Malang Neurology Journal <div id="__if72ru4sdfsdfrkjahiuyi_once" style="display: none;">Malang Neurology Journal (MNJ) is a continuously published twice a year scientific journal by PERDOSSI (Perhimpunan Dokter Spesialis Saraf Indonesia) - Indonesian Neurological Association branch of Malang cooperated with Study Program of Neurologist, Faculty of Medicine Brawijaya University. It is using review by peer group system. MNJ accepts original research article, review, case report, and readers’ letters related to neurology. </div> <div id="__if72ru4sdfsdfruh7fewui_once" style="display: none;"> </div> <div id="__zsc_once"> <p>Malang Neurology Journal (MNJ) is a continuously published twice a year international scientific journal by PERDOSSI <em>(Perhimpunan Dokter Spesialis Saraf Indonesia Cabang Malang)</em> - <a href="">Indonesian Neurological Association Branch of Malang cooperated with Neurology Residency Program</a>, Faculty of Medicine Brawijaya University, Malang, Indonesia. It is using review by peer group system. MNJ accepts original research article, review, case report, and letter to Editor related to neurology.</p> <p><strong>MNJ</strong> is accredited by Ministry of Research, Technology and Higher Education of the Republic of Indonesia based on <a href="">SK No 23/E/KPT/2019 dated 8th August 2019</a> for five years.</p> <p><strong>MNJ</strong> has been indexed by <a href="">Directory of Open Access Journals (DOAJ)</a>, <a href="">CROSSREF (DOI)</a>, <a href=";hl=en">Google Scholar</a>, <a href="">Microsoft Academic</a>, <a href=";mod=viewjournal&amp;journal=9628">Indonesian Publication Index (IPI)</a>, <a href="">indonesian Scientific Journal Database (ISJD)</a>, <a href="">SINTA</a>, <a href="">GARUDA</a>. MNJ is also under-reviewed by SCOPUS and WEB OF SCIENCE.</p> <p>Citations profile in <a href=";hl=en">Google Scholar</a> on March 2022 :</p> <p>Citations: 202, h-index: 6, index i10: 0 <span class="fs-journal-icv-ibox-title ng-binding ng-scope">ICV 2020: 92.56</span></p> </div> <div id="__hggasdgjhsagd_once" style="display: none;"> </div> en-US Malang Neurology Journal 2407-6724 <div class="right" style="text-align: right;"><a href="" rel="license"><img style="border-width: 0;" src="" alt="Creative Commons License" /></a><br />This work is licensed under a <br /><a href="" rel="license">Creative Commons Attribution-NonCommercial 4.0 International License</a></div> THE ROLE OF INTRAOPERATIVE NEUROPHYSIOLOGIC MONITORING TO ENHANCE SUCCESSFUL ORTHOPEDIC SURGERY <p>One of the main advance in orthopaedic surgery domain has a goal to investigates the safest and harmless method in surgical procedures. Less complications means a better outcome of surgery. One of the commonest risks at orthopaedic surgery is central and peripheral nerve injury. The modality of Intraoperative Neurophysiologic Monitoring (IONM) which act to limit the risk of nerve injury during operative procedure through the evaluation of nerve integrity and function enable the surgeon to decrease injury to the nerve associated with orthopaedic surgical procedure in the operating room. This article aims to explain and describe the latest modality of IONM, its basic concept and its function at surgery. The last part of the article discussed about orthopaedic surgical techniques which use IONM. The authors hope that this article will enhance the knowledge of all the readers about IONM. This article was written based on literature study searched at Google Scholar, Medline and PubMed. The references were taken from a relatively up to date study ranging from 2013-2018. The article was selected according to the authors inclusion criteria and six articles was chosen as the references for this review. As a conclusion, IONM has an important role to increase successful rate of surgery through minimizing nerve injury risk during surgical procedure.</p> Panji Sananta Anindita Eka Pramana Wijaya Marvin Anthony Putera Copyright (c) 2022 Malang Neurology Journal 2021-12-27 2021-12-27 8 1 35 38 10.21776/ub.mnj.2022.008.01.8 MANAGEMENT DYSPHAGIA IN POST-STROKE PATIENTS RECOMMENDATIONS FOR INDONESIAN NURSING INTERVENTION STANDARDS: A LITERATURE REVIEW <p><strong>Background: </strong>Dysphagia often occurs in post-stroke patients, causing aspiration that can result in disability or death. Nurses have an essential role to play in preventing these complications as they 24/7 care for patients. However, there is no written standard of nursing care regarding specific interventions of post-stroke dysphagia in reality.