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Rivan Danuaji
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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 82 Documents
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CLINICAL AND SOCIODEMOGRAPHIC FACTORS ASSOCIATED WITH QUALITY OF LIFE IN EPILEPSY PATIENTS AT DORIS SYLVANUS HOSPITAL PALANGKA RAYA Ariqah Ghaniyah Lembah; Ranintha Br. Surbakti; Ravenalla Abdurrahman Al Hakim Sampurna Putra Solihin; Farah Fauziyah Radhiyatulqalbi Ahmad; Nuch Sabunga
Magna Neurologica Vol. 4 No. 2 (2026): 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.v4i2.2986

Abstract

Background: Epilepsy is a chronic neurological disorder that affects patients' physical, psychological, and social aspects, influencing their quality of life (QoL). Identifying clinical and sociodemographic factors related to QoL is essential for comprehensive management. Objective: To analyze the relationship between clinical and sociodemographic factors and the quality of life of epilepsy patients at the Neurology Polyclinic of RSUD dr. Doris Sylvanus Palangka Raya. Methods: This analytical observational study with a cross-sectional design involved 53 respondents selected through consecutive sampling. Data were collected using the QOLIE-31 to assess QoL, the MARS-5 to assess medication adherence, the MSPSS to assess social support, and a validated knowledge questionnaire. Relationships between variables were analyzed using the Spearman correlation test with a significance level of p < 0.05. Results: Most respondents were adults aged 19-45 years (83.0%), male (52.8%), and had secondary education. The mean QOLIE-31 score was 52.24 (SD 20.02), indicating moderate QoL. Significant correlations were found between seizure frequency (r = -0.506; p < 0.001), comorbidity (r = -0.368; p = 0.007), medication adherence (r = 0.483; p < 0.001), social support (r = 0.396; p = 0.004), and knowledge level (r = 0.587; p < 0.001) with QoL. Age at diagnosis (p = 0.119) and epilepsy duration (p = 0.397) were not significantly related. Conclusion: Quality of life in epilepsy patients is significantly associated with seizure frequency, comorbidity, medication adherence, social support, and knowledge level. Improving adherence and psychosocial support can enhance patients' overall well-being.
ISCHEMIC STROKE IN A PATIENT WITH SUSPECTED CERVICAL CANCER: A THERAPEUTIC DILEMMA BETWEEN ANTICOAGULANT OR ANTIPLATELET STRATEGIES IN A RESOURCE-LIMITED SETTING: A RARE CASE REPORT Yang Yang Endro Arjuna; Vonny Fibrianty Goenawan; Vivien Puspitasari; Yohanes Chandra Kurniawan
Magna Neurologica Vol. 4 No. 2 (2026): 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.v4i2.3062

Abstract

Background: Approximately 5% of strokes with no identifiable cause are linked to previously undiagnosed malignancies. The involvement of multiple vascular territories observed on brain imaging may indicate a hypercoagulable state related to cancer. Early identification is crucial for prompt cancer diagnosis. Case: A 40-year-old woman with no established classic stroke risk factors presented with progressive left-sided weakness and difficulty with speech over three days. She had a history of persistent vaginal bleeding lasting four months. Non-contrast brain CT revealed multiple infarcts affecting the right frontoparietal region, left frontal lobe, and bilateral posterior as well as left anterior internal capsules. An abdominal ultrasound identified a 9.35 × 4.74 cm hypoechoic mass extending from the cervix to the uterus with bladder infiltration, findings highly suggestive of cervical carcinoma. Discussion: Ischemic stroke associated with female reproductive malignancies is rare, with an incidence of around 0.3%. It is mainly caused by cancer-related hypercoagulability due to tumor-derived mucin, procoagulants, and inflammatory cytokines. Multifocal infarcts across various vascular territories may indicate a hypercoagulable state and suggest an underlying malignancy. There is no standardized anticoagulant protocol. Low-molecular-weight heparin (LMWH) is commonly used, though its effectiveness varies. Use of direct oral anticoagulants (DOACs) and antiplatelets is increasing, showing similar safety and efficacy. Conclusion: To date, there is no definitive antithrombotic of choice for cancer-associated ischemic stroke. The selection of antithrombotic therapy should be carefully tailored based on individual risk factors and the patient's clinical condition.  
EFFECTS OF IMMERSION LEVEL AND INTERVENTION TIMING IN VR-BASED STROKE REHABILITATION: A META-ANALYSIS OF UPPER LIMB RECOVERY Zafira Zahra Aulia Rahma; Naufal Dzulhijar; Syakira Zahra Maulida
Magna Neurologica Vol. 4 No. 2 (2026): 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.v4i2.3269

