksana Meningitis Bakterialis Gogor Meisadona; Anne Dina Soebroto; Riwanti Estiasari
Cermin Dunia Kedokteran Vol 42, No 1 (2015): Neurologi
Publisher : PT. Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55175/cdk.v42i1.1048

Abstract

Meningitis bakterialis (MB) adalah kegawatdaruratan neurologik yang mengancam jiwa dan memerlukan diagnosis serta terapi yang cepat. Penanganan MB memerlukan pendekatan interdisipliner. Penegakan diagnosis MB kadang sulit jika hanya mengandalkan anamnesis dan pemeriksaan fisik. Hasil pemeriksaan cairan serebrospinal (CSS) harus diinterpretasikan secara hati-hati. Pemahaman karakter pasien sangat dibutuhkan untuk memberikan antibiotik empirik yang tepat.Bacterial meningitis is a life-threatening neurologic emergency that needs rapid diagnosis and treatment. Management of bacterial meningitis needs interdisciplinary approach. The diagnosis of bacterial meningitis can sometimes be difficult when relying only on history and physical examination. Cerebrospinal fluid (CSF) examination results must be interpreted carefully. To provide appropriate empiric antibiotics therapy, understanding of patient’s characteristic is essential. 
Characteristics of Ocular Fundusin Brain Infections at Cipto Mangunkusumo Hospital Jakarta Purba, Maria Jheny Fulgensia; Pradita Sari; Septiana Andri Wardana; Ni Nengah Rida Ariarini; Kartika Maharani; Darma Imran; Riwanti Estiasari
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.v1i2.716

Abstract

Background: Brain infections (BI) may cause optic nerve abnormalities. Awareness on optic nerve abnormalities will be useful in assisting further management. The characteristics of the ocular fundus (fundus) in BI have not been widely studied in Indonesia. Objective: This study aimed to apprehend the depiction of the fundus in BI in Cipto Mangunkusumo Hospital Jakarta (RSCM). Methods: Cross-sectional study was conducted on October-December 2021 at RSCM. Inclusion criteria: BI patients who had fundas results. Exclusion criteria: fundas results cannot be interpreted. Images from 20D-lens fundoscopy were captured with a digital camera. Captured images were then interpreted by three examiners in disguise. Results are analyzed if there are similarities between at least two examiners. Results: Among 49 subjects, 25 had normal fundus. Abnormalities were found in 8 subjects: 4 (12.1%) papilledema, 3 (9.1%) papillatrophy, and 1 (3%) retinal hemorrhage. The highest mean aperture pressure was in the papillatrophy group (37 cmH2O), followed by papilledema (27 cmH2O). Cryptococcal meningitis caused papilledema in 60% of cases. Of BI cases with mortality, 80% were tuberculous meningitis with normal fundus. BI can increase ICP, but only 12.1% had papilledema. Papillatrophy indicated prolonged ICP elevation. The highest mortality was in the normal fundus group, suggesting papilledema alone is not a definitive predictor of poor prognosis due to confounding factors. Conclusion: Although BI causes an increase in ICP, papilledema is not always found. High aperture pressure was found in the papillatrophy group, but the highest mortality was found in the normal fundus group.
MULTIPEL SKLEROSIS PROGRESIF SEKUNDER, GEJALA KLINIS, DIAGNOSIS, DAN TATA LAKSANA Riwanti Estiasari; Nadia Devianca; Kartika Maharani; Darma Imran
NEURONA Vol 37 No 3 (2020)
Publisher : PERDOSNI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52386/neurona.v37i3.166

Abstract

Multiple sclerosis (MS) is a chronic inflammatory autoimmune disorder of the central nervous system (CNS) affecting the myelin. MS is very detrimental which causes disability and will reduce the productivity and quality of life of the patients, especially if it progressed to secondary progressive multiple sclerosis (SPMS) which there will be a continuous worsening of neurological deficits. Early detection of symptom progression can be done to overcome the problems that may occur in SPMS. By early detection, immediate therapy of SPMS can be given thus preventing the progression. It is therefore important for us to know the definition of SPMS, how to detect progression, and the treatment options for SPMS that will be explained in this literature review. Keywords: Progression, therapy, SPMS
Pendekatan Diagnosis dan Tata Laksana Multipel Sklerosis Sutanto, Anyelir; Widya Andini, Putri; Maharani, Kartika; Imran, Darma; estiasari, riwanti
Majalah Kedokteran Neurosains Perhimpunan Dokter Spesialis Saraf Indonesia Vol 40 No 1 (2023): Vol 40 No 1 (2023)
Publisher : PERDOSNI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52386/neurona.v40i1.420

