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Neurona
Published by Perhimpunan Dokter Spesialis Neurologi Indonesia
ISSN : 02166402     EISSN : 25023748     DOI : https://doi.org/10.52386/neurona
Core Subject : Health, Science,
Health Professions Medicine & Pharmacology Neuroscience
Neurona merupakan satu-satunya jurnal yang memuat perkembangan penelitian dan kasus terbaru bidang neurosains oleh Perhimpunan Dokter Spesialis Saraf (PERDOSSI) Pusat di Indonesia. Jurnal ini diterbitkan bulan Maret, Juni, September dan Desember. Bidang studi cakupan NEURONA meliputi: Stroke dan Pembuluh darah Neurotrauma Neuroonkologi Neuro Infeksi Neuro Behavior Neurorestorasi Neuropediatri Gangguan Tidur Nyeri Kepala Neurootologi Neuro Intervensi Neuro Intensif Neurogeriatri Gangguan Gerak Epilepsi Neuro Epidemiologi
Arjuna Subject : Kedokteran - Neurologi Klinis
Articles 299 Documents
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TROMBEKTOMI MEKANIS DAN TROMBOLISIS INTRAARTERI PADA STROKE ISKEMIK: FOKUS PADA LUARAN KLINIS Listyawan, Rakhian; Setyawan, Tommy Rachmat
Majalah Kedokteran Neurosains Perhimpunan Dokter Spesialis Saraf Indonesia Vol 41 No 5: Edisi Suplemen Neurona Bekerjasama dengan JogjaCLAN 2025
Publisher : PERDOSNI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52386/neurona.v41i5.864

Abstract

Mechanical thrombectomy has become the standard recommended therapy for acute ischemic stroke due to large vessel occlusion. A series of fundamental clinical trials have demonstrated the superiority of mechanical thrombectomy in achieving functional independence (modified Rankin Scale [mRS] score 0-2) at 90 days compared to medical therapy alone. The therapeutic window for mechanical thrombectomy has even been extended to 24 hours for selected patients based on perfusion imaging. Meanwhile, the role of intraarterial thrombolysis has evolved from primary therapy to an adjunctive or rescue strategy, used in cases of incomplete recanalization or distal embolism after mechanical thrombectomy. Both treatment modalities continue to evolve to improve clinical outcomes in patients. Keywords: Ischemic stroke, mechanical thrombectomy, intraarterial thrombolysis, large vessel occlusion, clinical outcome.
VERTIGO SENTRAL: TINJAUAN TERKINI MENGENAI PATOFISIOLOGI DAN STRATEGI DIAGNOSIS Sutarni, Sri; Setyaningrum, Cempaka Thursina Srie; Ar Rochmah, Mawaddah; Bayuangga, Halwan Fuad
Majalah Kedokteran Neurosains Perhimpunan Dokter Spesialis Saraf Indonesia Vol 41 No 5: Edisi Suplemen Neurona Bekerjasama dengan JogjaCLAN 2025
Publisher : PERDOSNI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52386/neurona.v41i5.865

Abstract

Recent advances have fundamentally reshaped the clinical and pathophysiological landscape of central vertigo, moving beyond a simplistic brainstem model to a sophisticated understanding of a distributed central vestibular network. This network, encompassing the brainstem, cerebellum, thalamus, and cortex, provides a robust framework for explaining how disruptions from stroke, demyelination, or functional disorders produce diverse symptoms. In parallel, diagnostic paradigms have evolved dramatically. The advent of quantitative ocular motor testing, epitomized by the HINTS protocol and enhanced by video-head impulse testing (vHIT), now allows for highly sensitive bedside identification of central causes in acute settings. Furthermore, advanced neuroimaging techniques, including optimized diffusion-weighted and vessel wall MRI, have revolutionized our ability to detect subtle posterior fossa infarcts and vascular pathology. These mechanistic and technological insights have also refined our perspective on specific syndromes, solidifying vestibular migraine and persistent postural-perceptual dizziness (PPPD) as central disorders of sensory integration. Ultimately, the integration of this modern network-based pathophysiology with targeted diagnostic tools is establishing a new standard of care, significantly improving diagnostic accuracy, enabling timely intervention, and guiding future therapeutic development for patients with central vertigo. Keywords: Vestibular network, HINTS examination, neuroimaging, acute vestibular syndrome, central vertigo
FAKTOR PROGNOSIS: TUMOR OTAK PRIMER DAN SEKUNDER Dananjoyo, Kusumo; Malueka, Rusdy Ghazali; Briliansy
Majalah Kedokteran Neurosains Perhimpunan Dokter Spesialis Saraf Indonesia Vol 41 No 5: Edisi Suplemen Neurona Bekerjasama dengan JogjaCLAN 2025
Publisher : PERDOSNI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52386/neurona.v41i5.866

