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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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A NOVEL VARIANT OF HUWE1 GENE IN A FEMALE INFANT WITH SYNDROME PHENOTYPE AND DEVELOPMENTAL DELAY: A CASE REPORT Giannikopoulou, Iliana; Stogiannidou, Eleni; Oikonomou , Asimakis; Markou , Paraskevi; Karasmani , Paraskevi; Katerelos, Adamantios
MNJ (Malang Neurology Journal) Vol. 11 No. 2 (2025): 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.2025.011.02.13

Abstract

This case report presents a rare and novel variant of HUWE1 gene in a female infant with a syndrome phenotype and significant neurodevelopmental deficits. The HUWE1 gene is known to play a crucial role in the development and function of the nervous system. Mutations in this gene have been associated with Turner-type syndromic intellectual developmental disorder (MRXST), a disorder with variable phenotype. This gene is located in X chromosome, and therefore males are affected. Although there are a few cases of female carriers with abnormal findings, or with milder cognitive abnormalities, there are also female patients with de novo mutations who express the full phenotype. Here we describe the clinical and genetic features of a female infant, born to healthy parents and at birth was noted to have abnormal facial features, hypotonia and brachydactyly. At her second hospitalization it was sent genetic testing of her, which revealed a variant in HUWE1 gene, that had never been described in literature.
DEVELOPING NEW ICH (nICH) AND ICH-SURGICAL EVACUATION (ICH-SE) SCORE FOR PREDICTING 30-DAY MORTALITY OF SPONTANEOUS INTRACEREBRAL HEMORRHAGE Tedyanto, Eric Hartono; Pramana, Nyoman Angga Krishna; Widyadharma, I Putu Eka
MNJ (Malang Neurology Journal) Vol. 11 No. 2 (2025): 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.2025.011.02.05

Abstract

Introduction: The Original Intracerebral Hemorrhage (oICH) score has been widely used as a clinical assessment scale that is consistent and reliable for predicting patient mortality. However, the ICH score is sometimes complicated, does not contain an acute complication component of stroke, and is not developed to predict the mortality of patients undergoing surgery. We intended to create a new ICH (nICH) and ICH surgical evacuation (ICH-SE) score to predict 30-day mortality in spontaneous ICH patients. Methods: We conducted a retrospective cohort study involving all spontaneous ICH patients who were hospitalized at Prof. Dr. I.G.N.G. Ngoerah Denpasar between July 2020 and July 2022. To evaluate the relationship between the independent variables and the dependent variable, bivariate analysis will be followed by multivariate logistic regression analysis and the Hosmer and Lemeshow tests. The final model was converted into a scoring system and assessing the final area under the curve (AUC) model to determine predictive mortality value, optimal cut-off point, sensitivity, and specificity value. Results: 265 patients met the requirements, and 83 underwent evacuation surgery. Independent factors associated with ICH patient mortality were high NIHSS on admission, the volume of bleeding (P = 0.016 each), and age >65 years (P = 0.005). Independent factors for good outcomes were pneumonia, sepsis, respiratory failure (p=0.027, p=0.022, p=0.004, respectively), and the absence of mass effect (P<0.001). The nICH score was overall better than the oICH score (AUC 0.864 vs. 0.760). Taking a cut-off value of 2, the nICH score has a sensitivity of 75% and a specificity of 81.4%. Independent factors associated with the mortality of spontaneuous ICH patients who underwent surgery were pneumonia, midline shift >8mm, and intraventricular hemorrhage. By taking a cut-off value of 1, the ICH-SE score has a sensitivity of 71.7% and a specificity of 78.4% with a Youden index (YI) of 0.501. Conclusion: The nICH score proved more effective and reliable than the oICH score in predicting mortality within 30 days of spontaneous ICH patients. This study has also developed an ICH-SE score that can be used to predict 30-day mortality in spontaneous intracerebral hemorrhage patients who are about to undergo an evacuation surgery.
ISCEMIC STROKE IN PREGNANT WOMEN WITH AUTOIMMUNE HEMOLYTIC ANEMIA (AIHA) AND ANTIPHOSPHOLIPID SYNDROME (APS) Fakhrurrazy, Fakhrurazy; Khatimah, Husnul
MNJ (Malang Neurology Journal) Vol. 11 No. 2 (2025): 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.2025.011.02.14