Abstract

We reported three cases of young adults with typical and atypical neurological manifestations, supported by positive brain and spinal imaging findings, along with cerebrospinal fluid (CSF) analysis consistent with McDonald's criteria 2017 for multiple sclerosis (MS). Clinical manifestations varied with optic neuritis, myelopathy, vertigo, ataxia, and urinating problems in relapsing-remitting patterns in two cases and progressive in one other. Brain MRI showed T2-hyperintense lesion in cortical/juxtacortical, periventricular, and infratentorial areas, coupled with a spinal cord lesion shown in spinal MRI. The CSF analysis for oligoclonal band type II was positive in all cases. All three patients received relapse therapy with post-therapy clinical improvement, followed by long-term therapy with DMD (disease-modifying drugs) fingolimod, interferon β-1a, and one patient was treated with mycophenolate mofetil. Careful clinical observation was maintained to evaluate different relapse rates.
ENSEFALITIS ANTIRESEPTOR NMDA: ENSEFALITIS DENGAN GEJALA AWAL PSIKOSIS Estiasari, Riwanti; Imran, Darma; Maharani, Kartika; Pangeran, David; Octaviana, Fitri; Wulandari, Dewi
Majalah Kedokteran Neurosains Perhimpunan Dokter Spesialis Saraf Indonesia Vol 35 No 1 (2018)
Publisher : PERDOSNI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52386/neurona.v35i1.35

Abstract

     ANTI-NMDA RECEPTOR ENCEPHALITIS: ENCEPHALITIS PRESENTING WITH EARLY PSYCHOSIS SYMPTOMSABSTRACTAnti N-methyl-D-aspartate (NMDA) receptor encephalitis is seldom found in Indonesia. The atypical initial presentation of psychosis and cognitive disturbance results in underdiagnosed, or even undiagnosed case. This report described a 12-year-old girl presenting with initial psychiatric symptom followed by seizure and oropharyngeal dystonia. Anti-NMDA receptor antibody test carried out on both serum and  cerebrospinal  fluid (CSF) were positive and  no other pathogen was detected in the CSF. Clinical improvement was seen following the third day of methylprednisolone administration. This case demonstrates the importance of considering anti-NMDA receptor encephalitis or the other autoimmune encephalitis as the differential of infective encephalitis. Anti-NMDA receptor antibody test, which can already be performed in Indonesia, will greatly guide to the definitive diagnosis.Keywords: Encephalitis, NMDA, oropharyngeal dystonia, psychiatricABSTRAKEnsefalitis antireseptor N-metil-D-aspartat (NMDA) masih jarang ditemukan di Indonesia. Gejala awal yang tidak khas berupa psikosis dan gangguan kognitif menyebabkan keterlambatan diagnosis, atau bahkan tidak terdiagnosis, ensefalitis jenis ini. Berikut dilaporkan kasus seorang perempuan 12 tahun dengan gejala awal berupa gejala psikiatrik yang diikuti dengan kejang dan munculnya distonia orofaring. Pemeriksaan antibodi antireseptor NMDA pada serum dan cairan serebrospinal (CSS) positif dan tidak ditemukan patogen lain pada pemerikaan CSS. Perbaikan klinis terlihat setelah pemberian metilprednisolon selama 3 hari. Kasus ini memperlihatkan pentingnya mempertimbangkan diagnosis ensefalitis antireseptor NMDA atau ensefalitis autoimun lainnya sebagai diagnosis banding pada kasus ensefalitis infeksi. Oleh karena itu, pemeriksaan antibodi antireseptor NMDA yang telah dapat dilakukan di Indonesia akan sangat membantu proses penegakan diagnosis.Kata kunci: Distonia orofaring, ensefalitis, NMDA, psikiatrik
Gambaran Status Gizi Penderita Tumor Otak Primer dan Metastasis serta Faktor-faktor yang Memengaruhinya Aninditha, Tiara; Tanjung, Gloria; Andayani, Diyah Eka; Aman, Renindra Ananda; Estiasari, Riwanti; Yanuar, Ahmad; Sofyan, Henry Riyanto
Majalah Kedokteran Neurosains Perhimpunan Dokter Spesialis Saraf Indonesia Vol 39 No 3 (2022): Vol 39 No 3 (2022)
Publisher : PERDOSNI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52386/neurona.v39i3.280

