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All Journal Majalah Kedokteran Bandung Althea Medical Journal Communication in Biomathematical Sciences Majalah Kedokteran Neurosains Neurona Jurnal Sains dan Kesehatan
Suryani Gunadharma
Department Of Neurology Faculty Of Medicine Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital Bandung
Agriculture, Biological Sciences & Forestry Biochemistry, Genetics & Molecular Biology Chemistry Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Social Sciences

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Misdiagnosis of Epilepsy Attributed to Inadequate History Taking Ratana, Levina Tri; Gunadharma, Suryani; Soenggono, Arifin
Althea Medical Journal Vol 3, No 2 (2016)
Publisher : Althea Medical Journal

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (190.711 KB)

Abstract

Background: There was a noticeable amount of patient with epilepsy who were misdiagnosed at Dr. Hasan Sadikin General Hospital. Misdiagnosis of epileptic seizure will expose patients to inappropriate managements, and subsequently leads to complications. History taking is an important part for the diagnosis of epileptic seizure. This study aimed to see the improvement of diagnosis based on the adequacy and inadequacy of history taking attributed to misdiagnosis of epileptic seizure by the epilepsy consultant at Dr. Hasan Sadikin General Hospital.Methods: This was a descriptive study using medical records of misdiagnosis of epilepsy. It was indicated by different initial (before epilepsy consultant’s confirmation) and final (after epilepsy consultant’s confirmation) seizure diagnosis at Epilepsy Outpatient Clinic at Dr. Hasan Sadikin General Hospital during the period of January 2007−October 2012.Results: There were 61 medical records with different initial and final seizure diagnosis. This study indicated inadequate history taking in 83.6% patients. Misdiagnosis occurred due to incomplete history taking, absence of reliable witnesses, and misinterpretation of history taking result. History taking by epilepsy consultant improved the misdiagnosis in 27.9% patients. While it is used simultaneously with Electroencephalography (EEG), the result increased to 72.2%.Conclusions: The adequate history taking improved the accuracy of epileptic seizure diagnosis. The simultaneous used of history taking and EEG increased the result. [AMJ.2016;3(2):304–9]DOI: 10.15850/amj.v3n2.775
VARIAN GELOMBANG EEG NORMAL SEBAGAI FAKTOR PENYEBAB KESALAHAN DIAGNOSIS EPILEPSI Suryani Gunadharma*
NEURONA Vol 32 No. 3 Juni 2015
Publisher : Neurona Majalah Kedokteran Neuro Sains

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Abstract

INTRODUCTION ELECTROENCEPHALOGRAPHY EEG IS THE MOST USEFUL TEST FOR ASSESSMENT OF EPILEPTIC PATIENTS HOWEVER EEG IS OFTEN OVERANALYZED ESPECIALLY BY INEXPERIENCED READERS EEG OVERINTERPRETATION IS COMMON AND PLAYS AS AN IMPORTANT CONTRIBUTOR OF MISDIAGNOSIS OF EPILEPSY IMPACTING SIGNIFICANTLY IN PATIENTS LIVES INTERICTAL EPILEPTIFORM DISCHARGES IED HAVE A STRONG CORRELATION WITH EPILEPSY NOT ALL SPIKE OR SHARPWAVES HAVE A RELATION WITH EPILEPSY
Misdiagnosis of Epilepsy Attributed to Inadequate History Taking Levina Tri Ratana; Suryani Gunadharma; Arifin Soenggono
Althea Medical Journal Vol 3, No 2 (2016)
Publisher : Faculty of Medicine Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (190.711 KB)