Abstract

Background: An increased risk of thrombosis has been described in patients with autoimmune hemolytic anemia (AIHA) and antiphospholipid syndrome (APS), including stroke. The clinical manifestations of AIHA and APS occur due to thrombosis and embolism that spread to large and small blood vessels which can cause ischemia and infarction in tissues, including the blood vessels of the brain. Objective: There is a hypothesis states that free hemoglobin in AIHA and APS will cause endothelial dysfunction, inflammation, and procoagulant state that can increase the risk of stroke. This study aims to know what may caused ischemic stroke in pregnant women with autoimmune hemolytic anemia (AIHA) and antiphospholipid syndrome (APS). Methods: This is a case report of AIHA in a pregnant woman with ischemic stroke accompanied by a literature review. Conclusion: This case represents a rare arterial ischemic complication of AIHA and APS that may be associated with hypercoagulable state. Approximately 15-20% of AIHA cases are associated with arterial or venous thrombosis, and recent studies have shown an increased risk of ischemic stroke among patients with primary AIHA, especially in the first year after diagnosis.
DEVELOPMENT AND VALIDATION TEST OF DISINI (DISTAL SYMETRIC NEUROPATHY) IN DIABETES MELLITUS PATIENTS Maharani, Anyelir Dewi; Pinzon, Rizaldy Taslim; S, Sugianto
MNJ (Malang Neurology Journal) Vol. 11 No. 2 (2025): 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.2025.011.02.06

Abstract

Background: Diabetic neuropathy is a complication of diabetes mellitus that may lead to ulceration and potentially amputation of the feet in affected individuals. This may result in elevated rates of morbidity and mortality. Although certain health care facilities lack access to essential neuropathy screening equipment (e.g., 128 Hz tuning forks, reflex hammers, and monofilaments), alternative methods must be developed to ensure early detection of diabetic neuropathy. Objective: To determine the development and measure the validity of the DISINI (Distal Symmetric Neuropathy) questionnaire in diabetes mellitus patients. Methods: A quantitative cross-sectional analysis was conducted at Bethesda Hospital Yogyakarta utilising secondary data obtained from DISINI and DN4 examinations of 64 individuals diagnosed with diabetes mellitus. Utilising the ROC curve, AUC value, Pearson correlation test, and Spearman rank correlation, the acquired data were analysed. Results: Analysis of the ROC Curve and AUC values showed that the cut off for the DISINI questionnaire was ≥ 3. The diagnostic value of the DISINI questionnaire included sensitivity 91.84%, specificity 60.00%, positive predictive value (NPP) 88.24%, negative predictive value (NPN) 69, 23%, positive likelihood ratio (LR (+)) 2.30, and negative likelihood ratio (LR (-)) 0.14. The correlation test DISINI with DN4 shows that there is a relationship between the scores of the DISINI  and DN4 (p = 0.001). The correlation test between DISINI and DNE shows that there is a relationship between the DISINI and DNE scores (p = 0.013). The correlation test DISINI with DNS shows that there is a relationship between the scores of the DISINI and DNS (p = 0.007). The correlation test DISINI with Monofilament showed that there was no relationship (p = 0.318). Conclusion: The validation test of the DISINI (Distal Symmetric Neuropathy) questionnaire in diabetes mellitus patients had a sensitivity of 91.84% and a specificity of 60.00% using the gold standard DN4 (Douleur Neuropathique en 4 Questions).
IN-HOSPITAL MORTALITY DESCRIPTION OF PATIENTS POST DECOMPRESSION TREPANATION AND EVACUATION OF INTRACEREBRAL HEMORRHAGE Arisetijono, Eko; Agustin, Aisyiyah Alviana
MNJ (Malang Neurology Journal) Vol. 11 No. 2 (2025): 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.2025.011.02.07

