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All Journal Jurnal Kedokteran dan Kesehatan : Publikasi Ilmiah Fakultas Kedokteran Universitas Sriwijaya Acta Neurologica Indonesia
Irma Savitri
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Biochemistry, Genetics & Molecular Biology Medicine & Pharmacology Neuroscience Public Health

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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.
ERECTOR SPINAE PLANE BLOCK AS A RESCUE THERAPY IN CHRONIC POSTHERPETIC NEURALGIA: A CASE REPORT Anto, Lie; Ismi A. Hamdani; Irma Savitri; Tiara Aninditha; Nurul Fadli; Yusak Mangara Tua Siahaan; Dyah Tunjungsari; Henry Riyanto Sofyan
Jurnal Kedokteran dan Kesehatan : Publikasi Ilmiah Fakultas Kedokteran Universitas Sriwijaya Vol. 13 No. 1 (2026): Jurnal Kedokteran dan Kesehatan : Publikasi Ilmiah Fakultas Kedokteran Univers
Publisher : Fakultas Kedokteran Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32539/aby7m369

Abstract

Postherpetic Neuralgia (PHN) is a persistent neuropathic pain following Herpes Zoster, particularly in the elderly. A case is reported of a 70-year-old man with PHN two months after HZ, experiencing burning and throbbing pain in the right T11–12 thoracic dermatomes with a pain scale of 8/10, paroxysmal in nature up to 10 times/day, triggered by touch, and disturbing sleep. The pain was unresponsive to gabapentin 1,800 mg/day and amitriptyline 12.5 mg/day. Two perineural injections of 5% dextrose reduced the pain to 6/10. At week 13, an ultrasound-guided erector spinae plane block was performed at the T12 level using 2% lidocaine (10 mL) and dexamethasone 5 mg, which rapidly reduced the pain from 6/10 to 0/10, with sustained improvement and discontinuation of medication. No complications were found. This case shows the erector spinae plane block as a safe, minimally invasive, and effective rescue therapy for refractory PHN.
BACK PAIN IN PARKINSONISM: EXPLORING PAIN GENERATORS AND INTERVENTIONAL MANAGEMENT: A CASE SERIES Hamdani, Ismi; Lie Anto; Irma Savitri; Tiara Aninditha; Nurul Fadli; Yusak Mangara Tua Siahaan; Dyah Tunjungsari; Henry Riyanto Sofyan
Jurnal Kedokteran dan Kesehatan : Publikasi Ilmiah Fakultas Kedokteran Universitas Sriwijaya Vol. 13 No. 1 (2026): Jurnal Kedokteran dan Kesehatan : Publikasi Ilmiah Fakultas Kedokteran Univers
Publisher : Fakultas Kedokteran Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32539/kfdtz052

Abstract

Pain is a common non-motor symptom in parkinsonism, often overlooked despite its significant clinical impact. The most common form is Parkinson's disease (PD), followed by secondary and atypical parkinsonisms such as PSP. Two cases presented with musculoskeletal-spinal pain as the chief complaint: a PD patient with upper back pain that improved after an erector spinae nerve block, and a PSP patient with lumbar facet pain that improved after an intra-articular steroid injection. Pain in parkinsonism can originate from muscles, bones, joints, discs, ligaments, fascia, or nerves, requiring careful evaluation. Both cases demonstrate the effectiveness of pain injection interventions in patients unresponsive to conservative therapy. Appropriate pain assessment and management are crucial to improving the quality of life of parkinsonism patients.
Co-Authors Anto, Lie Dyah Ayu Puspita Anggarsari Dyah Tunjungsari Eka Susanto Erwin Danil Yulian Hamdani, Ismi Henry Riyanto Sofyan Ismi A. Hamdani Lie Anto M.T. Siahaan, Yusak Nurul Fadli Radius Kusuma Tiara Aninditha Tiara Aninditha