Abstract

Background: There was a noticeable amount of patient with epilepsy who were misdiagnosed at Dr. Hasan Sadikin General Hospital. Misdiagnosis of epileptic seizure will expose patients to inappropriate managements, and subsequently leads to complications. History taking is an important part for the diagnosis of epileptic seizure. This study aimed to see the improvement of diagnosis based on the adequacy and inadequacy of history taking attributed to misdiagnosis of epileptic seizure by the epilepsy consultant at Dr. Hasan Sadikin General Hospital.Methods: This was a descriptive study using medical records of misdiagnosis of epilepsy. It was indicated by different initial (before epilepsy consultant’s confirmation) and final (after epilepsy consultant’s confirmation) seizure diagnosis at Epilepsy Outpatient Clinic at Dr. Hasan Sadikin General Hospital during the period of January 2007−October 2012.Results: There were 61 medical records with different initial and final seizure diagnosis. This study indicated inadequate history taking in 83.6% patients. Misdiagnosis occurred due to incomplete history taking, absence of reliable witnesses, and misinterpretation of history taking result. History taking by epilepsy consultant improved the misdiagnosis in 27.9% patients. While it is used simultaneously with Electroencephalography (EEG), the result increased to 72.2%.Conclusions: The adequate history taking improved the accuracy of epileptic seizure diagnosis. The simultaneous used of history taking and EEG increased the result. [AMJ.2016;3(2):304–9]DOI: 10.15850/amj.v3n2.775
Etiology of Symptomatic Focal Epilepsy based on Neuroimaging Result in Neurology Outpatient Clinic of Dr. Hasan Sadikin General Hospital Agastya Prabhaswara; Suryani Gunadharma; Uni Gamayani
Althea Medical Journal Vol 6, No 1 (2019)
Publisher : Faculty of Medicine Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (68.842 KB) | DOI: 10.15850/amj.v6n1.1556

Abstract

Background: Focal epilepsy is the most common type of epilepsy that can be caused by structural lesions. Images from neuroimaging can show those structural lesions that may point to the etiology of epilepsy and would affect the management of epilepsy. The aim of the study was to explore the possible etiology of symptomatic focal epilepsy from neuroimaging result at the Neurology Outpatient Clinic in Dr. Hasan Sadikin General Hospital.Methods: This study was a cross-sectional descriptive study. The medical records that fulfilled the inclusion criteria were collected at the Neurology Outpatient Clinic of Dr. Hasan Sadikin General Hospital from the year 2017. The inclusion criteria were symptomatic focal epilepsy patients that had abnormal neuroimaging result.Results: In total, there were 71 medical records collected of which eight etiologies of symptomatic focal epilepsy were found, that were vascular disorder caused by strokes (33%), tumors (21%), hippocampal sclerosis (20%), infections (11%), head trauma (6%), malformations of cortical development (4%), vascular malformations (3%), and phakomatosis (1%). Vascular disorder was the most abundant etiology found in all brain lobes, except in temporal and frontal lobes, which also most often caused by hippocampal sclerosis and tumors, respectively.Conclusions: Vascular disorders due to stroke, is the most abundant etiology found in symptomatic focal epilepsy, therefore, stroke patients need to be informed about the possibility of having epilepsy later on.
Cut-off Score of Indonesian Version of Sensorimotor History Questionnaire for Preschooler and Soft Sign Cambridge Neurological Inventory against Intelligent Quotient Siti Aminah Sobana; Tiara Pramaesya; Uni Gamayani; Lisda Amalia; Suryani Gunadharma; Andi Basuki Prima Birawa
Majalah Kedokteran Bandung Vol 53, No 4 (2021)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15395/mkb.v53n4.2420

Abstract

Early detection of Sensory Processing Disorder (SPD) is important for deciding on appropriate interventions for children at risk. However, there is no valid screening tool available at this moment. The purpose of this study was to validate the deGangi, Sensorimotor History Questionnaire for Preschooler (SHQP), and neurological soft sign of Cambridge Neurological Inventory (NSS CNI) against intelligent quotient (IQ) to establish a reliable cut-off for SPD screening tools for children aged 4–6 years. Sixty-four parent-child were recruited randomly from 3 kindergartens in Bandung, Indonesia. Eligible parents were asked to fill out the SHQP, while their child was assessed using theWechsler Preschool and Primary Scale of Intelligent (WPPSI) and NSS CNI. The deGangi SHQP score and NSS CNI showed a weak and moderate correlation with Full-scale IQ (FIQ). The total score of deGangi SHQP’s sensitivity was 50% with a specificity of 53.4% and a negative predictive value (NPV) of 91.2% agaisnt the FIQ score. The total sensitivity for the NSS CNI was 66.7%, while the total specificity was 58.6% and the NPV was 94.4%. Meanwhile, the sensitivity for the sensory integration subscale score of the NSS CNI was 83.3%, with a specificity of 60.3% and an NPV of 97.2%. The deGangi SHQP can be considered to be an SPD screening tool with the cut-off scores for each subscale of self-regulation, sensory processing of touch, sensory processing of movement, emotional maturity, and motor maturity of 3, 3, 3, and 2, respectively, while the NSS CNI can be used for identifying SPD in children aged 4–6 years with a cut-off scores for the motor coordination, sensory integration, and disinhibition subscales of 7, 10, and 3, respectively.
Quantitative Measure to Differentiate Wicket Spike from Interictal Epileptiform Discharges Suryani Gunadharma; Ahmad Rizal; Rovina Ruslami; Tri Hanggono Achmad; See Siew Ju; Juni Wijayanti Puspita; Sapto Wahyu Indratno; Edy Soewono
Communication in Biomathematical Sciences Vol. 4 No. 1 (2021)
Publisher : Indonesian Bio-Mathematical Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.5614/cbms.2021.4.1.2

