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All Journal Jurnal Sinaps Majalah Kedokteran Neurosains Cermin Dunia Kedokteran Magna Neurologica Neurona
Riwanti Estiasari
Departemen Neurologi Fakultas Kedokteran Universitas Indonesia, RSUPN Dr. Cipto Mangunkusumo Jakarta
Education Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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Journal : Neurona

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ENSEFALITIS ANTIRESEPTOR NMDA: ENSEFALITIS DENGAN GEJALA AWAL PSIKOSIS Riwanti Estiasari; Darma Imran; Kartika Maharani; David Pangeran; Fitri Octaviana; Dewi Wulandari
NEURONA Vol 35 No 1 (2017)
Publisher : PERDOSNI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52386/neurona.v35i1.35

Abstract

     ANTI-NMDA RECEPTOR ENCEPHALITIS: ENCEPHALITIS PRESENTING WITH EARLY PSYCHOSIS SYMPTOMSABSTRACTAnti N-methyl-D-aspartate (NMDA) receptor encephalitis is seldom found in Indonesia. The atypical initial presentation of psychosis and cognitive disturbance results in underdiagnosed, or even undiagnosed case. This report described a 12-year-old girl presenting with initial psychiatric symptom followed by seizure and oropharyngeal dystonia. Anti-NMDA receptor antibody test carried out on both serum and  cerebrospinal  fluid (CSF) were positive and  no other pathogen was detected in the CSF. Clinical improvement was seen following the third day of methylprednisolone administration. This case demonstrates the importance of considering anti-NMDA receptor encephalitis or the other autoimmune encephalitis as the differential of infective encephalitis. Anti-NMDA receptor antibody test, which can already be performed in Indonesia, will greatly guide to the definitive diagnosis.Keywords: Encephalitis, NMDA, oropharyngeal dystonia, psychiatricABSTRAKEnsefalitis antireseptor N-metil-D-aspartat (NMDA) masih jarang ditemukan di Indonesia. Gejala awal yang tidak khas berupa psikosis dan gangguan kognitif menyebabkan keterlambatan diagnosis, atau bahkan tidak terdiagnosis, ensefalitis jenis ini. Berikut dilaporkan kasus seorang perempuan 12 tahun dengan gejala awal berupa gejala psikiatrik yang diikuti dengan kejang dan munculnya distonia orofaring. Pemeriksaan antibodi antireseptor NMDA pada serum dan cairan serebrospinal (CSS) positif dan tidak ditemukan patogen lain pada pemerikaan CSS. Perbaikan klinis terlihat setelah pemberian metilprednisolon selama 3 hari. Kasus ini memperlihatkan pentingnya mempertimbangkan diagnosis ensefalitis antireseptor NMDA atau ensefalitis autoimun lainnya sebagai diagnosis banding pada kasus ensefalitis infeksi. Oleh karena itu, pemeriksaan antibodi antireseptor NMDA yang telah dapat dilakukan di Indonesia akan sangat membantu proses penegakan diagnosis.Kata kunci: Distonia orofaring, ensefalitis, NMDA, psikiatrik
MULTIPEL SKLEROSIS PROGRESIF SEKUNDER, GEJALA KLINIS, DIAGNOSIS, DAN TATA LAKSANA Riwanti Estiasari; Nadia Devianca; Kartika Maharani; Darma Imran
NEURONA Vol 37 No 3 (2020)
Publisher : PERDOSNI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52386/neurona.v37i3.166

Abstract

Multiple sclerosis (MS) is a chronic inflammatory autoimmune disorder of the central nervous system (CNS) affecting the myelin. MS is very detrimental which causes disability and will reduce the productivity and quality of life of the patients, especially if it progressed to secondary progressive multiple sclerosis (SPMS) which there will be a continuous worsening of neurological deficits. Early detection of symptom progression can be done to overcome the problems that may occur in SPMS. By early detection, immediate therapy of SPMS can be given thus preventing the progression. It is therefore important for us to know the definition of SPMS, how to detect progression, and the treatment options for SPMS that will be explained in this literature review. Keywords: Progression, therapy, SPMS
Gambaran Status Gizi Penderita Tumor Otak Primer dan Metastasis serta Faktor-faktor yang Memengaruhinya Tiara Aninditha; Gloria Tanjung; Diyah Eka Andayani; Renindra Ananda Aman; Riwanti Estiasari; Ahmad Yanuar; Henry Riyanto Sofyan
NEURONA Vol 39 No 3 (2022): Vol 39 No 3 (2022)
Publisher : PERDOSNI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52386/neurona.v39i3.280

