Misdiagnosis of Epilepsy Attributed to Inadequate History Taking

Background: There was a noticeable amount of patient with epilepsy who were misdiagnosed at Dr. Hasan Sadikin General Hospital. Misdiagnosis of epileptic seizure will expose patients to inappropriate managements, and subsequently leads to complications. History taking is an important part for the diagnosis of epileptic seizure. This study aimed to see the improvement of diagnosis based on the adequacy and inadequacy of history taking attributed to misdiagnosis of epileptic seizure by the epilepsy consultant at Dr. Hasan Sadikin General Hospital.Methods: This was a descriptive study using medical records of misdiagnosis of epilepsy. It was indicated by different initial (before epilepsy consultant’s confirmation) and final (after epilepsy consultant’s confirmation) seizure diagnosis at Epilepsy Outpatient Clinic at Dr. Hasan Sadikin General Hospital during the period of January 2007−October 2012.Results: There were 61 medical records with different initial and final seizure diagnosis. This study indicated inadequate history taking in 83.6% patients. Misdiagnosis occurred due to incomplete history taking, absence of reliable witnesses, and misinterpretation of history taking result. History taking by epilepsy consultant improved the misdiagnosis in 27.9% patients. While it is used simultaneously with Electroencephalography (EEG), the result increased to 72.2%.Conclusions: The adequate history taking improved the accuracy of epileptic seizure diagnosis. The simultaneous used of history taking and EEG increased the result. [AMJ.2016;3(2):304–9]DOI: 10.15850/amj.v3n2.77

Outcomes of Tuberculous Meningitis Patients with or without Hydrocephalus from a Tertiary Hospital in West Java, Indonesia

Background: Tuberculous meningitis (TBM) is a severe form of extrapulmonary tuberculosis. One of the most common complications of TBM is hydrocephalus, with a higher risk of mortality. This study aimed to evaluate the outcome among TBM patients with or without hydrocephalus.Methods: This study was a retrospective cross-sectional comparative analytical study. A total sampling was employed based on the number of traceable resumes of TBM patients treated at the Department of Neurology Dr. Hasan Sadikin General Hospital, Bandung, Indonesia in 2018. Results: Of the 127 data of TBM patients, 55 (43.3%) had hydrocephalus, and 72 (56.7%) did not. The median age of TBM patients with and without hydrocephalus was 34 years (IQR 26–45) and 35 years (IQR 24–44), respectively. Decreased consciousness dominated the clinical symptoms for 94.5% in the hydrocephalus group and 84.7% in the non-hydrocephalus group. Hospital-acquired pneumonia occurred mainly in the hydrocephalus group (29.1%), whereas urinary tract infections mainly occurred in without hydrocephalus group (18%). There was a significant difference between the outcome of hydrocephalus and non-hydrocephalus (p=0.005). Mortality was higher in patients with hydrocephalus compared to those without hydrocephalus.Conclusions: The outcome of TBM patients with hydrocephalus is worse than those without hydrocephalus, as reflected by a higher grade of TBM, higher mortality rate, and lower good recovery upon treatment administration. Therefore, prompt diagnosis and treatment are needed to improve the outcome and survival among TBM patients with hydrocephalus

Etiology of Symptomatic Focal Epilepsy based on Neuroimaging Result in Neurology Outpatient Clinic of Dr. Hasan Sadikin General Hospital

Background: Focal epilepsy is the most common type of epilepsy that can be caused by structural lesions. Images from neuroimaging can show those structural lesions that may point to the etiology of epilepsy and would affect the management of epilepsy. The aim of the study was to explore the possible etiology of symptomatic focal epilepsy from neuroimaging result at the Neurology Outpatient Clinic in Dr. Hasan Sadikin General Hospital.Methods: This study was a cross-sectional descriptive study. The medical records that fulfilled the inclusion criteria were collected at the Neurology Outpatient Clinic of Dr. Hasan Sadikin General Hospital from the year 2017. The inclusion criteria were symptomatic focal epilepsy patients that had abnormal neuroimaging result.Results: In total, there were 71 medical records collected of which eight etiologies of symptomatic focal epilepsy were found, that were vascular disorder caused by strokes (33%), tumors (21%), hippocampal sclerosis (20%), infections (11%), head trauma (6%), malformations of cortical development (4%), vascular malformations (3%), and phakomatosis (1%). Vascular disorder was the most abundant etiology found in all brain lobes, except in temporal and frontal lobes, which also most often caused by hippocampal sclerosis and tumors, respectively.Conclusions: Vascular disorders due to stroke, is the most abundant etiology found in symptomatic focal epilepsy, therefore, stroke patients need to be informed about the possibility of having epilepsy later on

