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All Journal Medical Journal of Indonesia Indonesian Journal of Obstetrics and Gynecology (Majalah Obstetri dan Ginekologi Indonesia) Jurnal Sinaps Majalah Kedokteran Neurosains Journal of the Indonesian Medical Association : Majalah Kedokteran Indonesia Indonesian Journal of Cancer eJournal Kedokteran Indonesia Neurona Acta Neurologica Indonesia
Tiara Aninditha Tiara Aninditha
Departemen Neurologi FK Universitas Indonesia/RSUPN Dr. Cipto Mangunkusumo, Jakarta
Biochemistry, Genetics & Molecular Biology Education Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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GAMBARAN ARSITEKTUR TIDUR PADA PASIEN TUMOR OTAK YANG MENGALAMI GANGGUAN TIDUR Yesi Astri; Manfaluthy Hakim; Tiara Aninditha; Renindra Ananda Aman; Astri Budikayanti
NEURONA Vol 38 No 2 (2021)
Publisher : PERDOSNI

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Abstract

Introduction: Sleep disorder is commonly found in brain tumor patients (42-46%). It can be detected using thePittsburg Sleep ????uality Inde???? (PS????I) as a screening tool and confirmed by analyzing the sleep architecture obtainedthrough a Polysomnographic (PSG) examination.Aim: To evaluate the sleep architecture in brain tumor patients who experience sleep disorder.Methods: In this descriptive cross-sectional study, patients with primary brain tumor were screened for sleep disorderusing the PSQI. The ‘poor sleepers’ would proceed to PSG examination.Results: Of 40 participants, 14 were males and 26 were females with a mean age of 45.5±11.7 years old. The mostprevalent tumor was meningioma (42.5%), while the most affected regions were the frontal lobe (40%) and the sellarsuprasellarregion (2????.5%). Poor sleep ????uality and difficulty in initiating sleep (????3 times per week) was reported in77.5% and 60% of participants, respectively. All participants experienced reduced sleep duration, the majority of whichdemonstrated low sleep efficiency (8????.5%). An estimate of 60% participants e????perienced headache at night and 50% tooksleeping pills for these complaints. Most of them reported disruption in daytime activities. On PSG analysis, we observedshortening of sleep latency, reduced sleep efficiency, total sleep time, N2, N3, REM, arousal inde????, and increase of N1.There was a statistically significant difference between ????5 hours of sleep duration and decrease of N3 phase (p????0.05).Discussion: Abnormal sleep architecture presents in brain tumor patients with sleep disorder.Keywords: brain tumor, Pittsburgh Sleep Quality Index, polysomnography, sleep architecture
EKSTENSI DAN INVASI INTRAKRANIAL TUMOR KULIT KEPALA: TANTANGAN DIAGNOSIS DAN TATALAKSANA Sophie Yolanda; Tiara Aninditha; Henry Riyanto Sofyan; Rahmad Mulyadi
NEURONA Vol 39 No 2 (2022): Vol 39 No 2 (2022)
Publisher : PERDOSNI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52386/neurona.v39i2.312

Abstract

Scalp tumors are quite rare, only 1-2% are malignant and have a tendency for intracranial extension and invasion. This extension can lead to various neurological complications, such as cancer pain, increased intracranial pressure (ICP), and other neurological deficits. A 37-year-old woman presented with decreased consciousness since 2 days earlier. The patient had a history of lump on the top of her head since 4 years, repeated 3 times after resection without previous treatment. On the third recurrence, the tumor was enlarged until it some part of the tumor can be seen depressed against the skull and this part was painful. The pain worsened throughout the entire head accompanied by visual field disturbance of right inferior homonymous quadranopia, right central facial nerve paresis, and right hemiparesis. Contrast head CT scan revealed lobulated heterogeneous lesion in the parietooccipital region, extending to the extraaxial and intracerebral, accompanied by vasogenic edema with destruction of the parietal and occipital bones. The result of histopathology is trichilemmal carcinoma. The patient received morphine drip therapy 10mg/24 hours for the cancer pain, which was then replaced with its patch equivalent dose, dexamethasone 2x10mg IV tapering off gradually according to the clinical condition, gabapentin 2x300mg, and wholebrain radiotherapy (WBRT) 30 Gy in 10 sessions. The patient was discharged in conscious condition and her pain resolved to mild pain. Keywords: cancer pain, increased intracranial pressure, intracranial invasion, scalp tumor
Factors Influencing Distress and Coping Strategies Among Patients with Metastatic Spinal Tumor at Cipto Mangunkusumo General Hospital Agiananda, Feranindhya; Nugraeni, Tiara; Diatri, Hervita; Aninditha, Tiara; Kusumaningrum, Profitasari
Indonesian Journal of Cancer Vol 17, No 4 (2023): December
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v17i4.994

