Magna Neurologica is a journal that publishes original articles, review articles, and case reports. It releases two issues per year, in January and July. Magna Neurologica is a peer-reviewed and open-access journal, published by the Department of Neurology, Faculty of Medicine Universitas Sebelas Maret, that serves as a comprehensive platform for disseminating groundbreaking research in the field of neurology. Through the publication of original articles, reviews, and intriguing case reports, the journal promotes advancements in basic neurosciences and clinical neurology. Additionally, Magna Neurologica welcomes brief communications on medicine, the latest developments in diagnostic procedures of neurology diseases, treatments, and other critical health issues related to neurology. The journal also fosters scholarly discourse and collaboration within the neurological community by encouraging letters and commentaries on its published articles. Subjects suitable for publication in Magna Neurologica span a wide range of topics, including neuroepidemiology, neurovascular disorders, neuroinfections, neurobehavioral studies, neuroimmunology, neurodegenerative diseases, and more. From neurosurgery to neuroanatomy, the journal provides a comprehensive platform for researchers and practitioners worldwide to contribute in the elaboration knowledge of neurological sciences. To ensure the journal's quality and global relevance, the editorial board members are carefully selected. The journal's rigorous peer-review process is enriched by reviewers from five countries; South Korea, Iraq, United States of America, Italy, and Indonesia, reflecting a diverse range of expertise and perspectives.
Department of Neurology Faculty of Medicine Universitas Sebelas Maret
This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).
Acute Malignant Transformation as A Rare Complication of Middle Cerebral Artery Infarction
Background: Malignant ischemic stroke is a stroke characterized by extensive acute edema resulting in a space-occupying lesion. This transformation occurs in 10% of ischemic strokes with a mortality rate up to 80%. Hence, it is crucial to early detection and timely treatment. Case: A 51-year-old male was diagnosed with ischemic stroke, presented with NIHSS 11 and ASPECTS 4. Within 26 hours, the patient's level of consciousness declined progressively from a GCS of 15 to a GCS of 10. Serial brain imaging using CT scan and MRI revealed infarct expansion, a space-occupying lesion, and further midline shift. During decompressive craniectomy, extensive edema was found without hemorrhage, suggesting malignant ischemic stroke. After 6 months, the patient had undergone cranioplasty, with no significant complaints, but left hemiparesis remained. Discussion: Malignant ischemic stroke occurs within 5 days after onset. Diagnosis of malignant complication should be considered in ischemic stroke patients with younger age, higher NIHSS, not receiving thrombolysis, neurological status decline in 4-6 hours after onset, wide hypoattenuation in MCA territory, and signs of progressive space-occupying lesion in brain imaging. Management of malignant ischemic stroke consists of managing intracranial pressure with pharmacology and decompressive craniectomy. Conclusion: Malignant transformation is a rare complication of ischemic stroke. Early and accurate diagnosis is crucial to determine the prognosis. Pharmacological therapy and decompressive craniectomy surgery are considered life-saving therapies, but are not able to reduce morbidity in the patient.
Copyright (c) 2026 Annisa Bunga Nafara, Ika Yulieta Margaretha Permatasari https://creativecommons.org/licenses/by/4.0/
Oligodendrocyte Differentiation from Human iPSCs: Strategies Based on Signaling Pathways, Transcription Factors, and Novel Modulators for Research and Therapy
Background: Oligodendrocytes (OLs) are vital for central nervous system (CNS) function, producing myelin sheaths and maintaining axonal integrity. However, their limited accessibility in human disease-relevant contexts has historically hindered progress in research. The advent of induced pluripotent stem cell (iPSC)-derived OLs has transformed the study of myelin-related diseases and regenerative therapies. Objective: This review aims to provide a comparative overview of strategies for generating OLs from human iPSCs, emphasizing their mechanisms, efficiency, scalability, and translational applications. Methods: We analyzed three major differentiation approaches described in recent literature. Signaling-based protocols replicate developmental processes by modulating TGF-β, SHH, and Wnt pathways. Transcription factor-driven methods accelerate lineage specification by directly inducing OL fate. Modulator-enhanced strategies incorporate epigenetic, metabolic, or environmental cues to improve efficiency and adaptability. Results: Each approach offers distinct strengths and limitations. Signaling-based methods closely mimic in vivo development but require long culture times. Transcription factor-driven strategies enable rapid OL generation, although sometimes at the expense of physiological relevance. Modulator-enhanced protocols represent an emerging avenue, offering flexibility and potential for higher efficiency. Collectively, these strategies expand opportunities for disease modeling, therapeutic screening, and cell replacement therapies. Conclusion: Advances across signaling, transcriptional, and modulatory domains have significantly advanced iPSC-based OL generation. Integration of these approaches may enable more efficient, scalable, and physiologically relevant OL production. Such progress holds significant potential to accelerate the development of myelin targeted therapeutics and enhance translational research in demyelinating diseases.
transcription factor-myelin regeneration
Copyright (c) 2026 Maria Maylyn Evangelina Wong, Michelle Angelica Subrata https://creativecommons.org/licenses/by/4.0/
Vitamin D Receptor Gene Polymorphisms in Multiple Sclerosis Susceptibility: Updated Systematic Review and Meta-Analysis
Background: The relationship between Vitamin D Receptor (VDR) gene polymorphisms and the risk of developing Multiple Sclerosis (MS) has been explored in numerous studies. However, the results were inconclusive. Therefore, this study aimed to investigate the relationship between VDR gene polymorphisms and susceptibility to MS. Objective: This study aimed to systematically evaluate the association between Vitamin D Receptor (VDR) gene polymorphisms and susceptibility to Multiple Sclerosis (MS) through a meta-analysis of existing studies. Methods: This study is a meta-analysis conducted in accordance with the PRISMA guideline. The literature search was conducted using the PubMed and Google Scholar databases from January 2014 to December 2024. Studies included in this meta-analysis were assessed using the Newcastle-Ottawa Scale (NOS). The association between VDR polymorphisms and the risk of MS was evaluated using pooled odds ratios (ORs) and 95% confidence intervals (CIs). Results: Six studies (868 cases/982 controls) were included. The TaqI polymorphism showed that TT vs TC + CC was associated with reduced risk of MS (OR 95% CI = 0.43 [0.21 - 0.86], p = 0.02), while CC vs TT + TC was associated with an increased risk of MS (OR 95% CI = 1.89 [1.51 - 2.36], p < 0.00001). T vs C was associated with reduced risk of MS (OR 95% CI = 0.69 [0.49 - 0.98], p = 0.04) while C vs T was associated with an increased risk of MS (OR 95% CI = 1.45 [1.02 – 2.05], p < 0.04). Conclusion: In summary, our meta-analysis revealed a significant association between VDR gene polymorphism and MS susceptibility in certain genetic models of the VDR gene.
