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All Journal BALI MEDICAL JOURNAL (BMJ) Medicina E-Jurnal Medika Udayana MNJ (Malang Neurology Journal) The Indonesian Journal of Infectious Diseases Callosum Neurology Journal : Jurnal Berkala Neurologi Bali ISM (Intisari Sains Medis) : Jurnal Kedokteran Majalah Kedokteran Neurosains Cermin Dunia Kedokteran
Anak Agung Bagus Ngurah Nuartha
Departemen Neurologi, FK Universitas Udayana/RSUP Sanglah, Denpasar, Bali, Indonesia
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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MUTISME AKINETIK AKIBAT OKLUSI BILATERAL ARTERI SEREBRI ANTERIOR Parningotan Yosi Silalahi, Anak Agung Bagus Ngurah Nuartha, Ida Bagus Kusuma Putra
NEURONA Vol 29 No. 4 Agustus 2012
Publisher : Neurona Majalah Kedokteran Neuro Sains

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Abstract

INTRODUCTION AKINETIK MUTISM DUE TO BILATERAL LESIONS OF THE ANTERIOR FRONTAL LOBES ARE RARE AND THEREFORE HAS NOT REPORTED STATISTICS
HEMIANOPSIA HOMONIM SEBAGAI GEJALA TUNGGAL PADA PASIEN STROKE Gracia Meliana Tanoyo, AABN Nuartha
NEURONA Vol 32 No. 2 Maret 2015
Publisher : Neurona Majalah Kedokteran Neuro Sains

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Abstract

STROKE SIGNS AND SYMPTOMS MAY VARY DEPENDING ON THE BRAIN AREA THAT IS AFFECTED POSTERIOR CIRCULATION STROKE ARE RARE COMPARED TO ANTERIOR CIRCULATION SITE PATIENTS MAY COME WITH VISUAL PROBLEMS COMPLAINT ONLY MAKING CLINICIANS UNAWARE OF STROKE AS THE DIAGNOSIS WE REPORT 2 STROKE CASES PRESENTS ISOLATED HOMONYMOUS HEMIANOPSIA PATIENTS WHO COME WITH SUDDEN VISUAL IMPAIRMENT INCLUDING ISOLATED HOMONYMOUS HEMIANOPSIA AND ARE ASSOCIATED WITH VASCULAR RISK FACTORS HYPERTENSION DIABETES MELLITUS DISLIPIDEMIA SMOKING ALCOHOL CONSUMPTION ETC SHOULD BE SUSPECTED AS STROKE PATIENT UNTIL PROVEN OTHERWISE
BILATERAL PARAMEDIAN THALAMIC AND MIDBRAIN INFARCTION: A Case Report Andaka, D.; Nuartha, and A. A. B. N.
BALI MEDICAL JOURNAL Vol 2 No 3 (2013): Vol.2, No.3, September-December 2013
Publisher : BALI MEDICAL JOURNAL

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Abstract

Background: Bilateral paramedian thalamic and midbrain infarct is rare and present with varying symptoms. The occlusion of a rare arterial variant called the artery of Percheron results in bilateral thalamic infarcts, with or without midbrain involvement. To this date, the diagnosis of ischemic infarction due to occlusion of the artery of Percheronhas was uncommon. Case: We reports a 50 year-old man with acute ischemic infarcts of both paramedian thalami and midbrain, presenting with complete ophthalmoplegia, arreactive mydriasis pupils, and altered mental status (somnolent and fluctuating hypersomnia).Conclusions: Based on clinical and neuroimaging findings, we concluded this case as acute ischemic infarctions due to occlusion of the artery of Percheron.
HIPERTERMI DALAM 72 JAM AWITAN SEBAGAI PREDIKTOR PERBURUKAN KLINIS PENDERITA STROKE ISKEMIK AKUT SELAMA PERAWATAN Adja, Yuliana Monika Imelda Wea Ora; Nuartha, Anak Agung Bagus Ngurah; Purwata, Thomas Eko
Medicina Vol 46 No 2 (2015): Mei 2015
Publisher : Medicina

