Bleeding Volume, Blood Pressure, and Consciousness Level in Association with the Mortality Rate among Patients with Intracerebral Hemorrhage at Dr. Soetomo General Hospital, Surabaya

Background: Intracerebral hemorrhage is one of the deadliest acute conditions. The volume of bleeding and its location are factors that alter consciousness level, leading to death. This study aimed to explore the association between bleeding volume, blood pressure, and consciousness level with the mortality rate among patients with intracerebral hemorrhage, so proper treatment and diagnosis can be conducted efficiently.Methods: This was an observational retrospective study conducted from October 2018–July 2019. Bleeding volume, blood pressure, consciousness level, and mortality as the outcomes of the patients with intracerebral hemorrhage were evaluated. Consciousness level was determined by using the Glasgow Coma Scale score. Data were collected from the medical record of intracerebral hemorrhage patients of the Neurologic Department in Dr. Soetomo General Academic Hospital Surabaya in the period of 2016. The Chi-square analysis method was used to determine the correlation between variables.Results: In total, 51 medical records were retrieved, and the majority of the patients were in the 45–60 years old group (54.9%). The mortality during hospitalization was 17.6% with most of them (82.4%) had bleeding volume less than 30 cc. Interestingly, the bleeding volume correlated with the consciousness level (p=0.001) and the outcome of the patients (p=0.02). The blood pressure shows a correlation with the volume of bleeding (p=0.009).Conclusions: Bleeding volume and consciousness level as determined by the Glasgow Coma Scale score show significant correlations with the mortality rate in patients with intracerebral hemorrhage.

Bilateral asymptomatic common carotid artery stenosis: Mouse model for stroke research

Background: Asymptomatic carotid artery stenosis has become more prevalent worldwide and is often associated with a poor prognosis. Numerous guidelines highlighted surgical interventions as treatment for carotid artery stenosis, but only a few recommendations were made regarding non-surgical interventions due to its limited data.Aims: This study aims to develop a mice model for research in non-surgical interventions of asymptomatic carotid artery stenosis.Methods: Adult male Rattus norvegicus, Wistar strain models with bilateral asymptomatic common carotid artery stenosis (BACAS) were created by ligating the common carotid artery with a 0.6 mm diameter needle and then removing the needle. The mice’s body weight, clinical signs and symptoms, and post-mortem brain analysis were compared between the sham-operated group and the BACAS group.Results: The mortality rate among the BACAS group is 11.11%. There is no significant difference in mean body weight before surgery, after the observation period, and percentage of weight decrease between sham-operated and BACAS groups (p = 0.710, 0.632, and 0.806, respectively). None of the surviving mice in this study exhibit signs of motor paralysis. Gross examination of the brain reveals no signs of infarction or hemorrhage.Conclusion: We have established a novel BACAS mouse model which is cost-efficient, easy to produce, and with no significant alteration in body weight, clinical parameters, and brain morphology

Hubungan Antara Rasio H/M pada Stroke Akut dengan Derajad Spastisitas Pascastroke

Pendahuluan: Spastisitas adalah gangguan motorik yang sering dijumpai dan muncul setelah stroke. Spastisitas dapat menyebabkan nyeri dan disabililitas pada bagian tubuh yang mengalaminya. Tujuan: mencari hubungan antara rasio H/M yang diukur dengan elektromiografi dengan derajad spastisitas yang terjadi setelah fase akut stroke. Metode: Penelitian ini adalah studi analisis korelatif observasional, dengan 26 sampel. Pasien diukur rasio H/M pada saat stroke akut dan diukur derajad spastisitasnya dengan menggunakan Modified Ashworth Scale setelah 3 bulan. Hasil yang didapatkan dilakukan analisa statistik dengan menggunakan tes korelatif kategorik dari Spearman. Hasil: Pasien yang mengikuti penelitian ini sebanyak 26 orang. Terdapat perbedaaan antara nilai H/M rasio antara sisi parese dengan sisi sehat dan tidak didapatkan hubungan yang bermakna antara nilai rasio H/M yang diukur saat fase akut stroke dengan derajad spastisitas yang diukur dengan Modified Ashworth Scale (MAS) setelah 3 bulan (p = 0,06 ; r = 0, 37). Kesimpulan: Rasio H/M pada pasien stroke akut meningkat pada sisi parese dibanding pada sisi sehat, namun peningkatan ini tidak memiliki hubungan yang signifikan dengan derajad spastisitas pasca stroke yang diukur dengan MAS, sehingga rasio H/M tidak dapat digunakan sebagai prediktor munculnya spastisitas pasca strok

