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MNJ (Malang Neurology Journal)
Published by Universitas Brawijaya
ISSN : 24076724     EISSN : 24425001     DOI : -
Core Subject : Science,
Neuroscience
Malang Neurology Journal 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 welcome.
Arjuna Subject : -
Articles 278 Documents
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VASCULAR PARKINSONISM WITH EARLY COGNITIVE IMPAIRMENT: A CASE REPORT AND LITERATURE REVIEW Tertia, Clarissa; Trisnawati, Sri Yenni; Widyadharma, I Putu Eka; Samatra, Purwa
MNJ (Malang Neurology Journal) Vol. 10 No. 2 (2024): July
Publisher : PERDOSSI (Perhimpunan Dokter Spesialis Saraf Indonesia Cabang Malang) - Indonesian Neurological Association Branch of Malang cooperated with Neurology Residency Program, Faculty of Medicine Brawijaya University, Malang, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mnj.2024.010.02.16

Abstract

Introduction: Vascular parkinsonism has a prevalence 4.4% to 12% of parkinsonism. Until now there are no specific diagnostic criteria to establish diagnosis of vascular parkinsonism, so it is often misdiagnosed with idiopathic parkinsonism. Case Report: Male, 82 years old, with gait disorder 3 years ago, appeared stiff with small steps. The patient appears to be slower, drooling frequently, and has difficulty swallowing food. The patient was diagnosed with Parkinson's disease and given levodopa/benserazide. However, the progress of the disease was getting worse, so the dose was increased. Since 2 years, patient became forgetful and more irritable. History of ischemic stroke 3 years ago with no sequelae. History of hypertension and gout arthritis (GA). Patient was compos mentis without signs of focal deficit or lateralization, however, there was a cogwheel-type rigidity in all extremities without any tremor. MoCA-Ina (Montreal Cognitive Assesment Indonesian Version) test was 21. The head CT (Computer Tomography) scan revealed chronic lacunar infarct with brain atrophy and small vessel ischemic changes. Then patient was diagnosed with vascular parkinsonism and treated with levodopa, acetosal, candesartan and consulted to medical rehabilitation department. Discussion: Based on criteria of Zijlmans et al., and Winikates and Jankovic, patient is included in vascular parkinsonism, namely the presence of bradykinesia, rigidity and postural instability which indicates a parkinsonism accompanied by 3 vascular scores. Conclusion: Diagnosis of vascular parkinsonism is very complex and challenging. Multidisciplinary management from neurologists and medical rehabilitation specialists must be applied to improve the quality of life, reduce morbidity and mortality.
ANGIOPLASTIC STENOSIS IN SPONTANEOUS BILATERAL CAROTIC ARTERY DISSECTION: A CASE REPORT Subandi, Subandi; Danuaji, Rivan; Suroto, Suroto; Mirawati, Diah Kurnia; Budianto, Pepi; Hambarsari, Yetty; Hamidi, Baarid Luqman; Prabaningtyas, Hanindia Riani; Hutabarat, Ervina Arta Jayanti; Ristinawati, Ira; Tejomukti, Teddy; Tedjo, Raden Andi Ario; Santosa, Novian Anindito; Putra, Stefanus Erdana; Hafizhan, Muhammad
MNJ (Malang Neurology Journal) Vol. 10 No. 1 (2024): January
Publisher : PERDOSSI (Perhimpunan Dokter Spesialis Saraf Indonesia Cabang Malang) - Indonesian Neurological Association Branch of Malang cooperated with Neurology Residency Program, Faculty of Medicine Brawijaya University, Malang, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mnj.2024.010.01.20

