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Jurnal Sinaps
Published by Universitas Sam Ratulangi
ISSN : 26152002     EISSN : 26152002     DOI : -
Core Subject : Health, Science, Education,
Education Neuroscience Public Health
Sinaps: Jurnal Neurologi Manado (Nomor ISSN online 2615-2002)adalah Jurnal terbitan dari Perhimpunan Dokter Spesialis Saraf Cabang Manado dan Bagian/KSM Neurologi FK Unsrat/RSUP Prof. Dr. R.D Kandou Manado
Arjuna Subject : Ilmu Syaraf - Neorologi
Articles 85 Documents
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IRAMA SIRKADIAN PADA STROKE AKUT: CIRCADIAN RHYTHM IN ACUTE STROKE Merry septemi Ekayanti; Muhammad Fandy Bachtiar; Arthur H.P Mawuntu
Jurnal Sinaps Vol. 2 No. 1 (2019): volume 2 Nomor 1, Februari 2019
Publisher : Neurologi Manado

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Abstract

Latar Belakang: Irama sirkadian mempengaruhi perilaku dan hampir setiap fungsi fisiologis manusia. Stroke dapat mengganggu irama sirkadian sampai jangka waktu tertentu. Tujuan: Mengetahui perubahan pola irama sirkadian pada stroke akut di Manado. Metode: Penelitian kohort deskriptif di RSUP Prof. dr. R.D. Kandou, Manado bulan Desember 2015-Februari 2016. Subjek dibagi menjadi kelompok stroke iskemik dan stroke hemoragik. Perubahan irama sirkadian dinilai dengan melihat perubahan tekanan darah sistolik dan diastolik, denyut nadi, dan glukosa darah dalam 72 jam pertama perawatan. Hasil: Didapatkan 35 subjek (23 stroke iskemik dan 12 stroke hemoragik). Kenaikan tekanan sistolik dan diastolik pada stroke iskemik dan hemoragik mencapai puncaknya pada pukul 04.00. Tekanan darah sistolik menurun pada pukul 20.00 dan diastolik menurun lebih awal, pada pukul 08.00. Peningkatan rerata denyut nadi mencapai puncaknya pada pukul 16.00 dan menurun pada pukul 00.00 untuk kedua kelompok. Didapatkan peningkatan rerata kadar glukosa darah pada pukul 20.00 yang menurun pada pukul 08.00 untuk kedua kelompok. Diskusi: Pola diurnal dan nokturnal irama sirkadian untuk tekanan darah dan kadar glukosa darah masih terlihat tetapi nilai lonjakannya lebih tinggi daripada pola normal. Denyut nadi tidak mengalami perubahan berarti dibandingkan dengan pola normal. Umumnya irama sirkadian kembali normal setelah stroke melewati masa akut. Kata kunci : irama sirkadian, stroke akut, tekanan darah, nadi, glukosa darah. ABSTRACT Background: Circadian rhythm affects human behavior and almost all physiological functions. Stroke could disrupt the circadian rhythm until a certain period. Aim To learn the changes of circadian rhythm in acute stroke in Manado. Method: Descriptive cohort study conducted in R.D. Kandou hospital in Manado in December 2015-February 2016. Subjects were divided to ischemic stroke and hemorrhagic stroke groups. Changes in circadian rhythm was assessed by measuring the changes in systolic and diastolic blood pressures, heart rate, and blood glucose level within the first 72 hours of admission. Result: There were 35 subjects (23 ischemic stroke and 12 hemorrhagic stroke). The increase of systolic and diastolic blood pressures in ischemic and hemorrhagic stroke reached their peak at 04.00 am. Systolic blood pressure decreased at 08.00 pm while diastolic blood pressure decreased earlier at 08.00 am. The increase in average heart rate reached its peak at 04.00 pm and decreased at 00.00 am in both groups. There was an increase in the average blood glucose level at 08.00 pm that decreased at 08.00 am in both groups. Discussion: Diurnal-nocturnal pattern of circadian rhythm for blood pressure and blood glucose was still present but the spike was higher than normal. In general, the circadian rhythm returned to normal after stroke surpassed the acute period. Keywords: circadian rhythm, acute stroke, blood pressure, heart rate, blood glucose.
PENERJEMAHAN DAN VALIDASI LINGUSTIK RAPID EYE MOVEMENT SLEEP BEHAVIOR DISORDER SCREENING QUESTIONNAIRE (RBDSQ) KEBAHASA INDONESIA DI MANADO, INDONESIA: PENELITIAN PERMULAAN Riane Anggreani; Corry N. Mahama; Meilany F. Durry; Arthur H.P Mawuntu; Maria Th. Jasi; Mieke A.H.N Kembuan
Jurnal Sinaps Vol. 2 No. 2 (2019): volume 2 Nomor 2, Juni 2019
Publisher : Neurologi Manado

