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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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Stroke Risk Factor Profile in an Urban Population: A Community-Based Descriptive Study in Mojo Sub-District, Surabaya, Indonesia Ilham Ikhtiar; Muhammad Wijdan Rosyich; Muhammad Arief Ardhanu; Dewi Setyaning Bastiana; Dedy Kurniawan; Sita Setyowatie
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.v3i1.40764

Abstract

Highlight: The stroke risk of the urban population in Mojo sub-district, Surabaya, was high (more than 10% risk for 36.3% of the population) . The risk factor for stroke is highly prevalent in Indonesia's urban communities, such as Surabaya. The Indonesian version of the Cardiovascular Disease Risk Index chart aids in determining stroke risk factors. The development of a stroke-spesific index chart has been done before but requires validation for the Indonesian population   ABSTRACT Introduction: Stroke is still a major cardiovascular disease in Indonesia. Locally published data regarding stroke risk factors is still rarely reported. This condition complicates the regulation, policy-making, and community empowerment efforts to reduce modifiable stroke risk factors. Thus, a study is necessary to provide an overview of stroke risk factors and risks in cities in Indonesia, such as Surabaya. Objective: This study aimed to describe stroke risk factors in an urban Indonesian community, such as the Mojo sub-district in Surabaya. Methods: This was a descriptive study to describe stroke risk factors like age, gender, history of comorbidities, and history of cardiovascular disease, as well as patient clinical data like neurological symptoms, cardiovascular symptoms, anthropometry, vital signs, simple laboratory values, and cardiovascular risk categorization in the next ten years based on the Cardiovascular Disease Risk Index chart, Indonesian version. Results: In this study, 33 participants were included. Risk factors showed that many participants had histories of active smoking (18.2%), hypertension (45.5%), and diabetes (24.2%). One-third of the participants had a history of dyslipidemia. Based on the risk chart for cardiovascular disease, 36.3% of participants were at >10% risk of developing cardiovascular disease in the next ten years. Conclusion: The risk index of cardiovascular disease in the Mojo sub-district, Surabaya, was still high. A combination of government policies, public awareness improvement, and community empowerment are urgently required to manage these risk factors epidemiologically.
Diffusion Weighted Imaging (DWI) Classification and Apparent Diffusion Coefficient (ADC) Value Tendency Based on Cerebral Glioma Grading in Patients at Dr. Soetomo General Academic Hospital in 2016-2020 Komang Wahyu Kurniawan; Sri Andreani Utomo; Joni Wahyuhadi
AKSONA Vol. 3 No. 1 (2023): JANUARY 2023
Publisher : Universitas Airlangga

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

Abstract

Highlight: Many studies conclude that the prognosis of gliomas can be determined using the DWI sequence and ADC value on MRI The correlation between DWI and ADC values with glioma grading is related to tumor cellularity, nuclear-cytoplasmic ratio, and extracellular space, which affect the movement of water molecules.   ABSTRACT Introduction: Glioma grading is crucial to know its prognosis. Magnetic resonance imaging (MRI) is used as a preoperative examination that contains diffusion-weighted imaging (DWI) sequences confirmed by an apparent diffusion coefficient (ADC) value that helps assess tissue based on water diffusion. Objective: To prove the relationship between DWI and ADC values with cerebral glioma grading in patients at Dr. Soetomo General Academic Hospital in 2016—2020. Methods: This retrospective study collected medical records and MRI files in DICOM (Digital Imaging and Communications in Medicine) format. Gender, age, tumor histopathology, and glioma grading were collected. DWI and ADC values were obtained using the RadiAnt DICOM Viewer application. The data were analyzed using descriptive and analytical statistics. The chi-square test was used to analyze the relationship of DWI with glioma grading, and the spearman rank test was used to analyze the relationship of ADC value with glioma grading. Results: The majority of 35 patients were male (54.3%), aged 31–40 years old (22.9%), and the most common histopathology was glioblastoma (37.1%), WHO grade IV. On DWI, most low-grade glioma (LGG) patients showed unrestricted diffusion, and most high-grade glioma (HGG) patients showed restricted diffusion. The ADC value of HGG was lower than the ADC value of LGG. Statistical tests showed a relationship between DWI and glioma grading (p<0.05) and a relationship between the ADC value and glioma grading (p<0.05). Conclusion: There was a relationship between DWI and ADC with glioma grading in Dr. Soetomo General Academic Hospital patients for the period 2016—2020
Intracerebral Hemorrhage Score as a Prognosis Prediction of Spontaneous Intracerebral Hemorrhage at RSI Surabaya Jemursari Dyah Yuniati; Shobihatus Syifak; Prima Ardiansah Putra; Vena Saskia Prima Saffanah
AKSONA Vol. 3 No. 2 (2023): JULY 2023
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/aksona.v3i2.40242

