Characteristics of Cognitive Status in Sub-Population of Sub-Acute Stage of Ischemic Stroke Patients in West Nusa Tenggara, Indonesia

Cognitive decline is a significant complication that affects most stroke survivors. Early detection of cognitive decline in ischemic stroke patients and identification of risk factors improves their clinical outcomes. This study aimed to determine the characteristics of cognitive status in the sub-acute phase of ischemic stroke. A cross-sectional study was conducted on 89 sub-acute ischemic stroke patients in three hospitals in West Nusa Tenggara recruited consecutively from August 2019 to April 2020. The data collected were demographic and clinical characteristics, cognitive status, and functional outcome. The association between clinical and demographic characteristics and cognitive decline was analyzed using logistic regression. In addition, the relationship between cognitive status and functional outcomes of these patients was examined using the chi-square test. This study revealed that the prevalence of cognitive decline in these subjects was 71.9%. Multiple logistic regression showed that age was the only characteristic associated with cognitive decline in the subjects (OR = 5.12,95% CI = 1.08-24.28). Furthermore, the frequency of cognitive decline in these subjects was significantly associated with functional outcomes (p-value =0.014). Thus, there was a high prevalence of cognitive decline in sub-acute ischemic stroke patients associated with increasing age and poor functional outcomes

A robust allegation of von Hippel-Lindau (VHL) associated haemangioblastoma in the central nervous system (CNS) : A case report

Haemangioblastoma, a benign vascular tumor derived from the capillary of endothelial cells, is an inherited\ud disorder due to an autosomal dominant trait. The prevalence rates accounted for 1% to 2.5% of all intracranial tumors and 2%\ud to 3% of all intramedullary spinal cord tumors. We report the infrequent case of a robust allegation of von Hippel-Lindau\ud (VHL) associated haemangioblastoma in the central nervous system of a man. A 20 years old male presented to the hospital\ud with the chief complaint of progressive chronic cephalgia three months prior to hospitalization. He complained also of\ud blurred vision on neurologic examination; there is papilla edema with suspicion of retinal edema. Radiological examination\ud result suggested a cerebellar haemangioblastoma dextra with noncommunicating hydrocephalus. After the first operation\ud (installation of VP shunting) and subsequent operation (excision of the tumor), the pathological anatomy results revealed a\ud cavernous angioma

Kombinasi Repetitive Transcranial Magnetic Stimulation pada Dorsolateral Prefrontal Cortex kiri dengan Repetitive Peripheral Magnetic Stimulation Menurunkan Skala Nyeri pada Pasien Nyeri Punggung Bawah Kronik

Prevalence of chronic low back pain (CLBP) is still high, there is no effective pharmacological treatment with minimal side effects when consumed in the long term, while the treatment of CLBP generally requires long-term pain treatment. This study aims to assess the effect of a combination of repetitive Transcranial Magnetic Stimulation (rTMS) and repetitive Peripheral Magnetic Stimualtion (rPMS) on pain scale changes in patients with CLBP. This is an experimental study using consecutive sampling which is divided randomly into two groups. The treatment group received pharmacology treatment and combination of rTMS and rPMS for two weeks, the control group was only given pharmacology treatment. Pain was measured in both groups on the first, sixth, and thirteenth days. The results showed that there was a significant difference in pain reduction between the treatment group and the control group. The decrease in pain scale in the treatment group was much greater with a mean value of -6.07 compared to the control group with a value of -3.00, significant with a p value of 0.001. Conclusion: After 10 intervention sessions the combination of rTMS and rPMS had an effect on reducing the pain scale in patients with chronic low back pain.Prevalensi nyeri punggung bawah kronik (NPBK) masih tinggi, saat ini belum ada pengobatan farmakologis yang efektif dengan efek samping yang minimal apabila dikonsumsi dalam jangka panjang sedangkan pengobatan NPBK pada umumnya membutuhkan pengobatan nyeri jangka panjang. Penelitian ini bertujuan  menilai pengaruh intervensi kombinasi repetitive Transcranial Magnetic Stimulation ( rTMS) dan repetitive Peripheral Magnetic Stimualtion (rPMS)  terhadap perubahan skala nyeri pada pasien nyeri punggung bawah kronik. Jenis penelitian adalah studi eksperimental menggunakan consecutive sampling yang dibagi secara acak menjadi dua kelompok. Kelompok perlakuan mendapat pengobatan farmakologis dan terapi intervensi rTMS dan rPMS selama dua minggu, kelompok kontrol hanya diberikan pengobatan farmakologis. Pengukuran skala nyeri dilakukan pada kedua kelompok pada hari pertama, ke-enam, dan hari ke-tiga belas. Hasil penelitian menunjukan terdapat perbedaan penurunan nyeri yang signifikan antara kelompok perlakuan dan kelompok kontrol. Penurunan skala nyeri pada kelompok perlakuan jauh lebih besar dengan nilai mean -6.07 dibanding kelompok kontrol nilai -3.00, signifikan dengan nilai p 0.001. Setelah 10 kali sesi intervensi kombinasi rTMS dan rPMS terdapat pengaruh terhadap penurunan skala nyeri pada pasien nyeri punggung bawah kronik

Effectivity of Repetitive Transcranial Magnetic Stimulation Improving Depressive Symptoms and Motoric Strength Ischemic Stroke

