Introduction: There is an increasing number of new hemorrhagic stroke cases from 2017 to 2018 on The Province of Central Java and Salatiga. A study of demographics, laboratory examination, radiology, outcome, risk factor, and clinical presentation on hemorrhagic stroke patients are rarely done at Salatiga Regional Public Hospital. Objectives: This study aims to describe the hemorrhagic stroke profile on Salatiga Regional Public Hospital patients. Materials and Methods: Hemorrhagic stroke inpatient of Salatiga Regional Public Hospital in the period between October 2018 and October 2019 is studied. Demographic, laboratory examination, radiology, outcome, risk factor, and clinical presentation data are reported. Results: From a total of 192 data gathered, 120 meet the inclusion and exclusion criteria. 47,5% male and 52,5% female with highest age range (55-64) 33%. The majority of patients came from outside of Salatiga city 71,7%. Patients with blood pressure classification stage 1 11,7%; stage 2 80%. Laboratory examination data shows 52,5% high leucocyte count; normal thrombocyte count; normal lymphocyte count; normal monocyte count; 72,5% high neutrophil count; 71,7% high Neutrophil-Lymphocyte Ratio; 89,2% high ureum level; normal creatine serum; 80% not at risk based on eGFR. Types of hemorrhages are ICH, IVH, and SAH with percentages 68,7%; 25,3%; 6% respectively. Basal Ganglia (48,1%) are the most common location for ICH and lateral ventricle (61,9%) are the highest for IVH. Clinical presentation for GCS (14-15) are the highest 58%. Patients with mortality are dominant in males with mean age 59,61 (year); followed by high counts of leucocyte, neutrophil, NLR, and ureum. Conclusion: Hemorrhagic stroke patients at Salatiga Regional Public Hospital are mainly female with the age range of 55-64 are the highest, came from outside of Salatiga city. The most frequent risk factor is hypertension. Most patients have GCS of 14-15 and stage 2 blood pressure classification. Most of the patient have leucocytosis, neutrophillia, high NLR and ureum level. ICH is the highest stroke subtype with the most frequent location of basal ganglia. More patients with good outcomes compared with a bad outcome.

Continuing and accelerating child health are issues stated in Sustainable Development Goals (SDG) by United Nation (UN). Targets in improving child health in SDG are by decreasing neonatal and pediatric mortality. Reducing risk and prevention of neonatal mortality may be achieved by monitoring intrauterine fetal development. High burden of pediatric mortality may be seen in pediatric genetic, neoplasm and infectious disease. In this COVID-19 pandemic era, SARS-COV2 infection in children add more challenge in improving child health. In this issue, we proudly present articles on pediatric genetic, neoplasm and infectious disease especially in clinical manifestation, diagnostic and therapeutic challenge.

Sindrom Miller-Fisher merupakan salah satu varian Sindrom Guillain-Barre yang memiliki gambaran klinis unik dengan trias klasik optalmoplegia, ataksia dan arefleksia. Pemeriksaan penunjang pada Sindrom Miller-Fisher berperan penting karena beberapa kondisi penyakit juga dapat bermanifestasi seperti trias klasik Sindrom Miller-Fisher. Penunjang berupa analisis cairan serebrospinal, pencitraan otak, biomarker antibodi GQ1b telah banyak digunakan untuk menegakkan diagnosis Sindrom Miller-Fisher namun memiliki keterbatasan. Pemeriksaan elektrofisiologi kemudian banyak diteliti karena selain menunjang diagnosis dapat menjelaskan proses penyakit Sindrom Miller-Fisher. Penulisan ini bertujuan untuk membahas peran pemeriksaan elektrofisiologi dalam diagnosis Sindrom Miller-Fisher. Hasil studi menunjukkan bahwa abnormalitas amplitude Sensory Nerve Action Potential (SNAP) dan H-reflex secara konsisten terjadi pada Sindrom Miller-Fisher. Abnormalitas amplitudo SNAP akan membaik dengan cepat dan reversibel sehingga diperlukan juga pemeriksaan elektrofisiologi serial untuk dapat menunjang diagnosis Sindrom Miller-Fisher. Temuan tersebut dapat diperkuat dengan hasil pemeriksaan konduksi saraf motorik, konduksi saraf sensorik dan F-wave yang normal. Kata Kunci: Sindrom Miller-Fisher, Elektrofisiologi, Diagnosis

No abstract

Background: Ischaemic stroke is caused by various aetiology. Cryptogenic stroke diagnosis is established when no aetiologies are discovered although clinical manifestations are consistent with acute stroke. Diffusion-weighted magnetic resonance imaging (DW-MRI) is one neuroimaging modalities which could be useful in exploring aetiology instead of excluding intracranial haemorrhage. There are many conflicting pieces of evidence of the benefit using DW-MRI to confirm the presence or the absence of brain lesions. Objective: To report a clinical case of ischemic stroke with negative evaluation on advanced neuroimaging studies (DW-MRI). Case Description: A female, 35 years old, presented to the emergency unit with a 6 hours history of prickling sensation before admission. There were no risk factors of stroke, and no other neurological symptoms. The neurologic examination reveals left hemihypesthesia, with normal results on laboratory examination for stroke risk factors and negative ischemic lesion on brain DW-MRI. Explorative examination on cardiac aetiologies was negative. Patient was given a standard regimen for acute stroke management despite the negative results and established as a cryptogenic stroke case. Conclusion: Diagnosis of ischemic stroke should rely mainly on clinical findings, with consideration of cryptogenic stroke when there is no aetiology found after thorough examination. Nevertheless, comprehensive examination on cardiac function and coagulation tests should be performed whenever possible to determine the cause of ischaemic stroke.