<strong></strong></p><p><strong>Objective: </strong>The purpose of this article is to conduct a literature review of interventions that can be made in patients with post-stroke dysphagia so that it can be a recommendation for Indonesian nursing standards.</p><p><strong>Design: </strong>Electronic literature searches PubMed, EBSCO (Medline), ProQuest, and ScienceDirect databases from January 2011 to October 2020. There was sixteen studies reviewed included in this systematic study were experimental, randomized controlled trials, or systematic reviews (which are also experimental designs, randomized controlled trials). The study focused on non-invasive interventions performed on post-stroke dysphagia patients.</p><p><strong>Results: </strong>Interventions in dysphagia found, namely: The use of food thickeners against the risk of aspiration resulted in the patient's swallowing ability significantly increased by 71.9% (p &lt;0.01); Chin down intervention combined with thickening fluid provides a solution to improve the nutritional needs of patients dysphagia post-stroke; Tongue training interventions, swallowing training and speech therapy; Tongue stretching exercises that have a positive effect on tongue motility and oromotor function in post-stroke dysphagia patients; Intervention of Tongue resistance training that increases the strength of the tongue and reduces fluid residue in the vallecular; and early screening of dysphagia by nurses using formal guidelines to manage dysphagia patients thereby reducing chest infections and mortality.</p><p><strong>Conclusion: </strong>Nurses should not diagnose dysphagia, but can identify post-stroke dysphagia to determine the interventions necessary for nutrition management, hydration, and aspiration prevention. Interventions include early dysphagia screening within 24 hours after stroke, thickening nutrition according to nutritionist recommendations, laryngeal elevation exercises, peripheral stimulation, posture regulation, and education on eating and drinking.</p> Syahrun Syahrun Alfrina Hany Masruroh Rahayu Copyright (c) 2022 Malang Neurology Journal 2021-12-27 2021-12-27 8 1 39 48 10.21776/ub.mnj.2022.008.01.9 CLOSING THE GAP FOR PHARMACOLOGICAL TREATMENT OF PAINFUL DIABETIC NEUROPATHY : THE POTENTIAL ROLE OF VITAMIN D <p>Painful neuropathic pain is a challenging chronic pain to treat. It is heterogeneous in symptoms and could be resistant to the available treatments regimen. Current pharmacological treatments fail to achieve adequate pain relief in a most patients. The previous review showed that only less than 50% of patients can achieve good pain reduction with standard adjuvant treatment. The available adjuvants analgesic only focus in the symptom control, and do not interfere with the progressing damage of the nerve. Vit D insufficiency is quite frequent in type 2 diabetes patients.diabetes, particularly those with symptoms of DPN. The studies also showed that low serum vitamin D levels are an independent predictor of DPN development. Vitamin D supplementation is necessary for diabetic neuropathy patients since it promotes the synthesis of neurotrophins and neurotransmitters. Additional vitamin D therapy have big role in nerve growth factor and the regulation of neurotrophin and Ca<sup>2+</sup> homeostasis in neurons, and provides protection for neurons in the peripheral nervous system.  In this review, we do systematically search the studies about Vitamin D for the treatment of painful diabetic neuropathic condition. We used PubMed, Cochrane, Clinical Key, and search Google Scholar for papers that used vitamin D phrases. and painful diabetic neuropathy as our major database for this review and we make a systematic table to explain our review. However, there is still an unmet need in the management of neuropathic pain. The unmet needs maybe caused by the gap between pharmacological treatmnet in pain reduction in painful diabetic neuropathy patients. Therefore, in this review we discuss about the potential use of vitamin D as an add-on therapy to closing the gap in the management of neuropathic pain.