Copyright (c) 2026 Han Yang, Baarid Luqman Hamidi, Esti Nur Ekasari, Krisandi Hartanto, Rudi Ilhamsyah https://creativecommons.org/licenses/by/4.0/
Cell Based Treatment for Spinocerebellar Ataxia: A Clinical Case Report
Background: Spinocerebellar ataxia (SCA) is a dominant and monogenic central nervous system disorder, characterized by progressive motor disorders affecting coordination, balance, speech, and ADL. The prevalence is 2.7 out of 100,000 people. Currently, cell-based therapy is being developed for clinical improvement in SCA. Case: A 48-year-old woman with weakness in both legs and arms, difficulty walking, dysmetria, and dysarthria since 2015. Examination of SARA scoring is severe ataxia, EMG showed polyradiculopathy, muscle denervation, and suspicion of posterior ramus lesions; complete blood laboratory and tumor markers were routine. MRI brain contrast and whole spine contrast radiology imaging were also performed. Clinical improvement was achieved in 2016 following stem cell injection in Thailand (dose and type of cells unknown). However, clinical worsening occurred from 2020 to 2024. The patient received Umbilical Cord Mesenchymal Stem Cells (MSC) in October 2024, administered intrathecally at a dose of 20 million cells. Discussion: The first injection showed significant clinical improvement. The second injection showed no clinical improvement, but no worsening of symptoms was found. The difference in results may be due to variations in the route of administration, cell type, cell quality, and the dose administered. Conclusion: The administration of umbilical cord mesenchymal stem cells (UC-MSCs) in SCA is considered safe, with minimal complications, and can suppress disease progression, although it does not produce clinical improvement.
Copyright (c) 2026 Damar Dyah Mentari, Rivan Danuaji https://creativecommons.org/licenses/by/4.0/
Fahr Disease in Elderly Patients with Bronchopneumonia and History of Ischemic Stroke: A Case Report and Literature Review
Background: Fahr's Disease (Fahr's Syndrome) is a rare condition characterized by idiopathic bilateral basal ganglia calcifications, typically occurring in the lateral parts of the globus pallidus, dentate nuclei, and caudate nuclei. Diagnosis is based on clinical features of neuropsychiatric and somatic symptoms in conjunction with radiological findings. We report an unusual case of Fahr's disease in a 70-year-old woman with bronchopneumonia and a history of chronic ischemic stroke identified through a CT-SCAN. Case: The patient was a 70-year-old female, admitted to our emergency department with bronchopneumonia, who presented with declining consciousness and focal seizures for 3 hours before entering the hospital. Her brain’s CT scan revealed calcification in the bilateral lentiform nuclei, bilateral cerebellar dentate nuclei, and left corona radiata, consistent with Fahr's disease. The patient was also diagnosed with bronchopneumonia and chronic ischemic stroke. Discussion: Fahr's Disease is linked to abnormal calcium metabolism, leading to calcifications in the basal ganglia. While chronic ischemic stroke may not directly cause Fahr's Disease, it increases the risk of cerebrovascular events in affected individuals. The correlation between infection and Fahr's Disease is poorly understood, although it may exacerbate neurological symptoms. Conclusion: Basal ganglia calcification in Fahr's disease may be associated with an increased risk of stroke and bronchopneumonia, which can worsen the patient's condition. Further research is needed to understand the relationship between Fahr's disease, ischemic stroke, and infections.
Copyright (c) 2026 Miftahul Hasanah, Aditya Putra Priyahita https://creativecommons.org/licenses/by/4.0/
Haemorrhagic Transformation in Ischemic Stroke Induced by Polycythemia Vera: A Case Report
Background: Polycythemia vera (PV) is a myeloproliferative neoplasm characterized by the overproduction of red blood cells. This can lead to hyperviscosity, which significantly increases the risk of thrombosis, which in turn increases the risk of ischemic stroke. There is currently no reported case of haemorrhagic transformation of PV-induced acute ischemic stroke in Indonesia. Case: A 62-year-old female was admitted to the emergency department after a sudden onset of left-sided weakness one hour before admission. She has a history of polycythemia vera, with prior hemoglobin levels reaching 22 g/dL, and had a previous ischemic stroke one year prior. On physical examination, the patient was alert, with a GCS of 15, blood pressure of 168/94 mmHg, left-sided hemiparesis, dysarthria, and facial drooping. Laboratory tests revealed elevated hemoglobin 16.8 g/dL, hematocrit 56%, platelets 466,000/µL, and leukocytes 20.4 x 10³/µL. A non-contrast head CT showed a hypodense lesion in the right temporoparietal lobe with a hyperdense spot, consistent with hemorrhagic transformation of a thromboembolic infarction in the right middle cerebral artery (MCA) region, an infarct in the left thalamus, and cerebral atrophy. Discussion: PV-induced ischemic strokes involve a confluence of hyperviscosity, endothelial activation, and platelet aggregation. The thickened blood compromises microcirculatory flow, particularly in the cerebral vascular, increasing embolic risks. HT occurs due to the reperfusion of ischemic tissues following the breakdown of the blood-brain barrier (BBB). Conclusion: Hemorrhagic transformation can develop in PV-induced acute ischemic stroke. Effective management requires a multidisciplinary approach, integrating acute stroke care, rigorous hematologic control, antihypertensive therapy, lifestyle modifications, and antiplatelet treatment.
Copyright (c) 2026 Zalafi Kartika Azka, Irfan Pranowo https://creativecommons.org/licenses/by/4.0/
Epilepsy as the Main Clinical Manifestation of Congenital Hypothyroidism: A Rare Case Report
Background: Congenital hypothyroidism (CH) is defined as a deficiency of thyroid hormones present at birth and is one of the most common causes of intellectual disability. CH shows several manifestations, but it is rarely reported that CH manifests as epilepsy. To our knowledge, this rare manifestation of congenital hypothyroidism has only been reported four times previously. The potential association between CH and epilepsy remains unclear. Case: We reported a rare case of a 1-year-old child who presented to the emergency department with complaints of recurrent seizures. Laboratory results showed increased TSH levels and decreased FT4 levels. Electroencephalography (EEG) results were expected. The patient was diagnosed with epilepsy and congenital hypothyroidism. The patient received stabilization therapy in the ER and was admitted to the PICU for 7 days. During hospitalization and a seven-day evaluation at home, the patient did not experience any further seizures. Discussion: Epilepsy and congenital hypothyroidism can affect each other through three known pathogeneses: mitochondrial dysfunction, oxidative stress, and failure of amino acid regulation in the brain. Long-term use of some anti-epileptic drugs is known to reduce thyroid hormone levels. Conclusion: Thyroid hormones play an essential role in various aspects of epilepsy. Thyroid function screening in patients with epilepsy may be advisable, especially in patients with developmental disorders and relevant symptoms.
