TRANSIENT ISCHEMIC ATTACK

(TIA)

WAAZALIMAH BINTI WAHIDC11111863

dr. Lilian Triana LimoaDr. dr. Nadra Maricar, Sp. S

ANATOMI

DEFINISI Serangan iskemik transien (transient ischemic attack, TIA)

adalah hilangnya fungsi sistem saraf pusat fokal secara cepat yang berlangsung kurang dari 24 jam

Diduga diakibatkan oleh mekanisme vaskular emboli, thrombosis, atau hemodinamik.

Beberapa episode transien/sementara berlangsung lebih dari 24 jam, tetapi pasien mengalami pemulihan sempurna yang disebut reversible ischemic neurological deficits (RIND).[1]

REFERENSI1. Mark H. Beers, MD, Andrew J. Fletcher, MB, Thomas V. Jones, MD (2003), The Merck Manual of Medical Information.

United States of America : Merck & CO, Inc. ,Second Edition, pg 457-458.

EPIDEMIOLOGI

Antara 200,000 dan 500,000 TIA didiagnosis setiap tahun di Amerika Serikat.

TIA membawa risiko jangka pendek yang sangat tinggi terhadap stroke, dan sekitar 15% dari stroke didiagnosa didahului oleh TIA.

Insiden TIA pada pria (101 kasus per 100.000 penduduk) secara signifikan lebih tinggi dibanding perempuan (70 per 100.000

REFERENSI1. Ashish Nanda, MD; Chief Editor : Robert E O’Conner, MD, MPH, Transient Ischemic Attack, Dec 5 2014; accessed Feb

10 2014. Cited by Medscape Reference © 2011 WebMD, LLC. Available at http://emedicine.medscape.com/article/1910519-overview

2. A. Gregory Sorensen, MD, Transient Ischemic Attack Definition, Diagnosis, and Risk Stratification, NIH Public Access, 2011 May; 21 (2): 303-313.

FAKTOR RISIKO

UNMODIFIED : usia, jenis kelamin, ras, etnis, dan keturunan MODIFIED : hipertensi, merokok, diabetes mellitus, diet, konsumsi

alkohol, stres psikososial, depresi

REFERENSI1. Julia Buczeki, Anna Czlonkowska, Stroke and Genetic, Periodicum Biologorum, Vol. 114, No 3, 259-266, received

October 2012

ETIOLOGI Tromboemboli Lipohialinosis (pembuluh darah kecil intracranial) Emboli kardiogenik Etiologi yang lebih jarang adalah vaskulitis atau kelainan

hematologis.

REFERENSI1. Lionel Ginsberg, Neurology : Bab 11 Strokes, Lecture Notes, Eight Edition, 2005, pg 89-97.2. Michael Eliasziw, James Kennedy, Micheal D. Hill, Alastair M. Buchan, Henry J.M. Barnett, for the North American

Symptomatic Catorid Endarterectomy Trial (NASCET) Group, Early risk of stroke after a transcient ischemic attack in patients with internal carotid artery disease, CMAJ, Mar. 30, 2004; 170 (7) pg 1105-1109.

PATOFISIOLOGIFaktor risiko

Aterosklerosis(thrombus atau

ateroma)

Emboli

Penumpukan thrombus/emboli di arteri yang meyuplai darah

ke otak

Penurunan sementara atau

penghentian aliran darah

otak

Hipoksia

Hilangnya fungsi sistem

saraf pusat fokal

REFERENSI1. Ashish Nanda, MD; Chief Editor : Robert E O’Conner, MD, MPH, Transient Ischemic Attack, Dec 5 2014; accessed Feb

10 2014. Cited by Medscape Reference © 2011 WebMD, LLC. Available at http://emedicine.medscape.com/article/1910519-overview

2. Carine Michiels, Physiological and Pathological Responses to Hypoxia, American Journal of Pathology, Vol. 164, No. 6, June 2004, pg 1875-1882.

GEJALA KLINIS

Karotis Vertebrobasillar

• Hemiparesis• Hilangnya sensasi hemisensorik• Disfasia• Kebutaan monocular (amaurosis fugax)

yang disebabkan oleh iskemia retina

• Vertebrobasillar• Paresis atau hilangnya sensasi bilateral

atau alternatif• Kebutaan mendadak bilateral (pada

pasien usia lanjut)• Diplopia, ataksia, vertigo, disfagia –

setidaknya dua dari tiga gejala ini terjadi secara bersamaan.

• Hilangnya fungsi fokal Sistem Saraf Pusat secara mendadak• Durasi kurang dari 24 jam

REFERENSI1. Lionel Ginsberg, Neurology : Bab 11 Strokes, Lecture Notes, Eight Edition, 2005, pg 89-97.2. David Rubenstein, David Wayne, John Bradley, Kedokteran Klinis, Lecture Notes, Sixth Edition, 2003, pg 101-103.3. Mark H. Beers, MD, Andrew J. Fletcher, MB, Thomas V. Jones, MD (2003), The Merck Manual of Medical Information.

