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PREDIKTOR SYMPTOMATIC INTRACEREBRAL HEMORRHAGE PASCATROMBOLISIS INTRAVENA PADA STROKE ISKEMIK AKUT Al Rasyid; Salim Harris; Mohammad Kurniawan; Rakhmad Hidayat; Taufik Mesiano
NEURONA Vol 35 No 3 (2018)
Publisher : PERDOSNI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52386/neurona.v35i3.12

PREDICTORS OF SYMPTOMATIC INTRACEREBRAL HEMORRHAGE FOLLOWING INTRAVENOUS THROMBOLYSIS IN ACUTE ISCHEMIC STROKEABSTRACTDespite its effectiveness, the percentage of ischemic stroke patients who received definitive treatment, thrombolysis, never went above 10%, due to one of the reason is the occurrence of severe, post-therapeutic complications, such as symptomatic intracerebral hemorrhage (sICH). Several factors contribute to sICH occurrence are age, severity of stroke, early changes of ischemic sign, hyperglycemia, blood pressure, antiplatelet use and its interval. Patients with highest risk of sICH has been shown to have the greatest benefits from thrombolysis among other subgroup patients, therefore withholding therapy is not a choice. Compliance to the stroke’s guidelines could reduce the risk of complications as well as boost effectiveness of treatment.Keywords: Safety predictors, acute ischemic stroke, thrombolysis, sICH ABSTRAK Walau terbukti efektif, persentase pasien yang dapat dilakukan tindakan definitif stroke iskemik akut berupa trombolisis tidak pernah mencapai angka 10%, salah satunya disebabkan pertimbangan terhadap komplikasi berat, seperti symptomatic intracerebral hemorrhage (sICH). Beberapa faktor yang berpengaruh terhadap kejadian sICH antara lain usia, derajat stroke, perubahan tanda iskemik dini, hiperglikemia dan diabetes melitus, tekanan darah, penggunaan antiplatelet, serta waktu pemberian. Pasien dengan risiko sICH tertinggi memiliki keuntungan terbesar dari trombolisis sehingga menunda tindakan bukanlah suatu opsi. Kepatuhan terhadap panduan tindakan dapat mengurangi angka kejadian komplikasi berat.Kata kunci: Prediktor keamanan, stroke iskemik akut, trombolisis, sICH

PENGARUH KADAR INTERLEUKIN-6 DAN NEURON SPECIFIC ENOLASE TERHADAP LUARAN STROKE ISKEMIK AKUT Al Rasyid; Salim Harris; Muhammad Kurniawan; Taufik Mesiano; Rakhmad Hidayat
NEURONA Vol 35 No 4 (2018)
Publisher : PERDOSNI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52386/neurona.v35i4.26

