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I Wayan Widyantara
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Biochemistry, Genetics & Molecular Biology Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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Peran Manitol dalam Penanganan Peningkatan Tekanan Intrakranial pada Stroke Non-Hemoragik dengan Penyakit Jantung Bawaan: Laporan Kasus Putu Indah Mahardika Putri; I Wayan Widyantara
MEDICINUS Vol. 39 No. 2: MEDICINUS
Publisher : PT Dexa Medica

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56951/mfsfr250

Abstract

Background: Stroke is a condition of impaired cerebral circulation leading to brain tissue necrosis. It is the second leading cause of death worldwide after heart disease. Nonhemorrhagic stroke may result from thrombus formation or embolic occlusion. Congenital heart disease (CHD) is one of the risk factor for stroke, including tetralogy of Fallot (TOF). The incidence of stroke in CHD is approximately 1 in 11 males and 1 in 15 females. One of the complications of stroke is increased intracranial pressure (ICP). Mannitol is one of treatment that can be used to reduce elevated intracranial pressure (EICP). Case report: A 19-year-old male with a history of TOF presented with decreased consciousness and left-sided hemiparesis. A CT scan revealed a hypodense lesion suggestive of ischemic stroke. On the third day of hospitalization, the patient’s condition worsened, showing signs of increased ICP. A repeat CT scan showed hemorrhagic transformation accompanied by uncal herniation. Mannitol was administered for 3 days to manage the increased ICP, resulting in clinical improvement. Three days later, the patient was discharged with improved condition. Conclusion: The use of mannitol in stroke cases with CHD, such as TOF, showed favorable outcomes without causingadverse effects or worsening the underlying cardiac condition. Mannitol may be considered in patients with cardiac comorbidities.
Hubungan antara Asam Traneksamat dan Insiden Kejang pada Pasien dengan Perdarahan Subaraknoid Fitria, Dian Rizki; Dian Rizki Fitria; I Wayan Widyantara
MEDICINUS Vol. 39 No. 3 (2026): MEDICINUS
Publisher : PT Dexa Medica

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56951/4p5c2188

Abstract

Background: Subarachnoid hemorrhage (SAH) accounts for 2–7% of all strokes but contributes disproportionately to morbidity and mortality due to severe complications such as rebleeding, delayed cerebral ischemia, and seizures.Tranexamic acid (TXA) is used to prevent rebleeding in SAH; however, the association between TXA use and seizure riskremains controversial.Methods: A systematic literature review was conducted to identify clinical studies reporting seizure incidence in adult patients with SAH who received TXA. Randomized controlled trials, cohort and case-control studies were included as primary studies. Data were synthesized narratively, with limited quantitative analysis performed when feasible.Results: Five studies met the inclusion criteria. Most studies demonstrated a signal toward an increased risk of seizuresor adverse neurological effects in patients receiving TXA compared with control groups. Safety data suggests that seizure risk tends to increase with total TXA doses exceeding 2 g per day, whereas low-to-moderate doses administered for a shortduration were not consistently associated with an increased incidence of seizures.Conclusion: TXA use in patients with SAH may be associated with an increased risk of seizures, particularly at higher doses. Although TXA provides benefits in reducing rebleeding, careful risk–benefit assessment and appropriate dose selection are essential, especially in patients with neurological vulnerability.
Co-Authors Dian Rizki Fitria Fitria, Dian Rizki Putu Indah Mahardika Putri