Abstract

Case: A 28-years-old woman presented with sudden right extremities weakness, right sided facial droop, and not being able to speak. On examination, the patient had upper motor neuron (UMN) hemiplegia and motor aphasia. On blood laboratory, we found D-dimer level of 1068 ng/dl. A non-contrast head CT-scan and CT-angiography showed left cerebral hemisphere infarction, and bilateral carotid artery stenosis. Further investigation with transcranial Doppler demonstrated partial stenosis of internal carotid artery (ICA). On cerebral digital subtraction angiography (DSA), we observed pseudoaneurysm on the right ICA and flame-shaped appearance on the left ICA, both are common radiological finding of ICA dissection. Then we performed stenting angioplasty on bilateral ICA to provide recanalization, and aspirin 80mg q.d. and clopidogrel 75mg q.d. was initiated. Conclusion: Spontaneous dissection of the carotid artery can occur on young adults. DSA is considered as the gold standard for vascular examination, and stenting with angioplasty was performed for recanalization to prevent the progression to severe stroke.
AUTOIMMUNE ENCEPHALITIS: DIAGNOSTIC AND TREATMENT APPROACH Hamdani, Ismi Adhanisa; Agustina, Lydia; Sasongko, Hari Andang; Gaharu, Maula Nuruddin; Rachmatullah, Fahmi; Ghufira, Nanda; Stevany, Nabila; Pawestri, Natasya Rahma Dewi; Fatahuddin, Rahaliya Salsabila; Natasya, Natasya
MNJ (Malang Neurology Journal) Vol. 10 No. 2 (2024): July
Publisher : PERDOSSI (Perhimpunan Dokter Spesialis Saraf Indonesia Cabang Malang) - Indonesian Neurological Association Branch of Malang cooperated with Neurology Residency Program, Faculty of Medicine Brawijaya University, Malang, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mnj.2024.010.02.13

Abstract

Autoimmune encephalitis is a type of brain inflammation induced by an inappropriate immune response to a neuronal antigen, resulting in the generation of autoantibodies. Autoimmunity as important cause of encephalitis in recent years has not been much reported in Indonesia. Increased familiarity with autoimmune encephalitis among physician, not only neurologist, is extremely important for early detection. Prompt diagnosis and early immunotherapy leads to better prognosis in this potentially treatable disease, despite a long disease course. Autoimmune encephalitis is characterized by acute-subacute progressive neuropsychiatric symptoms with associated cognitive dysfunction, encephalopathy, psychiatric disorders, movement disorders and seizures, with anti-N-methyl-D-aspartate (NMDA) receptors encephalitis as the most common type. In addition to clinical features, further diagnostic investigations needed are brain magnetic resonance imaging (MRI), electroencephalography (EEG), cerebrospinal fluid (CSF) analysis, and autoantibody testing. Challenges in establishing diagnosis include wide range of clinical symptoms, absence of abnormalities in brain MRI, unspecified EEG findings, negative antibody testing, and limited availability of antibody testing in Indonesia. This literature review discusses the recognition, diagnosis and principle of treatment of autoimmune encephalitis.
A POLYMYOSITIS AFTER mRNA COVID-19 VACCINATION CASE REPORT Özkara Yılmaz, Buket
MNJ (Malang Neurology Journal) Vol. 10 No. 2 (2024): July
Publisher : PERDOSSI (Perhimpunan Dokter Spesialis Saraf Indonesia Cabang Malang) - Indonesian Neurological Association Branch of Malang cooperated with Neurology Residency Program, Faculty of Medicine Brawijaya University, Malang, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mnj.2024.010.02.14

Abstract

Polymyositis is a rare, acquired, and inflammatory muscular disease, which is characterized by the inflammation of muscles and has no known etiology. The autoimmunity created by the vaccine arose from molecular mimicking or directly by vaccine adjuvants. Polymyositis cases were reported after hepatitis B, influenza A (H1N1), tetanus toxoid, and Bacille Calmette-Guerin (BCG) vaccinations. However, no relationship with COVID-19 vaccination has been reported yet. Myositis and dermatomyositis cases have been seen after covid-19 vaccine. m-RNA COVID-19 vaccines might cause abnormal activation of the immune system due to a strong t-cell-mediated immune activation by vaccinesin the present case, without any additional triggering factor, a case diagnosed with polymyositis developing 10 days after the second dose of messenger RNA (mRNA) COVID-19 vaccine is presented. The findings suggest a potential association between mRNA COVID-19 vaccination and the development of polymyositis, prompting further investigation into this rare occurrence.
CASE SERIES: EFFICACY OF THROMBOLYSIS USING INTRAVENOUS ALTEPLASE IN ACUTE ISCHEMIC STROKE WITH ONSET LESS THAN 6 HOURS (CODE STROKE) Maskuri, Fajar; Ning Tyas, Humaera Elphananing; Evicennianing Tyas, Rosyida; Wiastuti, Arni; Akhsani, Fathiya; Yudo Pratama, Yanasta
MNJ (Malang Neurology Journal) Vol. 10 No. 2 (2024): July
Publisher : PERDOSSI (Perhimpunan Dokter Spesialis Saraf Indonesia Cabang Malang) - Indonesian Neurological Association Branch of Malang cooperated with Neurology Residency Program, Faculty of Medicine Brawijaya University, Malang, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mnj.2024.010.02.22

