Suryani Gunadharma
Department Of Neurology Faculty Of Medicine Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital Bandung

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Misdiagnosis of Epilepsy Attributed to Inadequate History Taking Ratana, Levina Tri; Gunadharma, Suryani; Soenggono, Arifin
Althea Medical Journal Vol 3, No 2 (2016)
Publisher : Althea Medical Journal

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Abstract

Background: There was a noticeable amount of patient with epilepsy who were misdiagnosed at Dr. Hasan Sadikin General Hospital. Misdiagnosis of epileptic seizure will expose patients to inappropriate managements, and subsequently leads to complications. History taking is an important part for the diagnosis of epileptic seizure. This study aimed to see the improvement of diagnosis based on the adequacy and inadequacy of history taking attributed to misdiagnosis of epileptic seizure by the epilepsy consultant at Dr. Hasan Sadikin General Hospital.Methods: This was a descriptive study using medical records of misdiagnosis of epilepsy. It was indicated by different initial (before epilepsy consultant’s confirmation) and final (after epilepsy consultant’s confirmation) seizure diagnosis at Epilepsy Outpatient Clinic at Dr. Hasan Sadikin General Hospital during the period of January 2007−October 2012.Results: There were 61 medical records with different initial and final seizure diagnosis. This study indicated inadequate history taking in 83.6% patients. Misdiagnosis occurred due to incomplete history taking, absence of reliable witnesses, and misinterpretation of history taking result. History taking by epilepsy consultant improved the misdiagnosis in 27.9% patients. While it is used simultaneously with Electroencephalography (EEG), the result increased to 72.2%.Conclusions: The adequate history taking improved the accuracy of epileptic seizure diagnosis. The simultaneous used of history taking and EEG increased the result. [AMJ.2016;3(2):304–9]DOI: 10.15850/amj.v3n2.775
VARIAN GELOMBANG EEG NORMAL SEBAGAI FAKTOR PENYEBAB KESALAHAN DIAGNOSIS EPILEPSI Suryani Gunadharma*
NEURONA Vol 32 No. 3 Juni 2015
Publisher : Neurona Majalah Kedokteran Neuro Sains

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Abstract

INTRODUCTION ELECTROENCEPHALOGRAPHY EEG IS THE MOST USEFUL TEST FOR ASSESSMENT OF EPILEPTIC PATIENTS HOWEVER EEG IS OFTEN OVERANALYZED ESPECIALLY BY INEXPERIENCED READERS EEG OVERINTERPRETATION IS COMMON AND PLAYS AS AN IMPORTANT CONTRIBUTOR OF MISDIAGNOSIS OF EPILEPSY IMPACTING SIGNIFICANTLY IN PATIENTS LIVES INTERICTAL EPILEPTIFORM DISCHARGES IED HAVE A STRONG CORRELATION WITH EPILEPSY NOT ALL SPIKE OR SHARPWAVES HAVE A RELATION WITH EPILEPSY
Misdiagnosis of Epilepsy Attributed to Inadequate History Taking Levina Tri Ratana; Suryani Gunadharma; Arifin Soenggono
Althea Medical Journal Vol 3, No 2 (2016)
Publisher : Faculty of Medicine Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (190.711 KB)

