Barriers to diagnosis and management of CNS infections in Indonesia

Imran, Darma; Satiti, Sekar; Sugianto, Paulus; Estiasari, Riwanti; Maharani, Kartika; Pangeran, David; Andini, Putri Widya; Munir, Badrul; Mawuntu, Arthur H.P.; Susilawathi, Ni Made; Ritarwan, Kiking; Hartanto, OS; Frida, Meity; Ganiem, Ahmad Rizal; Gunawan, Dede; Dian, Sofiati; Sudewi, Anak Agung Raka; Crevel, Reinout van

doi:10.1212/wnl.0000000000006732

Cited by 13 publications

(11 citation statements)

References 5 publications

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“…CSC is an idiopathic, serous detachment of the neurosensory retina located in the macula 16 that may be accompanied by RPE detachment 17 . The pathogenesis is believed to involve hyperchoroidal perfusion and RPE barrier dysfunction 17 , 18 . Previous reports have correlated the onset of CSC with various steroid use modes, including systemic and local applications 19 .…”

Section: Discussionmentioning

confidence: 99%

Concomitant cavernous sinus thrombosis and central serous chorioretinopathy in a patient with total ophthalmoplegia and monocular blindness: a case report

Fikriyah

Hidayati

Ardhi

2023

Annals of Medicine &Amp; Surgery

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Introduction: Cavernous sinus thrombosis (CST) is an unusual condition that can result in high mortality and morbidity rate if not treated immediately. Case presentation: An Indonesian male, 47 years old, presented with total right ocular ophthalmoplegia followed by blindness, headache, ptosis, periorbital swelling, and hypoesthesia over the left V1 region. MRI of the brain showed suitable cavernous thickening until the right orbital apex, which in contrast showed enhancement suggestive of right Tolosa–Hunt syndrome. The patient was treated with a high dose of steroids, but the patient’s complaints did not improve. The patient underwent digital subtraction angiography and found CST. The optical coherence tomography was found to be central serous chorioretinopathy. He was treated with an antibiotic, anticoagulant, and extraction of the right maxillary molar was performed to remove the source of the infection. After 3 weeks, visual acuity and optical coherence tomography examination were improved. Discussion: A comprehensive examination, such as digital subtraction angiography, is essential to confirm CST diagnosis for the patient to obtain the right therapy. This report highlighted the value of the prompt diagnosis of CST through neuroimaging and the importance of proper therapy in patient management. Conclusions: Early diagnosis, comprehensive examination, and proper treatment of CST will increase good prognosis.

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Section: Discussionmentioning

confidence: 99%

Concomitant cavernous sinus thrombosis and central serous chorioretinopathy in a patient with total ophthalmoplegia and monocular blindness: a case report

Fikriyah

Hidayati

Ardhi

2023

Annals of Medicine &Amp; Surgery

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“…The radiological findings of CNS tuberculoma are nonspecific, and usually similar to other diseases (Agrawal et al, 2020). Therapeutic approaches and results depend on identifying the source of CNS infections (Imran et al, 2019). We illustrate this case because it is rare in immunocompetent patients and the issue is in preoperative analysis.…”

Section: Introductionmentioning

confidence: 92%

Cerebellar tuberculoma in an immunocompetent patient

Sihombing

Sugianto

2022

ijhs

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Background: Tuberculosis infection of the Central Nervous System is the major cause of death and morbidity in developing countries. The clinical manifestations and radiological findings in tuberculoma are nonspecific. This article reports a rare case of cerebellar tuberculoma with the manifestation related to an intracranial mass and without the typical clinical symptoms of Tuberculosis in an immunocompetent patient. Case Report: A 20-year-old female with seizure, headache, and vertigo. A mass in the posterior fossa was revealed by Magnetic Resonance Imaging. Thorax scan results showed the Tuberculosis process. The patient then underwent surgery. Histopathological examination displayed chronic granulomatous inflammation and the presence of Acid-Fast Bacilli. The patient received anti-tuberculous drug treatment for one year and anti-seizure medication. Discussion: Cerebellar tuberculoma can resemble an intracranial tumor or cranial abscess. Diagnosis is based on clinical, radiological manifestations, and histopathological analysis. Surgical intervention still has a role in the treatment of this disease. The finding of Mycobacterium tuberculosis on histopathological examination is the gold standard in diagnosing Tuberculosis. Conclusions: Although it is rare, the involvement of Tuberculosis in the CNS should be taken into account in both immunocompetent and immunocompromised patients with neurological symptoms who are living in an endemic area.

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“…These data indicate that most TB meningitis occurs in developing countries, including Indonesia. 3 In the neurology department, Dr. M. Djamil Padang city 2007 found cases of TB meningitis in as many as 9 patients and in 2008 found 7 people. Cases of TBM are rare but deadly.…”

Section: Introductionmentioning

confidence: 99%

Pathogenesis of tuberculous meningitis (TBM): a mini-review

Haiga

2022

IJBS

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Background: Tuberculosis (TB) is the leading cause of death from a single infectious agent (Mycobacterium tuberculosis) and killed nearly 1.5 million people in 2018. TB mostly manifests as a pulmonary disease but can also affect other parts of the body, causing extrapulmonary TB. Approximately 5% of all cases of extrapulmonary TB are tuberculous meningitis (TBM), which is caused by the spread of M. tuberculosis to the meninges and cerebrospinal fluid (CSF). Result: TBM is the most devastating form of TB and causes high rates of morbidity and mortality, with an estimated 50% of patients dying or suffering from neurological sequelae and complications. Meningitis is categorized as a medical emergency because it can cause death due to inflammation that occurs in the brain and spinal cord. Most meningitis patients present with fever, and signs and symptoms of meningeal inflammation include headache, neck stiffness and altered mental status. Disease management has limitations due to the limited availability of available diagnostic approaches. Until now, knowledge about the pathogenesis of TBM has been limited. Conclusion: Further research is urgently needed to improve understanding of disease pathogenesis and diagnostic approaches based on biomarkers of disease. Current knowledge on the pathogenesis of TBM summarize the literature on diagnostic approaches based on biomarkers, which may be useful in the management of TBM.

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Barriers to diagnosis and management of CNS infections in Indonesia

Abstract: Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

Cited by 13 publications

References 5 publications

Concomitant cavernous sinus thrombosis and central serous chorioretinopathy in a patient with total ophthalmoplegia and monocular blindness: a case report

Concomitant cavernous sinus thrombosis and central serous chorioretinopathy in a patient with total ophthalmoplegia and monocular blindness: a case report

Cerebellar tuberculoma in an immunocompetent patient

Pathogenesis of tuberculous meningitis (TBM): a mini-review

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