stroke- smtr 4
Post on 07-Jul-2018
229 Views
Preview:
TRANSCRIPT
-
8/18/2019 Stroke- Smtr 4
1/108
I Wayan Tunjung, dr. Sp.S
BAGIAN NEUROLOGI
RSU KOTA MATARAM
-
8/18/2019 Stroke- Smtr 4
2/108
CEREBROVASCULAR DISEASECEREBROVASCULAR DISEASE(CVD)(CVD)
ACUTE CVDACUTE CVD
- ACUTE STROKE- ACUTE STROKE
CHRONIC CVDCHRONIC CVD
VASCULAR DEMENTIAVASCULAR DEMENTIA
- MULTI INFARCT DEMENTIA- MULTI INFARCT DEMENTIA
- BINSWANGER’S DISEASE- BINSWANGER’S DISEASE
-
8/18/2019 Stroke- Smtr 4
3/108
A Global public Health Problem.
Generic name of Brain attack.
Death rate are rising in some countries.
A Community Health Problem and at timesstroke cases are of acute medicalemergency problem needs early &accurate diagnosis prompt treatment.
-
8/18/2019 Stroke- Smtr 4
4/108
-
8/18/2019 Stroke- Smtr 4
5/108
Stroke aa!a" #$at$ e%&t 'e$ro!o&k%oka! ata$ e'*a& $$+ ata$ $$
,a' ter*a& #eara e'aak ata$ e.at
a!a /e/era.a et&k ata$ *a kare'aa'$a' %$'#& otak ,a' e/a/ka'
o!e" a'$a' .ereara' ara" otak
,a' /er!a'#$' !e/&" ar& 01 *a ata$/erak"&r e'a' keat&a'2
-
8/18/2019 Stroke- Smtr 4
6/108
-
8/18/2019 Stroke- Smtr 4
7/108
-
8/18/2019 Stroke- Smtr 4
8/108
MOTOR ACTIVIT3 SENSOR3 ACTIVIT3
-
8/18/2019 Stroke- Smtr 4
9/108
Origins of Gra! "ss#s fro$Origins of Gra! "ss#s fro$!% Aor!i& Ar&%!% Aor!i& Ar&%
-
8/18/2019 Stroke- Smtr 4
10/108
'ir of Wi##is'ir of Wi##is
-
8/18/2019 Stroke- Smtr 4
11/108
-
8/18/2019 Stroke- Smtr 4
12/108
- Me'er&a 45 6 ara" ,a' &.o.a ar& *a't$'
- Me'$'aka' 47-086 80 ,a'&.er!$ka' /aa' #e!$r$"',a
- Me'$'aka' 586 !$ko#a ,a' /eraaa!a #&rk$!a#&
-
8/18/2019 Stroke- Smtr 4
13/108
CBF = =
= =
=
ekanan perfusi
ahanan serebro!askuler
P "A # $%
C$
ekanan darah sistemik # ' mmHgC$
ekanan darah sistemik
C$
( A B P
C$
CAAA)*
CB+ , ' "'-/% ml per 0 gram 1aringan otak per menit
"total flo2* 3-4 ml per menit%.5 6epertiganya melalui arteri karotis interna kanan.
6epertiganya melalui arteri karotis interna kiri. 6epertiganya melalui sistem !ertebro-basilaris.5 7aktu sirkulasi darah dalam otak* # ' detik.
C$* 08/ mmHg per ml per 0 gram 1aringan otak per menit.
C(9:* ;8; ml 9: per 0 1aringan otak per menit "/ ml 9: per menit
untuk seluruh otak%. C( G
-
8/18/2019 Stroke- Smtr 4
14/108
AKTOR- AKTOR YANG MEMPENGARUHI
CEREBRAL BLOOD LOW (CB ):
+aktor ekstrinsik*
ekanan darah sistemik.
>emampuan 1antung untuk memompa darah.
>ualitas dinding pembuluh darah sistem karotis dan
!ertebro-basilaris.
>ualitas darah yang menentukan !iskositasnya. +aktor intrinsik*
Autoregulasi arteri serebral.
Proses-proses biokimia2i serebral regional yangmempengaruhi lumen arteri serebral.
ekanan intrakranial.
-
8/18/2019 Stroke- Smtr 4
15/108
AKTOR- AKTOR YANG MEMPENGARUHI
CEREBRAL VASCULAR RESISTANT (CVR):
Tonus dinding pembuluh darah.
Viskositas darah. Tekanan intrakranial
-
8/18/2019 Stroke- Smtr 4
16/108
I're#ae o% ere/ra! eta/o!I're#ae o% ere/ra! eta/o!
T#$!ar .COT#$!ar .CO 00 e'$r$'e'$r$'
E9trae!!$!ar .H e'&'katE9trae!!$!ar .H e'&'kat
VASOCONSTRICTIONVASOCONSTRICTION
T#$!ar .COT#$!ar .CO 00 e'&'kate'&'kat
E9trae!!$!ar .H e'$r$'E9trae!!$!ar .H e'$r$'
Ce##at&o' o% :a#o o'#tr&t&o'Ce##at&o' o% :a#o o'#tr&t&o'
Dere#ae o% ere/ra! eta/o!Dere#ae o% ere/ra! eta/o!
T#$!ar .COT#$!ar .CO 00 e'&'kate'&'kat
E9trae!!$!ar .H e'$r$'E9trae!!$!ar .H e'$r$'
VASODILATIONVASODILATION
T#$!ar .COT#$!ar .CO 00 e'$r$'e'$r$'
E9trae!!$!ar .H e'&'katE9trae!!$!ar .H e'&'kat
Ce##at&o' o% :a#o o'#tr&t&o'Ce##at&o' o% :a#o o'#tr&t&o'
-
8/18/2019 Stroke- Smtr 4
17/108
INTA'T BRAIN TISSUE
NORMAL STATE
(E'REASE IN )ROTEIN
S*NT+ESIS
SELE'TI"E GENEE)RESSION
LA'TI' A'I(OSIS
'*TOTOI' E(EMA
ENERG* (E-I'IT
GLUTAMATEE'ITOI'IT*
ANOI'(E)OLARIATION
'
:
0
;
/
3
4
CBF+ !;488 /ra&' t#$e;&'$teCBF+ !;488 /ra&' t#$e;&'$te
'
:
0
;
/
3
/ # 4min
; # /hours
; # 3days
I S C H E M I C C O R E
4
SEVERESEVERE
MODERATEMODERATE
MILDMILD
OLIGEMIAOLIGEMIA
I S C
H E M I A
I S C
H E M I A
TIME FROM STROKE ONSETTIME FROM STROKE ONSETUNTIL IRREVERSIBLE DAMAGEUNTIL IRREVERSIBLE DAMAGEOCCURSOCCURS
CBF+ !;488 /ra&' t#$e;&'$teCBF+ !;488 /ra&' t#$e;&'$te
A
-
8/18/2019 Stroke- Smtr 4
18/108
raditional concept
Alternati!e concept
-
8/18/2019 Stroke- Smtr 4
19/108
STROKESTROKEPenyebab kematian no 3 setelah penyakit jantung
dan keganasan.
+ 2!". penduduk !tahun.
Penyebab utama #a#at menahun.
$% & '%( adalah stroke non hemoragik )+ %3(adalah stroke trombotik* dan + 3"( strokeembolik.
,ngka kematian stroke trombotik + 3-(* danstroke embolik + $(.
"% & 3%( adalah stroke hemoragik )
+ " & 2( perdarahan!hematom intraserebral*dan + % & "%( perdarahan subaraknoid.
