The elderly are more likely to experience cognitive impairment, especially those who have a vascular risk factor. The purpose of this study was to determine the relationship between vascular risk factor and cognitive impairment in the elderly. Observational research method with cross-sectional design consist of 79 participant in Tresna Werdha Puspa Karma Social Institution, Mataram from October to November 2021. The subjects were measured blood pressure, weight and height to obtain BMI, glucose level, and total cholesterol. Furthermore, each participant underwent a cognitive function test using Moca-INA. Data were analyzed by chi-square and logistic regression. Diabetes mellitus (p =0.09), hypertension (p =0.037), lower education (p =0,01) and hight blood pressure (p =0.036) were associated with poor cognitive function.

Background: Haemorrhagic stroke causes high disability and mortality. Moreover, the prevalence is increasing. There is evidence of the involvement of the inflammatory process in haemorrhagic strokes. The neutrophil-lymphocyte ratio (NLR) is a strong and easily assessed marker of inflammation. Objective: This study aims to determine the NLR during hospital admission as a predictor of neurological deterioration in acute haemorrhagic strokes.Methods: This study was a prospective cohort study. The subjects were acute haemorrhagic stroke patients treated at the Stroke Unit of the RSUP Dr. Sardjito between March and November 2018. The demographic and laboratory test data, including NLR and National Institutes of Health Stroke Scale (NIHSS) measurement upon admission, were investigated. Logistic regression was performed to identify independent risk factors of neurological deterioration.Results: A total of 65 haemorrhagic stroke patients were included in this study. There were 21 subjects experiencing neurological deterioration, and 44 subjects did not. In bivariate analysis, there was a significant association between hyperglycaemia and neurological deterioration (RR=3.073; 95%CI=1.772-5.329; p=0.011). Glasgow Coma Scale (GCS) at admission was significantly associated with neurological deterioration (RR=2.732; 95%CI=1.455-5.131; p=0.006) as well as the NLR (RR=3.750; 95%CI=1.229-9.4441; p=0.005). The logistic regression results demonstrated that the variables that independently influenced neurological deterioration were NLR (RR= 4.424; 95%CI=1.196-16.369; p=0.026) and GCS (RR=7.461; 95%CI=1.711-32.526; p=0.007).Conclusion: High NLR can predict deterioration in acute haemorrhagic stroke.

Cerebellar infarctions account for about 2-3% of all ischemic strokes, and acute hydrocephalus due to brainstem compression or compression of the cerebrospinal fluid (CSF) flows is a rare manifestation from a stroke of the posterior circulation. The condition is considered one of the most life-threatening complications in cerebellar infarct due to the possibility of transforaminal and upward transtentorial herniation. The management of patients with cerebellar infarct is challenging, because the patient usually presents with non-specific signs and symptoms until the patient loses consciousness. Standard management should be provided by a stroke unit team or neuro-intensive care unit. The precision timing of treatment and evaluation with close observation is crucial, even when there is no life-threatening condition at initial presentation, but sometimes it is difficult to fulfill in rural areas due to the substandard facilities and lack of resources. Here we report a case of cerebellar infarct with massive edema in association with acute hydrocephalus with the progressive deterioration that happened in a rural area. A 59-year-old male patient complained about an episode of sudden headache which was followed by dizziness, vomiting, and loss of balance. A head non-contrast CT scan in the emergency room (ER) is performed 4 hours after ictus, showed a slightly hypodense lesion in the left cerebellum, without accompanying edema and hydrocephalus. The patient was then managed conservatively in the ward. In the next 36 hours, his consciousness level was reduced and a head CT scan evaluation showed the development of massive edema of cerebellar infarct with acute hydrocephalus. The patient underwent an emergency surgical procedure with suboccipital decompressive craniectomy (SDC) with strokectomy, expanded duraplasty, and ventricular drainage (ventriculoperitoneal shunt). Satisfactory results with rapid resolution of GCS was seen at daily follow-up after surgery. A 1-year follow-up also showed remarkable outcomes.

Bell’s palsy merupakan kelainan saraf fasialis yang paling banyak dijumpai. Gejala klinis bell’s palsy yaitu adanya lesi saraf fasialis akut tipe lower motor neuron yang terjadi secara tiba-tiba dan cepat. Sekitar 80% pasien sembuh spontan. Etiologi dan patofisiologi masih diperdebatkan. Kehamilan memiliki resiko tiga kali lipat terjadi bell’s palsy. Penegakkan diagnosis berdasarkan klinis. Terapi yang direkomendasikan yaitu pemberian steroid oral. Artikel ini merupakan sebuah studi pustaka.Kata kunci: Bell’s palsy, etiologi, diagnosis, penatalaksanaan ABSTRACTBell's palsy is the most common facial nerve disorder. The clinical symptom is acute lower motor neuron type facial nerve lesion that occurs suddenly and rapidly. About 80% of patients recover spontaneously. The etiology and pathophysiology are still being debated. Pregnancy has a threefold risk of developing Bell's palsy. Diagnosis based on clinical. The recommended therapy is oral steroid administration. This article was a literature review.Keyword: Bell’s palsy, diagnosis, etiology, treatment

Osteoartritis lutut merupakan penyakit degeneratif kronis yang menyebabkan nyeri, kekakuan, dan terbatasnya gerak sendi sehingga terjadi disabilitas dan penurunan kualitas hidup. Prevalensi semakin meningkat dengan peningkatan usia. Terdapat berbagai jenis terapi untuk osteoartritis tetapi hanya sedikit yang dapat memperbaiki derajat degenerasinya. Injeksi intraartikular masih merupakan terapi non bedah yang popular untuk osteoartritis lutut, terutama jika dengan obat oral dan latihan masih dirasakan nyeri. Proloterapi merupakan teknik injeksi regeneratif non bedah yang memasukkan sedikit larutan iritatif ke tempat yang nyeri dan insersi tendon, sendi, ligamen serta daerah sekitar sendi selama beberapa kali pemberian untuk merangsang pertumbuhan sel dan jaringan normal. Agen proloterapi yang sering digunakan adalah dekstrosa dengan konsentrasi berkisar antara 12,5% sampai 25%. Dekstrosa dianggap agen proloterapi yang ideal karena sifatnya yang larut air dan dapat diinjeksikan ke beberapa area dengan aman. Injeksi dekstrosa hipertonik intraartikular dan ekstrartikular dalam tiga sampai lima kali sesi memiliki efek klinis dan statistik yang signifikan dalam perbaikan skor WOMAC (Western Ontario McMaster University Osteoarthritis Index), skala nyeri dan fungsional. Keuntungan proloterapi dekstrosa yaitu aman, murah, dan mudah diberikan serta belum ada penelitian yang melaporkan efek samping jangka panjang maupun permanen.