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Background: Carpal Tunnel Syndrome (CTS) is a symptomatic compression neuropathy of the median nerve characterized by increased pressure in the carpal tunnel and decreased nerve function due to compression of the median nerve in the carpal tunnel. The purpose of the hydrodissection injection method in CTS is to separate the soft tissue adhesions that cause nerve compression and this method are known for being minimally invasive, fast healing, and easy to apply. Local injection of triamcinolone acetonide (TCA) is often used as therapy for CTS because it stabilizes the sodium channels and reduces abnormal stimulatio, thus it relieved the pain. 5% dextrose injection (D5W) is also widely used as therapy of CTS because it is harmless to nerves and may reduce neurogenic inflammation through inhibition of capsaicin-sensitive receptors. Aim: To compare the effectivity of hydrodissection injection therapy using ultrasound guidance with triamcinolone acetonide and 5% dextrose in CTS. Methods: This study recruited 30 participants who diagnosed with CTS and met the inclusion criteria. Participants were divided into two treatment groups, the first group (n=15) was given 1ml TCA injection and 1 ml lidocaine 2%, while the second group (n=15) was given 5% 5 ml Dextrose injection. The parameters measured in this study were NRS, FSS, and SSS value before injection and 4 weeks after injection of the agent. We compared these parameters at week four after injection between the TCA group and the D5W group. Results: NRS values before and 4 weeks after TCA injection (sig 0.001; p 0.05) for FSS (sig 0.512; p> 0.05) and SSS (sig 0.293; p> 0.05). Conclusion: There is a significant difference in NRS, FSS and SSS values at 4 weeks after hydrodissection injection, using either TCA or D5W. TCA hydrodissection injection compared to D5W hydrodissection injection was equally effective in improving NRS, FSS and SSS after 4 weeks of injection.

Background: Carpal tunnel syndrome (CTS) is the most common nontraumatic peripheral neuropathy, which is caused by suppression of the median nerve below the transverse carpi ligament. Local corticosteroid injection is considered the fastest and most effective method for improving symptoms that occur in CTS. There are several corticosteroid agents that can be used, but there are no objective standards that can explain the most ideal drugs. Objective: To compare the effectiveness of hydrodisection injection therapy of triamcinolone acetonide versus dexamethasone on carpal tunnel syndrome. Methods: This study involved 30 participants who were diagnosed with CTS and fulfilled the inclusion criteria and no exclusion criteria were obtained. Participants were divided into two treatment groups; the first group (n = 15) injected with Triamcinolone Acetonide (TCA) 10mg / 1ml and lidocaine 1% 1 ml and the second group (n = 15) injected with Dexamethasone 4mg / 0.8ml and lidocaine 1% 1 ml. The NRS, FSS, and SSS parameters were assessed before injection and 4 weeks after injection in each agent. Then compared these parameters at 4 weeks after injection compared to the TCA group with the dexamethasone group. Results: NRS score before and 4 weeks after TCA injection (sig 0.000; p 0.05) and FSS (sig 0.119; p> 0.05), while SSS values were significantly different (sig 0.027; p

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.

Knee osteoarthritis (OA) is one of the most common cartilage degenerative disorders that is a major problem because it causes chronic pain and disability. Therefore the method of treatment and prevention of old age is a big challenge. The results of Dextrose Prolotherapy compared to Triamcinolone therapy research are still varied. Objective: to compare the effectiveness of Dextrose Prolotherapy and Triamcinolone Acetonide (TA) in the treatment of moderate knee knee OA.True experimental single blind study, at the Neurology Polyclinic Dr. Saiful Anwar General Hospital Malang for 6 months (July-December 2019). Group I; Dextrose Prolotherapy (15%) intraarticularly injected 3 times every 4 weeks and group II; TA one- time intraarticular injection. The parameters studied were The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Score, Numeric Rating Scale (NRS), and Range of Motion (ROM), weeks 0, 4, 8, 12 and 24. Forty samples consisted of; the 20 samples of the Dextrose Prolotherapy group consisted of; male: female = 2 (10%): 18 (90%), age 62.4 + 7.28, BMI 25.6 + 3.69 kg / m2, pain duration 22.35 + 20.10 months, history of physiotherapy 40.27 + 20.79 times. Kellgren–Lawrence osteoarthritis severity grade II; 17 (85%), grade III 3 (15%). TA group; male: female = 5 (25%):15 (75%), age 62.5 + 9.02, BMI 28.4 + 5.01 kg/m2, pain duration 15.95 + 16.55 months, history of physiotherapy 34 + 24.87 times. Kellgren – Lawrence osteoarthritis severity grade II; 18 (90%), grade III; 2 (10%). Comparison of NRS at rest Dextrose Prolotherapy vs TA of week 4 (2.60 vs 1.25), week 8 (1.65 vs 1.40), week 12 (0.8 vs 2.05), week 24 (0.75 vs 3.35). Comparison of NRS during activity Dextrose Prolotherapy vs TA week 4 (4.45 vs 3.35), week 8 (3.25 vs 3.55), week 12 (2.55 vs 4.30), week 24 (2.55 vs 5.80). Comparison of ROM flexion Dextrose Prolotherapy vs TA week 4 (127.05° vs 123.60°), week 8 (130.85° vs 122.95°), week 12 (130.85° vs 122.95°), week 24 (131.05° vs 122.10°). Comparison of WOMAC score Dextrose Prolotherapy vs TA week 4 (30.05 vs 22.45), week 8 (22.90 vs 23.95), week 12 (19.30 vs 29.05), week 24 (18.95 vs 35.40). Intraarticular Injection Dextrose Prolotherapy is more effective for the long term based on pain scale NRS, WOMAC score and ROM. Whereas short-term TA is more effective than Dextrose Prolotherapy.