THE EFFECT OF INTERLEUKIN-6 AND NEURON SPECIFIC ENOLASE LEVEL ON ACUTE ISCHEMIC STROKE OUTCOME WITH PACS AND LACS SUBTYPEABSTRACTIntroduction: Brain blood flow disruption in ischemic stroke will trigger cells damage cascade and caused infarction. Interleukin-6 (IL-6) and neuron specific enolase (NSE) are brain cells damage marker that can be markers of acute ischemic stroke outcome.Aim: To investigate the effect of IL-6 and NSE levels on acute ischemic stroke outcome and its interacting factors.Methods: An observational cohort study on ischemic stroke patients with onset ≤3 days in several hospitals in Jakarta and Depok in 2014. Medical history and physical examination were carried out as well as laboratory parameters; hematocrit, fibrinogen, low density lipoprotein (LDL), high density lipoprotein (HDL), triglyceride, IL-6, and NSE. The National Institute of Health Stroke Scale (NIHSS) were assessed ≤72 hours of onset and 7 days along with Modified Rankin Scale (mRS) at 1 month of onset. Bivariate and multivariate logistic regression were done to investigate the association of IL-6 and NSE with stroke outcome and other factors.Results: One-hundred thirty-five subjects were included, mostly male (62%), with age mean 59,4±10,7 years and subtype PACS (76%). Interleukin-6 and NSE level were elevated in 61,5% and 21,5% subjects. Interleukin-6 and fibrinogen influenced the mRS, while diabetes and fibrinogen influenced the NIHSS. NSE serum didn’t show any association with mRS nor NIHSS, but influenced by dyslipidemia.Discussion: There was a tendency of worse outcome on high IL-6 level patients, although by multivariate analysis IL-2 alone was not sufficient enough as prognostic marker in acute ischemic stroke outcome. Neuron specific enolase serum didn’t show any association with acute stroke outcome due to also influenced by sex, smoking, and fibrinogen levels.Keywords: Acute ischemic stroke, IL-6, NSE, outcomeABSTRAKPendahuluan: Gangguan aliran darah otak pada stroke iskemik akut akan memicu kaskade kerusakan sel otak yang menyebabkan infark dan inflamasi. Interleukin-6 (IL-6) dan neuron specific enolase (NSE) merupakan penanda kerusakan sel otak yang dapat menjadi penanda luaran stroke iskemik akut.Tujuan: Mengetahui pengaruh kadar IL-6 dan NSE pada luaran stroke iskemik akut serta faktor-faktor yang memengaruhinya.Metode: Penelitian kohort observasional terhadap pasien stroke iskemik akut dengan awitan ≤3 hari yang dirawat di beberapa RS di Jakarta dan Depok pada tahun 2014. Dilakukan anamnesis dan pemeriksaan fisik serta pemeriksaan hematokrit, fibrinogen, low density lipoprotein (LDL), high density lipoprotein (HDL), trigliserida, IL-6, dan NSE serum. Dilakukan pemeriksaan National Institute of Health Stroke Scale (NIHSS) awal awitan ≤72 jam dan 7 hari serta modified rankin scale (mRS) pada 1 bulan. Analisis statistik bivariat dan regresi logistik multivariat dilakukan untuk mengetahui hubungan kadar IL-6 dan NSE dengan luaran stroke serta hubungannya terhadap faktor-faktor lainnya.Hasil: Didapatkan 135 subjek yang mayoritas laki-laki (62%) dengan rerata usia 59,4±10,7 tahun dan subtipe PACS (76%). Peningkatan kadar IL-6 dan NSE ditemukan pada 61,5% dan 21,5% subjek. Luaran berdasarkan skor mRS dipengaruhi oleh kadar IL-6 dan fibrinogen, sedangkan berdasarkan NIHSS dipengaruhi oleh diabetes melitus dan fibrinogen. Kadar NSE tidak berhubungan dengan mRS dan NIHSS, namun dipengaruhi oleh status dislipidemia.Diskusi: Terdapat kecenderungan luaran buruk pada kadar IL-6 tinggi, namun dengan analisis multivariat IL-6 belum bisa menjadi penanda prognosis luaran stroke iskemik akut. Kadar NSE serum tidak berperan terhadap luaran stroke iskemik akut, oleh karena juga dipengaruhi oleh jenis kelamin, merokok, dan kadar fibrinogen.Kata kunci: Stroke iskemik akut, IL-6, neuron specirefic enolase, luaran

MEKANISME IMUNODEPRESI PASCASTROKE Al Rasyid
NEURONA Vol 36 No 3 (2019)
Publisher : PERDOSNI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52386/neurona.v36i3.78

POST-STROKE IMMUNODEPRESSION MECHANISMSABSTRACTImmunodepression refers to a condition when immune system has reduced capacity to fulfill its functions therefore leading to infection. Infections develop frequently after stroke, and have been associated with poor clinical and functional outcome. Several studies show ischemic stroke, leads to impairment of immune responses, which increases susceptibility of an infection. This review analyzes the mechanisms of post-stroke immunodepression involving nervous system, such as adrenergic pathway, cholinergic pathway, or HPA axis, comprehensively based on recent clinical and experimental evidences. A better understanding of immune system modification after stroke could encourage further studies regarding immunomodulation therapy use in fighting infection.Keywords: Immune response, infection, post-stroke immunodepressionABSTRAKImunodepresi merupakan suatu kondisi saat sistem imun tidak dapat menjalankan perannya dengan baik sehingga dapat menimbulkan suatu infeksi. Infeksi sendiri merupakan komplikasi yang umum terjadi pascastroke, dihubungkan dengan luaran klinis dan fungsional yang buruk pada pasien stroke. Berbagai studi klinis menyimpulkan kondisi iskemik pada stroke menyebabkan gangguan pada respons imun sehingga menimbulkan kerentanan terhadap infeksi. Tulisan ini membahas mekanisme imunodepresi pascastroke terkait sistem saraf, baik jalur adrenergik, kolinergik, dan aksis HPA, secara komprehensif berbasis bukti klinis maupun eksperimental. Pemahaman konsep modifikasi sistem imun pascastroke dapat mendorong studi-studi lanjutan terkait penggunaan terapi imunomodulasi untuk melawan komplikasi infeksi.Kata kunci: Imunodepresi pascastroke, infeksi, respons imun

