AKSONA

Headache in Preeclampsia: Review Article

Mulia Dian Sumbawati — 2025-07-31

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Headache in preeclampsia is classified as a type of secodary headache.
Pregnant women with high blood pressure have a 17-fold increased risk of developing secondary headaches.
Typical preeclampsia-related headaches are progressive, bilateral (frontal or occipital), throbbing, associated with visual abnormalities, getting worse with elevated blood pressure or exercise, and resistant to over-the-counter drugs..

ABSTRACT

Preeclampsia is a multisystem vascular disease characterized by systemic disturbances in maternal endothelial function and symptoms such as arterial hypertension and organ dysfunction, including the kidneys, liver, and brain. A headache is defined as pain or discomfort localized in the head region. Pregnancy-related headaches may have primary causes, such as migraines, but they can also indicate potentially life-threatening secondary causes, including preeclampsia. Pregnant women with high blood pressure have a 17-fold increased risk of developing secondary headaches. Headaches associated with preeclampsia can adversely affect pregnancy and labor, increasing the risk of complications. Preeclampsia headaches can predict eclampsia or seizures 56% sensitivity and 83% specificity. According to research conducted in Indonesia, the majority of preeclampsia patients experienced severe headaches (65.2%), followed by moderate (19.6%), mild (13%), and no headaches (2.2%). Therefore, based on the existing literature, this article intends to compile scientific data on headache pain in preeclampsia patients.

Cerebellar Purkinje Cells and GABA Neurotransmission in the Diabetic Rodent Models: A Systematic Review

Viskasari P Kalanjati — 2025-07-31

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Reduced cerebellar Purkinje cell numbers and altered dendritic trees due to cell deaths were reported in hyperglycemia.
In hyperglycemia, altered GABAergic neurotransmissions are due to lower GABA synthesis and its receptors expression levels in cerebellum.
Impaired motor and cognitive functions were observed related to cerebellar Purkinje cell damage in a diabetic rat model.

ABSTRACT

Introduction: Hyperglycemia-induced neurotoxicity has been linked to the cerebellum, specifically the impairment of Purkinje cells; its relation to GABA neurotransmission has yet to be cleared. Objective: We conducted an updated review on the mechanism of hyperglycemia-induced impairment of cerebellar Purkinje cells in a rodent diabetic model. Methods: A modified ScR-PRISMA flow diagram was applied as the screening tool. All English-language research articles published between 2014 and 2024 that containing the purposed topics and were indexed in PubMed and Medline were included. These articles were then critically appraised using the JBI checklist to minimize potential bias. The final inclusion of 8 articles was included for analysis and discussion, together with additional retrieved articles. Results: Hyperglycemic-induced subjects demonstrated a marked reduction in Purkinje and granular cell populations, accompanied by several morphological impairments. Alterations were observed in GABAergic inhibitory neurotransmission, including receptors and GABA synthesis, compared to controls. These findings are consistent with observed deficits in motor coordination and cerebellar function. Conclusion: Hyperglycemia produces adverse effects on the function and survival of Purkinje cells in the cerebellum. Impaired GABAergic neurotransmission might result as parts of oxidative stress and inflammation induced by hyperglycemia in the cerebellar cells. Taken altogether, these results in motor impairment and cognitive dysfunction.

Analysis of Socioeconomic Status Among Risk Factors of Pediatric Abusive Head Trauma: A Systematic Review

Calista Felice — 2025-07-31

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Most studies agreed that socioeconomic status (SES) influences the prevalence of pediatric abusive head trauma.
SES is associated with other AHT risk factors and contributes to varied clinical outcomes.
AHT incidence can be reduced by prevention strategies that focus on education and enhanced healthcare access.

