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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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Challenging Endovascular Treatment of Ruptured Proximal Posterior Inferior Cerebellar Artery Aneurysm: A Case Report Prasetyo, Bambang Tri; Kurniawan, Ricky Gusanto; Rilianto, Beny; Windiani, Pratiwi Raissa; Kelvin, Kelvin Theandro
AKSONA Vol. 4 No. 1 (2024): JANUARY 2024
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/aksona.v4i1.44640

Abstract

Highlight: Posterior inferior cerebellar artery (PICA) aneurysms are rare in occurence. The endovascular management of PICA aneursysms is challenging due to anatomical difficulties in accessing the site. The rebleeding of PICA aneurysms, although rare than other intracranial anurysms, may still happen and must be considered in their management   ABSTRACT Introduction Aneurysms of the posterior inferior cerebellar artery (PICA) are rare clinical entities with a lower risk of rupture than other intracranial locations. This makes managing PICA aneurysms challenging and important for neurointerventionists to understand. In this case report, we looked at a rare case of PICA aneurysm with post-coiling rebleeding.  Case: We reported a 51-year-old female with complaints of dizziness and vomiting. The patient was found to be hypertensive and a neurologic assessment revealed neck stiffness and left hemiparesis. A computed tomography (CT) scan of the head indicated subarachnoid hemorrhage. CT angiography (CTA) showed an aneurysm at the right proximal PICA. Although endovascular coiling was performed, the patient rebleed one month later. Following the insertion of the second coil, successful embolization was achieved, and the patient showed clinical improvement. Conclusion: PICA aneurysms require careful endovascular management, considering the difficulty of access due to their anatomical location. An understanding of its proper management is of paramount importance to reducing mortality.  
Ischemic Stroke Risk Factor Profile at Prof. Dr. W. Z. Johannes Hospital, Kupang, East Nusa Tenggara Pramanasari, Indra
AKSONA Vol. 4 No. 1 (2024): JANUARY 2024
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/aksona.v4i1.45403

Abstract

Highlight: Ischemic stroke is a major public health issue in Indonesia. Clinical data correlated to an ischemic stroke patient's prognosis. Several clinical factors and laboratory testing describe the tendency of ischemic stroke patients.   ABSTRACT Introduction: In Indonesia, ischemic stroke is a major public health issue. Clinical data correlates with an ischemic stroke patient's prognosis. Objective: This study aimed to provide an overview of clinical data in ischemic stroke patients from October 2020 to December 2021. Methods: This was a retrospective, descriptive study using medical records. A non-probability purposive sampling strategy with a total sampling method is used in this study. Age, gender, cardiac comorbidities, diabetes, repeated strokes, blood laboratory exams, electrolyte tests, alcohol consumption, and smoking habits were all observed variables. Results: The sample consisted of 242 ischemic stroke patients. The majority of patients (32.23%) were in the 61 to 70 age group, and men (57.4%) made up the majority of the sex group. Then, cardiac comorbidities were dominated by coronary artery disease (CAD), with 33 patients (57.4%) with 4 deaths (12.1%), while 15 patients (6.19%) were found with atrial fibrillation (AF), with 7 deaths (46.67%). Hypertension was found in 81.40% of patients, diabetes in 26.03% of patients, and recurrent stroke in 31.40% of patients. Active smokers make up 52.06% of all patients, and 18.18% are heavy alcohol drinkers. The majority of patients showed blood and electrolyte levels within the normal range, except for an increased leukocyte count and a decreased potassium level. Conclusion: The main risk factors obtained sequentially are hypertension, coronary artery diseases, active smokers, diabetes, and excessive alcohol consumption.
Case Report: Meningitis in Postpartum Pratama, Medio Yoga
AKSONA Vol. 4 No. 1 (2024): JANUARY 2024
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/aksona.v4i1.45453