Prevalence of Opportunistic Infection in Central Nervous System among Patients with HIV/AIDS at Dr. Hasan Sadikin General Hospital Bandung, Indonesia

Background: The low coverage of diagnosis and treatment in patients with human immunodeficiency virus (HIV) infection in Indonesia increases the risk of opportunistic infections that affects various organs, including the central nervous system (CNS). This study aimed to determine the prevalence of opportunistic infections in the CNS among hospitalized patients with HIV/acquired immune deficiency syndrome (AIDS) at Dr. Hasan Sadikin General Hospital Bandung, Indonesia.Methods: In this cross-sectional study with a total sampling method, data were collected from HIV/AIDS patients who were diagnosed with CNS opportunistic infection and hospitalized in the neurology ward during the period 2015–2019. Data were presented as median (interquartile range) and percentage frequency.Results: Among the 2,606 HIV/AIDS patients registered, 219 (8.4%) were accompanied by CNS opportunistic infections. The highest number was cerebral toxoplasmosis (58.9%; n=129) followed by tuberculous meningitis (33.3%; n=73) and cryptococcal meningitis (7.8%; n=17). Most of the patients admitted for unconsciousness (64.4%; n=141), with unknown HIV-infection status (61.2%; n=134). Among patients with positive HIV-infection status, only 50.6% (43/85) patients were taking antiretroviral therapy (ART) and 24.7% (21/85) patients dropped out ART before being diagnosed with CNS opportunistic infections. The CD4+’s median value was 21 cells/mm3 (IQR 9-61.25), with mortality during hospitalization was 36.5% (80/219). Conclusions: The prevalence of CNS opportunistic infections among HIV-infected patients is 8.4%, dominated by cerebral toxoplasmosis, and laboratory result showed very low CD4+ levels. The diagnosis of HIV infection is shortly made before hospitalization, and those who has been diagnosed have low compliance with ART. The mortality rate during hospitalization is high

Prevalence of Opportunistic Infection in Central Nervous System among Patients with HIV/AIDS at Dr. Hasan Sadikin General Hospital Bandung, Indonesia

Background: The low coverage of diagnosis and treatment in patients with human immunodeficiency virus (HIV) infection in Indonesia increases the risk of opportunistic infections that affects various organs, including the central nervous system (CNS). This study aimed to determine the prevalence of opportunistic infections in the CNS among hospitalized patients with HIV/acquired immune deficiency syndrome (AIDS) at Dr. Hasan Sadikin General Hospital Bandung, Indonesia.Methods: In this cross-sectional study with a total sampling method, data were collected from HIV/AIDS patients who were diagnosed with CNS opportunistic infection and hospitalized in the neurology ward during the period 2015–2019. Data were presented as median (interquartile range) and percentage frequency.Results: Among the 2,606 HIV/AIDS patients registered, 219 (8.4%) were accompanied by CNS opportunistic infections. The highest number was cerebral toxoplasmosis (58.9%; n=129) followed by tuberculous meningitis (33.3%; n=73) and cryptococcal meningitis (7.8%; n=17). Most of the patients admitted for unconsciousness (64.4%; n=141), with unknown HIV-infection status (61.2%; n=134). Among patients with positive HIV-infection status, only 50.6% (43/85) patients were taking antiretroviral therapy (ART) and 24.7% (21/85) patients dropped out ART before being diagnosed with CNS opportunistic infections. The CD4+’s median value was 21 cells/mm3 (IQR 9-61.25), with mortality during hospitalization was 36.5% (80/219). Conclusions: The prevalence of CNS opportunistic infections among HIV-infected patients is 8.4%, dominated by cerebral toxoplasmosis, and laboratory result showed very low CD4+ levels. The diagnosis of HIV infection is shortly made before hospitalization, and those who has been diagnosed have low compliance with ART. The mortality rate during hospitalization is high