ABSTRACT

Introduction: Previous studies have shown that children from low socioeconomic status (SES) families are more likely to experience abusive head trauma (AHT). However, research on this topic remains limited. Some argue that clinicians may demonstrate diagnostic bias, tending to overidentify AHT in lower-SES children, regardless of actual risk. Is low SES truly a risk factor for AHT? If so, how does it affect AHT occurrence and its relationship with other risk factors? Objective: This review was to observe the relationship of SES as one of the risk factors of pediatric AHT. Methods: A systematic review was conducted on pediatric AHT using household SES data. Children with AHT were compared to non-abusive head trauma (non-AHT) controls. Articles published between 2002 and 2022 were searched from Scopus, PubMed, and Google Scholar, following PRISMA guidelines. Exlusion criteria included duplicates, inaccessible or non-English/Indonesia articles, and studies not meeting PECO criteria. Data on child age, sex, type of head trauma, and SES were collected. Demographic characterisctics, SES, risk factors, outcome, and preventive measures were analyzed. Results: A total of 19,700 articles were found after searching Scopus, PubMed, and Google Scholar. After several screenings, 18 articles were included. Of the 18 articles, 17 included data on patients with AHT, and 6 included data on control patients. In total, there were 21,451 patients with AHT and 411,185 controls. The control group consisted of children with non-AHT and children without trauma. The mean, median , and standard deviation of the percentage of low SES patients with AHT were relatively higher than controls. A higher amount of articles agreed that SES had a significant impact. Conclusion: SES may influence pediatric AHT prevalence, but it should not be used as a determinant in diagnostic decision-making.

Profile of Motoric and Non-Motoric Symptoms Using the Indonesian Version of the Wearing-Off Questionnaire-19 in Parkinson’s Patients

Bernadetha Muktiarini — 2025-07-31

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Tremors are the most common motor symptom in patients with Parkinson's disease.
Abdominal discomfort is a prevalent non-motor symptom of Parkinson's disease.
Comprehensive symptom management is essential for patients with Parkinson's disease.

ABSTRACT

Introduction: Parkinson's disease is a neurodegenerative disorder characterized by motor and non-motor symptoms. The prolonged administration of levodopa in patients may induce the wearing-off phenomenon, where symptoms recur before the next dose. Studies on the symptom profile of Parkinson's disease, especially in wearing-off conditions, are crucial for further management. Objective: This study aimed to determine the motor and non-motor symptom profile of patients with Parkinson's disease. Methods: conducted. The Indonesian version of the Wearing-Off Questionnaire-19 (WOQ-19) was used to identify motor and non-motor symptoms. Data were collected from 30 Parkinson’s patients at Bethesda Yogyakarta Hospital from October to December 2023 using a purposive sampling technique. The sample size was calculated using OpenEpi V3.01. Results: The most prevalent motor symptom among patients with Parkinson's disease was tremor (100%), followed by bradykinesia (93.33%) and rigidity (86.67%). The most common non-motor symptoms reported were abdominal discomfort (56.67%) and body aches (50%). Conclusion:Patients have a variety of Parkinson's disease symptoms. Parkinson's patients most commonly experienced motor symptoms such as tremors, bradykinesia, and rigidity, along with non-motor symptoms like abdominal discomfort and body aches. The significant percentage of wearing-off seen in this study underscores its common occurrence and highlights the importance of early identification and management.

Factor Associated with Orthostatic Hypotension in Parkinson’s Disease

Selly Marisdina — 2025-07-31

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Neurogenic orthostatic hypotension is commonly found in Parkinson’s disease (PD) and unnoticed by both patients and clinicians.
Underweight has been associated to orthostatic hypotension in Parkinson’s disease, among other factors.

ABSTRACT

Introduction: Orthostatic hypotension (OH) affect approximately 30% of patients with Parkinson's disease (PD). This condition not only reduces quality of life but is also associated with increased mortality. OH has been shown to double the risk of falls in the elderly, worsens motor function, and accelerate cognitive decline. There has been limited study into the prevalence and contributing factors of OH in Parkinson’s disease patients in Indonesia. Objective: This study aimed to determine factors associated with OH in patients with Parkinson’s disease. The variables analyzed included age, sex, duration of PD, disease stage based on the Hoehn and Yahr scale, levodopa equivalent dose (LED), the length of antiparkinsonian agents use, MoCA Ina (Montreal Cognitive Assessment Indonesian version) score, comorbid conditions, use of antihypertensive agents, and body mass index (BMI). Methods: This is a descriptive-analytic study with a cross-sectional design. The study population consisted of all Parkinson’s disease patients who visited the neurology polyclinics at two hospitals in Palembang. Patients were selected based on specific inclusion and exclusion criteria. To discover associations, bivariate and multivariate analyses were performed. Results: The study involved 41 patients with PD at Mohammad Hoesin Hospital and Pusri Medika Hospital in Palembang, from June to December 2024. OH, was found in 43.9% of PD patients, most of whom reported symptoms. Bivariate and multivariate analyses revealed no significant associations between OH and factors such as comorbidities, the length of antiparkinsonian medication use, total LED, age, sex, duration of PD, disease stage (Hoehn and Yahr scale), and of the use of antihypertensive agents. However, underweight BMI was significantly associated with OH in PD patients (p = 0.002, OR = 34.571, 95% CI: 3.77–317.28). Conclusion:Underweight was identified as a significant associated factor for OH in PD patients.

