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Alicia Yolandra0910710031Tia Maya Affrita0910710123Muhammad Iqbal W.0910711026Syarah Nandya D.0810714055Cerebro Vascular accident (cva) /stroke

Supervisor:dr. Munsifah Z, SpEMDefinitionStroke = Gangguan pada pembuluh darah otak yang menyebabkan defisit neurologis fokal selama >24 jam

Stroke -- 3rd cause of death

Stroke -- leading cause of death in Indonesia

Types of Stroke

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Ischemic stroke syndromes

Hemorrhagic stroke syndromeIntracerebral hemorrhageHeadache,nausea &vomiting often precede the neurological deficit The patients condition may quick deteriorateCerebellar hemorrhageSubarachnoid hemorrhageSevere occipital or nuchal headache

Kriteria DiagnosaPISSAHThrombosisEmboliUmur> 40 tahunTak tentu biasanya 20-3050 70 tahunSemua umurOnset Perjalanan Aktivitas CepatAktivitasCepat Bangun tidur Bertahap- Tak tentu- CepatGejala penyertaSakit kepalaMuntahVertigo++++_++++++++___+ / - __+ / -Risk faktorHipertensiPenyakit jantungDMHiperlipidHT berat/malignaHHD__+ / -___+ / - ASHD++++_RhHD__8Kriteria DiagnosaPISSAHThrombosisEmboliKesadaran / coma pelanN / N / Kaku kuduk+/-++++__KelumpuhanHemiplegiTangan = kaki

Hemiparese +/-Sdh 3-5 hariHemipareseTangan kakiHemipareseTangan kakiAfasia__++/-++/-LP darah+/-+++++__ArteriografiShift midlineAneurysma +Oklusi / Stenosis Oklusi CT ScanHiperdens ++++IntraserebralN / HiperdenEkstraserebralHipodensSdh 4 7 hariHipodensSdh 4 7 hariPrehospital consideration

Early detection must begin with the general public because TIME is critical in the care of stroke pxThe Cincinnati Prehospital Stroke Scale0

The CPSS or Cincinnati prehospital stroke scale identifies stroke on the basis of 3 physical findings.1. Facial droop,2. Arm drift,3. Abnormal speech.By using CPSS, a medical personnel can evaluate the patient in 85%

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Age>60 yearsHypertensionDiabetes mellitusSymptoms duration of >10 minutesWeaknessSpeech impairment

11Differential DiagnosisBrain neoplasm /abscessEpidural/subdural hematomaHypo/HyperglycemiaMeningitis/encephalitisBellss palsyGuillan Barre syndrome

Hypoglycemia /hyper glycemia AMS+Hemiparese + glucose 300Seizure -> AMS + HEMIPARESE (Todds paralysis) + history of seizure + seizure medicationsSubdural -> AMS +Hemiparesis + signs of trauma

A stroke results from reduced blood flow to all or some part of the brain, in turn leading to the death of some brain cells. a seizure is the result of excessive, synchronous electrical activity in brain circuits. Eventually, a brain affected by a seizure will recover. A seizure may appear more dramatic and upsetting, but a stroke is medically much more serious because in stroke brain cells die.First of all, strokes and seizures are common and some people can actually have both. Anything that injures the brain, including strokes, can lead later to seizures. In addition, strokes and transient ischemic attacks or TIAs,, which are sometimes called warning strokes, can be mistaken for seizures.A seizure also can imitate stroke. However, it is important to note that seizures almost never cause strokes. However, a body part that is involved in a seizure may be temporarily weak or paralyzed and this can look like a stroke. Temporary paralysis post-seizure is called Todd's paresis. On rare occasions, about 2 to 5% of the time, a stroke will lead to one or more seizures. If seizures occur within a week of a stroke, then it is called an acute symptomatic seizure and is not diagnosed as being epilepsy. A seizure that occurs more than a week after a stroke does raise the question of possible epilepsy. Two more seizures post-stroke is definitely epilepsy.Some types of strokes are more likely than others to produce seizures, such as bleeding in the brain or a traveling blood clot called an embolus that blocks a brain artery.Epilepsy that follows a stroke sometimes can be delayed even months or years after the stroke. This may be because as circuits in the brain heal and reconnect over time, they become more hyper-excitable, making the brain more prone to seizures. Importantly, a seizure does not mean that the person is having another stroke.When epilepsy occurs later in life, it may stem from prior strokes, even very small ones of which the person is not aware. While scars from these small strokes may be visible on an MRI, there is no easy way to know which, if any, of the scars is causing the seizures.Treatment of seizures caused by strokes is similar to treatment of any partial seizure. It usually involves antiepileptic medications. Of course, preventing a future stroke is also very important. More information can be obtained from your doctor or by searching the web for stroke prevention information. If you or someone you care about maybe having seizures or stroke symptoms, please contact a physician.