Abstract

Background: Virtual Reality (VR) has emerged as a contemporary modality in neurorehabilitation, utilizing interactive environments and multisensory feedback to support neuroplasticity and motor learning. However, the influence of stroke phase and VR immersion level on therapeutic effectiveness has not been systematically synthesized. Objective: To systematically synthesize the effectiveness of VR-based interventions on upper limb motor function after stroke and critically evaluate the moderating effects of stroke phase and VR immersion level on rehabilitation outcomes. Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines, with searches across major scientific databases. Experimental studies, including randomized controlled trials (RCTs) and quasi-experimental studies, assessing upper limb motor function using the Fugl-Meyer Assessment–Upper Extremity (FMA-UE) were included. Risk of bias was evaluated using the Cochrane Risk of Bias tool. A random-effects model was applied to calculate pooled Mean Differences (MDs), with subgroup analyses based on stroke phase and VR immersion level. Results: Eleven studies (10 RCTs and 1 quasi-experimental study) involving 388 participants were included. VR-based interventions demonstrated a statistically significant improvement in upper limb motor function compared with conventional therapy (MD = 8.97; 95% CI 6.11–11.82; p < 0.00001). Significant effects were consistently observed in both the chronic phase (MD = 9.96) and the subacute phase (MD = 8.36). Both non-immersive and immersive VR yielded clinically meaningful benefits, with no significant difference between immersion levels (p = 0.97). Conclusion: Virtual Reality based neurorehabilitation significantly enhances post-stroke upper limb motor recovery, with consistent effectiveness regardless of stroke phase or device immersion level. These findings support VR as a flexible and clinically applicable adjunct to standard rehabilitation, although standardized intervention protocols and long-term outcome evaluations remain necessary.
MONOCULAR QUADRANTANOPIA CAUSED BY INTRAOCULAR METASTASIS MIMICKING OCULAR TUBERCULOSIS: A NEURO-OPHTHALMOLOGIC DIAGNOSTIC PITFALL Ervina Rahma Meila Sari; Dinda Husna Azalia Soesetyo; Mahaputri Inas Indrajati; Raden Andi Ario Tedjo; Taufiq Wildan Laksono
Magna Neurologica Vol. 4 No. 2 (2026): 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.v4i2.3270

Abstract

Background: Monocular quadrantanopia is an uncommon visual field defect that is typically associated with prechiasmal lesions. In tuberculosis-endemic regions, intraocular lesions are frequently attributed to ocular tuberculosis. However, intraocular metastases may present with similar clinical and radiological characteristics, creating significant diagnostic challenges and potentially delaying appropriate management. Case: A 34-year-old man presented with headache and visual field loss in the superior temporal quadrant of the right eye. Neurological examination revealed monocular superior temporal quadrantanopia without additional deficits, while funduscopy showed a superior intraocular lesion. Orbital MRI demonstrated a solid posterior choroidal lesion with mild contrast enhancement, and brain MRI revealed multiple intraaxial supratentorial and infratentorial lesions. Although ocular tuberculosis was initially diagnosed based on epidemiological context and imaging, subsequent investigations excluded tuberculosis. Further systemic evaluation identified a primary lung malignancy, confirming that the intraocular and intracranial lesions represented metastatic disease. Discussion: Quadrantanopia usually results from retrochiasmal lesions, but focal intraocular pathology can mimic neurogenic visual field defects. Distinguishing ocular tuberculosis from intraocular metastasis is difficult because of overlapping clinical and imaging findings. Minimal perilesional edema, absent diffusion restriction, and poor response to antituberculosis therapy should raise suspicion for metastatic disease, underscoring key neuro-ophthalmologic diagnostic pitfalls in infection-endemic settings worldwide regions. Conclusion: Intraocular metastasis should be considered in patients presenting with atypical monocular visual field defects, even when tuberculosis is strongly suspected. Awareness of this diagnostic pitfall is essential to avoid misdiagnosis and delays in appropriate treatment.
ACUTE ISCHEMIC STROKE RISK FACTORS STRATIFICATION MODEL IN ISOLATED VERTIGO PATIENTS: TWO-YEARS COHORT RETROSPECTIVE STUDY Faizal Muhammad; Rivan Danuaji
Magna Neurologica Vol. 4 No. 2 (2026): 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.v4i2.3271

