Objective: Treatment of optic neuritic as recommended by the Optic Neuritic Treatment Trial (ONTT) was intravenous methylprednisolon followed by oral prednisone. This study aims to describe  characteristics and response to intravenous methylprednisolon followed by oral prednisone treatment of optic neuritic patient in Sanglah General Hospital Denpasar.

 Method: This report is an analytical cross sectional study. Data were collected retrospectively from medical report of optic neuritic patient who came to Sanglah General Hospital during a period of January 1^st 2010 until December 31^st 2011. Patient characteristics were analyzed with descriptive analyses and presented as frequency, percentage, mean and standar deviation. Visual acuity and contrast sensitivity improvement after intravenous methylprednisolon followed by oral prednisone treatment were statistically analyzed with Wilcoxon test

 Results:  Optic neuritic were found in twenty-three patients (33 eyes), majority was in age group of 15-40 years (56.5%) with female predominance (65.2%) and unilateral involvement was 56.3%. Mean onset patient presented to the hospital was 21.7±2.21 days and the most common symptom was decreasing vision (87.9%).  The majority of patient presented with papillitis (54.5%), totally color blindness found in 39.4% eyes, and the type of visual field defect at presentation was central scotoma (18.2%). All cases show lesion of optic nerve from visual evoked potential (VEP) examination and magnetic resonance imaging (MRI) shows normal results (39.1% patient). The mean of pretreatment logMAR visual acuity and contrast sensitivity were significant improve after treatment from 1.59±0.47 to 0.59±0.62 (p=0.0001) and 0.31±0.56 to 1.25±0.56 (p=0.0001), respectively. All cases in this study were idiopathic. Recurrences were seen in 2 eyes and none of patient had clinical features suggestive of multiple sclerosis.

 Conclusions: Visual acuity and contrast sensitivity improvement after intravenous methylprednisolon followed by oral prednisone treatment in this study is good, with lower rate of recurrence and none of cases associated with multiple sclerosis

Objective: There is around 1.5 million of epileptic in Indonesia within prevalence of 0.5-0.6%. Of these 440,000 will be intractable, and 220,000 of them are potential candidates for epilepsy surgery (ES). A decade has passed since the first ES performed on July 1999 and the number increases every year reaching of 35-47 ES per year in 2007-2009. Despite the excellent results, all of these ES were still performed in Semarang (Diponegoro University) while the patients were from all part of Indonesia. The major reason behind the unavailability of ES in most part of the country should be discussed for the sake of future development of ES in Indonesia.

Methods: Epilepsy surgery was started in July 1999 with anterior temporal lobectomy for a 34 Y-old female with left mesial temporal sclerosis (MTS) causing a long standing intractable seizures. The number of cases increases every year. Until the end of 2009, there were 238 cases of epilepsy surgery, including 212 anterior temporal lobectomies. Among these, 106 cases had been follow up more than 36 months, and evaluated for surgical results. To evaluate the patient‟s selection and the presurgical evaluation, we divide the ES cases into the first 5 years (56 cases) and the recent 5 years (182 cases). But for the purpose of evaluating surgical results, only those with at least 36 months postoperative follow-up were included (106 cases) and grouped into those operated before or after the age of 25 Yold (group A and group B), and into those operated before or after the length of epilepsy of 10 years (group I and group II).

Results: For the first five years-period, decision to operate were based on MRI and routine interictal EEG in 54 out of 56 TLE cases. One patient had long-term ictal EEG and another had subdural grid EEG implanted, since MRI in both patients showed visually normal MRI. For the last five years, decision to operate were based on MRI and routine EEG in 91 out of 156 TLE cases. Long term ictal EEG were performed in 46 patients, subdural grid EEG in 10 patients, PET study in 7 patients, and EcoG in 2 patients. The overall seizure free (SF) rate were 70.75%, but if grouped according to patient‟s age at surgery ( less than or over 25 Y-old ), the SF rates were 75.4% vs 66.04% respectively. So did if grouped according to length of disease ( less than or more than 10 year s ), the SF rates were 78.72% vs 64.40% respectively.

Conclusions: MRI plays very important role to decide the side of the epileptic temporal side, but this role is decreasing as it was 96.4% during the beginning five years to become 58.34% for the last five years. This means that we are working on more difficult epilepsy cases recently. SF rate was significantly higher for those who was operated at younger age and for those with shorter duration of epilepsy. This means that surgery should be offered earlier for those intractable TLE patients with obvious focus on MRI.

Objective: Glasgow Coma Scale (GCS) has been widely used to assess level of consciousness related to trauma, however, its use have a limitation especially in intubated patients. Full Outline Unresponsiveness Score (FOUR) consists of four components (eye, motor, brainstem, and respiration) and each component has a maximal score of 4 and total score 17. This study aims to evaluate correlation between FOUR score and GCS to evaluate level of consciousness in severe head injury patients.

Methods: This is a prospective study with correlation approach. We prospectively studied all severe head injury patients at surgical emergency department Kandou Hospital, Manado from March to May 2010. Level of consciousness was assessed using GCS and FOUR score. Data were analysed with Pearson correlation coefficient.

Results: From March to May 2010 at surgical emergency department there were 27 severe head injury patients (24 males and 3 females) with average range of age 10-20 years old (29,6%). The highest distribution of GCS in severe head injury patients were GCS 8 (33.3%) and GCS 3 (22.2%) while in FOUR score were 8 (33.3%) and 7 (14.8%).

Conclusions: we concluded that FOUR score can be used as important tools to assess level of consciousness of severe head injury patents. FOUR score provides greater neurological detail than GCS which can assess brainstem reflexes, breathing pattern, and herniation.

Objective: Minor Head Injury (MHI) patients should not cause severe sequelae. In fact, many studies had reported that some MHI patients had abnormal scan, clinical deterioration, and many of them have had neurosurgical intervention. This study analyzed correlations between clinical signs with abnormal scan, clinical deterioration and surgery intervention on minor head injury patients.

Methods: A series of 364 MHI patients were prospectively enrolled in this study. In all cases clinical data were collected and a CT Scan was obtained. The relationship between clinical findings (loss of conciousness, amnesia, seizure, vomiting, headache, cepalhameatome, skull fracture, age more than 60 years),were identified as independent risk factors in correlations to abnormal scan, clinical deterioration and surgery intervention using bivariate and logistic regression multivariate analytics with 95 % CI.

Results: the incidence of abnormal scan was 13.8% (48 patients), 3.3% (12 patients) with clinical deterioration, and incidence of surgery intervention was 3.8% (14 patiens). Lost of conciousness, amnesia, cepalhematoma, skull fracture, and age more than 60 years old are independent variabels had statistically significant with abnormal scan. Amnesia, cepalhematome, skull fracture are independent variables which had statistic significantly with clinical deterioration and surgical intervention.

Conclusions: Clinical variables which had statistic significantly can be used as predictors of abnormal scan, clinical deterioration, and surgical intervention. Avoiding systematic CT Scan indication implies a rate of misdiagnosis, but liberal scan can be increasing the cost of patients