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All Journal MEDICINUS Neurona
Rocksy Fransisca V Situmeang
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Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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ENSEFALOPATI PADA COVID-19 DENGAN MANIFESTASI GANGGUAN PERILAKU DAN KOGNITIF Reza Stevano; Rocksy Fransisca V Situmeang; Evlyne E Suryawijaya
NEURONA Vol 39 No 1 (2021)
Publisher : PERDOSNI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52386/neurona.v39i1.309

Abstract

Neurological manifestations of COVID-19 are wide and varied. We report a case of COVID-19-associated encephalopathy with manifestations of behavioral and cognitive changes, seizures, and altered consciousness, in a 47-year-old male previously diagnosed with COVID-19 two weeks prior. Upon physical examination, the patient was found to be agitated and disoriented. The neurological exam was nonfocal. Laboratory tests and a noncontrast head CT revealed normal results, while the nasopharyngeal swab polymerase chain reaction (PCR) was positive. Cerebrospinal fluid (CSF) studies were significant for elevated protein (0.54g/L) with a normal cell and glucose count, and CSF PCR were negative for presence of SARS-CoV-2. The patient received therapy with remdesivir, dexamethasone, heparin, antibiotics, and phenytoin, and was admitted for 8 days with marked improvement. Three weeks later, tests for cognitive function were performed and showed mild deficits in attention and short-term memory. Encephalopathy in COVID-19 can manifest as altered consciousness, seizure, behavioral and cognitive changes. It can emerge even without the presence of known risk factors and occur after the initial acute phase of SARS-CoV-2 infection, which might be due to a persistent immune response as a result of the presence of trace amounts of virus.
Disease-Modifying Therapy (DMT) Switch in Highly Active Multiple Sclerosis: A Case Report Rocksy Fransisca V Situmeang; Nadia Gabriella
MEDICINUS Vol. 38 No. 4 (2025): MEDICINUS
Publisher : PT Dexa Medica

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56951/jx5d6764

Abstract

Background: Highly active multiple sclerosis (HAMS) is a severe phenotype of multiple sclerosis (MS), accounting for 10% of all relapsing-remitting MS (RRMS) cases, characterized by rapid clinical decline and disease progression despite treatment with disease-modifying therapy (DMT). It is associated with high morbidity and mortality rates, thus requiring different therapeutic approaches. We report a case of DMT switch in a 30-year-old female with HAMS. Case: A 30-year-old female presented with a 3-month history of numbness and tingling on her fingers, back, and lower extremities. Examination revealed hyperreflexia and positive Hoffman-Tromner sign. Brain magnetic resonance imaging (MRI) revealed multiple demyelinating lesions suggestive of MS, including Dawson’s fingers. She was diagnosed with MS and initially treated with subcutaneous (SC) interferon beta-1a (IFNβ-1a) 22 mcg, three times weekly. As the patient continued to experience relapses and develop new lesions on biannual repetition of scans, she was diagnosed with RRMS. Four years after the initial diagnosis, her relapses became more frequent with incomplete recovery in between, suggestive of HAMS. Therapy was subsequently switched from IFNβ-1a to cladribine. Conclusion: Two approaches in the treatment of MS are the escalation and induction therapy. To date, no standardized treatment protocols for HAMS have been established. Patients with HAMS are candidates for the induction approach due to the narrow window of opportunity for treatment and the risk of early disease progression. Despite the risk of developing adverse reactions from being on potent immunosuppressive drugs, the imminent neurological disability that comes with HAMS outweighs this risk. The use of immune-reconstitution DMTs helps to achieve no evidence of disease activity (NEDA). Cladribine has shown promising outcomes in the treatment of HAMS and is frequently used for induction therapy.
Co-Authors Evlyne E Suryawijaya Nadia Gabriella Reza Stevano