,ngka kematian stroke hemoragik pada jaman praCT - & /%( dan pada jaman CT 2 & 3(.
-
8/18/2019 Stroke- Smtr 4
20/108
69>?69>?
BRAIN ISCHEMIA (786)BRAIN ISCHEMIA (786) BRAIN HEMORRAHGE (086)BRAIN HEMORRAHGE (086)
THROMBOSISTHROMBOSIS(6)
EMBOLISMEMBOLISM(1>6)(1>6)
INTRACEREBRALINTRACEREBRAL(76)(76)
SUBARACHNOIDSUBARACHNOID(486)(486)
SUBDURAL+SUBDURAL+E?TRADURALE?TRADURAL
(06)(06)
LARGELARGE
ARTERIESARTERIES
(4>6)(4>6)
=ENETRATING=ENETRATING
ARTERIESARTERIES
(LACUNAR)(LACUNAR)
(4>6)(4>6)
CARDIOGENICCARDIOGENIC
(0>6)(0>6)
ARTER3 TOARTER3 TO
ARTER3ARTER3
(086)(086)
AORTICAORTIC
DEBRISDEBRIS
(UNKNOWN)(UNKNOWN)
NON-NON-
ANEUR3SMALANEUR3SMAL
(
-
8/18/2019 Stroke- Smtr 4
21/108
)RE"ALENSI STROKE (I)RE"ALENSI STROKE (IUSA /USA /
2 per " pada usia 0% & %0 th
$ per " pada usia $% & -0 th 1ematian
0 & $(./% per " pada usia -% & '0 th
".A. 6tallon dkk8 03:%
-
8/18/2019 Stroke- Smtr 4
22/108
(ALAM 0 BULAN )AS'A(ALAM 0 BULAN )AS'A
STROKE /STROKE /2-( apat bekerja kembali tanpake#a#atan.
20( enderita #a#at ringan.23( enderita #a#at sedang.
""( enderita #a#at berat.
$( enderita #a#at berat danmemerlukan pera4atan khusus.
").+. Gordon dkk8 0
-
8/18/2019 Stroke- Smtr 4
23/108
Nona!a# 1 )rina!a#
'%i#d 1 2u3ni#
Adu#!
Edr#y
Nona!a# 1 prina!a# I"+.
)ri3n!ri&u#ar #u&o$a#a&a.
+rdi!ary, gn!i&s
'ongni!a#Inf&!ions, in4a$$a!ions, au!oi$$un.
'oagu#a!ions
'ardio53as&u#ar'%$i&a#s, nar&o!i&s, drugs.
La&unar
+ypr!nsi3 in!ra&r6ra#
%$orr%agA!%ro!ro$6o!i& 1 $6o#i&.
STROKESTROKE
A.A.B.). )uartha8 :3
-
8/18/2019 Stroke- Smtr 4
24/108
4242 Atero#k!ero#Atero#k!ero#
0202 Keraa'a';:a#k$!&tKeraa'a';:a#k$!&t
@ L$.$# er&teato#$# e&'at$#2@ L$.$# er&teato#$# e&'at$#2
@ Arter&t reato&2@ Arter&t reato&2
@ M&9e r,o!o/$!&'e&a2@ M&9e r,o!o/$!&'e&a2
@ .o!&arter&t 'o$#a@ .o!&arter&t 'o$#a
@ Arter&t te.ora!@ Arter&t te.ora!
@ Arter&t Taka,a#$2@ Arter&t Taka,a#$2
@ Dr$ 'erot&&' a'&t@ Dr$ 'erot&&' a'&t
( A%eta&'+ %e'&! .ro.a'o!a&'+( A%eta&'+ %e'&! .ro.a'o!a&'+
et&!%e'&at+ a!ko"o!+ koka&'+ "ero&'+ LSD+et&!%e'&at+ a!ko"o!+ koka&'+ "ero&'+ LSD+
MAO &'"&/&tor)MAO &'"&/&tor)
@ I'%ek#& !$e#+ TB+ HIV+ Me'&'&t+@ I'%ek#& !$e#+ TB+ HIV+ Me'&'&t+
#e.#+ !!2#e.#+ !!2
-
8/18/2019 Stroke- Smtr 4
25/108
I2 T&ak a.at &o&%&ka#& arker2 42 U#&a
02 e' ke!a&'
-
8/18/2019 Stroke- Smtr 4
26/108
STROKEISKEMIK
STROKE+EMORAGIK
5sia tambah tua. 6ipertensi.
Penyakit jantungiskemik. Fibrilasi atrium . iabetes melitus. Penyakit 7askuler
peri8er. 6ematokrit tinggi. 1olesterol tinggi 1olesterol rendah. Fibrinogen tinggi. erokok. ,lkohol. 1egemukan.
++++
+++++++++
++++:+++
++++
+++++
-
8/18/2019 Stroke- Smtr 4
27/108
H3=ERTENSIONH3=ERTENSION
INCREASED CEREBRALINCREASED CEREBRAL
ARTERIAL WALL TENSIONARTERIAL WALL TENSIONINCREASED VASCULARINCREASED VASCULAR
=ERMEABILIT3=ERMEABILIT3
FIBROMUSCULAR THICKENING OF CEREBRAL ARTERIESFIBROMUSCULAR THICKENING OF CEREBRAL ARTERIES
WITH NARROWING OF SMALL VESSELSWITH NARROWING OF SMALL VESSELS
H3=ERTENSIVE NICROVASCULAR DISEASEH3=ERTENSIVE NICROVASCULAR DISEASE
(SMALL VESSEL DISEASE)(SMALL VESSEL DISEASE)
CEREBRALCEREBRAL
ISCHEMIAISCHEMIA
ISCHEMICISCHEMIC
ATTACKSATTACKS
MICROTHROMBIMICROTHROMBI
MICROINFARCTSMICROINFARCTS
INTRACEREBRALINTRACEREBRAL
MICROANEURISMSMICROANEURISMS
RU=TURERU=TURE
THROMBOTIC STROKETHROMBOTIC STROKE
(SMALL STROKE)(SMALL STROKE)
INTRACEREBRALINTRACEREBRAL
HEMORRHAGEHEMORRHAGE
HEMORRHAGICHEMORRHAGIC
STROKESTROKE
H3=ERTENSIVE STROKEH3=ERTENSIVE STROKE
ATHEROGENIC STIMULUSATHEROGENIC STIMULUS
H3=ERLI=IDEMIA+ DIABETESH3=ERLI=IDEMIA+ DIABETES
H3=ERTENSIVE AND ATHEROSCLEROSTIC VASCULAR DISEASEH3=ERTENSIVE AND ATHEROSCLEROSTIC VASCULAR DISEASE
(LARGE AND SMALL VESSEL DISEASE)(LARGE AND SMALL VESSEL DISEASE)
CEREBRALCEREBRAL
THROMBOSISTHROMBOSIS
CEREBRALCEREBRAL
INFARCTIONINFARCTION
ATHEROTHROMBOTICATHEROTHROMBOTIC
STROKESTROKE
H3=ERTENSIVE ATHEROTHROMBOTIC STROKEH3=ERTENSIVE ATHEROTHROMBOTIC STROKE
CEREBRALCEREBRAL
ISCHEMIAISCHEMIA
TENSIENCT CEREBRALTENSIENCT CEREBRAL
ISCHEMIC ATTACKSISCHEMIC ATTACKS
7. Hollander8 03/.7. Hollander8 03/.
-
8/18/2019 Stroke- Smtr 4
28/108
". P;erebelum "(
Pons "(
2. P;
-
8/18/2019 Stroke- Smtr 4
29/108
Gangguan prdaran dara%o!a7.