Factor Affecting Insomnia in Ischemic Stroke Patients

Agustina Fajarini — 2025-07-31

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Insomnia is prevalent in ischemic stroke patients and can hinder the recovery process.
Stroke patients have a higher prevalence of insomnia and related symptoms than the general population.
This study found a complex relationship between physical, psychological, and social risk factors for insomnia following ischemic stroke.

ABSTRACT

Introduction: Insomnia is common in ischemic stroke patients and can negatively impact on the post-stroke recovery process by interfering with the body's natural healing process, reducing the effectiveness of rehabilitation therapy, and affecting the recovery of cognitive function. Effective management and early intervention in insomnia are needed to enhance health services for stroke patients, promote optimal recovery, and improve their quality of life. Objective: This study aimed to identify and analyze the various factors associated with the occurrence of insomnia among patients with ischemic stroke. Methods: This is a cross-sectional study that used secondary data from medical records and primary data gathered through questionnaire-based interviews. The subjects were 105 ischemic stroke patients at the Neurology Clinic of Dr. Mohammad Hoesin Hospital, Palembang, between May to July 2024. The data acquired for further analysis included social and demographic details, comorbid conditions, depression, anxiety, pain, insomnia, medication use, sleep hygiene, and stroke clinical features. The data was then analyzed using IBM SPSS Statistics 24 and assessed through bivariate and multivariate analyses to evaluate the relationships between variables. Results: The prevalence of insomnia in this study was 42.9%, with mild insomnia observed in 26.7%, moderate insomnia in 13.3%, and severe insomnia in 2.9% of the subjects. Obstructive sleep apnea (OSA) (OR: 22.718), sleep hygiene index (OR: 6.490), and education level (OR: 3.453) were identified as determinants related to insomnia in ischemic stroke patients. Indirect factors associated with insomnia in ischemic stroke patients include depression, the number of comorbid diseases, pain, diabetes, a history of insomnia, anxiety, and stroke onset. Conclusion: There is a complex relationship between various physical, psychological, and social factors and the incidence of insomnia after ischemic stroke.

Profile of Stroke Patients in John Piet Wanane General Hospital Sorong: A Descriptive Study

Djohan Ardiansyah — 2025-07-31

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Hypertension is the leading risk factor for cardiovascular disease and stroke.
Blood pressure variability, including early morning surge, increases stroke risk.
Low education is associated with an increased risk of stroke due to limited health literact and lifestyle challenges.

ABSTRACT

Introduction: Stroke has become the major cause of physical disability in adults and the second leading cause of death in middle- to high-income countries. Indonesia has the second-highest mortality rate and stroke burden in Southeast Asia. Furthermore, there is limited study on stroke in eastern Indonesia, especially in Papua. Objective: This study aimed to evaluate the clinical profile of stroke patients treated in John Piet Wanane General Hospital. Methods: This descriptive, hospital-based study was conducted at John Piet Wanane General Hospital, Sorong, Southwest Papua, from August 1, 2023, to January 31, 2024. Data were collected through interviews and the identification of subjects’ medical records based on inclusion and exclusion criteria. Results: This study involved a total of 143 patients, with an average age of 58.17 ± 10.516 years. The gender distribution was nearly equal, with 52.4% women and 47.6% men. The subjects mainly had an overweight Body Mass Index (BMI) (39,2%) or a normal BMI (36.4%). Obesity and underweight were the least common with percentage of 18.9%% and 5.6% of subjects, respectively. Hypertension (75.5%), prior stroke (33.6%), and hyperlipidemia (33.6%) were the most frequently found among subjects. Diabetes mellitus was found in 29.4% of subects, followed by smoking (28.7%), a history of heart disease (21%), and alcohol consumption (14.7%). Ischemic stroke was the most prevalent type of stroke (65.7%), followed by intracerebral hemorrhage (23,8%), transient ishcemic attack (TIA) (5.6%), subarachnoid hemorrhage (2.8%), and pontine hemorrhage (2.1%). Conclusion:This study revealed that ischemic stroke was the predominant subtype, while pontine hemorrhage was rare. Hypertension emerged as the most common risk factor, followed by prior stroke, hyperlipidemia, and diabetes mellitus, highlighting the substantial burden of modifiable vascular risk factors.

