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Magna Neurologica
Published by Universitas Sebelas Maret
ISSN : 29636027     EISSN : 29853729     DOI : https://doi.org/10.20961/magnaneurologica.v1i2.647
Core Subject : Health, Science,
Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health
Magna Neurologica is a peer-reviewed and open access journal that focuses on promoting neurological sciences generated from basic neurosciences and clinical neurology. This journal publishes original articles, reviews, and also interesting case reports. Brief communications containing short features of medicine, latest developments in diagnostic procedures of neurology disease, treatment, or other health issues related to neurology that is important also acceptable. Letters and commentaries of our published articles are welcomed.
Arjuna Subject : Kedokteran - Neurologi Klinis
Articles 52 Documents
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Characteristics of Ocular Fundusin Brain Infections at Cipto Mangunkusumo Hospital Jakarta Purba, Maria Jheny Fulgensia; Pradita Sari; Septiana Andri Wardana; Ni Nengah Rida Ariarini; Kartika Maharani; Darma Imran; Riwanti Estiasari
Magna Neurologica Vol. 1 No. 2 (2023): July
Publisher : Department of Neurology Faculty of Medicine Universitas Sebelas Maret

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/magnaneurologica.v1i2.716

Abstract

Background: Brain infections (BI) may cause optic nerve abnormalities. Awareness on optic nerve abnormalities will be useful in assisting further management. The characteristics of the ocular fundus (fundus) in BI have not been widely studied in Indonesia. Objective: This study aimed to apprehend the depiction of the fundus in BI in Cipto Mangunkusumo Hospital Jakarta (RSCM). Methods: Cross-sectional study was conducted on October-December 2021 at RSCM. Inclusion criteria: BI patients who had fundas results. Exclusion criteria: fundas results cannot be interpreted. Images from 20D-lens fundoscopy were captured with a digital camera. Captured images were then interpreted by three examiners in disguise. Results are analyzed if there are similarities between at least two examiners. Results: Among 49 subjects, 25 had normal fundus. Abnormalities were found in 8 subjects: 4 (12.1%) papilledema, 3 (9.1%) papillatrophy, and 1 (3%) retinal hemorrhage. The highest mean aperture pressure was in the papillatrophy group (37 cmH2O), followed by papilledema (27 cmH2O). Cryptococcal meningitis caused papilledema in 60% of cases. Of BI cases with mortality, 80% were tuberculous meningitis with normal fundus. BI can increase ICP, but only 12.1% had papilledema. Papillatrophy indicated prolonged ICP elevation. The highest mortality was in the normal fundus group, suggesting papilledema alone is not a definitive predictor of poor prognosis due to confounding factors. Conclusion: Although BI causes an increase in ICP, papilledema is not always found. High aperture pressure was found in the papillatrophy group, but the highest mortality was found in the normal fundus group.
The Effect of Levofloxacin Addition on the Outcome of Tuberculous Meningitis Patients: A Systematic Review and Meta-analysis Damastiwi, Lorisna Hardiknastia; Hidayat, Saiful; Sembiring, Paulus Stephen Pulung Aditya Nugraha
Magna Neurologica Vol. 2 No. 1 (2024): January
Publisher : Department of Neurology Faculty of Medicine Universitas Sebelas Maret