Gangguan fungsi o!a7.
(8si! nuro#ogi7fo7a#9$njadi u$u$9u$u$a7u!.
Br#angsung : ;< ja$ a!au6ra7%ir dngan 7$a!ian.
A.A.B.). )uartha8 :3
-
8/18/2019 Stroke- Smtr 4
30/108
Cerebro!"#$%!r &'"e!"e" or#erebr!%
!"#$%!r &'"or&er" (CVD) !re er"
$"e& *or &'"e!"e" +,'#, &!!e ,e
br!'. '""$e "e#o.&!r/ o
!b.or!%'/ o* ,e #erebr!% e""e%"0
I. e.er!%1 ,'" &'"e!"e '. !%"o #!%%e&
#erebr!% !2o2%e3/1 #erebro!"#$%!r
!##'&e. or #erebr!% "ro4e0
-
8/18/2019 Stroke- Smtr 4
31/108
E=ILE=S3E=ILE=S3 CEREBRAL STROKECEREBRAL STROKE
E=ILE=S3 AFTER STROKEE=ILE=S3 AFTER STROKE ISCHEMIA INFARCTISCHEMIA INFARCT HEMORRHAGEHEMORRHAGE
STROKE AFTER E=ILE=S3STROKE AFTER E=ILE=S3 VASCULARVASCULAR
MALFORMATIONSMALFORMATIONS
ANGIOMAANGIOMA
-
8/18/2019 Stroke- Smtr 4
32/108
P!r'!% "e'5$re" !.& "e#o.&!r/ e.er!%'5e&
#o.$%"'o." !re o" #oo.0 Co2%e3 2!r'!%
"e'5$re" !re r!re (L0 Gr! e !%0 6778)0
T,e or!%'/ r!e o* S!$" E2'%e2'#$" !*er
"ro4e +!" er/ ,', (91;)
(Ar"o"4! AA e !%0 )
-
8/18/2019 Stroke- Smtr 4
33/108
M!./ #%'.'#!% "$&'e" !4e ! &'"'.#'o. be+ee.
e!r%/ !.& %!e 2o" "ro4e "e'5$re" b!"e& o.
&'**ere.#e" '. ,e'r 2re"$e& 2!,o2,/"'o%o/0
? E!r%/ - o."e "e'5$re" !re ,o$, o re"$%
*ro #e%$%!r b'o#,e'#!%
D/"*$.#'o. %e!&'. o e%e#r'#!%%/
'rr'!b%e '""$e (H0@0 L$,!..1
677>)
? L!e - o."e "e'5$re" !re ,o$, o be #!$"e&
b/ %'o"'" !.& ,e &ee%o2e. o* !
e.'.o#erebr!% #'#!r'3 (B0 @e..e1 677)
-
8/18/2019 Stroke- Smtr 4
34/108
CLINICAL S3NDROMECLINICAL S3NDROME
ETIOLOG3ETIOLOG3
MOR=HOLOG3MOR=HOLOG3
STROKESTROKE
FOCAL ISCHEMIAFOCAL ISCHEMIA
NO STRUCTURALNO STRUCTURAL
LESIONLESION
ISCHEMIC INSULTISCHEMIC INSULT
STRUCTURALSTRUCTURAL
LESIONLESION
ISCHEMIC INFARCTISCHEMIC INFARCT
INTRA CEREBRALINTRA CEREBRAL
HEMORRHAGEHEMORRHAGE
SUBARACHNOIDSUBARACHNOID
HEMORRHAGEHEMORRHAGE
SUBDURALSUBDURAL
HEMORRHAGEHEMORRHAGE
SINUS THROMBOSISSINUS THROMBOSIS
OTHEROTHER
EMBOLICEMBOLIC
THROMBOTICTHROMBOTIC
HEMOD3NAMICHEMOD3NAMIC
IMMUNOLOGIC;INFLAMMMATOR3IMMUNOLOGIC;INFLAMMMATOR3
A.A.B.). )uartha8 :3
=ATHOGENESIS=ATHOGENESIS
-
8/18/2019 Stroke- Smtr 4
35/108
I. STROKE ISKEMIK9NON5+EMORAGIK.
=. R3rsi6# is&%$i&
a!!a&79s!ro7 >i!% fu##r&o3ry/
5 RIN( ?R3rsi6#
Is&%$i&Nuro#ogi&a#
(8&i!@
;. S!ro7 in3o#u!ion9progrssing
s!ro7.
. 'o$p#!d s!ro7.
II. STROKE +EMORAGIK.
'ATATAN/
TIA a!au $inor9$ini s!ro7saa! ini !r$asu7 fa7!or risi7o
s!ro7.
42 =art&a! A'ter&or
C&r$!at&o' I'%art&o'
(=ACI) VARIABLE02 Tota! A'ter&or C&r$!at&o'
I'%art&o'
(TACI) =OOR
02 La$'ar I'%art&o'
(LACI) GOOD
12 =o#ter&or C&r$!at&o'
I'%art&o'(=OCI) VARIABLE
A.A.B.). )uartha8 :3
-
8/18/2019 Stroke- Smtr 4
36/108
T9, eAsit neurologik 8okal akut yang timbulkarena iskemia otak sepintas dan menghilanglagi tanpa sisa dengan #epat dalam 4aktutidak lebih dari 20 jam.
-
8/18/2019 Stroke- Smtr 4
37/108
Perdarahan!hemetoma intraserebral
eAsit neurologik 8okal yang sangat akut sampaibilateral dengan kaku deselebri* sedang
akti8!melakukan akti7itas* didahului atau disertaimuntah dan nyeri kepala hebat* 4ajah merah*kesadaran menurun sampai koma* na8as berat!ngorokdan meniup:niup pada satu sisi* sering disertai kejang8okal:umum*kaku kuduk* brodikardia*sembab papil*
perdarahan retina )perdarahan subhialoid* danhipertensi!ri4ayat hipertensi.
Perdarahan suboraknoid
Perdarahan subaraknoid primer paling seringdihubungkan dengan pe#ahnya aneurisma )mis
aneurisma sirkulus illisi dan sebagian ke#il karenamal8ormasi arterio:7enosa.
-
8/18/2019 Stroke- Smtr 4
38/108
5nilateral heada#he
isartria
,8asia* bilamana mengenai hemis8erdominan
,mourosis 8ugaks )transient mono#ularblindness ipsilateral menetap.
6emiparesis!paralisis kontralateral.
6emiparestesia!anestesia kontralateral.
Bra#hio:Fa#ial or ?eg deA#it kontralateral.
e7iatin #onjugue ke arah lesi* dll.
6istem karotis.
-
8/18/2019 Stroke- Smtr 4
39/108
istagmus.
iplopia.
angguan penglihatan!pergerakan bola mata
Vomitus.
Parestesia sirkumoral
Vertigo.
Tinitus.,mnesia.
isartria.
is8agia.
rop atta#ks )drop spells.6emihipestesia!anestesia alternans.
6emiparesis!paralisis alternans.
,taksia serebeler ipsilateral.
>indroma 6orner ipsilateral.@8talmoplegia internuklearis* dll.
6istem !ertebro-Basilaris.
-
8/18/2019 Stroke- Smtr 4
40/108
)URE MOTOR STROKE KA)SULA INTERNA,)EN(UKULUS SEREBRIBAGIAN TENGA+, BASIS)ONTIS.
)URE SENSOR* STROKE NUKLEUS "ENTRALIS)OSTERIOR TALAMUS.