Abstract

Background: There was a noticeable amount of patient with epilepsy who were misdiagnosed at Dr. Hasan Sadikin General Hospital. Misdiagnosis of epileptic seizure will expose patients to inappropriate managements, and subsequently leads to complications. History taking is an important part for the diagnosis of epileptic seizure. This study aimed to see the improvement of diagnosis based on the adequacy and inadequacy of history taking attributed to misdiagnosis of epileptic seizure by the epilepsy consultant at Dr. Hasan Sadikin General Hospital.Methods: This was a descriptive study using medical records of misdiagnosis of epilepsy. It was indicated by different initial (before epilepsy consultant’s confirmation) and final (after epilepsy consultant’s confirmation) seizure diagnosis at Epilepsy Outpatient Clinic at Dr. Hasan Sadikin General Hospital during the period of January 2007−October 2012.Results: There were 61 medical records with different initial and final seizure diagnosis. This study indicated inadequate history taking in 83.6% patients. Misdiagnosis occurred due to incomplete history taking, absence of reliable witnesses, and misinterpretation of history taking result. History taking by epilepsy consultant improved the misdiagnosis in 27.9% patients. While it is used simultaneously with Electroencephalography (EEG), the result increased to 72.2%.Conclusions: The adequate history taking improved the accuracy of epileptic seizure diagnosis. The simultaneous used of history taking and EEG increased the result. [AMJ.2016;3(2):304–9]DOI: 10.15850/amj.v3n2.775
Etiology of Symptomatic Focal Epilepsy based on Neuroimaging Result in Neurology Outpatient Clinic of Dr. Hasan Sadikin General Hospital Agastya Prabhaswara; Suryani Gunadharma; Uni Gamayani
Althea Medical Journal Vol 6, No 1 (2019)
Publisher : Faculty of Medicine Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (68.842 KB) | DOI: 10.15850/amj.v6n1.1556

Abstract

Background: Focal epilepsy is the most common type of epilepsy that can be caused by structural lesions. Images from neuroimaging can show those structural lesions that may point to the etiology of epilepsy and would affect the management of epilepsy. The aim of the study was to explore the possible etiology of symptomatic focal epilepsy from neuroimaging result at the Neurology Outpatient Clinic in Dr. Hasan Sadikin General Hospital.Methods: This study was a cross-sectional descriptive study. The medical records that fulfilled the inclusion criteria were collected at the Neurology Outpatient Clinic of Dr. Hasan Sadikin General Hospital from the year 2017. The inclusion criteria were symptomatic focal epilepsy patients that had abnormal neuroimaging result.Results: In total, there were 71 medical records collected of which eight etiologies of symptomatic focal epilepsy were found, that were vascular disorder caused by strokes (33%), tumors (21%), hippocampal sclerosis (20%), infections (11%), head trauma (6%), malformations of cortical development (4%), vascular malformations (3%), and phakomatosis (1%). Vascular disorder was the most abundant etiology found in all brain lobes, except in temporal and frontal lobes, which also most often caused by hippocampal sclerosis and tumors, respectively.Conclusions: Vascular disorders due to stroke, is the most abundant etiology found in symptomatic focal epilepsy, therefore, stroke patients need to be informed about the possibility of having epilepsy later on.
Cut-off Score of Indonesian Version of Sensorimotor History Questionnaire for Preschooler and Soft Sign Cambridge Neurological Inventory against Intelligent Quotient Siti Aminah Sobana; Tiara Pramaesya; Uni Gamayani; Lisda Amalia; Suryani Gunadharma; Andi Basuki Prima Birawa
Majalah Kedokteran Bandung Vol 53, No 4 (2021)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15395/mkb.v53n4.2420