Abstract

A number of benign EEG patterns are often misinterpreted as interictal epileptiform discharges (IEDs) because of their epileptiform appearances, one of them is wicket spike. Differentiating wicket spike from IEDs may help in preventing epilepsy misdiagnosis. The temporal location of IEDs and wicket spike were chosen from 143 EEG recordings. Amplitude, duration and angles were measured from the wave triangles and were used as the variables. In this study, linear discriminant analysis is used to create the formula to differentiate wicket spike from IEDs consisting spike and sharp waves. We obtained a formula with excellent accuracy. This study emphasizes the need for objective criteria to distinguish wicket spike from IEDs to avoid misreading of the EEG and misdiagnosis of epilepsy.
Prevalence of Opportunistic Infection in Central Nervous System among Patients with HIV/AIDS at Dr. Hasan Sadikin General Hospital Bandung, Indonesia Dinda Sayyidah Laela Fatimatuzzahra; Ahmad Rizal Ganiem; Aih Cahyani; Suryani Gunadharma; Sofiati Dian
Althea Medical Journal Vol 9, No 2 (2022)
Publisher : Faculty of Medicine Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15850/amj.v9n2.2298

Abstract

Background: The low coverage of diagnosis and treatment in patients with human immunodeficiency virus (HIV) infection in Indonesia increases the risk of opportunistic infections that affects various organs, including the central nervous system (CNS). This study aimed to determine the prevalence of opportunistic infections in the CNS among hospitalized patients with HIV/acquired immune deficiency syndrome (AIDS) at Dr. Hasan Sadikin General Hospital Bandung, Indonesia.Methods: In this cross-sectional study with a total sampling method, data were collected from HIV/AIDS patients who were diagnosed with CNS opportunistic infection and hospitalized in the neurology ward during the period 2015–2019. Data were presented as median (interquartile range) and percentage frequency.Results: Among the 2,606 HIV/AIDS patients registered, 219 (8.4%) were accompanied by CNS opportunistic infections. The highest number was cerebral toxoplasmosis (58.9%; n=129) followed by tuberculous meningitis (33.3%; n=73) and cryptococcal meningitis (7.8%; n=17). Most of the patients admitted for unconsciousness (64.4%; n=141), with unknown HIV-infection status (61.2%; n=134). Among patients with positive HIV-infection status, only 50.6% (43/85) patients were taking antiretroviral therapy (ART) and 24.7% (21/85) patients dropped out ART before being diagnosed with CNS opportunistic infections. The CD4+’s median value was 21 cells/mm3 (IQR 9-61.25), with mortality during hospitalization was 36.5% (80/219). Conclusions: The prevalence of CNS opportunistic infections among HIV-infected patients is 8.4%, dominated by cerebral toxoplasmosis, and laboratory result showed very low CD4+ levels. The diagnosis of HIV infection is shortly made before hospitalization, and those who has been diagnosed have low compliance with ART. The mortality rate during hospitalization is high.
Outcomes of Tuberculous Meningitis Patients with or without Hydrocephalus from a Tertiary Hospital in West Java, Indonesia Nubella Citresna Zakiyyah; Suryani Gunadharma; Ahmad Rizal Ganiem
Althea Medical Journal Vol 9, No 4 (2022)
Publisher : Faculty of Medicine Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15850/amj.v9n4.2304