Abstract

Background: In 2010, there were 33 million global stroke cases, with hemorrhagic stroke responsible for one-third of cases and over half of deaths. Intracerebral hemorrhage (ICH) is more common in low-income countries, the elderly, men, and African-Asian populations. Despite surgery aiming to reduce mortality, postoperative death rates remain high (22-62%), especially among elderly patients with hypertension. Objective: To determine the in-hospital mortality rate of patients following decompressive trepanation and evacuation of intracerebral hemorrhage at Saiful Anwar Hospital, East Java, from March 2023 to March 2024. Method: This is a retrospective descriptive study at Saiful Anwar Hospital, East Java, to identify the in-hospital mortality rate of patients who underwent decompressive trepanation and evacuation of intracerebral hemorrhage (March 2023-March 2024). Samples were taken from medical records of CVA ICH post-TDE ICH patients and analyzed using frequency, mean, median, and standard deviation. Results: The study at Saiful Anwar Regional General Hospital (March 2023-March 2024) involved 74 CVA ICH patients who underwent decompressive trepanation. Of these, 54% were male, 46% female, and the most common age group was 46-60 years (44.6%). Most patients were from Malang (75.67%), with 11 from Kedungkandang and 13 from Malang Timur. The mortality rate was 75.6%. Conclusion: A high mortality rate was observed in post-TDE ICH patients at Saiful Anwar Regional General Hospital, with respiratory failure complications being the main factor. Further research is needed to understand the risk factors for mortality. From this study, Artificial Intelligence can be developed to predict post-operative mortality.
NON-SPECIFIC HEADACHE AS THE MAIN MANIFESTATION OF TUBERCULOUS MENINGITIS: A RARE CASE REPORT Mondiani, Yeni Quinta; Iryawati, Dinda; Munir, Badrul
MNJ (Malang Neurology Journal) Vol. 11 No. 2 (2025): 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.2025.011.02.15

Abstract

Introduction: Tuberculous meningitis (TBM) is the most severe form of extrapulmonary TB, posing a major public health challenge due to high morbidity and mortality. Non-specific symptoms and limited diagnostic access delay detection, worsening patient outcomes. Headache, as one of the non-specific symptoms of TB meningitis, often leads to misdiagnosis Case Report: Male, 31 years old, presented with a persistent headache as the primary symptom, without definite fever, neck stiffness, or altered mental status. Initial cerebrospinal fluid (CSF) analysis showed no significant abnormalities, delaying diagnosis. GeneXpert MTB/RIF later confirmed Mycobacterium tuberculosis, and the patient was diagnosed with tuberculous meningitis (TBM). Follow-up imaging revealed persistent meningeal enhancement, leading to an extended treatment duration. The patient showed clinical improvement after completing 12 months of anti-tuberculosis therapy. Discussion: The diagnosis of tuberculous meningitis (TBM) remains challenging due to its non-specific clinical presentation and overlap with other central nervous system (CNS) disorders. Delays in diagnosis often arise from non-specific headache (reported in over 50% of cases, typically presenting with a holocranial and throbbing pattern), unexplained fever, absence of classic meningeal signs, and inconclusive initial cerebrospinal fluid (CSF) findings. Early and accurate diagnosis relies on a comprehensive approach integrating CSF analysis, molecular diagnostics, and neuroimaging. Persistent imaging abnormalities may necessitate extended treatment beyond the standard duration in certain cases. Conclusion: Non-specific symptoms, such as headache, often lead to a delayed diagnosis of TBM, requiring CSF analysis, molecular testing, and neuroimaging. While a 12-month treatment course is standard, further research on advanced imaging and artificial intelligence is essential to improve TBM detection and management.
RISK FACTOR PROFILE OF ISCHEMIC STROKE PATIENTS Divastuti, Kedyatasya Rae Fahirah; Setyowatie, Sita; Suryantoro, Satriyo Dwi; Ardhi, Mohammad Saiful
MNJ (Malang Neurology Journal) Vol. 11 No. 2 (2025): 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.2025.011.02.16