</p> Rizaldy Taslim Pinzon Angela Angela Copyright (c) 2022 Malang Neurology Journal 2021-12-27 2021-12-27 8 1 49 52 10.21776/ub.mnj.2022.008.01.10 A COMPREHENSIVE APPROACH INTO STEREOSCOPIC VISION <p>Stereopsis (or stereoscopic) vision is the ability to see depth of perception, which is created by the difference in angle of view between both eyes. The first process is known as simultaneous perception. Objects will fall on each corresponding retina and there will be a process of fusion of the two images into one. Then, the brain initiates three-dimensional perception in visual cortex, creating stereoscopic vision. Stereoscopic vision will rapidly develop, especially at the age of 6-8 months of life. Stereoscopic is important in daily activities. There are many stereoacuity tests to evaluate stereoscopic vision. Stereoscopic examinations are based on the principle of haploscope, anaglyph, or polaroid vectograph. There are qualitative and quantitative examination methods to assess stereoscopic vision. Qualitative examinations such as Horizontal Lang Two Pencil test and Synoptophore. Quantitative examination including Contour stereopsis test and Clinical random dot stereopsis test. The inability of the eye to see stereoscopic can be called stereoblindness. This can be affected by amblyopia, decreased visual acuity, or the presence of ocular misalignment. Inability to achieve stereoscopic vision will impact an individual to perform some daily life activities, and lead to an increase in difficulty interacting in the world.<strong></strong></p> Lely Retno Wulandari Copyright (c) 2021 Malang Neurology Journal 2021-12-28 2021-12-28 8 1 53 57 10.21776/ub.mnj.2022.008.01.11 NEURODEGENERATION AS AN EARLY SIGN OF DIABETIC RETINOPATHY <p>Diabetic retinopathy is major cause of visual impairment and blindness in diabetic patients worldwide. The concept of diabetic retinopathy as vascular disease has established into not only microvascular complication but also neurodegeneration problems. Neurodegeneration plays an important role in pathogenesis of diabetic retinopathy. In fact, neuroretinal changes in diabetes can take place even before vasculopathy can be clinically detected. This condition is marked by accelerated loss of neurons due to apoptosis, particularly in the inner retinal layer. The characteristic of neurodegeneration can be detected through retinal imaging and electrodiagnostics. This review is very crucial, because identifying the pathophysiology of diabetic neurodegeneration better, we may be able to provide interventions using the appropriate therapy. We may also be able to utilize these diagnostic tools for early detections of diabetic retinopathy, thus preventing blindness due to diabetes.</p> Nadia Artha Dewi Muhammad Arfan Herisa Rahmasari Mutiara Kristiani Putri Rulli Rosandi Shahdevi Nandar Kurniawan Copyright (c) 2022 Malang Neurology Journal 2022-01-01 2022-01-01 8 1 58 63 10.21776/ub.mnj.2022.008.01.12 ATTENTION DEFICIT HYPERACTIVITY DISORDER SYMPTOMS IN ADULTS WITH ESSENTIAL TREMOR <p><strong>Background: </strong>Essential tremor is the most common movement disorder. İn this disease, which is characterized by tremor that increases with action and passes at rest, different accompanying symptoms can also be seen.<strong></strong></p><p><strong>Objective: </strong>The purpose of this study was to investigate attention deficit hyperactivity symptoms in adults with ET.</p><p><strong>Methods: </strong>Fifty six essential tremor patients and 56 controls were included in the study. Patients were recruited from outpatient clinic at Kirikkale University Medicine Faculty. An informed consent form was signed by each patient after detailed information. Institutional ethics committee approval was obtained. Patients’ characteristics such as education level, gender, age and disease duration were recorded. Symptoms of ADHD in patients and controls were determined by using the Adult Report Deficit / Hyperactivity Disorder Self Report Scale. Short Form-36 and Hospital Anxiety and Depression Scale were also performed. Essential tremor severity was determined by using the Whiget essential tremor scale.