AbstrakSpastisitas merupakan kelainan motorik yang ditandai dengan peningkatan kecepatan refleks regang otot dan peningkatan hentakan tendon sebagai sindrom upper motor neuron (UMN). Prevalensi spastisitas adalah 43% pada 6 bulan setelah serangan pertama stroke dan 38% pada 1 tahun setelah stroke. Spastisitas dapat menurunkan kualitas hidup, sehingga diperlukan terapi untuk memperbaikinya. Tujuan penelitian ini adalah untuk mengetahui efektivitas dry needling (DN) terhadap spastisitas, Range of Motion (ROM), status fungsional dan intensitas nyeri pada pasien paska stroke di RSUP dr. Moh. Hoesin Palembang. Penelitian ini adalah uji klinik randomized control trial (RCT) add on, double blind. Terdapat 20 subyek yang secara random terbagi ke dalam kelompok kontrol dan kelompok perlakuan. Kedua kelompok menjalani terapi standar rehabilitasi medik dan kelompok perlakuan diberikan terapi DN sebanyak 4 sesi, 1 kali perminggu. Evaluasi dilakukan dengan menilai Modified Modified Asworth Scale (MMAS), ROM, Upper Extremity Functional Index (UEFI) dan Numeric Rating Scale (NRS) penderita. Hasil penelitian ini menunjukkan adanya perbaikan MMAS, ROM, UEFI, dan NRS pada kelompok perlakuan selama evaluasi paska intervensi setiap minggu hingga minggu ke-4 dan bertahan hingga minggu ke-8 (4 minggu paska intervensi). Perbedaan yang signifikan didapatkan antar kelompok sejak minggu ke-2 hingga minggu ke-8 dengan p<0,05 pada MMAS fleksor siku, sedangkan MMAS fleksor pergelangan tangan berbeda signifikan pada minggu ke-3 (p=0,021). Perbedaan signifikan pada minggu ke-8 juga didapatkan pada nilai ROM (p=0,029 untuk fleksor siku dan p=0,036 untuk fleksor pergelangan tangan), UEFI (p=0,036), dan NRS (p=0,037). Sehingga, dapat disimpulkan bahwa DN terbukti efektif memperbaiki spastisitas, ROM, status fungsional dan intensitas nyeri dibandingkan dengan sham needling. AbstractSpasticity is a motor disorder with a velocity-dependent increase in tonic stretch reflexes and elevated tendon jerks as one of the upper motor neurone syndrome (UMN). Prevalence of spasticity is 43% after 6 months of first stroke and 38% after 1 year following stroke. Spasticity has a role in deprived quality of life, therefore effective treatment to reduce spasticity is needed. The aim of this study was to assess the effectivity of dry needling (DN) to spasticity, Range of Motion (ROM), functional status and pain scale of post stroke patients in RSUP dr. Moh. Hoesin. This study is a randomized control trial (RCT) add on, double blind study. There were 20 subjects randomly divided into control group and treatment group. Both groups underwent standard rehabilitation therapy and the treatment group was given 4 sessions of DN therapy weekly. Evaluation was performed by assessing the Modified Asworth Scale (MMAS), ROM, Upper Extremity Function Index (UEFI) and Numerical Assessment Scale (NRS). The results of this study showed improvement of MMAS, ROM, UEFI, and NRS in post-intervention evaluations every week until the 4th week and could last until the 8th week (4 weeks pos...
Sekalipun ada kemajuan besar dibidang penatalaksanaan stroke dalam 2 dekade terakhir ini, stroke masih merupakan penyebab utama kecatatan dan kematian di seluruh dunia. Terapi stroke iskemiksaat ini bertujuan untuk meningkatkan keluaran jangka panjang pada pasien stroke. Untuk tujuan tersebut, rekanalisasi dini merupakan satu-satunya terapi yang menjanjikan untuk stroke iskemik akut.1 Tujuan utama dari terapi reperfusi pada stroke iskemik akut adalah segera memperbaiki aliran darah (rekanalisasi) pada daerah otak yang iskemik dan belum mengalami infark. Tujuan jangka panjang adalah meningkatkan keluaran dengan menurunan kecacatan dan kematian akibat stroke. Faktor terpenting dalam keberhasilan terapi reperfusi pada stroke iskemik akut adalah terapi sedini mungkin. Namun, seleksi kandidat yang sesuai untuk terapi reperfusi membutuhkan evaluasi neurologi dan pemeriksaan neuroimaging
Pemberian trombolisis intravena (recombine tissue Plasminogen Activator intravenous/Alteplase) hingga saat ini masih merupakan rekomendasi utama dari Food and Drug Administration(FDA) sejak tahun 1996 pada stroke iskemik akut, dengan waktu pemberian kurang dari 4,5 jamsetelah onset. 3 Karena keuntungan terapi trombolisis intravena sangat bergantung pada waktupemberian, sangatlah penting memberikan terapi sesegera mungkin. 1 Namun sayangnya diIndonesia kebanyakan pasien datang ke pusat kesehatan/rumah sakit setelah 6 jam dari onset,sehingga terapi trombolisis intravena tidak dapat diberikan.
