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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 68 Documents
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Primary Spontaneous Brainstem Hemorrhage Leading to Sudden Cardiopulmonary Death: A Case Report Inonu, Vanessa Faradise
Acta Neurologica Indonesia Vol. 3 No. 04 (2025): Acta Neurologica Indonesia
Publisher : Departemen Neurologi Fakultas Kedokteran Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.69868/ani.v3i04.60

Abstract

Introduction : Brainstem hemorrhage refers to bleeding that occurs in the pons, pontomedullary junction, pontomesencephalic junction, midbrain, and medulla oblongata. It is an uncommon form of intracerebral hemorrhage, with a prevalence of 5-10% in Indonesia, but it is associated with high mortality due to its critical location affecting vital functions. Case Report : A 57-year-old man, without significant personal or family medical history, presented at a private hospital with a severe headache. Initially, he was conscious, with normal blood pressure and a suspected diagnosis of stroke with 12th cranial nerve paresis. Within hours, his condition deteriorated rapidly, progressing to unconsciousness, coma, and cardiopulmonary death within four hours of admission. Computed tomography revealed a brainstem hemorrhage. Discussion : Primary Spontaneous Brainstem Hemorrhage (PBSH) is a rare but fatal form of stroke, often associated with hypertension, age, and personal living habits. However, in this case, no significant risk factors were identified except for age. The rapid deterioration from full consciousness to death highlights the aggressive nature of PBSH. Factors such as low Glasgow Coma Scale (GCS), tachycardia, hypotension, and the need for mechanical ventilation significantly contribute to poor outcomes. Brainstem hemorrhage leads to respiratory and vasomotor dysfunction, which can cause sudden death. Prompt management of respiratory and circulatory functions is crucial to improve survival chances. Conclusion : PBSH has a low incidence but high mortality, often leading to sudden death. Early detection and aggressive management of respiratory and circulatory complications are essential in preventing fatal outcomes.
Dilemmatic Intersection in Cryptococcal Meningitis Treatment: Side Effects, Drug Resistance, and Efficacy Japutri, Josephine; Lalisang , Lilie; Sutanto, Anyeliria
Acta Neurologica Indonesia Vol. 3 No. 04 (2025): Acta Neurologica Indonesia
Publisher : Departemen Neurologi Fakultas Kedokteran Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.69868/ani.v3i04.64

Abstract

Background Fluconazole resistance in Cryptococcus neoformans is progressively increasing over the past 10 years, particularly in developing countries, which reached 43.6% resistance rate. This case demonstrates the emerging dilemma of cryptococcal meningitis management with antifungal resistance. Case Summary A 31-year-old male with HIV presented with severe headache, hearing loss, and fever. Brain imaging was within normal limits, and CSF analysis showed increased cell count (86, PMN 10, MN 76), elevated protein, glucose ratio <0.4, positive India ink, and positive Cryptococcus Ag, leading to a diagnosis of cryptococcal meningitis. He was treated with IV Amphotericin B for 14 days and Fluconazole, but developed acute kidney injury (AKI), delaying further fluconazole therapy. One month later, he returned with severe headache; CSF re-analysis showed positive Cryptococcus culture and fluconazole resistance. The patient was treated again with IV Amphotericin B for 14 days. Discussion Azole resistance in Cryptococcus spp is associated with ERG11 gene mutation which is the fluconazole’s target. Interruption of fluconazole in cryptococcal meningitis during the theraphy phase could be the risk factor for acquired resistance. The minimum inhibitory concentrations (MIC) test can help in the selection of therapy with Cryptococcus breakpoint for fluconazole susceptibility is MIC < 8 μg/mL. In previous cases, itraconazole and voriconazole were proven to replace fluconazole. However, in this case, there were limitations in costs and treatment coverage. Conclusion Drug evaluation in parallel with treatment in Cryptococcal meningitis, with prior fluconazole use or delayed therapy, is recommended. Keywords: Cryptococcal Meningitis, HIV, Fluconazole resistance
Potential Utilization of Modified Multitarget CAR-T Cells as an Advanced Immunotherapy for Glioblastoma: A Systematic Review Elysia Gita Pascadea; Diondra Eka Rizkiawan
Acta Neurologica Indonesia Vol. 3 No. 04 (2025): Acta Neurologica Indonesia
Publisher : Departemen Neurologi Fakultas Kedokteran Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.69868/ani.v3i04.69

