Introduction: Severe Acute Respiratory Syndrome Corona Virus-2 (SARS-CoV-2) is the primary etiology of Coronavirus Disease 2019 (COVID-19), which has been declared a global pandemic since March 11^th 2020. This virus invasion mainly attacks the respiratory system because most ACE2 receptors are found on the alveolar lung cells. However, it is known that the virus has attacked the extrapulmonary system, such as gastrointestinal and hepatic, ocular, dermatological, cardiovascular, rheumatic, and even the nervous system, resulting in a variety of non-specific manifestations.

Literature review: Manifestations in the nervous system start with mild symptoms such as olfactory dysfunction or even become serious complications such as stroke. These non-specific symptoms can present with or without general symptoms and are often missed in diagnostics for COVID-19. Therefore, it is essential to understand the neuropathogenesis mechanism due to SARS-CoV-2 infection, which will be discussed in this review by searching literature through online databases such as PubMed and Science Direct.

Conclusion: There are four main mechanisms of neuropathogenesis in both the central and peripheral nervous systems which include direct invasion, hypoxic brain injury, immune-mediated injury, and coagulopathy. The neuropathogenesis mechanism that can aggravate the condition is a hypoxic brain injury which increases the risk of ischemic stroke, seizures, and others. This condition occurs on average in COVID-19 patients aged more than 60 years old and with various comorbid, especially hypertension.

Keywords: nervous system, neuroinvasion, pathogenesis, SARS-CoV-2 infection

Introduction: Traumatic brain injury (TBI) is a global problem, it is the biggest cause of mortality and disability in all trauma cases. This study aimed to determine the characteristics and relationship between risk factors for TBI and its impact on mortality and also to provide epidemiological data related to TBI in the Belitung regency.

Methods: A retrospective study was conducted using secondary data from the medical records of participants who met the inclusion and exclusion criteria at dr. H. Marsidi Judono General Hospital Belitung from January to December 2019. Data were analyzed as univariate, bivariate, and multivariate using binary logistic regression.

Results: Two hundred and seventy patients were included in this study. Men were more likely to have a TBI than women in all categories (65.9%). The adolescent age group (33.7%) followed by adults (31.5%) were the largest contributors to TBI. Road traffic accident cases (86.7%) dominated the incidence of TBI. The use of headgear was still lacking (36.7%) while cases of road traffic accidents were high. The use of ambulances was lacking (10.4%) compared to other vehicles. A total of 119 patients (44%) were hospitalized in either the general ward or ICU with an average length of hospitalization was three days. Of all TBI cases, the mortality rate was 11.9%. Older age had a higher mortality rate compared to other age categories (OR 1.052, 95% CI 1.001 – 1.106).

Conclusion: The mortality rate due to TBI reached 11.9% in this region, with age as a statistically significant predictor of mortality due to TBI. Older patients tend to have a higher likelihood of death due to TBI. The data obtained can be used by general practitioners, disease-preventative planners, and policymakers to reduce mortality due to TBI in the Belitung regency.

Keywords: Belitung, mortality, risk factors, road traffic injury, traumatic brain injury

Introduction: Tortuous artery is a condition that generally occurs in the elderly. In general, vertebral artery loop formation (VALF) is asymptomatic, but in severe conditions and certain locations can cause symptoms such as cervical radiculopathy due to compression of cervical nerve fibers or the spinal cord. Some studies stated that VALF can be caused by many factors. In this study, we will report a case of VALF at a young age (22 years) with a complaint of cervical radiculopathy without any history of previous trauma.

Case presentation: A 22-year-old Indonesian man came with the chief complaint of pain and stiffness in the back of the neck radiating to the left hand. The patient also experienced weakness in the left hand. Magnetic resonance imaging with contrast revealed a tortuous left vertebral artery that forms a loop in the left neural foramen and compresses the spinal nerve at that level.

Conclusion: VALF is a rare case, especially in young people, and may present with symptoms like radiculopathy, depending on the location and degree of the condition. It is recommended that VALF should be considered as a differential diagnosis of these symptoms. Management of VALF can be done conservatively or surgically. The doctor should consider the choice of treatment based on the clinical aspects of the patient and also the risks of surgery.

Keywords: case report, cervical radiculopathy, tortuous vertebral artery, vertebral artery loop formation

Introduction: Obesity is linked to an increased risk of ischemic stroke. However, in young adults, the association is still unknown. This study aimed to analyze the association between obesity and the risk of ischemic stroke in young adults through systematic review and meta-analysis.

Methods: This was a systematic review and meta-analysis. Systematic searches were conducted in PubMed and Google Scholar databases for ischemic stroke studies among people with obesity and no obesity aged 15 to 55. Only validated cohort and case-control studies were included. Comprehensive Meta-Analysis (version 3.0; Biostat. Englewood, NJ, USA) was used as software for meta-analysis. Fixed and random-effects models were used to calculate pooled odds ratios (ORs) and 95% confidence intervals (CIs). The heterogeneity was assessed by I² statistics.

Results: Six articles were analyzed. The follow-up time ranged from 2.8 to 33 years. The pooled OR showed that the risk of ischemic stroke did not differ among young adults with obesity compared with no obesity (OR = 0.947; 95% CI = 0.632 – 1.420).

Conclusion: Obesity is not associated with an increased risk of ischemic stroke in young adults. Further research is needed to understand the effect of obesity on ischemic stroke risk in young adults.

Keywords: ischemic stroke, obesity, stroke, young adult

Introduction: Lipomyelomeningocele (LMMC) is a rare type of spina bifida with an approximate incidence of 0.1 – 2%. LMMC consists of lipid tissue, meninges, and the spinal cord that form a  posterior mass under the skin. We present a peculiar case of giant posterior sacrococcygeal LMMC of a newborn and the management of surgical approach.

Case presentation: A 1-month-old baby girl with a cystic mass in the lower posterior part of the back with a soft consistency, without signs of inflammation, normal skin, size of 20 x 20 cm, and paraparesis of inferior extremity. The magnetic resonance imaging showed the impression of meningocele-tethered cord syndrome and was planned to cele excision and laminectomy surgery. During surgery, there was a lipid layer that attach to the dura mater and spinal cord components.

Conclusion: LMMC is a rare case of spina bifida. Giant LMMC is a peculiar case and surgical treatment is indicated because the patient also had tethered cord syndrome.

Keywords: case report, lipoma, meningocele, myelocele, spina bifida, tethered cord syndrome