Abstract

Introduction: According to the pathophysiology, weight loss is a specific marker for suspected malignancy. However, this is rarely found in cases of brain tumors. The presence of the blood brain barrier is thought to play a role in differentiating nutritional status in primary and metastatic brain tumors. Therefore, it is necessary to do this research. Aim: Knowing the description, prevalence, differences in nutritional status of patients with primary and secondary brain tumors, and the affecting factors. Methods: Cross-sectional study in patients with primary and secondary brain tumors at Cipto Mangunkusumo General Hospital in 2017-2019. Malnutrition was diagnosed using the GLIM (Global Leadership Initiative on Malnutrition) criteria. Data analysis used Chi-Square/Fisher and multivariate logistic regression. There were 333 subjects: 246 primary and 87 secondary brain tumors. Description of nutritional status of patients with primary brain tumors: 47.6% obese; 6.1% malnutrition; the rest were normal, while in secondary brain tumors: 25.3% were malnourished; 24.1% obese; the rest is normal. Secondary brain tumor at risk of malnutrition with RR 1.257 (95% KI 1.108-1.426), p<0.001. Factors influencing malnutrition were the type of primary/secondary brain tumor, gender, age, decreased consciousness, anorexia, gastrointestinal complaints, intraaxial lesions, multiple lesions, and the location of the lesions involving the frontal lobes. The independently related factor was multiple lesions with an aOR of 3,423 (95% KI 1.124-10.426), p 0.03. Conclusion: The nutritional status of patients with primary and secondary brain tumors was different, with higher levels of malnutrition in secondary brain tumors and higher obesity in primary brain tumors. The number of multiple lesions in the brain affects the occurrence of malnutrition.
Neuritis Optik Unilateral sebagai Manifestasi Klinis Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease (MOGAD) Tannika, Ayudhea; Estiasari, Riwanti; Maharani, Kartika
Majalah Kedokteran Neurosains Perhimpunan Dokter Spesialis Saraf Indonesia Vol 39 No 3 (2022): Vol 39 No 3 (2022)
Publisher : PERDOSNI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52386/neurona.v39i3.364

Abstract

Myelin-oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is an oligodendrocytopathic autoimmune disorder, characterized by demyelination and inflammation in the central nervous system, especially brain parenchyma and spinal cord. There are three main clinical manifestations in MOGAD: optic neuritis, transverse myelitis, and acute disseminated encephalomyelitis (ADEM). This case report presents a seropositive anti-MOG patient with early manifestation of optic neuritis. A 29 years old man presented with a complaint of blurry right vision and dull pain around his right eye in the last 5 months before hospital admission. Neurological examination revealed a right visual acuity of 2/60 and right relative afferent pupillary defect (RAPD). Brain MRI with contrast revealed an enhancement on the right optic nerve and nonspecific, multiple hyperintense lesions in bilateral frontal and parietal lobes. The patient’s result was reactive for anti-MOG antibody. After the administration of high dose methylprednisolone (1000 mg) for 5 consecutive days, the patient’s visual acuity was slowly improving; supported with an improvement on the Humphrey visual field analyzer. Immunosuppressant agent azathioprine was given as a long-term treatment without any worsening symptoms to this day. Unilateral optic neuritis could be an early clinical manifestation in MOGAD. It is important for clinicians to identify typical and atypical optic neuritis to be able to determine follow-through examination and workup and the associated differential diagnosis. Optic neuritis in MOGAD could be improved by the administration of high dose methylprednisolone, along with immunosuppressant therapy as long-term therapy
DIAGNOSIS DAN TATA LAKSANA NEUROMYELITIS OPTICA SPECTRUM DISORDER (NMOSD) Estiasari, Riwanti; Chandra, Fitria; Remana Sitinjak, Monalisa; Susanto, Arief; Maharani, Kartika; Imran, Darma
Majalah Kedokteran Neurosains Perhimpunan Dokter Spesialis Saraf Indonesia Vol 41 No 1 (2024): Vol 41 No 1 (2024): Volume 41, No 1 - Desember 2024
Publisher : PERDOSNI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52386/neurona.v41i1.576

Abstract

Neuromyelitis optica spectrum disorders (NMOSD) is an autoantibody mediated chronic inflammatory disease that predominantly affects optic nerves and spinal cord. NMOSD patients could experience visual disturbances, sensorimotor disorders, or autonomic disorders aligned with the pathological lesion involvement. Diagnostic criteria of the International Panel for NMO Diagnosis (IPND) 2015 are utilized to establish NMOSD diagnosis. Management of NMOSD encompasses initial and maintenance treatments that aim to prevent disease progression.
Co-Authors Ahmad Yanuar Aman, Renindra Ananda Andayani, Diyah Eka Aninditha, Tiara Anne Dina Soebroto Arief Susanto Arthur H.P. Mawuntu Chandra, Fitria Darma Imran Darma Imran Dewi Wulandari Erwin Widi Nugraha Fitri Octaviana Gogor Meisadona Imran, Darma Kartika Maharani Kartika Maharani Kartika Maharani Maharani, Kartika Meisadona, Gogor Nadia Devianca Ni Nengah Rida Ariarini Pangeran, David Pradita Sari Purba, Maria Jheny Fulgensia Remana Sitinjak, Monalisa Septiana Andri Wardana Soebroto, Anne Dina Sofyan, Henry Riyanto Sutanto, Anyelir Tanjung, Gloria Tannika, Ayudhea Widya Andini, Putri