A seizure and a stroke are medical conditions having similar symptoms but different causes and course of treatments. A seizure is mostly a result of epilepsy while a stroke results from blockage of blood vessels inside the brain A seizure is not life threatening while a stroke is A seizure may not cause permanent disabilities but a stroke can cause permanent damages

Heart attack and stroke are severe life threatening conditions, which can increase due to high blood pressure (hypertension).Both heart attack and stroke can occur by blockage of the blood supply (ischemia).Lowering the cholesterol, stop smoking, controlling diabetes and controlling the blood pressure will help to reduce the risk of heart attack and stroke.Heart attack affects the heart muscles. Stroke affects the brain. Aspirin can be used in heart attack, but in stroke it is not advisable until bleeding inside the brain is excluded.In heart attack immediate death can happen, but stoke usually will result in muscle paralysis.

Read more:http://www.differencebetween.com/difference-between-heart-attack-and-stroke/#ixzz3BytfBxcG

Read more:http://www.differencebetween.com/difference-between-seizure-and-vs-stroke/#ixzz3BytMTk1h12Initial diagnosis evaluationProtokol yang terorganisir diperlukan untuk mengidentifikasi pasien dengan strokeTujuan protokol: Mengevaluasi dan menentukan penanganan dalam 60 menit pertama pasien datang ke IGD (AHA/ASA)

Penanganan Pasien Suspek Stroke dalam Departemen EmergencyPenanganan ABCPemasangan akses IVMempertahankan status fisiologis maksimal (oksigenasi, hidrasi, level gula darah)ECG, cek suhu & TD mencari penyebab strokeBila CVA trombosis Trombolytic agent:6 jam: anti-agregasi platelet per oralHead ct scan Definitive dx of stroke & stroke subtypesDisposition neurologist/ stroke specialist

Head ct scan emergency diindaksikan untuk Pasien ischemik stroke yang akan menggunakan trombolitik atau antikoagulanSuspek ichSuspek sah

14Laporan KasusIdentitasNama: Ny. TJenis Kelamin : WanitaUsia: 41 tahunNo Reg: 111945xxAlamat: WonosariDatang ke IGD 17 Novmber pukul 10.0016Primary SurveyA : Paten B : Gerak dinding dada simetris, RR 20 x/mnt, retraksi dinding dada (-) suara nafas tambahan (-)C : Nadi : 88x/mnt reguler lemah, akral hangat , Tax: 36.9C, CRT < 2 detik, TD 290/110 mmHgD : Alert (AVPU)Pasien masuk triage P2

Initial TreatmentA: -B: O2 NC 2 lpmC: Pasang IV line NaCl 0.9%, loading 200 ccD: -

AnamnesaPasien mengeluh mendadak lemah pada tubuh sebelah kiri. Keluhan pada awalnya dirasakan hari Jumat, 14 November 2014 pukul 07.00 (3 hari sebelumnya) pada saat pasien sedang menonton televisi. Kaluhan tidak membaik maupun memberat selama tiga hari ini. Wajah pasien juga tampak miring ke kanan. Tidak didapatkan penurunan kesadaran. Bicara pasien menjadi tidak jelas karena pelo. Tidak ada gangguan BAB maupun BAK.Riwayat penyakit dahulu : HT (+) diketahui sejak 5 bulan lalu, DM (-), Penyakit jantung (-)Riwayat pengobatan : tidak rutin mengkonsumsi obat HTRiwayat Sosial : Pasien suka mengkonsumsi makanan bersantan maupun makanan asin,Keluhan Utama : lemah tubuh sebelah kiriSecondary SurveyKU: Tampak sakit sedang GCS 456A: Paten B : RR= 20 x/m, simetrisC : T = 290/110 mmHg N = 125 x/m, reguler Akral hangat, CRT < 2 detik, Tax=36.5CHead to toeKepala : conjungtiva an (-), ict (-), cy (-), pupil bulat isokor 3 mm|3 mm, wajah asimetris, lidah melenceng ke arah kiriLeher : pembesaran KGB (-), massa (-), kaku kuduk (-)

Thoraks :C/I = ictus invisible P = ictus palpable P = RHM ~ SL (D) LHM ~ ictus A = S1 S2 tunggal, m (-), g (-)Abdomen : Flat, soefl, BU (+) NEkstremitas : edema (-), akral hangat, CRT