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Abstract

Stroke merupakan penyebab utama kematian dan kecacatan di dunia yang membutuhkan pengobatandan perawatan jangka panjang. Stroke iskemik akut dengan defisit neurologi yang berat terjadikurang lebih 2-10% dan berhubungan dengan prognosis buruk baik jangka pendek ataupun jangkapanjang. Banyak faktor yang mempengaruhi luaran dan tingkatan perbaikan setelah mengalamistroke iskemik di antaranya peningkatan suhu tubuh. Penelitian ini bertujuan mengetahui hipertermidalam 72 jam awitan yang dihubungkan dengan prediktor perburukan klinis penderita stroke iskemikakut selama perawatan.Penelitian ini merupakan penelitian observasional analitik dengan rancangankohort prospektif. Prediktor perburukan digolongkan atas dua kelompok yaitu prediktor perburukanklinis dan prediktor perbaikan klinis melalui nilai NIHSS pada saat awal dan hari ke tujuh perawatan,dan juga di lakukan pengukuran suhu aurikula dalam 72 jam awitan stroke.Selama periode Januarisampai Maret 2015 didapatkan 88 penderita yang memenuhi kriteria eligibilitas. Data dianalisismenggunakan SPSS 20 for windows dengan menampilkan berbagai karakteristik subyek penelitianmeliputi usia, jenis kelamin, awitan stroke, jenis stroke iskemik, skor NIHSS awal, skor NIHSS harike-7, dan derajat hemiparesis. Hubungan antara hipertermi dengan perburukan klinis penderita diujidengan Chi-square, didapatkan hasil yang bermakna secara statistik (RR= 8,01;IK 95% 3,02 sampai21,25; P <0,0001). Dapat disimpulkan bahwa hipertermi merupakan prediktor perburukan klinispenderita stroke iskemik akut selama perawatan yang diukur dengan skala NIHSS. [MEDICINA2015;46:104-11].Stroke is a leading cause of death and disability in worldwide which need a long term care and treatment.Acute ischemic stroke reveal a severe neurological deficits occur approximately 2-10% in population. Itis associated with poor short and long term prognosis. Many factors influence outcomes and degree ofrepairing after ischemic stroke, in which increasing of body temperature is one of it. This study aim todetermine whether a hyperthermia occur in 72 hours is associated with predictor of clinical deteriorationof ischemic stroke patients during treatment.This was an analytic observational prospective cohortstudy design. Predictors of clinical deterioration measures with NIHSS score at baseline and seventhday of treatment and auricular temperature measured in 72 hours of stroke onset.There was 88 patientswith ischemic stroke during January to March 2015 met the eligibility criteria. Data were analyzedusing SPSS 20 for windows to display the various characteristics of the study subjects including age,sex, stroke onset, type of ischemic stroke, first and seventh day NIHSS score, and the degree ofhemiparesis. The relationship between hyperthermia and clinical deterioration tested with Chi-squaretest. The results obtained were statistically significant (RR= 8.01; 95%CI= 3.02 to 21.25; P<0.0001).Itwas concluded a 72-hour hyperthermia as a predictor of clinical deterioration of acute ischemic strokepatients during treatment measured with NIHSS. [MEDICINA 2015;46:104-11].
GANGGUAN MOOD PADA STROKE Tantular, Gabriella; Westa, Wayan; Nuartha, AABN
Medicina Vol 46 No 1 (2015): Januari 2015
Publisher : Medicina

