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

Profile of Daily Life in Children with Brain Tumors: An Assessment of PedsQL 4.0 Generic Core Scales before and after Treatment

BACKGROUND: Pediatric brain tumors are the most common solid tumor and cause of death among all childhood cancers. In America, brain tumor prevalence is 21.42/100.000 population. Even though survival rate is improving, the impact of treatment for long-term quality of life is still a challenge. AIM: We aimed to investigate quality of life score using PedsQL 4.0 Generic Core Scales. METHODS: The data collected based on the inclusion criteria from patient’s medical records 2015–2017 period on January 2018–May 2018 in Siloam Hospital, Lippo Village, Karawaci. Twenty-six brain tumor pediatric patients with surgical treatment were evaluated using PedsQL 4.0 Generic Core Scales. The evaluation included before and after condition of the patient. PedsQL 4.0 Generic Core Scales were divided into four categories; physical function, emotional function, social function, and school function. They were analyzed statically using Wilcoxon test with p < 0.05 considered as statistically significant. RESULTS: The result showed that before treatment score of PedsQL 4.0 Generic Core Scales was classified as medium functioning (58.54/92) and after treatment score of PedsQL 4.0 Generic Core Scales was classified as intermediate functioning (37.3/92). CONCLUSION: The conclusion is that patient after treatment (surgery, chemotherapy, and radiation) shows improved quality of life score using PedsQL 4.0 Generic Core Scales

Protective Effects of Propolis Extract in a Rat Model of Traumatic Brain Injury via Hsp70 Induction

BACKGROUND: Traumatic brain injury (TBI) is one of the major global health problems. Secondary brain injury is a complex inflammation cascades process that causes brain cell apoptosis. Propolis is a natural product that has neuroprotective property. AIM: This study aimed to investigate the effect of propolis toward Hsp70 expression with apoptosis marker in brain tissue after TBI. METHODS: Thirty-three Sprague Dawley rats were randomised into three treatments group, i.e. sham-operated controls, closed head injury (CHI), and CHI with propolis extract (treatment group). In the treatment group, propolis was given 200 mg/kg per oral for 7 days then harvested brain tissues after sacrificed by cervical dislocation at day 8. We investigated Hsp70, Caspase 3, apoptosis-inducing factor (AIF), and TUNEL assay expression using immunohistochemistry staining. Statistical test using one-way ANOVA test and Tukey HSD as post hoc test. RESULTS: Mean of positive Hsp70 stained cells in group 1 was 6.82 ± 2.14, group 2 was 3.91 ± 2.26, and group 3 was 9.64 ± 3.53 with a significant difference of Hsp70 expression distribution within groups (p = 0.0001). Mean of positive caspase 3 stained cells in group 1 was 5.45 ± 2.30, group 2 was 13.82 ± 2.44, and group 3 was 7.03 ± 1.54 with a significant difference of caspase3 expression distribution within groups (p=0.0001). Mean of positive AIF stained cells in group 1 was 5.36 ± 2.11, group 2 was 12.82 ± 1.40, and group 3 was 8.09 ± 1.81 with a significant difference of AIF expression distribution within groups (p = 0.0001). Mean of positive TUNEL assay stained cells in group 1 was 4.82 ± 2.04, group 2 was 11.55 ± 1.51, and group 3 was 7.64 ± 1.96 with a significant difference of TUNEL test expression distribution within groups (p = 0.0001). CONCLUSION: Propolis may protect brain cell from apoptosis after injury by maintaining Hsp70 expression in addition to antioxidant and anti-inflammatory

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

Dynamic Pattern of Interleukin-1beta and -10 in Cerebrospinal Fluid Following Aneurysmal Subarachnoid Hemorrhage