PERDARAHAN INTRASEREBRAL SEBAGAI KOMPLIKASI NEUROLOGI EMBOLI SEPTIK PADA ENDOKARDITIS INFEKTIF: SEBUAH LAPORAN KASUS Mohammad Kurniawan; Salim Harris; Al Rasyid; Taufik Mesiano; Rakhmad Hidayat; Yesi Astri
NEURONA Vol 36 No 4 (2019)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52386/neurona.v36i4.93

INTRACEREBRAL HEMORRHAGE AS A NEUROLOGICAL COMPLICATION OF SEPTIC EMBOLISM IN INFECTIVE ENDOCARDITIS: A CASE REPORTABSTRACTInfective endocarditis (IE) is a life-threatening disease. The incidence of IE in developing countries is reported at 1.7-6.2 per 100,000 individuals per year. IE is also known as a potential condition for embolization, especially septic embolism to the brain. Septic embolism results in various neurological complications and manifestations due to vascular occlusion, aneurysm formation and rupture of the aneurysm. We report a case of 34-year-old male with definitive IE based on Duke criteria who experienced neurological complications of intracerebral bleeding. Patient was given pharmacological treatment according to the guidelines of the American Heart Association (AHA)with improvement in clinical symptoms.Keywords: Infective endocarditis, intracerebral hemorrhage, septic embolismABSTRAKEndokarditis infektif (EI) merupakan penyakit yang mengancam nyawa, walaupun angka kejadiannya kecil, yaitu 1,7-6,2 per 100.000 individu per tahun di negara berkembang. EI juga sangat potensial menyebabkan embolisasi, khususnya emboli septik ke otak. Emboli ini mengakibatkan manifestasi gangguan neurologis yang disebabkan karena oklusi pembuluh pembentukan dan ruptur aneurisma. Dilaporkan kasus seorang laki-laki 34 tahun dengan EI definitif berdasarkan kriteria Duke yang mengalami komplikasi neurologis perdarahan intraserebral. Pasien ditatalaksana sesuai panduan American Heart Association (AHA) dengan perbaikan gejala klinis.Kata kunci: Endokarditis infektif, emboli septik, perdarahan intrakranial

PERAN SISTEM IMUN TERHADAP TERJADINYA PNEUMONIA TERKAIT STROKE Al Rasyid
NEURONA Vol 36 No 4 (2019)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52386/neurona.v36i4.94

THE ROLE OF IMMUNE SYSTEM ON THE OCCURRENCE OF STROKE- ASSOCIATED PNEUMONIAABSTRACTStroke associated pneumonia (SAP) is one of the medical complication which associated with high mortality rate. Several studies conclude two factors involve significantly in pathophysiology of SAP, one of which is immunodepression state. Immunodepression occurs by 3 main pathways, symphathetic system activation, parasymphathetic system activation, and HPA (hypothalamus-pituitary-adrenal) axis activation. Simultaneously, they induce proinflammatory response suppression and immune cells alternation, which lead to an infection like pneumonia. Therefore, establishing an effective immunomodulation therapy could be one of the main focus in comprehensive stroke management’s future studies.Keywords: Immunodepression, stroke-associated pneumoniaABSTRAKKomplikasi pneumonia terkait stroke menjadi salah satu faktor penyebab mortalitas tertinggi. Studi-studi menyimpulkan bahwa ada dua faktor yang berperan pada patofisiologi pneumonia, salah satunya adalah imunodepresi terkait stroke. Imunodepresi terjadi melalui 3 jaras, yaitu aktivitas simpatis, aktivitas parasimpatis, dan aksis hipotalamus- pituitari-adrenal. Secara simultan, ketiganya menekan respons proinflamasi dan mengubah sel-sel imun sehingga pneumonia dapat mudah terjadi. Pembuatan terapi imunomodulasi yang dapat mencegah infeksi namun tidak memperburuk kondisi iskemia dapat menjadi fokus studi penanganan stroke komprehensif di masa datang.Kata kunci: Imunodepresi, pneumonia terkait stroke