Abstract

Early detection of Sensory Processing Disorder (SPD) is important for deciding on appropriate interventions for children at risk. However, there is no valid screening tool available at this moment. The purpose of this study was to validate the deGangi, Sensorimotor History Questionnaire for Preschooler (SHQP), and neurological soft sign of Cambridge Neurological Inventory (NSS CNI) against intelligent quotient (IQ) to establish a reliable cut-off for SPD screening tools for children aged 4–6 years. Sixty-four parent-child were recruited randomly from 3 kindergartens in Bandung, Indonesia. Eligible parents were asked to fill out the SHQP, while their child was assessed using theWechsler Preschool and Primary Scale of Intelligent (WPPSI) and NSS CNI. The deGangi SHQP score and NSS CNI showed a weak and moderate correlation with Full-scale IQ (FIQ). The total score of deGangi SHQP’s sensitivity was 50% with a specificity of 53.4% and a negative predictive value (NPV) of 91.2% agaisnt the FIQ score. The total sensitivity for the NSS CNI was 66.7%, while the total specificity was 58.6% and the NPV was 94.4%. Meanwhile, the sensitivity for the sensory integration subscale score of the NSS CNI was 83.3%, with a specificity of 60.3% and an NPV of 97.2%. The deGangi SHQP can be considered to be an SPD screening tool with the cut-off scores for each subscale of self-regulation, sensory processing of touch, sensory processing of movement, emotional maturity, and motor maturity of 3, 3, 3, and 2, respectively, while the NSS CNI can be used for identifying SPD in children aged 4–6 years with a cut-off scores for the motor coordination, sensory integration, and disinhibition subscales of 7, 10, and 3, respectively.
Quantitative Measure to Differentiate Wicket Spike from Interictal Epileptiform Discharges Suryani Gunadharma; Ahmad Rizal; Rovina Ruslami; Tri Hanggono Achmad; See Siew Ju; Juni Wijayanti Puspita; Sapto Wahyu Indratno; Edy Soewono
Communication in Biomathematical Sciences Vol. 4 No. 1 (2021)
Publisher : Indonesian Bio-Mathematical Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.5614/cbms.2021.4.1.2

Abstract

A number of benign EEG patterns are often misinterpreted as interictal epileptiform discharges (IEDs) because of their epileptiform appearances, one of them is wicket spike. Differentiating wicket spike from IEDs may help in preventing epilepsy misdiagnosis. The temporal location of IEDs and wicket spike were chosen from 143 EEG recordings. Amplitude, duration and angles were measured from the wave triangles and were used as the variables. In this study, linear discriminant analysis is used to create the formula to differentiate wicket spike from IEDs consisting spike and sharp waves. We obtained a formula with excellent accuracy. This study emphasizes the need for objective criteria to distinguish wicket spike from IEDs to avoid misreading of the EEG and misdiagnosis of epilepsy.
Prevalence of Opportunistic Infection in Central Nervous System among Patients with HIV/AIDS at Dr. Hasan Sadikin General Hospital Bandung, Indonesia Dinda Sayyidah Laela Fatimatuzzahra; Ahmad Rizal Ganiem; Aih Cahyani; Suryani Gunadharma; Sofiati Dian
Althea Medical Journal Vol 9, No 2 (2022)
Publisher : Faculty of Medicine Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15850/amj.v9n2.2298

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Background: The low coverage of diagnosis and treatment in patients with human immunodeficiency virus (HIV) infection in Indonesia increases the risk of opportunistic infections that affects various organs, including the central nervous system (CNS). This study aimed to determine the prevalence of opportunistic infections in the CNS among hospitalized patients with HIV/acquired immune deficiency syndrome (AIDS) at Dr. Hasan Sadikin General Hospital Bandung, Indonesia.Methods: In this cross-sectional study with a total sampling method, data were collected from HIV/AIDS patients who were diagnosed with CNS opportunistic infection and hospitalized in the neurology ward during the period 2015–2019. Data were presented as median (interquartile range) and percentage frequency.Results: Among the 2,606 HIV/AIDS patients registered, 219 (8.4%) were accompanied by CNS opportunistic infections. The highest number was cerebral toxoplasmosis (58.9%; n=129) followed by tuberculous meningitis (33.3%; n=73) and cryptococcal meningitis (7.8%; n=17). Most of the patients admitted for unconsciousness (64.4%; n=141), with unknown HIV-infection status (61.2%; n=134). Among patients with positive HIV-infection status, only 50.6% (43/85) patients were taking antiretroviral therapy (ART) and 24.7% (21/85) patients dropped out ART before being diagnosed with CNS opportunistic infections. The CD4+’s median value was 21 cells/mm3 (IQR 9-61.25), with mortality during hospitalization was 36.5% (80/219). Conclusions: The prevalence of CNS opportunistic infections among HIV-infected patients is 8.4%, dominated by cerebral toxoplasmosis, and laboratory result showed very low CD4+ levels. The diagnosis of HIV infection is shortly made before hospitalization, and those who has been diagnosed have low compliance with ART. The mortality rate during hospitalization is high.
Faktor Faktor Risiko terjadinya Pneumonia pada Stroke Akut di RSUP Dr Hasan Sadikin Bandung Novi Fatni Muhafidzah; Sobaryati Mansur; Emmy Hermiyanti Pranggono; Yusuf Wibisono; Cep Juli; Uni Gamayani; Suryani Gunadharma; Aih Cahyani
Jurnal Neuroanestesi Indonesia Vol 10, No 3 (2021)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (88.417 KB) | DOI: 10.24244/jni.v10i3.269

