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Paulus Sugianto
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Departemen Neurologi, Fakultas Kedokteran, Universitas Airlangga-RSUD Dr. Soetomo Surabaya, Jln. Mayjen Prof.Dr. Moestopo No 6-8, Airlangga, Gubeng, Surbaya
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AKSONA
Published by Universitas Airlangga
ISSN : -     EISSN : 28077970     DOI : https://doi.org/10.20473/aksona.v2i1.170
Core Subject : Health, Science,
Medicine & Pharmacology Neuroscience
AKSONA is a scientific journal published by the Department of Neurology, Faculty of Medicine, Universitas Airlangga; Dr. Soetomo General Academic Hospital. AKSONA focuses on original research, case reports, and review articles on all aspects of neuroscience: Neurosurgery, Neuropsychology, Movement Disorder, Sleep Disorder, Pain and pain intervention, Neuro infection, etc. This journal is a peer-reviewed journal established to improve understanding of all things in neurology and neurosciences.
Arjuna Subject : Kedokteran - Neurologi Klinis
Articles 101 Documents
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Trends in Brain Cancer-Associated Mortality Among South African Men and Women Yoshan Moodley; Samson Mashele
AKSONA Vol. 6 No. 1 (2026): JANUARY 2026
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/aksona.v6i1.72696

Abstract

Highlight: Mortality from brain cancer is generally much higher in South Africa when compared with other countries. Brain cancer mortality has declined among South African men and increased among South African women.   ABSTRACT Introduction: South Africa has seen a general increase in cancer burden. Mortality from brain cancer has yet to be studied, which is significant given the poor prognosis associated with this condition. Objective: The objective of this study was to report on the trends in mortality for brain cancer among South African men and women. Methods: This was a descriptive trends analysis of South African national mortality data for the period 2007-2016. The mortality dataset contains information on all reported deaths in South Africa, including deaths associated with brain cancer, and is based on the International Classification of Diseases Coding,10th Revision (ICD-10). A descriptive analysis was conducted to calculate the annual age-specific and age-standardized rates of brain cancer-associated mortality, which were then plotted separately for each gender. Results: There were 4,110 brain cancer-associated deaths included in this study. Mortality fluctuated across the study period but was mostly higher in the older age groups. Age-standardized mortality rates in men ranged from 4.26-4.63 per 100,000 population and declined at the end of the study period. Age-standardized mortality rates in women ranged from 2.34-2.62 per 100,000 population and increased at the end of the study period. Conclusion: The elderly and men had the highest rates of brain cancer-associated mortality, although a declining trend was noted in the latter. Brain cancer-associated mortality is increasing among women. There is an urgent need for improved brain cancer control in South Africa.
Determinants of Executive Dysfunction: Serum NRF2 and Sociodemographic Profiles in Lombok Island’s Coastal Population Inayah Wulandari; Nurhidayati Nurhidayati; Ilsa Hunaifi; Arina Windri Rivarti; Herpan Syafii Harahap; Legis Octaviana Saputri; Dini Suryani; Fitriannisa Faradina Zubaidi; Rohadi Muhammad Rosyidi
AKSONA Vol. 6 No. 1 (2026): JANUARY 2026
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/aksona.v6i1.74449

Abstract

Highlight: Coastal communities show high prevalence of cognitive decline. There is no correlation between NRF2 levels and executive function. Gender and education level were significantly associated with executive dysfunction.   ABSTRACT Introduction: Elderly people frequently suffer from neurodegenerative conditions that affect cognitive function. Redox homeostasis dysregulation plays a significant role in neurodegenerative diseases. Oxidative stress activates the transcription factor called nuclear factor erythroid 2-related factor 2 (NRF2), which is essential for regulating the expression of genes involved in cellular defense mechanisms. Objective: This study aimed to determine the relationship between serum NRF2 levels and executive function, as well as to identify other variables that may influence executive function among residents of coastal villages on Lombok Island. Methods: The study used a cross-sectional design with consecutive sampling. Data on sociodemographic characteristics, hypertension, diabetes mellitus, smoking status, and physical activity were collected. Statistical analyses employed Spearman's rank correlation test, Fisher's exact test, and logistic regression test. Results: A total of 39 participants were included, with an average age of 53.38 years. Most participants were female, had a low educational level, did not have hypertension or diabetes mellitus, had high physical activity levels, and were non-smokers. The average NRF2 level was 0.54 ng/mL. The correlation test showed no significant relationship between serum NRF2 levels and executive function. Fisher's exact test showed a significant relationship between gender and education with executive function. Furthermore, logistic regression analysis identified education level as a predictor of executive dysfunction. Conclusion: Serum NRF2 levels were not correlated with executive dysfunction. Educational level was identified as a predictive factor for executive dysfunction.
Study of Thrombolytic r-TPA Alteplase in Ischaemic Stroke Patients at Dr. Soetomo General Academic Hospital Surabaya Diah Utari Madiningrum; Achmad Firdaus Sani; Sumarno Sumarno; Muhammad Thariq Nadhafi
AKSONA Vol. 6 No. 2 (2026): JULY 2026
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/aksona.v6i2.67057

