cover
Contact Name
Paulus Sugianto
Contact Email
aksona@fk.unair.ac.id
Phone
+628989359888
Journal Mail Official
paulus.sugianto@fk.unair.ac.id
Editorial Address
Departemen Neurologi, Fakultas Kedokteran, Universitas Airlangga-RSUD Dr. Soetomo Surabaya, Jln. Mayjen Prof.Dr. Moestopo No 6-8, Airlangga, Gubeng, Surbaya
Location
Kota surabaya,
Jawa timur
INDONESIA
AKSONA
Published by Universitas Airlangga
ISSN : -     EISSN : 28077970     DOI : https://doi.org/10.20473/aksona.v2i1.170
Core Subject : Health, Science,
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.
Articles 92 Documents
Factor Associated with Orthostatic Hypotension in Parkinson’s Disease Marisdina, Selly; Nindela, Rini; Haddani, Muhammad Hasnawi; Minda Nur'aini; Ratnasari, Nurlia Puspita
AKSONA Vol. 5 No. 2 (2025): JULY 2025
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/aksona.v5i2.65006

Abstract

Highlight: Neurogenic orthostatic hypotension is commonly found in Parkinson’s disease (PD) and unnoticed by both patients and clinicians. Underweight has been associated to orthostatic hypotension in Parkinson’s disease, among other factors.   ABSTRACT Introduction: Orthostatic hypotension (OH) affect approximately 30% of patients with Parkinson's disease (PD). This condition not only reduces quality of life  but is also associated with increased mortality. OH has been shown to double the risk of falls in the elderly, worsens motor function, and  accelerate cognitive decline. There has been limited study into the prevalence and contributing factors of OH in Parkinson’s disease patients in Indonesia. Objective: This study aimed to determine factors associated with OH in patients with Parkinson’s disease. The variables analyzed included age, sex, duration of PD, disease stage based on the Hoehn and Yahr scale, levodopa equivalent dose (LED), the length of antiparkinsonian agents use, MoCA Ina (Montreal Cognitive Assessment Indonesian version) score, comorbid conditions, use of antihypertensive agents, and body mass index (BMI). Methods: This is a descriptive-analytic study with a cross-sectional design. The study population consisted of all Parkinson’s disease patients who visited the neurology polyclinics at  two hospitals in Palembang. Patients were selected based on specific inclusion and exclusion criteria. To discover associations, bivariate and multivariate analyses were performed. Results: The study involved 41 patients with PD at Mohammad Hoesin Hospital and Pusri Medika Hospital in Palembang, from June to December 2024. OH, was found in 43.9% of PD patients, most of whom reported symptoms. Bivariate and multivariate analyses revealed no significant associations between OH and factors such as comorbidities, the length of antiparkinsonian medication use, total LED, age, sex, duration of PD, disease stage (Hoehn and Yahr scale), and of the use of antihypertensive agents. However, underweight BMI was significantly associated with OH in PD patients (p = 0.002, OR = 34.571, 95% CI: 3.77–317.28). Conclusion:Underweight was identified as a significant associated factor for OH in PD patients.  
Factor Affecting Insomnia in Ischemic Stroke Patients Fajarini, Agustina; Mukhlisa, Mukhlisa; Handayani, Sri; Ramadhoni, Pinto Desti; Irfannuddin, Irfannuddin
AKSONA Vol. 5 No. 2 (2025): JULY 2025
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/aksona.v5i2.66533