United States of America : Merck & CO, Inc. ,Second Edition, pg 457-458

DIAGNOSA

Pemeriksaan darah rutin, LED, glukosa darah dan kolesterol, serologi sifilis

EKG Rontgen toraks Ekokardiogram USG karotis & color doppler Magnetik resonance angiography dan angiografi serebralREFERENSI1. Lionel Ginsberg, Neurology : Bab 11 Strokes, Lecture Notes, Eight Edition, 2005, pg 89-97.2. Mark H. Beers, MD, Andrew J. Fletcher, MB, Thomas V. Jones, MD (2003), The Merck Manual of Medical Information.

United States of America : Merck & CO, Inc. ,Second Edition, pg 457-458.3. A. Gregory Sorensen, MD, Transient Ischemic Attack Definition, Diagnosis, and Risk Stratification, NIH Public Access,

2011 May; 21 (2): 303-313.

DIAGNOSA BANDING

Migren disertai aura Epilepsi parsial Tumor intracranial, malformasi vaskuler, atau hematoma subdural kronik. Skelarosis multiple Gangguan vestibuler Lesi saraf perifer atau radiks saraf (misalnya palsi nervus kranialis) Hipoglikemia Hiperventilasi dan proses psikogenik lainnya

REFERENSI1. Lionel Ginsberg, Neurology : Bab 11 Strokes, Lecture Notes, Eight Edition, 2005, pg 89-97.

PENATALAKSANAAN

Obat antiplatelet Antikoagulan (warfarin) Endarterektomi karotis

REFERENSI1. David Rubenstein, David Wayne, John Bradley, Kedokteran Klinis, Lecture Notes, Sixth Edition, 2003, pg 101-1032. A. Gregory Sorensen, MD, Transient Ischemic Attack Definition, Diagnosis, and Risk Stratification, NIH Public Access,

2011 May; 21 (2): 303-313.3. Yongjun Wang, M.D., Yilong Wang, MD., Clopidogrel with Aspirin in Acute Minor Stroke or Transient Ischemic Attack,

Original Article, The New England Journal of MEDICINE, 2013.

PENCEGAHAN Memodifikasi faktor risiko

Hipertensi, diabetes, alkohol, merokok, obesiti, sindrom metabolik, aktivitas fisik, kolesterol, diet dan obat-obatan.

Mengobati penyakit jantung yang telah ada. Memperbaiki kontrol diabetes. Mengurangi asupan alkohol berlebihan

REFERENSI1. Lionel Ginsberg, Neurology : Bab 11 Strokes, Lecture Notes, Eight Edition, 2005, pg 89-97.2. David Rubenstein, David Wayne, John Bradley, Kedokteran Klinis, Lecture Notes, Sixth Edition, 2003, pg 101-103.3. Karen L. Furie, MD, MPH, FAHA, Chair; Scott E. Kasner, MD, MSCE, FAHA, Vice Chair, AHA/ASA Guideline, Guidelines

for the Prevention of Stroke in Patient With Stroke of Transcient Ischemic Attack, Stroke, cited by American Heart Association, Inc © 2010. Available at http://stroke.ahajournals.org , January, 2011.

PROGNOSIS

Probabilitas stroke pada 5 tahun setelah TIA dilaporkan 24-29%. Pencegahan stroke harus dilaksanakan dengan segera Dubia et malam

REFERENSI1. David Rubenstein, David Wayne, John Bradley, Kedokteran Klinis, Lecture Notes, Sixth Edition, 2003, pg 101-103.2. Ashish Nanda, MD; Chief Editor : Robert E O’Conner, MD, MPH, Transient Ischemic Attack, Dec 5 2014; accessed

Feb 10 2014. Cited by Medscape Reference © 2011 WebMD, LLC. Available at http://emedicine.medscape.com/article/1910519-overview

3. A. Gregory Sorensen, MD, Transient Ischemic Attack Definition, Diagnosis, and Risk Stratification, NIH Public Access, 2011 May; 21 (2): 303-313.

KESIMPULAN

TIA mungkin gejala awal stroke iskemik. Sekitar sepertiga dari orang-orang yang yang memiliki stroke

iskemik, setidaknya satu akan mengalami riwayat TIA; sekitar setengah dari stroke ini terjadi dalam waktu 1 tahun dari TIA.

Pentingnya identifikasi TIA untuk pencegahan stroke.

REFERENSI1. Lionel Ginsberg, Neurology : Bab 11 Strokes, Lecture Notes, Eight Edition, 2005, pg 89-97.2. Mark H. Beers, MD, Andrew J. Fletcher, MB, Thomas V. Jones, MD (2003), The Merck Manual of Medical Information.

United States of America : Merck & CO, Inc. ,Second Edition, pg 457-458.3. Karen L. Furie, MD, MPH, FAHA, Chair; Scott E. Kasner, MD, MSCE, FAHA, Vice Chair, AHA/ASA Guideline, Guidelines

for the Prevention of Stroke in Patient With Stroke of Transcient Ischemic Attack, Stroke, cited by American Heart Association, Inc © 2010. Available at http://stroke.ahajournals.org , January, 2011.