Effect of swallowing therapy to avoid aspiration in patients with post-stroke dysphagia at the stroke unit of Harjono hospital, Indonesia

Background: Aspiration is common complication of dysphagia stroke due to cranial nerve damage, especially cranial nerves V, VII, IX, X and XII. Existing therapies to prevent aspiration is the compensation strategy therapy and semisolid nutritional therapy, but each of these therapies is still have a weakness, so it needs a new therapeutic method namely swallowing therapy which combine the advantages and reduce the weaknesses of each of the therapy. Aim of the study is to determine the effect of swallowing therapy on aspiration prevention in patients with dysphagia stroke.Methods: This research was a quasi-experimental research involving 16 respondents in the intervention group and 16 respondents in the control group who obtained through consecutive sampling techniques. Data was collected from February-March 2016 at the Stroke Unit RSUD Dr. Harjono Ponorogo through observations using Gugging Swallowing Screen (GUSS) instruments. Data analysis used in this research was wilcoxon test to determine the difference of swallowing therapy effect before and after intervention. Mann-Whitney test was also used to determine the difference of swallowing therapy effect between intervention group and control group after intervention.Results: There was a differences of swallowing therapy effect between pre-test and post-test in the intervention group (p = 0.002). In addition, there was no differences between pre-test and post-test in the control group (p = 0.157).Conclusions: Swallowing therapy have a positive effect against aspiration prevention in patients with dysphagia stroke, so it can be recommended as an acute care intervention in stroke patients at stroke unit

Intervertebral Disc Characteristic on Progressive Neurological Deficit

Objective: To examine the intervertebral disc characteristic on magnetic resonance imaging (MRI) in lumbar herniated disc (LHD) patients with progressive neurological deficit.Methods: Patients were collected retrospectively from Dr. Hasan Sadikin General Hospital Database from 2011–2013 with LHD, had neurological deficit such as radiculopathy and cauda equine syndrome for less than four weeks with a positive sign confirmed by neurological examination and confirmatory with MRI examination.Results: A total of 14 patients with lumbar herniated disc disease (10 males, 4 females) suffered from progressive neurological deficit with an average age of (52.07±10.9) years old. Early disc height was 9.38±0.5 mm and progressive neurological deficit state disc height was 4.03±0.53 mm, which were significantly different statisticaly (p<0.01). Symptoms of radiculopathy were seen in 11 patients and cauda equine syndrome in three patients. Modic changes grade 1 was found in five patients, grade 2 in eight patients,grade 3 in one patient, Pfirmman grade 2 in eleven patients and grade 3 in three patients. Thecal sac compression 1/3 compression was seen in four patients and 2/3 compression in ten patients.Conclusions: Neurosurgeon should raise concerns on the characteristic changes of intervertebral disc in magnetic resonance imaging examination to avoid further neural injury in lumbar herniated disc patients.Keywords: Lumbar herniated disc, magnetic resonance imaging, progressive neurological deficit DOI: 10.15850/ijihs.v5n2.1042 

Rare Distal Anterior Choroidal Artery Aneurysm

Objective: To describe a rare patient with ruptur aneurysm case of distal anterior choroidal artery (AChA) and intraventricular hemorrhage. A 56-year old female came to our hospital with chief complaint sudden onset of severe headache and vomiting.Methods: Head computed tomography (CT)-scan and angiography on the lesion was performed at the Department of Radiology, Siloam Hospital, Tangerang, Indonesia.Results: Head CT-scan imaging revealed an intraventricular hemorrhage, primarily in the right lateral ventricle, with slight enlargement of both lateral, 3rd and 4th ventricles. Angiography examination revealed a round vascular lesion at the wall of the posterior cornu of the lateral ventricle and an occlusion of the M1 base segment of the left middle cerebral artery.Conclusions: The lesion, distal AChA aneurysm, at the posterior cornu was reached using an infratemporal lobe approach with the help of neuronavigation. Microsurgical clipping was successfully performed.Keywords: Aneurysm, distal anterior choroidal artery, neuronavigation DOI: 10.15850/ijihs.v4n2.83