Copyright (c) 2025 Lailita Dwi Cahyanti, Aslin Nur Ainiyah, Zidnal Mafaz, Ditya Arisanti https://creativecommons.org/licenses/by/4.0/
Acute Hemiballismus Due to Vascular or Diabetic Striatopathy: A Rare Case Report from KHZ Musthafa General Hospital, Tasikmalaya
Background: Hemiballismus is a hyperkinetic movement disorder characterized by sudden, involuntary, high-amplitude ballistic movements of the arm and leg on one side of the body, often due to contralateral central nervous system dysfunction. The most common causes are ischemic stroke and hyperosmolar hyperglycemic syndrome. Stroke-related movement disorders are rare, with an incidence of 0.4%–0.54%, while the prevalence of hyperglycemia-induced, known as diabetic striatopathy (DS), affects approximately 1 in 100,000 individuals, predominantly older women. Case: A 63-year-old male presented with sudden, involuntary left arm movements for one week, starting with throwing-like motions, followed by stiffness, tremors, rapid arm drop, and facial grimacing on the left side. The condition was accompanied by left leg weakness. He had a history of uncontrolled type 2 diabetes mellitus. Physical examination showed left hemiballismus with motor strength 5/5/3/2 and a positive Babinski reflex on the left. Blood tests revealed a random glucose of 686 mg/dL, HbA1C of 15%, and 126 mmol/L sodium. A non-contrast CT scan showed multiple bilateral lacunar infarcts in the basal ganglia region. Discussion: Hemiballismus occurs sporadically and is caused by multiple bilateral lacunar infarcts in the basal ganglia, with risk factors including type 2 diabetes mellitus and advanced age. Other causes, such as stroke and genetic factors, may still be considered. Conclusion: Hemiballismus is a rare form of movement disorder. Vascular and metabolic disorders are the most common causes of hemiballismus. In this case, acute hemiballismus occurred in an elderly stroke patient with type 2 diabetes mellitus as a risk factor.
Copyright (c) 2025 Nasyifa Nurul Fitriany, Billy Muchamad Ramdani, Indra Gunawan Affandi https://creativecommons.org/licenses/by/4.0/
Non-Traumatic Subarachnoid Hemorrhage with Brain Abscess due to Eisenmenger Syndrome: A Rare Case Report
Background: Non-traumatic subarachnoid hemorrhage in patients with congenital heart disease, such as Eisenmenger syndrome, may involve multiple organs and carries a risk of cerebral abscess due to multiorgan mechanisms. Case: A 20-year-old male with untreated congenital heart disease since childhood was admitted with severe headache, neck stiffness, projectile vomiting, fatigue, lip curling, slurred speech, and stroke-like symptoms. Neurological deficits included right-dominant tetraparesis, accompanied by cyanosis and clubbing of fingers. CT scan revealed a subarachnoid hemorrhage extending into the perimesencephalic cistern with a thick-walled hypodense lesion, suspected to be a brain abscess. Laboratory findings revealed secondary erythrocytosis, characterized by elevated hematocrit and erythrocyte levels. Discussion: In this case, the subarachnoid hemorrhage was non-traumatic and perimesencephalic, likely caused by a mycotic aneurysm associated with Eisenmenger syndrome. The brain is a frequent target of septic emboli linked to mycotic aneurysms that trigger hemorrhage. Hemodynamic instability contributes to arterial endothelial degeneration, while hyperviscosity from congenital heart disease and septic embolism facilitates aneurysm formation. Rupture of such aneurysms leads to a sudden rise in intracranial pressure, worsening neurological outcomes. Conclusion: Subarachnoid hemorrhage in Eisenmenger syndrome is strongly associated with mycotic aneurysms from septic emboli, which may progress to cerebral abscess due to diffuse hypoxia from impaired cardiac output. Early diagnostic evaluation is crucial to establish the etiology, and heightened vigilance is needed in Eisenmenger cases, given the elevated risk of subarachnoid hemorrhage through septic emboli and aneurysm rupture.
Copyright (c) 2026 Muhammad Ikhlas Muttaqin Aditiarman, Dhesty Fadhilah Faatin, Ni Nyoman Ayu Susilawati https://creativecommons.org/licenses/by/4.0/
Guillain-Barre Syndrome Associated with Disseminated Tuberculosis: A Case Report
Background: Guillain-Barre syndrome (GBS) is a life-threatening, acute, immune-mediated polyneuropathy associated with preceding infections. Tuberculosis (TB), although it has a high incidence rate, is rarely reported to be associated with GBS. Case: We report the case of a 20-year-old female admitted to our hospital with a progressive symmetrical paraparesis, which further developed to paraplegia, along with a month-long history of constitutional symptoms. After investigation, the patient was diagnosed with an acute motor and sensory axonal neuropathy (AMSAN) variant of GBS and disseminated TB. The patient was treated with plasmapheresis, and first-line anti-tuberculosis therapy was initiated. The patient demonstrated significant improvement in muscle strength in response to the treatment. The pathogenesis of GBS in TB is believed to be due to molecular mimicry, leading to nerve damage or direct invasion of the nerve root by tubercular bacilli. Discussion: Guillain-Barre syndrome could be induced by tuberculosis, and treatment for both could improve the outcome. Thus, early diagnosis is critical. Further investigations must be conducted to understand the association of GBS and TB. Conclusion: Guillain-Barre syndrome could be induced by tuberculosis, and treatment for both could improve the outcome. Thus, early diagnosis is critical. Further investigations must be conducted to understand the association of GBS and TB.
Copyright (c) 2025 Elsa Primadona Sulfana Putri, Idzni Mardhiyah, Sri Wahyu Evianti https://creativecommons.org/licenses/by/4.0/
Outcome of Aneurysmal Subarachnoid Haemorrhage at Posterior Communicating Artery with Obstructive Hydrocephalus Post Successful Surgical Clipping and External Ventricular Drainage: A Case Report
Background: Approximately 25% of patients with SAH die before hospital admission. Proper posterior communicating artery (PCoA) aneurysm-related SAH is rare, with an incidence of about 1%. It is typically treated with coil embolization via digital subtraction angiography (DSA). In this case, decompressive craniectomy and external ventricular drainage (EVD) were performed, followed by aneurysm clipping, resulting in an excellent outcome. Case: A 63-year-old woman presented with a sudden severe headache, vomiting, somnolence, and right-sided limb weakness. Head CT angiography revealed SAH from a ruptured saccular aneurysm with a daughter aneurysm on the PcoA, Modified Fisher scale 2, and intraventricular hemorrhage (IVH) with a modified Graeb score of 3. The patient underwent decompressive craniectomy, EVD placement, and aneurysm clipping. On postoperative day two, she was alert but had left oculomotor nerve palsy and global aphasia. Head CT showed an acute infarction. Nicardipine was administered for a hypertensive emergency. Intravenous ceftazidime and gentamicin were used to treat nosocomial pneumonia. Nutritional support, physiotherapy, and speech therapy were provided. Discussion: Clipping was chosen for higher aneurysm obliteration rates and better oculomotor nerve recovery, despite a higher risk of postoperative cerebral ischemia than coiling. Due to high Modified Fisher and Graeb scores, EVD was necessary. Hemodynamic management and pneumonia treatment were critical. Early intervention, multidisciplinary care, and close postoperative monitoring are essential to reduce mortality and improve outcomes in PcoA aneurysm-related SAH. Conclusion: Decompressive craniectomy, EVD, and clipping combined with optimal hemodynamic management and complication control resulted in satisfactory outcomes in this rare PcoA aneurysm SAH case.
