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All Journal E-Jurnal Medika Udayana MNJ (Malang Neurology Journal) Callosum Neurology Journal : Jurnal Berkala Neurologi Bali Bali Anatomy Journal
Ida Ayu Sri Indrayani
Neurology Consultant, Faculty Of Medicine, Universitas Udayana /Sanglah Hospital Denpasar, Bali, Indonesia
Health Professions Medicine & Pharmacology Neuroscience

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INDUSTRIAL REVOLUTION 4.0 IN NEUROREHABILITATION: THE IMPLEMENTATION OF VIRTUAL REALITY FOR NEUROLOGICAL DISORDERS Widyadharma, I Putu Eka; Limalvin, Nicholas Prathama; Dharmatika, I Made Pramana; G, Gayathridayawasi; Indrayani, Ida Ayu Sri; Nugraha, Boya
Malang Neurology Journal Vol 7, No 2 (2021): July
Publisher : Malang Neurology Journal

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mnj.2021.007.02.9

Abstract

Industrial revolution 4.0 has changed the health industry. Medical treatments derived from the latest technologies are expected to improve health and economic status. The rapid development of technology has influenced the learning and clinical practice of medicine. Virtual Reality (VR) is one of the latest technologies that is currently being implemented as a treatment for neurological disorders. This article seeks to give an overview of the development of VR implementation in neurorehabilitation. The data source of this article is research and studies published in NCBI, PubMed, Cochrane, and other relevant online databases. From this article, it is found that VR can be used as a pain reliever and motor function rehabilitation for patients with balance and gait deficits. VR is used to distract patients’ attention to pain for a short time period. VR also improves motor function recovery in stroke patients. Cybersickness is usually reported as a side effect of using VR and it depends on each individual. The implementation of VR for patients with neurological disorders has showed advantages in reducing pain and improving motor function but still need further research about applicability and authorization of virtual reality in the world of medicine.
HIPERTENSI SEBAGAI FAKTOR RISIKO NYERI NEUROPATI DIABETIK PADA PASIEN DIABETES MELLITUS TIPE II DI RSUP SANGLAH DENPASAR Made Dyah Vismita Indramila Duarsa; I Komang Arimbawa; Ida Ayu Sri Indrayani
E-Jurnal Medika Udayana Vol 8 No 10 (2019): Vol 8 No 10 (2019): E-Jurnal Medika Udayana
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (297.111 KB)

Abstract

Neuropati diabetik (ND) adalah komplikasi mikrovaskular yang paling sering terjadi pada pasien Diabetes Mellitus (DM) tipe 2. ND sebagian besar akan menimbulkan komplikasi lanjutan yaitu nyeri neuropati diabetik (NND) yang secara signifikan menurunkan kualitas hidup pasien DM. Hipertensi disebutkan sebagai salah satu faktor yang signifikan mempercepat terjadinya NND pada pasien DM. Tujuan penelitian ini adalah menentukan faktor risiko sebelum penatalaksanaan sehingga dapat meningkatkan outcome pada pasien. Penelitian ini menggunakan metode kasus kontrol dengan teknik pengambilan sampel consecutive sampling. Analisis data dilakukan dalam dua tahapan: (1) statistik deskriptif terkait karakteristik dasar subjek penelitian; (2) statistik analitik untuk menghitung Odds Ratio (OR) antara kelompok kasus dan kontrol. Dari 56 sampel yang diperiksa didapatkan hasil dari 2 tahapan analisis: (1) Statistik deskriptif terkait dengan hipertensi pada kelompok kasus, kontrol adalah 21 orang (75,00%),11 orang (39,30%); (2) Statistik analitik antara hipertensi dan kejadian NND OR=4,636 IK 95%, p =0,007 (p <0,05) artinya hipertensi memiliki hubungan bermakna dengan angka kejadian NND. Faktor perancu pada penelitian ini ; obesitas, dislipidemia, dan DM tidak terkontrol menunjukkan hasil p tidak bermakna terhadap kejadian NND (p>0,05). Hipertensi adalah faktor risiko independen terhadap angka kejadian NND. Kata Kunci : Nyeri Neuropati Diabetik, Diabetes Mellitus, Hipertensi
COVID-19 and cerebrovascular diseases: neuroanatomy and neuropathophysiology overview Ida Ayu Sri Indrayani; Ida Bagus Kusuma Putra; I Gusti Ngurah Ketut Budiarsa; Nyoman Angga Krishna Pramana; Kumara Tini
Bali Anatomy Journal Vol 4 No 1 (2021): Bali Anatomy Journal (BAJ)
Publisher : Department of Anatomy, Medical Faculty, Universitas Udayana, Bali-Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36675/baj.v4i1.55