Abstract

Background: The gold standard therapy for acute ischemic stroke is timely reperfusion of ischemic brain tissue. Intravenous thrombolysis with tPA is the only proven medical therapy for acute ischemic stroke within 4.5 hours of symptom onset using intravenous alteplase at a dose of 0.9 mg per kilogram of body weight. Hemorrhagic transformation is one of the complications of thrombolytic therapy and East Asian population having a higher prevalence of cerebral hemorrhage. This study will examine several cases of ischemic stroke that were treated with thrombolysis using a standard dose (0.9 mg/kg) of intravenous alteplase in acute ischemic stroke with an onset of less than 6 hours in the Special Region of Yogyakarta, especially at the UGM Academic Hospital. Objective: To determine the efficacy of standard dose thrombolysis using intravenous alteplase (rTPA-recombinant tissue plasminogen activator) in acute ischemic stroke with an onset of less than 6 hours through activation of the Code Stroke. Methods: Descriptive research design using a case series, the hyperacute stroke patients with an onset of less than 6 hours who received intravenous alteplase which were then assessed by the National Institutes of Health Stroke Scale (NIHSS) score at initial admission, 24 hours post-alteplase and 30 days post -alteplase. The study took place and was conducted from May to October 2022 by administering intravenous alteplase at a dose of 0.9 mg/kg body weight in acute ischemic stroke patients at UGM RSA who are eligible for thrombolysis therapy with a maximum administration time of 6 hours after stroke onset with the maximum dose of alteplase is 50 mg. Results: The study sample was 8 patients with acute ischemic stroke who were treated between May to October 2022. There were 2 patients who died before completing the 3-month follow-up. One of the patients died within the second week of treatment from sepsis which may have occurred from a pre-existing pneumonia. Another patient died from ileus that occurred 1 month after tissue plasminogen activator (tPA). However, the patient with this ileus showed clinical improvement at the 24-hour post-tPA follow-up, i.e. the initial NIHSS score of 12 improved to an NIHSS score of 6. Conclusion: The modified Alteplase dose, which is 0.9 mg/kg body weight with a maximum dose of 50 mg, at the onset of stroke less than 6 hours can be an option to maximize thrombolytic therapy while still considering the efficiency of treatment costs.
MAGNETIC RESONANCE IMAGING FINDINGS IN SEIZURE PATIENTS WITH NORMAL NEUROLOGICAL EXAMINATION Ardalani, Ghasem Fatahzadeh; Anari, Hasan; Sadegiyeh-Ahari, Saeed; Rezvanipour, Hossein
MNJ (Malang Neurology Journal) Vol. 10 No. 1 (2024): January
Publisher : PERDOSSI (Perhimpunan Dokter Spesialis Saraf Indonesia Cabang Malang) - Indonesian Neurological Association Branch of Malang cooperated with Neurology Residency Program, Faculty of Medicine Brawijaya University, Malang, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mnj.2024.010.01.5

Abstract

Background: Imaging plays a critical role in the treatment and diagnosis of individuals experiencing seizures, particularly those whose seizures cannot be explained. In various circumstances, CT scans and MRIs (Magnetic Resonance Imaging) are utilized in tandem. Objective: The purpose of this research was to evaluate the MRI findings of patients referred to Alavi Hospital with seizures and a normal neurological examination. Methods: This case-series study examined one hundred patients with epilepsy who underwent normal neurological examinations. All patients' imaging reports were meticulously examined, and any changes were documented in pre-established checklists that comprised of the following: age, gender, family history, EEG (electroencephalogram) results, neurological assessments (including motor, plantar, and tendon reflexes), and MRI findings derived from the patients' files and clinical histories. Result: In the range of 11 to 58 years, the mean age of patients was 7.46 + 32.62 years. Males comprised forty-six (46%) of the patients. In45% of the cases, a familial history of seizures was documented (n=45). Normal EEG results were obtained in 62 cases (62%). Twenty cases (20%) of abnormalities were detected on MRI, seven of which were tumor lesions, as reported by the radiologist. The imaging of the patient's brain revealed no significant correlation between the pathological findings and variables such as age, gender, or family history. No significant correlation was observed between electroencephalogram results and pathological findings on brain imaging in patients with epilepsy. Conclusion: brain imaging partially compensates for the false negatives that occur during electroencephalograms, and concurrently employing both modalities enhances the ability to diagnose underlying issues in patients experiencing seizures.
EVALUATION OF THE OPTIC NERVE IN MIGRAINE PATIENTS BY MAGNETIC RESONANCE IMAGING HISTOGRAM ANALYSIS Kara, Turgay; Dogan, Adil; Baykara, Murat; Yıldız, Cemile Buket Tugan; Tural, Ibrahim Cagri
MNJ (Malang Neurology Journal) Vol. 10 No. 1 (2024): January
Publisher : PERDOSSI (Perhimpunan Dokter Spesialis Saraf Indonesia Cabang Malang) - Indonesian Neurological Association Branch of Malang cooperated with Neurology Residency Program, Faculty of Medicine Brawijaya University, Malang, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mnj.2024.010.01.6

