<p><strong>Background: </strong>The main feature of COVID-19 is symptoms of respiratory system disorder, however, there has been an increase in reports of neurological symptoms that appear in COVID-19 patients. Several previous studies have linked SARS-CoV-2 with nervous system damage. Research studying neurological complaints in confirmed COVID-19 patients in Indonesia is still lacking</p><p><strong>Aim: </strong>To identify neurological, laboratory, and imaging findings in COVID-19 patients with neurological symptoms.</p><p><strong>Methods: </strong>This study was a cross-sectional observational study conducted at Siloam Hospitals Mampang, a COVID-19 referral hospital in South Jakarta. We analyzed medical records of confirmed COVID-19 patients during the period of April - July 2020. The data collected included demographic data, comorbidities, neurological manifestations, laboratory examinations, and neuroimaging.</p><p><strong>Results: </strong>There were 22 confirmed COVID-19 patients with neurological complaints referred to a neurologist. The mean age of patients was 60.4 (SD 15.8) years. The most common neurological complaints were altered mental status (50%), hemiparesis (27.3%), and tremors (22.7%). More than half of the patients (81.8%) had a comorbid condition or past history related to neurological symptoms. Laboratory examination results showed increased NLR (neutrophil-lymphocyte ratio) (50%), anemia (45.5%), and leukocytosis (40.1%). The most common neuroimaging feature was infarct (50%) in the brain CT scan.</p><p><strong>Conclusion: </strong>The neurological complaints in COVID-19 patients are mostly associated with exacerbation of pre-existing comorbidities as a result of the severe inflammatory process triggered by COVID-19. Further research is needed to establish the mechanism of nervous system dysfunction in COVID-19.</p>
Abstract BACKGROUND: Coronavirus disease 2019 (COVID‐19) continues to be a global issue. While immunizations comprise an important line of defense against it, adverse effects may occur. We report two cases of autoimmune conditions affecting the nervous system, anti-N-Methyl-D-Aspartate-receptor (NMDAR) encephalitis and myasthenia gravis (MG), that developed in close association following COVID-19 vaccination. CASE REPORT: In our first case, a 29-year-old woman presents with recurrent seizures, auditory hallucinations, psychiatric symptoms, and autonomic abnormalities, with an onset of one day after receiving the second dose of inactivated SARS-COV-2 whole virus vaccine. CSF analysis and electroencephalogram (EEG) was consistent with anti-NMDAR encephalitis. In our second case, a 23-year-old woman presents with ocular ptosis, diplopia, hoarseness, and fatigability, which first appeared one-day after her first dose of inactivated SARS-COV-2 whole virus vaccine. Electromyography (EMG) results established a definitive diagnosis of MG. CONCLUSION: To our knowledge, this is the first report of anti-NMDAR encephalitis and MG associated with inactivated SARS-COV-2 whole virus vaccine. In both cases, COVID-19 vaccination appears to be the only remarkable feature of history. The authors postulate that COVID-19 vaccination may trigger underlying defects or induce failure of positive and negative selection, which may lead to autoreactivity and subsequent autoimmunity. However, further studies are required to confirm this possibility.
<div class="WordSection1"><p><strong>Introduction: </strong>The SPAN-75 index is a modification of the SPAN-100 index as a prognostic tool in acute ischemic stroke patients. Previous studies were using SPAN index in cases of ischemic stroke patients treated with rTPA and in cases of intracerebral hemorrhage.</p><p><strong>Aim: </strong>To determine the role of the SPAN-75 index as a prognostic scoring in patients with acute ischemic stroke who did not get thrombolysis therapy.</p><p><strong>Method: </strong>The subjects were acute ischemic stroke patients at Siloam Hospitals Lippo Village who were not treated with thrombolysis therapy and had no disability before stroke onset during January to April 2019. Subjects were classified into a positive and negative of SPAN-75 index group. Disability due to stroke was assessed with Modified Rankin Score (mRS) at the time of admission and discharged from the hospital. This prospective study was analyzed by the Kruskal-Wallis test.</p><p><strong>Result</strong>: Forty subjects (average age of 57 years old) consisted of 31 negative and 9 positive of SPAN-75. Based on the Kruskal-Wallis test, the SPAN-75 index was positively associated with a more severe degree of stroke disability at the time of admission (p = 0.002), but not related to the change in the degree of disability when the patient was discharged from the hospital (p = 0.807). Age (p = 0.445) and gender (p = 0.578) had no significant relationship with the degree of disability of acute ischemic stroke.</p><p><strong>Conclusion: </strong>The SPAN-75 index is related to the degree of disability of acute stroke patients at the time of admission.</p></div>
Background: Peer pressure is defined as the pressure to conform from peers, which can occur both directly and indirectly. This can be strongly influenced by the interaction among peers.Anxiety is the most common mental disorder, caused by several factors, such as peer pressure.Several studies have found that peer pressure affects anxiety level. However, studies investigating the correlation between peer pressure and anxiety level in medical students have not been widely carried out in Indonesia, therefore it is necessary to study the correlation between peer pressure and anxiety level among medical students.Objective: To determine the correlation between peer pressure and anxiety level among medical students.
TOLOSA HUNT SYNDROME WITH OPTIC NERVE INVOLVEMENTABSTRACTTolosa Hunt syndrome (THS) is a very rare clinical syndrome, which is characterized by unilateral headaches accompanied by dysfunction and painful ophthalmic nerves. In some cases, optic nerve involvement can be found due to inflammation at the orbital apex. Corticosteroid administration is a management of THS with pain relief generally occurring in the first 72 hours. However, corticosteroid administration is not significantly associated with nerve dysfunction or visual acuity improvement.This article is a case report of women with STH and optic nerve involvement.Keywords: Tolosa Hunt syndrome, painful ophtalmoplegia, orbital apex, superior orbital fissureABSTRAKSindrom Tolosa Hunt (STH) adalah sindrom klinik yang sangat jarang, yang ditandai oleh nyeri kepala unilateral disertai disfungsi dan nyeri saraf penggerak bola mata (painful ophtamloplegia). Pada beberapa kasus, dapat ditemukan keterlibatan saraf optikus akibat inflamasi pada apeks orbita. Pemberian kortikosteroid merupakan tatalaksana STH dengan perbaikan nyeri umumnya terjadi pada 72 jam pertama. Meskipun demikian pemberian kortikosteroid tidak berhubungan secara signifikan dengan perbaikan disfungsi saraf penggerak bola mata maupun tajam penglihatan. Artikel ini merupakan laporan kasus perempuan dengan STH dan keterlibatan saraf optikus.Kata kunci: Sindrom Tolosa Hunt, painful ophtalmoplegia, apeksorbita, fisura orbitalis superior
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