Abstract

Background: Tuberculous meningitis (TBM) is a severe form of extrapulmonary tuberculosis. One of the most common complications of TBM is hydrocephalus, with a higher risk of mortality. This study aimed to evaluate the outcome among TBM patients with or without hydrocephalus.Methods: This study was a retrospective cross-sectional comparative analytical study. A total sampling was employed based on the number of traceable resumes of TBM patients treated at the Department of Neurology Dr. Hasan Sadikin General Hospital, Bandung, Indonesia in 2018. Results: Of the 127 data of TBM patients, 55 (43.3%) had hydrocephalus, and 72 (56.7%) did not. The median age of TBM patients with and without hydrocephalus was 34 years (IQR 26–45) and 35 years (IQR 24–44), respectively. Decreased consciousness dominated the clinical symptoms for 94.5% in the hydrocephalus group and 84.7% in the non-hydrocephalus group. Hospital-acquired pneumonia occurred mainly in the hydrocephalus group (29.1%), whereas urinary tract infections mainly occurred in without hydrocephalus group (18%). There was a significant difference between the outcome of hydrocephalus and non-hydrocephalus (p=0.005). Mortality was higher in patients with hydrocephalus compared to those without hydrocephalus.Conclusions: The outcome of TBM patients with hydrocephalus is worse than those without hydrocephalus, as reflected by a higher grade of TBM, higher mortality rate, and lower good recovery upon treatment administration. Therefore, prompt diagnosis and treatment are needed to improve the outcome and survival among TBM patients with hydrocephalus.
Cognitive Outcome of Intracerebral Hemorrhage Patients with and without Pneumonia Carissa Vania Pratama; Cep Juli; Chandra Calista; Suryani Gunadharma; Yusuf Wibisono; Paulus Anam Ong
Althea Medical Journal Vol 9, No 3 (2022)
Publisher : Faculty of Medicine Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15850/amj.v9n3.2320

Abstract

Background: There are high prevalence of cognitive impairment in patients with intracerebral hemorrhage (ICH) that may worsen the patients’ outcomes. Pneumonia, as the significant infection complication in stroke patients, may aggravate the decline in the cognitive outcome of patients. This study aimed to explore the cognitive outcomes among patients with or without pneumonia among patients with intracerebral hemorrhage.Methods: A cross-sectional retrospective analytical comparative numeric study was conducted from September 2020 to February 2021, using secondary data of patients with intracerebral hemorrhage admitted to the Department of Neurology Dr. Hasan Sadikin General Hospital in the year 2019. A total sampling method was employed. Data on pneumonia in stroke patients was retrieved, consisting of patients with pneumonia and without pneumonia. Data on Mini-Mental State Examination (MMSE) scores as the measures of cognitive outcomes were compared using the Mann-Whitney U test.Results: There were 108 patients with intracerebral hemorrhage included. There was a statistically significant difference (p value 0.049) in MMSE scores with  median MMSE score for pneumonia patients (n = 27) and non-pneumonia patients (n = 81) were 25 and 21, respectively.Conclusions: Cognitive outcome is worse in patients with pneumonia than those without pneumonia. Early intervention is needed for intracerebral hemorrhage patients who develop pneumonia as a complication to improve the cognitive outcome.
HUBUNGAN PERDARAHAN GASTROINTESTINAL DENGAN LUARAN PASIEN STROKE ISKEMIK AKUT Rico Defryantho; Lisda Amalia; Ahmad Rizal; Suryani Gunadharma; Siti Aminah; Nushrotul Lailiyya
NEURONA Vol 36 No 2 (2019)
Publisher : PERDOSNI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52386/neurona.v36i2.58