Histological Description of Meningeal and Periosteal Dural Layers at the Porus of Internal Acoustic Canal in the Vestibular Schwannoma

Objective: To study the transformation point of meningeal and periosteal dural at the porus of internal acoustic canal (IAC) in order to verify the different thickness of meningeal and periosteal dura in vestibular schwannomas (VS). Methods: Three IAC cadaver specimens and ten samples of VS patients from porus were obtained and analyzed. Samples were stained by using Masson trichrome technique after cutting in 6 micron of thickness. The samples were then observed under light microscopes to understand the meninges pattern in the IAC. Results: The meningeal dura is becoming thin at the porus and disappears at the meatal portion to form epineurium. However, the periosteal dura is lining continuously to the fundus. In VS, the meningeal dura becomes thick and forms a pseudo-capsule in the middle of meatus, known as perineurium. The residual nerve filament was compressed by the tumor parenchyma. Between the tumor and nerve interface, three or more perineureal layers are seen. The perineurium in the cisternal portion was consistently loose and forms the tumor and arachnoid nerve interface. Almost all the nerve filaments are displaced to the tumor periphery near the pseudocapsule. In contrast, the periosteal dural of VS is becoming thin and disappear nearby the middle of meatal portion. This changing site establishes “meningo-periosteal ring” of VS because of the encircling nearby the porus. Conclusions: In IAC, the meningeal dural becomes thin. The periosteal dura is lining continuously to the fundus. In VS, the meningeal dura becomes thick, joins perineurium and forms pesudocapsule near the porus, but the periosteal dura disappeared. This changing point is called meningo-periosteal ring.     Keywords: Meningeal,  periosteal, porus, vestibular schwannomasDOI: 10.15850/ijihs.v1n1.10

Korelasi Antara Volume Epidural Hematoma dari Hasil Penghitungan CT Scan dengan Temuan Volume Epidural Hematoma Intraoperatif

Latar Belakang: Cedera kepala merupakan kasus yang sering ditangani dibagian bedah saraf di Indonesia, dengan insidensi yang tinggi. Perdarahan intrakranial, khususnya perdarahan epidural (Epidural Hematoma/EDH), adalah kasus yang membutuhkan diagnosis dan tatalaksana darurat. Pembedahan pada kasus EDH bergantung pada pemeriksaan klinis dan hasil pemeriksaan radiologis. Penghitungan volume EDH yang tepat sangat penting dalam pemutusan tindakan pasien. Metode: yang dilakukan adalah studi analitik observasional berdasarkan catatan dan hasil CT scan pasien, di RS. Hasan Sadikin antara Nov. 2013 dan Mei 2014. Kalkulasi volume EDH dari hasil CT scans dilakukan menggunakan ellipsoid formula dan metode Espersen-Petersen. Hasil: kalkulasi dibandingkan dengan volume perdarahan intraoperatif. Hasil: Sebanyak 113 kasus, bersadarkan hasil analisis didapatkan korelasi terbaik dengan volume intraoperatif adalah dengan menggunakan metode Espersen-Petersen (0.786, sig. 0.007) dibandingkan formula ellipsoid (0.698, sig 0.025). Kedua rumus memberi hasil yang lebih banyak daripada volume intraoperatif. Simpulan: Estimasi volume EDH menggunakan metode Espersen-Petersen memberikan hasil yang lebih akurat dibanding rumus ellipsoid.Kata kunci: Perdarahan Epidural, EDH, Analisa Volumetrik ABSTRACT Introduction: Head injuries are commonly presented to the neurosurgeon. In case epidural hemorrhages (EDH) urgent diagnosis and treatment is needed. Surgical treatment is performed based on a criteria assessing clinical examination and several CT scan findings. In EDH, accurate volume blood calculating, highly needed for patient treatment. Methods: An observational analytical study was conducted using CT scan results and intraoperative reports taken from EDH patients in Hasan Sadikin Hospital between November 2013 and May 2014. EDH volume in CT scan results were calculated using the ellipsoid formula and the Espersen-Petersen method. Results: were compared to intraoperative findings. Result: Total of 113 datasets were available for this study. Best correlation was found using the Espersen-Petersen method (0.786, sig. 0.007) and ellipsoid volume calculation (0.698, sig 0.025). Both calculations produce higher result of EDH volume compared to intraoperative findings. Conclusions: The Espersen-Petersen method was determined to be most accurate in calculating EDH volume than  ellipsoid volume formulaKeywords: Epidural hemorrhage, EDH, Espersen-Peterse

