The correlation between the degree of traumatic brain injury based on the glasgow coma scale (GCS) and the emersion of post concussion syndrome (PCS) acute onset in the patients of post traumatic brain injury at Dr. M. Djamil Hospital Padang

Background: Traumatic brain injury is the main cause of death in the population under the age of 45 years, and the fourth leading cause of death in the entire of population. Based on the degree of traumatic brain injury, it is commonly categorized based on the Glasgow Coma Scale (GCS). Post-Concussion Syndrome (PCS) is the set of somatic, emotional / behavioral and cognitive symptoms that occur after a traumatic brain injury.

Objective: The aim of this study was to find out the prevalence and correlation of the degree of traumatic brain injury based on the Glasgow Coma Scale (GCS) and the emersion of Post-Concussion Syndrome (PCS) acute onset in patients with head injuries

Methods: This study was a cross-sectional analytic study of patients who experienced Post-Concussion Syndrome (PCS) after traumatic brain injury at DR. M. Djamil Hospital Padang in 2020 from June to November 2020. Data were collected by filling in a questionnaire (The Rivermead Post Concussion Symptoms Questionnaire) and medical record data of neurosurgical patients that met the inclusion and exclusion criteria.

Results: It indicated that 70 patients were included in the inclusion criteria of this study. A total of 38 (54.3) respondents did not undergo the acute onset of PCS, meanwhile respondents who experienced acute onset of PCS were 32 (45.7) respondents. The results showed that 25 (67.6%) respondents with mild traumatic brain injury had PCS acute onset, while 4 (17.4%) respondents with moderate degree of traumatic brain injury had PCS acute onset, and 4 (17.4%) respondents had PCS acute onset PCS 3 (30%) respondents experienced severe traumatic brain injury with acute onset PCS and statistically the difference in the proportion of data from each of these variables was significant with a p-value of 0.0001. The results of statistical tests showed that p value> 0.05 on the correlation between PCS and GCS, thus, it can be concluded that there was no correlation between the direction of the relationship between PCS and GCS.

Conclusion: There was no correlation between the degree of traumatic brain injury based on GCS and the incidence of PCS acute onset, either it was unidirectional or vice versa in patients with head injuries at RSUP M. Djamil Padang.

Keywords: Traumatic brain injury, GCS, PCS

Effect of pre-surgical factors against degenerative lumbal patient surgical actions: evaluation using modified oswestry disability index and rolland morris

Background: Lower back pain is the most common complaint in humans in their lives with a variety of heterogeneous substances that vary in their epidemiological studies. Several disability scales have been developed and developed for the assessment of low back pain patients as a measure of outcome of therapy. One of the pre- and post-operative evaluation methods that are widely used is the Modified Oswestry Disability Index (MODI) and the Rolland Morris Disability Index. This disability scale is a disability scale that assesses daily personal and social functions using a questionnaire method and has been extensively reviewed by various study centers so that it is widely used as a guide for operative evaluation

Objective: the study is aimed to knowing the effect of pre-surgical factors on surgical outcome in degenerative lumbar patients evaluated using the Modified Oswestry and Rolland Morris disability scales.

Methods: The study was conducted at the Dr. Soetomo General Academic Hospital by taking data from lumbar abnormality patients who were operated on in the period of 1 June 2018 until 30 June 2019. The data is processed by calculating the Modified Oswestry Disability Index score and the Rolland Morris Disability Index during pre and post-operative, then the variables are calculated with each categorical regression to assess the effect of each variable

Results: Total sample of 42 with 31 samples fulfilling the inclusion criteria. There are 19 male sex samples and 12 female sex samples. From the age variable data, obtained the most age range at the age of 40-60 years. Whereas in the variable body mass index was obtained the most in samples with a range of values of 18.5-25. The adjusted R² (coefficient of determination) result is 0.746 for MODI and adjusted R² (coefficient of determination) result of 0.513 for Rolland Morris Disability Scale.

Conclusion: There is an effect of sex, age, sitting working position and sacral slope factors on the outcome of surgical procedures in the degenerative lumbar patient evaluated with the Modified Oswestry disability scale. Whereas the age and sitting work position have an influence in surgical outcome in the patients evaluated with Rolland Morris scale.  Number of intervention levels tend to have a significant effect on disability score difference. 

Keywords: Lumbar Degenerative Disease, Disability Index, Modifies Oswestry, Rolland Morris

A Rare Combined Trigeminal Neuralgia with Hemifacial Spasm in a 78-Year-Old Male Patient

Background: Combined trigeminal neuralgia (TN) with hemifacial spasm (HFS) is a rare pathological condition. Microvascular decompression (MVD) can be used to treat combined TN and HFS in a single procedure with good outcome, mild complication, and low recurrence rate.

Case Presentation: A 78-year-old male patient has presented with stabbing-like pain over the right side forehead and upper cheek since 2014. He also presented with twitching on the right eyelid and forehead since 2016. He already taken a medication with anticonvulsant but the pain does not decrease at all. Physical examination revealed an increasing pain to light touch over the ophthalmic and maxillary distribution of right trigeminal nerve (N.V). No abnormalities found in the facial nerve (N.VII). Magnetic resonance examination (MRI) examination revealed compression of right N.V by right superior cerebellar artery (SCA) and no compression found in the N.VII. This patient is treated with MVD and we found out a compression of right N.V by right SCA and N.VII from right anterior inferior cerebellar artery (AICA). Postoperatively, the symptoms resolved with a transient hypoesthesia and no recurrence after 1 year follow up.

Conclusion: Combined TN and HFS is a rare finding and seldom addressed. This pathological condition is found to be caused by progressive atherosclerotic changes in elderly populations that lead to elongation of blood vessels and contact the nearby nerve structure. MVD can be done safely in elderly patients with a good outcome and a mild transient complication such as hypoesthesia and low recurrence rate of symptoms.

Keywords: hemifacial spasm, microvascular decompression, trigeminal neuralgia