Abstract

Background: Migraine is a chronic, paroxysmal neurovascular primary headache disease seen in approximately 15% of the world. In many studies on migraine, changes in the gray and white matter at the microvascular level have been detected. 90% of patients with aura have visual auras. Histogram analysis is an artificial intelligence application that can detect microscopic pathology in tissues before visual pathology. Objective: Histogram analysis was utilized in our investigation to ascertain whether or not the optic nerve, which is ordinarily visible on magnetic resonance images, was impacted. Methods: 120 adult migraine patients and 120 control group were involved. MRI was performed on a Philips 1.5 Tesla Ingenia device. For histogram analysis, optic nerve region of interest (ROI) measurement was performed in the coronal planes from the edges of the intraorbital segment, whose borders can be clearly distinguished, by using the manual drawing tool for both eyes. The data were analyzed through the MatLab program. Results: The average age of individuals diagnosed with migraine was 37.04 ± 9.57 years, whereas the control group had an average age of 37.8 ± 10.8 years. Between the two groups, 27 distinct parameters computed via histogram analysis were compared. In the control and migraine groups, no statistically significant distinction was observed between the right and left eyes. In contrast to the migraine and control groups, the Mean Local Standard Deviation of the Matrix was found to be The histogram's 5th, 10th, 25th, and 75th percentiles, the average squared, the root sum of squared, the size percent M, the most frequently used value, the median, and the average are all quantified using the root sum of squares. The number of pixels is also indicated. It was determined that ROI values were statistically significant (p0.05). Conclusion: In migraine patients, alterations in the optic nerve, which are typically discernible on conventional magnetic resonance images, may be identified via histogram analysis.
MYASTHENIA GRAVIS WITH FEATURES OF ACUTE PONS INFARCTION: A RARE CASE REPORT Kencana Dewi, Ni Luh Diah; Arimbawa, I Komang; Dwita Pratiwi, Ni Made
MNJ (Malang Neurology Journal) Vol. 10 No. 2 (2024): July
Publisher : PERDOSSI (Perhimpunan Dokter Spesialis Saraf Indonesia Cabang Malang) - Indonesian Neurological Association Branch of Malang cooperated with Neurology Residency Program, Faculty of Medicine Brawijaya University, Malang, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mnj.2024.010.02.19

Abstract

Background: Myasthenia gravis (MG) is an antibody-mediated autoimmune disease at neuromuscular synaptic transmission. The clinical sign of a myasthenia gravis is the presence of weakness that affects vision (ocular), bulbar and proximal skeletal muscles and also myasthenia gravis can resemble vascular disorders or any infectious diseases. Case: A 48-year-old Balinese male patient came to the emergency department of  Prof I.G.N.G Ngoerah Central General Hospital complaining of shortness of breath. Shortness of breath is said to have occurred since one month ago. Shortness of breath improves slightly when the patient rests. Another complaint felt by the patient is that the right eyelid drops, especially during the daytime, will improve in the afternoon. The patient denied any weight loss or a history of malignancy. The patient about three months ago had fallen from a motorcycle and felt numbness in his right cheek until now. The patient has been undergoing treatment at the District General Hospital and he was diagnosed with myasthenia gravis and took Mestinon. CT scan of the head showed an acute infarction of the left pons accompanied by a suspicion of acute meningoencephalitis. Discussion: From the results of the RNS (Repetitive nerve stimulation) in this patient, it was found that the neuromuscular junction lesion was supportive of the description of the myasthenia gravis case. Conclusion: Myasthenia gravis is a disease of the nervous system with various manifestations. Good clinical examination and supporting examination are very necessary to confirm the diagnosis.
HYPERTENSION AS DETERMINANT OF COGNITIVE DYSFUNCTION AMONG ELDERLY SUB-POPULATION Darmaningrat, Cokorda Istri Agung Asvini; Harahap, Herpan Syafii; Anggoro, Joko; Rianawati, Sri Budhi
MNJ (Malang Neurology Journal) Vol. 10 No. 2 (2024): July
Publisher : PERDOSSI (Perhimpunan Dokter Spesialis Saraf Indonesia Cabang Malang) - Indonesian Neurological Association Branch of Malang cooperated with Neurology Residency Program, Faculty of Medicine Brawijaya University, Malang, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mnj.2024.010.02.07