Copyright (c) 2026 Dyah Fiharjatin, Tommy Rachmat Setyawan, Rakhian Listyawan, Fajar Maskuri https://creativecommons.org/licenses/by/4.0/
A Rare Case of Anomic Aphasia and Gerstmann Syndrome Induced by Hemorrhagic Stroke
Background: Aphasia is a language disorder caused by brain damage, such as a stroke. Anomic aphasia, a rare subtype, impairs the ability to name objects or people while preserving fluency and comprehension. It is often associated with Gerstmann syndrome, which is characterized by acalculia, finger agnosia, left-right disorientation, and semantic aphasia. This report presents a case of a 61-year-old male with anomic aphasia and Gerstmann syndrome following a hemorrhagic stroke. Case: A 61-year-old male patient presented with sudden difficulty recalling the names of family members and objects. Imaging revealed an intracerebral hemorrhage in the left parietotemporooccipital lobe. The patient also exhibited left-right disorientation and finger agnosia, indicative of Gerstmann syndrome. The Aphasia Test for Rehabilitation Information Diagnosis (TADIR) confirmed the diagnosis of anomic aphasia. Although conservative treatment led to partial improvement, naming difficulties and associated deficits persisted. Discussion: Anomic aphasia primarily involves difficulties with naming, typically resulting from lesions in the dominant hemisphere, particularly the temporal and parietal lobes. Its coexistence with Gerstmann syndrome underscores the complexity of overlapping neurological deficits. The TADIR test was crucial in diagnosing and managing the patient's condition. Conclusion: This case highlights the importance of a thorough evaluation in aphasia cases, especially when rare syndromes like Gerstmann syndrome are involved. Early and accurate diagnosis enables targeted interventions that can improve patient outcomes.
Copyright (c) 2025 Daniel Mahendrakrisna, Bagus Ngurah Mahasena Putera Awatara, Gede Suputra, Ni Wayan Nurlina Ekasari, Dian Kusumastuti Anggraeni Putri, Anak Agung Ayu Putri Laksmidewi https://creativecommons.org/licenses/by/4.0/
Successful Pudendal Nerve Block and Radiofrequency in 4 Years Scrotal Pain Resistant to Treatment and Three Varicocelectomies: A Case Report
Background: Only a small percentage of patients (2-10%) report pain symptoms during varicocele or post-varicocelectomy. The cause of the pain remains unclear and is still a matter of debate. Neither conservative nor surgical treatments provide a conclusive solution for pain. Nerve blocks can serve as a diagnostic and therapeutic tool in cases where the origin of pain is unknown. Case: A 30-year-old male presented with 4 year history of chronic scrotal pain, worsening over the past three weeks. The pain, rated 6/10 on the Numeric Rating Scale (NRS), was unrelieved by rest or analgesics and worsened at night and with prolonged sitting (NRS 7/10), significantly impacting daily activities. He had bilateral recurrent varicocele and underwent three varicocelectomies and ureteroscopy. Oral analgesics and neuropathic pain medications provided only temporary relief. The neurological examination revealed hyperalgesia in the distribution of the pudendal nerve. The imaging results were expected. Discussion: A notable reduction in pain was observed following an ultrasound-guided diagnostic pudendal nerve block with 2 mL of 2% lidocaine, confirming pudendal neuralgia related to varicocele or post-varicocelectomy. The pain is likely due to compression of the pudendal nerve branch by an enlarged pampiniform plexus. Pulsed radiofrequency is utilized to provide longer-lasting pain relief. No complications were reported after the treatment. Conclusion: Pudendal nerve blocks can alleviate scrotal pain and may be an alternative to genitofemoral and ilioinguinal nerve blocks. This is the first report of a successful pudendal nerve block for scrotal pain associated with varicocele or varicocelectomy.
Copyright (c) 2026 Yang Yang Endro Arjuna, Tasya Meidy Pradhana, Yusak Mangara Tua Siahaan https://creativecommons.org/licenses/by/4.0
Civamide Nasal Spray: A Breath of Fresh Air in Migraine and Cluster Headache Therapy? Insights from A Systematic Review
Background: Migraines and cluster headaches are severe neurological disorders characterized by complex pathophysiological mechanisms, particularly involving the trigeminal nerve and vascular inflammatory responses. Both conditions primarily affect the trigeminal nerve, a key pathway in pain transmission, and are closely associated with vascular inflammation. Migraines are typically characterized by recurrent, unilateral, and intense headaches, whereas cluster headaches are marked by excruciating pain, often localized around the eye. These disorders are multifactorial, with various mechanisms contributing to their initiation and persistence. Civamide nasal spray, which modulates neural pathways, has emerged as a promising therapeutic option for targeted pain relief. This study aims to evaluate the effectiveness of Civamide nasal spray in managing these debilitating headaches. Objective: To assess the efficacy of civamide nasal spray in treating migraine and cluster headache attacks. Methods: This study followed the Synthesis without Meta-analysis (SWiM) guideline. A systematic search was conducted using a predefined query in Medline, Google Scholar, and Cochrane Central Library. Eight independent reviewers screened studies for eligibility based inclusion criteria and assessed the risk of bias using the Cochrane RoB 2.0 tool. Results: Two eligible studies were analyzed. Participants receiving civamide demonstrated a greater reduction in weekly headache frequency compared with those receiving a placebo. Additionally, civamide treatment was associated with decrease in pain intensity. Conclusion: The findings suggest that civamide nasal spray effectively reduces both the frequency and severity of headaches. Nonetheless, further investigations, particularly evaluating its long-term preventive use, are required to establish its clinical role in migraine and cluster headache management.