Abstract

Background: Patients with metastatic spinal tumor are experiencing various symptoms, including neurological deficits that cause distress and affects their quality of life. The vulnerability to distress is influenced by coping strategies. Therefore, this study aimed to investigate factors associated with distress and coping strategies in patients with metastatic spinal tumors at Cipto Mangunkusumo General Hospital. Methods: In a cross-sectional study conducted at Cipto Mangunkusumo General Hospital from September 2021 to May 2022, factors associated with distress and coping strategies in patients with metastatic spinal tumors were investigated. The analysis included a total of 104 subjects from both outpatient and inpatient settings. Distress levels and areas of concern were assessed using the Distress Thermometer (DT) questionnaire while coping strategies were evaluated through the Coping Orientation to the Problem Experienced (COPE) instrument. Bivariate and multivariable analyses were carried out to assess the relationship between sociodemographic factors, spinal tumor characteristics, specific areas of concern, coping strategies, and distress.Results: The results showed that 57.7% of metastatic spinal tumor patients experienced distress. In the 18-59 age group, motor disorders, sensory disturbances, autonomic disorders, treatment status, problem-focused coping (PFC), emotion-focused coping (EFC), and avoidance coping had significant associations with distress. However, the multivariable analysis showed that EFC (OR = 1.156, 95% CI: 1.024–1.304, p=0.019), avoidance coping (OR = 1.154, 95% CI: 1.005–1.326, p=0.042), and sensory disturbance (OR = 16.001, 95% CI: 1.472–173.960, p=0.023) were identified as risk factors for distress.Conclusions: Patients with metastatic spinal tumors who used emotion-focused coping, avoidance coping, and sensory disturbance faced significant risk factors for distress
An Overview of The Spinal Metastasis Pain with Opioid Therapy and The Affecting Factor Djohansjah, Joice Rosewitasari Aryanti; Andriani, Rini; Aninditha, Tiara; Sofyan, Henry Riyanto
Indonesian Journal of Cancer Vol 18, No 2 (2024): June
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v18i2.1065

Abstract

Background: Spinal metastasis is the most frequent type of spinal tumor. Opioid is the first line of treatment for cancer pain despite a multitude of side effects. This study aimed to evaluate the effectiveness of opioids as the latest ladder in the treatment of spinal cancer pain. Methods: A retrospective cross-sectional study was performed comprising 89 spinal metastasis patients at the National Cancer Centre, Dharmais Hospital from November 2021 to March 2022. The demographic and clinical data were retrieved from medical records. This study used the Numerical Rating Scale (NRS) to evaluate the improvement of pain. The change of NRS ≥ 2 was considered significant. The data was analyzed using bivariate (Wilcoxon, Mann-Whitney, and Fisher Exact test) and multivariate (linear regression) analysis. Results: A total of 89 subjects were included in the study (median age = 51 years, 57,3% females). There was a significant decrease in the severity of cancer pain (p0.005) between admission (initial NRS 7) and treatment completion (final NRS 2) in the first hospitalization of all groups. There was no correlation between the clinical characteristics of the participants and the NRS score determined upon admission and at the end of the course of treatment. Conclusions: There was a significant improvement in the cancer pain intensity in the subjects with spinal metastasis cancer pain who received opioid naive therapy.
HEPATIC METASTATIC MENINGIOMA FOLLOWING REPEATED INTRACRANIAL REMOVAL SURGERIES : Hepatic Metastatic Meningioma Audrey Clarissa; Tiara Aninditha; Eka Susanto; Kemal Fariz Kalista; David Tandian; Irma Savitri Madjid; Henry Riyanto Sofyan
Acta Neurologica Indonesia Vol. 3 No. 01 (2025): Acta Neurologica Indonesia
Publisher : Departemen Neurologi Fakultas Kedokteran Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.69868/ani.v3i01.41