Abstract

Introduction: Glioblastoma (GBM) is the most common and aggressive malignant brain tumor, characterized by high morbidity and mortality. Standard treatments—surgery, radiotherapy, and chemotherapy—are often ineffective due to tumor heterogeneity and recurrence. Immunotherapy, particularly chimeric antigen receptor T (CAR-T) cell therapy, has emerged as a promising alternative. This systematic review evaluates the potential of modified multitarget CAR-T cells in addressing GBM’s challenges. Material and methods: A systematic review was conducted following PRISMA 2020 guidelines. Searches in PubMed, ScienceDirect®, ProQuest, EBSCOhost®, SAGE®, ClinicalKey®, and Scopus focused on studies from the past decade. Data were analyzed to assess the efficacy, safety, and feasibility of multitarget CAR-T therapies. Of 1,512 identified studies, 11 met the inclusion criteria. Findings indicate multitarget CAR-T cells enhance tumor recognition and immune activation, reducing immune evasion. CAR-T designs targeting EGFRvIII, IL13Rα2, HER2, and GD2 exhibited improved cytotoxicity, eradicated tumors, demonstrated long-term memory response, and were able to achieved complete tumor clearance. Studies found that CAR-T cells therapy in GBM enhanced tumor suppression and prolonged survival in glioblastoma patients. Discussion: Originally developed for hematologic malignancies, CAR-T therapy is expanding to GBM by targeting tumor-associated antigens (TAAs) like CEA, GPC-3, MUC1, VEGFR2, EGFRvIII, IL13Rα2, HER2, and GD2. However, challenges such as the immunosuppressive tumor microenvironment (TME), antigen loss, and limited tumor penetration hinder efficacy. Strategies like multitarget CAR-T cells, immune checkpoint inhibition, and localized delivery methods may improve outcomes. Conclusion: CAR-T therapy holds potential for GBM treatment, but further research is required to enhance its effectiveness and clinical applicability.
Evaluating Brivaracetam As An Adjunctive Therapy For Refractory Focal Onset Seizure: A Meta-Analysis Chandra Kusuma, Hendrawan; Isadora, Eugenia; Putra, Aditya; Kurniawan Sindaka, Jonathan
Acta Neurologica Indonesia Vol. 3 No. 03 (2025): Acta Neurologica Indonesia
Publisher : Departemen Neurologi Fakultas Kedokteran Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.69868/ani.v3i03.70

Abstract

Background: This study evaluated the safety, tolerability and effectiveness of Brivaracetam (BRV) as an adjunctive therapy for managing focal-onset seizures that are uncontrolled by primary antiseizure medications (ASMs). Method: This review systematically incorporated studies from databases including PubMed, ProQuest, The Lancet, EBSCO and the Cochrane Library. Study quality was assessed using the Cochrane Risk of Bias 2 tool. Meta-analysis was conducted with Review Manager 5.4. Result: Seven studies were included, with five qualifying for meta-analysis involving 2,486 patients taking BRV alongside one or more AEDs. The pooled risk ratios for a 50% reduction in seizure frequency and complete seizure freedom were 1.83 (95% confidence interval of 1.60 to 2.08) and 7.52 (95% confidence interval of 3.59 to 15.75), respectively. In terms of safety, the use of adjunctive BRV was linked to significantly higher rates of somnolence (p<0.00001), dizziness (p=0.0001), and fatigue (p=0.0002), along with other drug-related treatment-emergent adverse effects (TEAEs) such as headache, irritability and nausea. There was no significant difference (p>0.05) between the two groups regarding serious adverse effects (SAEs) or the number of patients who withdrew from the study due to drug-related TEAEs or SAEs. Discussion: Adjunctive BRV (50-200 mg daily) notably enhanced efficacy outcomes compared to placebo. While mild to moderate side effects occurred, there were no significant differences in SAEs and withdrawal rate, indicating a favorable safety and tolerability profile that aligns with other adjunctive ASMs. Conclusion: BRV (50–200 mg) is favourable adjunctive therapy for uncontrolled focal-onset seizures.
Multiple Intracerebral Hemorrhage as a Possible Presentation of Churg-Strauss Syndrome: A Rare Case Report Prameswari, Dyandra; Ng, Peter
Acta Neurologica Indonesia Vol. 4 No. 02 (2026): Acta Neurologica Indonesia
Publisher : Departemen Neurologi Fakultas Kedokteran Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.69868/ani.v4i02.71