Copyright (c) 2026 Cyntia Arum, Danar Dwi Anandhika, Nabil Hajar, Moh. Iqbal Setiawan, Fatima Khiarun Nisa, Suwandhi, Firza Yoga Baskoro, Hera Dwi Priharti https://creativecommons.org/licenses/by/4.0/
New-Onset Intracranial Hemorrhage in A Patient with Glioblastoma Multiforme: A Case Report
Background: Glioblastoma multiforme (GBM) is the most common and aggressive primary brain tumor in adults. GBM is a high-grade glioma of the central nervous system associated with high morbidity and/or mortality, often accompanied by Intracranial Hemorrhage (ICH). Case: This study reports a 62-year-old male patient presenting with sudden-onset weakness in the left extremities, which worsened over the past week, without any history of trauma. A non-contrast computed tomography (CT) scan of the head revealed the presence of ICH. Laboratory findings showed leukocytosis and mild hyponatremia. The patient had previously been diagnosed with glioblastoma in the right parietal region, confirmed through magnetic resonance imaging (MRI), which revealed multiple lesions with solid-cystic components. The patient had undergone tumor removal surgery via craniotomy for further histopathological examination. A repeat craniotomy was performed to evacuate the ICH. Following the evacuation of the hemorrhage, clinical improvement was observed. Discussion: GBM classically presents with symptoms of increased intracranial pressure and gradually progressive neurological deficits. GBM also enhances vascular endothelial growth factor (VEGF) activity, contributing to the increased incidence of ICH. Acute presentation with ICH and rapid clinical deterioration is rare. The current treatment options for GBM are multimodal, including surgical resection, radiation therapy, and chemotherapy. Conclusion: GBM presenting with ICH is uncommon but life-threatening. This case underscores the need for high clinical suspicion and immediate neuroimaging in patients with known or suspected GBM presenting with acute neurological decline. Timely surgical intervention can improve outcomes.
Copyright (c) 2026 Adam Arya Pratama, Meritania Ridianti Putri, Hanis Setyono https://creativecommons.org/licenses/by/4.0
Paraplegia due to A Rare Spinal Metastasis of Hepatocellular Carcinoma: A Case Report
Background: Paraplegia caused by spinal cord compression is a rare but serious condition that can occur in cancer patients, including metastasis from hepatocellular carcinoma (HCC). Hepatocellular carcinoma metastasis to the spine can compress the spinal cord, disrupt nerve function, and lead to motor and sensory impairment in the lower limbs, ultimately resulting in paraplegia. Case: An 86-year-old man presented with progressive weakness in both lower limbs. He had not previously complained of weakness; his family attributed it to the natural effects of old age. However, the patient frequently complained of low back pain that did not improve with analgesics. Further investigation of the lesion revealed sensory impairment equivalent to the T8 dermatome. A complete physical examination showed an enlarged liver without stigmata of liver disease. CT scan revealed an extradural lesion at the T4 region and a compression fracture at the T8 region. The patient then underwent ultrasonography (USG), which identified a hepatoma suggestive of hepatocellular carcinoma (HCC). Discussion: Spinal cord compression as an initial presentation of HCC is uncommon and often delays diagnosis, especially in the absence of typical liver symptoms. MRI played a key role in identifying the extradural mass. Early recognition and management are crucial in preventing irreversible neurological damage. Treatment may include corticosteroids, radiotherapy, or surgery to relieve symptoms and improve quality of life; however, the prognosis remains poor without prompt intervention. Conclusion: These findings highlight the importance of early detection and comprehensive management in cases of paraplegia due to HCC metastasis to minimize neurological complications and improve patient survival.
Copyright (c) 2026 Nerissa Arviana, Hendra Gunawan, Nilna Nur Faizah, William Luth https://creativecommons.org/licenses/by/4.0/
A Case Report: Intracerebral and Intraventricular Hemorrhage Due to Rupture of Aneurysm in the Middle Cerebral Artery
Background: Intracerebral hemorrhage (ICH) and intraventricular hemorrhage (IVH) caused by aneurysm rupture without subarachnoid hemorrhage (SAH) is a rare condition, with a prevalence of 1.6%. Case: A 40-year-old male presented with a sudden headache, vomiting, and generalized seizures lasting one day. Initially conscious, he later developed recurrent seizures and transient decreased consciousness. He had a history of smoking and uncontrolled hypertension. Neurological examination showed normal motor function and positive neck stiffness. Head CT revealed ICH and IVH without SAH. The patient underwent ventriculoperitoneal (VP) shunt placement. Six months later, follow-up CT showed a hyperdense lesion in the inferolateral right frontal lobe. Digital subtraction angiography (DSA) identified a saccular aneurysm in the right middle cerebral artery (MCA), M1 segment. Endovascular coiling was performed. Discussion: The patient’s symptoms resembled SAHs, including thunderclap headache, vomiting, and decreased consciousness. However, initial CT showed only ICH and IVH without SAH, possibly due to the timing of imaging. Secondary ICH and IVH can result from aneurysm rupture and parenchymal hemorrhage near the ventricles. Seizures may contribute to aneurysm rupture and consciousness loss. Risk factors such as hypertension, smoking, and age were present. DSA confirmed the aneurysm as the bleeding source. Endovascular coiling was done to prevent rebleeding. Conclusion: Prompt diagnosis using CT and DSA is critical to identify aneurysm-related hemorrhage and guide effective treatment, improving patient outcomes.
Copyright (c) 2026 Siti Setya Sari Aglen, Lidia Chara Tania Ginting, Hendra Irawan https://creativecommons.org/licenses/by/4.0
Unknown Risk Factor in Pediatric Ischemic Stroke: Challenges in A Developing Country
Background: Stroke is a sudden neurological disturbance with high mortality rates in both children and older people. Pediatric stroke is rare but can lead to lifelong disability due to the immaturity of the brain, and its management can be challenging. Case: A 23-year-old female presented with a history of right-sided weakness and spasticity that began 11 years ago and improved over the past two years. Risk factors that could be excluded were ruled out, while congenital disorders could not be investigated due to financial constraints. Diagnosed with non-hemorrhagic stroke at age 12, an MRI revealed an old infarct in the left internal capsule. The absence of known risk factors underlying her ischemic stroke made a congenital disorder a plausible diagnosis. She was given botulinum toxin type A (BoNT-A) injections to manage spasticity, and her symptoms improved. In the past year, she developed mood disturbances and sleep difficulties, which were treated with quetiapine. Discussion: The pediatric brain is metabolically more active with higher cerebral blood flow demands, making it more susceptible to focal neurological injuries. Most pediatric strokes are ischemic, with numerous potential risk factors including cardiac issues, vasculopathy, coagulopathies, infections, and congenital disorders with vascular complications. Treatment for pediatric ischemic stroke is similar to that in adult cases. In this patient, BoNT-A injections reduced acetylcholine release, effectively treating the patient’s spasticity. Conclusion: Stroke can occur at any age, with pediatric strokes potentially resulting in worse outcomes. Therefore, thoroughly evaluating diverse potential etiologies, including congenital disorders, is crucial.