Cut-off Score of Indonesian Version of Sensorimotor History Questionnaire for Preschooler and Soft Sign Cambridge Neurological Inventory against Intelligent Quotient

Early detection of Sensory Processing Disorder (SPD) is important for deciding on appropriate interventions for children at risk. However, there is no valid screening tool available at this moment. The purpose of this study was to validate the deGangi, Sensorimotor History Questionnaire for Preschooler (SHQP), and neurological soft sign of Cambridge Neurological Inventory (NSS CNI) against intelligent quotient (IQ) to establish a reliable cut-off for SPD screening tools for children aged 4–6 years. Sixty-four parent-child were recruited randomly from 3 kindergartens in Bandung, Indonesia. Eligible parents were asked to fill out the SHQP, while their child was assessed using theWechsler Preschool and Primary Scale of Intelligent (WPPSI) and NSS CNI. The deGangi SHQP score and NSS CNI showed a weak and moderate correlation with Full-scale IQ (FIQ). The total score of deGangi SHQP’s sensitivity was 50% with a specificity of 53.4% and a negative predictive value (NPV) of 91.2% agaisnt the FIQ score. The total sensitivity for the NSS CNI was 66.7%, while the total specificity was 58.6% and the NPV was 94.4%. Meanwhile, the sensitivity for the sensory integration subscale score of the NSS CNI was 83.3%, with a specificity of 60.3% and an NPV of 97.2%. The deGangi SHQP can be considered to be an SPD screening tool with the cut-off scores for each subscale of self-regulation, sensory processing of touch, sensory processing of movement, emotional maturity, and motor maturity of 3, 3, 3, and 2, respectively, while the NSS CNI can be used for identifying SPD in children aged 4–6 years with a cut-off scores for the motor coordination, sensory integration, and disinhibition subscales of 7, 10, and 3, respectively

Cognitive Outcome of Intracerebral Hemorrhage Patients with and without Pneumonia

Background: There are high prevalence of cognitive impairment in patients with intracerebral hemorrhage (ICH) that may worsen the patients’ outcomes. Pneumonia, as the significant infection complication in stroke patients, may aggravate the decline in the cognitive outcome of patients. This study aimed to explore the cognitive outcomes among patients with or without pneumonia among patients with intracerebral hemorrhage.Methods: A cross-sectional retrospective analytical comparative numeric study was conducted from September 2020 to February 2021, using secondary data of patients with intracerebral hemorrhage admitted to the Department of Neurology Dr. Hasan Sadikin General Hospital in the year 2019. A total sampling method was employed. Data on pneumonia in stroke patients was retrieved, consisting of patients with pneumonia and without pneumonia. Data on Mini-Mental State Examination (MMSE) scores as the measures of cognitive outcomes were compared using the Mann-Whitney U test.Results: There were 108 patients with intracerebral hemorrhage included. There was a statistically significant difference (p value 0.049) in MMSE scores with  median MMSE score for pneumonia patients (n = 27) and non-pneumonia patients (n = 81) were 25 and 21, respectively.Conclusions: Cognitive outcome is worse in patients with pneumonia than those without pneumonia. Early intervention is needed for intracerebral hemorrhage patients who develop pneumonia as a complication to improve the cognitive outcome

Quantitative Measure to Differentiate Wicket Spike from Interictal Epileptiform Discharges