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/magnaneurologica.v2i1.890

Abstract

Background: Tuberculous meningitis (TBM) is one of tuberculosis's deadliest extra-pulmonary manifestations. Although early initiation of anti-tuberculosis drugs can reduce mortality and morbidity, poor blood-brain barrier penetration hampered their effectiveness. Levofloxacin is an anti-tuberculosis drug with good BBB penetration. Objective: We aim to explore whether levofloxacin addition to the TBM patients’ regimen has a potential benefit to improve their outcomes. Methods: The literature search was done on PubMed, Google Scholar, and ProQuest databases without publication date limits to identify studies investigating the effect of augmenting levofloxacin in the outcome of TBM patients. The primary outcome of this study was to analyze the impact of these regimens in decreasing the risk of death and neurological deficit. The articles were collected using the PRISMA diagram, critically appraised using PICO analysis, then the data were analyzed using Review Manager 5.4.1 software with a Fixed Effect Model. The results were expressed as odds ratio (OR). Results: Four randomized controlled trials with a total of 930 patients were identified. Two trials compared the effectiveness of levofloxacin addition only, whereas the other two used the regimen containing the increased dose of rifampicin alongside levofloxacin addition. Based on the analysis, neither levofloxacin addition only nor increasing rifampicin dose with levofloxacin addition had a significant impact on the mortality of TBM patients (OR=0.55; 95% CI 0.19-1.59; p=0.27, OR=1.01; 95% CI 0.74-1.36; p=0.97, respectively). Conclusion: Additional Levofloxacin on TBM treatment shows no significant improvement in patient mortality. Routine levofloxacin use in TBM is discouraged due to limited evidence.
Acquired Ptosis in Patient with Suspect Meningiomatosis Fahmi, Moch.; Widhianingsih, Nella Lusti
Magna Neurologica Vol. 2 No. 2 (2024): July
Publisher : Department of Neurology Faculty of Medicine Universitas Sebelas Maret

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/magnaneurologica.v2i2.893

Abstract

Background: Ptosis is abnormally low positioned upper eyelid. It can be classified as congenital and acquired. Meningiomas are mostly benign tumors originating from meningothelial (arachnoid) cells (MECs). A subset of meningioma patients bears two or more spatially separated synchronous or metachronous tumors termed “Multiple Meningiomas” (MM) or meningiomatosis. Case: A 51-year-old female complained the dizziness was associated with nausea and emetic episodes. She reported any blurred vision and woke up with the dropped eyelid. Prior to this she had double vision and light headedness that she had 3 months before. The ophthalmic examination presented partial left ptosis and the patient's left eye was shifted towards the lateral edge at rest. CT scan with contrast presented multiple solid masses, extra axial, homogeneous, strong contrast enhancement with calvaria hyperostosis and perifocal edema in the left frontal region and left temporoparietal region. Discussion: Ptosis in the left eye and exotropia is consistent with a left oculomotor nerve palsy. CT scan with contrast confirmed multiple solid masses leaning towards meningiomatosis. In this case, patient-acquired ptosis could be caused by direct oculomotor compression of the frontal lobe tumor, the tumor site being close to the superior orbital fissure. Conclusion: Stemming from third cranial nerve dysfunction, multiple solid masses in the left frontal region indicate meningiomatosis. Acquired ptosis may result from direct compression of the oculomotor nerve by the frontal lobe tumor. While surgery is the primary treatment for meningiomas, corticosteroids may be considered in acute conditions to alleviate perifocal edema.
Patient with Foreign Accent Syndrome in Post Infarct Thrombotic Stroke: A Case Report Tiffany, Firstiafina; Ristinawati, Ira; Nur Hanifa, Shafira
Magna Neurologica Vol. 2 No. 1 (2024): January
Publisher : Department of Neurology Faculty of Medicine Universitas Sebelas Maret

