Gaharu, Maula Nuruddin
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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

Abstract

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.
TB Meningitis: Tantangan Diagnosis Dini dan Implikasi terhadap Morbiditas serta Mortalitas Gaharu, Maula Nuruddin
Majalah Kedokteran Neurosains Perhimpunan Dokter Spesialis Saraf Indonesia Vol 40 No 2 (2024): Vol 40 No 2 (2024): Volume 40, No 2 - Maret 2024
Publisher : PERDOSNI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52386/neurona.v40i2.794

Abstract

Bulan Maret merupakan hari tuberkulosis (TBC) dunia yang di peringati setiap tanggal 24. Indonesia menempati urutan keduaterbanyak setelah India pada prevalensi tuberkulosis, Global TB Report 2023 mencatat sekitar 1 juta kasus baru dan kematian akibat TBCper tahun di Indonesia mencapai 100.000 kasus. Secara global, 8% kasus berasal dari Indonesia. TB meningitis (TBM) merupakanpenyebab mortalitas tersering pada kasus TB ekstrapulmonal, bahkan, dari TB pulmonal itu sendiri. TBM merupakan penyebab terseringpada kasus-kasus infeksi serebral. The Lancet Global Health Commision, melaporkan 50% mortalitas TBM disebabkan oleh buruknyalayanan kesehatan. Bermacam kendala dalam tata laksana TBM, mulai dari penegakan diagnosis, modalitas, regimen pengobatan, hinggafaktor kemampuan sarana kesehatan dalam menangani TBM.Manifestasi klinis yang kadang tidak khas terkadang tidak dikenali sebagai manifestasi TBM, seperti gangguan kognitif, manifestasiklinis menyerupai stroke, gangguan gerak bola mata, dan defisit neurologis lainnya, menyebabkan progresifitas infeksi yang semakinberat. Bahkan, tidak jarang tenaga kesehatan membuat diagnosis selain TBM pada tahap awal perjalanan penyakit. World HealthOrganization membagi keterlambatan diagnosis berdasarkan waktu, penegakan diagnostik, dan inisiasi medikamentosa antituberkulosa.Pada literatur, bahkan, disebutkan keterlambatan penegakan diagnosis dapat terjadi hingga 2 bulan. Hal-hal tersebut menjadi tantanganbagi para neurolog untuk meningkatkan kewaspadaan terhadap TBM, bahkan, pemahaman klinis TBM juga perlu diberikan pada dokterumum yang sering kali menjumpai pasien pada stadium awal. Literatur melaporkan 35% kasus pertama kali berobat pada praktek-praktekpribadi dan sisanya pada Pusat Kesehatan Masyarakat (Puskemas) bahkan fasilitas kesehatan informal seperti apotik, toko obat, dll.Jika kecepatan dan ketepatan diagnosis TBM dapat dilakukan pada tahap awal perjalanan penyakit, akan ada dampak besar padapenurunan morbiditas dan mortalitas TBM. Melengkapi sarana-sarana kesehatan mulai dari primer hingga sekunder dengan diagnostiklaboratorium hingga imajing. Selain itu tindakan lumbal pungsi juga penting dilakukan pada layanan Kesehatan sekunder, di sampingketersediaan diagnostik imajing CT scan kepala kontras. Peranan pemerintah dalam pembuatan kebijakan-kebijakan pada pembiayaanpenjaminanan nasional juga menentukan ketepatan dan kecepatan diagnosa.Kolaborasi yang baik akan memperkuat kewaspadaan dan kemampuan penanganan TBM, yang berdampak mengurangi morbiditasserta mortalitas TBM. Selamat hari tuberkulosis, bersama, kita bisa.
Paradoxical Hemiparesis from Cerebellopontine Angle Tumor: A Case Report Gunawan, James; Gaharu, Maula Nuruddin
International Journal of Integrated Health Sciences Vol 11, No 2 (2023)
Publisher : Faculty of Medicine Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15850/ijihs.v11n2.2947

Abstract

Objective: To report a vestibular schwannoma in the cerebellopontine angle presenting with paradoxical hemiparesis with the Kernohan-Woltman Notch Phenomenon (KWNP).Methods: A 31-year-old female presented to the neurology clinic at Bhayangkara Hospital TK. I R. Said Sukanto, Indonesia, on 29 November 2021 with loss of balance, hearing, vision, and weakness in her left arm and leg. On physical examination, the patient had reduced left arm and leg muscle strengths against resistance (MRC grade 4), face deviation to the left, abnormal finger-to-nose test, dysdiadochokinesia, and inability to perform tandem gait. She was admitted for a brain MRI but did not return to the hospital for re-evaluation and surgery. Results: The brain MRI showed a mass on the left side of the cerebellum with a size of 4.44x3.93x4.93 cm, suggesting vestibular schwannoma. The mass also caused the obliteration of the ventricle, causing hydrocephalus.Conclusion:KWNP is an unusual finding resulting in a paradoxical hemiparesis, a false-localizing neurologic sign. Physicians should recognize KWNP in patients with hemiparesis, especially in space-occupying lesions. Imaging studies can help localize the lesion to minimize misdiagnosis and optimize patient treatment.