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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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A Woman with Dyke-Davidoff-Masson Syndrome: A Case Report Rahayu, Fitriani Tri; Hexanto Muhartomo; Kurnianto, Aditya; Puspita Wati, Arinta
Magna Neurologica Vol. 3 No. 2 (2025): 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.v3i2.1689

Abstract

Introduction: Dyke-Davidoff-Masson Syndrome (DDMS) is a rare neurologic condition associated with drug-resistant epilepsy (DRE). Almost 100 DDMS cases were reported, and only 21 were reported among adults. This case report presented Dyke-Davidoff-Masson Syndrome in a 30-year-old woman.  Case: A 30-year-old woman presented with generalized tonic-clonic seizures the day before admission. Each seizure lasted 5 minutes and reoccurred up to three times daily. She communicated but was slow in answering questions post-seizure. Neurological examination revealed left hemiparesis and contracture. Electroencephalography showed diffuse abnormalities. Brain magnetic resonance imaging (MRI) revealed DDMS with crossed cerebellar atrophy. Although anticonvulsant treatment controlled seizures, motor impairments like hemiparesis and joint contractures persisted since childhood. Discussion: DDMS is a cerebral palsy-related condition resulting from an injury associated with calvarium immaturity or childhood brain damage. Prenatal and post-natal injury may be the etiologic factors of DDMS. The clinical features of DDMS are cerebral hemiatrophy or hypoplasia, facial asymmetry, seizure, and contralateral hemiplegia with diverse combinations and severity. Specifically, in this case, the MRI showed right-sided brain atrophy, enlarged right lateral ventricle, and crossed cerebellar atrophy, all consistent with DDMS. Compensatory changes in the right skull, like thickened bones and enlarged frontal sinus, were also observed​. Symptomatic management is the mainstay of DDMS treatment, one of which is antiepileptic medication. Surgery is indicated as the last therapeutic option in some instances. Conclusion: DDMS cases in adults are rare. At present, there is no management algorithm for DDMS. Thorough history taking and physical and radiology examinations are required for DDMS diagnosis.
A Case Report: Prevost’s as Early Sign of Subcortical Symptom to be Considered or Screening in Acute Ischemic Stroke Febriana, Fitria; Selohandono, Andrianto; Utomo, Yudhanto
Magna Neurologica Vol. 3 No. 2 (2025): 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.v3i2.0071

Abstract

Background: Stroke is the leading cause of death and disability. Stroke symptoms depend on the location of the lesion, whether cortical or subcortical (white matter, basal ganglia, or thalamus). Prevost's sign or horizontal conjugate eye deviation (CED) must be considered an early motoric sign of ischemic stroke. Case: Mrs. F, 61 years old, came to the ER complaining of headache and dizziness for a day without any complaints about her eyes, and had a history of diabetes mellitus. Neurological examination revealed conjugate eye deviation to the right side without other neurological deficits. A head CT scan showed a minimal infarction of the left putamen and an old minimal infarction of the right corona radiata. Discussion: Pathophysiologic mechanism of Prevost’s sign due to cerebral-mesencephalic-phonto-cerebellar pathway disorder and related to cranial nerves III and VI. The putamen is a nuclear structure part of the basal ganglia involved in that pathway. A provost's sign that appears in less than 90 days can be used for stroke screening for ischemic patients. Previous studies describe CED >140 as being identified as ischemic stroke. Patients with strabismus have an average of CED 14.20. Another retrospective study in 543 acute ischemic strokes showed that CED had a higher specificity value (0.78; 95% CI) than hemiparesis (0.35; 95% CI). The sensitivity values were 0.76 and 0.85 (95% CI). Conclusion: Prevost's sign is one of the signs of motor deficit in acute cerebral infarction. It needs to be considered as a subcortical lesion in stroke patients.
Automated Prediction of Large Vessel Occlusion Using Artificial Intelligence in Non-Contrast Computed Tomography: A Systematic Review and Meta-Analysis Umam, Hamid Faqih; Mustofa, Aila; David Noor Umam; Shabrina Nur Zidny; Dyah Pranani; Retnaningsih
Magna Neurologica Vol. 3 No. 2 (2025): 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.v3i2.1704

