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All Journal Jurnal Kedokteran Diponegoro International Islamic Medical Journal
Lisa Puspitorini
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Religion Humanities Health Professions Medicine & Pharmacology Public Health

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Case Report : Fahr’s Disease With Acute Double Hemiparese Manifestation Vania Ayu Puspamaniar; Giam, Billy Putera Kurniawan; Bonfilio Neltio Ariobimo; Lisa Puspitorini
Jurnal Kedokteran Diponegoro (Diponegoro Medical Journal) Vol 12, No 2 (2023): JURNAL KEDOKTERAN DIPONEGORO (DIPONEGORO MEDICAL JOURNAL)
Publisher : Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/dmj.v12i2.37711

Abstract

Fahr's disease is a very rare disease with a prevalence of 1/1,000,000 individuals. We present a case report of a male with sudden double hemiparese and basal ganglia calcification leading to the diagnosis of Fahr's disease. A 59 years old male presented to the emergency department with a chief complaint of unable to move his upper and lower extremities in a sudden. The complaint begins with weakness of the right side of the body, followed by weakness of the left side of the body the day after. The serum levels of calcium, magnesium, phosphorus, and Parathyroid Hormonal (PTH) have not been measured due to the patient’s financial problems. CT scan of the brain showed bilateral, symmetrical, wide areas of calcification over the fossa posterior, basal ganglia, periventricular, and parietal area, which were suggested as Fahr’s disease. The patient is being treated with the injection of neuroprotectant, antibiotic, vitamin, neuropathic analgesia, and fluids. He is also being consulted with medical rehabilitation to get some physical treatments. Treatment goals include: increase and or maintain ROM, prevent contractures, strengthens weak muscles that may be underutilized, improvement and maintenance of postural stability in static postures and during mobility, and fall prevention. Our case highlight sudden double hemiparese which different from previous literature which says that neurological deficit symptoms appear with a chronic nature and the importance of combining pharmacological therapy and physical therapy as in this patient to reduce the patient's morbidity.
Case Report: Ischaemic Stroke Presented with Hemichorea-Hemiballism Bonfilio Neltio Ariobimo; Vania Ayu Puspamaniar; Nurun Nujum; Lisa Puspitorini
Jurnal Medis Islam Internasional Vol 5 No 1 (2023): December
Publisher : UNUSA Press

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33086/iimj.v5i1.4911

Abstract

Introduction: Movement disorders can be separated into hypokinetic disorders, which cause paucity or slowness (bradykinesia), and hyperkinetic disorders, which cause excessive, aberrant involuntary motions Less than 5% of individuals with cerebrovascular diseases presented with involuntary movement. It might be difficult to identify and diagnose hyperkinetic disorders. Case: We describe a 56-year-old man who arrived at the hospital with 5 hours of abrupt, uncontrollable movement in his right upper and lower limbs. A complete neurological evaluation revealed an uncontrolled, nonrhythmic, non-patterned, aimless, and frequently jerky movement of the right upper and lower limbs with a ballistic component that varies in amplitude and frequency. Higher psychic function and cranial nerves were normal. Chest radiography, electrocardiography were normal. Hemorrhage was ruled out by a brain non-contrast CT scan at admission. The patient was diagnosed with hemichorea-hemiballism caused by an ischemic stroke based on clinical evidence of a sudden neurological deficit of aberrant involuntary movement. After receiving medical treatment for five days, the involuntary motions stopped occurring without causing any more neurological abnormalities or weakening. Discussion: Ischemic stroke diagnosis relied on skilled clinical assessment without explicit neuroimaging. While hemiballismus is characterized by violent irregular flinging movements of the limbs brought on by contractions of the proximal muscles, hemichorea consists of continuous random, anarchic, and jerking movements involving both the distal and proximal muscles (though it is occasionally localized more distally). Conclusion : Hyperkinetic movement disorders are a rare presentation of stroke. The pathophysiology of these abnormal movements remains uncertain. Even though they are uncommon, following a stroke, aberrant motions can occur suddenly or develop gradually. Hemichorea-hemiballismus with abrupt onset should be treated as an acute stroke unless proven other causes
Co-Authors Bonfilio Neltio Ariobimo Bonfilio Neltio Ariobimo Giam, Billy Putera Kurniawan Nurun Nujum Vania Ayu Puspamaniar