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All Journal JKKI : Jurnal Kedokteran dan Kesehatan Indonesia Magna Neurologica
Fairuzya, Azmi Farah
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Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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A 61-Years-Old Female with Moyamoya Syndrome: A Case Report Savitri, Martha Oktavia Dewi; Fairuzya, Azmi Farah; Subandi; Imanuddin, Iqbal; Romadhoni, Andry Nur Wahyu Putra; Hosoya, Tomohiro
Magna Neurologica Vol. 3 No. 1 (2025): January
Publisher : Department of Neurology Faculty of Medicine Universitas Sebelas Maret

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/magnaneurologica.v3i1.1119

Abstract

Background: Moyamoya vasculopathy (MMV), like Moyamoya disease (MMD) and Moyamoya syndrome (MMS), is a rare chronic cerebrovascular angiopathy, especially in elderly patients. The incidence onset of MMV were unique with bimodal peak age: 5-10 years old and 25-49 years old. Case: A 61-year-old-female complaint of sudden onset left-sided hemiparesis one month before admission, headache, and forgetfulness. She had history of diabetes mellitus for 3 years. Neurological physical examination found left hemiparesis with motoric strength 4/5. Laboratory findings are unremarkable. Brain MRI with contrast showed infarcts at subcortical regions. Her cerebral DSA examination suggested diffuse multiple stenosis in the anterior circulation and total occlusion of left external and internal carotid artery. “Puff of smoke” and “champagne-bottle like neck sign” were found in DSA imaging, typical signs of MMD. She received aspirin 80 mg as her secondary prevention of another stroke event.  Discussion: MMV case at elderly onset which is similar to prior small study with mean age of 60 years old. Previous study mentioned hypertension (44%) and diabetes mellitus (16%) were found in older MMD patients. Patient was given aspirin 80mg daily. Precautions in this case include taking lifelong antiplatelet, managing diabetes mellitus, and implementing lifestyle modification. This treatment approach was directed to lower concomitant risk of ischemic stroke. Conclusion: We report a case of MMV which was considered as a rare case and a cause of stroke event. The management of this case was directed to control the coexisting condition of ischemic stroke using antiplatelet drug and risk factor management.
Recurrent Brain Abscess in 40-Years-Old Female Associated with Ventricular Septal Defect: A Case Report Fairuzya, Azmi Farah; Savitri, Martha Oktavia Dewi; Prabaningtyas, Hanindia Riani; Watanabe, Yasuhiro; Murakami, Takenobu; Tajiri, Yuki
Magna Neurologica Vol. 3 No. 1 (2025): January
Publisher : Department of Neurology Faculty of Medicine Universitas Sebelas Maret

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/magnaneurologica.v3i1.1123

Abstract

Background: Ventricular septal defect (VSD) is one of the critical risk factors for brain abscess. The unsterile blood in uncontrolled cyanotic congenital heart disease cases will travel to the brain after escaping the filtration mechanism and cause brain abscess. Case: A 40-year-old female presented with a two-week course of moderate headaches, worsening severely four days before admission. Neurological manifestations included attention deficits, dysarthria, right-sided hemiparesis, and proper facial palsy. Laboratory findings indicated leukocytosis and polycythemia. Echocardiography revealed VSD. Brain MRI with contrast suggested a single abscess lesion in the left occipital lobe. A histopathological examination confirmed the diagnosis. Antibiotics were administered during hospitalization, with outpatient treatment afterward. A one-month follow-up revealed new symptoms and a subsequent surgical excision. Discussion: Brain abscess remains a challenging and life-threatening case despite advanced diagnostic techniques. Uncontrolled cyanotic heart disease might be an essential risk factor for brain abscess occurrence. Thorough diagnostic examinations must be conducted to establish the diagnosis. The optimal empirical-targeted antibiotic treatment is a cornerstone of management. After antibiotic therapy, a surgical approach must be considered in lesions with large-size or nonoptimal size reduction. It is essential to comprehensively manage brain abscesses and their etiology to reduce the recurrence rate. Conclusion: Brain abscess associated with uncontrolled cyanotic congenital heart disease requires comprehensive treatment involving antibiotics and surgery. Addressing underlying causes and cost-effective follow-ups with clinical and monthly imaging assessments are essential.
Combination of stem cell and repetitive transcranial magnetic stimulation in acute ischaemic stroke as a promising treatment: A case report Danuaji, Rivan; Hambarsari, Yetty; Hamidi, Baarid Luqman; Hutabarat, Ervina Arta Jayanti; Tedjo, Raden Andi Ario; Fairuzya, Azmi Farah; Savitri, Martha Oktavia Dewi
JKKI : Jurnal Kedokteran dan Kesehatan Indonesia JKKI, Vol 15, No 1, (2024)
Publisher : Faculty of Medicine, Universitas Islam Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20885/JKKI.Vol15.Iss1.art15

Abstract

Stroke is a major contributor to long-term disability and its incidence continues to rise annually. This case report aimed to explore the promising benefits of combining stem cell therapy with repetitive transcranial magnetic stimulation (rTMS) in managing acute ischaemic stroke patients. A 62-year-old male presented with left-sided hemiparesis and hemineglect, as well as a cognitive disturbance in the attention domain. His medical history included uncontrolled hypertension over decades and diabetes mellitus for five years. A non-contrast head computed tomography (CT) scan revealed infarction in the right middle cerebral artery (MCA), with an initial National Institutes of Health Stroke Scale (NIHSS) of 13 upon admission to the Emergency Room. The infection and tumour markers were conducted to confirm no contraindication in this patient receiving stem cell therapy. Following the acute phase, the patient underwent a comprehensive treatment regimen involving both stem cell therapy and serial rTMS. Clinical assessments included NIHSS, Barthel Index, and Fugl-Meyer Assesement to evaluate neurological deficits. Additionally, the Montreal Cognitive Assessment-Indonesian version (MoCA-INA) assessment, electroencephalography examination and motor threshold were conducted. The results of this case report revealed noteworthy improvements in NIHSS, motoric strength, and cognitive function post-treatment. In this case report, improvement in clinical outcomes was obtained in the form of motor strength and higher cortical function. Stem cell therapy combined with rTMS has good potential in treating various neuroregenerative and rehabilitative aspects in ischaemic stroke patients.
Co-Authors Hambarsari, Yetty Hamidi, Baarid Luqman Hosoya, Tomohiro Hutabarat, Ervina Arta Jayanti Iqbal Imanuddin Martha Oktavia Dewi Savitri Murakami, Takenobu Prabaningtyas, Hanindia Riani Rivan Danuaji Romadhoni, Andry Nur Wahyu Putra Tajiri, Yuki Tedjo, Raden Andi Ario Watanabe, Yasuhiro