Glioblastoma is the most common primary malignant tumor in the neural tissue and a highly aggressive primary tumor in human. It involves glial cells in 52% of functional brain tissue cases and 20% of all intracranial tumors. Extra cranial metastasis of Glioblastoma is very rare. Metastasis outside CNS was uncommon in GBM but it could occur with frequency 0.2% and can spread in head and neck sites. The mechanism of this spread is not understood yet. The extracranial spread routes were speculated on the direct lymphatic connections, the venous system and the adjacent structure like dura and bone. We present a case of female patient with a known glioblastoma who had an extracranial metastasis on her left neck with complete Radiotherapy n Chemotherapy and survive more than 2 years.

Headache is the most common neurological disorder among all the symptoms of general health problems. Headaches are the most frequently complained of after back pain, which brings someone to the doctor and harms personal, family, social, quality of life, work, and finances. This study aims to find out the characteristics of primary headache patients in the neurological polyclinic, RSUD dr. Saiful Anwar Malang. The design of this research was an observational descriptive study of the filled headache questionnaire was to determine the characteristics of headache patients who visited the neurological polyclinic at dr. Saiful Anwar Malang with complaints of primary headache. The procedure of this research is to provide a questionnaire. The data analysis technique used is that the research variables will be presented in the frequency distribution table. The results of this research show that primary headache was more common in women as many as 19 people (61%) compared to male 12 people (39%). Most of the primary headache patients who came to the neurological clinic of Saiful Anwar Hospital were 30-60 years old. Tension-Type Headache (TTH) in this study had the highest percentage of 58%. In this study, cluster headache two patients all attacked women.

Diabetic Neuropathy is the most common complication from diabetes, which experienced in almost 90% diabetes patient. Evenly pain is one of the most common symptoms of diabetic neuropathic, but the pathophysiology mechanism of pain is not clearly known. The hyptosesis of toxicity of hyperglycemia on development of pain complication has been widely accepted globally, but there is other proposed hypothesis. Basic concept in management of painful diabetic neuropathic is exclusion of the other cause of painful peripheral neuropathy, improving glycemic control for prophylaxis therapy and medication use for alleviating pain. The first choice drug of therapy for alleviating pain are anticonvulsant, like pregabalin and gabapentin, and antidepressant, mainly that work on inhibiting serotonine and noradrenaline reuptake. In conclusion, the better understanding of painful diabetic neuropathic underlying mechanism can help to find a better management that improving the guideline quality in optimalizing pain control.

Pain is a sensory experience that is responded to as an unpleasant stimulus that is often caused by tissue damage. Perdossi defines pain as an unpleasant sensory and emotional experience due to tissue damage, both actual and potential, or which is described in the form of such damage. Pain can affect everyone regardless of sex, age, race, social status, and occupation. Myofascial pain syndrome (MPS) is a term used to describe the condition of acute or chronic pain in musculoskeletal soft tissue. This is indicated by the findings of sensory, motoric, and autonomic symptoms related to myofascial trigger points (MTRP). The symptoms can be local or far from MTRP. In MPS that are far from MTRP, the pain patterns that appear are usually pain is pervasive The most common location for MPS is the neck and back. The purpose of writing this literature review is to explain epidemiology, clinical manifestations, pathogenesis mechanisms, pathophysiology mechanisms, and management in patients with myofascial pain syndrome. Myofascial pain syndrome is a pain syndrome in muscles that includes musculoskeletal abnormalities and MPS management shows that most interventions, both medical therapy and non-medical therapy, still need studies to prove its effectiveness.

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