SENSOR*5MOTOR STROKE NUKLEUS "ENTRALIS)OSTERIOR TALAMUS 1KRUS )OSTERIORKA)SULA INTERNA.
(*SART+RIA5'LUMS* +AN(S*N(ROME
BASIS )ONTIS,KA)SULA INTERNA.
ATAI' +EMI)ARESIS KRUS )OSTERIORKA)SULA INTERNA 1
KORONA RA(IATA,ROSTRALMENSE-ALON, BASIS)ONTIS.
Apa yang dilakukan ?
-
8/18/2019 Stroke- Smtr 4
41/108
pa yang d la u an ?- Pencegahan.- Pengobatan.
-
8/18/2019 Stroke- Smtr 4
42/108
-
8/18/2019 Stroke- Smtr 4
43/108
-
8/18/2019 Stroke- Smtr 4
44/108
M$punyai 7$a$puan 7o$uni7asi yang f7!if danM$punyai 7$a$puan 7o$uni7asi yang f7!if dan$nynang7an.$nynang7an.
M$punyai 7$a$puan 7#inis profsiona# yangM$punyai 7$a$puan 7#inis profsiona# yang!r7ini.!r7ini.
Mnydia7an >a7!u yang &u7up.Mnydia7an >a7!u yang &u7up.
Ana$nsis yang &pa! dan a7ura!.Ana$nsis yang &pa! dan a7ura!.
)$ri7saan 8si7 yang a7ura!.)$ri7saan 8si7 yang a7ura!.
S7or s!ro7 yang &pa! dan a7ura!.S7or s!ro7 yang &pa! dan a7ura!.
Sarana pnunjang yang !r7ini.Sarana pnunjang yang !r7ini.
(IAGNOSIS (IAGNOSIS
STROKE.STROKE.
-
8/18/2019 Stroke- Smtr 4
45/108
60 ANAMNESIS0
-
8/18/2019 Stroke- Smtr 4
46/108
)$ri7saan #a6ora!oriu$ 7#ini7 un!u7 s!ro7
)ungsi #u$6a# pada 7asus s!ro7 !r!n!u
'T9MS 'T, 'T9MS'T prfusion i$aging,'TA9MS'TA
MRI, fMRI, -LAIR i$aging, (WI, )WI, ()I, MRA,
MRS. Angiogra8 sr6ra#, (SA9(SA >i!% road $ap.
S)E'T, )ET, 'T5)ET.
EKG, E7o57ardiogra8 ?TTE, TEE@, d##
A.A.B.). )uartha8 :3
-
8/18/2019 Stroke- Smtr 4
47/108
-
8/18/2019 Stroke- Smtr 4
48/108
-
8/18/2019 Stroke- Smtr 4
49/108
-
8/18/2019 Stroke- Smtr 4
50/108
KRITERIA PENILAIANKRITERIA PENILAIAN
I.I. Kesdaran saat seranganKesdaran saat serangan * GCS 15* GCS 15 0.0.* GCS 12 – 14* GCS 12 – 14 1.1.* GCS 9 – 11* GCS 9 – 11 2.2.* GCS 3 – * GCS 3 – 3.3.
II.II. Per!"#aan seranganPer!"#aan serangan * Pe#an $%&0 !en't(* Pe#an $%&0 !en't( 0.0.* K"rang )endada $30 – &0 !en't(* K"rang )endada $30 – &0 !en't( 1.1.* )endada $1 – 30 !en't(* )endada $1 – 30 !en't( 2.2.* Sangat !endada $+ 1 !en't(* Sangat !endada $+ 1 !en't( 3.3.
III.III. ,at" serangan,at" serangan * -ang"n t'd"r* -ang"n t'd"r 0.0.* T'd"r* T'd"r 1.1.* Ist'raat/d"d"/t'd"ran* Ist'raat/d"d"/t'd"ran 2.2.
* -eera/!e#a"an at''tas* -eera/!e#a"an at''tas 3.3.I.I. Sa!a' terad' ner' ea#aSa!a' terad' ner' ea#a * % & a!/t'da ada* % & a!/t'da ada 0.0.
* 2 – & a!* 2 – & a! 1.1.* 1 + 2 a!* 1 + 2 a! 2.2.* + 1 a!* + 1 a! 3.3.
.. Ner' ea#a saat seranganNer' ea#a saat serangan * T'da ada* T'da ada 0.0.* R'ngan – sedang* R'ngan – sedang 1.1.* 6e7at* 6e7at 2.2.* Sangat e7at* Sangat e7at 3.3.
I.I. Sa!a' terad' !"ntaSa!a' terad' !"nta * % & a!/t'da ada* % & a!/t'da ada 0.0.* 2 – & a!* 2 – & a! 1.1.
* 1 + 2 a!* 1 + 2 a! 2.2.* + 1 a!* + 1 a! 3.3.
II.II. Sa!a' terad' re8#es -a7'ns' s't'8 Sa!a' terad' re8#es -a7'ns' s't'8 * %& a!/t'da ada* %& a!/t'da ada 0.0.* 2 – & a!* 2 – & a! 1.1.* + 2 a! "n'#atera#* + 2 a! "n'#atera# 2.2.* : 2 a! 7'#atera#* : 2 a! 7'#atera# 3.3.
II.II. Teanan daraTeanan dara * )AP ; 100* )AP ; 100 0.0.* )AP % 100 – 120* )AP % 100 – 120 1.1.* )AP % 120 – 140* )AP % 120 – 140 2.2.
-
8/18/2019 Stroke- Smtr 4
51/108
Sr tta# < 0 – & $Stre 'se!'/nn e!rag'
1& – 24 $Stre e!rag'(
= – 15 $)erag"an dan er#" e!er'saan #e7' #an"t
ata" en"nang: !'sa#na CT s>an( <
= – 11 Ke!"ng'nan Stre Ise!'/nn e!rag'.
12 – 15 Ke!"ng'nan stre e!rag'
Catatan <
- Cara Pen'#a'an 'n' ana d'erg"naan ada stre a"t
)a'n 7ana sr ang d'er#e ada t'a r'ter'a en'#a'an dan "!#a r'ter'a en'#a'an:
aan !a'n !e!ert'ngg' e!"ng'nan stre e!rag'.
-'#a!an t'da se!"a r'ter'a en'#a'an $I – III( daat d'er'sa !aa sr tta# daat d''t"ng
7erdasaran "!#a r'ter'a ang daat d'er'sa <
Sr tta# ? @ "!#a sr "!#a Kr'ter'a
)a'n se!'t enent"an rentang sr tta# ang d'er#e #enga dar' se#"r" r'ter'a en'#a'an
aan !e!ert'ngg' rsentase eteatan sr stre. )'sa#na da#a! 24 aan !endeat' eteatan
dengan CT s>an ang !endeat' 100B
(A2A2 B#2 Nr2 N$art"a+ ta"$' 08882
-
8/18/2019 Stroke- Smtr 4
52/108
-
8/18/2019 Stroke- Smtr 4
53/108
SKORSKOR SENSITIFITASSENSITIFITAS S=ESIFISITASS=ESIFISITAS
A!!e' (We&r et a!+ 41) 8+58 8+1
S&r&ra* (H$& et a!+ 0880) 8+4 8+8
Be##o' (Maer et a!+ 47) 8+ 8+
-
8/18/2019 Stroke- Smtr 4
54/108
-
8/18/2019 Stroke- Smtr 4
55/108
VOLUME PERDARAHAN PADA STROKEHEMORAGIK :
(CT0 SCAN)
2 2!.!.0
% %eb!r0
'.'0
D!%! #:
1;< ? 00;5 ? . ? ! ? t1;< ? 00;5 ? . ? ! ? t
-
8/18/2019 Stroke- Smtr 4
56/108
-
8/18/2019 Stroke- Smtr 4
57/108
-
8/18/2019 Stroke- Smtr 4
58/108
-
8/18/2019 Stroke- Smtr 4
59/108
-
8/18/2019 Stroke- Smtr 4
60/108
-
8/18/2019 Stroke- Smtr 4
61/108
-
8/18/2019 Stroke- Smtr 4
62/108
-
8/18/2019 Stroke- Smtr 4
63/108
A8 B * 9perati!e photo of subarachnoid
hemorrhage.