Abstract

Background: Acute ischemic stroke due to large vessel occlusion (LVO) requires rapid identification. Reducing the time to diagnosis and treatment of stroke patients is an important goal to improve clinical outcomes. Non-contrast computed tomography (NCCT) is widely used in clinical practice for suspected stroke patients. Automated analysis using artificial intelligence in NCCT may be a solution to accelerate the early detection of LVO. Objective: To determine the accuracy of artificial intelligence in NCCT to predict LVO. Methods: A systematic literature search was conducted based on the PRISMA flow chart in four databases (PubMed, ProQuest, ScienceDirect, Cochrane Library) until June 2024. Data extraction was performed to evaluate the accuracy of predicting LVO. Quality assessment was performed using QUADAS-2. All data were analyzed using Review Manager 5.4 and MetaDTA 2.0. Results: Five studies involving 4.862 patients were enrolled. The quality of all the studies was high and had a low risk of bias. All studies used different software. Artificial intelligence in NCCT had fairly good accuracy with a sensitivity and specificity of 0.83 (95% CI; 0.78-0.87) and 0.73 (95% CI; 0.52-0.87). NCCT plus clinical status (NIHSS, stroke onset) in two studies slightly improved overall accuracy with a sensitivity and specificity of 0.85 (95% CI; 0.80-0.89) and 0.74 (95% CI; 0.54-0.88). Two studies reported that machine learning took less than two minutes. Conclusion: Artificial intelligence in NCCT was reasonably accurate and took a short time to predict LVO. There are still opportunities for machine learning to improve performance. Further research is still needed.
Nontraumatic Spontaneous Bilateral Intracerebral Hemorrhage: A Rare Case Serial Rosalina Pradana Ayu; Andi Ario Tedjo, Raden; Roisya Aga Maydiana, Siti
Magna Neurologica Vol. 3 No. 2 (2025): 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.v3i2.1731

Abstract

Background: Nontraumatic spontaneous bilateral intracerebral bleeding is infrequent, with only 30-40 cases reported worldwide. Hypertension is the leading cause due to the formation of microaneurysms at the lenticulostriate arteries. Treatment follows current intracerebral hemorrhage guidelines, focusing on supportive care and early blood pressure management. This case report aims to further understand nontraumatic spontaneous bilateral intracerebral hemorrhage. Case: We report two cases of nontraumatic bilateral spontaneous intracerebral hemorrhage with similar etiologies. The first case involved a 34-year-old male with weakness in the right extremities, slurred speech, and high blood pressure (213/138 mmHg). The second case involved a 65-year-old woman with weakness in the left extremities, slurred speech, and high blood pressure (175/95 mmHg). Both patients had bilateral hemorrhages in different areas of the brain. They were treated according to management guidelines for intracerebral hemorrhage and showed improvement. Discussion: Nontraumatic spontaneous bilateral intracerebral bleeding is often caused by hypertension. CT angiography is a vital test for identifying vascular abnormalities. Treatment involves reducing risk factors for complications and controlling blood pressure. Typically, management of this condition is conservative, and unfavorable outcomes are common. However, these patients showed improvement. Conclusion: Conservative management, supportive care, and early blood pressure management for nontraumatic spontaneous bilateral intracerebral hemorrhage patients can cause improvement in the patient's condition.
Post-Procedural Outcomes in Subarachnoid Hemorrhage Patients Following Endovascular Coiling for Aneurysm Rupture at Dr. Moewardi General Hospital, Surakarta, Indonesia Hanifa, Shafira Nur; Subandi
Magna Neurologica Vol. 3 No. 2 (2025): 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.v3i2.1733

Abstract

Background: The insidious event of a ruptured intracranial aneurysm (IA) poses the requirement for urgent and effective medical intervention. Endovascular coiling came as an efficacious treatment option. However, no conclusive guideline is available regarding the best time to perform endovascular coiling on the ruptured IA. Objective: The study aims to evaluate the association of timing with endovascular coiling treatment and the post-procedural outcome. Methods: A retrospective cohort study was conducted on a Subarachnoid Hemorrhage (SAH) patient who underwent endovascular coiling on Dr. Moewardi General Hospital, Surakarta, Indonesia, between January 2021 and December 2023. The association between time to endovascular coiling and the postoperative outcome (evaluated by hospitalization duration, modified Rankin Score/mRS, and mortality) was assessed. Results: Of the 50 patients included in the study, it was observed that the aneurysms treated varied in size from 3.1 to 13 mm, with the internal carotid artery being the most common location. The analysis revealed that early intervention, performed within the first 3 days after rupture, significantly reduced the length of hospital stay compared to delayed intervention (6.467 vs. 8.80 days, p <0.030) and resulted in better functional outcome, evaluated by mRS (p <0.003). Despite the positive outcomes, the study also reported a postoperative mortality incidence in three patients. Conclusion: Earlier endovascular coiling in SAH patients can lead to shorter hospitalization and improved functional outcomes, highlighting the importance of timely intervention in managing this critical condition.
Sturge - Weber Syndrome: A Glimpse into A Rare Clinical Diagnosis Ketaren, Retno Jayantri; Cenadi, Jacob Christian
Magna Neurologica Vol. 3 No. 2 (2025): 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.v3i2.1823