Abstract

Highlight: Meningitis is an infectious disease of the brain membranes and spinal cord. Bacterial meningitis is a severe infection with high mortality and morbidity rates and can be one of the causes of fever in postpartum patients. The most common pathogen that can cause bacterial meningitis is Streptococcus agalactiae (GBS), which causes most of the cases.   ABSTRACT Introduction: Meningitis is an infectious disease of the brain membranes and spinal cord. Viruses, bacteria, fungi, parasites, or aseptic actions can all cause meningitis. Bacterial meningitis is a severe infection with high mortality and morbidity rates that can induce fever in postpartum patients. The incidence of invasive Streptococcus agalactiae Group B (SGB) in pregnant women reached 31.58%; the older the pregnant woman, the greater the risk of invasive SGB. Case: The patient came to the emergency room with unconsciousness, fever, and shortness of breath. The patient presented with Ronchi +, neck stiffness +, and GCS E1M1V1. A chest X-ray found cardiomegaly as well as pulmonary edema. A full blood count indicated leukocytosis, increased neutrophils, elevated SGOT and SGPT levels, and lymphocytopenia. The patient was then given antipyretics, anticonvulsants, neurotonics, neurotrophics, diuretics, antihypertensives, and antianginals. Conclusion: In this study, it can be determined whether infection during pregnancy or labor can cause postpartum meningitis. The most common pathogen that can cause bacterial meningitis is Streptococcus agalactiae Group B (SGB), which causes most cases. Early diagnosis of postpartum meningitis is important in order to begin as soon as possible and achieve the best results for the patient's recovery.  
Incidence of Stroke Cases at Blambangan General Hospital of Banyuwangi in January-December 2022: A Descriptive Study Hastuti, Riani Dwi; Setyawan, Andar; Handayani, Indah Ari; Khalisha, Putri Nabila
AKSONA Vol. 4 No. 1 (2024): JANUARY 2024
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/aksona.v4i1.47492

Abstract

Highlight: The majority of stroke cases at Blambangan General Hospital in Banyuwangi are ischemic strokes. The age group that experienced the most strokes was >40 years. The gender that experienced the most strokes was female.   ABSTRACT Introduction: Stroke is a leading cause of morbidity in Indonesia. It significantly contributes to the overall burden of disease and places a substantial impact on the health of the population in Indonesia. Objective: The purpose of this study was to show the incidence of stroke cases in the Blambangan General Hospital in Banyuwangi. Understanding the prevalence of strokes at this particular hospital is critical for identifying patterns, improving patient care, and taking preventive actions to deal with this important health issue. Methods: This study used a retrospective cross-sectional sampling method to look at all 342 inpatient stroke cases that were treated in the neurology department of Blambangan General Hospital in Banyuwangi in 2022. All of their data was collected and analyzed. Results: Most cases of stroke in this study were ischemic strokes, with a total of 212 cases (62.0% of all cases). The age group that experienced the most strokes was over 40 years old (96.2%) and female (56.4%). More than half of stroke patients had hypertension, and 80.1% had diabetes mellitus. Conclusion: This study found that ischemic stroke survivors, mostly female and aged over 40, were frequently associated with diabetes mellitus and hypertension. These findings provide insights into the frequency of these stroke types within the examined population.  
Successfully Procedure Endovascular Carotid Angioplasty Stent in a Case of Neck Stab Wound with Pseudoaneurysm, Recurrent Transient Ischemic Attack, and Horner Syndrome: A Case Report Ramadhoni, Pinto Desti; Martanusa, Hawari
AKSONA Vol. 4 No. 1 (2024): JANUARY 2024
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/aksona.v4i1.48951