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Abstract

Pendahuluan: Rapid Eye Movement (REM) Sleep Behavior Disorder (RBD) merupakan gangguan tidur dengan angka trauma yang tinggi. Metode diagnostik yang lazim digunakan, polisomnografi (PSG), tidak tersedia luas sehingga klinisi lebih memilih menyaring pasien terduga terlebih dahulu menggunakan metode seperti REM Sleep Behavior Disorder Screening Questionnaire (RBDSQ). Meskipun demikian, RBDSQ belum diterjemakan ke bahasa Indonesia. Tujuan: Menerjemahkan dan melakukan validasi linguistik RBDSQ ke dalam Bahasa Indonesia. Metode: Penelitian dilakukan di RSUP Prof. dr. R.D. Kandou Manado pada bulan Juni 2019. Penerjemahan bahasa dilakukan menggunakan metode penerjemahan terstandar seperti yang disyaratkan oleh pemegang hak cipta dan menghasilkan RBDSQ versi Indonesia awal. Validasi linguistik dilakukan pada subjek penelitian berupa pasien Klinik Rawat Jalan Neurologi dengan diagnosis penyakit Parkinson atau stroke, berusia >60 tahun, dan setuju untuk berpartisipasi. Pengambilan data dilakukan dengan wawancara langsung terekam tentang RBDSQ. Fokus wawancara adalah pengertian dan pendapat untuk setiap pertanyaan dalam kuesioner. Kami juga memberikan kesempatan bagi subjek untuk memberikan masukan mengenai penggunaan kata maupun kalimat pada kuesioner. Rekaman kemudian dianalisis untuk mengidentifikasi masalah yang dialami setiap subjek. Hasil: Kepercayaan supranatural adalah faktor yang terbanyak menyebabkan kesalahpahaman. Beberapa istilah kedokteran dan bahasa Indonesia baku juga tidak dimengerti oleh subjek. Kami telah mengembangkan RBDSQ versi Indonesia final setelah analisis. Dibutuhkan penelitian lanjut untuk menguji kuesioner ini pada populasi lebih besar. Kata kunci: RBD, RBDSQ, penerjemahan, validasi linguistik, bahasa Indonesia. ABSTRACT Introduction: Rapid Eye Movement (REM) Sleep Behavior Disorder (RBD) is a sleep disorder showing a high rate of trauma. The commonly used diagnostic method, polysomnography, is not widely available making many clinicians prefer to initially screen the suspected patients using methods like REM Sleep Behavior Disorder Screening Questionnaire (RBDSQ). However, RBDSQ has never been translated into the Indonesian language. Purpose: To translate and conduct linguistic validation of the RBDSQ to the Indonesian language. Method: This study was conducted in R.D. Kandou Hospital on June-July 2019. Language translation was done using a standardized language translation method as demanded by the copyright owner and resulting in the early RBDSQ Indonesian version. Linguistic validation was done on research subjects who were patients of Neurology Outpatient Clinic diagnosed as Parkinson’s disease or stroke, aged >60 years old, and agreed to participate. Data collection was done by a direct and recorded interview about the RBDSQ. The focus of the interviews was the understanding and perception of every question in the questionnaire. We also allowed the subjects to give inputs about words and sentences used in the questionnaire. The recordings of the interviews were analyzed to identify the problems encountered by each subject. Results: Supernatural beliefs are the most common factor leading to misunderstandings. Also, there are some medical terminologies and formal Indonesian language that was not understood by the subjects. We have developed the final RBDSQ Indonesian version after the analysis. Further study needs to be done to test this questionnaire in a larger population. Keywords: RBD, RBDSQ, translation, linguistic validation, Indonesian language.
MANAGEMENT OF CEREBRAL VENOUS SINUS THROMBOSIS IN PREGNANCY: A CASE REPORT Gilbert Tangkudung; Ricky Kohar; Corry Mahama; Mieke Kembuan
Jurnal Sinaps Vol. 2 No. 3 (2019): Volume 2 Nomor 3, September 2019
Publisher : Neurologi Manado