Partial Transvenous Coil Embolization with Significant Clinical Improvement in Patient with Indirect Carotid Cavernous Fistula

Highlight: • CCF is a rare vascular malformation with challenging management. • Partial transvenous embolization is quite effective as an alternative therapy for indirect CCF type D.   ABSTRACT Introduction: An indirect carotid-cavernous fistula (CCF) is an abnormal connection between the internal or external carotid artery and the cavernous sinus. The optic, trochlear, abducens, and trigeminal nerves are located in the cavernous sinus. Head Computed Tomography (CT) scan, Magnetic Resonance Imaging (MRI), and Cerebral Angiography are some imaging modalities used to establish and diagnose carotid-cavernous fistula. Endovascular intervention can be performed with trans-arterial or trans-venous access. In some cases, complete embolization by endovascular treatment is not possible because of difficult angioarchitecture. Case: A 61-year-old female reported having pain in her left eye (numerical rating scale was 6). The left eye was bulging, reddish, ptosis, and unable to move. The patient felt double vision when opening both eyes, complained of intermittent stabbing headaches on the left side, and heard a bruit from the left side of the head. The cerebral angiography showed bilateral indirect CCF Barrow type D. The procedure involved partial transvenous embolization with coiling. The angiographic evaluation showed partial occlusion, and residual flow from the fistula was still visible on angiography. There was a significant clinical improvement several days after the procedure and a five-month follow-up.  Conclusion: This case report showed that partial targeted transvenous embolization is quite effective in indirect CCF when complete embolization is impossible

The Association of Lipoprotein-a Levels, Neutrophil Lymphocyte Ratio and Hypertension with the Clinical Severity Scale Measured by NIHSS Scale in Patients with Acute Thrombotic Stroke

Background: The correlation between levels of Lipoprotein-a, Neutrophil Lymphocyte Ratio and hypertension with clinical severity scale remains a controversial issue. Objective: To determine the correlation of levels of Lipoprotein-a, Neutrophil Lymphocyte Ratio and hypertension with the severity scale measured by NIHSS scale in patients with acute thrombotic stroke. Method: Lipoprotein-a levels, Neutrophil Lymphocyte ratio, blood pressure in patients with acute thrombotic stroke were measured and clinical severity scale was assessed by NIHSS scale. The levels of lipoprotein-a were grouped into normal and high levels of lipoprotein-a, Lymphocyte Neutrophil Ratios were grouped into low and high and hypertension were grouped into stage 1 and 2. The data was analyzed using logistic regression. Results: There were 40 patients consisting of 29 (72.50%) male patients and 11 (27.50%) female patients. The demographic data included gender, age, LDL level, random blood sugar level, diabetes mellitus status and smoking status which were all homogeneous in both groups of lipoprotein-a, Neutrophil Lymphocyte ratio and hypertension stage. In the logistic regression analysis, the lipoprotein-a and neutrophil lymphocyte ratio were correlated with clinical severity scale (p = 0.018, RO 0.122 (CI 95% 0.022-0.696) vs p = 0.041, RO 0.068 (95% CI 0.005-0.895) while hypertension stage was not correlated with clinical severity scale (p = 0.97, RO 1.02 (95% CI 0.28-3.80). Conclusion: The levels of lipoprotein-a and lymphocyte neutrophil ratio were related to the clinical severity measured by NIHSS scale but not with hypertension