C * Photo at autopsy sho2ing blood clot
at the basal cisterns.
+ig. .:. 6ubarachnoid hemorrhage due to ruptured cerebral aneurysm.
-
8/18/2019 Stroke- Smtr 4
64/108
-
8/18/2019 Stroke- Smtr 4
65/108
42 D&a'o# ,a' e.at a' te.at2
02 Me'$ra'& e!$a#',a !e#& ata$ ko.re#&2
-
8/18/2019 Stroke- Smtr 4
66/108
=USKESMAS RUMAH SAKIT
EMERGENSI RS2 UNIT STROKE
Me'&'a! 086
S$r:&:or 786
Keaata'
R&'a' 106
Sea'
-
8/18/2019 Stroke- Smtr 4
67/108
HEMORAGIKHEMORAGIKNON-HEMORAGIKNON-HEMORAGIK
KONSERVATIFKONSERVATIF O=ERATIFO=ERATIF
=IS=IS SAHSAH
EFEK MASSAEFEK MASSA
()()EFEK MASSAEFEK MASSA
(-)(-)
J 01 AMJ 01 AM 0 MINGGU 0 MINGGU
O=ERATIFO=ERATIF KONSERVATIFKONSERVATIF
O=ERATIFO=ERATIFO=ERATIFO=ERATIF
ANGIOGRAFIANGIOGRAFI
01 AM 0 MINGGU01 AM 0 MINGGU
KONSERVATIFKONSERVATIF
A.A.B.). )uartha8 :3
-
8/18/2019 Stroke- Smtr 4
68/108
I. )ENGOBATAN UMUM/ DB.
II. STROKE ISKEMIK9NON +EMORAGIK.
=. Rprfusi !rapu!i7 1 0 ja$.
=.=. Tro$6o#i!i75 !)A i3 a!au in!r3nsi in!ra ar!ria#.
=.;. An!i 7oagu#an
5 +parin, LMW+, %parinoid, >arfarin.
=.. +$oro#ogi
5 +$odi#usi.5 )n!o7si8#in.
=.
-
8/18/2019 Stroke- Smtr 4
69/108
- C"a!&$ "a''e! a'tao't N&o&.&'2
- G!$taate ree.tor a'tao't Reae&e+ M SO12
- G!$taate ree.tor &'"&/&tor =e',to&'+ Fo#."e',to&'2
- Ga/a ao't C"!oet"&ao!e2
- G!,&'e2
0202 Ne$ro.rotek#& #ek$'er (< ) *a 5 "ar&2
- A't&o9&a't Free ra&a! #a:e'er T&r&!aa ()+
No-S,'t"a#e B!oker E/#e!e'2- I%!aator, &'"&/&tor#
(A't&-ICAM a't&/o,) E'!&oa/2
- Stat&' E#troe'2
- Ne$rotro."& %ator# /FGF2
- Ne$roo$!ator Ne$ro.e.t&e ACTH 1 48 (Sea9)
Cere/ro!,#&'2
- Ne$rore$!ator Ga'!&o#&e# GM42
- Me/ra'e #ta/&!&&' ae't C&t&o!&'e
Nootro.&# =&raeta2
A.A.B.). )uartha8 :3
??
PP
A A
A A
@@
$$
??
HH
??
A A
PP
yy
III. STROKE +EMORAGIK
44 =ENGOBATAN UMUM=ENGOBATAN UMUM
-
8/18/2019 Stroke- Smtr 4
70/108
4242 =ENGOBATAN UMUM=ENGOBATAN UMUM
4242 ABC >B24242 ABC >B2
4202 Ma'aee' teka'a' ara" ("&.erte'#&)+ IC= e'&'kat+ ke*a'+4202 Ma'aee' teka'a' ara" ("&.erte'#&)+ IC= e'&'kat+ ke*a'+
"&.erter&a+ a&ra' a' '$tr&2"&.erter&a+ a&ra' a' '$tr&2
0202 Me'ea";e'o/at& .erara"a' /er$!a'2Me'ea";e'o/at& .erara"a' /er$!a'2
0242 A't& %&/r&'o!&t&k0242 A't& %&/r&'o!&t&k - A#a tra'ek#aat2- A#a tra'ek#aat2
- EACA2- EACA2
-
8/18/2019 Stroke- Smtr 4
71/108
". )ENGOBATAN KAUSA, $is/
42 A'&o.!a#t, .re:e't&% e'a';ta'.a #te't&'2
02 Carot& e'artereto, arot& arter, #te'o#
-
8/18/2019 Stroke- Smtr 4
72/108
TD &'$4$r < "e%!. +!4$ 8 -
-
8/18/2019 Stroke- Smtr 4
73/108
D'2!4!' TD /!. %eb', '.'0
MAP
H'2ere."' 2!&! "ro4e '"4e'4 !4$
&'b'!r4!.1 4e#$!%' "'"o%'4
-
8/18/2019 Stroke- Smtr 4
74/108
Ob! !.' ,'2ere."' /!. "$&!,
&'2!4!' "ebe%$ o."e "ro4e&'er$"4!. &!. $.&! 2eber'!. ob!
!.' ,'2ere."' b!r$ "!2!' -6= ,!r'
2!"#! o."e "ro4e0Kr'er'! ob! 2'%',!. %',!
G$'&e%'.e"0
A.A.B.). )uartha8 :3
STROKE AKUTSTROKE AKUT
FLOW CHART PENATALAKSANAAN HIPERTENSIFLOW CHART PENATALAKSANAAN HIPERTENSI
PADA STROKE AKUTPADA STROKE AKUT
-
8/18/2019 Stroke- Smtr 4
75/108
Sto!&k 0
-
8/18/2019 Stroke- Smtr 4
76/108
Ba!as 7adar gu#a dara% a$an pada fasa7u! s!ro7 is7$i7 non #a7unar/ =5
;$gH ?op!i$a# =D $gH@. +iprg#i7$ia ra7!if $aupun !ida7 s#a$a
is7$ia o!a7 a7u! $ni$6u#7an f76r6a%aya F 7#uaran 7#inis #6i% 6uru7
!ru!a$a s!ro7 non #a7unar.
A.A.B.). )uartha8 :3
-
8/18/2019 Stroke- Smtr 4
77/108
Indi7asi dan syara! p$6rianinsu#in/
5 S!ro7 %$oragi7 dan non%$oragi7 dngan I((M a!au NI((M.
5 Bu7an s!ro7 #a7unar dngan(M.
A.A.B.). )uartha8 :3
-
8/18/2019 Stroke- Smtr 4
78/108
(iindi7asi7an pada s!ro7 is7$i7$6o#i7 a7u! un!u7 &ga% s!ro7u#ang.
+parin9LMW+9%parinoid Fdi#anju!7an dngan >arfarin 6i#a$$nu%i syara! dapa! sgra
di6ri7an pada TIA a!au s!ro77ardio $6o#i7 yang s$6u%s$purna =5; %ari dngan 86ri#asia!riu$.