Abstract

Introduction : Meningioma is mostly benign. With appropriate management, it may have a good prognosis. However, it may reoccur and metastasize in <1% of all cases. Studies describing re-occurrences of meningioma and extracranial metastasis, especially to the liver, are limited. Case Report : A 54-year-old female with secondary headache, cognitive impairment, blindness in the left eye, and paresis of the left facial nerve due to recurrent left spheno-orbital meningioma with scalp invasion had undergone four tumor removal surgeries. Previous histopathological findings were atypical meningioma (2017) and transitional meningioma (2023). A suspicion of a new primary tumor arose as an increase in transaminase and multiple liver nodules were observed despite being an asymptomatic patient. Histology and immuno-histochemistry from the intracranial tumor was an atypical meningioma, and cancer in the liver had a similar immunohistochemistry profile as the intracranial tumor, suggesting meningioma metastasis. Discussion : Recurrences were more prevalent in higher histologic grading, which can lead to serial operations, higher complication rates, and morbidities. While the lungs are the most common site for metastasis, hepatic metastasis is thought to be underestimated as patients are often asymptomatic. Factors such as scalp and brain invasion, blood vessel proximity, meningioma recurrences, and subtotal resection increase the risk of metastasis. To date, there are no specific guidelines on metastasis treatment. Conclusion : Meningioma can re-occur and metastasize to distant organs despite its usual benign characteristics. Aggressive tracking should be implemented in females with recurrent meningioma and scalp involvement
RARE CASE OF LEPTOMENINGEAL METASTASES FROM POORLY DIFFERENTIATED PAROTID CARCINOMA : RARE CASE OF LEPTOMENINGEAL METASTASES Tiara Aninditha; Dyah Ayu Puspita Anggarsari; Radius Kusuma; Eka Susanto; Erwin Danil Yulian; Irma Savitri; Henry Riyanto Sofyan
Acta Neurologica Indonesia Vol. 3 No. 01 (2025): Acta Neurologica Indonesia
Publisher : Departemen Neurologi Fakultas Kedokteran Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.69868/ani.v3i01.43

Abstract

exceedingly rare and challenging to diagnose, requiring confirmation via imaging and cerebrospinal fluid (CSF) cytology. Clinical signs like secondary headache often signal critical intracranial involvement. Case Report: A 27-year-old woman presented with severe headache, dizziness, and vomiting. She had a history of poorly differentiated parotid carcinoma with liver metastases and prior chemotherapy (CAF: cisplatin, doxorubicin, and fluorouracil). Physical exam revealed mild peripheral facial nerve palsy, ataxic gait, and tremor. High-dose dexamethasone and acetaminophen provided headache relief. CT brain imaging showed vasogenic edema with leptomeningeal enhancement in the right cerebellum and a 46% reduction in the parotid lesion. MRI of the nasopharynx identified leptomeningeal enhancement, notably in the right cerebellum, suggesting metastasis, along with fourth ventricle narrowing and ventricular dilation. CSF cytology revealed poorly differentiated malignant cells with pleomorphic nuclei. Craniospinal irradiation was planned. Discussion: Leptomeningeal metastasis is an uncommon parotid carcinoma complication. Secondary headache, diffuse and bilateral, typically affects the C2-C3 dermatome and is accompanied by dizziness. Symptom relief with high-dose dexamethasone was observed. Definitive LM diagnosis combines CSF cytology and MRI leptomeningeal enhancement. As chemotherapy options for LM from parotid carcinoma are limited, craniospinal irradiation is the preferred treatment. Conclusion: Leptomeningeal metastasis from poorly differentiated parotid carcinoma is extremely rare, confirmed by clinical signs, imaging, and CSF analysis. Severe secondary headache is a key indicator, and delayed diagnosis could prove fatal.
Educating General Practitioners about Medication-overuse Headache: Importance and Call to Action Sofyan, Henry Riyanto; Madjid, Irma Savitri; Faiq, Ahmad Rafi; Indrapriambada, Ery Riady; Humaira, Sarah; Aninditha, Tiara
Acta Neurologica Indonesia Vol. 3 No. 01 (2025): Acta Neurologica Indonesia
Publisher : Departemen Neurologi Fakultas Kedokteran Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.69868/ani.v3i01.49