MEMBANGUN SISTEM CODE STROKE PADA DUA RUMAH SAKIT PENDIDIKAN DI INDONESIA Rakhmad Hidayat; Hirari Fattah Yasfi; Dinda Diafiri; Reyhan Eddy Yunus; Andi Ade Wijaya Ramlan; Taufik Mesiano; Mohammad Kurniawan; Al Rasyid; Salim Harris
NEURONA Vol 37 No 3 (2020)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52386/neurona.v37i3.165

Code stroke system is rapid respond system for ischemic stroke patient’s care to have immediate therapy in order to increase effectiveness and achieve maximum outcome. Cipto Mangunkusumo Hospital and Universitas Indonesia Hospital are educational hospitals with different background, resources, facilities, and conditions in code stroke system implementation. This paper compares the code stroke system between both hospitals from some aspects, such as emergency unit health care providers, cost and facility, diagnostic imaging, initiator of code stroke system, observation room, availability of catherization lab, and communication within code stroke team. Code stroke system can be implemented in many hospitals correspondingly adjusting each of hospital conditions by maximizing advantages to cover the hospital’s shortcomings. Keywords: Code stroke, hospital, ischemic stroke, thrombectomy, thrombolysis

KEJADIAN STROKE ISKEMIK PADA PASIEN POSITIF COVID-19 TERKONFIRMASI DI RUMAH SAKIT UNIVERSITAS INDONESIA Rakhmad Hidayat; Gemia Clarisa Fathi; Ramdinal Aviesena Zairinal; Raden Rara Diah Handayani; Mohammad Kurniawan; Taufik Mesiano; Al Rasyid; Salim Harris
NEURONA Vol 38 No 2 (2021)
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Coronavirus disease 2019 (COVID-19) is not only disrupts the respiratory system, it can disrupt various organ systems, one of which is the central nervous system. Indonesia still has a little literature that discusses COVID-19 and its relation to ischemic stroke. This study aims to report the course of ischemic stroke cases in patients who have been confirmed positive for COVID-19. A 56 year old man presented with confirmed COVID-19, the patient had a history of type 2 diabetes mellitus and also a history of dyslipidemia. At initial presentation the patient did not complain of neurological symptoms, but after 12 days of treatment the patient complained of weakness in the left side of the upper leg. The CT scan of the head with contrast revealed an infarction in the peripheral area, perfusion CT found that the patient was hypoperfused in the right cerebral hemisphere area without the presence of a large core infarction or a clear perfusion mismatch defect. CT angiography did not reveal stenosis or occlusion of the large vessels. It can be concluded that ischemic stroke in COVID-19 patients can occur due to various underlying factors, one of which is hypercoagulability. Keywords: COVID-19, Stroke, Universitas Indonesia Hospital