Abstract

Background: Vertigo is a common complaint in medical settings, with the most important differential diagnosis to exclude being vertebrobasilar ischemic stroke. However, there have been no cohort studies evaluating the risk of stroke following hospitalization for acute vertigo without other neurological symptoms (isolated vertigo). Objective: To assess the long-term risk of stroke in patients with a history of hospitalization due to isolated vertigo. Methods: This retrospective cohort study was conducted at Dr. Moewardi Hospital in Surakarta, utilizing secondary data from electronic medical records for the years 2024–2025. A total of 268 patients hospitalized for vertigo and 223 control patients (elective gastrointestinal endoscopy patients) were selected based on similar age distribution. Stroke incidence data were analyzed using Kaplan-Meier methods and Cox regression, with adjustments for demographic variables and vascular risk factors. Results: Over a 2-year period, stroke occurred in 16 vertigo patients (5.8%) and 2 control patients (1.1%). After adjustment, vertigo patients had a 3.25-fold higher risk of stroke compared to the control group (HR: 3.25; 95% CI: 2.18–4.15; p = 0.002). Stroke risk significantly increased in patients with ≥3 vascular risk factors (HR: 5.01). Approximately 68% of strokes occurred within the first year. Conclusion: Isolated vertigo significantly increases the risk of ischemic stroke, particularly in patients with risk factors during the first year following the initial symptoms of isolated vertigo.
TIME COURSE OF BOTULINUM TOXIN ANALGESIA IN PERIPHERAL NEUROPATHIC PAIN: A SYSTEMATIC REVIEW AND META-ANALYSIS Endang Ulupi Khoirunnisa; Yessi Mekarsari; Sih Reka Prawidya
Magna Neurologica Vol. 4 No. 2 (2026): 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.v4i2.3280

Abstract

Background: Peripheral neuropathic pain (PNP) is frequently refractory to systemic therapies. Botulinum toxin (BTX) has emerged as a targeted option, but its time course of analgesic effect remains incompletely defined. Objective: To characterize the onset, peak, and durability of BTX analgesia in PNP. Methods: A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted according to PRISMA guidelines. A search was performed on December 19, 2025, covering studies published from 2006 to 2025. Included etiologies comprised diabetic neuropathy, trigeminal neuralgia, postherpetic neuralgia, and other PNP conditions. Pain outcomes were synthesized across predefined time windows: early (≤4 weeks), intermediate (6–12 weeks), and late (≥24 weeks). Random-effects meta-analyses using standardized mean differences (SMDs) were conducted at approximately 4 and 12 weeks. Results: Eighteen RCTs were included (n=916); four (n=129) and three (n=99) contributed to the 4- and 12-week meta-analyses, respectively. BTX-A significantly reduced pain versus placebo at 4 weeks (SMD −2.79, 95% CI −4.67 to −0.90; I² = 93%) and 12 weeks (SMD −2.54, 95% CI −4.55 to −0.53; I² = 92%). Analgesia began within 1–2 weeks and peaked at 6–12 weeks. Excluding one outlier reduced heterogeneity from I² = 92% to 55% while preserving significance. Evidence beyond 24 weeks was limited. Conclusion: BTX-A demonstrates a time-dependent and etiology-specific analgesic effect, with onset within 1–4 weeks, peak at 6–12 weeks, and waning after 12–16 weeks. These findings inform patient counselling and reinjection planning, typically at approximately 3-month intervals.
MELATONIN SUPPLEMENTATION IN MULTIPLESCLEROSIS: A SYSTEMATIC REVIEW Muvida; Yunandia Rahmawati; Helen Anince Heretringgi
Magna Neurologica Vol. 4 No. 2 (2026): 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.v4i2.3298

