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All Journal Majalah Kedokteran Bandung Majalah Kedokteran Majalah Kesehatan FKUB Neurologico Spinale Medico Chirurgico
Robert Sinurat
Departemen Bedah Fakultas Kedokteran Universitas Kristen Indonesia
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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Neurogenesis pada Perdarahan Intraserebral Spontan Robert Sinurat
Majalah Kedokteran UKI Vol. 28 No. 4 (2012): OKTOBER-DESEMBER
Publisher : Fakultas Kedokteran Universitas Kristen Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33541/mkvol34iss2pp60

Abstract

Abstrak Perdarahan intraserebral spontan (PIS) adalah salah satu tipe stroke berdarah, akibat ruptur pembuluh darah sehingga darah menggenangi parenkim otak. Mortalitasnya mencapai 34,6% dan hanya 38% yang dapat pulih seperti sediakala atau dengan kecacatan ringan. Pada PIS terjadi cedera primer yaitu kerusakan neuron dan glia secara mekanis yang diikuti oleh deformasi, pelepasan neurotransmitter, disfungsi mitokondria dan depolarisasi membran sel. Selanjutnya terjadi cedera sekunder akibat pemecahan hemoglobin dan faktor koagulasi khususnya trombin. Produk tersebut akan mengaktifkan mikroglia sehingga menghasilkan zat toksik seperti reactive oxygen species (ROS), matrix metalloproteinase (MMP), cyclooksigenase-2, prostaglandin, heme oxygenase-1 (HO-1), faktor komplemen, tumor necrotizing factor α (TNFα), dan interleukin 1β yang mengakibatkan cedera jaringan. Selain cedera, juga terjadi penggantian sel mati melalui proses neurogenesis yaitu pertumbuhan sel punca neural di area subventrikel dan hipokampus. Sel tersebut akan bermigrasi ke area perdarahan karena terjadi perbedaan kadar stromal derived factor-1 (sdf-1) pada kedua area tersebut. Sebanyak 80% sel yang bermigrasi tersebut akan mati sehingga hanya sedikit yang dapat menggantikan sel mati. Kata Kunci: sel punca neural, habitat, mikroglia, zat toksik Abstract Spontaneous intracerebral hemorrhage (SICH) is a type of hemorrhagic stroke. There are brain vessels rupture which bleeds into parenchym. Mortality rate of ICH is about 34.6% and only 38% of the patients can be fully recovered. Mechanical disruption will appear by the bleeding as primary injury. The neuron and glia will be deformed, neurotransmitter released, dysfunctional mitochondria and cell membrane depolarization will occur. Primary injury will be followed by secondary injury due to degradation of blood product such as hemoglobin and coagulation factor, especially thrombin. These product will activate microglia resulted in the production of toxic factors i.e. reactive oxygen species (ROS), matrix metalloproteinase (MMP), cyclooksigenase-2 (Cox-2), prostaglandin, heme oxygenase -1 (HO-1), complement factor, tumor necrotizing factor α (TNFα), and interleukin 1β. Furthermore, there is replacement of dead cells by neuroendogenesis proscess, performed by stem cells that normally exist in a special niche in subventricle zone and hippocampus.. The stem cells in the migrates to perihematoma zone attracted by the different concentration of stromal derived factor-1 (SDF-1) between the niche and the peri-hematoma area. But most of the activated cells (80%) will die and only small number survive to replace the dead cells. Key words: neural stem cells, niche, microglia, toxic subtance
Tuberculosis transverse myelitis in pediatric patient Robert Sinurat
Neurologico Spinale Medico Chirurgico Vol 4 No 3 (2021)
Publisher : Indoscholar

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36444/nsmc.v4i3.168

Abstract

Tuberculosis myelitis usually impact adult patients and associated with tuberculous meningitis, miliary tuberculosis, or human immunodeficiency virus infection. Pediatric tuberculosis myelitis cases without any associated diseases have never been reported. The author reported a case of a pediatric patient with tuberculosis myelitis without any other organ involvement and the outcome after treatment. Girl 13 years old suffered from paraplegia of her lower extremities. Two months before paraplegia she felt weakness in her left leg and followed by the right side. The legs were spastic and ankle clonus was positive. She lost sensation from epigastrium level to her both of legs and difficult to bowel. Laboratories result was normal but spinal magnetic resonance imaging showed hyperintense lesion of spinal cord thoracic vertebrae 5-8. During the laminectomy procedure, there was no any tumor, abscess, or tuberculoma, but the spinal cord looked brown. A biopsy was performed, and the histopathology results showed the granuloma containing lymphocytes, epithelioid macrophages, and datia langhans cells. The patient was treated with anti-tuberculosis chemotherapy for twelve months. Clinical symptoms improved gradually and the patient was able to walk slowly. Tuberculosis myelitis is an inflammatory spinal cord disease and it can cause paralyzed, sensory and autonomic disturbance. Magnetic resonance imaging can differentiate between spinal tuberculosis and spinal tumors, but it will be difficult if there are no signs of vertebral body and discs inflammation. Tuberculosis myelitis should be considered as a differential diagnosis of spinal cord lesions in children and its response to anti-tuberculosis chemotherapy is excellent.
HUBUNGAN ANTARA FAKTOR RISIKO DENGAN MASA PERAWATAN SERTA OUTCOME PASIEN STROKE ISKEMIK Robert Sinurat; Janice Eloise Tan; Irasandi Marindatu Senobua
Majalah Kesehatan Vol. 9 No. 4 (2022): Majalah Kesehatan
Publisher : Faculty of Medicine Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/majalahkesehatan.2022.009.04.1