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Abstract

Stroke adalah salah satu sindrom neurologi yang dapat menimbulkan kecacatan dalam kehidupanmanusia. Salah  satu gejala yang dapat  timbul  setelah  seseorang  terkena  stroke adalah gangguanmood. Gangguan mood berhubungan dengan disabilitas fisik, beratnya stroke dan gangguan kognitif.Gangguan mood yang ditemukan pada stroke adalah depresi, gangguan afektif bipolar dan mania.Gambaran  gejala  berhubungan dengan  lesi  anatomis  stroke. Terapi  yang diberikan dapat  berupafarmakologis, psikoterapi, dan rehabilitasi. [MEDICINA 2015;46:33-36].Stroke is one of neurology syndrome that cause disability in human life. One of the symptoms thatappear after stroke was mood disorder. Mood disorder were related to physical disability, severity ofstroke  and  cognitive  dysfunction. Mood  disorder  found  in  stroke was  depression,  affective  bipolardisorder, and mania. Symptoms were associated with anatomical lesion. Treatment for this disorderare pharmacologic treatment, psychotherapy, and rehabilitation. [MEDICINA 2015;46:33-36].
Lesi talamus sebagai faktor risiko perburukan neurologis pada stroke perdarahan intraserebral supratentorial akut Suryawati, Ni Nyoman Ayu; Nuartha, AABN; P, Thomas Eko
Medicina Vol 47 No 1 (2016): Januari 2016
Publisher : Medicina

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Abstract

Stroke merupakan salah satu kegawatdaruratan di bidang neurologi. Insidens stroke di Indonesia adalah 12,1 per 1000 penduduk tahun 2013, sama banyak antara wanita dan lelaki dengan mortalitas di Indonesia sebesar 22%, (21,2% untuk stroke iskemik dan 28,2% untuk stroke perdarahan). Perdarahan talamus sering menimbulkan penurunan kesadaran akibat kerusakan sistem ascending reticular activating system bagian rostral. Tujuan penelitian ini adalah untuk mengetahui bahwa lesi talamus merupakan faktor risiko perburukan neurologis pada penderita stroke perdarahan intraserebral supratentorial akut. Rancangan penelitian ini adalah kohort prospektif pada 60 orang penderita stroke perdarahan intraserebral supratentorial akut dari Maret-Oktober 2015. Subjek dibagi 2 kelompok, masing-masing 30 subjek dengan lesi di daerah talamus dan lesi bukan talamus berdasarkan hasil CT scan kepala. Hubungan antar-variabel dinyatakan dengan risiko relatif (RR) (IK95%) dengan tingkat kemaknaan (P)<0,05. Pada analisis data didapatkan hubungan bermakna antara lesi talamus dengan perburukan klinis neurologis [RR=7,98 (IK95% 2,23 sampai 28,52), P=0,001]. Kami menyimpulkan bahwa lesi talamus secara bermakna merupakan faktor risiko terjadinya perburukan klinis neurologis pada penderita stroke perdarahan intraserebral akut. Stroke is one of the emergency case in neurology. Incidence of stroke in Indonesia was 12.1 per 1000 population in 2013, and women were equally affected as men; mortality among stroke patients in Indonesia was 22% (21.2% for ischemic stroke and 28.2% for haemorrhagic stroke). Thalamic hemorrhage often cause decrease of consciuosness due to damage of rostral ascending reticular activating system. The purpose of this study was to know whether thalamic lesion is a risk factor of worsening neurology in acute supratentorial intracerebral stroke patients. This study was prospective cohort design involving 60 acute supratentorial intracerebral stroke patients from March until October 2015. Subjects were divided into 2 groups consist of 30 subjects for each group (thalamic lesion and another location in head) based on head CT scan. Association between variable was expressed in relative risk (RR) (95%CI) with level of significance P<0.05. Data analysis revealed that there were association between thalamic lesion and worsening of clinical neurology [RR=7.98 (95%CI 2.23 to 28.52), P=0.001]. We conclude that thalamic lesion is a a risk factor of worsening of clinical neurology in acute haemorrhagic stroke patient.
PENURUNAN JUMLAH LEUKOSIT SEBAGAI PREDIKTOR PERBAIKAN KLINIS PENDERITA STROKE HEMORAGIK SELAMA PERAWATAN Harkitasari, Saktivi; Nuartha, Anak Agung Bagus Ngurah; Purwata, Thomas Eko
Medicina Vol 46 No 2 (2015): Mei 2015
Publisher : Medicina