Abstract

Brain tumors represent a heterogeneous group of diseases with considerable biological and clinical variability, resulting in highly diverse prognoses even among patients with similar histopathological diagnoses. Accurate prognostic assessment plays a crucial role in guiding appropriate treatment selection, preventing overtreatment or undertreatment, and facilitating the planning of palliative and supportive care. Multiple prognostic factors influence patient survival, including clinical variables (age, functional status, tumor location, and extent of resection), radiological features (tumor size, peritumoral edema, enhancement patterns, diffusion and perfusion MRI), histopathological findings (WHO grade, histological subtype), and biomolecular markers (IDH mutation, 1p/19q co-deletion, MGMT promoter methylation, ATRX loss, EGFR amplification, TERT mutation). In high-grade gliomas, IDH mutation, MGMT methylation, and 1p/19q co-deletion are associated with improved prognosis, while microRNAs such as miR-15b and miR-221 are increasingly recognized as potential prognostic biomarkers. In meningiomas, gross total resection (Simpson grade 1–3) is associated with lower recurrence rates compared to subtotal resection, whereas in brain metastases prognosis is determined by age, Karnofsky Performance Status, number of lesions, and control of the primary tumor. Thus, prognostic estimation extends beyond survival figures, serving as a critical foundation for individualized treatment planning, resource allocation, and effective communication with patients and families, ultimately supporting personalized therapy to enhance quality of life and patient satisfaction. Keywords: Prognostic factors, glioma, meningioma, brain metastases, brain tumors
NYERI KEPALA PASCATRAUMA: TELAAH EPIDEMIOLOGI DAN PATOFISIOLOGI Setyaningsih, Indarwati; Kurniandari, Nindriya; Habibi, Muhammad Najmi; Sejahtera, Desin Pambudi
Majalah Kedokteran Neurosains Perhimpunan Dokter Spesialis Saraf Indonesia Vol 41 No 5: Edisi Suplemen Neurona Bekerjasama dengan JogjaCLAN 2025
Publisher : PERDOSNI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52386/neurona.v41i5.867

Abstract

Post-traumatic headache (PTH) is one of the most common complications following mild traumatic brain injury (TBI). Its clinical presentation often resembles primary headache disorders, such as migraine or tension-type headache; however, it possesses a more complex and multifactorial pathophysiological basis. This article aims to review the epidemiological aspects and pathophysiological mechanisms of PTH based on recent literature. Globally, more than 69 million individuals experience TBI each year, and up to two-thirds of patients with mild TBI are reported to develop PTH. While most cases are transient, approximately 15–25% progress to persistent PTH. The pathogenesis of PTH involves interactions among structural damage, neurometabolic dysfunction, and neuroinflammatory processes that trigger activation of the trigeminovascular system and both peripheral and central sensitization. Cervical factors, hyperadrenergic mechanisms, and disturbances in the descending pain modulatory system further exacerbate symptoms. Advanced neuroimaging studies such as diffusion tensor imaging (DTI), Voxel-based morphometry (VBM), and magnetic resonance spectroscopy (MRS) provide supporting evidence of axonal injury, cortical thinning, and neuronal metabolic abnormalities associated with symptom persistence. A deeper understanding of the interaction among structural, metabolic, and inflammatory dysfunctions may serve as the foundation for developing more effective diagnostic and therapeutic strategies to improve patient’s clinical outcome. Keywords: post-traumatic headache, traumatic brain injury, neuroinflammation, central sensitization, peripheral sensitization
PENDEKATAN KLINIS DAN STRATEGI MANAJEMEN TERKINI PADA NYERI PUNGGUNG BAWAH TIPE CAMPURAN Tama, Whisnu Nalendra; Yudiyanta
Majalah Kedokteran Neurosains Perhimpunan Dokter Spesialis Saraf Indonesia Vol 41 No 5: Edisi Suplemen Neurona Bekerjasama dengan JogjaCLAN 2025
Publisher : PERDOSNI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52386/neurona.v41i5.868