Abstract

Introduction Churg-Strauss syndrome (CSS) is a rare small-to-medium vessel vasculitis, associated with asthma, eosinophilia, and systemic inflammation. While peripheral nerve involvement is common in CSS, central nervous system (CNS) involvement is rare, with cerebral infarction and encephalopathy being the most frequent. Here, we report a rare case of multiple intracerebral hemorrhage (ICH) thought to be associated to CSS.   Case Report A 26-year-old woman with history of asthma and allergic rhinitis presented with an acute headache, worsening a day before admission, accompanied by nausea, vomiting, low-grade fever, and arthralgias. Further investigations revealed multiple cerebral hemorrhage with perifocal edema and partial sulcal enhancements bilaterally. Cerebrospinal fluid (CSF) analysis showed eosinophilic pleocytosis, with elevated Immunoglobulin E (IgE) in the blood test, suggesting cerebral vasculitis by CSS manifested in ICH. Treatment with corticosteroids and immunosuppressant was initiated, leading to a favorable outcome.   Discussion CSS is a rare systemic disorder characterized by multi-organ vasculitic involvement, though rare, CNS involvement was reported in 6–10% and ICH in association of CSS is extremely rare. The exact mechanism of CSS related cerebral bleeding remains unclear, but may result from cerebral vasculitis (indicated by raised inflammatory markers or eosinophilia), as seen in our patient.   Conclusion This case highlights that, although rare, ICH can be a manifestation of CSS-related vasculitis. Therefore, it should be considered as a differential diagnosis of ICH. In this patient, an immunosuppressive treatment using methylprednisolone and azathioprine led to a favorable outcome, emphasizing the importance of prompt intervention to minimize morbidity and mortality.
Persistent Hiccup in Supratentorial Infarction with Global Aphasia: A Case Report Putu, Utamia Suma Masyuni; Vincent Ongko Wijaya; Ni Ketut Ayu Sudiariani
Acta Neurologica Indonesia Vol. 4 No. 02 (2026): Acta Neurologica Indonesia
Publisher : Departemen Neurologi Fakultas Kedokteran Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar

Abstract

ABSTRACTIntroductionA persistent hiccup is an involuntary contraction involving the diaphragm and intercostal muscle that lasts more than 2 days until a month. This condition is often associated with cerebrovascular infarction in the brainstem region. In contrast, persistent hiccup related to ischemic stroke in the supratentorial region was rarely reported. Here, we describe a patient with a persistent hiccup accompanied by global aphasia in acute supratentorial infarction. Case Summary A male, 61 years old Balinese, right-handed, was admitted due to palpitation. In the emergency room, the patient developed sudden right-sided weakness and an inability to speak. Neurological examination showed right-sided hemiplegia with muscle strength of 1 and global aphasia. EKG showed Rapid Atrial Fibrillation. Non-Contrast CT-Scan showed acute cerebral infarction within the left middle cerebral artery territory. Afterward, the patient experienced hiccups from the time he was in the emergency unit until he was discharged, and the hiccups lasted for more than 7 days. The patient was treated with anticoagulant and neuroprotectant alongside supportive therapy. The hiccup was treated with oral chlorpromazine. Discussion The central hiccup component is believed to lie in the medulla oblongata. Although the exact mechanism of persistent hiccups is still unclear, global aphasia, which involves a large part of the dominant hemisphere, may provide a new insight into the pathophysiology of hiccups. Conclusion Persistent hiccups may occur in supratentorial lesions with global aphasia, where a large portion of the dominant hemisphere is affected.
Effect of Multiple Transcranial Direct Current Stimulation Sessions on Cognitive Function in Parkinson’s Disease: A Systematic Review Martalia, Violine; Fakhri, Aldithya; Andini, Dheanita Nissrina; Gabrian, Arden; Gabrielle, Aileen; Lestari, Yohana Eka Trisnawawti; Prawiroharjo, Pukovisa
Acta Neurologica Indonesia Vol. 4 No. 02 (2026): Acta Neurologica Indonesia
Publisher : Departemen Neurologi Fakultas Kedokteran Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.69868/ani.v4i02.77

