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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 83 Documents
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Perbaikan Klinis dan Radiologis Tuberkuloma Serebral dengan Terapi Non Operatif: Dua Laporan Kasus Muhammad Ikbal; Paulus Sugianto
AKSONA Vol. 1 No. 1 (2021): JANUARY 2021
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (402.789 KB) | DOI: 10.20473/aksona.v1i1.96

Abstract

Pendahuluan: Tuberkuloma serebral merupakan suatu bentuk tuberkulosis (TB) yang jarang dan serius karena penyebaran hematogen Mycobacterium tuberkulosis (MT). Tuberkuloma serebral ditemukan paling sedikit dibandingkan tuberkulosis intrakranial lainnya, yaitu sekitar 1%. Tuberkuloma serebral yang multipel hanya 15–33% kasus. Obat anti TB penting untuk keberhasilan pengobatan tuberkuloma serebral tapi belum ada kesepakatan mengenai durasi terapi. Kasus: Kasus 1: Laki- laki usia 33 tahun dengan keluhan penurunan kesadaran, kejang, sakit kepala, kelemahan tubuh sisi kanan. Gambaran MRI kepala dan biopsi menunjukan tuberkuloma. Penderita mendapat obat anti tuberkulosis rifampisin, INH, pirazinamid, dan injeksi streptomisin. Setelah pengobatan selama 13 bulan, penderita mengalami perbaikan secara klinis maupun radiologis. Kasus 2: Laki-laki usia 33 tahun dengan keluhan nyeri kepala kronik, demam tidak tinggi, muntah, dan dismetria kanan. Penderita juga diketahui menderita TB paru yang sedang dalam pengobatan selama 1 minggu. MRI kepala dengan kontras menyokong gambaran tuberkuloma serebral dan Gene Xpert MTB positif. Penderita mendapat pengobatan anti tuberkulosis berupa rifampisin, INH, pirazinamid, etambutol, dan injeksi streptomisin. Keluhan penderita membaik dimana tidak ada nyeri kepala dan dismetria setelah pengobatan selama 1 bulan. Kesimpulan: Tuberkuloma serebral dapat diterapi dengan obat antituberkulosis (OAT), minimal 9 bulan pengobatan. Pada beberapa kasus, masa pengobatan dapat ditambah sesuai dengan kondisi klinis dan radiologis penderita. Sedangkan pada kasus yang berat, tindakan eksisi tuberkuloma mungkin diperlukan.
Partial Transvenous Coil Embolization with Significant Clinical Improvement in Patient with Indirect Carotid Cavernous Fistula Muh. Wildan Yahya; Achmad Firdaus Sani; Dedy Kurniawan; Mohammad Saiful Ardhi
AKSONA Vol. 2 No. 2 (2022): JULY 2022
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (476.891 KB) | DOI: 10.20473/aksona.v2i2.36633

Abstract

Highlight: CCF is a rare vascular malformation with challenging management. Partial transvenous embolization is quite effective as an alternative therapy for indirect CCF type D.   ABSTRACT Introduction: An indirect carotid-cavernous fistula (CCF) is an abnormal connection between the internal or external carotid artery and the cavernous sinus. The optic, trochlear, abducens, and trigeminal nerves are located in the cavernous sinus. Head Computed Tomography (CT) scan, Magnetic Resonance Imaging (MRI), and Cerebral Angiography are some imaging modalities used to establish and diagnose carotid-cavernous fistula. Endovascular intervention can be performed with trans-arterial or trans-venous access. In some cases, complete embolization by endovascular treatment is not possible because of difficult angioarchitecture. Case: A 61-year-old female reported having pain in her left eye (numerical rating scale was 6). The left eye was bulging, reddish, ptosis, and unable to move. The patient felt double vision when opening both eyes, complained of intermittent stabbing headaches on the left side, and heard a bruit from the left side of the head. The cerebral angiography showed bilateral indirect CCF Barrow type D. The procedure involved partial transvenous embolization with coiling. The angiographic evaluation showed partial occlusion, and residual flow from the fistula was still visible on angiography. There was a significant clinical improvement several days after the procedure and a five-month follow-up.  Conclusion: This case report showed that partial targeted transvenous embolization is quite effective in indirect CCF when complete embolization is impossible.
Characteristics of Patients with Low Back Pain among Healthcare Professionals at John Piet Wanane General Hospital: A Cross-Sectional Study Lu Jordy Luhur; Agustinus Ruma; Paulus Sugianto
AKSONA Vol. 2 No. 2 (2022): JULY 2022
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (538.975 KB)