2uga un!u7 pr3nsi ("T pada s!ro7is7$i7 dngan %$ip#gia a!au
A.A.B.). )uartha8 :3
-
8/18/2019 Stroke- Smtr 4
79/108
LMW+ yang di!rus7an an!i7oagu#an ora#$$6ri 7#uaran 7#inis #6i% 6ai7 pada
!ro$6osis sinus sr6ra# ?$is/ !ro$6osissinus 7a3rnosus@.
An!i7oagu#an ora# diindi7asi7an padarisi7o !inggi $6o#i o!a7 F u#ang ?A- non
3a#3u#r, 7a!u6 jan!ung 6ua!an, !ro$6us$ura#, AMI@.
Ef7!i8!as F 7a$anan %parin I.".
un!u7 s!ro7 is7$i7 a7u! 6#u$ &u7up6u7!i F $asi% 7on!ro3rsia# F !ida7dir7o$ndasi. A.A.B.). )uartha8 :3
ISCHEMIC STROKE
EVALUATION MANAGEMENT O ISCHEMIC STROKE
-
8/18/2019 Stroke- Smtr 4
80/108
ISCHEMIC STROKE
SUS=ECTED LARGE ARTER3SUS=ECTED LARGE ARTER3
THROMBOSIS;STENOSISTHROMBOSIS;STENOSISLACUNAR STROKELACUNAR STROKE SUS=ECTED CARDIOGENICSUS=ECTED CARDIOGENIC
EMBOLISMEMBOLISM
THROMBOL3TIC DRUGTHROMBOL3TIC DRUG
WITH;ORWITH;OR
ANTICOAGULANT ORANTICOAGULANT OR
ANGIO=LAST3ANGIO=LAST3
NO ANTICOAGULANT+ CONTROLNO ANTICOAGULANT+ CONTROL
H3=ERTENSION+ =LATELETH3=ERTENSION+ =LATELET
INHIBITOR INHIBITOR
THROMBOL3TIC DRUGTHROMBOL3TIC DRUG
WITH;ORWITH;OR
ANTICOAGULANTANTICOAGULANT
HIGH-GRADEHIGH-GRADE
STENOSISSTENOSIS
DEFINITIVEDEFINITIVETHERA=H3THERA=H3
NOT HIGH-GRADENOT HIGH-GRADE
STENOSISSTENOSIS
=LATELET=LATELETINHIBITORSINHIBITORS
E"o EGE"o EG
DEFINITIVEDEFINITIVE
THERA=H3THERA=H3
U!tra#o$' &t" Do..!er orU!tra#o$' &t" Do..!er or
a'&ora.",a'&ora.",
A.A.B.). )uartha8 :3
STROKESTROKE
CT SCANCT SCAN
ISCHEMIC STROKEISCHEMIC STROKE HEMORAGIC STROKEHEMORAGIC STROKE
-
8/18/2019 Stroke- Smtr 4
81/108
SURGICAL SURGICAL
3ES 3ES
O=ERATING THEATREO=ERATING THEATRE
I C UI C UNONO
INSERT IC= MONITORINSERT IC= MONITOR
RECOMMENDED IC= J 08 HRECOMMENDED IC= J 08 H
MA= J 4
-
8/18/2019 Stroke- Smtr 4
82/108
CT SCAN
SKOR STROKE
ABC >B2 Me.erta"a'ka' .ate'#& *a!a' 'a%a# #&rk$!a#&
aek$at2 O0 #e#$a& ke/$t$"a' (4 0 L;e'&t)2
E$:o!e& %!$& #tat$# /er&ka' &:% NaCL 8+6 r&'er
!aktat ; a#etat+ "&'ar& ek#tro#a+ .a'ta$ $r&'e o$t.$t2 =a'ta$ ta'a :&ta! #tat$# 'e$ro!o #e!aa 01 50
*a =a'ta$ %$'#& #a!$ra' er'a+ #a!$ra' ke'&'+
ke#e&/a'a' a&ra' e!ektro!&t+ $!a ara" =e'ea"a' .e'a'a'a' ke*a' ata$ eea otak Stat$# && e'a' a#$.a' '$tr& aek$at Ne$ro.rotek#& Ne$rore#tora#& re"a/&!&ta#& =e'ea"a' .e'a'a'a' ko.!&ka#& #e&'& $'k&' =e'ea"a/ .e'a'a'a' %aktor r&ko+ .e',ak&t
.e',erta+ ata$ ka$#a2
STROKE
ISKEMIK STROKE HEMORAGIK
(= I S) 3A 3A TIDAKTIDAK
A.A.B.). )uartha8 :3
EVALUASIEVALUASI
.e/er&a'.e/er&a'
t=A t=A A't&"&.erte'#& /&!a &.er!$ka'22 H&.erte'#&
SB= 008 H ata$ DB= 408 H+
& k 48 4 63A3A
TIDAKTIDAK
-
8/18/2019 Stroke- Smtr 4
83/108
&t$r$'ka' 48 4>62
La/eta!o!2
N&kar&.&'2 D&!t&ae2 DB= 418 H+ &t$r$'ka' 48 4>6
N&tro.r$##&e2 A't& koa$!a' .aa ka#$# #e!ekt&% e'a'
.er#,arata' .ea'ta$a' ketat2 A't& .!ate!et ae't
A#eto#a! ora!+ o# aa! 48 + #e!a'*$t',a
5> ;"ar&
3A 3A
MANAGEMEN TEKANAN DARAHMANAGEMEN TEKANAN DARAH A't& "&.erte'#& /&!a &.er!$ka'2 SB= 47> H ata$ DB= 448 H
La/eta!o!2 N&kar&.&'2 D&!t&ae2
DB= 418 N&tro.r$##&e2
&ka teka'a' ara" t&ak e'$r$'+ *a'a'
/er&ka' t=A2
TROMBOLISISTROMBOLISIS t=A &:
=aa #troke ke&k ak$t e'a' o'#et *e!a# t&ak < *a2 Mee'$"& kr&ter&a &'k!$#& ek#k!$#&2
D&raat & ICU ; #troke $'&t2 Do# 8+ ;k &: 8 e'&t+ 486 o# #e/aa& /o!$# &'&a! 86 #a',a a!a
&'%$# 8 e'&t o# ak#&a! 8 2 D&.a'ta$ teka'a' ara"+ aa',a e*a!a .erara"a' .e/$r$ka' k!&'
t=A &'tra-arter&a! O'#et *e!a# t&ak *a2
ANTI =LATELET AGENTANTI =LATELET AGENT CT #a' t&ak aa .erara"a' a!a 01 *a #ete!a" .e/er&a' t=A2 A#eto#a! ora! o# aa! 48 + #e!a'*$t',a 5> ;"ar&
=REVENSI=REVENSI
SEKUNDERSEKUNDER
A.A.B.). )uartha8 :3
STROKE HEMORAGIK
(PERDARAHAN INTRASEREBRALPIS SPONTAN)
S O
A$te #troke $#t /e treate a# a e&a! eere',2 = &k k!& & ! / ECG
-
8/18/2019 Stroke- Smtr 4
84/108
STROKE
CT SCAN
SKOR
STROKE
=eer&k#aa' k!&'+ !a/+ ECG2
ABC > B5 I't$/a#& e'otrakea! /&!a =O0 J 8 H;5+ k=a ata$ =CO0 >8
H;+< k=a+ #a'o#+ &.e'&'’ aa! 'a%a#+ ata$ a'aa'
a#.&ra#&25 E$:o!e& #tat$# /er&ka' NaCL 8+6+ r&'er !aktat;a#etat+ "&'ar&
