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Acta Neurologica Indonesia
Published by Universitas Indonesia
ISSN : -     EISSN : 30326303     DOI : https://doi.org/10.69868/ani.v2i02
Core Subject : Health, Science,
Medicine & Pharmacology Neuroscience Public Health
Acta Neurologica Indonesia is the official publication of the Department of Neurology, Faculty of Medicine, Universitas Indonesia under Directorate of Administration, Data, and Product Management of Research and Innovation Universitas Indonesia. This journal is published in trimonthly cycle with e-ISSN: 3032-6303. The Journal aims for continuous dissemination of updates in relation to neurology and its related fields in the form of original articles, case reports and reviews.
Arjuna Subject : Kedokteran - Neurologi Klinis
Articles 37 Documents
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Spinal Cord Compression Due to Intradural Extramedullary Hematopoiesis in a Young Adult with Cooley’s Anemia Taufik Mesiano; Al Rasyid; Mohammad Kurniawan; Rakhmad Hidayat; David Pangeran; Anna Mira Lubis; Mohamad Saekhu; Kevin Gunawan; Stefanie Karina Putri; Arizari Haj Rahmana; Salim Harris
Acta Neurologica Indonesia Vol. 1 No. 01 (2023): Acta Neurologica Indonesia
Publisher : Departemen Neurologi Fakultas Kedokteran Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.69868/ani.v1i01.4

Abstract

Cooley's anemia, also known as beta thalassemia major, is an inherited multisystemic disorder characterized by skeletal and non-skeletal complications resulting from hemoglobinopathies. Extramedullary Hematopoiesis (EMH) is a complication of thalassemia major due to insufficient erythropoiesis expansion. The incidence rate of paraspinal EMH in beta-thalassemia is rare but tends to be on the rise. We present a case of spinal cord compression due to intradural EMH in a 21-year-old man with Beta Thalassemia major, who exhibited acute lower motor, sensory, and autonomic disorder, along with severe anemia, and electrolyte imbalance. Patients were treated with corticosteroids, blood transfusions, electrolyte correction and pain medications. Several days later, the patient experienced clinical improvement in reduced pain and motor improvement. The patient was planned to undergo elective surgery and radiotherapy after reaching the stabilized condition. Management options of spinal cord compression due to EMH include corticosteroids, adequate blood transfusion, hydroxyurea, radiotherapy, surgical decompression, exchange transfusion, or a combination of these approaches. The choice of therapy should be based on the patient's clinical condition, diagnostic evaluations, and the size of the mass exerting pressure on the spinal cord. The optimal management of EMH remains uncertain. We need further research to establish effective treatment strategies of spinal cord compression due to EMH in Cooley’s Anemia.
Nosocomial COVID-19 Infection in Acute Neurological Diseases at the Indonesian National Referral Hospital Taufik Mesiano; Dyah Tunjungsari; Astri Budikayanti; Yetty Ramli
Acta Neurologica Indonesia Vol. 1 No. 01 (2023): Acta Neurologica Indonesia
Publisher : Departemen Neurologi Fakultas Kedokteran Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.69868/ani.v1i01.6