Abstract

Highlight: Spontaneous intracerebral hemorrhage, or hemorrhagic stroke, is one of the leading causes of mortality and disability in Indonesia. The intracerebral hemorrhage (ICH) score is a widely used predictive tool for the prognosis of death 30 days after spontaneous intracerebral hemorrhage, but the intracerebral hemorrhage-grading scale (ICH-GS) score has a more specific interval to assess prognosis prediction after intracerebral. The higher the total score, the more likely it is to have a poor outcome. The results of this study indicate that patients with a high total score did not always die.   ABSTRACT Introduction: Spontaneous intracerebral hemorrhage, or hemorrhagic stroke, is one of the leading causes of mortality and disability in Indonesia. Objective: The intracerebral hemorrhage (ICH) score is a widely used predictive tool for the prognosis of death 30 days after spontaneous intracerebral hemorrhage, but the intracerebral hemorrhage-grading scale (ICH-GS) score has a more specific interval to assess prognosis prediction after intracerebral hemorrhage. Methods: The type of research used was observational-retrospective research. The population included all patients with spontaneous intracerebral hemorrhage hospitalized at RSI Jemursari Surabaya in 2017–2019. Results: The results revealed that there were 110 spontaneous intracerebral hemorrhage patients with complete data in medical e-records during 2017–2019; 65.5% (72 patients) were male and 34.5% (38 patients) were female. The data showed that 20% (22 patients) had an ICH-GS score of 8 and 0.9% (1 patient) had an ICH-GS score of 12. Conclusion: The higher the total score, the more likely it is to have a poor outcome. The results of this study indicate that patients with a high total score did not always die.
Cerebral Salt Wasting Syndrome in Traumatic Epidural Hematoma and Subarachnoid Hemorrhage: A Case Report Chandrika Najwa Malufti; Stephanus Andy Prakasa Kaligis; Harris Istianggoro; Kathi Swaputri Kancana
AKSONA Vol. 3 No. 2 (2023): JULY 2023
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/aksona.v3i2.40755

Abstract

Highlight: CSWS is a rare case of hyponatremia in central nervous system disorders. The correct diagnosis of CSWS is very important because it has a different treatment strategy from other diseases so that patients will get a good outcome.   ABSTRACT Introduction: Electrolyte imbalance is common in patients with neurologic disease, including traumatic brain injury. The most common type is hyponatremia, a condition in which serum sodium <135 mmol/L. High morbidity and mortality rates are associated with hyponatremia, especially if the underlying causes are misdiagnosed and improperly treated. One such condition that comes to mind is cerebral salt wasting syndrome (CSWS), which is treated primarily with volume resuscitation and sodium replacements and is characterized by hyponatremia, elevated urine sodium, and hypovolemia. Case: A 21-year-old man was hospitalized for a traumatic brain injury due to a traffic accident. He suffered from an epidural hematoma (EDH) and a subarachnoid hemorrhage (SAH). He underwent an emergency decompression craniotomy and hematoma evacuation. The operation went well, as expected. During hospitalization, the patient developed agitation, restlessness, and polyuria with hyponatremia in serum but elevated in urine. We identified that CSWS was the underlying cause and administered isotonic, hypertonic, and hydrocortisone treatments to the patient. The patient showed progressive improvement. His condition tends to be stable, and he has a normal electrolyte level. Conclusion: Cerebral salt wasting syndrome (CSWS) is an important but underrecognized cause in hyponatremic patients with central nervous system disorders.
Preoperative Endovascular Embolization of Intracranial Hemangioma: A Case Report Gilbert Tangkudung; Jeffry Foraldy; Yovanka Manuhutu
AKSONA Vol. 3 No. 2 (2023): JULY 2023
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/aksona.v3i2.44051