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/magnaneurologica.v2i1.894

Abstract

Background: Stroke is the second leading cause of death in the world and is the leading cause of disability worldwide. One of the disabilities is language disorder. Foreign Accent Syndrome (FAS) is a clinical condition associated with a noticeable change of accent, that could affect verbal communication and social interaction skills. By identifying this case earlier, we hope that the patient’s activity daily living is less disrupted. Case: A 54-year-old woman presented with right limb weakness and tingling, along with a change in speech accent from Javanese to Madurese, despite no prior exposure to Madurese. Neurobehavioral examination revealed language and memory disturbances, and MRI showed cerebral infarction in the bilateral hippocampi, small vessel ischemia in the bilateral frontal lobes, and corona radiata. Discussion: The accent change, known as FAS that was experienced by the patients are thought to be due to neurological causes, which was stoke. In a study using a lesion network mapping approach concluded that the lesion causing accent disorder was located within a single network in the bilateral frontal lobe. In line with the existing theory, the MRI results in this patient showed ischemia in the blood vessels of the bilateral frontal lobes. Conclusion: Clinical symtoms related to stroke depending on the location of the lesion. The accent change in this patient, known as Foreign Accent Syndrome (FAS), is believed to be caused by stroke affecting the bilateral frontal lobes. Early recognition of FAS can help reduce disruptions in communication and social interactions.
Cerebral Proliferative Angiopathy as the Cause of Symptomatic Epilepsy in a Young Adult Male: A First Case Report from Indonesia Swatan, Jovian Philip; Sani, Achmad Firdaus; Islamiyah, Wardah Rahmatul; Kurniawan, Dedy; Fatimah, Ersifa
Magna Neurologica Vol. 2 No. 1 (2024): January
Publisher : Department of Neurology Faculty of Medicine Universitas Sebelas Maret

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/magnaneurologica.v2i1.895

Abstract

Background: Cerebral proliferative angiopathy (CPA) is a rare and distinct vascular malformation that was once considered a subset of cerebral arteriovenous malformation (AVM). Due to its relatively benign course with no distinctive clinical feature, CPA may often be overlooked and misdiagnosed with other diseases. We would like to report a case of CPA as the underlying cause of symptomatic epilepsy. Case: A 31-year-old male presented to the outpatient clinic with a history of focal to bilateral tonic-clonic seizure for 2 years. Following conservative management with an oral antiepileptic agent, the seizure frequency significantly decreased from once daily to once or twice monthly. The patient was lost to follow-up; however, he was incidentally referred back to our clinic two years later for further evaluation. A head Magnetic Resonance Imaging and Magnetic Resonance Angiography revealed a suspicion of giant AVM in the left hemisphere. Cerebral digital subtraction angiography (DSA) was performed and revealed a CPA in the left frontal area. The patient was managed conservatively, and during the 6-month follow-up period, the patient did not have any seizures. Discussion: In young adults, seizures may be caused by an underlying vascular abnormality. Cerebral DSA remained the gold standard for distinguishing various etiologies of vascular malformation, including CPA. Conclusion: Conservative treatment using oral antiepileptic agents was effective in controlling the seizure frequency in CPA. However, a complete diagnostic evaluation is still warranted to determine the most appropriate treatment while revealing some peculiar and unexpected etiologies in the process.
A Life-Threatening Neurotoxicity in Bungarus Candidus Snake Bite: A Case Report Putra, Zaki Rusmana; Anthoni, Togar; Budiharto, Chris Eko
Magna Neurologica Vol. 2 No. 1 (2024): January
Publisher : Department of Neurology Faculty of Medicine Universitas Sebelas Maret

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/magnaneurologica.v2i1.903

Abstract

Background: Bungarus Candidus is a snake that induces severe neurotoxic symptoms. Case: A 31-year-old female came to the emergency department with complaints of pain in the whole body, limb weakness, shortness of breath, and epigastric pain after being bitten by a snake. Neurological examination, ptosis of both eyelids was found with normal movement of the eyeballs. Muscle strength in all extremities is 4, followed by decreased physiological reflexes. There are fang marks in the form of 2 slightly swollen and reddened black dots on the left foot. During observation, the patient had decreased consciousness and severe shortness of breath with desaturation without any signs of shock. Other clinical revealed bilateral dilated pupils, dysphonia, dysarthria, and muscle strength that was difficult to assess. The patient was intubated and subsequently admitted to the ICU. The patient regained consciousness but still had difficulty opening his eyes and weak muscle strength on the 2nd of ICU. The patient's condition improved on the 5th of ICU, extubating was performed and transferred to the non-ICU. The treatment obtained included 17 vials of SABU, analgesics, antibiotics, anticholinesterase, and anticholinergic. The patient was discharged after 11 days of hospitalization. Discussion: The neurotoxicity of snake venom is related to mechanisms of neuromuscular transmission blockade, pre-synaptic and post-synaptic. Bungarus Candidus has a peculiar type of toxin, candoxin, that inhibits nicotinic acetylcholine receptors at the postsynaptic site. Conclusion: Prompt recognition of symptoms and management interventions in snakebite cases are critical to patient outcomes and survival.
The Correlation Between the Number of Vascular Risk Factors and The Onset of Hemodialysis with Cognitive Impairement in Chronic Kidney Disease (CKD) Patients Utami, Priyanka Ganesa; Sundawiyani, Wiwin
Magna Neurologica Vol. 2 No. 1 (2024): January
Publisher : Department of Neurology Faculty of Medicine Universitas Sebelas Maret