IMPLEMENTASI DAN EVALUASI SURVEI KONDISI JALAN KABUPATEN MENGGUNAKAN METODE PENILAIAN BINA MARGA DI KECAMATAN VII KOTO DAN IV NAGARI KABUPATEN SIJUNJUNG

Belakangan ini sering ditemukan jalan yang kondisinya kurang terawat atau bahkan sudah tidak layak. Hal ini disebabkan oleh beberapa faktor, salah satunya sistem drainase yang tidak baik sehingga mengakibatkan penurunan kualitas pelayanan jalan tersebut. Dengan menurunnya kualitas pelayanan jalan akan mengakibatkan penuruan pelayanan jalan tersebut mengakibatkan keadaan, keamanan dan kenyaman jalan menurun. Dalam menjaga kualitas pelayanan dari jalan tersebut maka diperlukan suatu usaha, salah satunya melakukan evaluasi kodisi permukaan dengan cara penilaian kondisi telah ada. Dari nilai kondisi tersebut dapat dijadikan sebagai acuan pada program yang akan diperlukan dalam penanganan jalan yang sesuai pada jenis kerusakan jalannya. Tujuan dari tugas akhir ini yaitu mengimplementasikan survei kondisi jalan dikabupaten Sijunjung, Sumatera Barat dengan metode Bina Marga berdasarkan panduan Survei Kondisi Jalan Nomor : SMD�03/RCS (2011) dan menggambarkan kondisi jalan secara structural dengan menentukan nilai besaran Surface Distress Index (SDI) dan Road Condition Index (RCI). Serta memberi evaluasi dari pelaksanaan survei sebelumnya untuk dijadikan usulan survei kondisi jalan selanjutnya. Pada penelitian ini menggunakan metode survei dengan mengamati secara visual serta melakukan pengukuran terhadap bagian�bagian jalan guna mendapatkan data kerusakan jalan, kemudian data tersebut diolah dan dianalisa. Berdasarkan hasil penelitian dengan metoda Surface distress Index dan Road Condition Index didapatkan kesimpulan kondisi jalan pada Kecamatan VII Koto dan IV Nagari. Jalan berkondisi Baik : 44,38 Km (31,12%) dengan penangannya pemeliharaan rutin, Jalan berkondisi Sedang : 25,10 Km (17,60%) dengan penangannya pemeliharaan rutin, Jalan berkondisi Rusak Ringan : 13,85 Km (9,71%) dengan penangannya pemeliharaan berkala, Jalan berkondisi Rusak berat : 59,30 Km (41,58%) dengan penangannya pemeliharaan/rekontruksi.Penambahan informasi geografis pada pengolahan data peta dari hasil tracking jalan Kabupaten Sijunjung, ditambahkan data seperti tipe perkerasan jalan serta kondisi jalan pada atributnya serta tambahan foto geotagging pada peta

Improvement of cerebral perfusion in hemodynamic stroke patients after carotid stenting: Clinical, cerebral TCD, and cerebral DSA evaluations

Hemodynamic stroke is caused by hypoperfusion, instead of infarction or embolism, with a prevalence of approximately 10% of all cerebral infarctions. Introducing hypoperfusion as the causative factor for ischemic stroke is crucial in patient care and management. It can be demonstrated through clinical symptoms, physical examination, and diagnostic imaging. Transcranial Doppler (TCD) and Digital Subtraction Angiography (DSA) examinations to determine cerebral blood flow are very helpful in assessing cerebral perfusion improvement in hemodynamic stroke. A 49-year-old male patient complained of sudden weakness in the right half of the body after waking up, accompanied by a headache and communication difficulties. He also experienced weakness of the right upper and lower limb 1 week before hospital admission and improved 10 hours afterward. The results of the physical examination indicated differences in right and left arm systolic blood pressure of more than 20 mmHg, severe dysarthria, central right facial and lingual palsy, right hemiparesis, and right hemihypesthesia. The results of the CT scan of the head without contrast revealed a subacute cerebral ischemia infarct in the cortical/subcortical left parietal lobe

Multiple cranial palsy in pasein with cerebral cavernoma malformations on the brain stem: A rare case report

