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AUTOIMMUNE ENCEPHALITIS: DIAGNOSTIC AND TREATMENT APPROACH Hamdani, Ismi Adhanisa; Agustina, Lydia; Sasongko, Hari Andang; Gaharu, Maula Nuruddin; Rachmatullah, Fahmi; Ghufira, Nanda; Stevany, Nabila; Pawestri, Natasya Rahma Dewi; Fatahuddin, Rahaliya Salsabila; Natasya, Natasya
MNJ (Malang Neurology Journal) Vol. 10 No. 2 (2024): July
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.2024.010.02.13

Autoimmune encephalitis is a type of brain inflammation induced by an inappropriate immune response to a neuronal antigen, resulting in the generation of autoantibodies. Autoimmunity as important cause of encephalitis in recent years has not been much reported in Indonesia. Increased familiarity with autoimmune encephalitis among physician, not only neurologist, is extremely important for early detection. Prompt diagnosis and early immunotherapy leads to better prognosis in this potentially treatable disease, despite a long disease course. Autoimmune encephalitis is characterized by acute-subacute progressive neuropsychiatric symptoms with associated cognitive dysfunction, encephalopathy, psychiatric disorders, movement disorders and seizures, with anti-N-methyl-D-aspartate (NMDA) receptors encephalitis as the most common type. In addition to clinical features, further diagnostic investigations needed are brain magnetic resonance imaging (MRI), electroencephalography (EEG), cerebrospinal fluid (CSF) analysis, and autoantibody testing. Challenges in establishing diagnosis include wide range of clinical symptoms, absence of abnormalities in brain MRI, unspecified EEG findings, negative antibody testing, and limited availability of antibody testing in Indonesia. This literature review discusses the recognition, diagnosis and principle of treatment of autoimmune encephalitis.

EFEKTIVITAS TOKSIN BOTULINUM TIPE A TERHADAP SKALA SPASME, SKALA DEPRESI DAN KUALITAS HIDUP PASIEN HEMIFASIAL SPASME DI RSUD CIAWI Cornelia, Celine; Hamdani, Ismi Adhanisa; Gaharu, Maula N.; Agustina, Lydia
Majalah Kedokteran Neurosains Perhimpunan Dokter Spesialis Saraf Indonesia Vol 40 No 4 (2024): Volume 40, No 4 - September 2024
Publisher : PERDOSNI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52386/neurona.v40i2.560

Introduction: Approximately 10/100.000 individuals worldwide experience hemifacial spasm (HFS) with a ratio of women-to-men at 2:1. Around 90% HFS patients face social life challenges, leading to self-isolation and decreased quality of life. Therapy modalities for HFS include oral therapy, botulinum toxin injection and surgery, but the oral therapy response rate is low. Aim: To determine the effectiveness of botulinum toxin type A injection on, spasm scale, depression scale and quality of life of HFS patients Methods: A quasi-experimental study was conducted at Ciawi Regional Hospital in May-December 2023. Data were collected using a total sampling technique, injection of Clostridium botulinum neurotoxin type A and succeeded by a 2-weeks, 1 month and 2 month follow-up. We used modified Jankovic scale, Mini International Neuropsychiatric Interview and HFS-7 criteria for our instruments. Results: 29 patients are included in this research, aged 30-93 years (31% are male and 69% are female). 69% suffered left-sided HFS and 31% right-sided HFS. 44,8% patients had hypertension. After 2 weeks post-injection, 81.8% patients with 2nd degree HFS and 71.4% patients with 1st degree HFS reported significant symptom improvement (p = 0.046 and 0.025). Both patientÃ¢â‚¬â„¢s degree reported depression improvement without significant p-value (p = > 0.05) after 2 weeks until 2 month post injection. Increased quality of life (p = 0.001). Discussion: Clostridium botulinum neurotoxin type A injection is an effective treatment modality to improve spasm, depression and quality of life in HFS patients at Ciawi Regional Hospital. Keywords: Botulinum Toxin, Degree of Spasm, Experimental, Hemifacial Spasm, Quality of Life

Tuberculous Meningoencephalitis in Lost To Follow-Up Patient: A Case Report Graciela, Yemima; Wisnuwardhani, Dian; Hamdani, Ismi Adhanisa
Jambi Medical Journal : Jurnal Kedokteran dan Kesehatan Vol. 12 No. 1 (2024): JAMBI MEDICAL JOURNAL: Jurnal Kedokteran dan Kesehatan
Publisher : FAKULTAS KEDOKTERAN DAN ILMU KESEHATAN UNIVERSITAS JAMBI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22437/jmj.v12i1.29103