Abstract

Medication overuse headache (MOH) is a secondary headache that frequently accompanied chronic primary headaches which poses a great burden in an individual and systemic level. Globally, it is recognized as one of the relevant headaches for primary care. However, in Indonesia, it has not been included in the standard competence for doctors, and therefore has been underrecognized by general practitioners who encountered headache patients in primary care. In this policy brief, we mapped the problems regarding MOH and proposed several action plans, including educating GPs, as the recommendations.
Cerebrospinal Fluid Profile in Suspected Leptomeningeal Metastases in Dr. Cipto Mangunkusumo National Referral Hospital and Dharmais National Cancer Center Hospital Aninditha, Tiara; Maulina, Lisa; Andriani, Rini; Susanto, Eka; Ranakusuma, Teguh; Sofyan, Henry Riyanto
Indonesian Journal of Cancer Vol 19, No 1 (2025): March
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v19i1.1286

Abstract

Background: Leptomeningeal metastases (LM) are a condition in which malignant cells spread to the leptomeninges and subarachnoid space, with an increasing incidence and poor prognosis. Cerebrospinal fluid (CSF) analysis is an important examination, with cytology as the gold standard for detecting malignant cells in CSF. We aim to describe the CSF profile (i.e. protein, glucose, cell count, and cytology) in detecting malignant cells among patients with suspected LM in Cipto Mangunkusumo National Referral Hospital and Dharmais National Cancer Center Hospital from January 2018 to December 2021. Method: A multicenter cross-sectional retrospective study was conducted to describe the CSF profile in suspected LM from January 2018 to December 2021. Suspected LM cases were established from clinical and radiological findings. The lumbal puncture was performed in those suspected LM cases. Clinical manifestations, radiological data, tumor type, some aspects from CSF routine analysis (i.e. protein, glucose, cell count), and lumbar puncture frequency were described. Their correlation with CSF cytology was analyzed. Results: There were 153 subjects with abnormalities on CSF routine analysis (75.2%), consisting of CSF cell count 5/uL (47.1%) with a median of 5 (1–3504)/uL, CSF protein 45 mg/dL (52.9%) with a median of 50 (5–820) mg/dL, and CSF glucose 50 mg/dL (15%) with a median of 68 (3–629) mg/dL. The positive CSF cytology result was 20.3%. Positive CSF flow cytometry immunophenotyping in hematological malignancy with suspected LM was 25.6%. There was a significant correlation between the increase in CSF cell count, hematological malignancy, and MRI results with CSF cytology (p 0.001; p = 0.03; p = 0.03). There was no significant correlation between clinical manifestations and lumbar puncture frequency with CSF cytology.Conclusion: Abnormalities in CSF routine analysis were found in the majority of subjects with suspected LM, but the CSF cytology positivity rate was considered low. The presence of varied clinical symptoms and repeated lumbar punctures didn’t increase the likelihood of positive CSF cytology
The Correlation of Inflammatory Markers with Clinical Manifestation, Peritumoral Edema, and Recurrence in Meningioma Patients Aninditha, Tiara; Auliya, Putri; Mulyadi, Rahmad; Aman, Renindra Ananda; Andriani, Rini; Sofyan, Henry Riyanto
Indonesian Journal of Cancer Vol 19, No 2 (2025): June
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v19i2.1287

