Asian Australasian Neuro and Health Science Journal (AANHS-J)

Mortality of Guillain Barre Syndrome and Myasthenic Crisis in Haji Adam Malik Central General Hospital Medan January 2021- December 2022

2024-09-04

Introduction: Neuromuscular disorders are disorders of the neuro system that impact the muscular system. Among them are Guillain-Barré Syndrome and Myasthenic Crisis. Guillain-Barré syndrome is an autoimmune disorder of the nervous system that is polyradiculoneuropathic, characterized by weakness that radiates from the legs to the arms, torso, and face. Myasthenic crisis is a state of acute respiratory failure due to the exacerbation of Myasthenia Gravis. These two diseases are the most common types of neurodiseases found in hospital ICU patients.

Objective: Determining the mortality rate of Guillain-Barré Syndrome and Myasthenic Crisis at Haji Adam Malik Central General Hospital Medan January 2021-December 2022.

Methods : This study was a descriptive study with data obtained from medical records. The subjects were inpatients and outpatients with Guillain Barré Syndrome and Myasthenia Crisis, with as many as 129 patients. The subjects were selected by purposive sampling and met the inclusion and exclusion criteria.

Results: A total of 40 Guillain-Barré Syndrome patients were studied, and 6 of them died. The majority were patients aged 36-50 years, and the male and female sexes were equally significant. A total of 89 patients with Myasthenic Crisis were studied, and 1 of them died, namely patients with the age category of 36-50 years and female.

Conclusion: Guillain-Barré Syndrome mortality was 15%, and Myasthenic Crisis was 1.12% at Haji Adam Malik Center General Hospital Medan January 2021-December 2022.

Keyword : Guillain-Barré Syndrome, Mortality, Myasthenic Crisis

Transsphenoidal Approach for Sellar Region Tumor : A Case Series

Sabri Ibrahim — 2024-09-04

Introduction: Transsphenoidal approaches to the sellar region, with endoscopic or microscopic techniques, are regularly used to treat a diverse collection of pathologies.

Case Description: Three patients with presenting symptoms visual disturbance and headache were evaluated with MRI that showes sellar region masses. All patients were undergo transphenoid tumor removal. Post operation evaluation show improvement in visual disturbance and headache with no adverse event after procedure.

Discussion : Transsphenoidal endoscopic surgery (TSS) for functional pituitary adenomas yields better endocrinologic results for noninvasive macroadenomas. However, the rate of postoperative CSF leakage was greater with the endoscopic method. In patients with pituitary adenomas, younger age, dense visual field defect, and the preoperative absence of central or bilateral visual field abnormalities were predictive factors of visual field recovery following transsphenoidal approach-tumor excision. Overall survival rates are generally high, ranging from 91% to 98%.

Conclusion: Transphenoid approach was a good surgical method for sellar region masses and show good outcomes after operation.

Keyword : Sellar region masses; Surgical; Transsphenoid approach

Temporary Visual Hallucinations in a 31-year-old Female Patient Post Falcotentorial Meningioma Resection with No History of Psychosis: A Case Report

Sebastian Sipayung — 2024-09-04

Introduction: Falcotentorial meningiomas are rare, comprising 1%–2% of all intracranial meningiomas, arising at the junction of the falx cerebri and tentorium. These tumors may compress the quadrigeminal plate and/or splenium, leading to peduncular hallucinosis—vivid, colorful visual hallucinations of people and animals, which can persist even after tumor removal.

Case Description: A 31-year-old woman with no psychosis history presented with a bilateral visual field deficit and left extremity weakness. Brain MR imaging revealed a lobulated mass attached to the right cerebellar tentorium, posterior falx cerebri, and adjacent venous sinuses. Visual field analysis showed homonym superior quadranopsia. Following craniotomy and tumor removal, histology confirmed a mixed-type meningioma. Post-surgery, the patient experienced vivid visual hallucinations that resolved in two weeks, but bilateral visual field deficits remained. A post-op CT showed reduced structural compression around the lesion with slight narrowing of the quadrigeminal cistern.

Discussion : Visual hallucinations in falcotentorial meningioma patients, often as peduncular hallucinosis, occur due to compression of the quadrigeminal plate and/or splenium and may persist post-surgery if lesions are present in the cerebral peduncles or nearby midbrain areas.

Conclusion: The patient's temporary hallucinations may have resulted from post-resection tissue edema causing quadrigeminal cistern narrowing or indicate lesions in the cerebral peduncles or adjacent midbrain regions.

Successful Management of Ischemic Stroke : A Case Report and Literature Review

Monicha Vanessa Rahman Gunardi — 2024-09-04

Introduction: Stroke is a clinical condition characterized by the sudden onset of focal (or global, in cases of coma) neurological symptoms that persist for over 24 hours or result in death, with no clear cause other than a vascular issue.

Case Description: Male, 62 years old, with chief of complaint of mouth dropped to the right since 1 day before admission. Complaints made the patient speak more difficult, slow and unable to form sentences. Physical examination show parese CN. VII UMN dextra. Siriraj score -5 and Head NCCT show cerebral infarction in the internal capsula interna. Patient was diagnosed with ischemic stroke.

Discussion: The use of a scoring system can be useful when there are no brain imaging facilities that can clearly distinguish the causative pathology of stroke. criteria for diagnosis of ischemic stroke are symptoms of global neurological deficits or one / several focal neurological deficits that occur suddenly with evidence of brain imaging images (CT scan or MRI). The most common differential diagnosis is hemorrhagic stroke.

Conclusion. Early recognition and appropriate treatment is important to cure acute ischemic stroke to achieve good quality of life and prevent further infarct to brain tissue.

Keyword: Craniotomy, Brain Metastases, Hepatocellular Carcinoma

Craniotomy Tumor Removal for Brain Metastases of Hepatocellular Carcinoma : A Case Report

Andri Josua Barutu — 2024-09-04

Introduction: Brain metastases (BM) are the most frequent type of brain tumors in adults and are the leading source of neurological issues related to systemic cancers.

Case Description: Female, 49 years old, presented with decreased consciousness that occurred since 1 month before admission. Weakness of the right limbs is found. CT scan abdomen with contrast show hepatic segment VIII infarction. histopathological examination of hepatic tissue biopsy with the results of hepatocellular carcinoma MRI brain shows multiple lesions suggestive of brain metastasis.

Discussion: Patient was diagnosed with space occupying lesion on the frontotemporal dd brain metastasis dd orbital roof meningioma + multiple space occupying lesion intracranial on the left parietooccipital ec. brain metastasis + hepatocellular segment V, VI, VII, and VIII. Patients underwent craniotomy tumor removal to remove intracranial masses. The patient's postoperative condition showed improvement in the level of consciousness with GCS E4M5V3.

Conclusion. Craniotomy tumor removal provides several advantages for managing patients with brain metastases of hepatocellular carcinoma.

Keyword: Craniotomy, Brain Metastases, Hepatocellular Carcinoma