Coronavirus disease 2019 (COVID-19) can reportedly manifest as an acute stroke, with most cases presenting as large vessel ischemic stroke in patients with or without comorbidities. The exact pathomechanism of stroke in COVID-19 remains ambiguous. The findings of previous studies indicate that the most likely underlying mechanisms are cerebrovascular pathological conditions following viral infection, inflammation-induced endothelial dysfunction, and hypercoagulability. Acute endothelial damage due to inflammation triggers a coagulation cascade, thrombosis propagation, and destabilization of atherosclerosis plaques, leading to large-vessel occlusion and plaque ulceration with concomitant thromboemboli, and manifests as ischemic stroke. Another possible mechanism is the downregulation of angiotensin-converting enzyme 2 as the target action of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). Acute stroke management protocols need to be modified during the COVID-19 pandemic in order to adequately manage stroke patients with COVID-19.

Jumlah kasus epilepsi di Indonesia cukup tinggi dengan prevalensi 8,2 per 1.000 penduduk dan insiden mencapai 50 per 100.000 penduduk. Data demografi dapat digunakan sebagai pertimbangan klinisi dalam mendiagnosis serta menentukkan penanganan lanjutan yang tepat. Belum ada penelitian demografi pasien epilepsi di Bali, sehingga penting untuk melakukan penelitian yang bertujuan untuk mengetahui karakteristik klinis pasien epilepsi. Penelitian deskriptif observasional menggunakan data rekam medis pasien epilepsi yang berobat di poliklinik saraf RSUP Sanglah pada Januari sampai dengan Desember 2016. Sebanyak 70 pasien memiliki rerata usia 35 tahun dengan dominasi jenis kelamin laki-laki sebanyak 55,7%. Rerata usia awitan kejang yaitu 29 tahun. Jenis bangkitan paling banyak adalah bangkitan umum dan mayoritas disebabkan etiologi yang simtomatik. Sebanyak 77,1% pasien menggunakan monoterapi dan tercatat 72,9% melakukan pengobatan kurang dari dua tahun. Fenitoin merupakan OAE utama dalam monoterapi maupun sebagai kombinasi dengan OAE yang lain.

Introduction. Stroke is the leading cause of disability and has a high mortality rate with most death occur in developing countries. Unfortunately, only a few informations available about strokes in developing countries, including Indonesia. Thus, this research aimed to provide a general overview of stroke patients from stroke unit in Bali, Indonesia.Methods. A cross-sectional study was carried out in Sanglah General Hospital, Denpasar Bali between August 2017 – January 2018 evaluating newly admitted stroke patients. There was no age limit, both male and female were enrolled. Data related to socio-demographic, risk factors, clinical features, and imaging result were extracted from medical records.Results. A total of 82 subjects were enrolled. Strokes were more common in males (61%) with most affected age group was 50-59 years (29.3%) and young stroke (age ≤45 years) accounted for 19.5% of the cases. Ischemic stroke (53.7%) was more common type encountered, and hypertension (76.8.3%) was leading risk factor. First-time stroke accounts for 80.5% while recurrent stroke accounts for 19.5% with 3.6% admitted for the ≥3 episodes. Overall, territories of middle cerebral artery including basal ganglia (25%) and internal capsule (20.5%) were frequently affected in ischemic stroke while lenticular-capsular (44.7) and lobar structure (18.4%) in hemorrhagic stroke. Typical chief clinical presentation was hemiparesis (42.7%) and altered consciousness (26.8%).Conclusions. Stroke tends to affect late adult with male predominance and hypertension as leading risk factor. Ischemic stroke was the most common type. There were differences in clinical presentations and anatomic site preferences between hemorrhagic and ischemic stroke.

Background Coronavirus disease 2019 (COVID-19) pandemic has started in December 2019 and still ongoing. The disease has been expanding rapidly with a high variety of phenotypes from asymptomatic, mild respiratory tract infection, multiple organ system dysfunction, and death. Neurological manifestations also appear in patients with COVID-19, such as headache, seizures, a decrease of consciousness, and paralysis. The hypercoagulable state in patients with COVID-19 is associated with the thromboembolic incident including ischemic strokes, venous thromboembolism, pulmonary artery embolism, and many further. Cerebral sinus venous thrombosis (CSVT) is a rare neurovascular emergency that is often found in critically ill patients. We report two cases of CSVT with different onsets, neurologic manifestations, and prognoses. Case presentation Two cases of cerebral sinus venous thrombosis in COVID-19 patients were reported, following respiratory, hematology, and coagulation disarrangements, which was triggered by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The first patient, which was presented with a seizure, had hypertension and diabetes mellitus as comorbidities. The latter case had no comorbidity but showed more severe presentations of COVID-19 such as brain and lung thrombosis, although already had several days of intravenous anticoagulant administrations. These two cases also have a different course of disease and outcomes, which were interesting topics to study. Conclusions CSVT is one of the neurological complications of the COVID-19 when the brainstem venous drainage is involved. Despite successful alteration to the negative result of SARS-CoV-2 through the rt-PCR test, thrombogenesis and coagulation cascade continuing. Therefore, a high level of neutrophil to lymphocyte ratio (NLR), D-dimer, fibrinogen, and C-reactive protein (CRP) are paramount indicators of poor prognosis.

Ischemic stroke is one of the leading causes of mortality and disability. The only effective non-surgical treatment for acute ischemic stroke within three to four and a half hours of the onset of symptoms is thrombolytic therapy. Time is of the essence when diagnosing and treating an acute ischemic stroke. After evaluating the advantages and disadvantages of thrombolysis, selecting the ideal patient for the indication is essential. Magnetic Resonance Imaging (MRI) is more sensitive and specific than Computed Tomography (CT) scans when identifying acute ischemic stroke. In approximately 80% of cases, infarcts are detectable within the first 24 hours. MRI can detect an ischemic stroke within a few hours of its onset. Multimodal imaging provides information for the diagnosis of ischemic stroke, patient selection for thrombolytic therapy, and prognosis estimation.