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Reaksi Paradoksikal pada Kasus Definitif Meningoensefalitis Tuberkulosis Nagpal, Chand
Majalah Kedokteran Neurosains Perhimpunan Dokter Spesialis Saraf Indonesia Vol 40 No 1 (2023): Vol 40 No 1 (2023)
Publisher : PERDOSNI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52386/neurona.v40i1.423

Abstract

PARADOXICAL REACTION IN A DEFINITIVE CASE OF TUBERCULOUS MENINGOENCEPHALITIS ABSTRACT Tuberculous Meningoencephalitis is an infection of the central nervous system (CNS) that is characterized by fever, headaches, nuchal rigidity, focal neurological deficit and altered consciousness. This is a case report illustrating the clinical progress of a 22-year old woman with HIV-negative status diagnosed with definitive tuberculous meningoencephalitis with a paradoxical reaction, which is a clinical syndrome where the patient experiences clinical deterioration after a phase of clinical improvement; syndrome of inappropriate antidiuretic hormone secretion (SIADH) and hydrocephalus, which are two relatively common complications in cases of tuberculous meningitis, which pose as challenges in clinical management of such cases. Ventriculoperitoneal (VP) shunt is an invasive treatment option for the management of hydrocephalus is cases of central nervous system infections that do not respond adequately to pharmacologic therapy. Keywords: meningoencephalitis, paradoxical, SIADH, shunt, tuberculous
Bacterial Meningitis as a complication of Urosepsis: A case report Nagpal, Chand; Maharani, Kartika; Estiasari, Riwanti; Imran, Darma
Acta Neurologica Indonesia Vol. 3 No. 04 (2025): Acta Neurologica Indonesia
Publisher : Departemen Neurologi Fakultas Kedokteran Universitas Indonesia

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Abstract

Bacterial meningitis is a severe bacterial infection that infiltrates the meninges and is characterized by headache, fever and neck stiffness. We present a case of a 60-year-old female with urosepsis consulted to the neurology department with loss of consciousness. Her clinical symptoms progressed over 7 days, with loss of consciousness, fever, meningeal signs and right-sided hemiparesis, suggestive of acute meningitis. Lumbar puncture was performed and CSF analysis suggested partially treated meningitis. Blood culture revealed growth of Enterococcus faecalis. Intravenous dexamethasone and meropenem were given and oral antibiotics were continued until the patient regained consciousness completely. Bacterial meningitis should be suspected in any severe systemic infection with clinical symptoms such as loss of consciousness. Establishing a diagnosis with the help of CSF analysis, culture, and appropriate treatment with antibiotic selection and dosage is imperative to ensure adequate penetrance to the central nervous system. Physician’s clinical judgement to establish an early diagnosis and initiate treatment is crucial and determines patient outcome. Initial phase of BM can be clinically severe, and often requires treatment in the ICU initially.
Posterior Reversible Encephalopathy Syndrome (PRES) with Hypertensive Retinopathy and Hyperaldosteronism Nagpal, Chand; Mesiano, Taufik; Rasyid, Al; Hidayat, Rakhmad; Pangeran, David; Kurniawan, Mohammad; Harris, Salim
Acta Neurologica Indonesia Vol. 4 No. 01 (2026): Acta Neurologica Indonesia
Publisher : Departemen Neurologi Fakultas Kedokteran Universitas Indonesia

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Abstract

Introduction: Posterior Reversible Encephalopathy Syndrome (PRES) is a neurological syndrome with an acute or subacute onset characterized by reversible cerebrovascular dysregulation. Hypertension is the primary risk factor for PRES, however other conditions such as hyperaldosteronism accompany and precipitate PRES. Case Report: This case illustrates a 32-year-old man without prior medical history with loss of consciousness and seizures 1 day prior to admission with blurry vision and vomiting 2 weeks prior that progressed gradually. Brain MRI revealed vasogenic edema of bilateral occipital lobes. The patient was assessed for hypertensive retinopathy and suspected primary hyperaldosteronism. Management with anti-hypertensives, anti-epileptic medications, electrolyte correction and supportive therapy was given, and the patient improved gradually and was discharged 10 days later without any complications. Discussion: No diagnostic criteria is available for PRES, however brain MRI is the crucial to establish a diagnosis of PRES. The resolution of symptoms with blood pressure regulation is another validation of the diagnosis of PRES. Ruling out differentials is prudent to ensure appropriate therapy. Management of PRES encompasses blood pressure regulation, anti-epileptic medications, treating other causes such as drug exposure and metabolic disorders. Previous reports PRES due to secondary hypertension attributed to primary hyperaldosteronism have been reported, although evidence about this causality is limited, nonetheless must be explored and treated as a cause of the hypertension triggering PRES. Conclusion : PRES is a neurological syndrome that is reversible, with hypertension as the primary risk factor that could be secondary due to disorders like primary hyperaldosteronism, that could ultimately trigger PRES.