MANAJEMEN TRAUMA TEMBUS OTAK : LAPORAN KASUS

Pendahuluan. Trauma tembus otak merupakan kegawatan medis yang meskipun jarang terjadi namun sering mengakibatkan mortalitas dan morbiditas yang tinggi. Penanganan trauma tembus otak sendiri masih menjadi tantangan bagi para ahli bedah saraf di seluruh dunia. Menajemen yang optimal pada penaganan trauma tembus otak memerlukan pemahaman yang komprehensif terhadap mekanisme dan patofisiologi terjadinya cedera tersebut. Sampai saat ini penanganan standar pada kasus trauma tembus otak masih menjadi perdebatan. Metode. Artikel ini berbentuk serial kasus, kami melaporkan 3 kasus trauma tembus pada institusi kami. Artikel ini disusun dari berbagai referensi dan pengalaman kasus yang pernah ditangani di Rumah Sakit Umum AkademikDr. Soetomo. Hasil. Pada pasien trauma tembus yang dilakukan kraniotomi debridement kurang dari 12 jam post trauma diikuti pemberikan antibiotik profilaksis empirik dengan ceftriaxone dan metronidazole selama 7 hari dan antikejang phenytoin selama 7 hari didapatkan keluaran yang memuaskan. Kesimpulan Manajemen trauma tembus otak memerlukan metode diagnostic yang cepat dan tepat. Pemeriksaan CT scan kepala menjadi wajib untuk penegakan diagnosis trauma tembus kepala. CT angiografi diperlukan pada kasus kasus yang dicurigai menyebabkan lesi vaskular. Yang kemudian iikuti dengan penangan operasi segera dan pemberian antibiotic yang tepat. Kata Kunci: Trauma tembus otak, kraniotomi debridement, antibiotik profilaksis empiri, CT angiograf

Chronic Subdural Hematoma-Induced Parkinsonism: A Systematic Review

Abstract Background: Chronic subdural hematoma (CSDH) is one of the most common neurosurgical cases, especially in elderly individuals. Secondary parkinsonism due to CSDH is a rare entity. The mechanism of parkinsonism symptoms in chronic subdural hematoma has been suggested to include direct mechanical compression of the basal ganglia due to hematoma or indirectly through brain structure changes due to space lesions and vascular disorders. Surgery on the subdural hematoma provides a favorable outcome for parkinsonism symptoms. Objectives: To systematically review the literature on CSDH-induced parkinsonism. Search methods: This is a systematic review on case reports. Literature search was performed using the predefined keywords on PubMed, ProQuest, and Google Scholar. We also provided our own case report and compared it with published studies. Result: Sixteen cases from 13 case reports/series were identified, predominantly consisting of male patients with the mean age of 66.5 ± 9.73 years. The most common symptoms were rigidity, gait disturbance, and bradykinesia, observed in 12 (75%) cases each. The second and third most common symptoms were tremor (11; 68.75%) and facial masking (8; 50%), respectively. Other reported symptoms were dysphasia (3; 18.75%), dysarthria (3; 18.75%), and urinary incontinence (2; 12. 5%). Time gap between the symptom onset and CSDH diagnosis and unilateral location seemed to influence the outcome. Conclusion: Only 16 CSDH-induced parkinsonism were identified since the 1960s. This condition is thought to occur due to basal ganglia compression. Surgery on the subdural hematoma provides a favorable outcome for parkinsonism symptoms. Timely CSDH diagnosis might yield better outcome. However, further research on CSDH-induced parkinsonism is needed, especially in the mechanisms and treatment outcomes

Chronic Subdural Hematoma-Induced Parkinsonism: A Systematic Review

Abstract Background Chronic subdural hematoma (CSDH) is one of the most common neurosurgical cases, especially in elderly individuals. Secondary parkinsonism due to CSDH is a rare entity. The mechanism of parkinsonism symptoms in chronic subdural hematoma has been suggested to include direct mechanical compression of the basal ganglia due to hematoma or indirectly through brain structure changes due to space lesions and vascular disorders. Surgery on the subdural hematoma provides a favorable outcome for parkinsonism symptoms. Objectives To systematically review the literature on CSDH-induced parkinsonism. Search methods This is a systematic review on case reports. Literature search was performed using the predefined keywords on PubMed, ProQuest, and Google Scholar. We also provided our own case report and compared it with published studies. Result Sixteen cases from 13 case reports/series were identified, predominantly consisting of male patients with the mean age of 66.5 ± 9.73 years. The most common symptoms were rigidity, gait disturbance, and bradykinesia, observed in 12 (75%) cases each. The second and third most common symptoms were tremor (11; 68.75%) and facial masking (8; 50%), respectively. Other reported symptoms were dysphasia (3; 18.75%), dysarthria (3; 18.75%), and urinary incontinence (2; 12. 5%). Time gap between the symptom onset and CSDH diagnosis and unilateral location seemed to influence the outcome. Conclusion Only 16 CSDH-induced parkinsonism were identified since the 1960s. This condition is thought to occur due to basal ganglia compression. Surgery on the subdural hematoma provides a favorable outcome for parkinsonism symptoms. Timely CSDH diagnosis might yield better outcome. However, further research on CSDH-induced parkinsonism is needed, especially in the mechanisms and treatment outcomes