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All Journal MNJ (Malang Neurology Journal) Medicinus : Jurnal Kedokteran Majalah Kedokteran Neurosains Eduvest - Journal of Universal Studies Neurona Acta Neurologica Indonesia
Vivien Puspitasari, Vivien
Department Of Neurology, Faculty Of Medicine, University Of Pelita Harapan Siloam Hospital Lippo Village
Aerospace Engineering Computer Science & IT Health Professions Medicine & Pharmacology Neuroscience Public Health Social Sciences

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UNCONTROLLED DIABETES AS FACTOR AFFECTING COGNITIVE FUNCTION IN TYPE 2 DIABETES MELLITUS Simanungkalit, Astra Dea; Puspitasari, Vivien; Solansa, Tracy
MNJ (Malang Neurology Journal) Vol. 11 No. 1 (2025): January
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

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mnj.2025.011.01.21

Abstract

Background: Impairment or decline in cognitive function can be caused by various things, one of which is uncontrolled diabetes. In Indonesia, the research on the effect of blood sugar levels on cognitive function has been done, but still limited and less were using HbA1c. Objective: This research aims to find correlation between HbA1C level and cognitive function based on MoCA-Ina. Methods: This is a cross sectional study with a sample of 130 type 2 diabetes mellitus patients at Siloam Hospital Karawaci through a non-randomized purposive sampling method. Data collection was taken on January to May 2020 using medical record data for glycated hemoglobin (HbA1c) levels (cut off score 7%) and Montreal Cognitive Assessment ver. Indonesia (MoCA-Ina) score (cut off score 26) to evaluate the cognitive function. Statistical bivariate analysis performed using chi-square and multivariate analysis covariate variables using logistic regression. Results: Uncontrolled diabetes mellitus as shown by a high HbA1c level were significantly increase the risk of cognitive decline. The study showed a significant relationship between HbA1c levels with cognitive function (OR=5,98; CI 95% 2,25-15,58; p=0,000). A logistic regression analysis of various cognitive functions showed that memory was the most affected domain in patient with uncontrolled type 2 diabetes. Conclusion: Uncontrolled diabetes mellitus as shown by a high HbA1c level were significantly increase the risk of cognitive decline and the most affected domain was memory.
POLA DISTRIBUSI NYERI ALIH DAN POSISI TUBUH PENCETUS NYERI SENDI SAKROILIAKA Siahaan, Yusak Mangara Tua; Puspitasari, Vivien; Hartoyo, Vinson
Majalah Kedokteran Neurosains Perhimpunan Dokter Spesialis Saraf Indonesia Vol 35 No 2 (2018)
Publisher : PERDOSNI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52386/neurona.v35i2.5

Abstract

REFERRAL PAIN DISTRIBUTION PATTERN AND TRIGGERING POSITION OF SACROILIAC JOINT PAINABSTRACTIntroduction: sacroiliac joint (sIJ) contribution to cause low back pain is still widely debated. sIJ is hardly distinguished from facet joint pain or other musculoskeletal disorder causing low back pain and leads to diagnostic difficulties. There are several factors that contribute to SIJ pain diagnosis, which are referral pain area and triggering position.Aim: To investigate the distribution pattern of referral pain and position that could trigger the sacroiliac joint pain.Method: Patients with complaints of pain in buttock area and diagnosed as sIJ pain by intra articular block diagnostic test at Neurology Clinic of of siloam Hospitals Lippo Village between August to december 2017 were interviewed to record the area of referral pain and position which triggered the pain.Results: 114 subjects with complaint of buttock pain, ratio between men and women was 1:2.35 (n=34 and 80), were included in this study. Posterior compartment of the thigh (19.3%, n=22) is the most common referral pain area followed by lateral part of the thigh (11.4%, n=13). Getting up from sitting position and long period of sitting were the two most dominant factors that could trigger pain (61.4%, n=70 and 49.1%, n=56).Discussion: The referral pain distribution pattern of sacroiliac joint pain was dominated by the posterior part and lateral part of thigh, while getting up from sitting and long period of sitting is found in majority of the subjects as the most dominant triggering position.Keywords: Pain pattern, sacroiliac joint pain, triggering positionABSTRAKPendahuluan: Kontribusi nyeri sendi sakroiliaka sebagai penyebab nyeri pinggang masih menjadi perdebatan. Secara klinis, nyeri sendi sakroiliaka sulit dibedakan dengan nyeri sendi faset lumbal maupun gangguan muskuloskeletal lainnya sehingga menyulitkan dalam diagnosis. Terdapat faktor yang memengaruhi terjadinya nyeri sendi sakroiliaka antara lain posisi tubuh yang mencetuskan nyeri dan area nyeri alih yang menyertainya.Tujuan: Untuk mengetahui pola distribusi nyeri alih dan faktor posisi tubuh yang mencetuskan atau memperberat nyeri sendi sakroiliaka.Metode: Pasien yang datang dengan keluhan nyeri bokong yang terdiagnosis mengalami nyeri sendi sakroiliaka berdasarkan tes diagnostik injeksi blok intraartikular di poliklinik saraf RS Siloam Lippo Village dalam rentang waktu Agustus–Desember 2017 dilakukan wawancara untuk mengetahui area nyeri alih dan posisi pencetus nyeri.Hasil: Sebanyak 114 pasien dengan keluhan pada area bokong, rasio antara laki-laki dan perempuan dengan perbandingan 1:2,35 (n=34 dan 80) diikutsertakan dalam studi ini. Paha bagian posterior merupakan area nyeri alih terbanyak (19,3%, n=22) diikuti area paha lateralis (11,4%, n=13). Sedangkan posisi tubuh yang paling dominan memicu timbulnya nyeri sendi sakroiliaka adalah posisi bangun dari duduk (61,4%, n=70) dan duduk lama (49,1%, n=56).Diskusi: Pola distribusi nyeri alih pada pasien nyeri sendi sakroiliaka yang paling banyak ditemukan adalah nyeri pada daerah paha sisi posterior dan paha sisi lateral sedangkan faktor yang paling dominan mencetuskan atau memperberat nyeri sendi sakroiliaka adalah posisi bangun dari duduk dan posisi duduk yang lama.Kata kunci: Nyeri sendi sakroiliaka, pola nyeri, posisi tubuh pencetus
Comprehensive Analysis of Histamine-2 Receptor Antagonists on Dementia Risk: A Systematic Review of Cohort Studies Yong, Yee Wen; Puspitasari, Vivien
Acta Neurologica Indonesia Vol. 3 No. 02 (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.v3i02.68