Copyright (c) 2026 Edeline Samudra, Retno Jayantri Ketaren https://creativecommons.org/licenses/by/4.0/
The Impact of Additional Ginkgo Biloba Extract on Cognitive Function in Acute Ischemic Stroke: A Systematic Review and Meta Analysis
Background: Stroke is the primary cause of mortality and disability among patients worldwide, and can cause cognitive impairment among these patients. Ginkgo Biloba Extract is an organic compound made from G. Biloba. The active ingredients in Ginkgo biloba extract have demonstrated some clinical benefits for cognitive impairment. Objective: We aim to investigate whether the addition of Ginkgo Biloba Extract to patients with acute ischemic stroke improves their cognitive function after follow-up. Methods: A literature search was conducted on PubMed, Google Scholar, and the Cochrane Database, without publication date limits, to identify studies investigating the effect of Ginkgo Biloba Extract on the cognitive function of patients with Acute Ischemic Stroke. The study's primary outcome is a change in cognitive status compared with the baseline, which was assessed with the Montreal Cognitive Assessment (MoCA) after follow-up. Results: Four randomized controlled trials with 3824 patients were identified. Based on the analysis, the addition of Ginkgo Biloba Extract had a significant impact on improving the MoCA score of acute ischemic stroke patients (MD = 0.47 [0.45-0.49], I2 = 76%, p < 0.00001). Conclusion: Additional Ginkgo biloba extract may improve cognitive function in patients with acute ischemic stroke.
Copyright (c) 2026 Mohammad Sandhia Mahardhika Putra, Mutiyas Nadia Ulfa, Krisninda Anggonowati https://creativecommons.org/licenses/by/4.0/
Efficacy and Safety of Evobrutinib in Relapsing Multiple Sclerosis: A Systematic Review of Randomized Controlled Trials
Background: Evobrutinib is a selective Bruton’s tyrosine kinase (BTK) inhibitor that crosses the blood-brain barrier. BTK regulates B lymphocytes and myeloid cells, significantly contributing to multiple sclerosis (MS) inflammation. While current MS treatments alleviate relapses and disability, they have a limited impact on inflammation within the central nervous system. Objective: We aim to evaluate the efficacy and safety of evobrutinib in relapsing MS. Methods: A systematic search of databases, including PubMed, Elsevier, NEJM, BMJ Journals, and Neurology, was conducted. Inclusion criteria: Studies within 5 years, randomized controlled trials, and interventions with evobrutinib. Exclusion criteria: Incomplete reporting, non-phase two trials, and JADAD score < 3. The quality of the included studies was evaluated using the JADAD scale. Results: The literature search yielded 552 studies, of which eight were included in the final analysis. All studies consistently demonstrated significant benefits in reducing disease activity. The efficacy of evobrutinib 75 mg BID showed a significant reduction in ARR (mean ARR = 0.10) and gadolinium-enhancing lesions compared to placebo (mean ARR = 0.37). SEL volume was significantly reduced, especially in patients with higher disability and longer disease duration. The safety profile of evobrutinib was comparable to that of a placebo, with similar rates of TEAEs. Liver enzyme elevations were noted in one study but were generally manageable. Stability in EDSS scores over extended treatment periods suggests effective disease control. Conclusion: Evobrutinib is a promising therapeutic option for managing MS, particularly relapsing forms, due to its efficacy in reducing disease activity and favorable safety profile.
Copyright (c) 2025 Edeline Samudra, Anyeliria Sutanto https://creativecommons.org/licenses/by/4.0/
Traumatic Spinal Cord Injury Due to Horse Riding Accident in A Patient with Klippel-Feil Syndrome: A Case Report
Background: Spinal cord injury is a severe medical illness that frequently leaves patients permanently disabled and with severe morbidity. In some cases, sports may be one of the factors causing spinal cord injuries, like horse riding. Anatomical variation in the vertebra may become a potential risk factor for an injury such as Klippel-Feil syndrome. Case: A 30-year-old female came to the emergency room after falling while riding a horse. The patient complained of not being able to move her hands and feet and feeling numb from the neck area to the feet. X-rays of the cervical spine showed an anatomical variation in fusion at the C4 and C5 vertebrae, known as Klippel-Feil syndrome. No visible fracture or dislocation was found. The MRI results showed intramedullary lesions at the C3 to C5 vertebral bodies level and compression fracture of the C4-C5 vertebral body accompanied by narrowing of the C4-C5 intervertebral disc. Discussion: Patients with Klippel-Feil syndrome may be more vulnerable to transient neurologic deficits after minor trauma. The fused segments' altered mechanical force transfer, which results in the adjacent non-fused segments moving excessively, is most likely related to this. Conclusion: Serious medical conditions like spinal cord injuries often leave victims severely sick and permanently incapacitated. Sports such as horse riding are associated with traumatic spinal cord injuries. Patients with Klippel-Feil syndrome may be more susceptible to this trauma.
Copyright (c) 2025 Christy Angeline, Debora Hendra, Rani Maria, Denny Maulana Siahaan https://creativecommons.org/licenses/by/4.0
Virtual Conventional Therapy for Motor Rehabilitation in Stroke Patients: A Systematic Review
Background: Stroke is a leading cause of disability worldwide, significantly impacting motor function, sensory, visual, and cognitive abilities. Conventional physical therapy has traditionally been used for stroke rehabilitation. However, technological advances have introduced virtual reality (VR) as a rehabilitation tool. Research has highlighted the therapeutic value of VR in improving motor functions, with some studies suggesting superior outcomes compared to traditional therapy. Despite this, the literature presents varied results, necessitating a systematic review to evaluate the breadth of evidence. Objective: This study aims to compare the effectiveness of VR therapy with conventional physical therapy in extremity function among stroke patients. Methods: A primary search was conducted across PubMed, Scopus, and ProQuest databases using keywords related to stroke, VR, and conventional therapy. Studies will be included if they compare the efficacy of VR with conventional therapy in stroke rehabilitation. Non-comparative studies, non-English publications, and irrelevant topics will be excluded. Results: A literature search yielded 15 eligible journals using a randomized clinical trial. Analysis showed that 4 out of 15 articles found VR therapy not superior to conventional therapy, while the other 11 articles demonstrated that VR therapy statistically improved patient conditions compared to conventional therapy. Conclusion: VR-based exercises stimulate cortical reorganization and strengthen neural systems involved in motor planning, learning, and execution. Most studies indicate that VR therapy is more effective in enhancing motor recovery, balance, and limb function in stroke patients and increasing patient motivation and engagement than conventional training.