A number of benign EEG patterns are often misinterpreted as interictal epileptiform discharges (IEDs) because of their epileptiform appearances, one of them is wicket spike. Differentiating wicket spike from IEDs may help in preventing epilepsy misdiagnosis. The temporal location of IEDs and wicket spike were chosen from 143 EEG recordings. Amplitude, duration and angles were measured from the wave triangles and were used as the variables. In this study, linear discriminant analysis is used to create the formula to differentiate wicket spike from IEDs consisting spike and sharp waves. We obtained a formula with excellent accuracy. This study emphasizes the need for objective criteria to distinguish wicket spike from IEDs to avoid misreading of the EEG and misdiagnosis of epilepsy

COMPARISON OF COGNITIVE FUNCTION BETWEEN FIRST ISCHEMIC STROKE AND RECURRENT ISCHEMIC STROKE PATIENTS

Background: Cognitive impairment is a common condition that may affect up to 50% of stroke patients. Post stroke cognitive impairment is associated with reduced quality of life, which may increase the number of dependency. Recurrent stroke may happen in approximately 25% patients and they have higher rates of cognitive impairment. Objective: The aim of this study is to examine the comparison of cognitive function between first ischemic stroke and recurrent ischemic stroke patients in Hasan Sadikin Hospital, Bandung. Methods: This study is a retrospective, cross-sectional study using the data recruited between the year 2012 - 2016 at the Department of Neurology at the Hasan Sadikin Hospital Bandung. The data collected in this study were demographic data, including age, level of education, and residence, and the clinical data as well. Cognitive function was assessed using Mini-Mental State Examination (MMSE). The comparison between the cognitive function between both groups were analyzed using the Mann-Whitney U test. Results: There were 428 subjects eligible for this study, with 207 subjects categorized as first ischemic stroke group and 221 subjects categorized as recurrent ischemic stroke group. There was a statistically significant difference in MMSE scores between the first ischemic stroke patients (24.90 ± 4.64) and recurrent ischemic stroke patients (22.85 ± 4.64 ) with a p value of 0.002. Conclusion: Recurrent ischemic stroke patients had lower MMSE scores than the first ischemic stroke patients. Clinicians should be more aware in detecting early cognitive impairment in stroke patients and in preventing the incidence of recurrent stroke

Studi Efikasi dan Pemantauan Reaksi Obat Merugikan dari Antiplatelet pada Pasien Pasca Stroke Iskemik di RSUP dr. Hasan Sadikin Bandung: Efficacy Study and Monitoring of Adverse Drug Reactions of Antiplatelet Therapy in Post-Ischemic Stroke Patients at dr. Hasan Sadikin General Hospital

Stroke iskemik merupakan jenis stroke yang paling banyak terjadi. Resiko kejadian stroke ulang meningkat pada pasien yang telah mengalami stroke sebelumnya. Terapi antiplatelet dapat mencegah terjadinya stroke ulang pada pasien. Penelitian ini bertujuan untuk menilai keberhasilan terapi pencegahan stroke ulang pada pasien stroke iskemik yang menerima terapi antiplatelet dan mengidentifikasi reaksi obat merugikan yang terjadi selama penggunaan obat tersebut. Penelitian menggunakan metode kohort prospektif dengan pembanding internal dengan pengambilan sampel secara non- probability  menggunakan teknik consecutive sampling dan diperoleh 45 sampel. Hasil penelitian menunjukkan 3 bulan setelah penggunaan antiplatelet, stroke ulang hanya terjadi pada 1 orang (5%) yang menggunakan terapi asetosal dan 8 orang (40%) pada pasien yang mengalami putus obat antiplatelet sebelum 3 bulan. Selama penggunaan asetosal terjadi beberapa reaksi obat merugikan seperti nyeri ulu hati (13,95%), mual (6,98%), ekimosis (4,65%), dan berkurangnya turgor kulit (2,36%). Terdapat perbedaan bermakna untuk kejadian stroke ulang (p<0.05) antara kelompok pengguna asetosal dengan kelompok yang mengalami putus obat selama 3 bulan penelitian. Berdasarkan hasil penelitian tersebut dapat disimpulkan asetosal efektif mencegah stroke ulang selama tiga bulan penelitian berdasarkan angka kejadian stroke ulang. Reaksi Obat merugikan yang terjadi hanya 26,83% berupa nyeri ulu hati, mual, dehidrasi dan ekimosis