Abstract

Introduction : Histamine-2 Receptor Antagonist (H2RA) are widely used to manage upper gastrointestinal diseases (UGID). However, growing concerns have emerged regarding their potential neurocognitive side effect, particularly an increased dementia risk. H2RAs are often preferred over proton pump inhibitors (PPIs) for enhanced therapeutic efficacy in clinical settings. Material and methods : This research adhered to the PRISMA guidelines to select studies and assess biases. Databases (PubMed, Scopus, and Cochrane) are systematically searched from 2020-2025, and available studies are further evaluated for eligibility and risk of bias using the Cochrane risk of bias assessment tools for non-randomized studies of interventions (ROBINS-I). Discussion : Six studies were analyzed, with four cohort studies showing no significant association between H2RA use and dementia risk. However, H2RA use was associated with accelerated cognitive decline in patients with mild cognitive impairment (MCI) and Alzheimer’s disease (AD). The anticholinergic effects of H2RAs may contribute to cognitive impairment by disrupting histamine's role in the central nervous system and vitamin B12 absorption. However, the pathophysiological mechanisms remain unclear and the findings across studies are inconsistent. Further randomized controlled trials (RCTs) with larger sample sizes are needed to elucidate the potential long-term effects of H2RAs on cognitive health. Conclusion : This systematic review found no clear association between H2RA use and an increased risk of dementia, but noted accelerated cognitive decline in MCI and AD patients. Keywords: alzheimer’s disease; cognitive impairment; dementia; gastric acid-suppressive agents; histamine-2 receptor antagonists
The Importance of Immunohistochemical Analysis in Silent Pituitary Adenoma Harsono, Ivan William; Stevina, Nathania Victoria; Puspitasari, Vivien; July, Julius
Medicinus Vol. 6 No. 3 (2017): June 2017 - September 2017
Publisher : Fakultas Kedokteran Universitas Pelita Harapan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19166/med.v6i3.1150

Abstract

Pituitary adenoma contributes to 15% of all intracranial neoplasm. It is usually following benign course and some of them are silent (asymptomatic clinically, but hormone-secreting). Silent adenoma usually found incidentally or when the patients show mass effect (neurological deficits). Many of histologically aggressive silent adenoma subtypes are associated with invasiveness, recurrence and progression to clinically functioning adenomas. Aggressive silent adenoma radiologically tends to invade in downward direction, invading bone, sinus cavernosus, parasellar region. The nature of aggressive silent adenoma subtypes is differing in nature compared to benign nature of pituitary adenoma and should be confirmed immunohistochemically to determine the prognosis and anticipate the risk of recurrence or progression. The case illustration show a real case of 46 years old female progressive headache and visual disturbance diagnosed with non-functional pituitary macroadenoma but positive for more than one immunochemistry biomarker (plurihormonal aggressive silent adenoma).
Sindrom-Guillain Barre Pada Pasien Demam Dengue Puspitasari, Vivien
Medicinus Vol. 5 No. 3 (2016): June 2016 - September 2016
Publisher : Fakultas Kedokteran Universitas Pelita Harapan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19166/med.v5i3.1172