Abstract

Stroke umumnya didasari suatu faktor risiko seperti hipertensi atau diabetes, dan pasien stroke akan memerlukan rawat inap di rumah sakit. Terapi stroke serta faktor risikonya akan berdampak pada outcome pasien. Penelitian ini bertujuan untuk menilai hubungan antara faktor risiko dengan masa perawatan serta outcome pasien stroke iskemik. Penelitian retrospektif ini mengevaluasi faktor risiko, kesadaran, masa perawatan, serta outcome pasien berdasarkan data rekam medis pasien stroke iskemik yang dirawat tahun 2019-2020 di Rumah Sakit Universitas Kristen Indonesia dengan kriteria pasien dirawat lebih dari 24 jam. Data kesadaran pasien diuji dengan uji t berpasangan, sementara hubungan antara faktor risiko dengan masa perawatan dan outcome diuji dengan Chi-square. Hasil penelitian menunjukkan sebagian besar pasien adalah laki-laki yaitu 63 (63,64%) dari 99 orang, dan terbanyak berusia 61-70 tahun yaitu 37 (37,37%) pasien. Hipertensi didapatkan pada 52 (52,53%) pasien dan masa rawat inap rata-rata 5,7 hari, namun pasien dengan penyakit jantung sampai 8,4 hari. Tingkat kesadaran berdasarkan Glasgow Coma Scale menunjukkan sebagian besar pasien adalah 15, dan hasil uji t tidak menunjukkan perbedaan antara saat masuk dan keluar rumah sakit (p > 0,05). Pada 58 (58,9%) pasien didapatkan defisit neurologis moderate atau moderate-severe, sembuh total 10 (10,10%) pasien, dan 3 (3,03%) pasien meninggal. Hasil uji Chi-square menunjukkan hubungan tidak bermakna antara faktor risiko dengan masa perawatan serta outcome (p > 0,05).  Penelitian menyimpulkan hubungan faktor risiko dengan masa perawatan serta outcome pasien stroke iskemik tidak bermakna, namun bila memiliki faktor risiko penyakit jantung maka perawatan akan lebih lama.  
Hematoma Evacuation Outcome in Patients with Spontaneous Supratentorial Intracerebral Hemorrhage Robert Sinurat; Ahmad Faried
Majalah Kedokteran Bandung Vol 54, No 3 (2022)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15395/mkb.v54n3.2788

Abstract

The mortality rate of spontaneous supratentorial intracerebral hemorrhage evacuation is still high and varies in all neurosurgical centers. Currently, minimally invasive surgery to evacuate bleeding has become an option, but not all neurosurgical centers can perform the procedures due to limited resources. In addition, there are several guidelines for determining which patients will undergo a surgery. This study assessed the outcome of selected patients who were operated on using micro neurosurgical procedures or external ventricular drainage for intraventricular hemorrhage between 2016 and 2021. Patients included in this study were recruited from a hospital in Jakarta, Indonesia and  selected based on the guideline of the 2015 American Heart Association/American Stroke Association (AHA/ASA). The outcome was assessed by a modified Rankin scale (mRS). There were 301 patients with hemorrhagic stroke but only fifty patients were matched the criteria in the guideline. Male patients constituted the majority of the patients (n=28, 56%) and hypertension has occurred in 37 (74%) patients. The hematoma was mostly located in the intracerebral with intraventricular extension (n=27, 54%) patients. The pre-operative Glasgow Coma Scale (GCS) of 23 (46%) patients were comatose and the other was 9–13. Postoperatively, there were 37 (74%) patients with a scale of 13–15, but 10 (20%) patients died. Pair t-test of the preoperative and postoperative scales showed a significant difference, p < 0.01. The outcome of 40 (80%) patients was good (modified Rankin scale of 0–3), and the Spearman’s rank correlation coefficient was -0.739 with the Sig.2-tailed was <0.01. The outcome of spontaneous supratentorial intracerebral hemorrhage evacuation is good when selecting patients following the 2015 AHA/ASA guideline and there is a strong correlation between postoperative GCS with 3-month mRS results.
Co-Authors Ahmad Faried Irasandi Marindatu Senobua Janice Eloise Tan