Abstract

Highlight: Preoperative tumor embolization was performed to reduce intraoperative risk and maximize resection success Endovascular embolization has developed into an important and effective adjuvant in tumor management before a surgical resection.   ABSTRACT Introduction: Hypervascular tumors of the head, neck, and central nervous system are associated with a high risk of bleeding during surgery. Hemangioma is a benign neoplasm that tends to grow rapidly, bleed, and have a high recurrence rate, especially after partial resection. Considering that hemangioma is a type of tumor with high vascularity, preoperative tumor embolization was performed to reduce intraoperative risk and maximize resection success. Case: A 33-year-old female came with the chief complaint of chronic progressive headaches and vision loss in the last 5 years. She got a lump on her forehead and had a visual acuity of 1/∞ in both eyes. She had already been diagnosed with hemangioma at a secondary regional hospital, where she bled profusely on the operating table, causing the resection to be discontinued. She was referred to our hospital for preoperative embolization. She underwent an endovascular embolization procedure with PVA particles to seal the feeder artery to the tumor. After embolization, angiography showed a complete devascularized tumor lesion. A total resection was done three days later with minimal bleeding compared to the first surgery. After a three-month follow-up, there was no new neurological deficit, and her headache was resolved completely, although her vision still did not improve. Conclusion: Endovascular embolization has developed into an important and effective adjuvant in tumor management before a surgical resection. Advances in catheter-based techniques, in conjunction with the development of the neurointervention field, are expected to raise the number of perioperative embolization procedures performed.
HDL Cholesterol and Functional Scale Measured by the NIHSS in Acute Thrombotic Stroke Patients Rahayu Nofita Sari; Hanik Badriyah Hidayati; Jusak Nugraha
AKSONA Vol. 3 No. 2 (2023): JULY 2023
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/aksona.v3i2.44469

Abstract

Highlight: Stroke is one of the leading causes of death and disability in the world. There is correlation between HDL cholesterol in acute thrombotic patients and the functional degree of the NIHSS. The lower rate of HDL cholesterol is related to the higher NIHSS score or the higher level of stroke severity.   ABSTRACT Introduction: Stroke is one of the world’s leading causes of death and disability. Acute thrombotic stroke accounts for 87% of all stroke cases. The study of the correlation between high-density lipoprotein (HDL) cholesterol levels and acute thrombotic stroke is still limited, especially on the relationship between HDL levels and the degree of functional stroke. Objective: This study aimed to prove a correlation between HDL cholesterol and the functional scale measured by the NIHSS (National Institutes of Health Stroke Scale) in acute thrombotic stroke. Methods: The design study was cross-sectional, with sampling by consecutive admission based on inclusion and exclusion criteria in the neurological ward (Seruni A) at Dr.Soetomo General Academic Hospital, Surabaya. The NIHSS was used to determine the degree of functional scale, and HDL levels were measured by enzymatic endpoint methods. Results: From the 40 subjects studied, 16 (40%) had normal HDL levels of ≥ 40 mg/dL with an NIHSS score between 0–10, and 24 (60%) had lower HDL levels of ≤ 40 mg/dL with an NUHSS score between 0–20. There were significant results in this study (r = 0.391 and p = 0.013). Conclusion: There was a negative correlation between HDL cholesterol levels and the functional scale measured by the NIHSS in acute thrombotic stroke patients.
Case Series: Gamma Knife Radiosurgery in Brain Arteriovenous, Is It Good Enough? Yohan Budi Hartanto; Debora Sharon Rory; Jesisca Jesisca
AKSONA Vol. 3 No. 2 (2023): JULY 2023
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/aksona.v3i2.44747