Abstract

Guillain-Barre syndrome is an acute poliradiculopathy that characterizes as flaccid limb weakness subsequently after an infection disease. It is scarcely found to be triggered by the dengue virus infection. Here in a case report of 48-year-old male, presented as an ascending weakness of both limbs, following 2 days fever. Anti-dengue examination was found to be positive.Keywords: Guillain-Barre Syndrome, Dengue Fever
Case Report : Generalized Myasthenia Gravis Widjaja, Devita; Puspitasari, Vivien
Medicinus Vol. 8 No. 3 (2019): June 2019
Publisher : Fakultas Kedokteran Universitas Pelita Harapan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19166/med.v7i5.2497

Abstract

Generalized myasthenia gravis is a rare case of autoimmune wherein the antibodies destroy the post-sinaptic acetylcholine receptors at skeletal muscle’s neuromuscular junctions. The clinical presentation is specific distributin of motoric deficit without sensoric deficit which diminished with rest and worsens with excessive use. We report a case of a woman 52 yo with symptoms of ptosis, diplopia and dificulty of swallowing. Repetitive nerve stimulation showed >10% decrement and prostigmin test was positive. The patient was treated and showed clinical improvement.
Role of Span-75 in Determining Prognosis of Non-Thrombolysis Acute Ischemic Stroke Patients Sutanto, Anyeliria; Simanungkalit, Astra Dea; Yunita, Evelyn; Chandra, Anastasya; Pangestu, Aristo; Tiffani, Pamela
Medicinus Vol. 9 No. 2 (2020): February : 2020
Publisher : Fakultas Kedokteran Universitas Pelita Harapan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19166/med.v7i7.2759

Abstract

Introduction: The SPAN-75 index is a modification of the SPAN-100 index as a prognostic tool in acute ischemic stroke patients. Previous studies were using SPAN index in cases of ischemic stroke patients treated with rTPA and in cases of intracerebral hemorrhage.Aim: To determine the role of the SPAN-75 index as a prognostic scoring in patients with acute ischemic stroke who did not get thrombolysis therapy.Method: The subjects were acute ischemic stroke patients at Siloam Hospitals Lippo Village who were not treated with thrombolysis therapy and had no disability before stroke onset during January to April 2019. Subjects were classified into a positive and negative of SPAN-75 index group. Disability due to stroke was assessed with Modified Rankin Score (mRS) at the time of admission and discharged from the hospital. This prospective study was analyzed by the Kruskal-Wallis test.Result: Forty subjects (average age of 57 years old) consisted of 31 negative and 9 positive of SPAN-75. Based on the Kruskal-Wallis test, the SPAN-75 index was positively associated with a more severe degree of stroke disability at the time of admission (p = 0.002), but not related to the change in the degree of disability when the patient was discharged from the hospital (p = 0.807). Age (p = 0.445) and gender (p = 0.578) had no significant relationship with the degree of disability of acute ischemic stroke.Conclusion: The SPAN-75 index is related to the degree of disability of acute stroke patients at the time of admission.
Clinical Spectrum of Neurological Complaints in COVID-19: Experiences from a COVID-19 Referral Hospital in Indonesia Situmeang, Rocksy Fransisca V.; Simanungkalit, Astra Dea; Sutanto, Anyeliria; Pangestu, Aristo
Medicinus Vol. 10 No. 3 (2021): June 2021
Publisher : Fakultas Kedokteran Universitas Pelita Harapan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19166/med.v9i1.4195

Abstract

Background: The main feature of COVID-19 is symptoms of respiratory system disorder, however, there has been an increase in reports of neurological symptoms that appear in COVID-19 patients. Several previous studies have linked SARS-CoV-2 with nervous system damage. Research studying neurological complaints in  confirmed COVID-19 patients in Indonesia is still lackingAim: To identify neurological, laboratory, and imaging findings in COVID-19 patients with neurological symptoms.Methods: This study was a cross-sectional observational study conducted at Siloam Hospitals Mampang, a COVID-19 referral hospital in South Jakarta. We analyzed medical records of confirmed COVID-19 patients during the period of April - July 2020. The data collected included demographic data, comorbidities, neurological manifestations, laboratory examinations, and neuroimaging.Results: There were 22 confirmed COVID-19 patients with neurological complaints referred to a neurologist. The mean age of patients was 60.4 (SD 15.8) years. The most common neurological complaints were altered mental status (50%), hemiparesis (27.3%), and tremors (22.7%). More than half of the patients (81.8%) had a comorbid condition or past history related to neurological symptoms. Laboratory examination results showed increased NLR (neutrophil-lymphocyte ratio) (50%), anemia (45.5%), and leukocytosis (40.1%). The most common neuroimaging feature was infarct (50%) in the brain CT scan.Conclusion: The neurological complaints in COVID-19 patients are mostly associated with exacerbation of pre-existing comorbidities as a result of the severe inflammatory process triggered by COVID-19. Further research is needed to establish the mechanism of nervous system dysfunction in COVID-19.
Isolated Abducens Nerve Palsy: A Case Report of Cerebral Pseudocyst of Dorello’s Canal Puspitasari, Vivien; Japutri, Josephine; Solansa, Tracy; Cenweikiawan, Anderson
Medicinus Vol. 13 No. 2 (2024): February
Publisher : Fakultas Kedokteran Universitas Pelita Harapan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19166/med.v13i2.8108