Copyright (c) 2025 Rudi Ilhamsyah, Yetty Hambarsari, Markus Santoso, Hendry Gunawan, Esti Nur Ekasari, Krisandi Hartanto, Han Yang https://creativecommons.org/licenses/by/4.0/
A Woman with Dyke-Davidoff-Masson Syndrome: A Case Report
Introduction: Dyke-Davidoff-Masson Syndrome (DDMS) is a rare neurologic condition associated with drug-resistant epilepsy (DRE). Almost 100 DDMS cases were reported, and only 21 were reported among adults. This case report presented Dyke-Davidoff-Masson Syndrome in a 30-year-old woman. Case: A 30-year-old woman presented with generalized tonic-clonic seizures the day before admission. Each seizure lasted 5 minutes and reoccurred up to three times daily. She communicated but was slow in answering questions post-seizure. Neurological examination revealed left hemiparesis and contracture. Electroencephalography showed diffuse abnormalities. Brain magnetic resonance imaging (MRI) revealed DDMS with crossed cerebellar atrophy. Although anticonvulsant treatment controlled seizures, motor impairments like hemiparesis and joint contractures persisted since childhood. Discussion: DDMS is a cerebral palsy-related condition resulting from an injury associated with calvarium immaturity or childhood brain damage. Prenatal and post-natal injury may be the etiologic factors of DDMS. The clinical features of DDMS are cerebral hemiatrophy or hypoplasia, facial asymmetry, seizure, and contralateral hemiplegia with diverse combinations and severity. Specifically, in this case, the MRI showed right-sided brain atrophy, enlarged right lateral ventricle, and crossed cerebellar atrophy, all consistent with DDMS. Compensatory changes in the right skull, like thickened bones and enlarged frontal sinus, were also observed​. Symptomatic management is the mainstay of DDMS treatment, one of which is antiepileptic medication. Surgery is indicated as the last therapeutic option in some instances. Conclusion: DDMS cases in adults are rare. At present, there is no management algorithm for DDMS. Thorough history taking and physical and radiology examinations are required for DDMS diagnosis.
Copyright (c) 2025 Fitriani Tri Rahayu, Hexanto Muhartomo, Aditya Kurnianto, Arinta Puspita Wati https://creativecommons.org/licenses/by/4.0
A Case Report: Prevost’s as Early Sign of Subcortical Symptom to be Considered or Screening in Acute Ischemic Stroke
Background: Stroke is the leading cause of death and disability. Stroke symptoms depend on the location of the lesion, whether cortical or subcortical (white matter, basal ganglia, or thalamus). Prevost's sign or horizontal conjugate eye deviation (CED) must be considered an early motoric sign of ischemic stroke. Case: Mrs. F, 61 years old, came to the ER complaining of headache and dizziness for a day without any complaints about her eyes, and had a history of diabetes mellitus. Neurological examination revealed conjugate eye deviation to the right side without other neurological deficits. A head CT scan showed a minimal infarction of the left putamen and an old minimal infarction of the right corona radiata. Discussion: Pathophysiologic mechanism of Prevost’s sign due to cerebral-mesencephalic-phonto-cerebellar pathway disorder and related to cranial nerves III and VI. The putamen is a nuclear structure part of the basal ganglia involved in that pathway. A provost's sign that appears in less than 90 days can be used for stroke screening for ischemic patients. Previous studies describe CED >140 as being identified as ischemic stroke. Patients with strabismus have an average of CED 14.20. Another retrospective study in 543 acute ischemic strokes showed that CED had a higher specificity value (0.78; 95% CI) than hemiparesis (0.35; 95% CI). The sensitivity values were 0.76 and 0.85 (95% CI). Conclusion: Prevost's sign is one of the signs of motor deficit in acute cerebral infarction. It needs to be considered as a subcortical lesion in stroke patients.
Copyright (c) 2025 Fitria Febriana, Andrianto Selohandono, Yudhanto Utomo https://creativecommons.org/licenses/by/4.0/
Vitamin D Deficiency in Relapsing Anti-NMDAR Encephalitis Presenting with Acute Cognitive Impairment: A Case Report
Background: Anti N-methyl-D-aspartate Receptor (NMDAR) encephalitis is an autoimmune disease characterized by neuropsychiatric symptoms caused by autoantibodies against NMDAR. It is a treatable disease, but approximately 12-25% of patients experience relapse. Vitamin D has several immunomodulatory effects and its deficiency is associated with systemic and neurologic autoimmune disease. Case:A 21-year-old woman presented with acute cognitive impairment, followed by status epilepticus during hospitalization. Two years ago, she was diagnosed with anti-NMDAR encephalitis and completely recovered after immunotherapy. During relapse, magnetic resonance imaging (MRI) showed chronic lacunar infarct on the right basal ganglia, and electroencephalography (EEG) showed diffuse slowing, identical to findings from the first event. Laboratory testing during relapse indicated vitamin D deficiency, which was normal before relapse onset. Symptoms improved following intravenous methylprednisolone, plasma exchange, vitamin D supplementation, and symptomatic treatment. Discussion: Inadequate immunotherapy has been suggested as a major risk factor for relapse, while other determinants have not been well recognized. Vitamin D inhibits proliferation of B cells, an important immunomodulator in anti-NMDAR encephalitis. Previous study revealed vitamin D levels were reduced in anti-NMDAR encephalitis patients and it is also thought to influence response to therapy. On the other hand, vitamin D also influence neurotransmitter activities and synaptic formation involved in cognitive and memory functioning. Conclusion: Anti-NMDAR encephalitis is a treatable autoimmune disease but still has the possibility of relapse. Vitamin D deficiency may be related with relapse of anti-NMDAR encephalitis. Routine screening for vitamin D deficiency can be considered in relapsed patients or during maintenance therapy.
Copyright (c) 2025 Audiza Luthffia, Cempaka Thursina Srie Setyaningrum, Amelia Nur Vidyanti, Desin Pambudi Sejahtera, Sekar Satiti https://creativecommons.org/licenses/by/4.0
Pediatric Epilepsy Surgery in A Drug-Resistant Epilepsy Patient Aggravated by SARS-CoV-2: A Case Report
Introduction: Epilepsy is a manageable neurological disorder, but about one-third of cases are classified as drug-resistant epilepsy (DRE). DRE in pediatrics is more complex and may lead to cognitive function impairment, while surgery can offer seizure control in cases of focal DRE. Case: A 10-year-old male presented with a four-year history of recurrent seizures, thought to be caused by a left temporal cerebral cyst diagnosed five years earlier. During episodes, he experienced body stiffness, bilateral eye twitching, and drooling, with intact consciousness. After SARS-CoV-2 exposure, seizures became more frequent despite antiepileptic treatment, leading to partial resection of the left temporal lobe nine months later. Two years post epileptic surgery, he has become drug-responsive and achieved seizure control with symptomatic relief through medication. Discussion: Epilepsy is common in children, and DRE should be considered in cases of intractable epilepsy. Various factors can cause DRE, and in this patient, SARS-CoV-2 is thought to aggravate seizures by binding to ACE2 receptors in the central nervous system. This neural interaction may trigger reactive astrogliosis and neuroinflammation, disrupting the balance between glutamate and GABA levels. However, epilepsy surgery has been effective in improving the quality of life. Conclusion: Epilepsy surgery, either resective or non-resective surgery, is still rarely performed in Indonesia, while the management of DRE may require surgery. Although complete seizure freedom is not guaranteed, surgery can often convert DRE into a drug-responsive condition.