Abstract

Background: Multiple sclerosis (MS) is a chronic neurodegenerative disease marked by progressive inflammation and demyelination, in which symptom management remains challenging. Melatonin has potential antioxidant and anti-inflammatory effects, but evidence of its efficacy in MS is limited. Objective: This systematic review evaluated the effects of melatonin supplementation on inflammatory biomarkers and symptom-related outcomes in patients with MS using randomized controlled trials (RCTs). Methods: This systematic review was conducted on November 10, 2025, using PubMed, Scopus, and ScienceDirect, including English-language RCTs published within the past ten years. Study quality was assessed using the Cochrane Risk of Bias 2 tool, and the review followed PRISMA guidelines with PROSPERO registration (CRD420251273486). Results: A total of 12 RCTs involving 406 participants were included. Inflammatory biomarkers demonstrated heterogeneous responses, particularly for TNF-α and IFN-1β, with no significant changes observed in C-reactive protein (CRP), whereas oxidative stress biomarkers showed more consistent improvement. Regarding clinical outcomes, melatonin supplementation was associated with improvements in certain symptoms, including pain and fatigue, although findings varied across studies. Cognitive performance particularly executive function, information processing speed, and visuospatial memory showed relatively consistent improvement, while no significant changes were observed in global neurological disability or overall quality of life. Conclusion: Melatonin supplementation in patients with MS demonstrates consistent benefits in reducing oxidative stress and provides limited improvement in symptoms such as pain, fatigue, and cognitive function; however, it does not confer significant benefits on global disability or overall quality of life.
A ‘DEADLY’ BENIGN TUMOR: RAPIDLY FATAL RECURRENCE OF ATYPICAL MENINGIOMA Tasya Lianda Sari; Cindy Yusliani; Riza Pratama Putra; Arindi Maretzka
Magna Neurologica Vol. 4 No. 2 (2026): 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.v4i2.3301

Abstract

Background: Meningioma is the most common primary CNS tumor. While most are benign (WHO grade I), approximately 15–20% are grade II (atypical) and 1-2% are grade III (anaplastic), carrying a higher recurrence risk. Rapidly fatal recurrence of grade II meningioma remains infrequently reported, particularly in resource-limited settings such as Indonesia. Case Report: A 65-year-old woman with a history of atypical meningioma (WHO grade II) resection eight months earlier presented with decreased consciousness, severe headache, projectile vomiting, and left-sided hemiparesis. Due to the unavailability of the operative report and postoperative imaging from the initial procedure, the Simpson grade and extent of resection could not be determined. Non-contrast head CT revealed a recurrent extra-axial mass in the right temporal region with edema and a midline shift of ±15 mm, suggestive of malignant progression. The patient received supportive therapy without reoperation or adjuvant radiotherapy. Despite a transient improvement, the clinical course deteriorated progressively and led to death on day 19. Discussion: Rapid decompensation is explained by the Monro-Kellie doctrine, whereby the expanding recurrent mass exhausted intracranial compensatory reserve, culminating in fatal herniation. The absence of documented Simpson grade, serial postoperative MRI, adjuvant radiotherapy, and molecular profiling contributed to delayed detection and fatal outcome. Geographic inaccessibility, financial constraints, and low health literacy further impeded surveillance. Conclusion: Grade II meningioma should not be regarded as benign. A structured surveillance protocol; MRI within 48 hours postoperatively, at 4 months, and annually thereafter, combined with Simpson grade documentation and consideration of adjuvant radiotherapy, is essential to prevent fatal recurrence.
BLOOD-BASED BIOMARKERS FOR PREDICTING POST-STROKE PROGNOSIS: A SCOPING REVIEW OF PENTRAXIN-3, NEUROPENTRAXIN-1, AND NEUROPENTRAXIN-2 Elizabeth Divina; Siti Alyaa Salma Ghozali; Pukovisa Prawiroharjo
Magna Neurologica Vol. 4 No. 2 (2026): 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.v4i2.3308