Abstract

Highlight: Alteplase effectiveness depends on efficient in-hospital stroke care. Code Stroke optimization is needed to improve thrombolysis timelines.   ABSTRACT Introduction: Acute ischemic stroke is a leading cause of disability and mortality worldwide. Intravenous thrombolysis with recombinant tissue plasminogen activator (r-TPA, alteplase) is an effective treatment when administered within 3–4.5 hours of stroke onset. However, its utilization remains limited due to delayed hospital arrival, limited early recognition of stroke, and variations in hospital preparedness. Objective: This study provides real data on the use of intravenous alteplase thrombolysis and evaluates implementation by assessing dosing regimen, treatment timelines, potential drug-related problems, and the implementation of the Code Stroke program at Dr. Soetomo General Academic Hospital. Methods: This descriptive observational study analyzed secondary data from the medical records of 17 patients with acute ischemic stroke treated with intravenous alteplase between January 1, 2023 and April 30, 2024. Data collected included demographic characteristics, comorbidities, history of recurrent stroke, and length of hospital stay. Clinical outcomes were evaluated using National Institutes of Health Stroke Scale (NIHSS) scores, therapy timing and dosage, door-to-needle time, and door-to-imaging time. Results: Intravenous alteplase was administered at doses of 0.6 mg/kg (12%), 0.7 mg/k (12%), and 0.9 mg/kg (76%). Although all patients were treated within the recommended 3–4.5-hour therapeutic window after stroke onset, only 23% achieved a door-to-needle time of ≤60 minutes. Adverse events were limited to gingival bleeding (6%) and hematuria (12%). Conclusion: Intravenous alteplase thrombolysis at Dr. Soetomo General Academic Hospital has generally followed established guidelines. However, further optimization of the Code Stroke program is required to improve treatment timeliness.
Clinical Characteristics and Neurological Deficit Profiles of Ischemic Stroke Patients at Dr. Soetomo General Academic Hospital Salsabil Putri Adelia Febryan; Mohammad Saiful Ardhi; Imam Subadi; Sita Setyowatie
AKSONA Vol. 6 No. 2 (2026): JULY 2026
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/aksona.v6i2.79010

Abstract

Highlight: Ischemic stroke most often occus in men aged 56-70 years. Limb weakness is the most common deficit in stroke patients. Most patients showed moderate neurological deficits based on NIHSS.   ABSTRACT Introduction: Stroke is one of the primary causes of disability and mortality. Its incidence increases with advancing age. Approximately 65% of all strokes are ischemic, which can present with a wide range of symptoms, including hemiparesis, facial palsy, aphasia, and dysarthria. A high score on the National Institutes of Health Stroke Scale indicates greater neurological impairment. The lack of neurological impairment data on ischemic stroke patients in Indonesia makes this study important. Objective: This study aimed to examine the clinical features and neurological impairment profiles of ischemic stroke patients admitted to Dr. Soetomo General Academic Hospital. Methods: This descriptive observational study used a cross-sectional design and secondary data from the medical records of 175 ischemic stroke patients admitted to the neurology ward of Dr. Soetomo General Academic Hospital, Surabaya, between January and June 2024.  Results: There were 175 people who had ischemic strokes; 100 of them were men and 75 of them were women. Among them, 48% were in the 56-70 year age group. Hemiparesis (84.6%) was the most prevalent neurological problem, followed by facial palsy (77.7%), dysarthria (52%), and aphasia (27.4%). Of the individuals with aphasia, 64.6% had global aphasia, 25% had motor aphasia, and 10.4% had sensory aphasia. The NIHSS scores of 50 patients showed 6 mild, 37 moderate, 5 moderate-to-severe impairments, and 2 severe impairments. Conclusion: Ischemic stroke most commonly affected older adults, and males with motor weakness, dysarthria, and aphasia as the main neurological manifestations. These common clinical presentations may facilitate early diagnosis, support comprehensive neurological evaluation, and improve patient management.
Peripheral Blood Inflammatory Biomarkers Reflect Glioma Malignancy Grade: A Single-Center Study Naura Salma Ramadhani; Djohan Ardiansyah; Ferdy Royland Marpaung
AKSONA Vol. 6 No. 2 (2026): JULY 2026
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/aksona.v6i2.81066