Abstract

Background: Meningiomas can induce inflammation in their tumorigenesis process, thereby linking inflammation with clinical symptoms, peritumoral edema, and recurrence of meningiomas. Easily accessible and cost-effective inflammatory markers include the neutrophillymphocyte ratio (NLR) and monocyte-lymphocyte ratio (MLR). This study aims to investigate the relationship between peripheral inflammation markers, specifically the NLR and MLR, and their association with clinical symptoms, peritumoral edema, and meningioma recurrence.Method: A retrospective cohort study was conducted at Cipto Mangunkusumo National General Hospital from January 2016 to December 2019, utilizing a consecutive non-probability sampling method. Inclusion criteria were patients aged 18 years or older with meningiomas(gradesI-III), first surgery. Peripheral inflammatory markers were derived from differential blood counts, peritumoral edema data from radiological reports, and other data from medical records. The cut-off valuesfor NLR and MLR were determined to be 2.415 and 0.295, respectively. Bivariate analyses using ChiSquare and Mann-Whitney tests were followed by multivariate logistic regression analysis. Results: 173 patients were eligible for analysis. Of these, 27 had preoperative CT scans, 126 had MRIs, and 20 had no preoperative radiology data. Clinical and recurrence analyses were performed on all 173 patients, with radiology and tumor size analyses conducted on subsets of 153 and 126 patients, respectively. The majority of meningiomasin thisstudy were grade I, found in 94.2% of subjects, with the remainder being grade II and III. Higher NLR and MLR values were significantly associated with headaches (p 0.001). Elevated NLR and MLR were also correlated with peritumoral edema (p 0.001). MLR was independently associated with recurrence, with an adjusted odds ratio (aOR) of 12.647 (95% CI 2.355–67.919); p = 0.003.Conclusion: NLR and MLR as peripheral inflammatory markers demonstrated higher median values in meningioma patients with headaches and peritumoral edema. Additionally, inflammation in meningiomas was associated with the occurrence of recurrence.
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.
Co-Authors -, Liana Alviah Saputri Adriana Damayanti Agiananda, Feranindhya Ahmad Rafi Faiq Ahmad Yanuar Albertin, Elizabeth Alvonsius Silalahi, Raymond Aris Nimrod Alvonsius, Raymond Aris Nimrod Among Wibowo Anastasia Asylia Dinakrisma Andayani, Diyah Eka Andhika Rachman Andira Larasari Anne Dina Subroto Ardhi Rahman Ahani Aria Kekalih Ariarini, Ni Nengah Rida Arthur H.P. Mawuntu Audrey Clarissa David Tandian Diafiri, Dinda Djohansjah, Joice Rosewitasari Aryanti Dyah Ayu Puspita Anggarsari Eka Susanto Elsa Susanti Eny Nurhayati Ery Riady Indrapriambada Fahmi Radityamurti Faiq, Ahmad Rafi Ferucha Moulanda Hakim, Manfaluthy Hartono, Chandra Henry Riyanto Sofyan Henry Riyanto Sofyan Henry Riyanto Sofyan Henry Riyanto Sofyan Henry Riyanto Sofyan Henry Riyanto Sofyan Hervita Diatri Humaira, Sarah Ikhlas Rahmadi Imran, Darma Indrapriambada, Ery Riady Irma Savitri Irma Savitri Irma Savitri Madjid IRWANTO Jonathan Odilo Jonathan Odilo Karnasih, Artasya Kartika Maharani Kemal Fariz Kalista Kusuma, Radius Louis Kwandou Madjid, Irma Savitri Mariana Nur Laila Maulina, Lisa Mohamad Saekhu Natadisastra, Raden Muharram Nugraeni, Tiara Nur Afany Nurmiati Amir Pratiwi, Intan Prayangga, Regina Profitasari Kusumaningrum Pukovisa Prawiroharjo, Pukovisa Puspaseruni, Putri Air Putri Auliya, Putri Radius Kusuma Rahmad Mulyadi Rahmi Ardhini Ramdinal Aviesena Zairinal Ranakusuma, Teguh Ranakusuma, Teguh A. S Renindra Ananda Aman Rini Andriani Rini Andriani Rini Andriani Rini Andriani Rini Andriani Rini Andriani Rini Andriani Ririhena, Fiorentina C Riwanti Estiasari Riyanto Sofyan, Henry Saekhu, Mohammad Samjunanto, Achmad Sari, Riska Nanda Savitri, Irma Sembiring, Saulina Sinthia, Novita Ayu Sitorus, Freddy Sofyan, Henry Riyanto Sophie Yolanda Stefen Weliadi Ali Susanto, Eka Tan Yosephine Tanjung, Gloria Tejomukti, Teddy Tiara Aninditha Velyani, Dyani Pitra Vera Nevada Wahmurti, Tuti Wibisono, Sasanto Winnugroho Wiratman Yesi Astri Yesnuar Safri, Ahmad Yetty Ramli Yulian, Erwin D.