INDIRECT CEREBRAL REVASCULARIZATION ON OPTHALMIC ARTERY BY USING A DRUG-ELUTING BALLON FOR SUSPECTED MOYAMOYA DISEASE

Moyamoya disease (MMD) is a rare idiopathic progressive vaso-occlusive disease causing multiple occlusion of cerebral vessels lead to ischemic stroke. Asian population is the most common race to be affected. We present a male patient 33-years old with suspected MMD with right hemiparesis and neurocognitive changes. On digital substraction angiography (DSA) there was appearance of ‘puff of smoke’ on his right hemisphere, stenosis middle cerebral arteries M1 bilaterally, stenosis of right opthalmic artery (OA), stenosis of left anterior cerebral artery (ACA) and aplasia of right ACA. Ballon angioplasty was performed on right OA that supply the contralateral symptomatic stenosis area (left A1) indirectly through anterior ethmoidal artery and anterior falcine artery (OA-ACA collateral). While no guidelines for the management of MMD, cerebral revascularization by using drug-eluting ballon (DEB) in right opthalmica artery is potentially effective treatment  that could allow the brain to have good blood supply (gives good collateral to both ACA), reduces burden of the fragile moya-moya vessels to be ruptured followed by  improvement of clinical results. Patient’s selection by understanding the stage, its progressivity and collateral formation are crucial before decision is made

Review article: DOES INTRA-ARTERIAL HEPARIN FLUSHING (IAHF) CAN ACTUALLY INCREASE MANUAL MUSCLE TEST (MMT) SCORE IN CHRONIC ISCHEMIC STROKE PATIENTS?

Stroke is still a major health problem in the world. Ischemic stroke accounts for 87% of all acute stroke occurrences. In 2013, the American Heart Association (AHA)/American Stroke Association (ASA), published a Guideline for the Early Management of Patients with Acute Ischemic Stroke. The managements consist of the use of recombinant tissue plasminogen activator (rtPA), endovascular treatment, etc. Unlike acute ischemic stroke, until now, no guidelines have been provided about the management of chronic ischemic stroke that approved universally. The result of the study with the title of “Intra Arterial Heparin Flushing Increases Manual Muscle Test – Medical Research Councils (MMT-MRC) Score in Chronic Ischemic Stroke Patient” is very interesting, because it is a new attempt to treat patients with chronic ischemic stroke. The purpose of this article is to review the study mentioned above, in accordance with the applied scientific principles and is based on the standard literatures and guidelines. Our review is limited only to the discussion of the study results. From this discussion can be proved the existing references that support and/or refuse the study results. Based on the discussions and conclusions of this study, there were no references to support that IAHF can improve motor functions (muscles) in patients with chronic ischemic stroke

Transverse sinus stenosis distribution in refractory chronic headache patients in Pelni hospital

Background: Transverse sinus stenosis (TSS) is a common finding on MRI of patients with refractory chronic headaches. Bilateral TSS with severity >50% was found in almost all (93%) patients with idiopathic intracranial hypertension (IIH). IIH can lead to papilledema and result in loss of visual function. This study aimed to determine the prevalence of TSS in patients with refractory chronic headache at Pelni hospital, Jakarta.Methods: This was a descriptive analytical study and conducted at Pelni hospital, Jakarta from January to June 2021, with a sample of patients suffering from refractory chronic headaches. Data were analyzed using SPSS version 24.Results: There were 70 subjects, with a mean age of 52.97±13.29, the majority aged <60 years (65.7%), with the male sex being more dominant (62.9%). There were 39 people (55.7%) with TSS; as many as 37 with (52.9%) left TSS and 2 (2.8%) with right TSS. Bivariate analysis with Chi square showed no relationship between age and sex with the presence of TSS in patients with refractory chronic headache (p=0.798 and p=0.487).Conclusions: TSS was associated with the incidence of IIH. However, this finding has not yet been proven to be significant. This study also did not find a correlation between age and gender with the incidence of TSS

Incidence and predictors of groin complication after cerebral neurointervention procedure: single centre study

Background: Cerebrovascular disease is characterized by an acute compromise of the cerebral perfusion or vascular which caused morbidity and mortality around the world. The most accurate imaging technique for the evaluation of cerebrovascular system is digital subtraction angiography (DSA), but it can cause many complications, one of the most is groin complication. Our objective was to determine incidence and predictors of groin complication after cerebral neurointervention procedure.Methods: An observational prospective study was conducted in PELNI hospital, from January until June 2021, with a total sample of 246 patients. We observed hematoma that occurred within 24 h after procedure. Data was analysed using SPSS ver 24. Results: There were 246 patients who underwent DSA procedures. The average age of patients was 54.3±11.9 years and the majority were male (59.5%). The incidence of groin complication was 37.4%. The predictors of groin complication evaluated with bivariate analysis were age (p=0.167), gender (p=0.827), frequency of puncture (p=0.178), catheter size (p=0.200), duration of compression (p=0.477), comorbidities (hypertension; p=0.839, diabetes; p=0.178, heart disease; p=0.373), and history of anticoagulant (p=0.022). Multivariate analysis showed that history of anticoagulant (p=0.023, OR=2.118 (95% CI 1.107-4.049) to be the most significant factors contributing to groin complication after the intervention.Conclusions: Groin complications appeared to be the most complications after cerebral neurointervention procedure with incidence rate 37.4% and associated mostly with the history of anticoagulant

45 Penyakit dan Gangguan Saraf. Deteksi Dini & Atasi 45 Penyakit dan Gangguan Saraf

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