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Abstract

We report a case of cerebral venous sinus thrombosis (CVST) in pregnancy. A 26-years-old female with G2P1A0, 30-31 weeks of gestation without regular antenatal care, presented with seizure and unconsciousness, had been admitted to Obstetrics and Gynecology Department. Patient were diagnosed with eclampsia and HELLP syndrome and managed by their protocols. The further management was done an emergency cesarean section. Hemiparesis on the right side was emerged thereafter. The patient then consulted to Neurology Department. The brain non-contrast CT (NCCT) scan was revealed an intracranial hemorrhagic (sICH score=5) and suspected of CVST. The further management was heparinization with strictly controlled of aPTT. The further evaluation of NCCT scan revealed a resolution of intracranial hemorrhagic followed by improvement on neurological deficit and clinical symptoms of HELLP syndrome. Cerebral angiography was revealed a cortical vein thrombosis. Oral anticoagulant was administered, and modified rankin scale (MRS) after being discharged from the hospital was 0. Keywords: management, cerebral venous sinus thrombosis, pregnancy
CHARACTERISTIC OF FACTORS ASSOCIATED WITH ADMISSION TIME OF STROKE PATIENTS IN HOSPITAL Tangkudung G; Pertiwi JM; Girsang R; Tongku AS; Ate A
Jurnal Sinaps Vol. 2 No. 3 (2019): Volume 2 Nomor 3, September 2019
Publisher : Neurologi Manado

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Abstract

Introduction: Stroke is a major cause of disability and death in Indonesia. Based on Riskesdas 2013 data, the incidence of stroke in North Sulawesi was ranked second after hypertension. Early management of stroke contributes to have better outcome. Our hospital data showed limited number of stroke patients who were admitted in early onset. We investigated factors related to admission time of stroke patients in RSUP Prof. dr. R. D Kandou Manado during 2015-2017. Method: This was a retrospective study using secondary data from stroke patients who met the eligibility. The statistical analysis was performed with Chi-square test with SPSS. Result: There were 1060 patients that were interviewed; only 0,5 % came in less than and equal 4 hours. There were 62% male. The mean age was 57,47 years. Of all patients, 47,1% patients had stroke ischemic and 52,8% patients had stroke hemorrhage. Those who delayed admission to the hospital beyond 4 hours were 98,3% patients did not recognize the urgency of immediate help for their symptoms and 99,8% patients traveled more than 10 km to reach our hospital. Conclusion: Approximately one-quarter of stroke patients correctly interpret their symptoms as representing a stroke. This knowledge was associated with delayed admission to the emergency department. Widespread public education of stroke-prone individuals may increase the proportion of patients eligible for new acute stroke treatments. Keywords: Admission time, stroke, knowledge.
PROFIL KEAMANAN PROSEDUR CEREBRAL DIGITAL SUBTRACTION ANGIOGRAPHY DI MANADO Gilbert Tangkudung; Sandy Kumala; Junita Maja Pertiwi
Jurnal Sinaps Vol. 2 No. 3 (2019): Volume 2 Nomor 3, September 2019
Publisher : Neurologi Manado