ektro#a+ .a'ta$ $r&'e o$t.$t25 Detek#& .e/$r$ka' e%&t 'e$ro!o&k %oka!;%oka! - $$25 Detek#& ta'a tra$a ka.&t ka$#a tra$a2
5 =a'ta$ ta'a :&ta! #tat$# 'e$ro!o #e!aa 01 50 *a25 =a'ta$ #tat$# &&+ a!'$tr& aka' e'"a/at .e$!&"a'2 Ne$ro .rotek#&2 =rora %&otera.& re"a/&!&ta#&2 =e'ea"a' a' .e'a'a'a' ko.!&ka#&+ %aktor r&ko+ a'
.e',ak&t;a'$a' .e',erta ata$ ka$#a2
STROKE ISKEMIK STROKE HEMORAGIK
(= I S)
TIDAK 3A
A.A.B.). )uartha8 :3
STROKE HEMORAGIK
(= I S)
-
8/18/2019 Stroke- Smtr 4
85/108
MANAGEMEN TEKANAN DARAHANAGEMEN TEKANAN DARAH
HI=ERTENSI Teka'a' ara" o.t&$ &'&:&$a!2 A't& "&.erte'#& /&!a MA= 4 ;*a &2:2 &'%$#+ &t&'katka' 0+> ;*a t&a. 4> e'&t #a.a& o# ak#&a! 4> ;*a2 D&!t&ae > 18 ;k;e'&t &'%$# ko't&',$2 N&tro.r$##&e 8+0> 8+> ;k;e'&t &2:2 &'%$# t&tra#& &t&'katka' 8+> ;k;e'&t+ o# ak#&a! 48
;k;e'&t (*&ka SB= 0 ;k;'t I+: &'%$#+ &t&'katka' #a.a& > 48 ;k;'t2 Do/$ta&' > 4> ;k;'t &2:2 &'%$#+ &t&'katka' #a.a& 18 ;k;'t2
STROKE
HEMORAGIK
(= I S)
-
8/18/2019 Stroke- Smtr 4
86/108
MANAGEMEN
ANAGEMEN
OPERATI
PERATI
Ko'#$! Bea" #ara%2 Ka'&at o.era#& (reo:a! o%
"eatoa)=erara"a' #ere/e!$ <
+ e'a' eter&ora#&
'e$ro!o&k+ ko.re#& Bra&'
#te "&ro#e%a!$# ak$t2=IS e'a' e%ek e#ak+
e'a' ke$'k&'a'
Goo o$toe2U#&a $a e'a'
.erara"a' !o/ar
oerate-!are’
eter&ora#& k!&'
MANAGEMEN
ANAGEMEN
CAIRAN
AIRAN
Goa! E$:o!e&a2 O.t&a! CV= =W=2 488 0088 !;"r2 Korek#& e!ektro!&t /&!a
&.er!$ka'2
MANAGEMEN
ANAGEMEN
KE@ANG
E@ANG
B&!a .er!$ a't& ko':$!#&
/&!a ke*a' ata$
e'ea" ke*a'2 Fe'&to&' !oa&' o#e 47
(4> 08) ;k
-
8/18/2019 Stroke- Smtr 4
87/108
MANAGEMENANAGEMEN
SUHU BADAN
UHU BADAN
H&.erter&a Coo!&' B!a'ket2 Ie Water a#tr&
!a:ee2 =araetao!
&2:;ora!;reta!2
MANAGEMEN ICPANAGEMEN ICP
MENINGKAT
ENINGKAT
IC= 08 H > e'&t2 Goa! IC= J 08 H C== 58 H2 O#otera.&
Ma''&to! 4> 0>6 8+0> 0 ;k &2:2 &'%$#
-
8/18/2019 Stroke- Smtr 4
88/108
OPERASI DEKOMPRESI J
=. Ting7a! 7sadaran/
-
8/18/2019 Stroke- Smtr 4
89/108
=. Ting7a! 7sadaran/
Ksadaran $nurun ?sopor 1 7o$a@9G'S , oprasia!au !ida7 oprasi ang7a 7$a!ian !!ap !inggi ?J5= H@, 7&ua#i #if sa3ing surgry pada G'S <dngan 7o$prsi 6a!ang o!a7 dari prdara%ansr6#u$.
;. T$pa! #si/
+$a!o$ 6sar di sr6#u$ a!au su6s!ansia a#6asu67or!i7a#9#o6ar dngan p$6uru7an 7unis &pa!.. )na$pang %$a!o$/
: &$, 7%ususnya prdara%an sr6#u$.
-
8/18/2019 Stroke- Smtr 4
90/108
+EMATOM
A
(I'
ATION
)u!a$n
T%a#a$us
Su6&or!C
)ons
'r6##u$
A#r!, %$a!o$a $#.
+$a!o$a 3o#u$ : $#
Sopor &o$a, : 0 $#
(p &o$a,
......
.(ro>sy 9 #!%argi&, ; 5 0$# ...
*oung, progrssi3 d8&i!s .
Ad3an&d ag ...
.......+$a!o$a : &$ dia$!r
5
5
5
5
* ecommended - * not recommended * uestionable
"(. +isher8 :0%
A.A.B.). )uartha8 :3
CLASI ICATION O SUBARACHNOID HEMORRHAGE
WORL( -E(ERATION O-NEUROLOGI'AL SURGEONSGRA(E
+UNT AN( +ESS 'LASSI-I'ATIONS'ALE
-
8/18/2019 Stroke- Smtr 4
91/108
GRA(E S'ALE
W-NSGRA(E
G'S MOTOR(E-I'IT
GRA(E NEUROLOGI'AL STATUS
I
II
IIII"
"
=D
=< 1 =
=< 1 ==; 1 J
0 1
A6sn!
A6sn!
)rsn!)rsn! ora6sn!
)rsn! ora6sn!
I
II
IIII"
"
Asy$p!o$a!i&, or $ini$a#%ada&% and s#ig%!
nu&%a# rigidi!y.Modra! !o s3r%ada&%, nu&%a# rigidi!yno nuro#ogi& d8&i! C&p!&rania# nr3 pa#sy.
(ro>sy, $ini$a# nuro#ogi&d8&i!.
S!uporous, $odra!5!o5s3r %$iparsispossi6#y ar#y d&r6ra!rigidi!y and 3g!a!i3dis!ur6an&s.
(p &o$a, d&r6ra!
rigidi!y $ori6undaparan&.
SUBARACHNOID HEMORRHAGE OUTCOME OUTCOME ALGORITHM
S A HS A H
-
8/18/2019 Stroke- Smtr 4
92/108
WFNSWFNS
GRADE I IIIGRADE I III
CLI= ; COILCLI= ; COIL
S A HS A H
WFNSWFNS
GRADE IV VGRADE IV V
CEREBRALCEREBRAL
VASO=ASMVASO=ASM
FUNCTIONALFUNCTIONAL
INDE=ENDENCEINDE=ENDENCE
WFNS GRADE II IIIWFNS GRADE II III
AFTER SURGER3 FORAFTER SURGER3 FOR
HEMATOMA ORHEMATOMA OR
VENTRICULOSTOM3VENTRICULOSTOM3
INDETERMINATEINDETERMINATE =OOR UTCOME=OOR UTCOME
3ES 3ES 3ES 3ES
NONO
NONO
NO ASISTANCE NEEDED+NO ASISTANCE NEEDED+
MINOR HANDICA=MINOR HANDICA=
SEVERE DISABILIT3+SEVERE DISABILIT3+
VEGETATIVE STATE+VEGETATIVE STATE+
OR DEATHOR DEATH
(E2F2N2 W&*&k#+ 088
-
8/18/2019 Stroke- Smtr 4
93/108
PROGNOSTICATOR O POOR OUTCOME
D - years.
le7el o8 #on#iousness a8ter i#tus )ea#hgrade.