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Latar Belakang dan Tujuan: Pneumonia adalah komplikasi non neurologis paling sering pada stroke akut (22%) yang meningkatkan angka kematian, lama rawat inap dan biaya perawatan. Perlu dilakukan identifikasi faktor-faktor risiko terjadinya pneumonia salah satunya neurogenic pulmonary edema (NPE) agar dapat dilakukan pencegahan dan intervensi dini. Tujuan penelitian ini untuk mengetahui gambaran faktor-faktor risiko terjadinya pneumonia (termasuk NPE) pada pasien stroke akut di RSUP Dr Hasan Sadikin Bandung.Subjek dan Metode: Deskriptif observasional prospektif, metode consecutive sampling, periode September - Oktober 2019, mengumpulkan data primer pasien stroke akut yaitu derajat keparahan stroke, tipe, lokasi dan ukuran lesi stroke, terapi dan tindakan selama perawatan, komorbiditas (termasuk NPE). Pneumonia ditegakkan berdasarkan kriteria Centers for Disease Control and Prevention (CDC), NPE berdasarkan kriteria Davison.Hasil: 30 orang mengalami pneumonia pada pasien stroke akut (28,30%). Kejadian pneumonia, lebih sering ditemukan pada pemakaian Nasogastric Tube (NGT) (90%), disfagia (64,71%), lokasi infark Sirkulasi Anterior Total (SAT) (61,54%), ukuran infark besar (61,54%), GCS 9-12 (50%) dan NIHSS 16-20 (50%). NPE didapatkan pada 6,60% pasien stroke akut, 54,17% diantaranya menjadi pneumonia.Simpulan: Kejadian pneumonia pada pasien stroke akut lebih banyak ditemukan pada pemakaian NGT, disfagia, stroke infark lokasi SAT, ukuran infark besar, GCS lebih rendah dan derajat keparahan stroke lebih berat.Risk Factors of Pneumonia in Acute Stroke at Hasan Sadikin Hospital BandungAbstractBackground and Objective:Pneumonia is the most common non neurological complications in acute stroke (22%) that increase mortality rate, length of stay and hospitalization cost. It is necessary to identified risk factors for pneumonia including neurogenic pulmonary edema (NPE) for better prevention and early intervention. The purpose of this study is to determine risk factors of pneumonia (including NPE) in acute stroke patients at Hasan Sadikin General Hospital Bandung.Subject and Methods: Prospective observational descriptive study, consecutive sampling method, during September – October 2019. Primary data collected from acute stroke patients such as stroke severity, type, location and size of stroke, treatment during hospitalizataion, comorbidities (including NPE). Pneumonia was diagnosed based on Central for Disease Control Prevention (CDC) criteria, NPE based on Davison criteria.Results: 30 patients (28.3%) with pneumonia in acute stroke patients. Pneumonia were commonly found in NGT insertion (90%), dysphagia (64,71%), total anterior circulation infarct (TACI) (61,54%), large infarct size (61,54%), GCS 9-12 (50%) and NIHSS 16-20 (50%). NPE only found in 6,60% acute stroke patients, 57,14% of them developed pneumonia.Conclusions: Pneumonia in acute stroke patients is more often found in NGT insertion, dysphagia, TACI location, large infarct size, lower GCS and more severe stroke degree. 
Faktor-faktor yang Berperan pada Status Epileptikus Non-konvulsivus di RSUP Dr. Hasan Sadikin Bandung Cristina Trislawati; Suryani Gunadharma; Uni Gamayani; Yusuf Wibisono; Sobaryati Sobaryati; Lisda Amalia
Jurnal Neuroanestesi Indonesia Vol 11, No 3 (2022)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v11i3.423