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Abstract

Latar Belakang: Cerebral digital subtraction angiography (DSA) saat ini masih merupakan pemeriksaan baku emas dalam mendeteksi kelainan pada pembuluh darah otak, DSA saat ini semakin umum dilakukan untuk mendeteksi etiologi pasien stroke. Akan tetapi di negara berkembang termasuk Indonesia keamanan dan angka komplikasi prosedur DSA belum sepenuhnya dilaporkan sehingga beberapa neurolog masih meragukan keamanan prosedur DSA. DSA dipercaya dapat menyebabkan morbiditas dan mortalitas pada pasien. Tujuan: Penelitian ini bertujuan menggambarkan karakteristik dan profil keamanan prosedur DSA. Metode: Penelitian retrospektif ini dilakukan di RSUP Prof . Dr. R.D Kandou Manado mulai bulan Agustus 2017- Desember 2018. Data yang dikumpulkan berupa karakteristik demografi, detail prosedur, serta komplikasi yang timbul selama dan setelah prosedur. Komplikasi DSA dipisahkan menjadi komplikasi neurologi dan non neurologi. Hasil: Subyek total sebanyak 161 pasien, 93 (57.8%) laki-laki dan 68 (42.2%) perempuan. Usia rata rata subyek 47.1 tahun. Sebanyak 161 pasien yang dilakukan prosedur DSA. Komplikasi non-neurologi yang didapatkan berupa hematoma pada lipatan paha <10cm (23.6%), hematoma >10cm pada lipatan paha (8.69%), nyeri kepala (7.45%), pseudoaneurisma (1.24%), dan gangguan ginjal akut (1.24%). Komplikasi neurologi transient hanya ditemukan pada 1 pasien (0.62%). Tidak didapatkan komplikasi neurologi reversible maupun permanen pada penelitian ini. Tidak didapatkan angka kematian pada penelitian ini. Kesimpulan: DSA merupakan pemeriksaan invasif tetapi sudah terbukti aman dengan angka komplikasi yang minimal sehingga seharusnya dijadikan salah satu pemeriksaan diagnostik pilihan pada pasien. Kata Kunci: Keamanan, Prosedur, Angiography
ENDOVASCULAR EMBOLIZATION OF RUPTURED BRAIN ARTERIOVENOUS MALFORMATION (AVM) Gilbert Tangkudung; David Susanto; Corry N Mahama
Jurnal Sinaps Vol. 2 No. 3 (2019): Volume 2 Nomor 3, September 2019
Publisher : Neurologi Manado

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Abstract

AVM of the brain are anomalies of the blood vessels that are derived from maldevelopment of the capillary network, allowing direct connections between cerebral arteries and veins. The most common presenting symptoms are cerebral hemorrhage and seizures. Current therapeutic modalities include microsurgical resection, radiosurgery, endovascular embolization, and conservative treatment. Appropriate treatment regimen according to patient characteristics and AVM morphology. Endovascular embolization can used as primary therapy, particularly for smaller, surgically difficult AVMs that contain few arterial feeders. Male, 61 years old, presented with severe headache and weakness of right limbs suddenly. Headache especially felt on the left side, with Visual Analog Scale (VAS) = 8-9, Glasgow Coma Scale (GCS) was E4M6V5, and patient underwent brain Magnetic Resonance Imaging (MRI) which revealed a hemorrhage in the left frontal lobe with flow void sign around the lesion. Patient underwent palliative targeted embolization procedure with Onyx-18 in left precentralis artery and left frontal medial artery. The results obtained changes in angioarchitecture of malformed lesion in nidus size were significant with slowing flow to drainage veins. This case was follow up after 7 months with Brain MRI which revealed no nidus and flow void sign, and from the checked cerebral angiography revealed a very small nidus with significant hemodynamic changes. Keywords: Endovascular, embolization, ruptured, AVM
KEPATUHAN MINUM OBAT ANTIEPILEPSI PADA PASIEN EPILEPSI DI MANADO, INDONESIA Arthur H.P. Mawuntu; Corry N. Mahama; Sekplin A.S. Sekeon; Karema Winifred; Herlyani Khosama
Jurnal Sinaps Vol. 2 No. 3 (2019): Volume 2 Nomor 3, September 2019
Publisher : Neurologi Manado