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Abstract

Prognosis penderita stroke hemoragik dipengaruhi oleh banyak faktor, salah satunya adalah jumlahleukosit. Berbagai penelitian menyatakan bahwa peningkatan jumlah leukosit sebagai prediktorperburukan klinis dan kematian pada penderita stroke hemoragik, tetapi sampai saat ini masihbelum jelas apakah penurunan jumlah leukosit setelah terjadi leukositosis dapat sebagai prediktorperbaikan klinis penderita stroke hemoragik. Penelitian ini menggunakan rancangan kohort prospektif.Subjek penelitian adalah penderita stroke hemoragik dengan awitan datang d”24 jam denganleukositosis saat masuk rumah sakit yang dirawat di Sanglah Denpasar. Kelompok yang mengalamipenurunan jumlah leukosit dibandingkan dengan kelompok yang tidak mengalami peningkatan atautanpa perubahan jumlah leukosit. Penilaian luaran klinis menggunakan perubahan skor NIHSS yangdinilai pada hari ketujuh. Total sebanyak 44 subjek dimasukkan dalam penelitian, 19 subjekmeunjukkan perbaikan skor NIHSS. Penurunan jumlah leukosit memiliki hubungan yang signifikandengan perbaikan klinis (RR=5,33; IK95%: 1,81 sampai 15,74; P<0,0001). Hasil penelitianmenunjukkan hanya penurunan jumlah leukosit memiliki hubungan yang independent dengan perbaikanskor NIHSS. Disimpulkan bahwa pada penderita stroke hemorgaik dengan leukositosis, penurunanjumlah leukosit dapat menjadi prediktor perbaikan klinis selama perawatan yang diukur denganskala NIHSS. [MEDICINA 2015;46:92-8].The prognosis of hemorrhagic stroke patients is associated with many factors, leucocyte count is one ofthem. Many studies indicated that elevated leucocyte count is a predictor for bad clinical outcome anddeath in patients with hemorrhagic stroke, however, there is remain unclear whether leucocyte reductionafter leucocytosis could be a predictor for better clinical outcome of patients with hemorrhagic stroke.Thisis a prospective cohort study. Subject were hemorrhagic stroke patients who were arrival time d”24hours onset with leucocytosis admitted in Sanglah hospital Denpasar. Group with leucocyte countreduction were compared with group leucocyte count elevation or without changing. Clinical outcomewere measured with NIHSS score changing at day 7.A total of 44 subjects were recruited, 19 of themhad better NIHSS score. Leucocyte count reduction was significantly associated with better clinicaloutcome (RR=5,33; 95%CI: 1,81 to 15,74; P<0,0001). Leucocyte count reduction was the onlyindependently associated with better NIHSS score. It was concluded that in hemorrhagic stroke patientswith leucocytosis, leucocyte count reduction could be a predictor for better clinical outcome duringhospitalization measured with NIHSS.[MEDICINA 2015;46:92-8].
LOW TOTAL CHOLESTEROL SERUM LEVELS AS A POOR OUTCOME PREDICTOR FOR INTRA-CEREBRAL HEMORRHAGE STROKE Ariswanda, I Gusti Agung Gede; Adnyana, I Made Oka; Widyadharma, I Putu Eka; Nuartha, A A B N; Laksmidwei, A A A Putri; Arimbawa, I Komang
MNJ (Malang Neurology Journal) Vol. 6 No. 2 (2020): July
Publisher : PERDOSSI (Perhimpunan Dokter Spesialis Saraf Indonesia Cabang Malang) - Indonesian Neurological Association Branch of Malang cooperated with Neurology Residency Program, Faculty of Medicine Brawijaya University, Malang, Indonesia