Abstract

Highlight: Brain AVMs are a special concern due to their inherent high risk of bleeding. Gamma Knife radiosurgery (GKRS), as one of the modality treatments, is intended to induce progressive occlusion of an AVM by using high-dose targeted radiation The result of Gamma Knife radiosurgery (GKRS) can be full obliteration, with complications because adverse radiation effects.   ABSTRACT Introduction: Brain arteriovenous malformations (AVMs) are relatively uncommon. Gamma Knife radiosurgery (GKRS) is one of the AVM’s therapeutic interventions, with both advantages and disadvantages. Here, we report the results of two cases of brain AVM after GKRS. Cases: Case 1: Non-contrast head MRI imaging of a 45-year-old man with persistent left-sided headaches revealed a 1.4 x 2.5 x 2.28 cm AVM nidus in the left parasagittal frontal lobe. After a single GKRS with a 25-Gy marginal dose, the MRI contrast showed complete obliteration, with persistent perifocal edema and headache. Case 2: A 25-year-old woman with a history of generalized seizures. The angiograms revealed an AVM nidus with a diameter of 32.58 mm on her right posterior frontal lobe. After a single GKRS with a 22-Gy marginal dose, the MRI contrast showed full obliteration with large edema. The patient had presented with hemiparesis. Conclusion: In these cases, the results after GKRS were full obliteration with complications of edema, headache, and hemiparesis. We also found that complications appear to be associated with adverse radiation effects.  
In Silico Analysis of Pongamia pinnata to Inhibit Neuronal Apoptosis after Ischemic Stroke via NMDAR and Caspase-3 Muhammad Ja'far Shodiq; Farmindo Hartono; Siti Khaerunnisa; Abdulloh Machin
AKSONA Vol. 3 No. 2 (2023): JULY 2023
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/aksona.v3i2.44759

Abstract

Highlight: The potential of Pongamia pinnata as an inhibitor of apoptosis in ischemic stroke has never been evaluated before. Pongamia pinnata has potential to inhibit neuronal apoptosis via NMDAR and Caspase-3 in ischemic stroke. Karanjachromene has the best binding interaction to inhibit NMDAR.   ABSTRACT Introduction: One of the cardiovascular diseases with the highest mortality rate is stroke. Stroke is the second-leading cause of death worldwide. Each year, 12.2 million new cases of stroke occur, of which 7.6 million are ischemic strokes. In ischemic stroke, there are several pathways that cause neuronal apoptosis. The activity of NMDAR and caspase-3 is one of the pathways. Pongamia pinnata phytochemicals have a neuroprotective function against neurological disorders. However, its use as an inhibitor of apoptosis in ischemic stroke has never been evaluated before. Objective: This research was designed to evaluate the phytochemicals of Pongamia pinnata as inhibitors of neuronal apoptosis in ischemic stroke using an in silico study. Methods: This study used four main phytochemicals of Pongamia pinnata, namely Karanjin, Karanjachromene, Pongapin, and Pongachromene. The protein targets for neuronal apoptosis were NMDAR and caspase-3. The molecular docking processes were ligand preparation, protein preparation, grid box determination, molecular docking, and visualized molecular docking. Results: In silico results showed that at NMDAR target proteins, Karanjin, Karanjachromene, Pongapin, and Pongachromene have binding energies of -5.12, -5.83, -5.03, and -5.13 kcal/mol. At protein targets, Caspase-3, Karanjin, Karanjachromene, Pongapin, and Pongachromene have binding energies of -4.87, -4.98, -4.88, and -5.08 kcal/mol. Conclusion: The phytochemicals of Pongamia pinnata have the potential to inhibit neuronal apoptosis via NMDAR and caspase-3 in ischemic stroke. The binding of Karanjachromene to NMDAR demonstrated the compound's best interaction.
D-Dimer Levels as a Predictor of Clinical Outcome and Mortality in Acute Ischemic Stroke Patients: A Systematic Review and Meta-Analysis Pearl Dhodik Wirasman; Abdulloh Machin; Jenar Harumi
AKSONA Vol. 3 No. 2 (2023): JULY 2023
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/aksona.v3i2.44770