Abstract

Highlight: Uncommon Presentation and Diagnosis: The case report presents a unique and rare clinical scenario involving a 14-year-old boy who sustained a neck stab wound, leading to the development of a pseudoaneurysm within the common carotid artery. Multidisciplinary Approach to Treatment: The case highlights the complexity of managing such casesm where a multidisciplinary approach is paramount. The manuscript underscores the significance of involving neurology, interventional neurology, and vascular surgery teams to provide comprehensive and tailored patient care Efficacy of Endovascular Intervention: The successful outcome of the endovascular carotid angioplasty stent procedure highlights its effectiveness as a treatment option for addresing complex vascular conditions like pseudoaneurysm or dissection of the carotid artery.   ABSTRACT Introduction: Neck stab wounds can lead to various vascular complications, including pseudoaneurysm or carotid artery dissection. Proper diagnosis and management can prevent recurrent strokes. Case: We reported a case of a 14-year-old boy with a previous left neck stab wound who developed recurrent transient ischemic attacks (TIAs) accompanied by Horner's syndrome and headache following a traumatic common carotid artery dissection. An angiographic examination revealed a pseudoaneurysm or dissection of the left common carotid artery. The patient was initially treated with oral anticoagulant therapy, but he continued to experience recurrent TIA. The patient was then treated endovascularly with a carotid angioplasty stent to restore the compromised carotid artery. Following the endovascular procedure, the patient experienced no complications, showed improvement in Horner syndrome, and had no headache. During the follow-up period, the patient had no more TIAs. Conclusion: Endovascular carotid angioplasty stents are an effective and safe way to treat pseudoaneurysm or dissection of the carotid artery, especially in cases presenting with recurrent TIAs and Horner syndrome. The observed clinical improvement following the procedure indicates significant benefits in enhancing the patient's quality of life and preventing complications from recurrent TIA episodes.
Bell's Palsy Post COVID-19 Vaccination: An Unwanted Occurence of Coincidence Pramanasari, Indra; Chrissanty, Chrissanty
AKSONA Vol. 4 No. 2 (2024): JULY 2024
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/aksona.v4i2.49467

Abstract

Highlight: The COVID-19 vaccination is one of the methods used to combat the COVID-19 pandemic. Bell's palsy is one of the unwanted side effects of the COVID-19 vaccination. The benefits and protective impacts of the COVID-19 vaccine exceed the dangers.   ABSTRACT Introduction: TOne way to fight the COVID-19 pandemic is through vaccination. Indonesia widely uses a number of vaccines. The inactivated virus vaccine (Sinovac-CoronaVac), the recombinant adenovirus vector vaccine ChAdOx1-S/nCoV-19 (AstraZeneca), the mRNA-1273 vaccine (Moderna), and the BNT162b2 mRNA vaccine (Pfizer-BioNTech) are some of these. The COVID-19 vaccination has reported several cases of acute facial nerve paralysis as an adverse event. Case: A 34-year-old female patient complained of drooping lips to the left side and being unable to close the right eyelid three days after receiving the first dose of the COVID-19 vaccine inactivated virus type (CoronaVac). Physical examination revealed obesity, right lagophthalmos, and right peripheral facial nerve paralysis, but no extremity paresis. The patient was clinically diagnosed with Bell's palsy and received corticosteroid therapy. The patient's complaints improved after 2 weeks of treatment. Reports indicate that several types of COVID-19 vaccines have resulted in acute facial nerve paralysis. The mRNA-type COVID-19 vaccine led to the most widely reported cases of Bell’s palsy. The incidence of Bell's palsy after the COVID-19 vaccine is very rare. Conclusion: Overall, the advantages and protective effects of the COVID-19 vaccine outweigh the risks.    
Comparison of Recurrent Stroke in Patients with First Stroke Ischemic and Hemorrhagic in Soetomo General Academic Hospital Surabaya Sihotang, Marselia Febriyanti; Ardhi, Mohammad Saiful; Parenrengi, Muhammad Arifin
AKSONA Vol. 4 No. 1 (2024): JANUARY 2024
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/aksona.v4i1.50403