Abstract

Highlight: Insomnia is prevalent in ischemic stroke patients and can hinder the recovery process. Stroke patients have a higher prevalence of insomnia and related symptoms than the general population.  This study found a complex relationship between physical, psychological, and social risk factors for insomnia following ischemic stroke.   ABSTRACT Introduction: Insomnia is common in ischemic stroke patients and can negatively impact on the post-stroke recovery process by interfering with the body's natural healing process, reducing the effectiveness of rehabilitation therapy, and affecting the recovery of cognitive function. Effective management and early intervention in  insomnia are needed to enhance health services for stroke patients, promote optimal recovery, and improve their quality of life. Objective: This study aimed to identify and analyze the various factors associated with the occurrence of insomnia among patients with ischemic stroke. Methods: This is a cross-sectional study that used secondary data from medical records and primary data gathered through questionnaire-based interviews. The subjects were 105 ischemic stroke patients at the Neurology Clinic of Dr. Mohammad Hoesin Hospital, Palembang, between May to July 2024. The data acquired for further analysis included social and demographic details, comorbid conditions, depression, anxiety, pain, insomnia, medication use, sleep hygiene, and stroke clinical features. The data was then analyzed using IBM SPSS Statistics 24 and assessed through bivariate and multivariate analyses to evaluate the relationships between variables. Results: The prevalence of insomnia in this study was 42.9%, with mild insomnia observed in 26.7%, moderate insomnia in 13.3%, and severe insomnia in 2.9% of the subjects. Obstructive sleep apnea (OSA) (OR: 22.718), sleep hygiene index (OR: 6.490), and education level (OR: 3.453) were identified as determinants related to insomnia in ischemic stroke patients. Indirect factors associated with insomnia in ischemic stroke patients include depression, the number of comorbid diseases, pain, diabetes, a history of insomnia, anxiety, and stroke onset. Conclusion: There is a complex relationship between various physical, psychological, and social factors and the incidence of insomnia after ischemic stroke.  
Cerebellar Purkinje Cells and GABA Neurotransmission in the Diabetic Rodent Models: A Systematic Review Kalanjati, Viskasari P; Mahdi, Rayhan B; Aditya, Dwi Martha Nur
AKSONA Vol. 5 No. 2 (2025): JULY 2025
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/aksona.v5i2.70359

Abstract

Highlight: Reduced cerebellar Purkinje cell numbers and altered dendritic trees due to cell deaths were reported in hyperglycemia.  In hyperglycemia, altered GABAergic neurotransmissions are due to lower GABA synthesis and its receptors expression levels in cerebellum. Impaired motor and cognitive functions were observed related to cerebellar Purkinje cell damage in a diabetic rat model.   ABSTRACT Introduction: Hyperglycemia-induced neurotoxicity has been linked to the cerebellum, specifically the impairment of Purkinje cells; its relation to GABA neurotransmission has yet to be cleared. Objective: We conducted an updated review on the mechanism of hyperglycemia-induced impairment of cerebellar Purkinje cells in a rodent diabetic model. Methods: A modified ScR-PRISMA flow diagram was applied as the screening tool. All English-language research articles published between 2014 and 2024 that containing the purposed topics and were indexed in PubMed and Medline were included. These articles were then critically appraised using the JBI checklist to minimize  potential bias. The final inclusion of 8 articles was included for analysis and discussion, together with additional retrieved articles. Results: Hyperglycemic-induced subjects demonstrated a marked reduction in Purkinje and granular cell populations, accompanied by several morphological impairments. Alterations were observed in GABAergic inhibitory neurotransmission, including receptors and GABA synthesis, compared to controls. These findings are consistent with observed deficits in motor coordination and cerebellar function. Conclusion: Hyperglycemia produces adverse effects on the function and survival of Purkinje cells in the cerebellum. Impaired GABAergic neurotransmission might result as parts of oxidative stress and inflammation induced by hyperglycemia in the cerebellar cells. Taken altogether, these results in motor impairment and cognitive dysfunction.
Carpal Tunnel Syndrome (CTS) at the Neurology Clinic of Dr. Soetomo General Academic Hospital Hegemur, Ratih Dewi Anggraini Jubair; Fidiana, Fidiana; Andriana, Meisy; Basuki, Mudjiani
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.v6i1.55031