Introduction: Post-stroke depression often causes problems. Depression can slow motor recovery. Giving antidepressants takes one month, and thus Transcranial Magnetic Stimulation (TMS) was developed, especially repetitive Transcranial Magnetic Stimulation (rTMS). This study aims to assess the effectiveness of rTMS in improving depressive symptoms and motor strength in ischemic stroke patients. Methods:  An experimental study with a randomized pretest-posttest control group design was conducted at Wahidin Sudirohusodo Hospital and a network hospital in Makassar from August to October 2022. The treatment group received standard therapy for ischemic stroke, antidepressants, and rTMS; the control group received standard therapy for ischemic stroke and antidepressants for ten days. In this study, the Hamilton Depression Rating Scale (HDRS) and the Medical Research Council (MRC) scale were used and measured in the treatment and control groups on the first and tenth days. Results: A total of 40 subjects met the criteria and were divided into a treatment group (n = 20) and a control group (n = 20). The HDRS score in the treatment group was smaller than in the control group. The value of left extremity motor strength in the treatment group was greater than that of the control group using the Wilcoxon Test. The correlation of the HDRS score to motor strength in the treatment and control groups showed a negative correlation of the HDRS score to the left extremity using the Spearman Test.   Conclusions:  rTMS effectively improves depressive symptoms and motor strength in ischemic stroke, given standard ischemic stroke therapy, antidepressants, and rTMS

Repetitive Transcranial Magnetic Stimulation (rTMS) as Non-Invasive Therapeutic for Post-Stroke Dysphagia: A Case Report

Introduction and importance: One of the worst complications that affects people with stroke is dysphagia. Dysphagia causes mortality through dehydration, malnutrition, aspiration pneumonia, and suffocation. For stroke survivors to have better results, post-stroke dysphagia must be adequately addressed using proven treatment methods. Presentation of case: A 64-year-old man complaints of difficulty swallowing with Gugging Swallowing Screen scoring (GUSS)= 7 (severe dysphagia) with left hemiparesis and slurred speech due to ischemic stroke on August 14th 2022. Head CT Scan found bilateral lacunar basal ganglia infarcts with brain atrophy. Patients were treated with standard ischemic stroke therapy, medical rehabilitation and repeated Transcranial Magnetic Stimulation (rTMS) procedures for 10 sessions. GUSS was carried out after the 10th session of rTMS and increased to 14 (moderate dysphagia). Discussion: By stimulating the esophagus cortex bilaterally in post-stroke dysphagia, rTMS is known to be beneficial in modulating cortical excitability and minimizing the imbalance between the hemispheres. Furthermore, it appears to be safe and well-accepted by patients. Conclusions: Our case study shows that rTMS in bilateral esophageal cortex is safe and has therapeutic potential in patients with post-stroke dysphagia

Effect of Repetitive Transcranial Magnetic Stimulation on Change in Delta Theta Alfa Beta Ratio (DTABR) and Motor Function in Ischemic Stroke Patients

Background: Stroke is the leading cause of long-term disability worldwide. The electroencephalography (EEG) of ischemic stroke patients is a slow background and the quantitative electroencephalogram (qEEG) shows an increased delta+theta/alpha+beta ratio (DTABR). Disability can be assessed using a Fugl Mayer Motor Assessment (FMA). In this study, we will examine the effect of Repetitive transcranial magnetic stimulation (rTMS) on changes in DTABR and assess motor function improvement in ischemic stroke patients with unilateral brain lesions. Methods: Thirty patients were divided into 2 groups. The first group received standard stroke therapy and gave rTMS intervention. The second group received only standard stroke therapy. All patients recorded using a EEG recorder and the results will be converted into qEEG. All samples will also be assessed for motor function using FMA before and after the intervention. The qEEG results obtained the absolute value of the power of each brain wave which we then calculated DTABR before and after treatment. Results: There was a greater decrease in DTABR in the treatment group when compared to the control group on the EEG electrodes Cz (p=0.029), C3 (p=0.048), C4 (p=0.004), Pz (p=0.015) and total DTABR (p=0.011) and greater motor improvement in the treatment group when compared to the control group p<0.001. In the Spearman's test there is a relationship between changes in DTABR and FMA with p value = 0.001. Conclusion: There is an increase in motor function associated with a decrease in DTABR in patients with ischemic stroke with unilateral lesions after rTMS interventio

Plasma D-dimer as a biomarker for the early classification of common acute ischemic stroke subtypes in Indonesia

Abstract Background D-dimer is a well-known marker for abnormal hemostasis in acute ischemic stroke (AIS), indicating the presence of fibrin degradation due to thrombus formation and lysis. The diagnostic performance of D-dimer for different AIS types in the Indonesian population has not been established. The aim of this study is to compare the plasma D-dimer levels in three of the most common AIS subtypes in Indonesia; the cardioembolic, large artery atherosclerosis (LAA), and small-vessel occlusion (SVO), and to determine its most optimal diagnostic performance. Results In this cross-sectional study, 64 subjects with confirmed AIS diagnosis at the Wahidin Sudirohusodo General Hospital Makassar between June and October 2019 were recruited. Plasma D-dimer levels were measured and grouped according to the subtype of acute ischemic stroke based on the TOAST classification. A significant difference was observed between the D-dimer levels across the three AIS subtypes, with an average D-dimer of 2.93 ± 1.7, 1.27 ± 0.81, and 0.56 ± 0.46 µg/ml in the cardioembolic, LAA, and SVO subtypes, respectively. As a marker of cardioembolic stroke, an optimal cut-off was determined to be 1.52 µg/ml, yielding a sensitivity of 84.44% (CI 71.22–92.25% and specificity of 84.21% (CI 62.43–94.48%). Conclusion Plasma D-dimer levels varied significantly between the cardioembolic, LAA, and SVO subtypes of AIS, with the highest D-dimer level in the cardioembolic subtypes. As a marker of cardioembolic stroke, an optimal cut-off was determined to be 1.52 µg/mL, yielding a sensitivity and specificity of 84.44% and 84.21%, respectively