Abstract

Highlight: The incidence of recurrent stroke in patients with the first stroke of ischemic type was 2.5-fold higher than that of hemorrhagic type, with the majority of recurrent strokes being the same type as the first stroke. Hypertension is the most common modifiable stroke risk factor in both stroke types, and in 5% of cases, secondary prevention is still not optimal. The average length of hospital stay for patients with the first stroke of hemorrhagic type was 3 days longer, along with a higher average NIHSS score on presentation than patients with ischemic stroke.   ABSTRACT Introduction: Stroke is the leading cause of mortality and disability in Indonesia, as well as being the major cause of death and disability-adjusted life years (DALY) lost worldwide. Recurrent stroke is one of the most common complications of stroke after discharge, despite being highly preventable. Objective: This study aimed to compare the differences in recurrent stroke profiles between patients with first stroke ischemic and hemorrhagic strokes. Methods: The study was done by collecting secondary data from medical records and the stroke registry at Dr. Seotomo General Academic Hospital over a period of six months (January–July 2020). Result: This study examined 36 samples that met the inclusion criteria. The results revealed that patients who experienced their first stroke of the ischemic type had a 2.5-fold higher incidence of recurrent stroke than those who suffered a hemorrhagic type. Except for one case, the majority of patients had the same type of stroke as the first. The most frequent modifiable risk factors seen in these two types of strokes are hypertension and physical inactivity. It was found that there were still 5% of the risk factors for which secondary prevention had not been carried out optimally with antidyslipidemic, antidiabetic, or antihypertensive drugs. The most common acute treatment for ischemic stroke is antiplatelet therapy, either single or dual therapy. Up to 90% of hemorrhagic strokes were treated conservatively, and in one patient, extraventricular drainage was performed. Conclusion: There were more stroke patients with a first stroke of hemorrhagic type that presented with NIHSS scores in the severe to very severe range, and the average length of hospitalization in this group was longer.    
Spontaneous Intracranial Hemorrhage in a 34-Year-Old Male Patient Related to Hypertensive Emergency Nurmalasari, Mifta; Widodo, Djoko
AKSONA Vol. 4 No. 2 (2024): JULY 2024
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/aksona.v4i2.51228

Abstract

Highlight: Unhealthy lifestyles are believed to be cause of hypertension at a young age. Untreated hypertension increases cardiovascular disease morbidity and mortality. The incidence of intracranial hemorrhage associated with hypertension is approximately 60%. It commonly occurs in the deep brain structure, which is considered to have a poor clinical outcome.   ABSTRACT Introduction: The incidence of hypertension is currently moving toward younger ages. It’s thought that an unhealthy lifestyle serves as a trigger. Hypertension can increase morbidity and mortality related to cardiovascular disease, even at a young age. This case report is intended to report the incidence of spontaneous intracranial hemorrhage in a 34-year-old male patient during a hypertensive emergency. Case: A 34-year-old male patient was rushed to the emergency unit at midnight due to a sudden decrease in consciousness. Headaches and seizures occurred before admission. The patient denied having any history of head trauma. The patient’s habits included excessive caffeine consumption, frequent late-night sleeping, and extensive smoking. At the time of admission, the patient’s vital signs indicated a poor clinical condition: GCS E1V1M1, BP 212/118 mm/Hg, deep irregular rapid breathing, sometimes followed by periodic apnea, RR 28 breath/minute, HR 111 beat/minute, SpO2 50%, T 36.8°C, which gradually developed hyperthermia. Both eyes had constricted and fixed pupils; the light reflexes were negative. A neurological examination revealed the body’s left lateralization. The head CT scan without contrast indicated hemorrhage in the right intracerebral, midbrain, pons, intraventricular, and subarachnoid areas, with estimated total volume of about 31 ml. Conservative treatment was chosen due to the bleeding location in the deep brain structure of GCS 3, which was considered to have a poor outcome. Conclusion: Hypertension in the younger age group is commonly associated with unhealthy lifestyles, which increase morbidity and mortality related to cardiovascular disease.    
The Impact of Chronic Exposure to Organophosphate Pesticides on the Incidence of Primary Brain Tumors in Farmers: A Narrative Review Purwandhono, Azham; Tartila, Jasmine; Firdaus, Jauhar
AKSONA Vol. 4 No. 1 (2024): JANUARY 2024
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/aksona.v4i1.51648