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/magnaneurologica.v2i1.904

Abstract

Background: Cognitive impairment is a common disorder in patients with chronic kidney disease (CKD). At least, 50% of CKD patients experience impaired cognitive function caused by ischemia associated with impaired vascular function. In addition, significant changes during the dialysis process such as loss of water and ultrafiltration will disrupt the blood supply to the brain and exacerbate ischemia that underlies the incidence of impaired cognitive function. Objective: Analyze the correlation between vascular risk factors, dialysis onset, and cognitive impairment in CKD patients. Methods: This analytic observational study sampled CKD patients on hemodialysis between February-July 2023, using purposive sampling. Inclusion and exclusion criteria were applied, and cognitive function was assessed using MOCA-INA. Spearman's rho statistical analysis was employed at a 95% confidence level (p <0.05). Results: The results of correlation test using Spearman Rho showed patients undergoing hemodialysis for more than 5 years had a correlation with impaired cognitive function, P=0.02. Cognitive domains that are most affected sequentially are memory/delayed recall, visuospatial, abstraction, language, attention and naming. While the number of vascular risk factors did not have a correlation with cognitive impairment with P=1.38. Conclusion: CKD patients on hemodialysis for more than 5 years show a correlation with impaired cognitive function, primarily affecting memory/delayed recall, visuospatial, abstraction, language, attention, and naming. Vascular risk factors, however, exhibit no correlation with cognitive impairment.
Diabetes Mellitus and Hypertension are Associated with Bell's Palsy Romadhoni; Herianti, Silva Optalmi; Yekti, Murwani; Khamsiyati, Siti Istiqomah
Magna Neurologica Vol. 2 No. 1 (2024): January
Publisher : Department of Neurology Faculty of Medicine Universitas Sebelas Maret

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/magnaneurologica.v2i1.908

Abstract

Background: Bell's palsy occurs in approximately 40-70% of all cases of acute peripheral facial nerve paralysis, and its cause is unknown. Bell's palsy has several risk factors, including diabetes mellitus and hypertension. Objective: This study aims to identify the association between diabetes mellitus and hypertension with the occurrence of Bell's palsy. Methods: This research was conducted at RSUD Tugurejo Semarang in March 2022 using a retrospective study design and purposive sampling technique. Data collected included the history of diabetes mellitus, hypertension, and the occurrence of Bell's palsy. Medical records were used as research instruments. Hypothesis testing was performed using the Fischer exact test. Results: A total of 32 samples were included in this study. There were 11 patients (34.4%) with a history of diabetes mellitus, 21 patients (65.6%) with a history of hypertension, 11 patients experienced acute Bell's palsy (34.4%), and 21 patients had subacute Bell's palsy (65.6%). The statistical analysis showed a significant association between diabetes mellitus (p=0.017) and hypertension (p=0.033) with the occurrence of Bell's palsy. Conclusion: This study reveals a significant correlation between diabetes mellitus and hypertension and the occurrence of Bell's palsy. Several studies also suggest that hypertension is linked to a poorer prognosis in patients with comorbidities and facial paralysis in Bell's palsy. However, there are also studies stating that age and gender are associated with the occurrence of Bell's palsy independently of diabetes and hypertension.
A 21-Years-Old Man with Mesial Temporal Lobe Epilepsy and Dystonia: A Rare Case Report Putri, Puspita Sari Sugiyarto; Mirawati, Diah Kurnia; Hutabarat, Ervina Arta Jayanti
Magna Neurologica Vol. 2 No. 2 (2024): July
Publisher : Department of Neurology Faculty of Medicine Universitas Sebelas Maret