Abstract

Background: COVID-19 has expanded globally and has become a health burden for the entire world's population. SARS-CoV-2 as the causative virus, currently does not only cause respiratory disorders, it also involves other organs, including the cerebrovascular system, causing manifestations in the central and peripheral nervous systems. Review: SARS-CoV-2 is classified under the β-coronavirus genus of the Coronaviridae family, and 1 of 4 major protein of its structures, known as spike (S) glycoprotein acts as an important role in promoting the viral invasion process. Olfactory and trigeminal nerves are suggested to be the entry point of SARS-CoV-2 to central nervous system, and promote the disruption of brain cells and vasculatures. Conclusion: Manifestations of cerebrovascular disease are becoming more intense, where there is a dysregulation of the ACE2 receptor to perform its main tasks due to the SARS-CoV-2 invasion. SARS-CoV-2 viruses cause various impairments to cerebrovascular endothelial cells, promote hypercoagulation and increasing the risk of thrombosis, downregulate the host immune cells and cause hyperinflammation as well as cytokine storm, lead to brain damages and further complications.
Characteristics, comorbidities, and outcomes of acute ischemic stroke cases treated with thrombolysis in Sanglah General Hospital Bali: A case series Ida Ayu Sri Indrayani; Valentina Tjandra Dewi; Ida Bagus Kusuma Putra; I Gusti Ngurah Ketut Budiarsa; Nyoman Angga Krishna Pramana; Kumara Tini; I Made Oka Adnyana
Bali Anatomy Journal Vol 4 No 1 (2021): Bali Anatomy Journal (BAJ)
Publisher : Department of Anatomy, Medical Faculty, Universitas Udayana, Bali-Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36675/baj.v4i1.56

Abstract

Background: Intravenous recombinant tissue plasminogen activator (IV rt-PA) in eligible patient groups is the main therapy for acute phase ischemic stroke within 4.5 hours of symptom onset which can significantly improve functional outcome. However, not all patients who underwent thrombolysis had a good outcome. Case: We report a series of seven patients cases undergoing IV thrombolysis from 2019-2020 at Sanglah General Hospital with varying baseline conditions and outcomes. Most cases benefit from IV rt-PA administration. There was one case with a poor outcome and one case with a rare anaphylactic reaction following alteplase administration. Conclusion: The number of thrombolysis procedure which is the main treatment of acute ischemic stroke is quite small. It is necessary to increase public education and understanding regarding the rapid response to acute stroke symptoms. Most of the cases yielded good outcomes while several cases had unfavorable outcomes related to variable factors. Hemorrhagic transformation does not directly associate with poor outcome. Clinicians also need to increase awareness of allergic reactions risk to rt-PA and provide prompt treatment.
TRANSIENT BILATERAL VISUAL LOSS PADA PASIEN DENGAN DECOMPRESSION SICKNESS TIPE II Ida Ayu Sri Indrayani; Yenita Khatania Ardjaja; Anak Agung Mas Putrawati Triningrat; Anita Devi
Callosum Neurology Vol 2 No 1 (2019): Callosum Neurology Journal
Publisher : The Indonesia Neurological Association Branch of Denpasar

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (175.94 KB) | DOI: 10.29342/cnj.v2i1.60