Abstract

Highlight: Primary brain tumors have high mortality and morbidity rates. Organophosphate pesticides are commonly used by farmers. Chronic exposure to organophosphate pesticides can increase the incidence of primary brain tumors farmers.   ABSTRACT Introduction: Primary brain tumors have high mortality and morbidity rates. Its causes and risk factors have not been explored further. Several studies indicate that exposure to pesticides can be one of the main triggering factors. Organophosphate insecticide is one of the most common pesticides used by farmers. Chronic exposure to organophosphates is known to trigger an imbalance of reactive oxygen species (ROS) in the body by suppressing the acetylcholinesterase enzyme. Objective: This study aimed to determine the impact of chronic exposure to organophosphates in terms of the types of organophosphates used by farmers, frequency of usage, and duration of exposure, using a narrative review method. Methods: A literature search was conducted with multiple electronic databases, such as PubMed, ScienceDirect, Cochrane Library, and Springer. The keywords will be searched using the boolean operator method, while synonyms will be found in the Medical Subject Heading (MeSH) database. Articles were assessed using the Newcastle-Ottawa Scale (NOS) Questionnaire. Results: There were 1071 articles found, but only 14 were selected for review. The studies showed that there was a relationship between the type, frequency, and duration of organophosphate usage and the incidence and risk factors for primary brain tumors. Conclusion: Chronic exposure to organophosphate pesticides, either directly or indirectly, can increase the incidence of primary brain tumors in farmers. The influencing factors include the type, frequency, and duration of pesticide exposure. The most influential factor is the duration of chronic pesticide exposure by farmers. Pesticide reduction exposure is beneficial in preventing the incidence of primary brain tumors in farmers.    
Refractory Hyponatremia due to Systemic Infection: A Systematic Review Inayah, Dinda Rifdayani; Priyanto, Bambang; Rohadi, Rohadi; Januarman, Januarman
AKSONA Vol. 4 No. 2 (2024): JULY 2024
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/aksona.v4i2.51685

Abstract

Highlight: Hyponatremia is a potentially life-threatening condition. Refracter hyponatremia can be seen in patients with systemic infection who have undergone therapy.   ABSTRACT Introduction: Hyponatremia is a condition in which the sodium serum level is below the normal range. This condition is most common in hospitalized patients receiving systemic infection therapy and can lead to worse outcomes, potentially life-threatening.Objective: This study aimed to summarize the incidence of refractory hyponatremia due to systemic infection therapy. Methods: This was a systematic literature search conducted in October 2023 on the online database PubMed regarding refractory hyponatremia due to systemic. The analysis excluded narrative reviews, non-English studies, and studies that only discussed transient hyponatremia or local infections. Results: A total of 10 case reports of 11 patients were included in the final analysis. The mean age of patients was 46.63 years (SD = 20.79 years), and 63.64% were male. Strongloides stercoralis hyperinfection was the most common cause of systemic infection (54%). It was followed by disseminated Varicella-zoster virus infection (28%), tuberculosis (9%), and systemic nocardiosis (9%). The most common cause of immune compromise is stem cell transplant recipients (28%), followed by miliary tuberculosis (18%). Up to 91% of cases are caused  by the syndrome of inappropriate antidiuretic hormone (SIADH), which is the pathophysiology of hyponatremia. Conclusion: Most patients with systemic infections and refractory hyponatremia have conditions that encourage immune compromise. The treatment of systemic infections is a priority since they contribute to hyponatremia.

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