</p><p><strong>Results: </strong>Essential tremor patients had significantly higher rate of Adult Attention Disorder Self-Report Scale Deficit/Hyperactivity scores compared to controls. Scores of Adult Attention Deficit/Hyperactivity Disorder Self-Report Scale were associated with depression and anxiety scores and physical and mental component scores of Short Form-36 in bivariate analyses. There was a positive correlation between tremor severity and ASRS scores( ASRS A scores= 17,3±5,5, p=0,032, ASRS B scores= 27,7±6,7,p=0,043, ASRS T scores= 45±12,2, p=0,017) however there was no significant statistical relationship between the duration of disease and ASRS scores.</p><p><strong>Conclusion: </strong>This study showed that ADHD symptoms can be observed in adult essential tremor patients and this may be associated with increased psychosocial morbidity and lowered quality of life in ET patients.</p> Omer Oguzturk Murat Alpua Ersin Kasim Ulusoy Copyright (c) 2021 Malang Neurology Journal 2021-12-27 2021-12-27 8 1 1 5 10.21776/ub.mnj.2022.008.01.1 STUDY OF SIGNIFICANCE OF PHASE MASK IMAGE IN ACUTE STROKE PATIENTS <p><strong>Background: </strong>Phase images contains information regarding local susceptibility changes between the tissues, which can help measure the iron and other content which changes the local field. Typically, this information is ignored before looking at console. Susceptibility weighted imaging (SWI) is a magnetic resonance (MR) technique detects an early hemorrhagic transformation within the infarct to provide insight into cerebral hemodynamics following the stroke.<strong></strong></p><p><strong>Objective:</strong> Significance of “phase mask imaging in differentiation of hemorrhage and calcifications” in acute stroke patients.</p><p><strong>Methods: </strong>An observational non-interventional study carried out on 100 patients with stroke and headache symptoms. MRI Brain Stroke Profile with FLAIR, DWI, ADC, SWAN, and Phase mask sequences, done on 3T GE MRI scanner.</p><p><strong>Results: </strong>All patients underwent MRI study with SWI sequence. Of 183 cases, 33%(n=60) patients had microbleeds, 5%(n=10) patients had granulomas, 32%(n=58) patients had arterial thrombus with infarct, 11%(n=20) patients had falx calcifications, 11%(n=20) patients had intraparenchymal haemorrhage, and 8%(n=15) patients had infarcts with haemorrhagic transformation. The sensitivity of phase imaging in the detection of calcification was 90%.</p><p><strong>Conclusion: </strong>Phase mask imaging plays an important role to detect intracranial calcifications and chronic microbleeds. Phase mask imaging acts as a supplement tool in acute stroke patients, which guides further management.</p> Krishna Teja Nerella Dileep Reddy Ayapaneni Surekha Srikonda Copyright (c) 2022 Malang Neurology Journal 2021-12-27 2021-12-27 8 1 6 10 10.21776/ub.mnj.2022.008.01.2 THE RELATIONSHIP BETWEEN CEREBROSPINAL FLUID PRESSURE AND ATHEROGENIC INDEX OF PLASMA IN IDIOPATIC INTRACRANIAL HYPERTENSION PATIENTS <p><strong>Background: </strong>Idiopathic intracranial hypertension (IIH) is a disease thought to be associated with obesity and rapid weight gain. There is no objective parameter with practical use in its follow-up and treatment other than optical coherence tomography.<strong></strong></p><p><strong>Objective: </strong>The aim of our study is to investigate the relationship between atherogenic index of plasma (AIP) and cerebrospinal fluid (CSF) pressure.</p><p><strong>Methods: </strong>Serum vitamin B12, vitamin D, homocysteine, folic acid, triglyceride (TG), high density lipoprotein cholesterol (HDL-C) levels, CSF pressure, CSF microprotein levels were recorded from the file data of patients diagnosed with IIH. AIP was calculated by dividing the TG level logarithmically by HDL-C. Height (kg) and weight (kg) data of the patients were used to calculate the body mass index (BMI).</p><p><strong>Results: </strong>File data of 64 patients were examined. 8 patients with secondary intracranial hypertension were excluded from the study. 