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All Journal Neurona Acta Neurologica Indonesia
Henry Riyanto Sofyan
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Health Professions Medicine & Pharmacology Neuroscience Public Health

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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
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

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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.
Co-Authors Audrey Clarissa David Tandian Dyah Ayu Puspita Anggarsari Eka Susanto Erwin Danil Yulian Irma Savitri Irma Savitri Madjid Kemal Fariz Kalista Radius Kusuma Rahmad Mulyadi Sophie Yolanda Tiara Aninditha Tiara Aninditha