Abstract

Latar Belakang: Transient visual loss adalah hilangnya tajam penglihatan mendadak baik parsial maupun komplit pada satu atau kedua mata yang terjadi kurang dari 24 jam. Decompression sickness terjadi apabila gelembung gas (bubble) yang terbentuk pada saat tubuh mengalami penurunan tekanan ambient secara mendadak pada pembuluh darah (intravaskular), sistem muskuloskeletal, atau jaringan tubuh lainnya menimbulkan suatu gejala. Bubble di intravaskular dapat mengakibatkan obstruksi vaskular, menghambat aliran darah dan menyebabkan iskemia. Iskemia pada daerah occipital akan menyebabkan terjadinya transient bilateral visual loss. Kasus: Pasien laki-laki berusia 23 tahun dengan keluhan penglihatan kabur yang terjadi mendadak setelah pasien naik ke permukaan dari kegiatan menyelam sedalam ± 5 meter selama 1 menit. Pasien dengan riwayat menarik napas dalam dan cepat beberapa kali sebelum melakukan free diving. Tajam penglihatan kedua mata pasien saat di rumah sakit adalah 4/60. Pemeriksaan segmen anterior dan posterior kedua mata dalam batas normal. Dilakukan terapi oksigen hiperbarik. Tajam penglihatan kedua mata pasien membaik menjadi 6/6 setelah terapi. Diskusi: kasus transient bilateral visual loss pada pasien dengan iskemia occipital post free diving dicurigai disebabkan oleh adanya sumbatan intravaskular oleh bubble yang terbentuk pada decompression sickness. Diagnosis decompression sickness ditegakkan secara klinis dan dapat dipastikan bila gejala membaik setelah pemberian terapi rekompresi. Terapi oksigen hiperbarik merupakan terapi pilihan pada semua kasus dengan riwayat terpapar lingkungan hiperbarik atau kondisi unpressurized high-altitude. Mencegah terbentuknya bubble dalam tubuh adalah dengan menghindari faktor risiko terbentuknya bubble dan mematuhi cara naik ke permukaan (ascending) yang benar setelah diving. Kata Kunci: Buta Mendadak Sementara, Decompression Sickness, Penyelam
PROFIL SKRINING INFEKSI COVID-19 DAN KADAR D-DIMER PADA PASIEN STROKE DI RSUP SANGLAH DENPASAR Ida Ayu Sri Indrayani; Ida Bagus Kusuma Putra; I Gusti Ngurah Ketut Budiarsa; Anak Agung Bagus Ngurah Nuartha; Angga Krishna; Kumara Tini; I Made Odie Lastrawan; Putu Ngurah Arya Darmawan; Eric Hartono Tedyanto; Aurelia Vania
Callosum Neurology Vol 4 No 1 (2021): Callosum Neurology Journal
Publisher : The Indonesia Neurological Association Branch of Denpasar