Abstract

Background: Abducens nerve is the second longest intracranial path out of all of the cranial nerves. Abducens nerve pasly had a prevalence 11.3/100.000 and mostly seen in adults. Isolated abducens nerve palsy due to neoplastic lesion are rare and mostly related to skull base tumor.Case Presentation: We present a case of 57 years old woman with complaints of red right eye and worsening headache associates with diplopia on the right lateral gaze for three days prior admission. She was later diagnosed with isolated abducens nerve palsy associated to neoplasm cause in Dorello’s canal. Patient was then discharged with symptomatic therapy and educated for head posturing and avoid triggers.Conclusions: Abducens nerve palsy is the most common isolated ocular nerve palsy. The incidence of mass formation such as neoplastic lesion or cyst are rare.
Pharmacoresistant Temporal Lobe Epilepsy Controlled by Bilateral Anterior Thalamic Nuclei Thalamotomy Inggas, Made Agus Mahendra; Ketaren, Retno Jayantri; Puspitasari, Vivien; Wahyoepramono, Julianta
Eduvest - Journal of Universal Studies Vol. 5 No. 1 (2025): Journal Eduvest - Journal of Universal Studies
Publisher : Green Publisher Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59188/eduvest.v5i1.50815

Abstract

Introduction: Several potential targets have been suggested for the treatment of pharmacoresistant epilepsy, including medial parts of temporal lobes, caudate nucleus, cerebellum, centromedian nucleus of the thalamus, subthalamic nucleus and anterior thalamic nucleus (ATN). The effectiveness of bilateral ATN thalamotomy as treatment option for pharmacoresistant temporal lobe epilepsy is a considerable approach in this recent advances. Method: Case report. Result: A 24-year old male patient presented with unknown onset of generalized tonic clonic seizures and serials of drop attacks since 4 years of age. He was also diagnosed with Attention Defcit Hyperactivity Disorder (ADHD) and a history of febrile seizures. Brain MRI was normal. He has been treated with so many combination of antiepileptic drugs (AEDs) with last combination were Valproic acid 500 mg twice daily, Clonazepam 2 mg thrice daily and Zonisamide 100 mg twice daily. Despite all polytherapy AEDs given, he was still having recurrent seizures. Vagal Nerve Stimulation (VNS) was then conducted and seizures were slightly better. After maximal VNS voltage given, seizures became more frequent. ATN bilateral thalamotomy was done five years after, where seizure was better controlled. Levetiracetam 500mg twice daily and phenobarbital 15 mg once was given in concordance to the surgery, and the patient is doing well until now. Conclusion: In pharmacoresistant temporal lobe epilepsy where AEDs and VNS showed no signifcant improvement, ATN bilateral thalamotomy is considered to be a compelling treatment option. As we know, this is a first case report for ATN thalamotomy for epilepsy in south east asia region.
Co-Authors Amiruddin Aliah, Amiruddin Budhianto Suhadi Cahyono Kaelan, Cahyono Cenweikiawan, Anderson Chandra, Anastasya Djuanda, Gerald Eka J. Wahjoepramono Evelyn Yunita Harsono, Ivan William Hartoyo, Vinson Ilhamjaya Patellongi Ivan William Harsono Jan S. Purba, Jan S. Japutri, Josephine Julius July Ketaren, Retno Jayantri M.T. Siahaan, Yusak Made Agus Mahendra Inggas, Made Agus Mahendra Nathania Victoria Stevina Pangestu, Aristo Pangestu, Aristo Rinaldi Situmeang, Rocksy Fransisca V. Solansa, Tracy Stevano, Reza Stevina, Nathania Victoria Sutanto, Anyeliria Syarifuddin Wahid Tiffani, Pamela Wahyoepramono, Julianta Widjaja, Devita Yong, Yee Wen