Copyright (c) 2025 Edeline Samudra, Retno Jayantri Ketaren, Made Agus Mahendra Inggas https://creativecommons.org/licenses/by/4.0/
Comparison of Seizure-Free Rates Between Levetiracetam and Phenytoin Administration in Seizure Patients with Brain Metastases Tumor (BM) During Period January 2023-December 2024
Background: Brain metastase tumor (BM) is the most frequently found intracranial tumor. The prevalence of seizures in BM ranges from 30%-50%. One of the treatments for seizure patients with BM is the administration of Anti-Epileptic Drugs (AED). The latest neuropharmacology now makes Levetiracetam (LEV) the first-line choice in BM cases compared to phenytoin (PHT), which was previously often used in BM cases. Objective: This study aims to compare seizure-free rates in patients with seizures on BM who received PHT or LEV treatment at Regional General Hospital Dr. Moewardi Surakarta from January 2023 – December 2024. Methods: An observational study using a cross-sectional method with a retrospective approach. Patients included were patients with BM who experienced seizures and received AEDs, either PHT 2x100 mg or LEV 2x500 mg, for a minimum duration of 6 months during the period January 2023–December 2024. Results: There were 50 research subjects with an age range of 38-67 years. The independent T-Test showed a significance value of 0.007 < value (0.05). In the group of patients given PHT, the seizure-free rate was 6.83±1.26 a (7 months), while in the LEV group, it was 9.02±0.85 b (9 months). Conclusion: A longer seizure-free rate in research subjects with LEV than PHT was found. This result is to previous research regarding the effectiveness of LEV as the leading choice in seizure patients with BM.
Copyright (c) 2025 Dhiandra Dwi Hapsari, Teddy Tejomukti, Ranum Anggun Nastiti https://creativecommons.org/licenses/by/4.0/
A 22-Years-Old Male with Tuberculoma of the Brain and Spinal Cord with Miliary Tuberculosis
Background: Tuberculosis (TB) remains a significant health issue in Indonesia. Central nervous system (CNS) tuberculoma is one of the extrapulmonary TB diseases and accounts for approximately 1% of all cases. The emergence of this disease is primarily associated with a weakened immune system. However, several other factors, such as comorbidities, a history of inadequate TB treatment, and poor nutrition, also play a role in the development of tuberculoma. Case: A 22-year-old male complained of weakness in all four limbs for the past month, accompanied by tingling and numbness from both feet up to the T10-11 dermatome level. The patient has a history of seizures from one year ago, interrupted treatment for military tuberculosis, and malnutrition. An MRI of the head and whole spine with contrast revealed tuberculomas. The patient was treated with medication, including intravenous dexamethasone 5 mg every 8 hours, oral phenytoin 200 mg every 24 hours, and anti-tuberculosis therapy. Discussion: Tuberculoma in the central nervous system is rare, especially multiple tuberculomas co-occurring in the brain and spinal cord. MRI is a sensitive tool for diagnosing tuberculomas, characterized by the presence of a target sign. The combination of corticosteroids, antiepileptic drugs, and an entire course of anti-tuberculosis medications aims to address both the immediate neurological symptoms and the underlying infection. Conclusion: TB can present as lesions in the brain and spinal cord, requiring the ability to correlate clinical manifestations and radiological features to establish a diagnosis and necessitating adequate therapy.
Copyright (c) 2025 Rosinondang Deolita Simamora, Retnaningsih, Elta Diah Pasmanasari, Hexanto Muhartomo https://creativecommons.org/licenses/by/4.0
Sturge - Weber Syndrome: A Glimpse into A Rare Clinical Diagnosis
Background: Sturge-Weber syndrome is a spectrum of neurocutaneous disorders characterized by angiomas involving the face, choroid, and leptomeninges. Patients present with the typical “port wine stain”, acute seizure onset, and increasing hemiparesis. Case: A 1-year-old female presented to the ED with a seizure that coincided with a fever. The patient had two generalized tonic-clonic seizures in a day, which lasted less than 5 minutes. Before this, the patient had a history of seizures that started at 6 months old. The patient had an erythematous patch covering the right side of her face, along with left-sided weakness and positive plantar reflex on the left foot. Head non-contrast MRI scan showed a hypointense lesion/blooming artifact in the right frontal lobe on T2FFE and a prominent vascular structure on the right frontal lobe, accompanied by the widening of multiple veins and sinuses. Discussion: Sturge-Weber syndrome is complete when both facial angioma and leptomeningeal involvement are present. Diagnosis is confirmed through clinical features, with seizures and hemiparesis correlating to imaging findings. In our patient’s case, a type I Sturge-Weber syndrome diagnosis was made. The patient was started on oral anticonvulsants and future controls. Conclusion: Sturge-Weber syndrome is a clinical syndrome with many neurological complications. The lack of specific treatment urges an early diagnosis, as it can affect the patient’s outcome.
Copyright (c) 2025 Retno Jayantri Ketaren, Jacob Christian Cenadi https://creativecommons.org/licenses/by/4.0
Automated Prediction of Large Vessel Occlusion Using Artificial Intelligence in Non-Contrast Computed Tomography: A Systematic Review and Meta-Analysis
Background: Acute ischemic stroke due to large vessel occlusion (LVO) requires rapid identification. Reducing the time to diagnosis and treatment of stroke patients is an important goal to improve clinical outcomes. Non-contrast computed tomography (NCCT) is widely used in clinical practice for suspected stroke patients. Automated analysis using artificial intelligence in NCCT may be a solution to accelerate the early detection of LVO. Objective: To determine the accuracy of artificial intelligence in NCCT to predict LVO. Methods: A systematic literature search was conducted based on the PRISMA flow chart in four databases (PubMed, ProQuest, ScienceDirect, Cochrane Library) until June 2024. Data extraction was performed to evaluate the accuracy of predicting LVO. Quality assessment was performed using QUADAS-2. All data were analyzed using Review Manager 5.4 and MetaDTA 2.0. Results: Five studies involving 4.862 patients were enrolled. The quality of all the studies was high and had a low risk of bias. All studies used different software. Artificial intelligence in NCCT had fairly good accuracy with a sensitivity and specificity of 0.83 (95% CI; 0.78-0.87) and 0.73 (95% CI; 0.52-0.87). NCCT plus clinical status (NIHSS, stroke onset) in two studies slightly improved overall accuracy with a sensitivity and specificity of 0.85 (95% CI; 0.80-0.89) and 0.74 (95% CI; 0.54-0.88). Two studies reported that machine learning took less than two minutes. Conclusion: Artificial intelligence in NCCT was reasonably accurate and took a short time to predict LVO. There are still opportunities for machine learning to improve performance. Further research is still needed.
Copyright (c) 2025 Hamid Faqih Umam, Aila Mustofa, David Noor Umam, Shabrina Nur Zidny, Dyah Pranani, Retnaningsih https://creativecommons.org/licenses/by/4.0/