Clinical Improvement of Chronic Spinal Cord Injury and Immune Thrombocytopenia (ITP) with Corticosteroids Administration: A Case Report

Athalia Anastasia Talaway — 2025-07-31

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Understanding the causes and associated factors of of spinal cord injury (SCI) is important.
Immune thrombocytopenia may contribute to spinal cord injury.
Corticosteroid therapy for ITP, has shown improved clinical outcomes.

ABSTRACT

Introduction: Spinal cord injury (SCI) is a significant medical condition caused by either traumatic events or pathological diseases, which leads to neurological deficits and various levels of motor, sensory, and autonomic dysfunction. Several treatments, including corticosteroids, have been proposed to reduce secondary neuronal damage, but they are still controversial. Meanwhile, immune thrombocytopenia (ITP) can be treated with corticosteroids. The lack of research necessitates a review of steroids as a therapy for ITP and spinal cord trauma. Case: A 76-year-old woman complained of weakness in both legs for 15 days before being admitted to the hospital.The weakness was noticed after experiencing a fall. Additionally, the patient complained about having difficulty with both defecating and urinating. On examination, muscle strength in the lower limbs was graded 4 on both sides according to the Medical Research Council (MRC) scale. The classification of the American Spinal Injury Association (ASIA) score was D, with neurological level injury (NLI) at the 6th thoracic level with immune thrombocytopenia (ITP). Considering the patient's condition, steroids were administered as a treatment option. Fortunately, the patient showed clinical improvements, with the ASIA score improving from D to E, suggesting a positive response to steroids and potential for neurological recovery. Conclusion: Steroids may be regarded as a possible treatment alternative for individuals suffering from spinal cord injuries and immune thrombocytopenic purpura (ITP).

Todd’s Paresis as a Post Ictal Phenomenon in Post-Traumatic Epilepsy: A Case Report

I Gusti Agung Ayu Andra Yusari — 2025-07-31

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Todd’s paresis presented as transient hemiparesis in a case of untreated post-traumatic epilepsy.
Proposed pathomechanisms of Todd’s paresis include neuronal exhaustion, active inhibition, and postictal hypoperfusion.
Todd’s paresis was commonly misdiagnosed as acute ischemic stroke due to the similar clinical presentation

ABSTRACT

Introduction: Todd’s paresis is defined as a paralysis state after an epileptic seizure that lasts for several hours to days and recovers completely afterwards. It usually manifests as a transient hemiparesis after a focal or generalized seizure. Todd’s paresis cases and its mechanisms were still widely discussed. Case: A 48-year-old man with history of post-traumatic epilepsy presented with right-sided hemiparesis and facial weakness after a general motor tonic-clonic seizure. The location of the hemiparesis was contralateral to the post-trauma lesion in left frontal lobe which was suspected to be the focus of the seizure. The postictal weakness resolved completely after 30 hours without any specific intervention. It was revealed that the patient had been having several seizures beforehand after the epidural and subdural hematoma due to head trauma. The patient was diagnosed as Todd’s paresis following a post ictal condition in patient with post-traumatic epilepsy. Conclusion: Todd’s paresis should be considered as a diagnosis in patients with seizure and stroke-like syndrome such as hemiparesis due to its similar manifestations, especially if it resolves within hours. Several mechanisms were suggested to be the pathophysiology of Todd’s paresis including neuronal exhaustion, active inhibition, and postictal hypoperfusion.