80.36% of the patients were overweight, 16.07% were obese, 3.57% were with normal weight. There was no significant correlation between vitamin B12, vitamin D, homocysteine, HDL-C and CSF microprotein levels and CSF pressure level in patients with a diagnosis of IIH. There was a negative correlation between folic acid level and CSF pressure level, and a positive correlation between BMI, TG, AIP and CSF pressure level.</p><p><strong>Conclusion: </strong>Using folic acid supplements and drugs that reduce TG levels can contribute positively to the course of the disease.</p> Fatma Şimşek Recep Yevgi Yıldız Dağcı Copyright (c) 2022 Malang Neurology Journal 2021-12-27 2021-12-27 8 1 11 15 10.21776/ub.mnj.2022.008.01.3 NORMAL PLANTAR FASCIA THICKNESS IN ADULT <p><strong>Background: </strong>Plantar fasciitis is a common problem caused by thickening of the plantar fascia. The normal plantar fascia thickness ranged between 2-3 mm and it was generally accepted that value more than 4mm was considered pathologic.<strong></strong></p><p><strong>Objective: </strong>to identify normal plantar fascia thickness in adults using ultrasonography.</p><p><strong>Methods: </strong>This is a cross sectional study measuring the thickness of plantar fascia in 145 subjects with no history of heel pain. Plantar fascia thickness was measured in both feet using an ultrasound. Age, height and weight were recorded and analysed.</p><p><strong>Results: </strong>As much as 145 subjects were included in this study. Male to female ratio was 0.7. Mean age was 44 and body mass index (BMI) was mostly within normal range. Plantar fascia thickness in male was 2.71 ± 0.48 mm in right foot, and 2.74 ± 0.47 mm in left foot. Fascia thickness in female was 2.55 ± 0.50 mm in right foot, and 2.57 ± 0.45 mm in left foot. There was a significant plantar fascia thickness difference between male and female (p = 0.035 in right foot, and p=0.04 in left foot). Age, weight and BMI had a significant correlation towards plantar fascia thickness. In multivariate analysis, age and BMI revealed to have a linear correlation to plantar fascia thickness</p><p><strong>Conclusion: </strong>Age and BMI were found to be the best predictive factor of plantar fascia thickness.</p> Yusak Mangara Tua Siahaan Pricilla Yani Gunawan Jeffry Foraldy Haryanto Veli Sungono Copyright (c) 2022 Malang Neurology Journal 2021-12-27 2021-12-27 8 1 16 20 10.21776/ub.mnj.2022.008.01.4 PROFILE OF HISTORY OF FEBRILE SEIZURE IN PATIENTS WITH EPILEPSY <p><strong>Background: </strong>Febrile seizure is convulsions with fever (temperature ³38°C) with no central nervous system infection that commonly found in children (6-60 months). Febrile seizures do not always mean the child has epilepsy. However, febrile seizures can be a possible long-term risk factor for epilepsy.<strong></strong></p><p><strong>Objective: </strong>The objective of this study is to know the profile of febrile seizure in patients with epilepsy.</p><p><strong>Methods: </strong>A retrospective descriptive study on 23 patients with epilepsy in the EEG Department of Neurology, Dr. Soetomo General Hospital, Surabaya, Indonesia in the period 2018-2019 based on inclusion and exclusion criteria. The total number of epilepsy patients is 849 patients, 216 of whom had a history of febrile seizure. Among 216 epilepsy patients who had a history of febrile seizures, 23 of them were qualified as the sample. The sampling technique used was total population sampling. The instrument of this research is the patients’ medical record. Data analysis is carried out descriptively.</p><p><strong>Results: </strong>The characteristics of the history of febrile seizures that found in patients with epilepsy are more patients are male, have the age of onset on less than 2 years old, have the body temperature more than 38.3°C, have the seizure duration less than 15 minutes, have focal seizures, have recurrent seizures in 24 hours, have a history of more than one febrile seizure, have accompanying neurological disorders, and have no family history of epilepsy.</p><p><strong>Conclusion: </strong>Febrile seizure is still becoming a concern because there is a possibility that it may develop into epilepsy. Even though, not all children who experience febrile seizure will generate epilepsy.