Abstract

Background: Cognitive impairment is a common non-motor symptom of Parkinson’s disease (PD) that significantly affects quality of life. Transcranial direct current stimulation (tDCS), a non-invasive neuromodulation technique, has been proposed to enhance cognitive function in PD. This study systematically reviews the effects of multiple tDCS sessions on cognitive outcomes in PD patients. Methods: A systematic search of PubMed, Cochrane, ScienceDirect, and Medline was conducted in accordance with PRISMA guidelines. Randomized controlled trials (RCTs) assessing the impact of tDCS on cognitive function in PD were included. Study quality was evaluated using the RoB 2 tool. Results: Three RCTs using anodal tDCS over the dorsolateral prefrontal cortex (DLPFC) for 20–25 minutes per session were included. Two studies reported improvements in executive function, attention, memory, and language, with some effects maintained at 3-month follow-up. One study found delayed improvements at 1-month follow-up. However, findings were mixed across studies, especially for memory, language, visuospatial abilities, and global cognition. All studies reported that tDCS was safe and well-tolerated, with only mild, transient side effects. Discussion: Anodal tDCS may enhance specific cognitive functions, particularly executive function and attention, in PD. However, inconsistent findings across studies likely reflect differences in stimulation protocols and outcome measures. Conclusion: While tDCS is a safe intervention, its cognitive efficacy in PD remains uncertain. Methodological variability across studies limits generalizability. Further large-scale RCTs using standardized protocols, consistent cognitive measures, and extended follow-up are needed to clarify the role of tDCS in cognitive rehabilitation for PD.
Ossification Of The Posterior Longitudinal Ligament As A Predisposing Factor In Spinal Cord Injury: A Case Report Tjahaja, Skolastika Beatrice; Congdro, Jessica; Atmadja, Andika Surya
Acta Neurologica Indonesia Vol. 3 No. 03 (2025): Acta Neurologica Indonesia
Publisher : Departemen Neurologi Fakultas Kedokteran Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.69868/ani.v3i03.81

Abstract

Introduction: Ossification of the posterior longitudinal ligament (OPLL) is a risk factor for SCI. It is found during imaging studies in approximately 30% SCI patients. SCI on OPLL patients can lead to neurological morbidity and significant reduction in quality of life if not treated adequately. Case Report: A 35-year-old female fell from the stairs. The head and neck were not hit during the incident, however patient complained of weakness in all extremities, especially in both legs, which was accompanied by tingling and numbness. Patient’s motor strength was 4555/5554+ and 3111/3222. There was also hypoesthesia at C5 level and below. The OPLL was found at level V.C1 through V.Th1, which impinged on thecal sac and spinal cord especially on V.C3 to V.C7. Spinal cord edema was also seen in cervical and lumbar segments. The patient was then given collar neck, intravenous methylprednisolone, and symptomatic treatments. After 1 week of treatment, the patient could stand and walk with assistance. After 2 months of routine physiotherapy, the patient could walk and do activities independently. Discussion: There are several factors affecting OPLL namely genetic, hormonal, and environmental factors. Increase in osteogenesis-triggering growth factors is also frequently found in OPLL patients. OPLL patients have higher risk of getting SCI during trauma. Pharmacology treatment can be combined with physiotherapy, orthosis usage, or surgery. Conclusion: Patients with OPLL are at risk of experiencing more severe symptoms in SCI events. Appropriate therapy and management of SCI in OPLL can improve patient morbidity rates. Keywords: SCI; OPLL; myelopathy
Sterile Subdural Empyema Secondary to Submandibular Abscess: A Case Report Khansa, Amany; Geraldi, Iskandar Purba; Fadli, Nurul
Acta Neurologica Indonesia Vol. 3 No. 03 (2025): Acta Neurologica Indonesia
Publisher : Departemen Neurologi Fakultas Kedokteran Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.69868/ani.v3i03.82