Abstract

Highlight: Healthcare professionals have a higher risk of suffering LBP than other industrial workers. Adult women who have a high body mass index are likely to experience LBP. Healthcare professional should maintain a healthy lifestyle to increase productivity and decrase mortality   ABSTRACT Introduction: Low back pain (LBP) is musculoskeletal pain, tension, or stiffness that occurs below the costal margin and above the inferior gluteal folds, with or without sciatica. It has been found that healthcare professionals are more likely to experience LBP than other industrial workers. Many factors contribute to higher rates of LBP, including occupation, age, obesity, family history, lack of exercise, and psychosocial condition. Objective: To determine LBP’s prevalence and risk factors among healthcare professionals at John Piet Wanane General Hospital. Methods: This is a cross-sectional study that included 158 healthcare professionals. The data was collected using questionnaires and analyzed using univariate and multivariate logistic regression. Results: The overall prevalence of LBP in this study was 62.7%. Descriptive statistics showed that LBP was most common in the female group (71.7%), age group 35-50 years (52.5%), overweight group (61.6%), married group (80.8%), never or rarely exercise group (84.8%), non-smoking group (85.9%), non-drinkers group (84.8%), and moderate perceived stress group (63.6%). Multivariate logistic regression analysis showed that BMI was significantly associated with LBP. Compared with underweight participants, overweight participants were four times more likely to experience LBP (OR = 4.344, 95% CI: 1.297-14.552). Conclusion: This study demonstrates a high prevalence of LBP among healthcare professionals. High BMI, especially being overweight, increases the risk of developing LBP. Overweight and obesity among healthcare professionals may affect their credibility in providing patients with healthy nutrition and exercise advice. Healthcare professionals should maintain a healthy lifestyle to increase productivity and decrease mortality.
Homonymous Hemianopia Secondary to A Long Fusiform Aneurysm of Posterior Cerebral Artery in A Patient with Connective Tissue Disease Pinto Desti Ramadhoni; Asep Riswandi
AKSONA Vol. 2 No. 2 (2022): JULY 2022
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (613.67 KB)

Abstract

Highlight: Fusiform aneurysms are uncommon, accounting for only 1% of total intracranial aneurysms, and posterior circulation involvement is only 3-13% of cases of intracranial aneurysms. Connective tissue diseases are very rare as the cause of this vasculopathy. Homonymous hemianopia due to the mass effect or dilated blood vessels compressing the left optic tract.   ABSTRACT Introduction: Fusiform aneurysms are uncommon, accounting for 1% of all intracranial aneurysms. Dissection and atherosclerosis are the main causes of this vasculopathy, but connective tissue disease is a very uncommon cause. Ehlers-Danlos Syndrome is the most common connective tissue disease, accounting for  11% of all cases. Symptoms depend on the location and size of the aneurysm, including headaches, blurred or double vision, and focal neurological deficits. Case: A 36-year-old man suddenly experienced blurred vision in both eyes on the right, starting with a chronic left-sided headache and no history of cardiovascular disease. In the confrontation test, Humphrey gave the right homonymous hemianopia. A head CT scan showed a lobulated lesion which showed enhancement in the left suprasellar region, and cerebral digital subtraction angiography (DSA) gave the impression of a long fusiform aneurysm L PCA. Clinically, the patient’s skin on the left side of his face was darker than on the right, his skin was more elastic, and his blood vessels were wider and more prominent on the side of the fusiform aneurysm. Conclusion: Posterior circulation involvement is only 3-13% of cases of intracranial aneurysms. Many cases of intracranial aneurysms are not detected before rupture, resulting in delays in treatment. Surgical or endovascular surgery can be performed if the size is >10 mm and causes clinical symptoms. Symptoms of ischemia are managed with antiplatelets or anticoagulants. Incidentally detected unruptured aneurysms are generally managed conservatively because of the highly friable nature of the blood vessels in patients with connective tissue diseases.
The Role of Dual Antiplatelet in Stent-Assisted Coiling in Wide-Neck Aneurysm Ricky Gusanto Kurniawan; Bambang Tri Prasetyo; Beny Rilianto; Abrar Arham
AKSONA Vol. 3 No. 1 (2023): JANUARY 2023
Publisher : Universitas Airlangga