Abstract

Background: Cognitive dysfunction is one of the main impacts of hypertension in the elderly population. Early detection and adequate management of early-stage cognitive dysfunction in hypertensive elderly is expected to improve their cognitive status and quality of life. Objective: This study aimed to determine the association between hypertension and cognitive dysfunction in a sub-population of the elderly in Mataram, Indonesia. Methods: This cross-sectional study involved elderly sub-population recruited consecutively in three public health centers in Mataram, Indonesia. Data included in this study were age, gender, occupation, educational level, hypertension, diabetes mellitus, and cognitive status. Cognitive status was assessed using the Indonesia version of Montreal Cognitive Assessment instrument. Multiple logistic regression analysis was performed to test whether hypertension was a determinant of cognitive dysfunction in participants taking into account the presence of socio-demographic status and diabetes mellitus as another vascular risk factor. Results: This study included 88 elderly as eligible participants. The frequency of cognitive dysfunction among participants was 61.4%. Multiple logistic regression analysis revealed that hypertension was the single variable significantly associated with a high frequency of cognitive dysfunction in elderly sub-population (odds ratio = 3.7; 95% confidence intervals = 1.3 – 10.4; p = 0.014). Conclusion: The frequency of cognitive dysfunction in the elderly sub-population in Mataram was high, amounting to 61.4%. Hypertension was the determinant of this high frequency of cognitive dysfunction in the sub-population studied.
THE EFFECT OF HIGH-INTENSITY FOCUSED ELECTRO-MAGNETIC (HIFEM) THERAPY ON URINARY INCONTINENCE Daryanto, Besut; Kustono, Andri; Negara, Edvin Prawira
MNJ (Malang Neurology Journal) Vol. 10 No. 1 (2024): January
Publisher : PERDOSSI (Perhimpunan Dokter Spesialis Saraf Indonesia Cabang Malang) - Indonesian Neurological Association Branch of Malang cooperated with Neurology Residency Program, Faculty of Medicine Brawijaya University, Malang, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mnj.2024.010.01.9

Abstract

Introduction: Urinary incontinence (UI) is an involuntary leakage of urine, regardless of the amount or frequency, which alters physical, emotional, and social well-being and quality of life. The therapy currently being studied is magnetic stimulation (MS) has been used to stimulate the pelvic floor muscles. It is based on Faraday's law of magnetic induction, where a changing magnetic field over time induces electrical activity that depolarizes nerves and causes contraction of the pelvic floor muscles. However, the research on the effect of High-Intensity Focused Electromagnetic is still minimal, especially in Indonesia, so its effectiveness in overcoming UI in Indonesia is still doubtful. Method: This study used a prospective cohort design where patients were followed for one month. Patients were followed from when they were first diagnosed until the therapy was completed and evaluated. The variables in this study were as follows: pre and post International Prostate Symptom Score (IPSS), Overactive Bladder Syndrome Score (OABSS), Barhal index, and progress of patient complaints from the first therapy. Result: This research was conducted for 6 sessions, and significant results were obtained in sessions 1, 4, 5, and 6. From this data, we conclude that the HIFEM therapy had a significant effect from session 4. Furthermore, we found a significant therapeutic effect between sessions 4 and 6, but not between sessions 4 and 5. There was also a significant therapeutic effect between sessions 5 and 6. Conclusion: HIFEM can improve incontinence and OAB complaints. HIFEM works to strengthen the pelvic floor muscles.

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