Abstract

Latar Belakang dan Tujuan: Status epileptikus merupakan kasus emergensi neurologis dengan mortalitas 57%, 63% merupakan status epileptikus non-konvulsivus (SENK). Diagnosis SENK tidak mudah karena pasien tidak menunjukkan bangkitan yang jelas sehingga diperlukan pemeriksaan elektroensefalografi (EEG). Penyakit serebrovaskular, infeksi susunan saraf pusat (SSP), tumor otak, penyakit autoimmun, dan gangguan metabolik dapat mengakibatkan SENK selain itu dapat memiliki gambaran klinis menyerupai SENK. Tujuan penelitian untuk melihat faktor-faktor yang berperan pada diagnosis SENK.Subjek dan Metode: Penelitian observasional analitik potong lintang retrospektif pada 132 pasien dengan diagnosis klinis SENK di RSUP dr. Hasan Sadikin Bandung selama periode Juli 2017 – Juni 2020. Hasil: Dari 132 subjek dengan diagnosis klinis SENK, hanya 100 pasien yang memenuhi kriteria inklusi. Pemeriksaan EEG dilakukan pada semua pasien, sebagian besar dalam waktu 24 jam (82,4 – 87,9%), hanya 34 pasien yang terkonfirmasi sebagai SENK. Gangguan metabolik secara signifikan berperan pada SENK sebesar 29,4% (p=0,049). Pada pasien yang tidak terkonfirmasi SENK, penurunan kesadaran diakibatkan gangguan metabolik.Smpulan: Gangguan metabolik berperan pada kejadian SENK. Pasien dengan diagnosis klinis SENK memerlukan pemeriksaan EEG segera untuk menghindari diagnosis berlebihan
Outcomes of Tuberculous Meningitis Patients with or without Hydrocephalus from a Tertiary Hospital in West Java, Indonesia Nubella Citresna Zakiyyah; Suryani Gunadharma; Ahmad Rizal Ganiem
Althea Medical Journal Vol 9, No 4 (2022)
Publisher : Faculty of Medicine Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15850/amj.v9n4.2304

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Background: Tuberculous meningitis (TBM) is a severe form of extrapulmonary tuberculosis. One of the most common complications of TBM is hydrocephalus, with a higher risk of mortality. This study aimed to evaluate the outcome among TBM patients with or without hydrocephalus.Methods: This study was a retrospective cross-sectional comparative analytical study. A total sampling was employed based on the number of traceable resumes of TBM patients treated at the Department of Neurology Dr. Hasan Sadikin General Hospital, Bandung, Indonesia in 2018. Results: Of the 127 data of TBM patients, 55 (43.3%) had hydrocephalus, and 72 (56.7%) did not. The median age of TBM patients with and without hydrocephalus was 34 years (IQR 26–45) and 35 years (IQR 24–44), respectively. Decreased consciousness dominated the clinical symptoms for 94.5% in the hydrocephalus group and 84.7% in the non-hydrocephalus group. Hospital-acquired pneumonia occurred mainly in the hydrocephalus group (29.1%), whereas urinary tract infections mainly occurred in without hydrocephalus group (18%). There was a significant difference between the outcome of hydrocephalus and non-hydrocephalus (p=0.005). Mortality was higher in patients with hydrocephalus compared to those without hydrocephalus.Conclusions: The outcome of TBM patients with hydrocephalus is worse than those without hydrocephalus, as reflected by a higher grade of TBM, higher mortality rate, and lower good recovery upon treatment administration. Therefore, prompt diagnosis and treatment are needed to improve the outcome and survival among TBM patients with hydrocephalus.