Abstract

Highlight: CTS is a frequent peripheral neuropathy that causes a variety of debilitating symptoms, underscoring the importance of understanding its clinical characteristics for better diagnosis and treatment. The study conducted at the Neurology Clinic of Dr. Soetomo General Academic Hospital, Surabaya, highlights consistent patterns in CTS patient characteristics. This provides valuable insights into CTS demographics and symptoms, which may contribute to the development of effective management strategies.   ABSTRACT Introduction: Carpal Tunnel Syndrome (CTS) is a common neuropathy of the upper extremities, with a higher prevalence in women, particularly those aged 40 to 60 years. It is characterized by compression of the median nerve within the carpal tunnel, most frequently caused by hypertrophy of surrounding synovial tissue or inflammatory responses from extensive wrist use or trauma. Clinical symptoms include pain, tingling, numbness, and weakness, which often worsen at night. Diagnosis is typically based on clinical evaluation using the Phalen and Tinel tests, and is confirmed by electromyography (EMG) and nerve conduction studies (NCS). Recognizing CTS traits is essential for accurate diagnosis and appropriate management, which motivated this study. Objective: To describe the characteristics of patients with CTS treated at the Neurology Clinic of Dr. Soetomo General Academic Hospital, Surabaya. Methods: This is a descriptive cross-sectional study conducted using secondary data collected between January 2019 and December 2020. The study used electronic medical records (EMRs), comprising 44 CTS cases that met the predefined criteria. Data were processed using statistical software. Results: Among the 44 patients diagnosed with CTS, the majority were aged 45-64 years (63.7%), and were predominantly women (88.6%), with housewives comprising the largest occupational group (29.5%). Paresthesia was the most reported symptom (97.7%), and hypertension was the most common comorbidity (92.9%). All patients received non-operative therapy (100%). Conclusion: This study revealed that CTS predominantly affects early elderly individuals, particularly women and housewives, with paresthesia as the main symptom and hypertension as the common comorbidity. Non-operative treatment was the primary management strategy, yielding insights for future therapeutic strategies.
The Effect of Linezolid Therapy Duration on The Occurrence of Toxic Optic Neuropathy Sutantyo, Quinamora Estevan; Agustini, Lukisiari; Kusmiati, Tutik; Permatasari, Ariani
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.v6i1.67289

Abstract

Highlight: The occurence of toxic optic neuropathy in this study was similar to the occurence of anemia. Discontinuation of Linezolid therapy improves visual disturbance Linezolid therapy duration to cause TON in this study varies   ABSTRACT Introduction: Linezolid is recommended by the World Health Organization (WHO) for the treatment of drug-resistant tuberculosis (DR-TB) because it improves treatment outcomes and therapy success. However, linezolid has several serious side effects, such as toxic optic neuropathy (TON). Previous studies have shown that various therapy durations are associated with the development of  TON, and the duration gap between linezolid exposure and TON occurrence remains inconclusive. Consequently, it is still unknown whether therapy duration affects the occurrence of TON. Objective: To identify the effect of linezolid therapy duration on the occurrence of TON among patients treated at the tuberculosis clinics of Dr. Soetomo General Academic Hospital, Surabaya, during the period from January 2020 to July 2021. Methods: This retrospective cohort study used data obtained from medical records, funduscopy examinations, Humphrey Field Analyser (HFA), and Optical Coherence Tomography (OCT). Results: A total of  30 subjects were included in this study, with a predominance of male patients (53.3% vs. 46.7%) and a mean age of 40.7 years. The most frequently administered dose of linezolid was 600 mg (n = 24), followed by 450 mg (n = 4), and 300 mg (n = 2). The majority of subjects (90%) received linezolid therapy for ≥6 months. TON occurred in 6 subjects, receiving 450 mg (n = 1) and 600 mg (n = 5). Visual symptoms improved following therapy termination.  The mean duration of linezolid to induce TON was 8.8 ± 1.5 months. Fisher’s exact test showed no significant association between linezolid therapy duration and TON (p-value = 1.000). Conclusion: Although all subjects who experienced TON had received linezolid therapy for ≥6 months, statistical analysis found no significant association between linezolid duration and the occurrence of TON.
An Analysis of Chronotype and Cognitive Function in Pre-Clinical Medical Students at Universitas Airlangga Prayogo, Hana Evangelin; Islamiyah, Wardah Rahmatul; Irwadi, Irfiansyah; Setyowatie, Sita
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.v6i1.70271

