Introduction. Gastrointestinal (GI) bleeding is a serious complication of stroke causing high morbidity. Atrial fibrillation is associated with both ischemic stroke and GI bleeding due to usage of anticoagulant. The aim of this study is to determine the risk factors of GI bleeding in ischemic stroke patients with atrial fibrillation. Material and methods. All ischemic stroke patients with atrial fibrillation from January 2017 to December 2018 were extracted from our hospital-based stroke registry. We extracted demographical characteristic, subtypes of stroke, and medication history. Results. We found 96 ischemic stroke patients with AF were included in the study. Dyslipidemia (RR: 0.2; 95%CI: 0.043-0.939; p = 0.049) and antihyperlipidemic drugs (RR: 0.183; 95%CI: 0.039-0.857; p = 0.022) was associated with lower GI bleeding risk. There were no significant association between other risk factors and GI bleeding incidence Conclusion. Our research shows that dyslipidemia and history of antihyperlipidemic drugs are associated with lower GI bleeding risk in ischemic stroke patients with AF.
Background/aim. Coronavirus Disease 2019 (COVID-19) is an infectious disease caused by SARS-CoV-2. Although the main symptoms of this virus are in the respiratory system, neurological clinical manifestations in the form of the central nervous system (CNS), peripheral nervous system (PNS) and musculoskeletal system are often found. This study aims for data on the characteristics of neurological manifestations in COVID-19 patients. Research methods. A retrospective cohort study with medical record from June 2020 to June 2021 which was analyzed descriptive, Chi-Square test and survival using SPSS program. Research result. There were 136 patients with PCR swab results (+), 80 (58.8%) male and 56 (41.2%) female, age > 50 years 92 (67.6%), 47 (34.6%) died. Neurological manifestations in the CNS that stroke 72 (52.9%) RR 4.8 (CI 95% 2.1-10.6; p<0.001), seizures 19 (14%) RR 14.7 (95% CI 4-54.3; p <0.001), headache 32 (23.5%) RR 5.7 (95% CI 2, 4-13.4; p<0.001), encephalopathy 35 (25.7%) RR 41.1 (95% CI 12.7-132.7; p<0.001), in the PNS myasthenic crisis 6 (4.4%) RR 10.4 (95% CI 1.2-92.5; p = 0.035) anosmia 73 (53.7%) RR 0.2 (95% CI 0.1-0.5; p<0.001) while musculoskeletal myalgia 25 (18.4%) and low back pain 18 (13.2%) was not significant. Conclusion. Most neurological clinical manifestations in the CNS (stroke, headache, seizures and encephalopathy) followed by the PNS (myasthenia crisis and anosmia). Neuroinvasive complications are thought to play a role as one of the causes of respiratory failure and death in patients with COVID-19.
Pendahuluan: Penyakit Parkinson (PP) memiliki dimensi gejala sangat luas yang secara langsung dan tidak langsung mempengaruhi kualitas hidup penderita maupun keluarga. Gejala non motorik PP diantaranya adalah gangguan neuropsikiatri seperti depresi, psikosis, ansietas. Kami melaporkan sebuah kasus PP dengan gejala psikotik berupa halusinasi yang jarang dijumpai. Laporan Kasus: Pasien perempuan berusia 74 tahun terdiagnosis Parkinson sejak lebih dari 20 tahun, dibawa ke rumah sakit dengan bicara tidak nyambung, adanya halusinasi visual, dan emosi yang tidak stabil sejak 1 bulan. Keluarga pasien juga merasa sejak 6 bulan terakhir pasien menjadi sering lupa. Pasien dengan riwayat PP tidak rutin mengkonsumsi obat parkinson di bawah supervisi dokter. Keluhan halusinasi pernah dirasakan 2 tahun lalu namun membaik setelah perawatan. Diskusi: Gejala non motorik dapat dijumpai seiring perkembangan penyakit Parkinson dandapat diidentifikasi sebelum sindrom motor muncul. Adanya gejala psikosis berupa halusinasi dalam kasus yang dipaparkan terhadi setelah 18 tahun sejak pasien terdiagnosis, dimana berdasarkan hasil studi terdahulu dilaporkan 60% penderita PP berkembang adanya halusinasi atau delusi setelah 12 tahun perawatan dan pada usia lebih tua saat onset PP. Gangguan kognitif pada PP juga dicurigai dalam kasus walau belum sepenuhnya dapat ditegakan serta adanya gangguan tidur pada PP dengan prevalensi 40-90% dijumpai pada kasus yang kami laporkan. Kesimpulan: Manifestasi non motorik PP yang mencakup gejala neuropsikiatri sangat mempengaruhi kualitas hidup pasien maupun keluarga dan perawat pasien. Klinisi harus meningkatkan kewaspadaan terhadap gejala non motorik PP dan pemberian tatalaksana farmakologi dan non farmakologi harus dilakukan secara terintegratif bersama dengan bidang-bidang terkait sesuai dengan kondisi pasien. Kata kunci: Parkinson, non-motor, psikotik, neuropsikiatri
Background: Cavernous sinus thrombosis is a complication of infection around the face or paranasal sinuses with high morbidity and mortality rates. Cavernous sinus thrombosis is generally caused by septic infection, such as orbital cellulitis. Case Illustrations: A 35-year-old male who came to the neurology polyclinic complained of swelling in the left eyelid, red, watery eyes, blurred vision, difficulty opening the left eye, and the movement of the left eyeball felt normal. The patient had a history of left orbital cellulitis. Laboratory investigations showed an increase in inflammatory markers. The CT scan with contrast showed a hyperdense lesion in the left orbit, suggesting orbital cellulitis. The patient was diagnosed with a cavernous sinus thrombosis due to orbital cellulitis. He was treated with an antibiotic, anticoagulant, and corticosteroid. Three months after treatment, the visual complaints improved, the headache decreased drastically, and we did not find any extraocular muscles weakness. Conclusions: The administration of antibiotics and anticoagulant therapy in patients with cavernous sinus thrombosis has been proven clinically. The use of corticosteroids has not been proven but is strongly suspected to reduce edema caused by compression of the cavernous sinus. Keywords: Cavernous sinus thrombosis, orbital cellulitis. infections.
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