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Abstract

Background: Stroke is affected by several factors, age, infection during treatment, obesity, and total cholesterol (TC) levels.  Objective: The study aimed to prove low TC serum levels as an unfortunate outcome predictor for intracerebral hemorrhage stroke. Methods: This study is a prospective cohort design. The research did in the Stroke Unit of Sanglah Hospital, Denpasar, from July 1st, 2018 to January 31th, 2019. The study involved patients with hemorrhage strokes with low TC serum levels and aged 40-95 years. Depending on variable divided into two groups with low TC serum levels (<180 mg/dL) and normal TC serum levels (>180mg/dL). Independent variable is The National Institutes of Health Stroke Scale (NIHSS) as an outcome. The processing of data analysis using Mac for SPSS version 23. Result: This study used 70 subjects. The age characteristics of the study subjects with a median value of 62 years in for low TC levels, and 57 years for normal TC levels, dominant in male (60% ), working (71.5%), not obese (58.6%), stroke-related infections (51.4%), and mean arterial blood pressure (MABP) £130mmHg (90%). Subjects with low TC had a risk of 64 times experiencing adverse outcomes (RR = 64: CI 95% = 14.06-291.32: p <0.001). Multivariate analysis showed a low TC serum level as an independent variable.Conclusion: Low TC serum levels as an independent predictor having a poor outcome in intracerebral hemorrhage stroke
Kebutaan pada Karsinoma Nasofaring Handayani, Khristi; Purna Putra, I Gusti Ngurah; Ngurah Nuartha, Anak Agung Bagus
Cermin Dunia Kedokteran Vol 41, No 3 (2014): Farmakologi
Publisher : PT. Kalbe Farma Tbk.

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Abstract

Latar belakang: Keluhan karsinoma nasofaring (KNF) pada hampir separuh pasien adalah benjolan di leher. Gejala neurologi lebih jarang dijumpai, kebutaan hanya terjadi kurang dari satu persen. Laporan kasus: Laki-laki 26 tahun dengan keluhan nyeri kepala, suara sengau, dan tidak dapat melihat sejak satu bulan. Dari pemeriksaan didapatkan massa di kavum nasi kanan, pembesaran kelenjar getah bening leher kanan, lesi nervus III, IV, V1, V2, V3, VI, VII kanan, dan nervus II kanan. Refleks makula kanan pada funduskopi menurun. Pada CT scan didapatkan massa nasofaring kanan yang meluas ke intrakranial dan intraorbital kanan. Simpulan: Terdapat infiltrasi KNF perkontinuitatum ke jaringan sekitar sampai intrakranial. Kebutaan pada satu mata dapat disebabkan oleh perluasan ke fosa serebri media dan invasi ke orbita, juga karena kompresi nervus optikus oleh jaringan tumor.Background: The common complaint in almost half of nasopharyngeal carcinoma (NPC) patients was a lump in the neck. Neurological symptoms occured less frequently, whereas blindness occurred in only less than one percent of cases. Case report: A 26 year-old male complained about headache, nasal voice, and blindness in right eye since a month ago. Examination found mass in the right nasal cavity, right neck lymph nodes enlargement, damage to the right oculomotor (III), trochlear (IV), trigeminal (V), and abducens (VI) nerve, and right opticus nerve (II). On fundoscopy, right macular reflex decreased. On CT scan there was right nasopharyngeal mass extending to intracranial and right intraorbital spaces. Summary: There was a direct infiltration of NPC into surrounding and intracranial structures. Unilateral blindness may be caused by expansion to middle cerebral fossa and orbita. It can also be caused by optic nerve compression from surrounding tumor tissue. Khristi
Neurorestorasi Pasca-stroke: Harapan Baru Penderita Stroke Wijaya, Hadi; IBK, Putra; AABN, Nuartha
Cermin Dunia Kedokteran Vol 42, No 4 (2015): Alergi
Publisher : PT. Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (290.081 KB) | DOI: 10.55175/cdk.v42i4.1019