</p> Rayhan Muhammad Basyarahil Wardah Rahmatul Islamiyah Prastiya Indra Gunawan Copyright (c) 2022 Malang Neurology Journal 2021-12-27 2021-12-27 8 1 21 24 10.21776/ub.mnj.2022.008.01.5 EFFECT OF DATE FRUIT (PHOENIX DACTYLIFERA L.) EXTRACT ON TNFα LEVELS AND BRAIN WEIGHT OF ALZHEIMER’S MODEL RATS <p><strong>Background: </strong>Alzheimer's disease (AD) is a neurodegenerative disorder marked by brain inflammation resulted in structural damage and brain dysfunction. Tumor necrosis factor α (TNFα) is a cytokine that plays an important role in inflammation. Dates fruit may help to fight oxidative stress and inflammation in the brain.<strong></strong></p><p><strong>Objective: </strong>To determine the effect of date fruit extracts on blood TNFα levels and brain weight of alzheimer’s model rats.</p><p><strong>Methods: </strong>This research is a laboratory experimental study by post-test only with control group design using alzheimer model rats. This study used 6 treatment groups with simple randomization. Each treatment group was represented by 8 Sprague Dawley rats. The normal control group (KN) was not induced by Hcy and was not given date palm extract, the negative control group (K-) was the Alzheimer's experimental rats which was not given the date palm extract, the positive group was the Alzheimer's experimental rats which was given the Donepezil (K+). Groups P1, P2, P3 were Alzheimer's experimental rats that were given date palm extract at a dose of 200, 400,800 mg / kgBW / day. The effect of date palm extract dosage on TNFα levels and brain weight were analyzed using the One Way Anova test followed by Tukey's post hoc test.</p><p><strong>Results: </strong>The difference in TNFα levels between groups showed a significant difference (p = 0.00). Meanwhile there was no significant difference in brain weight among all groups (p &gt; 0,05). </p><p><strong>Conclusion: </strong>Date palm extract at doses of 200, 400, 800 mg / kgBW can decrease blood TNFα levels of Alzheimer’s model rats.</p> Elita Marintan Brian Wasita Adi Magna Copyright (c) 2022 Malang Neurology Journal 2021-12-27 2021-12-27 8 1 25 29 10.21776/ub.mnj.2022.008.01.6 COMPARISON OF COGNITIVE FUNCTION BETWEEN FIRST ISCHEMIC STROKE AND RECURRENT ISCHEMIC STROKE PATIENTS <div class="WordSection1"><p><strong>Background: </strong>Cognitive impairment is a common condition that may affect up to 50% of stroke patients. Post stroke cognitive impairment is associated with reduced quality of life, which may increase the number of dependency. Recurrent stroke may happen in approximately 25% patients and they have higher rates of cognitive impairment.</p><p><strong>Objective: </strong>The aim of this study is to examine the comparison of cognitive function between first ischemic stroke and recurrent ischemic stroke patients in Hasan Sadikin Hospital, Bandung.</p><p><strong>Methods: </strong>This study is a retrospective, cross-sectional study using the data recruited between the year 2012 - 2016 at the Department of Neurology at the Hasan Sadikin Hospital Bandung. The data collected in this study were demographic data, including age, level of education, and residence, and the clinical data as well. Cognitive function was assessed using Mini-Mental State Examination (MMSE). The comparison between the cognitive function between both groups were analyzed using the Mann-Whitney U test.</p><p><strong>Results: </strong>There were 428 subjects eligible for this study, with 207 subjects categorized as first ischemic stroke group and 221 subjects categorized as recurrent ischemic stroke group. There was a statistically significant difference in MMSE scores between the first ischemic stroke patients (24.90 ± 4.64) and recurrent ischemic stroke patients (22.85 ± 4.64 ) with a <em>p</em> value of 0.002.</p><p><strong>Conclusion: </strong>Recurrent ischemic stroke patients had lower MMSE scores than the first ischemic stroke patients. Clinicians should be more aware in detecting early cognitive impairment in stroke patients and in preventing the incidence of recurrent stroke.