Background: Tuberculous meningoencephalitis (TBME) is a rare extrapulmonary TB that accounted for less than 1-2% with high mortality and morbidity rate. Loss of follow-up (LTFU) TB cases are also associated with worse prognosis, treatment failure, drug-resistant cases, decompensations, and complications. The objective of this study is to present a TBME case in LTFU patient as both conditions are correlated with worse outcomes for the patient. Case report: A 20-year-old man with a history of discontinued TB therapy presented to the emergency room (ER) with complaints of depressed consciousness, absence seizure, fever, shivers, nausea, vomiting, and holo-cranial headache. The diagnosis of TBME was confirmed by contrast-enhanced radiological findings, detection of M. tuberculosis in sputum, and blood investigations. Early initiation of anti-tuberculous drugs was given and showed marked clinical improvement followed by complete relief after a month follow-up. Conclusion: TBME should be diagnosed in patients living in high-rate TB countries with presumptive symptoms and signs supported by laboratory investigations as well as radiological findings to initiate early treatment. LTFU patients should be monitored with family or social group support while improving TB regimens in healthcare facilities. Keywords: Tuberculosis, meningoencephalitis, loss-to-follow up

One and a Half Syndrome and Internuclear Ophthalmoplegia as Neuro-Ophthalmological Manifestations in Patients with Brainstem Stroke: A Case Series Mahardhika Maghfirani Sadewa; Celine Cornelia; Maula Nuruddin Gaharu; Hamdani, Ismi Adhanisa
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 4 (2024): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v8i4.969

Background: Brainstem stroke syndrome accounts for 10-15% of all types of strokes, which may result in relatively rare neuroophthalmological manifestations. The aim of this case report is to report findings of one and a half syndrome (OAHS) and internuclear ophthalmoplegia in a patient with brainstem stroke. Case presentation: First case, female, 56 years old, came with sudden weakness on the right side of the body. One and a half syndrome was found, namely when asked to glance to the left, conjugate gaze palsy was obtained horizontally, and when asked to glance to the right, there was adduction inability of the left eye (ipsilateral). Right eye abduction was normal with present nystagmus. Paresis of right central CN. VII, XII was present, along with hemiparesis dextra (contralateral). Head CT scan shows hemorrhage in pons and intraventricular. Second case, female, 65 years old, came with a protruding mouth, vertigo, and sudden double vision Internuclear ophthalmoplegia was present, namely an adduction inability of the left eye (ipsilateral) when asked to glance to the right. Right eye abduction was normal with present nystagmus. no abnormalities were seen in the primary position and when asked to glance to the left. Paresis of right peripheral CN. VII, hemiparesis and right (contralateral) hemihypesthesia was present. MRI shows multiple chronic infarcts as well as subacute infarcts in bilateral parietal and pons. Conclusion: Clinical knowledge is necessary for topic determination, rehabilitation process and evaluation.

One and a Half Syndrome and Internuclear Ophthalmoplegia as Neuro-Ophthalmological Manifestations in Patients with Brainstem Stroke: A Case Series Mahardhika Maghfirani Sadewa; Celine Cornelia; Maula Nuruddin Gaharu; Hamdani, Ismi Adhanisa
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 4 (2024): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v8i4.969

Background: Brainstem stroke syndrome accounts for 10-15% of all types of strokes, which may result in relatively rare neuroophthalmological manifestations. The aim of this case report is to report findings of one and a half syndrome (OAHS) and internuclear ophthalmoplegia in a patient with brainstem stroke. Case presentation: First case, female, 56 years old, came with sudden weakness on the right side of the body. One and a half syndrome was found, namely when asked to glance to the left, conjugate gaze palsy was obtained horizontally, and when asked to glance to the right, there was adduction inability of the left eye (ipsilateral). Right eye abduction was normal with present nystagmus. Paresis of right central CN. VII, XII was present, along with hemiparesis dextra (contralateral). Head CT scan shows hemorrhage in pons and intraventricular. Second case, female, 65 years old, came with a protruding mouth, vertigo, and sudden double vision Internuclear ophthalmoplegia was present, namely an adduction inability of the left eye (ipsilateral) when asked to glance to the right. Right eye abduction was normal with present nystagmus. no abnormalities were seen in the primary position and when asked to glance to the left. Paresis of right peripheral CN. VII, hemiparesis and right (contralateral) hemihypesthesia was present. MRI shows multiple chronic infarcts as well as subacute infarcts in bilateral parietal and pons. Conclusion: Clinical knowledge is necessary for topic determination, rehabilitation process and evaluation.

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