Abstract

Introduction: Neurological diseases elevate the susceptibility to respiratory tract ailments. This study aims to evaluate the incidence of nosocomial coronavirus disease 2019 (COVID-19) among non-COVID neurology inpatients and identify associated risk factors. Objective: To assess nosocomial COVID-19 infection in non-COVID neurology inpatients and identify associated risk factors. Material and Methods: A prospective cohort study was conducted during the initial wave of the COVID-19 pandemic, encompassing all non-COVID neurology inpatients at Dr. Cipto Mangunkusumo Hospital from May to September 2020. Clinical data were collected, and bivariate and multivariate analyses were employed to examine risk factors. Result and Discussion: Among 308 subjects, 31 (10.6%) experienced nosocomial COVID-19 infection. Suspect cases constituted 77.4%, probable cases 16.1%, and confirmed cases 6%. Predominant neurological diseases included cerebrovascular disease (36.7%), CNS neoplasm (18.8%), and traumatic brain injury (15.6%). Comorbid diseases increased the infection risk by 6.53 times (95% CI 1.52-28.0), particularly non-CNS malignancy (12.37, 3.7-41.00), chronic pulmonary TB (12.29, 2.7-55.89), and hypertension (3.8, 1.3-11.4). Loss of consciousness and nasogastric tube (NGT) usage elevated the risk by 2.92 (1.37-6.21) and 4.68 (1.95-11.24) times. This study reinforces existing evidence that hospitalized patients with neurological diseases are more susceptible to COVID-19, particularly due to loss of consciousness and NGT usage. The risk is amplified with comorbidities such as non-CNS malignancy, chronic pulmonary TB, and hypertension. Conclusion: Individual neurological diseases alone did not heighten the risk of COVID-19 infection. Notably, factors like loss of consciousness, NGT usage, and comorbid diseases significantly correlate with nosocomial COVID-19 infection in non-COVID neurology inpatients.
Factors Affecting Progonosis in Tuberculous Meningoencephalitis Vivien Puspitasari; Anyeliria Sutanto; Reza Stevano; Gerald Djuanda
Acta Neurologica Indonesia Vol. 1 No. 01 (2023): Acta Neurologica Indonesia
Publisher : Departemen Neurologi Fakultas Kedokteran Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.69868/ani.v1i01.7

Abstract

Introduction: Cases of tuberculosis is still highly prevalent in the world, including Indonesia.Tuberculous meningoencephalitis (TBME) is the most severe form of tuberculosis. This study aims to establish the factors affecting prognosis in TBME. Objective: To Identify the clinical factors that affect the prognosis of tuberculous meningoencephalitis patients. Material and Methods: This is cross-sectional study evaluating factors (clinical features, imaging, and treatment) affecting prognosis in TBME patients who underwent treatment in Siloam Hospitals Lippo Village. Univariate analyses was done, followed by bivariate analyses with logistic regression to compare factors between good (Glasgow outcome scale [GOS] 4-5) and poor (GOS 1-3) prognosis. Results and Discussion: 64 patients were included. On univariate analysis, significant differences was found between Glasgow coma scale (GCS) scores (p=0.012), clinical features of meningeal irritation (p=0.004), findings of hydrocephalus (p=0.023) and vasculitis/infarction (p=0.020) on imaging, antibiotic use (p=0.013), and MRC grading (p=0.008). On logistic regression, 4 factors were found to be significant: headache (OR 5.398 95% CI 1.165-25.008, p=0.031), meningeal irritation (OR 0.146 95% CI 0.026-0.813, p=0.028), hydrocephalus (OR 0.167 95% CI 0.032-0.881, p=0.035), and antibiotic use (OR 0.155 95% CI 0.034-0.717, p=0.017). Conclusion: Clinical manifestations of meningeal irritation and altered consciousness, imaging findings of hydrocephalus and vasculitis/infarction, and antibiotic usage is associated with poor prognosis, while presence of headache is associated with a better prognosis.
Hemorrhagic Stroke as the Manifestation of Neuropsychiatric Systemic Lupus Erythematosus Mohammad Kurniawan; Ilham Nurdin; Al Rasyid; Taufik Mesiano; Rakhmad Hidayat; Salim Harris
Acta Neurologica Indonesia Vol. 1 No. 01 (2023): Acta Neurologica Indonesia
Publisher : Departemen Neurologi Fakultas Kedokteran Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.69868/ani.v1i01.8

Abstract

Stroke is a major cause of mortality and disability. It can be classified into ischemic stroke and hemorrhagic stroke. Systemic Lupus Erythematosus (SLE) is a systemic autoimmune disease that can cause neuropsychiatric systemic lupus erythematosus (NPSLE) complications, one of those manifests as stroke, which happens often in young adults. Ischemic stroke is more common in SLE patient, but hemorrhagic stroke can also ensue. We present a case of SLE in a young woman with left-sided hemiparesis and convulsion. After undergoing clinical evaluation, laboratory testing, and radiological imaging, she was diagnosed with hemorrhagic stroke. She was treated conservatively; blood pressure control, steroid administration to improve the condition, and anticonvulsants.
Optimizing Stroke Care in Indonesia: A Policy Brief on Expanding Access to Thrombolysis for Improved Outcomes Rakhmad Hidayat; Siti Pujiwati Permata Rima; David Pangeran; Taufik Mesiano; Mohammad Kurniawan; Al Rasyid; Salim Harris
Acta Neurologica Indonesia Vol. 1 No. 01 (2023): Acta Neurologica Indonesia
Publisher : Departemen Neurologi Fakultas Kedokteran Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.69868/ani.v1i01.12