Abstract

     ASSOCIATION BETWEEN GASTROINTESTINAL BLEEDING WITH CLINICAL OUTCOME ACUTE ISCHEMIC STROKE PATIENTABSTRACTIntroduction: Gastrointestinal bleeding associated by the delay in the administration of antiplatelet and anticoagulant, thus affected the clinical outcome and patient treatment.Aims: To find the association between gastrointestinal bleeding and clinical outcome in acute ischemic stroke patient.Methods: This study was a prospective observational, conducted at Hasan Sadikin Hospital Bandung in November 2017 to February 2018. Acute ischemic stroke patients that fulfill the inclusion and exclusion criteria were observed while being treated in the ward and the survival rate and length of stay were studied. This study used univariate, bivariate, multivariate, and stratification analysis.Results: In the study period, 100 acute ischemic stroke patients were found and 24 patients had gastrointestinal bleeding. A history of previous peptic ulcer/gastrointestinal bleeding was found in patient with gastrointestinal bleeding (20.8%). Median NIHSS score was higher (16 vs 7) and GCS score was lower (12 vs 15) in patients with bleeding. Multivariate analysis showed that gastrointestinal bleeding were significantly associated with survival and length of stay. The analysis of stratification showed subjects with infections who later experienced gastrointestinal bleeding had a lower risk of death and length of stay than subjects without infection who experienced gastrointestinal bleeding (1.7  vs  22.5 times and 1.5 vs 2 times).Discussion: Ischemic stroke with gastrointestinal bleeding had higher mortality and length of stay than without gastrointestinal bleeding in acute ischemic stroke patient.Keyword: Acute ischemic stroke, gastrointestinal bleeding, length of stay, mortalityABSTRAKPendahuluan: Perdarahan gastrointestinal berhubungan dengan penundaan terapi antiplatelet atau antikoagulan, sehingga berpengaruh terhadap luaran dan tata laksana pasien.Tujuan: Mengetahui hubungan perdarahan gastrointestinal dengan luaran pasien stroke iskemik akut.Metode: Penelitian prospektif observasional terhadap pasien stroke iskemik akut di RSUP Dr. Hasan Sadikin, Bandung pada bulan November 2017 hingga Februari 2018. Pasien stroke iskemik akut yang memenuhi kriteria inklusi dan eksklusi diobservasi selama perawatan untuk mengetahui survival dan lama perawatan di rumah sakit. Analisis statistik yang digunakan adalah univariat, bivariat, multivariat, dan stratifikasi.Hasil: Selama periode penelitian didapatkan 100 subjek stroke iskemik akut dengan 24 subjek mengalami perdarahan gastrointestinal. Riwayat ulkus peptikum/perdarahan gastrointestinal sebelumnya sebanyak 20,8% pada perdarahan gastrointestinal. Median skor NIHSS lebih tinggi (16 vs 7) dan skor GCS lebih rendah (12 vs 15) pada perdarahan. Analisis multivariat didapatkan perdarahan gastrointestinal memiliki hubungan signifikan dengan survival dan lama perawatan. Berdasarkan analisis stratifikasi subjek dengan infeksi yang kemudian mengalami perdarahan gastrointestinal memiliki risiko mortalitas dan lama perawatan lebih rendah dibandingkan subjek tanpa infeksi kemudian mengalami perdarahan gastrointestinal (1,7 vs 22,5 kali dan 1,5 vs 2 kali).Diskusi: Stroke iskemik akut yang mengalami perdarahan gastrointestinal memiliki risiko mortalitas dan lama perawatan lebih tinggi dibandingkan tanpa perdarahan gastrointestinal.Kata kunci: Lama perawatan, mortalitas, perdarahan gastrointestinal, stroke iskemik akut
Co-Authors Agastya Prabhaswara Ahmad Rizal Ahmad Rizal Ahmad Rizal Ganiem Aih Cahyani Anam Ong Andi Basuki Prima Birawa Arifin Soenggono Arifin Soenggono, Arifin Carissa Vania Pratama Cep Juli Chandra Calista Dinda Sayyidah Laela Fatimatuzzahra Edy Soewono Hendra Irawan Indrs Gunawan Affandi Juni Wijayanti Puspita Kusnandar Anggadiredja Kusnandar Anggadiredja Levina Tri Ratana Lia Amalia Lisda Amalia Lisda Amalia Nubella Citresna Zakiyyah Nushrotul Lailiyya Paulus Anam Ong Raden Retno Ariani Ratana, Levina Tri Rico Defryantho,* Lisda Amalia,* Ahmad Rizal,** Suryani Gunadharma,* Siti Aminah,* Nushrotul Lailiyya* Rovina Ruslami, Rovina Sapto Wahyu Indratno See Siew Ju Siti Aminah Siti Aminah Sobana Sobaryati Sobaryati Sofiati Dian Tiara Pramaesya Tri Hanggono Achmad Uni Gamayani Uni Gamayani Yusuf Wibisono