?imb paresis )ea#h grade.
6ypergli#emia a8ter i#tus.
9C6 Blood 7olume D $ ##.
9V6 blood 7olume D 2 ##. idline shi8t o8 septum pellu#idum!pineal
gland )$ & " mm on CT s#an.
,#ute hydro#ephalus )putaminal hemorrhage"Da!erat et al8 00E +ieschi et al8 044E Phan et al8 :%
A.A.B.). )uartha8 :3
ISCHEMIC STROKE (ANTERIOR CIRCULATION):
PROGNOSTICATOR O POOR OUTCOME
-
8/18/2019 Stroke- Smtr 4
94/108
?e7el o8 #on#iousness a8ter i#tus.
aEe palsy* gaEe pre8eren#e* pupillaryasymmetry.
6ypodensity D %( o8 arterial territory*brain s4elling* or early midline shi8t onCT s#an.
eed 8or reintubation and me#hani#al7entilation.
"7i1dicks8 6cott8 03%.
ISCHEMIC STROKE (POSTERIOR CIRCULATION):
-
8/18/2019 Stroke- Smtr 4
95/108
PROGNOSTICATOR O POOR OUTCOME
Basilar artery o##lusion #ausing lo#ked:in syndrome or #oma.
Cerebellar in8ar#tion 4ith brain stem#ompression and hydro#ephalus.
Bilateral thalami# in8ar#ts.
")adeau8 et al8 0:%.
B!oo .re##$re
Sok&' !&.&#Stroke orta!&t,
Ma## #trate, &' .o.$!at&o' A$te treate't
-
8/18/2019 Stroke- Smtr 4
96/108
F&r#t e:er #troke=r&ar, =re:e't&o' Seo'ar, =re:e't&o'
H&"-rk #trate,I' &'&:&$a!
Re"a/&!&tat&o'
Re$rre't #troke
H,.erte'#&o'
TIA
Atr&a! %&/r&!at&o'
Ot"er :a#$!ar ea#e
Stroke-re!ate a/&!&t,
-
8/18/2019 Stroke- Smtr 4
97/108
-
8/18/2019 Stroke- Smtr 4
98/108
PENCEGAHAN
-
8/18/2019 Stroke- Smtr 4
99/108
STROKE42=roo#& ke#e"ata'
02=e'ea"a' .r&er
-
8/18/2019 Stroke- Smtr 4
100/108
STROKE PREVENTION
SECONAR! PREVENTION
PRI"AR! PREVENTION
STROKE CONTROL STRATEGY
-
8/18/2019 Stroke- Smtr 4
101/108
NOR"A# RISK $ACTOR STROKE%TIA
& "OI$! #I$E&ST!#E - "OI$! #I$E&ST!#E
- CONTRO# O$ RISK $ACTOR
- "OI$! #I$E&ST!#E
- CONTRO# O$ RISK $ACTOR
- ANTI T'RO"(OTIC.
- T'RO"(ECTO"!.
- AN)IOP#AST! AN
STENTIN)
PRO"OTION PRI"AR! PREVENTION SECONAR! REVENTION
MODI Y
ODI Y
CONTROL O
ONTROL O
ANTI
NTI
THROMBECTO
HROMBECTO
ANGIOPLASTY
NGIOPLASTY
-
8/18/2019 Stroke- Smtr 4
102/108
LI E-STYLEI E-STYLE RISKISK
ACTORS
ACTORS
THROMBOTIHROMBOTI
C
MYY ANDND
STENTING
TENTING
*.*.ietiet
+.+. Phy,icalPhy,ical
e-eci,e.e-eci,e.
/./.Ce,,ation o0Ce,,ation o0
,1oking.,1oking.
2.2.AlcoholAlcohol
eduction.eduction.
*.*.In1odi0iable.In1odi0iable.
+.+."odi0iable."odi0iable.
*.*.Anti platelet.Anti platelet.
+.+.Anti coagulant.Anti coagulant.
*.*.Sy1pto1aticSy1pto1atic
,teno,i, 345678.,teno,i, 345678.
+.+.A,y1pto1aticA,y1pto1atic
,teno,i, 39:678.,teno,i, 39:678.
*.*. Patient ;ith highPatient ;ith high
i,k ,y1pto1atici,k ,y1pto1atic
caoted ,teno,i,caoted ,teno,i,
o inopeableo inopeable
ca,e,.ca,e,.
-
8/18/2019 Stroke- Smtr 4
103/108
Gaya %idup s%a!/
Mnga!ur po#a $a7an yang s%a!.
Mng%n!i7an ro7o7.
Mng%indari $inu$ a#7o%o# dan
pnya#a% guna7an o6a!.
O#a% raga !ra!ur.
Mng%indari s!rs dan is!ira%a!yang &u7up.
-
8/18/2019 Stroke- Smtr 4
104/108
PREVENSI SEKUNDER
-
8/18/2019 Stroke- Smtr 4
105/108
4242 Mo&%&ka#& a,a "&$. a' %aktor r&ko2Mo&%&ka#& a,a "&$. a' %aktor r&ko2
0202 A't& =!ate!et ae'tA't& =!ate!et ae't
A#eto#a!;ASA ta/ 5> ;"ar&+ 4 ? I2A#eto#a!;ASA ta/ 5> ;"ar&+ 4 ? I2
ASA 0> ;D&.,r&ao!e 088 a. 0 ? I2ASA 0> ;D&.,r&ao!e 088 a. 0 ? I2
C!o.&ore! 5> ta/ 4 ? I2C!o.&ore! 5> ta/ 4 ? I2
T&!o.&&'e 0>8 ta/ 0 ? I2T&!o.&&'e 0>8 ta/ 0 ? I2
A#.&r&' 5> ta/ C!o.&ore! 5> ta/ 4 ? I2A#.&r&' 5> ta/ C!o.&ore! 5> ta/ 4 ? I2
-
8/18/2019 Stroke- Smtr 4
106/108
Ca'a&a' Ne$ro!o&a! Sa!e2
Sa'&'a:&a' Ne$ro!o&a! Stroke Sa!e2
E$ro.ea' Stroke Sa!e2Ra'k&' Sa!e2
Bart"e! I'e92
O$tae a%ter oa2
COMACOMA
DEADDEAD SURVIVORSURVIVOR
-
8/18/2019 Stroke- Smtr 4
107/108
DE=ENDENTDE=ENDENT
(ASSISTANCE WITH =ERSONAL NEEDS)(ASSISTANCE WITH =ERSONAL NEEDS)INDE=ENDENTINDE=ENDENT
(LOCK AFTER THEMSELVES)(LOCK AFTER THEMSELVES)
MODERATEL3MODERATEL3
DISABLEDDISABLED
GOODGOOD
RECOVER3RECOVER3VEGETATIVEVEGETATIVE
STATESTATESEVEREL3SEVEREL3
DISABLEDDISABLED
=ERSISTENT=ERSISTENT
VEGETATIVE STATEVEGETATIVE STATELOCK-INLOCK-IN
S3NDROMES3NDROMEAKINETIC MUTISMAKINETIC MUTISM
-
8/18/2019 Stroke- Smtr 4
108/108
top related