Abstract

Highlight: Glioma represents the most prevalent form of malignant brain tumor, displaying a spectrum of grades. The dNLR shows a significant correlation with glioma grade. Inflammatory biomarkers could facilitate the early prediction of glioma aggressiveness.   ABSTRACT Introduction: Gliomas are the most prevalent primary tumors of the central nervous system with varying degrees of aggressiveness and prognoses. Peripheral blood inflammatory markers, including the neutrophil-to-lymphocyte ratio (NLR), the derived neutrophil-to-lymphocyte ratio (dNLR), the platelet-to-lymphocyte ratio (PLR), and the lymphocyte-to-monocyte ratio (LMR), have been proposed as prognostic indicators for tumors. Inflammation is a major factor in tumor progression. Objective: To identify peripheral inflammatory markers correlated with glioma grade and assess their potential as non-invasive, cost-effective tools for clinical decision-making. Methods: This retrospective observational study reviewed the medical records of 144 patients with histopathologically confirmed gliomas treated at Dr. Soetomo General Hospital, Surabaya, between 2019 and 2024. Preoperative peripheral blood inflammatory markers obtained 24–72 hours before neurosurgical intervention were analyzed using Spearman correlation and non-parametric group comparison tests to evaluate their association with glioma grade according to the 2021 WHO criteria.  Results: The trends of NLR, PLR, and LMR were as expected but statistically insignificant. Statistical analysis showed that elevated dNLR values ​​were significantly associated with higher glioma grade (p < 0.001). Conclusion: dNLR is an important inflammatory marker associated with glioma malignancy, suggesting its potential clinical utility for predicting disease severity and patient outcomes.
Pediatric Fahr Syndrome Secondary to Hypoparathyroidism with Paraparesis-Like Presentation: A Rare Case from West Borneo: Pediatric Fahr Syndrome with Paraparesis-Like Presentation Anna Marita Gelgel; Renald Patria Dharmansyah; Melda Melda; Pascanus Lamsihar Parluhutan Togatorop; Anthony Ekaputra
AKSONA Vol. 6 No. 2 (2026): JULY 2026
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar

Abstract

Highlight: A paraparesis-like presentation in pediatric Fahr syndrome is uncommon. Paraparesis-like symptoms were associated with basal ganglia involvement and hypocalcemia. Calcitriol is preferred over cholecalciferol in hypoparathyroidism.   ABSTRACT Introduction: Pediatric Fahr syndrome is a rare disorder with diverse clinical manifestations, making its diagnosis challenging. In West Borneo, access to advanced diagnostic facilities is limited, increasing the risk of misdiagnosis and delayed treatment. To our knowledge, no previous cases have described hypoparathyroidism–associated Fahr syndrome in a child presenting with a paraparesis-like gait disturbance. Case: We report a rare case of a 9-year-old girl with generalized tonic-clonic seizures without fever, accompanied by bilateral lower-limb weakness. She had a history of recurrent seizures several months before presentation. Neurological findings showed a flaccid, paraparesis-like gait disturbance of the lower limbs. Laboratory evaluation revealed hypocalcemia and reduced parathyroid hormone levels. CT imaging revealed symmetrical calcification of the basal ganglia and subcortical white matter. A working diagnosis of Fahr syndrome Secondary to hypoparathyroidism was made. Although hypocalcemia was corrected and seizure control was initially achieved, the patient experienced recurrent seizures and eventually died due to pneumonia. Conclusion: Fahr syndrome in children may mimic paraparesis but often presents with gait disturbances caused by basal ganglia calcifications. Secondary causes, especially hypoparathyroidism, should always be considered during the diagnostic evaluation. As history-taking and physical examination alone may be insufficient to exclude other differential diagnoses, additional laboratory and imaging investigations are required. When the underlying cause remains uncertain, symptomatic management and parental counseling should be initiated while the patient awaits referral to a higher-level healthcare facility.
When the Brain Speaks Ambigously: Encephalitis of Encephalopathy Yang Yang Endro Arjuna; Pricilla Yani Gunawan
AKSONA Vol. 6 No. 2 (2026): JULY 2026
Publisher : Universitas Airlangga