Abstract

Background: Stroke remains a major global health challenge, with substantial losses in disability-adjusted life-years, particularly in low-middle-income countries. Predicting post-stroke outcomes remains challenging because outcomes are driven by complex and overlapping processes, including inflammation, vascular injury, and neurodegeneration. Consequently, blood-based biomarkers, such as the pentraxin group that reflect underlying pathophysiology, have gained attention. However, existing evidence is fragmented and heterogeneous, underscoring the need for systematic mapping of the pentraxin group as biologically informed prognostic tools. Objective: This systematic scoping review aims to map and synthesize existing evidence on the prognostic value of blood-based biomarkers Pentraxin-3 (PTX3), Neuropentraxin-1 (NPTX1), and Neuropentraxin-2 (NPTX2) in predicting clinical outcomes after stroke. Methods: This PRISMA-ScR–guided scoping review systematically mapped evidence on blood-based biomarkers: PTX3, NPTX1, and NPTX2, for post-stroke prognosis from 6 databases and used NOS for quality assessment. Results: A total of 18 studies were included in the final scoping review. Lower serum NPTX2 levels were significantly associated with post-stroke cognitive impairment. Studies investigating PTX3 demonstrated substantial heterogeneity in sampling timing, cutoff definitions, and follow-up duration. Across studies, higher PTX3 concentrations were independently associated with increased mortality (AUC ~0.73–0.81, P value <0.0001), greater baseline neurological severity as measured by the National Institutes of Health Stroke Scale (NIHSS), and poorer functional outcomes assessed by the modified Rankin Scale (mRS). Conclusion: Despite the large heterogeneity of studies, the overall evidence supports PTX3, NPTX1, and NPTX2 as less-invasive prognostic blood-based biomarkers for post-stroke outcomes. However, studies on NPTX1 and NPTX2 are still very limited.
ALTERNATIVE MANAGEMENT OF DECOMPRESSION ILLNESS IN BREATH-HOLDING DIVERS USING NPPV Priyanka Ganesa Utami; Eka Musridharta; Mursyid Bustami; Ita Muharram Sari; Sardiana Salam
Magna Neurologica Vol. 4 No. 2 (2026): 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.v4i2.3315

Abstract

Background: Decompression illness (DI) is a syndrome caused by the formation of gas bubbles during rapid decompression. DI can manifest with neurological manifestations. Divers are at risk of developing DI even in shallow water. Case: A 25-year-old woman lost consciousness after a training dive. She lost consciousness shortly after  surfacing, having previously dived to a depth of four meters. She vomited once and denied seizures. This was her third training dive; the second occurred two days prior, and the first ten days prior. The patient was in good health and had no history of heart or lung problems. A non-contrast head CT scan and MRI revealed ischemic lesions in the bilateral thalamus and cerebellum. Chest X-ray (CXR), transthoracic echocardiography (TTE), echocardiography, and bubble contrast scans showed no abnormalities. The patient was treated with 100% oxygen via non-invasive positive pressure ventilation (NPPV – CPAP mode) and showed improvement in her neurological deficits after 10 days. Discussion: DI is associated with vascular or extravascular bubbles that form as a result of rapid decompression. Pure oxygen inhalation using HBOT is the main therapy for DI. But, in the absence of HBOT, NPPV can be considered for its effectiveness to achieve a mean arterial pO2 concentration above 500 mm Hg. Conclusion: Recognizing the signs and symptoms of DI is important because they are nonspecific. Oxygen: 100% oxygen should be administered to those suspected of having DI.

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