PROFIL KLINIS DAN LUARAN STROKE ISKEMIK AKUT DENGAN TROMBEKTOMI MEKANIK BERDASARKAN LOKASI OKLUSI DI RSUPN DR. CIPTO MANGUNKUSUMO Kevin Kevin; Taufik Mesiano; Mohammad Kurniawan; Rakhmad Hidayat; Affan P. Permana; Al Rasyid; Salim Harris
NEURONA Vol 38 No 3 (2021)
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Introduction: Occlusion in anterior circulation gives variable clinical manifestations. Mechanical thrombectomy promises almost two times higher recanalization rate as opposed to thrombolysis. Aim: To evaluate the clinical and outcome profile of acute ischemic stroke patients who underwent mechanical thrombectomy based on the occlusion site. Methods: This was a retrospective cohort conducted at Cipto Mangunkusumo National Referral Hospital from May 2017 to January 2020. All acute ischemic stroke patients in anterior circulation who underwent mechanical thrombectomy with or without bridging intravenous thrombolysis were analyzed. Occlusion site and recanalization rate were scored based on arteriogram. Results: Sixteen patients had occlusion in ICA-M1 segment, while ten others were in the M2 segment. NIHSS value was two points higher in ICA-M1 occlusion (p>0.05), which further analysis found that the proportion of aphasia manifestation was higher in the ICA-M1 segment (50.0% vs 20.0%; p=0.218). Demographical and clinical characteristics were similar between the two groups. Thrombolysis did not modify the occlusion site on thrombectomy (p>0.05). Despite statistical insignificancy, ICA-M1 occlusion showed an earlier time trend from admission to recanalization. The M2 segment had a higher proportion of mTICI 2b/3 recanali????ation (50.0% vs 70.0%; p=0.428) and mRS 0-2 on discharge (12.5% vs 50.0%; p=0.053). Discussion: Aphasia was more common in proximal occlusion???? which drove family members to bring patients earlier to the hospital. The functional outcome on discharge was lower in proximal occlusion due to more extensive and permanent brain tissue loss. Future coordination is warranted to improve the therapeutic time from admission to recanalization. Keywords: functional outcome, ischemic stroke, mechanical thrombectomy, occlusion site

PERAN PARAMETER HEMOREOLOGI DAN HEMOSTASIS SEBAGAI FAKTOR PROGNOSIS STROKE ISKEMIK AKUT DENGAN COVID-19 Al Rasyid
NEURONA Vol 38 No 4 (2021)
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Heretofore Coronavirus Disease-2019 (COVID-19) is still a serious global health threat. COVID-19 manifests not only in the respiratory system but also in the nervous system, one of which is acute ischemic stroke. There may be a reciprocal association between COVID-19 and acute ischemic stroke. Infection that occurs in COVID-19 offers detrimental effects on blood viscosity and the coagulation system. Disturbance of blood viscosity and coagulation system would cause deceleration of blood ????ow and thromboembolic, hence predisposing ischemic stroke. Disturbance of both parameters is also associated with worsening outcomes in ischemic stroke and COVID-19, as evaluated by the modified Rankin scale (mRS), Barthel index (BI) and mortality rate. Keywords: Acute ischemic stroke, blood viscosity, coagulopathy, COVID-19

KEJADIAN IKUTAN NEUROLOGIS PADA TENAGA KESEHATAN RUMAH SAKIT RUJUKAN COVID-19 PASCA VAKSINASI MRNA-1273 BOOSTER Rakhmad Hidayat; Muhammad Hafiz Aini; Zlatikha Djuliannisaa; Alyssa Putri Mustika; Mohammad Kurniawan; Taufik Mesiano; Al rasyid; Salim Harris
NEURONA Vol 38 No 4 (2021)
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Introduction: Vaccine effectivity to decrease COVID-19 transmission has been proven by the decrease in hospitality rate and death rate caused by COVID-19. Nowadays, Indonesian health workers are fully vaccinated for more than six months. The government want to give mRNA-1273 (Moderna) vaccine as the third vaccine dose booster for health workers. The booster’s effect remains unknown, but there are some vaccine side effects. Aim: To know the neurological side effects of the Moderna vaccine that are still unknown and not yet studied in Indonesia. Methods: This study used a prospective cohort with the primary data collected through an online form filled by health workers of Universitas Indonesia Hospital that get Moderna vaccine as a booster. Research data analysis will be carried out through a comparative study through the chi-square method using SPSS 20. Results: The previous history of adverse events following immunization (AEFI) significantly affects the type, the severity degree, and the acceptance of AEFI after the Moderna vaccine booster. BMI and regular medication affect the severity degree of AEFI (P<0.05). Regular medication insignificantly increases the possibility of no side effects. Meanwhile, the use of antipyretic medication for AEFI in????uenced the history of previous AEFI (P<0.05). Discussion: AEFI is any untoward medical occurrence that follows immunisation and does not necessarily have a causal relationship with the usage of the vaccine. Further investigation is necessary to evaluate the correlation between those factors and the AEFI of the Moderna booster vaccine. Keywords: COVID-19, health workers, Moderna vaccine, vaccine side effects

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