</p></div> Fildza Intan Rizkia Chandra Calista Suryani Gunadharma Asep Nugraha Hermawan Lisda Amalia Paulus Anam Ong Copyright (c) 2022 Malang Neurology Journal 2021-12-27 2021-12-27 8 1 30 34 10.21776/ub.mnj.2022.008.01.7 DECREMENTAL RESPONSE ON PROLONGED EXERCISE TEST IN A PATIENT WITH THYROTOXIC PERIODIC PARALYSIS <p>Paralysis of acute onset often presents a diagnostic challenge for the assessing physician because of a large number of differential diagnosis and overlap of clinical features among them. Thyrotoxic periodic paralysis is an uncommon cause of acute weakness. In addition to serological tests, electromyography findings during prolonged exercise test are very helpful in confirming the diagnosis. Only a few case reports of thyrotoxic periodic paralysis have been published from Middle East and none of them have described this specific electrophysiological data. A man in his 20s presented to us with acute onset weakness in both legs which was evaluated further and found to have hypokalemia. The work up for the etiology revealed thyrotoxic status and a final diagnosis of thyrotoxic periodic paralysis was established. The prolonged exercise test performed in this patient showed typical progressive decremental respsonse with nadir at 40 minutes after the exercise.<strong></strong></p> Piyush Ostwal Maher Alshaheen Copyright (c) 2022 Malang Neurology Journal 2022-01-01 2022-01-01 8 1 64 67 10.21776/ub.mnj.2022.008.01.13 CASE REPORT OF ADULT-ONSET CHARCOT MARIE TOOTH TYPE X <p>Charcot-Marie-Tooth (CMT) or Hereditary Motor and Sensory Neuropathy (HMSN) is the most common hereditary peripheral nerve disease with progressive chronic weakness, muscle atrophy, and sensory disturbances. There are several types and subtypes of CMT with their respective clinical manifestations. In this article, we reported a patient with of CMT type X. A 43-year-old male patient was referred to a neurology clinic with weakness in both limbs for 2 years, accompanied by tingling and sensory disturbance in both hands and feet. There are several of his family members who had similar complaints. Lumbosacral magnetic resonance imaging (MRI) examination revealed mild nucleus pulposus herniation. Electroneuromyography (ENMG) examination revealed demyelinating sensory motor polyneuropathy. Histopathological examination of nerve biopsy showed demyelination of the sural nerve. It is hard to make a diagnosis of CMT, because it requires high suspicion from clinicians once encounter a suspected case and also need to supported by sophisticated equipment such as electrophysiological examinations, nerve biopsy examinations, and genetic examinations. It is vital for clinicians for being able to diagnose CMT correctly and provide treatment as soon as possible in order to maintain the patients’ quality of life.<strong></strong></p> Richard Suherlim Anak Agung Ayu Putri Laksmidewi Sudiarini NKA Copyright (c) 2022 Malang Neurology Journal 2022-01-01 2022-01-01 8 1 68 71 10.21776/ub.mnj.2022.008.01.14 INDIRECT CEREBRAL REVASCULARIZATION ON OPTHALMIC ARTERY BY USING A DRUG-ELUTING BALLON FOR SUSPECTED MOYAMOYA DISEASE <p>Moyamoya disease (MMD) is a rare idiopathic progressive vaso-occlusive disease causing multiple occlusion of cerebral vessels lead to ischemic stroke. Asian population is the most common race to be affected. We present a male patient 33-years old with suspected MMD with right hemiparesis and neurocognitive changes. On digital substraction angiography (DSA) there was appearance of ‘puff of smoke’ on his right hemisphere, stenosis middle cerebral arteries M1 bilaterally, stenosis of right opthalmic artery (OA), stenosis of left anterior cerebral artery (ACA) and aplasia of right ACA. Ballon angioplasty was performed on right OA that supply the contralateral symptomatic stenosis area (left A1) indirectly through anterior ethmoidal artery and anterior falcine artery (OA-ACA collateral). While no guidelines for the management of MMD, cerebral revascularization by using drug-eluting ballon (DEB) in right opthalmica artery is potentially effective treatment that could allow the brain to have good blood supply (gives good collateral to both ACA), reduces burden of the fragile moya-moya vessels to be ruptured followed by improvement of clinical results. Patient’s selection by understanding the stage, its progressivity and collateral formation are crucial before decision is made.<strong></strong></p> Ahmad Sulaiman Alwahdy Fritz Sumantri Usman Copyright (c) 2022 Malang Neurology Journal 2022-01-01 2022-01-01 8 1 72 76 10.21776/ub.mnj.2022.008.01.15