Despite major advances in stroke management in the last 2 decades, stroke is still the leading cause of disability and death worldwide. Current ischemic stroke therapy aims to improve long-term outcomes in stroke patients. For this purpose, early recanalization is the only promising therapy for acute ischemic stroke. The main goal of reperfusion therapy in acute ischemic stroke is to immediately improve blood flow (recanalization) in areas of the brain that are ischemic and have not undergone infarction. The long-term goal is to increase outcomes by reducing disability and death from stroke. The most important factor in the success of reperfusion therapy in acute ischemic stroke is therapy as early as possible. However, selection of suitable candidates for reperfusion therapy requires neurologic evaluation and neuroimaging studies.
Introduction: Cerebral sinus venous thrombosis (CSVT) is a major cause of stroke in young patients. The incidence of CSVT ranging from 1-12 cases per 1 million adults per year. Autoimmune diseases such as Systemic Lupus Erythematosus (SLE) can cause CSVT. The incidence of CSVT involvement in SLE is 1%. It is characterized by thrombosis in the sinuses and veins, which causes various symptoms, such as headache, seizures, motor weakness, and decreased consciousness. Cases: We report a case of a 20-year-old woman with SLE who complained of seizures accompanied by weakness on both sides of the body and a history of headaches. There is an increase in D-dimer, with positive ANA and anti-ds-DNA tests. A non-contrast CT scan of the head showed a lobar venous infarct with hyperdense lesions, a head non-contrast MRI/MRV revealed a dural sinus thrombosis with a deep cortical/subcortical venous infarct, no bleeding was seen. Patients were given Fondaparinux sodium therapy for 5 days, followed by Warfarin sodium for 3-12 months with a target INR of 2.0-3.0, and control SLE by administering immunosuppressants gave better outcomes for patients. Conclusion: The diagnosis of CSVT in this patient was based on clinical suspicion and imaging confirmation, and elevation of D-dimer. Non-contrast CT of the head as an initial examination often shows normal imaging. Still, there is also an image of a hyperdense lesion that usually causes an incorrect diagnosis, resulting in delays in therapy. Anticoagulation in CSVT should still be given even if there is bleeding.
Highlight: Fusiform aneurysms are uncommon, accounting for only 1% of total intracranial aneurysms, and posterior circulation involvement is only 3-13% of cases of intracranial aneurysms. Connective tissue diseases are very rare as the cause of this vasculopathy. Homonymous hemianopia due to the mass effect or dilated blood vessels compressing the left optic tract. ABSTRACT Introduction: Fusiform aneurysms are uncommon, accounting for 1% of all intracranial aneurysms. Dissection and atherosclerosis are the main causes of this vasculopathy, but connective tissue disease is a very uncommon cause. Ehlers-Danlos Syndrome is the most common connective tissue disease, accounting for 11% of all cases. Symptoms depend on the location and size of the aneurysm, including headaches, blurred or double vision, and focal neurological deficits. Case: A 36-year-old man suddenly experienced blurred vision in both eyes on the right, starting with a chronic left-sided headache and no history of cardiovascular disease. In the confrontation test, Humphrey gave the right homonymous hemianopia. A head CT scan showed a lobulated lesion which showed enhancement in the left suprasellar region, and cerebral digital subtraction angiography (DSA) gave the impression of a long fusiform aneurysm L PCA. Clinically, the patient’s skin on the left side of his face was darker than on the right, his skin was more elastic, and his blood vessels were wider and more prominent on the side of the fusiform aneurysm. Conclusion: Posterior circulation involvement is only 3-13% of cases of intracranial aneurysms. Many cases of intracranial aneurysms are not detected before rupture, resulting in delays in treatment. Surgical or endovascular surgery can be performed if the size is >10 mm and causes clinical symptoms. Symptoms of ischemia are managed with antiplatelets or anticoagulants. Incidentally detected unruptured aneurysms are generally managed conservatively because of the highly friable nature of the blood vessels in patients with connective tissue diseases.
A carotid-cavernous fistula (CCF) is an abnormal vascular connection, which allows blood to flow either directly or indirectly from the carotid artery into the cavernous sinus. The classic triad of ocular symptoms mostly seen in direct CCFs but less common without ocular symptoms. This difference in symptoms depends on the draining venous flow from the fistula, whether it affects the ophthalmic veins or affects the cortical veins. We presented a case of a 32-year-old man with decreased consciousness, seizures, vomiting, a history of long-standing headache, ringing in the ears and double vision, without ptosis, opthamoplegia and without proptosis. Head CT showed a sulcal and perimesencepalic type of subarachnoid hemorrhage. Digital subtraction angiography (DSA) results obtained arterial vein fistula from the right internal carotid artery to the cavernous sinus with the dominant vein draining into the cortical vein, accompanied by dilatation and elongation of the cortical veins. No disturbances in ophthalmic venous outflow were found. Endovascular therapy was performed to close the fistula with detachable balloon embolization modality, with the result of complete fistula closure. The symptom pattern of CCF depended on flow velocity, location of CCF venous drainage, inflammation and pressure within the venous sinuses. Cerebral catheter angiography is the gold standard imaging modality used in the diagnosis and classification of CCF and embolization using a detachable balloon is one of the treatment options for direct CCF.
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