Abstract

Introduction: Subdural empyema is a rare, serious condition characterized by the accumulation of pus in the space between the dura mater and the arachnoid mater. One of the rare causes is odontogenic infection. This case report discusses a sterile subdural empyema as a complication of a submandibular abscess. Case: A 46-year-old man presented with loss of consciousness, seizure, fever, and swelling of the right lower jaw. Three months earlier, he had undergone an extraction of his lower right tooth. A CT scan of the patient's head showed a crescent-shaped hypodense lesion in the right parietotemporooccipital region and a hypodense lesion with an enhancing edge in the submandibular area. A buccal incision and drainage procedure and craniotomy were performed. Pus was found in the subdural space. Cultures were taken from blood and both drainage sites, but culture did not show any growth of microorganisms. Meropenem and metronidazole were used as antibiotics. The patient later died due to multiple organ dysfunction syndrome (MODS). Discussion: Subdural empyema is an infectious condition caused by hematogenous spread, direct spread of surrounding tissue, and venous or lymphatic spread. One rare cause is odontogenic infection. The main treatment includes surgical intervention and antibiotic therapy. Infection is generally polymicrobial. Previous antibiotic administration or inappropriate culture medium can cause negative culture. Conclusion: Subdural empyema can arise from odontogenic infection. Therefore, rapid and appropriate identification and treatment are essential to prevent intracranial complications and reduce mortality and morbidity. Keywords: subdural empyema; odontogenic infection complications; intracranial infection
Epilepsy As A Rare Intracranial Complication of Pansinusitis: A Case Series Samudra, Edeline; Ketaren, Retno Jayantri
Acta Neurologica Indonesia Vol. 4 No. 01 (2026): Acta Neurologica Indonesia
Publisher : Departemen Neurologi Fakultas Kedokteran Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar

Abstract

Introduction: Epilepsy is a condition characterized by recurrent and unpredictable seizures with an underlying mechanism that remains incompletely understood. A hallmark feature is over-synchronized neuronal discharge due to the loss of inhibitory control over glutamatergic neurons, with neuroinflammation being a potential contributing factor. Case Report: We report two cases of epilepsy in patients with a history of pansinusitis. A 14-year-old male experienced a first-onset generalized seizure, while a 23-year-old female presented with recurrent focal-to-bilateral seizures. CT scans revealed pansinusitis, predominantly affecting the bilateral frontal sinuses with bilateral ostiomeatal complex blockage in one patient, and the maxillary sinuses with an open bilateral ostiomeatal complex in the other patient. No evidence of intracranial infection or other epilepsy causes were found, suggesting epilepsy as an intracranial complication (IC) of pansinusitis. One patient was managed with medication, while the other underwent functional endoscopic sinus surgery. (FESS), revealing sinonasal polyps on histology. Discussion: ICs, including epilepsy, are rare but serious complications of pansinusitis and can lead to disabling neurological sequelae. The most common source of IC is frontal sinusitis, followed by ethmoid, sphenoid, and maxillary sinusitis. ICs occur via direct infection spread through dehiscent bone or through natural pathways, such as the olfactory foramina. Neuroinflammation can activate microglia and trigger reactive astrogliosis, leading to inflammatory cascades, neurotransmitter imbalances, and ion channel dysfunction. Conclusion: We have presented rare cases of epilepsy as an IC of pansinusitis, highlighting the need for thorough evaluations in epilepsy patients without known intracranial infections, including investigations for other potential infectious sources.

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