Facial palsy is a condition that is often encountered in neurological practice. The weakness of closing the eyes can be found in cases of central facial paralysis. Facial palsy is characterized by acute, unilateral, partial, or complete facial paralysis. Cerebral cavernous malformation is one rare form of lesion, accounting for about 5 to 13% of blood vessel anomalies in the central nervous system. Brain stem cavernomas are rare and less than 20% intracerebral cavernomas. Most patients with cerebral cavernoma of the brain stem have symptoms of acute neurological deficits. The inferior cerebellar pedunkel, vestibular nucleus, trigeminal nucleus of the spine, and ambiguous nucleus are usually affected. Clinical signs include vestibulocerebellar symptoms such as vertigo, falling to the side of lesions, diplopia, multidirectional nystagmus, ipsilateral Horner syndrome, hiccups, contralateral body weakness, pain and sensation of temperature, motion, dysphonia, dysphagia, dysarthria, and decreased gag reflex (Sciacca et al., 2019). A 26-year-old man with a right eye cannot close, the right face cannot be moved since 4 months, the right side face feels thick from the right cheek to the right chin. The patient has no previous history of stroke. In the examination obtained hipestesi NV2 and NV3 right, facial palsy peripheral right

Symptomatic obstructive hydrocephalus due to cerebrospinal fluid pathway obstruction from vertebrobasilar dolichoectasia

Vertebrobasilar Dolichoectasia (VBD) is a rare vascular anomaly in which the vertebral/basilar artery is elongated, swollen, and tortuous. Symptoms can be ischemic or obstructive hydrocephalus although they are rarely found because it is usually asymptomatic. Therefore, it is necessary to establish a proper diagnosis to obtain appropriate management. A 62-year-old man had memory loss, imbalance walking, and urinary incontinence which then gradually decreased consciousness. Magnetic resonance imaging (MRI) revealed active hydrocephalus obstruction and suspicion of a fusiform type aneurysm in the basilar artery. Digital Subtraction Angiography (DSA) procedure was performed and the dolichoectasia of the basilar artery was obtained with non-communicant hydrocephalus which then improved after a Ventriculo-Peritoneal (VP) shunt was inserted. The information in this case report is essential for scholarly purposes and the participant gave written informed consent for publication.The gold standard imaging with DSA is needed to confirm the case of VBD. Information regarding the management of patients with VBD is scarce. Patients with manifestations of compression may undergo surgical evaluation with arterial repositioning or ventricular shunt placement. For patients with cerebrovascular complications, acute management should be based on the best care practices for patients with hemorrhagic or ischemic stroke

Spontaneous thrombosis of post-traumatic direct carotid-cavernous fistula

Carotid cavernous fistula (CCF) is an abnormal communication between the carotid artery and the cavernous sinus, which is most commonly caused by trauma. Due to its high-flow nature and aggressive clinical course, spontaneous resolution of CCF is rare, making endovascular embolization necessary. This procedure aims to prevent potential vision loss, emphasizing the importance of timely intervention to preserve visual function. We report a case of Barrow type A carotid-cavernous fistula which resolved spontaneously. A 42-year-old male was referred to Emergency Room with a chief complaint of seizure 3 days before admission. The seizure was both arm stiff and jerking, the eyes gazing upward, bitten tongue, foamy mouth, no bed wetting. Meanwhile, the patient was unconscious during and after the seizure. Regarding the medical history, the patient experienced head trauma 8 months ago due to a traffic accident. Additionally, the patient reported symptoms of redness, swelling, double vision, and inability to look to the right eye. Initial cerebral angiography was performed, reporting a carotid-cavernous fistula of Barrow type A. Further endovascular treatment could not be carried out, but a second cerebral angiography was conducted after a year, demonstrating spontaneous thrombosis of the carotid-cavernous fistula of Barrow type A. CCF were classified by Barrow et al. into types A, B, C, and D. It has been proposed that spontaneous resolution of CCF Barrow type A may result from thrombosis of the cavernous sinus