Radiofrequency (RF) intervention uses high frequency alternating current (AC) to inhibit and alter nociceptive pathway in various locations. Radiofrequency is divided into Continuous RF (CRF) and Pulsed RF (PRF). Continuous RF is a process in which the RF current is used to produce thermal lesions on the target nerve that will result in resistance to the afferent nociceptive pathway. PRF is a process whereby short bursts of RF are discharged toward a neural target that will produce a signal for lowering pain. PRF is a therapy of neural tissue with small neurodestructive possibility and is an alternative technique for continuing RF. RF therapy is a minimally invasive procedure that has been used for about three decades to treat various chronic pain syndromes such as trigeminal neuralgia, post herpes neuralgia, lower back pain (LBP), and complex regional pain syndromes or sympathetic reflex dystrophy. The mechanism action of the PRF involves cellular structure damage, neuronal activation, altered gene expression, a global continuation of evoked synaptic activity in pain fibers through centrals and changes in synaptic strength and long-term potentiation. PRF with its various characteristics has a better outcome than conventional RF.

Background: Coronavirus disease 2019 (Covid-19) caused by SARS-Cov-2 had been spreading worldwide including Indonesia, but In Indonesia, it was difficult to diagnose confirmation Covid-19 by Polymerase Change Reaction (PCR). and in clinical practice to treat covid-19, Indonesia Health Ministry use term probable covid-19 for patients under observation Covid-19, but study for neurological manifestation on probable Covid-19 is very lacking. Objective: Knowing the neurological manifestation of patient probable Covid-19. Methods : Observational study from Covid-19 medical record and neuro-Covid-19 medical record of all probable Covid-19 hospitalized in the isolation ward of Saiful Anwar Hospital (RSSA) Malang since March-May, 2020 (3 months). Probable Covid-19 criteria were given by Covid-19 task force team based on Health Minister Indonesia criteria. This criterion was based on clinical manifestation (severe upper respiratory symptoms, or mild-severe pneumonia), radiologic examination (lung infiltrate and or chest CT scan), and laboratory examination. Neurological manifestation is based on clinical symptom appeared while patient hospitalized, supported with radiologic and laboratory data which was supervised by neurologist or neurologist resident. All data was inputted to neuro-Covid-19 e-registry on the smartphone application, sent periodically to the data center in Neurology Department RSSA Malang. Results: A hundred and fourteen probable Covid-19 was registered with mean age 34,5 year old and mostly at the young age of 20-50 years (38%). The neurological manifestation was observed in 4 patients (3,4% from all possible Covid-19 patients) with thrombotic stroke as the most common manifestation (50%), followed by myelum tumor (25%) and hypoxia encephalopathy (25%). Stroke patients in probable Covid-19 had old age (72 and 82 years) accompanied by several comorbid such as hypertension, DM and CVA history and Covid symptoms of cough, shortness of breath and fever. Hemiparesis was found improved with aspirin and neurotropic therapy. Patient with myelum tumor had a covid symptom of shortness of breath, cough, and fever with UMN tetraparesis. Previous MRI examination results suspected meningioma. The patient died while hospitalized. Patients with hypoxia encephalopathy admitted with decreased consciousness due to shortness of breath with acidosis respiratory symptoms (pH 7,22 ). This condition improved after oxygenation without focal neurologic deficit. Conclusion: Neurological manifestation in probable Covid-19 was 3,4% of all patients. The most common diagnosis was a thrombotic stroke, followed by myelum tumor, hypoxia encephalopathy, and mortality rate is 25%.