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.29342/cnj.v4i1.157

Abstract

Pendahuluan: Coronavirus Disease 2019 (COVID-19) diumumkan sebagai pandemi oleh World Health Organization (WHO) pada tanggal 11 Maret 2020. Studi menemukan stroke dapat merupakan salah satu manifestasi neurologi COVID-19. Studi mengenai karakteristik pasien stroke pada masa pandemi COVID-19 dipublikasi untuk menunjang data mengenai COVID-10 pada pasien stroke sehingga mendukung penyusunan pedoman tatalaksana stroke yang lebih baik di masa pandemi COVID-19 Tujuan: Untuk mengetahui karakteristik pasien stroke selama pandemi COVID-19 di RSUP Sanglah Kota Denpasar Metode: Studi ini merupakan studi deskriptif dengan kriteria inklusi pasien yang didiagnosa stroke di RSUP Sanglah pada periode Juni-Agustus 2020. Subjek dipilih menggunakan teknik consecutive sampling Hasil Penelitian: Studi melibatkan 69 pasien stroke dengan laki-laki sebanyak 62,3% dan perempuan 37,7%. Stroke non-hemoragik didapatkan sebanyak 67,7% dan stroke hemoragik 33,3%. Dari skrining Rapid Test ditemukan 7,2% hasil reaktif dan 92,8% non-reaktif. Pemeriksaan PCR pada tes swab menunjukkan hasil 10,1% positif, negatif 11,6%, dan yang tidak diperiksa sebanyak 78,3%. Hasil pemeriksaan rontgen thorax menunjukkan gambaran pneumonia sebanyak 23,2%, tidak pneumonia sebanyak 75,4%, dan TB 1,4%. Hasil pemeriksaan D-Dimer ditemukan 62,3% normal dan 37,7% meningkat. Dari pasien yang memiliki hasil swab test positif (7 orang), didapatkan 7 orang dengan hasil D-Dimer meningkat Simpulan: COVID-19 dapat ditemukan sebagai penyebab atau penyakit penyerta pasien stroke pada masa pandemi ini. Kadar D-dimer yang tinggi dapat menjadi marker gangguan koagulasi pada COVID-19 yang merupakan salah satu mekanisme penyebab stroke pada infeksi SARS-CoV-2 ini Kata Kunci: COVID-19, D-dimer, Karakteristik, Stroke
NEUROMYELITIS OPTICA SPECTRUM DISORDER (NMOSD) DENGAN ANTIBODI AQP4 POSITIF Rima Febry Lesmana; Anak Agung Mas Putrawati Triningrat; Made Paramita Wijayanti; I Made Agus Kusumadjaja; Ida Ayu Sri Indrayani; Gede Kambayana
Callosum Neurology Vol 4 No 2 (2021): Callosum Neurology Journal
Publisher : The Indonesia Neurological Association Branch of Denpasar

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.29342/cnj.v4i2.138

Abstract

Background: Neuromyelitis optica (NMO) is an in?ammatory demyelinating autoimmune disease of the central nervous system that most commonly affects the optic nerves and spinal cord. Seropositive antiAQP4 differentiates NMO from MS and the presence of manifestation in the postrema, brainsteam or diencephalic areas extend to NMO Spectrum Disorder (NMOSD). Case Description: A 18 years old male complain sudden vision loss on his left eye since 2 weeks ago. The examination show the visual acuity on the right eye was 6/6 and LPBP on the left eye. Positive RAPD on the left eye, funduscopy and the OCT RNFL within normal limits. Head MRI focus orbita with contrast show optic neuritis. Patient was diagnosed with left eye retrobulbar optic neuritis and ONTT therapy was given. The visual acuity improved to 1/60 then therapy change to oral steroid. Four months later, the patient suddenly got vision loss on the right eye accompanied by paraparesis. The visual acuity on the right eye was NLP and the left eye was 1/300, with mid-dilated papil. The results of the OCT RNFL show on the right eye edema papil and left eye atrophy papil. An MRI of the head focus orbital and whole spain was reexamined followed by VEP examination and an AntiAQP4 which showed an NMOSD. He was given ONTT then continued with immunosuppressants. The visual acuity of the right eye improved to 3/60 and the left eye remained 1/300. Discussion: This patient first presented with complain on the left eye with clinical and supporting symptoms suggesting an optic neuritis. The presence of a new attack on the right eye with paraparesis is a clinical feature of NMO supported by MRI results and seropositive AQP4 indicates an NMOSD. Conclusion: Establishment of diagnosis and administration of therapy quickly and precisely can reduce the severity and risk of recurrence which leads to greater disability and blindness. Key Words: Neuromyelitis Optica, Neuromyelitis Optica Spectrum Disorder, AQP4
LESI NERVUS OKULOMOTOR INVOLVED PUPIL ET CAUSA ANEURISMA PADA PASIEN DENGAN STROKE SUBARACHNOID HEMORRHAGIC DAN SYSTEMIC LUPUS ERITHEMATOSUS I Ketut Aryawan; Anak Agung Mas Putrawati Triningrat; Made Paramita Wijayanti; Ida Ayu Sri Indrayani; Pande Ketut Kurniari
Callosum Neurology Vol 4 No 2 (2021): Callosum Neurology Journal
Publisher : The Indonesia Neurological Association Branch of Denpasar