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Abstract

Highlight: Encephalitis can present atypically, with symptoms overlapping with other neurological disorders. Hyperglycemia may mimic encephalitis, causing seizures and hemianopia. Early steroids may improve suspected viral or autoimmune encephalitis.   ABSTRACT Introduction: Encephalitis does not always exhibit the typical clinical triad and can manifest with a broad spectrum of symptoms that overlap with other neurological or systemic disorders. Additionally, supportive diagnostic tests, including cerebrospinal fluid analysis, may yield nonspecific findings, further complicating the diagnosis. Case: A 28-year-old man reported having a headache for 3 weeks, followed by cognitive impairment, short-term memory loss, right homonymous hemianopia, and recurrent focal seizures of the left face lasting 30 seconds without loss of consciousness for the past 2 weeks. On examination, the patient was alert, with no signs of nuchal rigidity or motor impairment; random blood glucose was 637 mg/dL, ketone level was 0.8 mmol/L, and ketonuria was present. Non-contrast and contrast-enhanced cranial CT, as well as electroencephalogram (EEG), revealed no abnormalities. Based on the entire clinical evaluation, the patient was diagnosed with hyperglycemia-induced encephalopathy. Despite initiation of hyperglycemia management, no clinical improvement was observed. Cerebrospinal fluid examination on the second day of admission revealed mononuclear-dominant pleocytosis, a protein concentration of 60 mg/dL, and a glucose level of 90.1 mg/dL. The patient received blind intravenous methylprednisolone three times daily, resulting in significant clinical improvement. Conclusion: Viral and autoimmune encephalitis are the most common etiologies, but overlapping clinical manifestations and limited diagnostic tools often complicate diagnosis. Hyperglycemia is typically associated with focal rather than generalized seizures and may cause visual disturbance that usually improves following metabolic normalization. In cases where diagnostic resources are limited and viral or autoimmune encephalitis is suspected, empiric corticosteroid therapy may be beneficial.
Post-Stroke Cognitive Impairment and Its Association with Quality of Life: A Retrospective Cross-Sectional Study Kevin Alexander John; Rizaldi Taslim Pinzon
AKSONA Vol. 6 No. 2 (2026): JULY 2026
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/aksona.v6i2.85537

Abstract

Highlight: Post-stroke cognitive impairment affected over half of ischemic stroke patients. PSCI was not associated with WHOQOL-BREF quality-of-life domains. Post-stroke quality of life is influenced by factors beyond cognitive function.   ABSTRACT Introduction: Stroke is a disease that is a major cause of long-term disability and has a significant impact on patients’  quality of life because of cognitive impairment. However, despite the high prevalence of post-stroke cognitive impairment (PSCI), existing evidence on the quality of life (QoL) remains inconsistent, with limited evidence from the Indonesian population. Objective: This study aimed to determine whether cognitive impairments following ischemic stroke are associated with changes in perceived quality of life. Methods: A retrospective cross-sectional study was conducted on 117 ischemic stroke patients at Bethesda Hospital in Yogyakarta. The Mini-Mental State Examination (MMSE) and the Clock Drawing Test (CDT) measured cognitive function, and validated criteria indicated PSCI. Quality of life (QoL) was evaluated using the  WHOQOL-BREF, which assesses physical, psychological, social, and environmental domains. The PSCI-QoL associations were analyzed using a chi-square test. Multivariate logistic regression was subsequently used to control for potential confounding variables. A p-value of < 0.05 indicated statistical significance. Result: Post-stroke cognitive impairment was found in 51.7% of patients. Bivariate analysis showed no significant association between cognitive function and quality of life across all WHOQOL-BREF domains, including physical, psychological, social, and environmental. Multivariate logistic regression confirmed the absence of significant associations between PSCI and quality of life across all domains. Conclusion: Post-stroke cognitive impairment was common among ischemic stroke patients but did not affect quality of life across the WHOQOL-BREF domains. These findings emphasize the need for holistic and multidisciplinary post-stroke therapy because physical, psychological, social, and environmental factors influence post-stroke quality of life.
An Unusual Case of Ipsilateral Hemiparesis in a Patient with Small Hypertensive Supratentorial Hemorrhage Fadhlan Abdur Rahman; Septy Aulia Rahmy; Dwi Ayu Novinda Sari; Fahmi Syahtama Hasyim; Avie Baldana Bi'izzyk
AKSONA Vol. 6 No. 2 (2026): JULY 2026
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar

