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All Journal Callosum Neurology Journal : Jurnal Berkala Neurologi Bali
Made Paramita Wijayanti
Departemen Ilmu Kesehatan Mata, FK Universitas Udayana/RSUP Sanglah, Denpasar, Bali, Indonesia
Health Professions Medicine & Pharmacology Neuroscience

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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
Co-Authors Anak Agung Mas Putrawati Triningrat Gede Kambayana I Ketut Aryawan Ida Ayu Sri Indrayani Made Agus Kusumadjaja Pande Ketut Kurniari Rima Febry Lesmana