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.29342/cnj.v4i2.163

Abstract

Introduction: Oculomotor nerve palsy is an pathological condition caused by microvascular injury, head injury, compression due to neoplasm or aneurysm, and also oculomotor nerve palsy can be caused by autoimmune prosses. Peripheral neuropathy is one of the clinical manifestations in patient with SLE, Oculomotor nerve palsy is one type of cranial neuropathy seen with SLE patient. Patient with SLE have a higher risk of serebrovascular event than general population. Case Illustration: Female 34 years old complained drop of the eyelid on the left eye and double vision when see with both eyes since 1 mounth before examination. Patient with history of headace and diagnosed with SLE since 2006 with regular treatment. From the examination, pupil anisocor, on the right eye pupil was 3 mm in diameter with positif direct and indirect reflex. On the left eye pupil was 6 mm with negative direct and indirect reflex. Extraocular movement on the left eye was limited except abduction movement.  CT-Scan examination shows bilateral subarachnoid hemorrhage and from CT-Angiography shows dilatation of the left siphon carotid artery. Patient was diagnosed with oculomotor nerve palsy involving pupil caused by aneurysm with SAH and SLE. Discussion: Oculomotor nerve palsy mostly caused by aneurysm compression in posterior communicating artery (PCoA) and internal carotid artery (ICA). Cerebrovascular imaging, MRA and CTAngiography, can showing the aneurysm and its location. Risk of cerebrovascular event increased in patient with SLE than general population. Management patient with oculomotor nerve palsy with SLE nowadays is with pulse dose corticosteroid. Conclusion: SLE with oculomotor nerve palsy will increase risk of cerebrovascular event. Key Words : Oulomotor Nerve Palsy, Subarachnoid Hemorrhage, Systemic Lupus Erithematosus
PENINGKATAN D-DIMER DAN LUARAN KLINIS PASIEN TERKONFIRMASI COVID-19 YANG MENGALAMI STROKE DI RSUP SANGLAH : LAPORAN KASUS Ida Ayu Sri Indrayani; Andre Dharmawan Wijono; Aurelia Vania; Edwin Pranata Laban; Johan Andrasilli; Muhammad Arismunandar; Fuji Restu Firma
Callosum Neurology Vol 4 No 2 (2021): Callosum Neurology Journal
Publisher : The Indonesia Neurological Association Branch of Denpasar

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.29342/cnj.v4i2.164

Abstract

Latar Belakang: COVID-19 sering dihubungkan dengan terjadinya hiperkoabilitas yang menyebabkan komplikasi pada sistem neurovascular, salah satunya adalah stroke. D-dimer merupakan salah satu pemeriksaan yang dapat digunakan untuk melihat adanya koagulopati. Tinjauan ini bertujuan untuk melihat pentingnya pemeriksaan d-dimer pada pasien COVID-19 yang mengalami stroke. Kasus: Dari data yang diambil di RSUP Sanglah bulan Juni sampai dengan Agustus 2020, didapatkan 4 pasien stroke non hemoragik yang terkonfirmasi COVID-19. Keempat pasien tersebut berusia 80, 75, 59, dan 76 tahun dimana semua pasien berjenis kelamin laki-laki. Klinis neurologis yang didapatkan pada keempat pasien tersebut yaitu paresis nervus cranialis VII, paresis nervus cranialis XII dan hemiparesis flaksid disertai dengan adanya refleks patologis. Dari keempat pasien tersebut, hanya ada satu pasien yang tidak mengalami sesak napas. Tiga pasien mengalami pneumonia pada pemeriksaan rontgen thorax. Setelah dilakukan pemeriksaan d-dimer, semua pasien menunjukkan peningkatan angka D-dimer dengan angka masing-masing 0.73, 1.03, 7.03, dan 1.51. Pasien dengan D-dimer 7.03 memiliki skor NIHSS tertinggi yaitu 8. Diskusi: Proses apoptosis sel-sel endotel dari struktur vaskular mengakibatkan terjadinya koagulopati dan peningkatan D-dimer. Studi melaporkan hasil laboratorium D-dimer yang lebih tinggi pada kondisi COVID-19 berat atau COVID-19 dengan gangguan serebrovaskular. Mekanisme gangguan serebrovaskular tanpa faktor risiko vaskular sebelumnya diduga berasal dari kondisi hiperkoagulasi yang menyebabkan pembentukan trombus dalam pembuluh darah. D-dimer meningkat pada 36% pasien dengan COVID-19 di Wuhan, yang dikaitkan dengan risiko kematian yang lebih tinggi. Kesimpulan: Kadar D-dimer berkorelasi dengan keparahan penyakit dan merupakan suatu penanda prognostik tingkat keparahan pada pasien yang dirawat karena COVID-19. Kata kunci: D-dimer, Covid-19, stroke, luaran klinis
CHARACTERISTICS OF ACUTE ISCHEMIC STROKE PATIENTS DUE TO SMALL VESSEL OCCLUSION Richard Suherlim; Nyoman Angga Krishna Pramana; Kumara Tini; Ida Bagus Kusuma Putra; Ida Ayu Sri Indrayani
MNJ (Malang Neurology Journal) Vol. 9 No. 1 (2023): 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.2023.009.01.5