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Abstract

Highlight: Dual antiplatelet is the gold standard for endovascular treatment of wide-neck aneurysms. The role of dual antiplatelet is to prevent stent thrombosis after treatment. The thrombosis rate reported during stent-assisted coiling is quite high.   ABSTRACT Stent-assisted coiling (SAC) in wide-neck aneurysm treatment is associated with antiplatelet use. Dual antiplatelet therapy (DAPT) has been the gold standard for protecting against thrombosis events and is widely accepted for endovascular embolization treatment with a stent-assisted or flow diverter. Some patients experience vascular events due to the reduced efficacy of antiplatelet agents despite taking DAPT. The reported thrombosis rates during stent-assisted coiling embolization range from 2% to 20%. Thromboembolic complications, such as in-stent thrombosis, can manifest in 4.6% of cases. The correlation between platelet reactivity during treatment and bleeding events remains unclear. However, the association between High Residual Platelet Reactivity (HRPR) or hyporesponsiveness and ischemic events is well established. Based on various laboratory definitions, hyperresponsiveness in patients with clopidogrel occurs in about 14–30% of patients due to major and minor bleeding. Therefore, the optimization of antiplatelet therapy has developed significantly in the neurointerventional community.  
Generalized Tetanus in A Patient with Infected Sutured Wound: A Case Report Novi Tejaya; Marina Musyawwirina Desiprimayanti Ruslan Ramli
AKSONA Vol. 3 No. 1 (2023): JANUARY 2023
Publisher : Universitas Airlangga

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Abstract

Highlight: Tetanus in patients with infected sutured wound. Complications of death in generalized tetanus. The importance of education about tetanus.   ABSTRACT Introduction: Tetanus is a disease caused by Clostridium tetani, which produces an exotoxin. Tetanus can rapidly progress into life-threatening muscle spasms accompanied by respiratory insufficiency with or without autonomic dysfunction. Case: A 43-year-old male patient was referred from the public health center to Tora Belo Hospital with mouth stiffness and difficulty swallowing food. He also had stiffness and pain in the neck, abdomen, and lower back. Seven days prior, the patient received lacerations on his right forearm caused by a machete. The patient’s wound had been stitched up without an anti-tetanus injection at the public health center. The symptoms worsened on the second day of admission, and the patient died from respiratory failure. Conclusion: It is very important to enhance public awareness that tetanus is a preventable disease, with proper vaccination and sanitization potentially lowering mortality and morbidity.
Treatment of Wide-Neck Intracranial Aneurysm: Current Concepts and Endovascular Approach Ricky Gusanto Kurniawan; Bambang Tri Prasetyo; Beny Rilianto; Pratiwi Raissa Windiani; Kelvin Theandro Gotama; Abrar Arham
AKSONA Vol. 3 No. 1 (2023): JANUARY 2023
Publisher : Universitas Airlangga

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Abstract

Highlight: Endovascular treatment is recommended for aneurysms Wide-neck aneurysm is difficult to treat with endovascular approach. Stent-assisted coiling and flow diverter are choices for wide-neck aneurysms   ABSTRACT A wide-neck aneurysm, described as an aneurysm with a neck of 4 mm or a dome-to-neck ratio of <2, requires more advanced endovascular treatment than a narrow-neck aneurysm. Stent-assisted coiling (SAC) was the sole endovascular approach for wide-neck cerebral aneurysms, which were difficult to treat surgically or by embolization. More advanced endovascular approaches have since been developed in recent years, namely the flow diverter (FD) as an endovascular treatment for wide-neck cerebral aneurysms with an endoluminal reconstruction approach. Both techniques have advantages and disadvantages that must be studied further to develop a wide-neck cerebral aneurysm therapy. Therefore, based on the current literature, this article intends to review the differences in the efficacy and complications of SAC and FD for wide-neck aneurysm therapy.  
Dyke-Davidoff-Masson Syndrome (DDMS) in Adult: A Rare Case in Rural Area Indra Pramanasari
AKSONA Vol. 3 No. 1 (2023): JANUARY 2023
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/aksona.v3i1.38419