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Abstract

Pendahuluan: Epilepsi memerlukan pengobatan yang lama. Kepatuhan minum obat akan mempengaruhi hasil pengobatan. Belum ada data tentang kepatuhan minum obat pada pasien epilepsi di Manado padahal karakteristik pasiennya mungkin berbeda dengan tempat lain. Tujuan: Mengetahui kepatuhan minum obat antiepilepsi (OAE) pada pasien epilepsi di Manado yang berhubungan dengan karakteristik pasiennya. Metode: Penelitian retrospektif dengan memeriksa rekam medis pasien-pasien epilepsi di Rumah Sakit Umum Pusat Prof. Dr. R.D. Kandou Manado tahun 2017-2018. Pasien yang dianalisis minimal telah meminum obat selama tiga bulan. Tingkat kepatuhan diukur menggunakan skala kepatuhan minum obat Morisky delapan item (Morisky medication adherence scale 8 Items/MMAS-8) versi Indonesia. Variabel yang diperiksa adalah usia, jenis kelamin, tipe epilepsi, adanya gangguan memori, durasi minum OAE, jenis OAE, adanya efek samping obat bermakna, dan adanya obat lain yang diminum. Hasil: Diperoleh 114 subjek. Rerata usianya adalah 28,57 tahun (median 25,5 tahun; minimal 6 dan maksimal 78 tahun). Jika usia ≤15 tahun dianggap sebagai anak-anak, diperoleh 26 (22,8%) anak. Subjek laki-laki berjumlah 65 orang (57,01%). Tipe epilepsi terbanyak adalah epilepsi fokal (82,5%). Mayoritas subjek mendapatkan satu jenis OAE. Berdasarkan skala MMAS-8 versi Indonesia, sebagian besar subjek memiliki kepatuhan tinggi (48 subjek dengan kepatuhan tinggi, 36 sedang, dan 30 rendah). Tidak ada perbedaan yang bermakna antara subjek laki-laki dan perempuan untuk masalah kepatuhan minum obat. Kepatuhan minum obat secara bermakna ditemukan lebih tinggi pada pasien dengan OAE >1 (p = 0,03). Kata kunci: pasien epilepsi. Manado, kepatuhan minum OAE, MMAS-8 versi Indonesia ABSTRACT Background: Epilepsy requires long-term treatment. Medication adherence will influence the treatment result. There are no data about medication adherence among epilepsy patients in Manado whereas the patients’ characteristics may differ from other places. Aim: To know the anti-epileptic drugs (AEDs) adherence among epilepsy patients in Manado concerning the patients’ characteristics. Methods: A retrospective study conducted by reviewing the medical records of epilepsy patients in R.D. Kandou hospital Manado year 2017-2018. The studied patients were at least have taken the medication for three months. Level of adherence was measured by Morisky medication adherence scale 8 items/MMAS-8 Indonesian version. Examined variables were age, gender, epilepsy type, the presence of memory impairment, AEDs duration, AEDs type, the presence of significant drug side effect, and concomitant medication. Results: We find 114 subjects. The mean age is 28.57 years old (median 25.5; minimal 6 and maximal 78 years old). By determining children as those aged ≤15 years old, we find 26 (22.8%) children. Sixtyfive (57.01%) subjects are male. The mostly found epilepsy type is focal epilepsy (82.5%). The majority of subjects only received one AED type. According to the MMAS-8 Indonesian version, most subjects have high adherence level (48 subjects have high, 36 moderate, and 30 low adherence). There is no significant difference between male and female subjects for medication adherence. Medication adherence is significantly higher in those who have >1 AEDs (p = 0.03). Keywords: epilepsy patients, Manado, adherence to AED, MMAS-8 Indonesian Version
INTERLEUKIN 10 MASA AKUT DAN ASAM URAT PADA CEDERA OTAK TRAUMATIK SEDANG DAN BERAT: PENELITIAN PENDAHULUAN Toar F. Mamuaja; Jimmy Mahama; Denny J. Ngantung; Sekplin A.S. Sekeon; Arthur H.P Mawuntu
Jurnal Sinaps Vol. 2 No. 3 (2019): Volume 2 Nomor 3, September 2019
Publisher : Neurologi Manado