Abstract

Background: Ischemic stroke account for about 87% of all stroke cases. This study will focus on ischemic stroke due to small vessel occlusion as one of the subtypes based on TOAST (trial of ORG 10172 in acute stroke treatment). Objective: To determine the characteristics of ischemic stroke patients caused by small vessel occlusion and are expected to be used as a basis for further research. Methods: A descriptive observational retrospective study regarding the characteristics of acute ischemic stroke patients due to small vessel occlusion at Sanglah Hospital. Secondary data were obtained from patient medical records. Results: The total number of cases of small vessel occlusion was 338. The majority of the sample were men (64.5%) between 40-60 years old (53.6%). Most of the samples were patients who had experienced an ischemic stroke for the first time (75.1%) with NIHSS (National Institute of Health Stroke Scale) scores showing mild (48.2%) and moderate (51.5%) symptoms. Around half of them had a history of hypertension (60.1%), dyslipidemia (59.5%), and diabetes mellitus (44.1%). The most common location of infarction was in the anterior circulation (77.5%) with almost the same ratio of right and left hemisphere locations. Conclusion: Ischemic stroke due to occlusion of small vessels at Sanglah Hospital Denpasar for 3 years was 35.2% of the total ischemic stroke cases. Half of the total sample had classic vascular risk factors. Further research is needed to determine another effective treatment strategy other than just secondary prevention such as life style moderation to prevent recurrency.
Co-Authors Anak Agung Bagus Ngurah Nuartha Anak Agung Mas Putrawati Triningrat Andre Dharmawan Wijono Angga Krishna Anita Devi Aurelia Vania Dewa Putu Gede Purwa Samatra Edwin Pranata Laban Eric Hartono Tedyanto Fuji Restu Firma G, Gayathridayawasi Gede Kambayana I Gusti Ngurah Ketut Budiarsa I Ketut Aryawan I Komang Arimbawa I Made Odie Lastrawan I Made Oka Adnyana I Made Pramana Dharmatika I Putu Eka Widyadharma Ida Ayu Sri Wijayanti Ida Bagus Kusuma Putra Ida Bagus Kusuma Putra Ida Bagus Kusuma Putra Johan Andrasilli Ketut Widyastuti Kumara Tini Limalvin, Nicholas Prathama Made Agus Kusumadjaja Made Dyah Vismita Indramila Duarsa Made Paramita Wijayanti Muhammad Arismunandar Ni Putu Sista Ijya Savitri Ni Putu Winda Apriyanti Nugraha, Boya Nyoman Angga Krishna Pramana Nyoman Angga Krishna Pramana Pande Ketut Kurniari Putu Ngurah Arya Darmawan Richard Suherlim Rima Febry Lesmana Valentina Tjandra Dewi Yenita Khatania Ardjaja