Abstract

Highlight: Dyke-Davidoff-Masson syndrome (DDMS) is an uncommon neurological disease defined as cerebral hemiatrophy with a contralateral motor deficit, facial asymmetry, and seizures. The proper diagnosis and early causative treatment significantly improve the outcome of thee disease.   ABSTRACT Introduction: Dyke-Davidoff-Masson syndrome (DDMS) could be a rare neurological disorder characterized by cerebral hemiatrophy and an engine shortfall on the contralateral side of the body. Furthermore, facial asymmetry and seizures are common symptoms. Classic imaging findings in individuals with DDMS are ventriculomegaly, cerebral hypoplasia, paranasal sinus hyperpneumatization, and compensatory osseous broadening. The relationship between symptoms and imaging findings is used to determine DDMS. Case: A 46-year-old female patient arrived at the hospital with an inability to speak three days before admission, refused to eat or drink, and had a fever. She also had a slanted mouth and right-sided hemiparesis with a history of seizures. A firm boundary consolidation on the right pericardium was found on the chest X-ray, suggesting pulmonary TB. On a non-contrast head CT scan, thickening of the left hemicalvaria was found, accompanied by a widening of the left frontal-ethmoidal sinus, hyperpneumatization of the left mastoid air cell, and left cerebral hemiatrophy, all accompanied by left lateral ventricular dilatation. Conclusion: The proper diagnosis and early causative treatment significantly improve the outcome of the disease.  
Dendritic Cells as Adjuvant Therapy to Decrease Mortality for Glioblastoma Patients: Meta-Analysis Allyssa Rahmaditta; Ervin Monica
AKSONA Vol. 3 No. 1 (2023): JANUARY 2023
Publisher : Universitas Airlangga

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Abstract

Highlight: Dendritic cells (DC) are one type of immune therapy that is being explored to improve treatment effectiveness in glioblastoma multiforme (GBM). DC was predicted to improve survival rates in GBM patients within 3 years. Effects of DC in the fifth year need to be explored to prove their. effectiveness in increasing the GBM survival rate.   ABSTRACT Introduction: Glioblastoma multiforme (GBM) is a primary neoplasm of the central nervous system with a low survival rate, requiring more effective treatment to improve long-term survival. Dendritic cell (DC) therapy is expected to reduce tumor progressivity. Obective: The purpose of this meta-analysis was to analyze the administration of DC in reducing mortality in GBM patients. Methods: A systematic literature search was conducted using the PRISMA method through the Embase database, PubMed, and the Cochrane Controlled Trials Register for relevant studies between giving DC to GBM patients with conventional therapy on the number of living patients compared to controls. Article quality was assessed using the Newcastle-Ottawa Scale and statistically analyzed using RevMan 5.4. Results: Of the 14 articles, the rates of reduction in the probability of death during the first three years after initiation of therapy were 26%, 36%, and 38%, respectively [1st-y HR: 0.74 (0.57-0.95), I2: 15%, p=0.02; 2nd-y HR: 0.64 (0.51-0.81), I2: 14%, p=0.0002; 3rd-y HR: 0.62 (0.48-0.81), I2: 0%, p=0.0004]. However, there was no difference after 5 years [HR 0.81 (0.62-1.06), I2: 0%, p=0.13].  Conclusion: The DC vaccine reduces the likelihood of death in the early years of therapy but has not been proven for long-term therapy.
Hemorrhagic Wallenberg Syndrome Accompanied by Horner Syndrome at Young Age Imran I; Lailatul Fadhila
AKSONA Vol. 3 No. 1 (2023): JANUARY 2023
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/aksona.v3i1.39495

Abstract

Highlight: Wallenberg syndrome caused by medulla oblongata hemorrhage with good functional outcome. Wallenberg syndrome is accompanied by Horner's syndrome, which occurs at a young age. In patients with Wallenberg syndrom, conservative management and medical rehabilitation are used.   ABSTRACT Introduction: Wallenberg syndrome is a rare syndrome involving the medulla oblongata, an uncommon hemorrhage site. It is also known as lateral medullary syndrome or posterior inferior cerebellar artery syndrome. Wallenberg syndrome has several symptoms that can be divided into vestibulo-cerebellar, bulbar, autonomic, sensory, and atypical. Case: A 27-year-old man came to the emergency unit complaining of dizziness and swinging, as well as a left eyelid that did not open completely, a lack of sweat on the left side of the face, a hoarse voice, swallowing disturbances, hiccups, decreased hearing in the left ear, and a lack of sensation on the left side of the face and the right side of the body. The patient tended to fall to the left and was unsteady when standing. Physical examination revealed Horner syndrome, bidirectional nystagmus, left dysdiadochokinesia, and left ataxia. A CT scan of the head showed a left-sided medulla oblongata hemorrhage. The patient was given conservative therapy, feeding through a nasogastric tube, and medical rehabilitation. A repeat CT scan of the head was done one week later, and it was discovered that the hemorrhage in the medulla oblongata had begun to absorb. Conclusion: Wallenberg syndrome, with a manifestation of hemorrhagic stroke in the medulla oblongata, can occur at a young age with various clinical symptoms. The diagnosis of Wallenberg syndrome is made based on clinical symptoms and imaging findings. Conservative therapy using medicines and medical rehabilitation can provide a speedy recovery. An incorrect diagnosis is a major hazard to patient safety and can have serious consequences, including permanent disability or death.

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