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Pendahuluan: Inflamasi pada cedera otak traumatik (COT) berhubungan dengan peningkatan interleukin 10 (Il-10) dan asam urat (AU) namun interaksinya belum banyak diteliti. Tujuan: Mengetahui hubungan kadar AU dan Il-10 masa akut (<24 jam) dengan luaran COT sedang dan berat. Metode : Penelitian kohort prospektif di RSUP Prof. dr. R.D. Kandou Manado (RS RDK). Subjek adalah pasien COT sedang dan berat, berusia >16 tahun, dan mengalami COT dengan awitan yang jelas <24 jam. Subjek dieksklusi jika memiliki penyakit infeksi aktif dan kondisi lain yang dapat mempengaruhi hasil pemeriksaan Il-10 dan AU. Pemeriksaan skala koma Glasgow (SKG), kadar AU awal, dan Il-10 dilakukan dalam waktu <24 jam setelah pasien masuk. Pemeriksaan kadar AU kontrol dilakukan pada hari rawat ke-4/ke-5. Selanjutnya dihitung selisih kadar AU kontrol dan awal. Subjek dirawat sesuai alur klinis COT sedang dan berat RS RDK. Saat keluar rumah sakit dilakukan evaluasi luaran pasien menggunakan skala luaran Glasgow (SLG). Hasil: Didapatkan 50 subjek yang didominasi laki-laki (n = 43; 86%) bermedian usia 26 tahun. SKG berkorelasi positif dengan SLG sedangkan leukosit dan Il-10 masa akut berkorelasi negatif. Perubahan AU tidak memiliki korelasi yang bermakna dengan SLG namun kadar AU awal berkorelasi dengan meningkatnya kadar Il-10 fase akut. Kata kunci : Cedera otak traumatik, interleukin 10, asam urat, skala luaran Glasgow ABSTRACT Background: Inflammation in traumatic brain injury (TBI) is associated to the increase of interleukin 10 (Il-10) and uric acid (UA) but the interaction is rarely studied. Aim: To find the correlation between UA level and acute phase (<24 hours) Il-10 and the outcome of moderate to severe TBI. Method: A prospective cohort study in R.D. Kandou Hospital Manado (RS RDK). Subjects were moderate and severe TBI patients, age >16 years old, and had a clear TBI onset of <24 hours. Subject was excluded if having an active infectious disease or other conditions that could influence the result of Il-10 and UA examinations. Glasgow scoma scale (GCS), initial UA level, and Il-10 were examined <24 hours before admission. Control UA was examined on the 4-th/5-th admission day. The initial and control UA level was then calculated. Subjects were treated according to the hospital’s moderate and severe TBI clinical pathway. Subjects’ outcomes were evaluated on discharge using Glasgow outcome scale (GOS). Result: We founf 50 subjects who were mostly male (n = 43, 86%) with median age of 26 years old. GCS was positively correlate to GOS whole leucocyte and acute phase Il-10 have negative correlations. UA difference has no significant correlation with GOS but initial UA level has a correlation with the increase of acute phase Il-10. Keywords: Traumatic brain injury, interleukin 10, uric acid, Glasgow outcome scale
Laporan Kasus : Dekompresi Mikrovaskular pada Spasme Hemifasial
Jurnal Sinaps Vol. 3 No. 1 (2020): Volume 3 Nomor 1, Februari 2020
Publisher : Neurologi Manado