Trigeminal neuralgia (TN) is a sudden, severe, brief, stabbing, and recurrent pain within one or more branches of the trigeminal nerve. Trigeminal neuralgia has a prevalence of 0.1-0.2 per thousand and an incidence ranging from about 4-5/100,000/year up to 20/100,000/year after age 60. A 35 year old woman presented with 1 year history of right facial pain. Physical examination showed hyperalgesia and allodynia in all division of right trigeminal nerve. Magnetic resonance imaging with contrast demonstrated flow void signal in the right cerebellopontine angle. Computed tomography angiography confirmed the diagnosis of AVM (arteriovenous malformation), and demonstrated the malformed niduses were fed by the right posterior inferior cerebellar artery and the right superior cerebellar artery, and drained vein into basal vein of rosenthal, without hemorrhage or aneurysm intranidal appearance. carbamazepin 2x100 mg per oral for 7 days effectively decreased the facial pain significantly (from the numeric rating scale (NRS) score 8 to 5). Open surgical was not prefered for this patient because the AVM was small, unruptured, and located in eloquent area. Radiosurgery is considered if the medication fails. Trigeminal neuralgia with facial pain affecting all devision of nervus trigeminus with pulsatile headache can be suspected symptomatic TN. Radiological examination such as Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) angiography can be performed to detect the cause of TN.

Background: Carpal tunnel syndrome (CTS) is a peripheral nerve lesion because of the nontraumatic mechanism or a pressure or entrapment of the median nerve under the transverse ligament ( flexor retinaculum ). Hydrodisection is used for adhesiolysis to eliminate adhesion and release the median nerve from the retinaculum and connective tissue around it and avoid injury to the nerves. Objective: Compare the effectiveness of hydrodisection injection therapy using an ultrasound guide between normal saline and triamcinolone in patients with carpal tunnel syndrome. Methods: Experimental study was carried out in the outpatient clinic of the hospital Dr. Saiful Anwar Malang from August 2018 to October 2018. A total of 30 patients. All study subjects were subjected to NPS, FSS, SSS scoring compared to before and 4 weeks after injection of hydrodisection and compared the effectiveness of injection agents. Results: NPS before and after triamcinolone injection (sig 0.000; p

Tuberculous meningoencephalitis (TBM) is the most severe, life-threatening form of tuberculosis that contributes to as much as 5% of cases of extrapulmonary tuberculosis. Emerging at the end of 2019, COVID-19 has been shown to affect various organs, including the brain. In this case report, a 21-year-old woman diagnosed with TBM, being in the intensive phase of tuberculous therapy, came with dysphagia and dysphonia as new complaints felt one day before admission accompanied by a positive meningeal sign, diplopia, and cephalgia, which became heavier after previously getting better. Cough and fever followed this complaint two days before admission. About the laboratory results, the PCR was positive for COVID-19, and CT scans showed increased leptomeningeal enhancement when compared with CT scan one month earlier. The patient received intravenous dexamethasone, anti-tuberculosis drugs, phenytoin, aspirin, oseltamivir, and hydroxychloroquine. The patient died four days after being hospitalized due to respiratory failure. This case report shows the coinfection of COVID-19 and TBM resulting in a poor tuberculosis treatment response and outcome.

Zoster Herpes which is also known as ‘shingles’ may cause infection on neuro system through the reactivation of the virus. This infection causes skin eruption along the affected dermatomal distribution and it is called post herpetics neuralgia. This condition occurs on approximately 9-15% patients of zoster herpes who receive no treatment. Elderly women have a higher risk of the condition. Complete oftamoplegia is also related with zoster herpes. It was reported that there were 16 cases in the past one year with a relatively good prognosis (total recovery within 18 months) with an analysis starting from inflammation of trigeminus nervus to cavernosus sinus, cranialis nervus microinfark caused by vasculitis, meningeal inflammation, and demyelinisation (of autopsy). On the other hand, there are theories showing a correlation between zoster herpes infection and multiple sclerosis. Based on the epidemiologic study which has been conducted, that zoster herpes is influencing multiple sclerosis. This virus might induce autoimmune cascade and proinflammatory via particle like Toll – like receptor 4 (TLR-4).

Majority of spinal cord tumour is a benign tumour with symptoms are due to spinal cord compression. One of the symptoms that are often difficult to treat is a sensory deficit. The authors report a case of primary intradural extramedullar spinal cord tumour in 57-year-old man. This tumour was presenting symptoms of chronic low back pain, gradual progressive inferior paraplegia, and sensory deficit on both legs. MRI thoracal showed intradural lesion at Th 4-5-6, with isointensity on T1-weighted images and hyperintensity-isohomogen on T2-weighted images. The tumour was completely resected, and histopathology examination revealed schwannoma types. Patient showed a clinical improvement in motoric function noticeable after surgery, but showed sensory deficits sequelae requiring therapy for neuropathic pain.