Abstract

Recurrent Intracerebral Hemorrhage as a Result of Cerebral Amyloid Angiopathy Mohammad Kurniawan; Dhara Ayu Lestari; Salim Harris; Al Rasyid; Taufik Mesiano; Rakhmad Hidayat
Acta Neurologica Indonesia Vol. 1 No. 01 (2023): Acta Neurologica Indonesia
Publisher : Departemen Neurologi Fakultas Kedokteran Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.69868/ani.v1i01.13

Abstract

Stroke is a major health problem in the world with high mortality dan morbidity rate. Hemorrhagic stroke is a type of stroke with a high mortality rate. One of the most common causes of hemorrhagic stroke in elderly is cerebral amyloid angiopathy. We present a case of recurrent hemorrhagic stroke with clinical manifestations of extremity weakness and seizure. Radiological imaging showed a lobar hemorrhage. Referring to the Boston criteria, based on the results of clinical evaluation and imaging, the patient was diagnosed with intracerebral hemorrhage et causa probable CAA without pathologic feature was established. Patients were treated with antihypertensive medicine for blood pressure control and steroid as anti-inflammatory agents with a good clinical and functional outcome.
Role of Visual Evoked Potential in Direct Traumatic Optic Neuropathy: A Case Report : VEP in Direct TON Aurelia Vania; I Komang Arimbawa; Ni Made Dwita Pratiwi
Acta Neurologica Indonesia Vol. 2 No. 01 (2024): Acta Neurologica Indonesia
Publisher : Departemen Neurologi Fakultas Kedokteran Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.69868/ani.v2i01.16

Abstract

Traumatic optic neuropathy (TON) is a rare cause of visual impairment following blunt or sharp trauma and the diagnosis is established clinically. Lesions on the optic nerve may not always be visible in neuroimaging examinations. Studies on Visual Evoked Potential (VEP) in TON patients are still limited, despite being beneficial for objectively detecting optic nerve lesions. A 16-year-old male patient was referred to the neurology clinic with a sudden loss of vision in the left eye approximately 25 days after a head injury due to a motor vehicle accident. The patient had epidural bleeding and fractures in the orbital and facial bones, as revealed by a head CT scan. Neurological examination showed a visual acuity of 1/300 in the left eye, left midriasis, and a negative light reflex in the left eye. VEP examination of the left eye revealed prolonged P100 latency and a decrease in P100 amplitude (>50%), indicating a lesion in the left optic nerve. This visual impairment persisted for up to 6 months post-head trauma. TON is a vision-threatening disorder that should be considered in patients with ocular or head trauma and visual impairment. A decrease in amplitude ratio <50% and prolonged P100 latency >140 ms are associated with poor visual function recovery. VEP examination is an objective assessment of visual pathway integrity and serves as one modality for early TON diagnosis and a predictor of visual function prognosis in TON patients.   Keywords: diagnostic; prognostic; traumatic optic neuropathy; visual evoked potential
Association Between Brain Atrophy with EDSS and Number of Lesion Sites in Indonesian Multiple Sclerosis Patients Riwanti Estiasari; Salsabila Firdausia; Rahmad Mulyadi; Reyhan Eddy Yunus; Kartika Maharani; Darma Imran
Acta Neurologica Indonesia Vol. 2 No. 01 (2024): Acta Neurologica Indonesia
Publisher : Departemen Neurologi Fakultas Kedokteran Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.69868/ani.v2i01.17