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Abstract

Hemifacial spasm (HFS) is a movement disorder of the seventh cranial nerve which is characterised by either brief or persistent intermittent twitching of the muscle innervated by the facial nerve. Although HFS is a benign disease, it can lead to increasing embarassment dan social withdrawl. There are several treatment for HFS, such as pharmacotherapy, botulinum toxin therapy, and microvascular decompression (MVD). MVD has been established as a first-line surgical treatment for patient with HFS and has been reported to provide relief from spasm in over 90% of cases. In this case, Female 47 years old, presenting with persistent intermittent twitching of his left facial muscle which getting worse for several years. Brain MRI showed compression of N.VII sinistra with left Anterior Inferior Cerebellar artery. Patient got consulted to neurosurgeon for DMV treatment, after she didn’t show any improvement with pharmacotherapy. After surgical, patient showed improvement in symptoms, follow up after 3 months is needed for evaluating prognosis of the patient.
TINJAUAN PATOFISIOLOGI TUMOR OTAK METASTASIS DARI KANKER KELENJAR PAROTIS – LAPORAN KASUS: PATHOPHYSIOLOGY REVIEW OF METASTASIC BRAIN TUMOR FROM PAROTIS GLANDS CANCER - CASE REPORT Eric Tanoto; Junita Maja Pertiwi; Rizal Tumewah
Jurnal Sinaps Vol. 3 No. 1 (2020): Volume 3 Nomor 1, Februari 2020
Publisher : Neurologi Manado

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Abstract

Laporan kasus: Keganasan kelenjar ludah memiliki perkiraan insiden 0,5-2,5 per 100.000 orang. Sebagian besar timbul dari kelenjar parotis (70–80%), dengan sisanya timbul dari kelenjar submandibular (10%) atau kelenjar ludah sublingual dan minor (5%). Tempat yang paling umum untuk metastasis adalah paru-paru (80%), tulang (15%), dan hati dan situs lainnya (5%). Kasus yang ditampilkan menggambarkan kejadian metastasis kanker di otak yang berasal dari kanker kelenjar ludah parotis. Pasien awalnya menderita benjolan pada bagian depan telinga kanan yang makin lama membesar secara perlahan mulai dari bulan november 2017 hingga januari 2019 dan pasien melakukan operasi pengangkatan dan pemeriksaan histopatologi sebanyak 3 kali dengan hasil tumor ganas epitelial dengan jenis karsinoma sel skuamosa non keratinisasi. Pasien mengalami kejang yang diawali nyeri kepala dan kelemahan anggota gerak sisi kiri yang semakin memberat pada bulan juli 2019 dan dilakukan pemeriksaan CT scan kepala dengan gambaran metastasis otak. Pasien mengalami sesak nafas dan dilakukan pemeriksaan rontgen thoraks pada bulan September 2019 dan ditemukan gambaran tumor paru-paru sebelah kiri. Laporan kasus ini menunjukan bahwa pasien mengalami keganasan kelenjar ludah parotis yang diikuti metastasis ke otak terlebih dahulu kemudian ke paru-paru, dimana pada literatur mengatakan bahwa angka kejadian keganasan kelenjar ludah sendiri tergolong kecil dan metastasis keganasan tersebut terbanyak ke paru-paru menunjukkan kelangkaan kasus ini sehingga penulis melaporkan kasus ini sebagai referensi. Kata kunci : Kanker kelenjar parotis, tumor otak metastasis, patofisiologi

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