Abstract

Highlight: An increase in the D-dimer level indicates activation of the coagulation system through thrombus formation and fibrinolysis. The meta-analysis found a significant relationship between elevated d-dimer levels and worsening clinical outcomes and increased mortality. The D-dimer level can be used as a predictor for predicting clinical outcomes and mortality in acute ischemic stroke patients at each duration of follow-up.   ABSTRACT Introduction: In ischemic stroke, high D-dimer levels are frequently found, indicating coagulation with ongoing thrombus formation and fibrinolysis. Objective: The purpose of this study was to analyze the role of D-dimer in predicting clinical outcomes and mortality in acute ischemic stroke patients. Methods: A systematic literature search was conducted using the PRISMA method through the PubMed, Science Direct, and Google Scholar databases. The quality of the article was assessed using the Newcastle-Ottawa Scale (NOS) and statistically analyzed using Review Manager software version 5.4.1. Results: Eight articles had good quality according to NOS and matched the criteria for the literature search. Elevated D-dimer levels and worsened clinical outcomes have a significant result when discharged from the hospital: OR 2.37 (95% CI 1.68–3.35); I2 = 45% p < 0.00001; 1-month: OR 1.75 (95% CI 1.38–2.23), I2 = 47% p < 0.00001; 3-months: OR 2.43 (95% CI 2.00–2.95), I2 0% p < 0.00001; 6-months: OR 2.64 (95% CI 1.92–3.63), I2 = 0% p < 0.00001; and 12-months: OR 1.92 (95% CI 1.31–2.82), I2 = 62% p < 0.0008. Elevated D-dimer level and increased mortality have a significant result with OR 2.25 (95% CI 1.78–2.85), I2 = 45% p < 0.00001. Conclusion: D-dimer can be used as a predictor of clinical outcome and mortality in acute ischemic stroke.  
A Rare Case of Dural Tail Sign in the Patient with Glioblastoma Multiforme: A Case Report Risdiansyah Risdiansyah; Kusuma Eko Purwantari; Viskasari P Kalanjati; Rahadian I Susilo
AKSONA Vol. 3 No. 2 (2023): JULY 2023
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/aksona.v3i2.46639

Abstract

Highlight: A dural tail sign was found in T1W1-MR-images with contrast of a patient with glioblastoma multiforme. Glioblastoma multiforme as a grade IV malignancy of the astrocytes' glioma, the dura mater can be infiltrated and shown as DTS, although rarely reported.   ABSTRACT Introduction: The dural tail sign (DTS), which is rarely seen in patients with glioblastoma multiforme (GBM), is reported here. This sign is generally found as a manifestation of meningioma due to the reactive changes of the tumor’s invasion. Case: A 61-year-old Javanese man presented with a gradually worsening headache two months prior to hospital admission. He also suffered from paralysis of his right extremities. His complete blood tests and clinical chemistry were within normal limits. A head CT scan showed a large mass near the convexity of the brain in the left parietal lobe, along with edema and a shift of the midline structures to the right. This was confirmed on the T1W1 MR images with contrast, where DTS was clearly shown. Following surgical resection and tumor excision, histopathology analysis revealed GBM with malignant cell infiltration to the dura in the vicinity of the neoplasm. Conclusion: Here we showed a DTS in GBM as a malignant infiltration marker into the dura    

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