Abstract

Low back pain (LBP) is one of the most common musculoskeletal complaints and a frequent cause of chronic pain. It has a complex etiology which may involve overlapping pain mechanisms, including nociceptive, neuropathic, and nociplastic, resulting in a mixed pain condition. Several studies have shown that neuropathic components are present in a significant proportion of LBP cases, even in the absence of clear radicular symptoms. Understanding the pathophysiological mechanisms underlying mixed pain is essential, including both peripheral and central sensitization processes, as well as interactions between neural and non-neural structures such as the intervertebral disc and facet joints. The clinical approach to LBP requires comprehensive history taking and physical examination, including identification of pain characteristics and red flags, along with the use of neuropathic pain screening questionnaires such as PainDETECT, Douleur Neuropathique en 4 (DN4), and ID Pain. Supporting investigations, including Magnetic Resonance Imaging (MRI) and electrophysiological studies, should be performed as indicated to determine the etiology and degree of nerve involvement. Management of mixed-type LBP should be multimodal, encompassing nonpharmacological therapies such as patient education, medical rehabilitation, and postural correction, as well as pharmacological treatments combining anti-inflammatory and neuropathic pain agents. Although such combination therapy is theoretically beneficial, supporting clinical evidence remains limited and warrants further research. Increasing clinicians’ awareness of the possibility of mixed pain in LBP is crucial for determining more optimal and precise therapeutic strategies to improve patient clinical outcomes. Keywords: low back pain, mixed pain, central sensitization, multimodal management, mechanism-based therapy
PROFIL SEROLOGI MYASTHENIA GRAVIS: TINJAUAN ATAS TIPE, KARAKTERISTIK, DAN RELEVANSI KLINIS AUTOANTIBODI Asmedi, Ahmad; Bayuangga, Halwan Fuad
Majalah Kedokteran Neurosains Perhimpunan Dokter Spesialis Saraf Indonesia Vol 41 No 5: Edisi Suplemen Neurona Bekerjasama dengan JogjaCLAN 2025
Publisher : PERDOSNI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52386/neurona.v41i5.869

Abstract

Myasthenia gravis (MG) is an autoimmune disorder of the neuromuscular junction characterized by muscle weakness and fatigability. Understanding the serological profile of MG is key to accurate diagnosis and management. This literature review discusses the types and characteristics of autoantibodies in MG and their clinical relevance. Autoantibodies against the acetylcholine receptor (Anti-AChR) are the most common, found in the majority of generalized MG cases, and their pathogenesis involves antigenic modulation, ligand blockade, and complement activation. This subtype has a strong correlation with thymic abnormalities such as hyperplasia and thymoma. Autoantibodies against MuSK and LRP4 define other MG subtypes with distinct clinical phenotype, MuSK-MG often presents with severe bulbar symptoms, while LRP4-MG tends to be milder. A recommended diagnostic approach is algorithmic, starting with Anti-AChR testing, followed by Anti-MuSK and Anti-LRP4 in seronegative cases. Mapping this serological profile enables neurologists to achieve a precise diagnosis, predict disease course, and determine personalized therapy strategies, including the choice of immunomodulators and evaluation for thymectomy. Thus, serological classification has become the foundation of a precision neurology approach in managing myasthenia gravis. Keywords: Anti-AChR, Anti-LRP4, Anti-MuSK, Myasthenia gravis, Thymoma
PENCEGAHAN PERBURUKAN PADA PENYAKIT PARKINSON: PENDEKATAN FARMAKOLOGIS DAN NON-FARMAKOLOGIS Subagya; Rohma, Novita Nur; Gofir, Abdul; Ar Rochmah, Mawaddah
Majalah Kedokteran Neurosains Perhimpunan Dokter Spesialis Saraf Indonesia Vol 41 No 5: Edisi Suplemen Neurona Bekerjasama dengan JogjaCLAN 2025
Publisher : PERDOSNI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52386/neurona.v41i5.870

Abstract

Parkinson's disease (PD) is a complex neurodegenerative disorder with a progressive course. Most patients experience symptom deterioration over time, although the rate of progression varies between individuals. PD is the second most common neurodegenerative disease worldwide, with prevalence exceeding ~1% in people over 60 and ~5% in those over 85. Its incidence is rising globally with aging populations, and the number of PD cases is projected to double by 2040 compared to 2015. Despite significant advances in symptomatic treatments, no intervention has been proven to halt or reverse the underlying pathology of PD. This therapeutic gap underscores the importance of strategies aimed at preventing disease progression in order to preserve functional capacity and improve patients’ quality of life. This review provides an overview of the progressive nature of PD, current challenges in its management, and both pharmacological and non-pharmacological approaches aimed at preventing further deterioration. Keywords: Prevention, Parkinson’s disease, progressive, neurodegenerative
PENDEKATAN TERKINI DALAM DIAGNOSIS DAN TATA LAKSANA NEUROSIFILIS Satiti, Sekar; Bayuangga, Halwan Fuad; Aifa, Bardatin Lutfi
Majalah Kedokteran Neurosains Perhimpunan Dokter Spesialis Saraf Indonesia Vol 41 No 5: Edisi Suplemen Neurona Bekerjasama dengan JogjaCLAN 2025
Publisher : PERDOSNI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52386/neurona.v41i5.871