Abstract

Introduction : Multiple sclerosis (MS) is a potentially disabling inflammatory demyelination of the central nervous system. The demyelination process will end up with the destruction of neurons that leads to the decrease of brain volume. Brain atrophy may cause more severe disability and affect the quality of life of MS patients, who are mostly at a young age. Objective : Our study aims to assess the brain atrophy among Indonesian MS patients and the association between with the degree of disability. Material and methods : A cross-sectional study included 28 MS patients. To determine the brain atrophy, we compared 11 healthy control group to the MS group. Head MRI was performed using 1.5T MRI and the brain volume was processed with Freesurfer type 6.0 automatic software. Result : The white matter (WM) and gray matter (GM) volume of MS patients was significantly lower compared to normal control with 78.6% GM atrophy and 67.9% WM atrophy. EDSS score is significantly associated with WM atrophy but not with GM atrophy. Factors related to WM atrophy is age, age of onset, and subtype of MS. A number of lesion sites were found greater in subjects with GM and WM atrophy. Discussion : The mechanisms of brain atrophy in MS involve inflammatory processes and neurodegeneration. Various factors, including lesion volume impact atrophy rates. Brain atrophy had correlation with EDSS scores. Conclusion : Brain atrophy was common in MS patients and significantly associated with the level of disability and number of lesion sites.
The Comorbidity Profile of Neurological Disease in Elderly in the Taman Sari Public Health Center from January to December 2023 Ika Yulianti; Syairah Banu
Acta Neurologica Indonesia Vol. 2 No. 02 (2024): Acta Neurologica Indonesia
Publisher : Departemen Neurologi Fakultas Kedokteran Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.69868/ani.v2i02.18

Abstract

Background: The burden of neurological diseases in elderly patients is often underestimated. Therefore, our study aimed to investigate the comorbidity profile of NDs in patients aged 60 years or older at the Taman Sari Public Health Center. Method: This was a retrospective, descriptive study with a cross-sectional design. The data were collected from medical records (e-puskesmas) and SIPTM (Non-Communicable Diseases Surveillance Information System) at the Taman Sari Public Health Center from January to December 2023. The study focuses on patients diagnosed with chronic diseases who also have comorbidities of NDs. Result: Analysis was conducted on 803 individuals, including 382 males and 421 females which revealed that 68.4% of the participants had polyneuropathy, 26.8% were diagnosed with cerebrovascular disease, 2.1% had CNS infection, 1.1% had CNS metabolic disorders, 1.6% of patients exhibited symptoms of dementia. Discussion: The study has shown that polyneuropathy is a prevalent issue, with cerebrovascular diseases exhibiting intermediate to high levels of patient comorbidity. CNS infection with tuberculosis meningitis is the leading cause of CNS infection. Furthermore, metabolic diseases can cause CNS metabolic disorders, while dementia is often associated with patient comorbidity, which significantly influences its clinical progression. Conclusion: Understanding the comorbidity profile of neurological diseases in elderly patients at the Taman Sari District Health Center could improve patient care management and lead to better outcomes.
Case Series: Risk and Clinical Manifestation of Non-Convulsive Status Epilepticus After Traumatic Brain Injury Yetty Ramli
Acta Neurologica Indonesia Vol. 2 No. 01 (2024): Acta Neurologica Indonesia
Publisher : Departemen Neurologi Fakultas Kedokteran Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.69868/ani.v2i01.20

Abstract

Traumatic brain injury occurs due to impacts on the head or penetrating injuries that result in damage to the brain. Traumatic brain injury can lead to complications, including post-traumatic seizures. Seizures following traumatic brain injury (TBI) present a complex interplay of various risk factors and determinants that significantly impact clinical outcomes and patient management, especially in non-convulsive status epilepticus. Non-convulsive status epilepticus (NCSE) is an underrecognized complication following traumatic brain injury (TBI), with potentially severe consequences for patient outcomes. Factors contributing to NCSE development include level of consciousness, injury severity, and cortical involvement. Clinical presentation is often subtle, ranging from altered mental status to focal neurological deficits. Early recognition through EEG monitoring is crucial, guiding targeted antiepileptic therapy to mitigate neuronal injury and improve outcomes Understanding these risk factors and clinical manifestations are crucial for effective surveillance, early intervention, and tailored treatment strategies aimed at mitigating the burden of seizures and improving the long-term prognosis of individuals with TBI.

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