Abstract

Introduction: According to the pathophysiology, weight loss is a specific marker for suspected malignancy. However, this is rarely found in cases of brain tumors. The presence of the blood brain barrier is thought to play a role in differentiating nutritional status in primary and metastatic brain tumors. Therefore, it is necessary to do this research. Aim: Knowing the description, prevalence, differences in nutritional status of patients with primary and secondary brain tumors, and the affecting factors. Methods: Cross-sectional study in patients with primary and secondary brain tumors at Cipto Mangunkusumo General Hospital in 2017-2019. Malnutrition was diagnosed using the GLIM (Global Leadership Initiative on Malnutrition) criteria. Data analysis used Chi-Square/Fisher and multivariate logistic regression. There were 333 subjects: 246 primary and 87 secondary brain tumors. Description of nutritional status of patients with primary brain tumors: 47.6% obese; 6.1% malnutrition; the rest were normal, while in secondary brain tumors: 25.3% were malnourished; 24.1% obese; the rest is normal. Secondary brain tumor at risk of malnutrition with RR 1.257 (95% KI 1.108-1.426), p<0.001. Factors influencing malnutrition were the type of primary/secondary brain tumor, gender, age, decreased consciousness, anorexia, gastrointestinal complaints, intraaxial lesions, multiple lesions, and the location of the lesions involving the frontal lobes. The independently related factor was multiple lesions with an aOR of 3,423 (95% KI 1.124-10.426), p 0.03. Conclusion: The nutritional status of patients with primary and secondary brain tumors was different, with higher levels of malnutrition in secondary brain tumors and higher obesity in primary brain tumors. The number of multiple lesions in the brain affects the occurrence of malnutrition.
Neuritis Optik Unilateral sebagai Manifestasi Klinis Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease (MOGAD) Ayudhea Tannika; Riwanti Estiasari; Kartika Maharani
NEURONA Vol 39 No 3 (2022): Vol 39 No 3 (2022)
Publisher : PERDOSNI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52386/neurona.v39i3.364

Abstract

Myelin-oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is an oligodendrocytopathic autoimmune disorder, characterized by demyelination and inflammation in the central nervous system, especially brain parenchyma and spinal cord. There are three main clinical manifestations in MOGAD: optic neuritis, transverse myelitis, and acute disseminated encephalomyelitis (ADEM). This case report presents a seropositive anti-MOG patient with early manifestation of optic neuritis. A 29 years old man presented with a complaint of blurry right vision and dull pain around his right eye in the last 5 months before hospital admission. Neurological examination revealed a right visual acuity of 2/60 and right relative afferent pupillary defect (RAPD). Brain MRI with contrast revealed an enhancement on the right optic nerve and nonspecific, multiple hyperintense lesions in bilateral frontal and parietal lobes. The patient’s result was reactive for anti-MOG antibody. After the administration of high dose methylprednisolone (1000 mg) for 5 consecutive days, the patient’s visual acuity was slowly improving; supported with an improvement on the Humphrey visual field analyzer. Immunosuppressant agent azathioprine was given as a long-term treatment without any worsening symptoms to this day. Unilateral optic neuritis could be an early clinical manifestation in MOGAD. It is important for clinicians to identify typical and atypical optic neuritis to be able to determine follow-through examination and workup and the associated differential diagnosis. Optic neuritis in MOGAD could be improved by the administration of high dose methylprednisolone, along with immunosuppressant therapy as long-term therapy
Co-Authors Ahmad Yanuar Anne Dina Soebroto Arthur H.P. Mawuntu Ayudhea Tannika Darma Imran Darma Imran Darma Imran David Pangeran Dewi Wulandari Diyah Eka Andayani Erwin Widi Nugraha Fitri Octaviana Gloria Tanjung Gogor Meisadona Henry Riyanto Sofyan Imran, Darma Kartika Maharani Kartika Maharani Kartika Maharani Kartika Maharani Kartika Maharani Maharani, Kartika Meisadona, Gogor Nadia Devianca Ni Nengah Rida Ariarini Pradita Sari Purba, Maria Jheny Fulgensia Renindra Ananda Aman Septiana Andri Wardana Soebroto, Anne Dina Sutanto, Anyelir Tiara Aninditha Widya Andini, Putri