Abstract

Background: Stroke remains a leading cause of disability and mortality, with ischemic stroke being the most prevalent type. The high incidence of ischemic stroke is associated with various risk factors, both modifiable and non-modifiable. In Indonesia, limited public awarness and data availability contribute to the increasing burden of ischemic stroke. Objective: This study aims to identify the risk factor profile of ischemic stroke patients in the Inpatient Unit of Universitas Airlangga Hospital, Surabaya. Methods: This retrospective descriptive study utilized secondary data from medical records of patients diagnosed with ischemic stroke between January and December 2023. The variables analyzed included age, gender, hypertension, diabetes mellitus, dyslipidemia, and smoking habits. A total sampling method was applied to the medical records of ischemic stroke patients admitted to the Inpatient Unit of Universitas Airlangga Hospital, Surabaya, during the specified period. Results: Based on 412 collected medical records, the results showed that the most prevalent non-modifiable risk factor was male gender (55.1%), followed by age 45–60 years (44.42%). Meanwhile, the most common modifiable risk factor was dyslipidemia (71.04%), followed by hypertension (66.5%), diabetes mellitus (33.33%), and smoking habit (25.97%). Conclusion: Dyslipidemia was the most prevalent risk factor, followed by hypertension, male gender, age 45–60 years, diabetes mellitus, and smoking habit.
PRIMARY BRAIN ABSCESS BY Burkholderia cenocepacia - A RARE AND UNIQUE PRESENTATION J K, Saravana Priya; T, Vidhya; Shekar, Nagarathna; HB, Veena Kumari
MNJ (Malang Neurology Journal) Vol. 11 No. 2 (2025): 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.2025.011.02.17

Abstract

Burkholderia cenocepacia, a gram-negative bacillus belonging to the Burkholderia cepacia complex (BCC), is an opportunistic pathogen known for its high intrinsic antibiotic resistance and ability to cause life-threatening infections in immunocompromised individuals. While this organism is commonly encountered in hospital-acquired infections, particularly in patients with cystic fibrosis and chronic granulomatous disease, cases of community-acquired infections are exceedingly rare. This case report presents a unique community-acquired Burkholderia cenocepacia brain abscess in a chronic alcoholic and diabetic patient, highlighting the interplay between immunosuppression, occupational exposure, and the emergence of rare infections. A 35-year-old male, working as a painter, presented with headache and generalized tonic-clonic seizures. He had a history of chronic alcohol consumption and diabetes, both of which compromise immune function and increase susceptibility to infections. Advanced imaging revealed chronic subdural hematoma (SDH) at the right convexity, necessitating surgical intervention. A right fronto-parietal craniotomy was performed with evacuation of empyema and augmentive duroplasty, followed by placement of the bone flap in the abdomen. Laboratory findings demonstrated anemia, neutrophilia, and lymphopenia, suggestive of an ongoing systemic infection. Microbiological analysis, including MALDI-TOF MS, confirmed Burkholderia cenocepacia as the causative organism. Antibiotic susceptibility testing revealed sensitivity to ceftazidime, cotrimoxazole, meropenem, minocycline, and levofloxacin, with ceftazidime selected as the primary treatment. Targeted intravenous ceftazidime therapy at a dosage of 2 grams every 6 hours for four weeks resulted in significant clinical improvement, marked by resolution of headache and seizures, improved hematological parameters, and a follow-up CT scan showing no new abscess formation. The absence of adverse effects and excellent treatment adherence reinforced the efficacy of the antibiotic regimen. This case underscores the critical role of early recognition, advanced imaging techniques, and culture-based antibiotic selection in managing rare brain abscesses. The immunocompromised state induced by chronic alcohol consumption and diabetes likely predisposed the patient to this atypical central nervous system infection, further compounded by occupational exposure and smoking history. The findings highlight the importance of multidisciplinary management in treating such challenging infections, with prompt neurosurgical intervention and tailored antimicrobial therapy proving essential for successful outcomes. This report adds to existing literature by documenting the first-known community-acquired Burkholderia cenocepacia brain abscess in an immunocompromised adult. It emphasizes the need for heightened clinical awareness, individualized therapeutic approaches, and stringent infection control strategies in the management of rare pathogens in non-hospital settings.

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