Abstract

Highlight: The intermediate chronotype was most common among 2020-2021 medical students at Universitas Airlangga, followed by the morning type and the evening type No significant differences in TMT A, TMT B, or PVT scores were observed among the morning, intermediate, and evening chronotypes. Chronotype showed no significant relationship with cognitive outcomes, likely because medical students adapt to rigorous demands requiring sustained focus throughout the day.   ABSTRACT Introduction: Chronotype refers to an individual’s predisposition to engage in activities at specific times of the day. Numerous studies have explored the relationship between chronotype and cognitive function, yet the findings vary across different populations. Objective: This study aimed to identify chronotypes among medical students at Universitas Airlangga and to assess differences in cognitive function and attentional performance between these chronotypes. Methods: We selected participants using a stratified random sampling technique, focusing on cognitive function, attention, and chronotype. Those who met the inclusion criteria provided informed consent and completed the Morningness-Eveningness Questionnaire to determine their chronotype. A total of 65 participants completed the questionnaire and then underwent Trail Making Tests (TMT) A and B at times tailored to their chronotypes: 08:00-10:00 for morning types, 16:00-18:00 for evening types, and 12:00-13:00 for intermediate types. The Psychomotor Vigilance Test (PVT) was uniformly administered between 08:00-10:00. Data were collected and analyzed using Kruskal-Wallis and one-way ANOVA. Results: Of the 65 participants, 18 were identified as morning types, 42 as intermediate types, and 5 as evening types. No significant differences were observed in TMT A or B performance (p > 0.05). Similarly, the PVT results, which assessed lapses, false starts, and average reaction time, showed no significant differences among the three chronotypes (p > 0.05). Conclusion: The intermediate chronotype was the most prevalent among medical students at Universitas Airlangga, followed by morning and evening types. No significant differences were observes in TMT and PVT outcomes across the chronotypes.
Dementia Mimicking Presentation in Normopressure Hydrocephalus: A Case Report Susianti, Noor Alia; Nathania, Caroline Evanthe; Prodjohardjono, Astuti; Gofir, Abdul; Setyaningsih, Indarwati; Setyaningrum, Cempaka Thursina Srie; Sutarni, Sri; Putri, Vega Pratiwi
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.v6i1.70306

Abstract

Highlight: Normal pressure hydrocephalus (NPH) is characterized by gait apraxia, urinary incontinence, ventriculomegaly, and cognitive impairment that mimics dementia, potentially leading to misdiagnosis. Comprehensive assessment, including clinical examination, brain imaging, and CSF testing, is critical for distinguishing NPH from dementia. Early and prompt diagnosis and treatment of NPH are crucial for improving long-term outcomes.   ABSTRACT Introduction: Normal Pressure Hydrocephalus (NPH) can occur following Traumatic Brain Injury (TBI). It is characterized by ventricular enlargement and presents with a classic triad: gait apraxia, urinary incontinence, and cognitive impairment. Cognitive impairment in NPH often overlaps with other neurocognitive disorders, such as dementia, which frequently leads to misdiagnosis. Case: A 59-year-old man presented with progressive memory decline, bladder incontinence, and gait apraxia following a head trauma. A CT scan performed after the head trauma revealed an intracerebral hemorrhage in the right thalamus. One year later, the patient complained of gait disturbance, as well as urinary and fecal incontinence. His general examination was normal, but the neurological examination showed the presence of a primitive reflex, specifically, the glabellar sign—and the patient exhibited a gait apraxia, poor spontaneity, and slowed speech. Neurobehavioral assessment showed attention and orientation disturbances, sensory cortical aphasia, and dementia syndrome. A follow-up CT scan revealed cerebral atrophy with ventriculomegaly ex vacuo with cerebrospinal fluid leakage. The patient subsequently underwent ventriculoperitoneal shunt therapy, and the cognitive assessment score showed improvement after the procedure. Conclusion: Diagnosing an NPH remains challenging due to the overlap of its cognitive impairment symptoms with other neurocognitive disorders. Furthermore, the treatment response varies widely, posing a further obstacle for clinicians to effectively manage NPH patients. Although early and prompt diagnosis is crucial for successful therapy, it continues to pose a significant challenge for clinicians.
Clinical Improvement in Autism Spectrum Disorder Symptoms Following Hyperbaric Oxygen as Adjuvant Therapy in a 12-Year-Old Boy Untari, Ni Komang Sri Dewi; Nugraheni, Pramita Anindya; Agustin, Renny; Oktavia, Reza Mardiana Ayu; Rantika, Rheina Hasna; Hadi, Rifqi Athaya Vinanta; Utami, Rina Mega; Adiwinoto, Ronald Pratama
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.v6i1.70643