Incidence of Cavum Septum Pellucidum and Cavum Vergae in Dr. Hasan Sadikin General Hospital, Bandung, Indonesia

Objective: To describe the cavum septum pellucidum (CSP) and cavum vergae (CV) findings. Methods: Thirteen samples were recruited in the study. The study was conducted at the Department of Neurosurgery, Dr. Hasan Sadikin Hospital, Bandung, Indonesia in the period of 2015–2016. Thirteen samples were recruited for the study. Cavum septum pellucidum and CV spaces are relatively rare. During neurology and neurosurgery examination of patients with head computed tomography (CT) scan and magnetic resonance imaging (MRI), CSP and CV were discovered accidentally. The incidence of these unique spaces reported from many countries, but have never been reported from Indonesia.Results: This is the first-time reported incidental finding of CSP and CV from Indonesia, 13 cases in one-year period. Since the presence of CSP and CV is usually asymptomatic, clinician seem don’t really care to put it in their report.Conclusions: The presence of CSP and CV as a common incidental finding can be more revealed in our country in years to come and hopefully can be more studied in term of anatomical landmark on neurosurgical field.Keywords: Cavum septum pellucidum, cavum vergae, incidental finding DOI: 10.15850/ijihs.v5n1.96

Anterior Interhemispheric Approach for Olfactory Groove Meningioma

Objective: To evaluate the surgical technique with bifrontal interhemispheric approach for total removal of tumor in olfactory groove meningioma (OGM). Methods: This study described a case of a 38-year-old woman with bilateral blindness, anosmia, and behaviour changes. Imaging studies show a tumor mass in midfrontal base. Surgery using a bifrontal interhemispheric approach was performed and total removal was achieved and postoperative computed tomography (CT) scan was performed to confirm the result. Histopathological findings established a diagnosis of meningioma.Results: A coronal skin incision behind the hairline was utilized. The scalp was elevated, taking care to reserve the vascularized pericranium medial to the linea temporalis of each side, and preserving the 2 supraorbital nerves. Eight burr holes were used, with the two initial holes made on each side of the orbitotemporal region, and the other four holes at the midline. A bifrontal craniotomy was performed. The tumor was first detached from its attachment with bipolar cautery and debulked. During this step, the main tumor feeder arteries from the anterior and posterior ethmoidal artery were interrupted, and the tumor devascularized. Total tumor removal through surgical intervention was achieved and confirmed by head CT-scan postoperatively.Conclusions: This case report supports the suitability of the bifrontal interhemispheric approach for OGM resection with additional radiation therapy.Keywords: Anterior interhemispheric approach, olfactory groove meningioma DOI: 10.15850/ijihs.v4n2.83

Peripheral and Intracranial Compartment Serum Level of Selenium in Pediatric Patients with Intracranial Tumor in Department of Neurosurgery, Faculty of Medicine, Universitas Padjadjaran–Dr. Hasan Sadikin Hospital, Bandung, Indonesia: a Preliminary Study and Literature Review

