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All Journal Medicinus : Jurnal Kedokteran MEDICINUS Jurnal Kedokteran Meditek
Gabriella, Nadia
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Biochemistry, Genetics & Molecular Biology Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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Laporan Kasus: Tantangan dalam Manajemen Epilepsi Katamenial pada Menstruasi Tidak Teratur Gabriella, Nadia; Kennytha Yoesdyanto
MEDICINUS Vol. 38 No. 8 (2025): MEDICINUS
Publisher : PT Dexa Medica

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56951/kmv0je25

Abstract

Introduction: Catamenial epilepsy (CE) is characterized by periodic seizures, defined as ≥2-fold increase in seizure frequency during a specific period of the menstrual cycle. The prevalence of CE ranges from 10 to 70%, affecting over 40% of women with epilepsy. It is particularly prevalent among women with focal epilepsy, especially in cases of temporal lobe epilepsy (TLE). Exacerbation of seizures in CE is attributed to the fluctuations in reproductive steroid levels, which affect neuronal excitability. As of now, there is no definitive treatment available for CE. We reported a case of CE in a female patient with TLE.Case Report: A 20-year-old female patient with irregular periods presented with cluster seizures occurring within three days of her menstrual period. Seizure semiology is described as focal to generalized tonic-clonic seizures, with rightsidelateralization. No neurological deficits were found. Brain magnetic resonance imaging showed no abnormality. The electroencephalogram revealed sharp waves in both left and right temporal lobe. The patient was already treated with phenytoin 400 mg/day. However, due to persistence of seizures during the perimenstrual period, clobazam 20 mg/day was added. Seizure frequency has decreased but the patient remains under close observation.Discussion: The patient has been diagnosed with CE due to the cyclic exacerbation of seizures coinciding with her menstrual cycle. Her seizures consistenly occur within the perimenstrual phase, which is marked by a sudden withdrawal of progesterone and corresponding increase in seizure frequency. The recommended approach involves administering an add-on antiepileptic drug (AED) prior to and during menstruation. However, given the patient’s irregular periods, the mainchallenge lies in determining the optimal timing for this intervention.
Isolated Hypoglossal Nerve Palsy Associated with Tuberculosis of the Atlantoaxial Joint: A Rare Case Report Situmeang, Rocksy Fransisca V; Gabriella, Nadia; Koesbandono
Medicinus Vol. 15 No. 2 (2026): February
Publisher : Fakultas Kedokteran Universitas Pelita Harapan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19166/med.v15i2.10189

Abstract

Background: Venous thromboembolism (VTE) is the third most common cardiovascular disorder worldwide. While lower-extremity deep vein thrombosis and pulmonary embolism are typical presentations, thrombosis in atypical sites remains challenging to recognize and diagnose.   Case Description: A 27-year-old female flight attendant with history inflammatory bowel disease (IBD), tuberculosis and combined oral contraceptive (COC) use presented with an acute abdominal pain. Initial contrast-enhanced CT revealed thrombosis of the left renal and ovarian veins. Laboratory tests showed elevated hs-CRP and D-dimer, with positive ANA but negative antiphospholipid antibodies. She was treated with intravenous heparin followed by oral rivaroxaban, though adherence was inconsistent due to episodes of heavy vaginal bleeding. Repeat CT imaging eight months later demonstrated resolution of the initial thrombi but revealed a new thrombus in the inferior vena cava extending into the right common iliac vein, accompanied by recurrent elevation of D-dimer.   This case illustrates the interplay of multiple risk factors for VTE, including IBD, prolonged immobility during long-haul travel, COC use, tuberculosis, and rifampicin therapy. These overlapping chronic and transient triggers likely contributed to recurrent thrombosis despite ongoing treatment.   Conclusions: Recurrent VTE in unusual venous sites can occur particularly in patients with multiple risk factors. Early recognition, appropriate imaging, and anticoagulant therapy adherence are essential to preventing progression and recurrence.
Paradoxical Reaction in Tuberculous Meningitis and Tuberculoma: Diagnostic Challenges Following Incomplete Treatment Situmeang, Rocksy Fransisca V; Gabriella, Nadia
Jurnal Kedokteran Meditek Vol 31 No 6 (2025): NOVEMBER
Publisher : Fakultas Kedokteran Universitas Kristen Krida Wacana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36452/jkdoktmeditek.v31i6.3856

Abstract

Introduction: Exacerbation of clinical or radiological findings in tuberculous meningitis (TBM) may result from a paradoxical reaction (PR), an immune-mediated response occurring in 6–30% of cases during or after anti-tuberculosis treatment (ATT). This case highlights the potential for PR to occur in the context of an incomplete ATT regimen. Case Illustration: A 20-year-old female presented with a 1-month history of headache, fever, double vision, nuchal rigidity, and bilateral abducens palsy. Cerebrospinal fluid analysis revealed pleocytosis and elevated protein, while brain MRI demonstrated leptomeningeal enhancement with multiple tuberculomas. She received standard ATT (RHZE), but discontinued therapy before completion due to symptom resolution and medication burden. One year later, she developed altered sensorium and behavioral changes; MRI showed new tuberculomas with edema despite negative serology. A diagnosis of PR was made, and high-dose intravenous corticosteroids were administered, resulting in clinical and radiological improvement. Discussion: PR remains a diagnostic challenge, often mistaken for microbiological relapse, drug resistance, or treatment failure. It arises from a distinct immune response to mycobacterial antigens, distinguishing it from relapse or drug resistance. Conclusion: Clinicians should suspect PR in worsening TBM cases, even in the setting of incomplete ATT, to prevent misdiagnosis and initiate prompt treatment.  
Co-Authors Kennytha Yoesdyanto Koesbandono Situmeang, Rocksy Fransisca V