Abstract

Highlight: The potential role of hyperbaric oxygen therapy (HBO) as an adjunctive treatment for autism spectrum disorder (ASD), demonstrating significant improvements in clinical symptoms. By exploring the plausible mechanisms of HBO, the manuscript underscores the importance of further research and clinical trials to validate its efficacy and safety in the ASD population. This study adds to the literature advocating for innovative therapeutic strategies that address the complex interplay of oxidative stress, neuroinflammation, and mitochondrial dysfunction, inviting a personalized treatment approach.   ABSTRACT Introduction:  Autism spectrum disorder (ASD) is a multifaceted neurodevelopmental condition influenced by both genetic predispositions and environmental factors. Its underlying pathophysiology commonly involves oxidative stress, impaired cerebral perfusion, neuroinflammation, immune dysregulation, and mitochondrial dysfunction. Although conventional interventions, such as applied behavior analysis (ABA), are commonly employed, they may yield limited progress for some individuals. Consequently, emerging interventions, such as hyperbaric oxygen therapy (HBO), show promise for enhancing neurological outcomes and warrant further exploration. HBO, a well-established treatment for decompression sickness, is currently being investigated for its potential benefits in various neurological disorders, including ASD. Case: We present a case of ASD in a 12-year-old boy characterized by minimal eye contact, limited expressive language, and restricted, repetitive behaviors. On neurological examination, the patient was alert and capable of spontaneous eye opening, vocalizing incomprehensible words, and, at times, responding to simple commands. Despite undergoing ABA therapy, the patient exhibited limited developmental progress. The patient was subsequently undergoing hyperbaric oxygen therapy (HBO) at 1.3 ATA for 60 minutes for 10 days. Following the completion of HBO therapy, there was a decline in the CARS score from 41.5 (severe) to 29 (mild), the ATEC score from 115 to 68, the platelet count (51,000 / μL), and interleukin-1β levels (181.4 pg/mL). Conclusion: This case highlights the potential of HBO therapy as an adjunctive treatment modality for ASD, offering significant symptomatic improvements in a patient for whom traditional therapies were insufficient. The presumed mechanisms underlying these effects include anti-inflammatory effects and enhanced cerebral oxygen delivery, which may facilitate neuronal recovery and function. Given these findings, further research and clinical trials are warranted to confirm the therapeutic efficacy, long-term benefits, and safety profile of HBO therapy.
Atypical Presentation of Rheumatic Fever: Isolated Hemichorea with Subclinical Carditis and No Joint Involvement Pikatan, Orlando; Putri, Dian Kusumastuti Anggraeni; Trisnawati, Sri Yenni; Widyantara, I Wayan; Lavenia, I Gusti Agung Ayu Gita
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.v6i1.71139