Objective: To determine the level of Selenium (Se) in peripheral and intracranial serum in pediatric patients with intracranial tumor. Selenium has chemopreventive potentials and acts as neuromodulator.Methods: This study was conducted on 13 pediatric patients with intracranial tumors who were treated in Dr. Hasan Sadikin Hospital, Bandung in the period of February 2014 to February 2015. Samples were taken from peripheral and intracranial serum. The results were analyzed with independent t-test and Pearson correlation test. Significance is defined as p≤0.05 with 95% confidence interval.Results: The results showed that the average Se concentration in peripheral serum was significantly higher than the Se concentration in intracranial serum (95.92±20.95 μg/L and 66.62±22.37 μg/L, respectively). After classifying the subjects into groups based on sex, age, tumor location, and grades, the difference between Se concentrations were still statistically significant (p≤0.05), with the exception of the supratentorial group (p=0.0053). Pearson correlation test showed very-low to medium strength correlations between peripheral and intracranial serum Se concentration in all groups (r=0.16–0.59, p>0.05).Conclusions: A significant difference is seen between the peripheral and intracranial serum Se concentration means in pediatric patients with intracranial tumors, with higher concentrations observed in the peripheral serum. Further studies are required to investigate the roles of Se in the management of pediatric patients with intracranial tumors.Keywords: Pediatric intracranial tumor patients, selenium concentration in peripheral and intracranial serum DOI: 10.15850/ijihs.v4n2.83

PERBANDINGAN PENGUKURAN STATUS SEDASI RICHMOND AGITATION SEDATION SCALE (RASS) DAN RAMSAY SEDATION SCALE (RSS) PADA PASIEN GAGAL NAFAS TERHADAP LAMA WEANING VENTILATOR DI GICU RSUP Dr.HASAN SADIKIN BANDUNG

Sedation is an important factor to improve patient comfort. Over sedation may lead to a longer ventilator time. To prevent over sedation need an instrument can measure accurately the status of sedation. This study aimed to analyze the differences between Richmond Agitation Sedation Scale (RASS) and the Ramsay Sedation Scale (RSS) in measuring the status of sedation for respiratory failure patient against time weaning ventilator. This study is observational analytic with prospective cohort study. This study was conducted in 13 respiratory failure patient and use mechanical ventilator. Sampling is done by non probability sampling method with consecutive sampling that received sedation therapy in GICU RSUP Dr Hasan Sadikin, Bandung. Samples will be measured with two sedation instrument they are RASS and RSS. Patient will be observed until the patient is successfully weaning ventilator mode CPAP or CPAP PS with PS 5-8 cmH2O and PEEP 5 cmH2O.These results indicate the measurement status with RASS sedation and RSS have a significant impact on weaning ventilator time with a value of p &lt;0.05. Based on analysis results there is a significant difference between the measurement of sedation status by RASS and RSS for respiratory failure patient and weaning ventilator time with p &lt;0.05, and the post hoc analysis shows that there are differences in each measurement sedation with p &lt;0,05.Measurement status with RASS sedation better in reducing the length of ventilator weaning compared to RSS. This study can be used as the basis for further research regarding the relationship status measurement sedation to morbidity, mortality and length of stay in patients receiving sedation therapy.</p

Penetrating Wound in the Skull by a Sharp Metal Object

Objective: Penetrating skull injury (PSI) is a neurosurgical emergencies. Most PSI cases reported were caused by gunshot wounds. Although the diagnosis and management of those cases has been described, the actual cases, especially in our center, were quite rare.Methods: A craniectomy debridement with a supine position was performed and removal of the object was achieved. Intraoperatively, we succed control the bleeding as expected.Results: The patient was operated and hospitalized in our center; physical examination revealed neurologically intact before and after the removal of the object. The patient was sent home without any neurological deficits or other complications.Conclusions: We reported a case of penetrating skull injury in a 5-year-old girl caused by a scissors. Penetrating skull injuries were interesting due to its mechanism, management and complications. Early diagnosis and appropriate treatment should resulted in good outcomes.Keywords: Penetrating skull injury, a sharp metal object DOI: 10.15850/ijihs.v3n2.58