BACKGROUND: Inflammation following aneurysmal subarachnoid hemorrhage (SAH) is associated with patient outcome. This study aimed to analyze the dynamics pattern of the pro-inflammatory interleukin (IL)-1β and anti-inflammatory cytokine IL-10 in the cerebrospinal fluid (CSF) following aneurysmal SAH.METHODS: This is a prospective observational study. The CSF was collected prior to surgery, and on the 2nd, 4th and 6th days after surgery. The CSF was then analyzed for IL-1β and -10 using enzyme-linked immunosorbent assay. Delayed Ischemic Neurological Deficits (DIND) was determined based on new neurological deficits within the first week after surgery. Data was analysed with T test or Wilcoxon Rank-Sum test to evaluate the pattern of biomarkers between DIND and non-DIND groups.RESULTS: There were 33 patients enrolled in this study, 16 patients (48.48%) who experienced DIND and 17 patients (51.52%) were non-DIND. There were significant increase dynamic levels of IL-10 and -1β in DIND patients (p<0.05).CONCLUSION: Significant increase levels of IL-10 and -1β in CSF after aneurysmal SAH are associated with DIND

Surgery of Intramedullary Tumours

Surgery still offers a cure to the majority of intramedullary tumours. The challenge of the surgery is taking out the tumour while preserving the function. Very often the patient has a huge tumour with very minimal symptoms, such as mild numbness. The slow growth of the tumour nature provides enough time for the cord fibres to adapt accordingly.  Usually, the motor function is preserved and most of the pathologies are benign. For this reasons, the majority of cases have good long-term tumour control. The functional outcome is depending on the preoperative functional state, especially for motor function. The patient should be educated prior to surgery, especially to anticipate the post-surgical rehabilitation period. The surgical technique should preserve the motor function, but the fine movement usually gets worst for several months after surgery and slowly recover within 6 months. We share our experience of 45 surgical cases with intramedullary tumour (14F;31M), the pathologies distributions are 20 ependymomas, 8 astrocytomas (1/8 anaplastic astrocytoma), 7 cavernomas, 8 hemangioblastomas, 1 glioblastoma multiforme, and 1 tuberculoma. The location distribution varied from 27 at the cervical cord, 11 thoracal, 4 thoracolumbal, and 3 MO-upper cervical. The surgical outcome for all cases experienced sensory changes and recovered over 6 months. Almost all cases experienced some degree of spasticity and fine movement difficulty and they are improving over 6 months. Motor strength is usually preserved. One case of GBM, improve gradually for the first two months then followed by the disease course regardless of the treatment. The tuberculoma case required one year to recover her neurological function with adequate treatment. 

Mari mencegah stroke

xii, 142 hl

Surgical management of benign peripheral nerve tumors

Peripheral nerve tumors are rare lesions that can arise anywhere in the body and hence have a myriad of wide differential diagnosis. They commonly present as a non-specific mass which is diagnosed as a peripheral nerve tumor at surgery. While these tumors may initially be referred to a wide variety of surgeons, early recognition of the nature of the lesion and appropriate surgical treatment by an expert peripheral nerve surgeon is essential in order to minimize post-operative neurological deficits. The objective of this article is to provide a general management scheme for the most common setting of benign peripheral nerve tumors. (Med J Indones 2008; 17: 163-8) Keywords: Operative technique, Schwannoma, neurofibrom

Preoperative intralesional injection of triamcinolone acetonide for a large head and neck lymphangioma in a baby: a case report

Lymphangiomas (LMs) are uncommon congenital malformations of the lymphatic system, with an estimated incidence of one in 2,000 to 4,000 live births.1 About half of these lesions are diagnosed at birth, and by two years of age, 90% of those with lesions have been diagnosed.2 Histologically, LMs are benign lesions; however, they can pose a serious threat to the patient due to possible growth into surrounding structures, sometimes causing life-threatening complications. Treatment of large head and neck lymphangiomas in young infants is very challenging, due to the risk of surgical complications. Further challenges include the limited volume of blood loss that infants can tolerate, the lack of the option for radiotherapy or radiosurgery, and the high chance of life-threatening complications if the LM is not treated. Here, we report a case of a two-month-old baby girl presenting with a large head and neck lymphangioma. She was successfully treated with intralesional triamcinolone acetonide injections, followed by surgical resection of the lesion