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/magnaneurologica.v2i2.934

Abstract

Background: Mesial temporal lobe epilepsy (MTLE) with dystonia is a rare case. Seizures and movement disorders have almost the same phenomenology, so it is often difficult to distinguish them. In this study, we report a unique case of MTLE and co-occurring dystonia. Case: A 21 years old male with complaints of seizures since 4 years ago. Seizures of one body jerking and drooling with a duration of less than 5 minutes. Prior to the seizure the patient was nauseous then vomited and followed by an empty mind, after the seizure the patient was confused. The patient also complained of unconscious movements in his right hand since 8 years ago. The movements disappeared when the patient slept. Physical examination revealed dystonic movement with a sensory trick on the right hand. Magnetic resonance imaging (MRI) of the brain with contrast showed bilateral hippocampal atrophy accompanied by left hippocampal sclerosis. Blood laboratory results, electroencephalography, and neurobehavior examination were within normal limits.. Discussion: MTLE can be caused by mutations in SCN1A, VPS13A, C90RF72, or TDP 43. Dystonia can be caused by mutations in SCN1A, TUBB4A, TOR1A, THAP1, or GNAL. SCN1A causes an increase in sodium influx, causing depolarization which causes clinical manifestations in the form of seizures and dystonia. For some disorders, although genetic causes have been identified, the molecular pathophysiology remains largely unknown, requiring further research. Conclusion: For some disorders, although genetic causes have been identified, the molecular pathophysiology remains largely unknown, requiring further research.
Efficacy of Repetitive Transcranial Magnetic Stimulation (r-TMS) Therapy on Improving Motor Strength in Stroke Patients at Dr. Moewardi Surakarta Revianto, Ari; Hambarsari, Yetty
Magna Neurologica Vol. 2 No. 1 (2024): January
Publisher : Department of Neurology Faculty of Medicine Universitas Sebelas Maret

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/magnaneurologica.v2i1.940

Abstract

Background: Stroke, an acute neurological dysfunction, poses a health challenge with a potential fatality, emerging as a leading cause of long-term disability. This study explores the efficacy of repetitive transcranial magnetic stimulation (r-TMS) with medical rehabilitation in enhancing stroke patients' motor strength, comparing it with standard therapy and focusing on the Medical Research Council score. Objective: Stroke is an acute manifestation resulting from neurological dysfunction, persisting for ≥24 hours or leading to death due to blood vessel disorders. The study aims to determine the effectiveness of r-TMS therapy in improving stroke patients' motor strength, comparing it with standard therapy based on the Medical Research Council score. Methods: A quasi-experimental study with a pre-post control group design involved 30 respondents selected through consecutive sampling in stroke units and outpatient clinics. Upper extremity muscle strength, measured with the Medical Research Council score, was analyzed using the Mann-Whitney U test, with a significance level set at p < 0.05. Results: The post-test ranking value of the r-TMS group (20.56) exceeded that of the Non r-TMS group (10.46). The Mann-Whitney U test indicated a significant difference in the average ranking of the Medical Research Council scores between the two groups (p < 0.05, 0.001), highlighting the efficacy of r-TMS therapy in enhancing motor strength. Conclusion: This study shows that stroke patients receiving standard therapy and transcranial magnetic stimulation exhibit improvements in extremity motor strength compared to those undergoing medical rehabilitation alone. The r-TMS group notably showed a significant increase in extremity motor strength.

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