Abstract

Background: Sturge-Weber syndrome is a spectrum of neurocutaneous disorders characterized by angiomas involving the face, choroid, and leptomeninges. Patients present with the typical “port wine stain”, acute seizure onset, and increasing hemiparesis. Case: A 1-year-old female presented to the ED with a seizure that coincided with a fever. The patient had two generalized tonic-clonic seizures in a day, which lasted less than 5 minutes. Before this, the patient had a history of seizures that started at 6 months old. The patient had an erythematous patch covering the right side of her face, along with left-sided weakness and positive plantar reflex on the left foot. Head non-contrast MRI scan showed a hypointense lesion/blooming artifact in the right frontal lobe on T2FFE and a prominent vascular structure on the right frontal lobe, accompanied by the widening of multiple veins and sinuses. Discussion: Sturge-Weber syndrome is complete when both facial angioma and leptomeningeal involvement are present. Diagnosis is confirmed through clinical features, with seizures and hemiparesis correlating to imaging findings. In our patient’s case, a type I Sturge-Weber syndrome diagnosis was made. The patient was started on oral anticonvulsants and future controls. Conclusion: Sturge-Weber syndrome is a clinical syndrome with many neurological complications. The lack of specific treatment urges an early diagnosis, as it can affect the patient’s outcome.
Pediatric Epilepsy Surgery in A Drug-Resistant Epilepsy Patient Aggravated by SARS-CoV-2: A Case Report Samudra, Edeline; Ketaren, Retno Jayantri; Inggas, Made Agus Mahendra
Magna Neurologica Vol. 3 No. 2 (2025): 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.v3i2.1882

Abstract

Introduction: Epilepsy is a manageable neurological disorder, but about one-third of cases are classified as drug-resistant epilepsy (DRE). DRE in pediatrics is more complex and may lead to cognitive function impairment, while surgery can offer seizure control in cases of focal DRE. Case: A 10-year-old male presented with a four-year history of recurrent seizures, thought to be caused by a left temporal cerebral cyst diagnosed five years earlier. During episodes, he experienced body stiffness, bilateral eye twitching, and drooling, with intact consciousness. After SARS-CoV-2 exposure, seizures became more frequent despite antiepileptic treatment, leading to partial resection of the left temporal lobe nine months later. Two years post epileptic surgery, he has become drug-responsive and achieved seizure control with symptomatic relief through medication. Discussion: Epilepsy is common in children, and DRE should be considered in cases of intractable epilepsy. Various factors can cause DRE, and in this patient, SARS-CoV-2 is thought to aggravate seizures by binding to ACE2 receptors in the central nervous system. This neural interaction may trigger reactive astrogliosis and neuroinflammation, disrupting the balance between glutamate and GABA levels. However, epilepsy surgery has been effective in improving the quality of life. Conclusion: Epilepsy surgery, either resective or non-resective surgery, is still rarely performed in Indonesia, while the management of DRE may require surgery. Although complete seizure freedom is not guaranteed, surgery can often convert DRE into a drug-responsive condition.
Efficacy and Safety of Evobrutinib in Relapsing Multiple Sclerosis: A Systematic Review of Randomized Controlled Trials Samudra, Edeline; Anyeliria Sutanto
Magna Neurologica Vol. 3 No. 2 (2025): 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.v3i2.1929

