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Diagnosis kasus neuromyelitis optika tanpa pemeriksaan aquaporin-4-immunoglobulin-G serta terapi kortikosteroid dosis tinggi

Abstract

Background: Neuromyelitis optica (NMO) is a demyelination of the central nervous system disease and more dominant involving the spinal cord and optic nerve. The diagnosis is established by finding positive NMO-IgG serological tests or without serological tests but fulfilling core criteria (optic neuritis, acute myelitis, area postrema syndrome, symptomatic narcolepsy and symptomatic cerebral syndrome). The purpose of this case report is to establish the diagnosis of NMO without serological tests and treatment with optic neuritis treatment trial (ONTT).

Case Ilustration: This report describes a 22-year-old man with a sudden vision loss and pain on eye movement. One month before, patient was diagnosed with transverse myelitis by neurologist with complaints of vomiting, fatigue, weakness of the lower limbs, urinary and fecal incontinence, and respiratory failure. From eyes examination found visual acuity right eye (RE) 6/6 and left eye (LE) no light perception. Relatively afferent pupillary defect (RAPD) was positive, funduscopy and optical coherence tomography (OCT) revealed swelling of the left optic disc. Thoracolumbar magnetic resonance imaging (MRI) showed longitudinal lesions in the spinal cord. The patient was then diagnosed with optic neuromyelitis OS and a high dose of corticosteroid was given according to the ONTT procedure. After 1 month of treatment, left eye visual acuity increased from NLP to 6/6 and there was a resolution of the optic disc swelling. Optic neuromyelitis is a disease with a high recurrence rate, and can cause permanent blindness.

Conclusion: Rapid diagnosis, administration of high-dose systemic corticosteroids, and preventing recurrence play significant role in reducing the disabilities and improvement in vision.


Latar Belakang: Neuromyelitis optika (NMO) merupakan penyakit demyelinisasi susunan saraf pusat dan lebih dominan mengenai sumsum tulang belakang dan saraf optik. Diagnosa ditegakkan dengan ditemukan tes serologi NMO-IgG yang positif atau tanpa tes serologi tapi memenuhi kriteria inti (neuritis optik, myelitis akut, area postrema syndrome, narkolepsi simptomatik dan sindrom serebral simptomatik). Tujuan dari laporan kasus ini adalah penegakan diagnosa NMO tanpa pemeriksaan serologi dan terapi dengan optic neuritis treatment trial (ONTT).

Ilustrasi Kasus: Laporan ini memaparkan lelaki usia 22 tahun dengan penurunan tajam penglihatan mendadak dan nyeri saat menggerakkan bola mata. Riwayat 1 bulan sebelumnya, pasien didiagnosa myelitis transversa oleh neurologis dengan keluhan muntah, lemas, kelemahan tungkai bawah, inkontinensia urin dan alvi, hingga gagal napas. Pemeriksaan mata didapatkan tajam penglihatan okuli dekstra (OD) 6/6 dan okuli sinistra (OS) no light perception. Relatif afferent pupillary defect (RAPD) positif, funduskopi dan optical coherence tomography (OCT) didapatkan pembengkakan saraf optik pada OS. Magnetic resonance imaging (MRI) thorakolumbal menunjukkan lesi longitudinal yang panjang pada sumsum tulang belakang. Pasien kemudian didiagnosa dengan OS neuromyelitis optika dan kortikosteroid dosis tinggi diberikan sesuai dengan prosedur ONTT. Setelah 1 bulan pengobatan, tajam penglihatan OS meningkat dari NLP menjadi 6/6 dan terjadi perbaikan pada pembengkakan saraf optik. Neuromyelitis optika adalah penyakit dengan angka kekambuhan yang tinggi, dan dapat penyebabkan kebutaan yang permanen.

Kesimpulan: Diagnosa yang cepat, pemberian kortikosteroid sistemik dosis tinggi, serta mencegah kekambuhan signifikan dalam menurunkan akumulasi kecacatan dan perbaikan pada tajam penglihatan.


References

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How to Cite

Natalia, N. L. N., Triningrat, A. A. M. P., & Susilawathi, N. M. (2020). Diagnosis kasus neuromyelitis optika tanpa pemeriksaan aquaporin-4-immunoglobulin-G serta terapi kortikosteroid dosis tinggi. Medicina, 51(1). https://doi.org/10.15562/medicina.v51i1.886

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Ni Luh Nita Natalia
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Anak Agung Mas Putrawati Triningrat
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Ni Made Susilawathi
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