Abstract

Stroke merupakan penyebab kecacatan utama di dunia, baik di negara maju maupun berkembang. Biaya pengobatan dan rehabilitasi pasca-stroke diperkirakan mencapai US$ 140.000/pasien, sehingga penderita stroke dengan kecacatan merupakan beban ekonomi bagi keluarga dan sistem asuransi kesehatan. Berbagai upaya telah dilakukan untuk mengembangkan terapi stroke yang efektif, sejauh ini terbatas pada bidang neuroproteksi untuk mencegah perluasan cedera otak. Hal ini disebabkan karena paradigma lama menyatakan bahwa sistem saraf pusat sifatnya permanen, neuron yang mengalami kematian tidak dapat mengalami regenerasi. Penelitian neuroscience dewasa ini membuktikan adanya aktivitas neuroregenerasi dan neuroplastisitas pada susunan saraf pusat yang terus berlangsung sepanjang kehidupan mamalia, termasuk manusia. Neurorestorasi meliputi proses pembentukan neuron baru (neurogenesis), vaskulerisasi baru (angiogenesis), dan hubungan antar neuron yang baru (sinaptogenesis). Proses ini dapat ditingkatkan melalui terapi farmakologis dan latihan berulang. Fakta ini memberi harapan baru bagi penderita stroke di masa mendatang.Stroke is the major leading cause of disability in the world, either in developed and developing country. The estimated cost for stroke treatment and rehabilitation is about US$ 140.000/patient, causing financial burden for family and also for insurance and health care system. Several efforts had been made to develop effective stroke treatment, but are still limited in neuroprotective area to prevent further brain injury. Contrary to central dogma that once the neuron died, it cannot regenerate, neuroscience research found an evidence that neuroregeneration and neuroplasticity in human central nervous system is an ongoing process during lifetime. Neurorestoration is a definition that covered neurogenesis, angiogenesis, and synaptogenesis. This process can be enhanced by pharmacological agent and repetitive exercise. This fact gives a new hope for stroke patient.
Co-Authors Akira Ito Angga Krishna Arimbawa, I Komang Ariswanda, I Gusti Agung Gede Aurelia Vania Bagus Ngurah Mahasena Putra Awatara Candida Isabel Lopes Sam Christine Kathy Putri Sari D. Andaka Dewa Putu Gede Purwa Samatra Eric Hartono Tedyanto Florence Diana Thomas Gabriella Tantular, Gabriella Hadi Wijaya Handayani, Khristi I Gusti Ngurah Ketut Budiarsa I Gusti Ngurah Purna Putra I Made Odie Lastrawan I Made Oka Adnyana I Putu Eka Widyadharma IBK, Putra Ida Ayu Sri Indrayani Ida Ayu Sri Wijayanti Ida Bagus Kusuma Putra Johann Andrasili Kazuhiro Nakaya Khristi Handayani Kumara Tini Laksmidwei, A A A Putri Made Widhi Asih Mirani Ulfa Yusrika NFN Moestikaningsih Ni Nyoman Ayu Suryawati, Ni Nyoman Ayu Oka Adnyana Priska Widiastuti Priska Widiastuti, Priska Purna Putra, I Gusti Ngurah Putra IBK Putu Ngurah Arya Darmawan Raka-Sudewi A. A. Saktivi Harkitasari, Saktivi Skolastika Savitri Sujatmiko Solly Aryza Thomas Eko P, Thomas Eko Thomas Eko Purwata Toni Wandra Trisa Permata Suhadi Trisnawati, Sri Yenni Wayan Westa Yasuhito Sako Yuliana Monika Imelda Wea Ora Adja, Yuliana Monika Imelda Wea Ora