Abstract

Background: Evobrutinib is a selective Bruton’s tyrosine kinase (BTK) inhibitor that crosses the blood-brain barrier. BTK regulates B lymphocytes and myeloid cells, significantly contributing to multiple sclerosis (MS) inflammation. While current MS treatments alleviate relapses and disability, they have a limited impact on inflammation within the central nervous system. Objective: We aim to evaluate the efficacy and safety of evobrutinib in relapsing MS. Methods: A systematic search of databases, including PubMed, Elsevier, NEJM, BMJ Journals, and Neurology, was conducted. Inclusion criteria: Studies within 5 years, randomized controlled trials, and interventions with evobrutinib. Exclusion criteria: Incomplete reporting, non-phase two trials, and JADAD score < 3. The quality of the included studies was evaluated using the JADAD scale. Results: The literature search yielded 552 studies, of which eight were included in the final analysis. All studies consistently demonstrated significant benefits in reducing disease activity. The efficacy of evobrutinib 75 mg BID showed a significant reduction in ARR (mean ARR = 0.10) and gadolinium-enhancing lesions compared to placebo (mean ARR = 0.37). SEL volume was significantly reduced, especially in patients with higher disability and longer disease duration. The safety profile of evobrutinib was comparable to that of a placebo, with similar rates of TEAEs. Liver enzyme elevations were noted in one study but were generally manageable. Stability in EDSS scores over extended treatment periods suggests effective disease control. Conclusion: Evobrutinib is a promising therapeutic option for managing MS, particularly relapsing forms, due to its efficacy in reducing disease activity and favorable safety profile.
A Rare Case of Anomic Aphasia and Gerstmann Syndrome Induced by Hemorrhagic Stroke Mahendrakrisna, Daniel; Bagus Ngurah Mahasena Putera Awatara; Gede Suputra; Ni Wayan Nurlina Ekasari; Dian Kusumastuti Anggraeni Putri; Anak Agung Ayu Putri Laksmidewi
Magna Neurologica Vol. 3 No. 2 (2025): 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.v3i2.2262

Abstract

Background: Aphasia is a language disorder caused by brain damage, such as a stroke. Anomic aphasia, a rare subtype, impairs the ability to name objects or people while preserving fluency and comprehension. It is often associated with Gerstmann syndrome, which is characterized by acalculia, finger agnosia, left-right disorientation, and semantic aphasia. This report presents a case of a 61-year-old male with anomic aphasia and Gerstmann syndrome following a hemorrhagic stroke. Case: A 61-year-old male patient presented with sudden difficulty recalling the names of family members and objects. Imaging revealed an intracerebral hemorrhage in the left parietotemporooccipital lobe. The patient also exhibited left-right disorientation and finger agnosia, indicative of Gerstmann syndrome. The Aphasia Test for Rehabilitation Information Diagnosis (TADIR) confirmed the diagnosis of anomic aphasia. Although conservative treatment led to partial improvement, naming difficulties and associated deficits persisted. Discussion: Anomic aphasia primarily involves difficulties with naming, typically resulting from lesions in the dominant hemisphere, particularly the temporal and parietal lobes. Its coexistence with Gerstmann syndrome underscores the complexity of overlapping neurological deficits. The TADIR test was crucial in diagnosing and managing the patient's condition. Conclusion: This case highlights the importance of a thorough evaluation in aphasia cases, especially when rare syndromes like Gerstmann syndrome are involved. Early and accurate diagnosis enables targeted interventions that can improve patient outcomes.
Epilepsy as the Main Clinical Manifestation of Congenital Hypothyroidism: A Rare Case Report Lailita Dwi Cahyanti; Aslin Nur Ainiyah; Zidnal Mafaz; Ditya Arisanti
Magna Neurologica Vol. 3 No. 2 (2025): 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.v3i2.2269

Abstract

Background: Congenital hypothyroidism (CH) is defined as a deficiency of thyroid hormones present at birth and is one of the most common causes of intellectual disability. CH shows several manifestations, but it is rarely reported that CH manifests as epilepsy. To our knowledge, this rare manifestation of congenital hypothyroidism has only been reported four times previously. The potential association between CH and epilepsy remains unclear. Case: We reported a rare case of a 1-year-old child who presented to the emergency department with complaints of recurrent seizures. Laboratory results showed increased TSH levels and decreased FT4 levels. Electroencephalography (EEG) results were expected. The patient was diagnosed with epilepsy and congenital hypothyroidism. The patient received stabilization therapy in the ER and was admitted to the PICU for 7 days. During hospitalization and a seven-day evaluation at home, the patient did not experience any further seizures. Discussion: Epilepsy and congenital hypothyroidism can affect each other through three known pathogeneses: mitochondrial dysfunction, oxidative stress, and failure of amino acid regulation in the brain. Long-term use of some anti-epileptic drugs is known to reduce thyroid hormone levels. Conclusion: Thyroid hormones play an essential role in various aspects of epilepsy. Thyroid function screening in patients with epilepsy may be advisable, especially in patients with developmental disorders and relevant symptoms.

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