Abstract

Highlight: Ipsilateral hemiparesis after supratentorial stroke is a rare neurological presentation. Recurrent stroke may cause ipsilateral motor deficits due to prior corticospinal tract injury. Recognition of this atypical presentation may improve diagnosis and understanding of motor pathway reorganization.   ABSTRACT Introduction: Ipsilateral hemiparesis following supratentorial stroke is a rare neurological presentation that contradicts the typical contralateral motor deficit caused by corticospinal tract decussation. The underlying mechanism remains poorly understood and has most commonly been associated with previous contralateral cerebral injury and motor pathway reorganization. We report a rare case of recurrent supratentorial hemorrhagic stroke presenting with ipsilateral hemiparesis. Case: A 59-year-old woman presented with acute worsening of right-sided hemiplegia and dysarthria that began approximately 2.5 hours before presentation. She had experienced a history of stroke two years earlier, resulting in persistent right-sided motor weakness, as well as poorly controlled hypertension. Neurological examination demonstrated ipsilateral upper motor neuron hemiplegia and facial palsy. Brain CT revealed a small right thalamic intracerebral hemorrhage, consistent with acute intracerebral hemorrhage. Conclusion: The patient had Ipsilateral motor weakness . This rare clinical presentation may be associated with abnormal corticospinal tract anatomy, such as the presence of non-decussating corticospinal fibers, or with compensatory reliance on the ipsilateral corticospinal tract following contralateral tract injury from a previous cerebrovascular event. However, these proposed mechanisms could not be confirmed because advanced neuroimaging modalities, including magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) tractography, were unavailable. Further studies using advanced neuroimaging are warranted to better characterize the underlying motor pathway reorganization.
Effects of Glucomannan and Inulin Supplementation on Glial Inflammation in Mice Fed a High-Fat, High-Sucrose Diet Nita Kurniawati; Cristoforus Aji Pamungkas; Shanea Veronica Jovangka; Bernadette Dian Novita; Yudy Tjahjono; Hendy Wijaya; Irene Lingkan Parengkuan; FX Himawan Haryanto Jong; Pauline Meryana; Arya Pandhu Wiratama
AKSONA Vol. 6 No. 2 (2026): JULY 2026
Publisher : Universitas Airlangga

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Abstract

Highlight: Inulin and glucomannan modulated IL-6 and IL-10 in HFHS-fed mice. Inulin reduced IL-6, while combined fiber modulated IL-10 expression.   ABSTRACT Introduction: A HFHS (high-fat, high-sucrose) diet induces neuroinflammation through dysregulated glial cell signaling and persistent low-grade inflammation, characterized by elevated IL-6/interleukin-6 and decreased IL-10/interleukin-10 levels. Dietary fibers including glucomannan and inulin are reported to modulate gut microbiota and inflammatory responses; however, their effects on HFHS-induced neuroinflammation remain unclear. Objective: This study examined the effects of glucomannan, inulin, and their joint administration on IL-10 and IL-6 expression in glial cells of mice fed an HFHS diet. Methods: As many as 15 male C57BL/6 mice were allocated at random to five groups: control (AQ), HFHS (KN), HFHS plus glucomannan (GO), HFHS plus inulin (IO), as well as HFHS plus a mixture of inulin and glucomannan (IG), with three animals in each group. During the intervention period, fiber supplements were administered orally. IL-10 and IL-6 expression in glial cells was evaluated through immunohistochemistry and quantified by mean gray value (MGV) analysis using ImageJ software. Statistical analysis was executed via one-way ANOVA with a p < 0.05 significance level. Results: IL-6 expression was lowest in the control (AQ) group, whereas the combination treatment (IG) showed reduced IL-6 expression relative to the other HFHS-fed groups. The IG group also exhibited the lowest IL-10 expression among all groups. These findings suggest that the combined supplementation may attenuate pro-inflammatory IL-6 expression but does not appear to enhance the anti-inflammatory IL-10 response. Conclusion: Combined supplementation with glucomannan and inulin reduced IL-6 expression within HFHS-fed mice but did not increase IL-10 expression. These findings indicate that dietary fiber supplementation may selectively modulate inflammatory pathways associated with diet-induced neuroinflammation.

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