Abstract

Highlight: The clinical manifestation of the Sydenham chorea The mechanism of hemichorea in Sydenham chorea involves the antigen found throughout the body.   ABSTRACT Introduction: Rheumatic fever (RF) is an autoimmune inflammatory disease that develops as a complication of a previous infection with group A beta-hemolytic Streptococcus (GABHS), typically following episodes of tonsillopharyngitis. Although its prevalence has decreased due to advances in medical treatment and improved living conditions, RF remains a major health issue in developing countries. Sydenham chorea (SC) is a well-known neurological complication of RF, which occasionally presents as hemichorea, a rare condition affecting only one side of the body. Therefore, early identification is important for initiating treatment promptly and preventing further complications.  Case: A 12-year-old boy presented with involuntary, dance-like movements on the left side, following a fever. Laboratory tests showed elevated inflammatory markers and ASTO titers, suggesting a prior streptococcal infection. Imaging revealed left-sided pneumonia. Brain scans were normal, but echocardiography revealed mild mitral regurgitation, indicating subclinical carditis. The patient was diagnosed with RF complicated by hemichorea and was subsequently treated with benzathine penicillin, ceftriaxone, haloperidol, and valproic acid. Increasing the valproic acid dosage effectively resolved the symptoms. Conclusion: Rheumatic fever should be considered in children presenting with hemichorea, even in the absence of joint involvement or overt cardiac symptoms. Early diagnosis, adherence to the 2015 revised Jones criteria, and long-term antibiotic prophylaxis are crucial to prevent disease recurrence and complications.
Survival Rate of Patients with Glioblastoma Treated with Radiotherapy and Temozolomide Compared to Radiotherapy Alone: A Comprehensive Systematic Review and Meta-Analysis Billy, Billy; Christoper, Andreas; Sembiring, Indri Meiya; Donny, Donny; Risfandi, Marsal
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.v6i1.71425

Abstract

Highlight: Glioblastoma is the most prevalent and deadly primary malignant brain tumor. The prognosis for glioblastoma remains unfavorable because of detrimental prognostic factors. Appropriate and advanced treatment can help in improving the survival rate of patients with glioblastoma.   ABSTRACT Introduction: Glioblastoma is one of the deadly malignant brain tumor associated with a highly unfavorable prognosis, making it one of the significant challenge for clinicas due to its unfavorable poor prognostic. Patients with glioblastomas may experience headaches, nausea, vomiting, loss of consciousness, seizure/convulsion, altered mental status, and focal neurological deficits. Chemotherapy, radiation, and surgical resection became standar therapeutic options for patient with glioblastoma. This advanced treatment is important for increasing the survival rate of patients. Objective: This study aimed to evaluate survival outcomes in patients with glioblastoma treated with temozolomide plus radiotherapy compared with radiotherapy alone Methods: This study followed PRISMA guidelines and used the PICO framework. The inclusion criteria encompassed a range of study designs, including randomized controlled trials (RCTs), quasi-experimental, observational, and case-control studies, that evaluated survival outcomes in glioblastoma patients treated with radiotherapy plus 6 cycles of adjuvant temozolomide versus radiotherapy alone. Exclusion criteria eliminated studies that were  not relevant to the comparative treatment approach. Results: Following three stages of screening, six articles that were directly relevant to the systematic review were selected for full-text analysis. Overall, radiotherapy plus temozolomide had better outcomes than radiotherapy alone. Median overall survival (OS) ranged from 10 to 17.5 months in patients with radiotherapy plus temozolomide, compared with 8 to 14 months in those treated with radiotherapy alone. Median progression-free survival (PFS) ranged from 6 to 10.1 months in patients with radiotherapy plus temozolomide, and 3.8 treated with radiotherapy alone. Conclusion: Diagnosing NPH remains challenging due to the overlap of its cognitive impairment symptoms with other neurocognitive disorders. Furthermore treatment response vary widely, makin it difficult for clinicians to effectively manage NPH patients. Although early and prompt diagnosis is crucial for successful therapy, clinician still face significant challenge.

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