Abstract

Neurosyphilis is a manifestation of Treponema pallidum infection involving the central nervous system which may occur at any stage of syphilis. This condition remains a global health concern with increasing incidence, particularly among individuals coinfected with human immunodeficiency virus (HIV). Its broad and often nonspecific clinical spectrum poses significant challenges for both diagnosis and management. This review discusses current approaches to the diagnosis and management of neurosyphilis based on the latest guidelines from the Centers for Disease Control and Prevention (CDC), the British Association of Sexual Health and HIV (BASHH), and the European Guidelines. The diagnosis of neurosyphilis is established through the integration of clinical findings, treponemal and nontreponemal serologic tests, and cerebrospinal fluid (CSF) analysis. Parenteral penicillin G for 10–14 days remains the first-line therapy in all major international guidelines. Ceftriaxone, doxycycline, or a combination of amoxicillin and probenecid may serve as alternative regimens in patients with penicillin allergy, although penicillin desensitization is still recommended whenever feasible. Corticosteroids, such as prednisolone, may be used prophylactically to prevent the Jarisch–Herxheimer reaction. Post-treatment monitoring through periodic clinical, serologic, and CSF evaluations is essential to ensure eradication of infection and prevent reinfection. A comprehensive diagnostic approach, early detection, appropriate antimicrobial therapy, and long-term follow-up are key determinants for improving outcomes in patients with neurosyphilis. Keywords: neurosyphilis, Treponema pallidum, neurosyphilis diagnosis, penicillin G, ceftriaxone
APLIKASI KLINIS N-ACETYLCYSTEINE PADA STROKE ISKEMIK AKUT Setyopranoto, Ismail; Aifa, Bardatin Lutfi; Satiti, Sekar
Majalah Kedokteran Neurosains Perhimpunan Dokter Spesialis Saraf Indonesia Vol 41 No 5: Edisi Suplemen Neurona Bekerjasama dengan JogjaCLAN 2025
Publisher : PERDOSNI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52386/neurona.v40i3.872

Abstract

Pharmacological strategies to enhance reperfusion in acute ischemic stroke currently rely on the use of recombinant tissue plasminogen activator (rtPA), which acts by activating the fibrinolytic cascade. Although its clinical efficacy has been well established, rtPA does not significantly affect the non-fibrin components of thrombi, resulting in relatively low rates of early arterial recanalization (~30%), particularly in cases involving platelet-rich clots. Furthermore, rtPA increases the risk of intracerebral hemorrhage, thereby limiting its overall benefit–risk ratio. Consequently, alternative thrombolytic agents capable of dissolving arterial thrombi without elevating bleeding risk are urgently needed. Von Willebrand factor (vWF) plays a pivotal role in primary hemostasis, and elevated plasma vWF levels are associated with an increased risk of arterial thrombosis. Therapeutic strategies targeting vWF offer a novel approach to lysing platelet-rich thrombi, as their mechanisms operate independently of conventional platelet activation pathways. During arterial thrombosis, vWF multimers mediate platelet cross-linking; thus, proteolysis of vWF has the potential to disrupt platelet-rich thrombi and restore cerebral blood flow. N-acetylcysteine (NAC) cleaves disulfide bonds within vWF multimers, promoting thrombus dissolution and enhancing arterial recanalization. Compared with conventional antithrombotic agents, NAC demonstrates a superior safety profile, even in hemorrhagic stroke models, making it a promising therapeutic candidate for acute ischemic stroke. Moreover, NAC exhibits antioxidant, anti-inflammatory, and neuroprotective effects that support neuronal recovery and improve functional outcomes. Therefore, intravenous NAC may provide dual benefits—as an effective, safe, and affordable thrombolytic and neuroprotective agent—particularly in populations with limited access to rtPA. Keywords: N-acetylcysteine, von Willebrand factor, thrombolytic, neuroprotectant, acute ischemic stroke

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