CASE REPORT Presentan : dr . Yudi Prasetyono Moderator : dr . H. Ahmad Asmedi, M.Kes, SpS Examiner : dr. H. Pernodjo Dahlan, SpS (K dr. H. A!

dul "o#ir, SpS $ommentator : dr. %etty Kurnia&ati May, ''th ())* Identity : +ame A,e Sex -..upation Edu.ation /eli,ion Address Date o# admisson Medi.al /e.ord : Mr. 0SP : *1 years : Male : /etired inspe.tor o# elementary s.hool : $olle,e : 2slam : "unun,sari, 0ejiharjo, Karan,mojo, "unun, Kidul : '3 April ())* : '.(4.*5.43

Anamnesis : -!tained #rom the patient and his &i#e on April, () th, ())* Chief complaint : 6ea7ness o# ri,ht arm and ri,ht le, The present history of illness : A!out '5 hours !e#ore admission to hospital, &hen he &a7ed up in the mornin, ()*.)) a.m. , suddenly he .omplained &ea7ness on the ri,ht arm and le,. He &as una!le to ta7e up a ,lass &ith ri,ht hand !ut a!le to ,et up #rom seat, to &al7 assisted !y his &i#e. He also .omplained spee.h lisp. Pre8iously, he did not .omplain #or heada.he. %here &ere no un.ons.iousness, nausea or 8omitin,, 8erti,o, a.ute !lindness or loss o# partial 8isual #ield, num!ness or &ithout #eelin, a hal# o# the !ody, &et the !ed, sei9ure, #e8er. %he patient ne8er had head injury !e#ore. A!out * hours !e#ore admission to hospital, his .omplaint &as &orsenin,. He &as una!le to ,et up #rom seat, so he .ould only raise ri,ht arm and le,. His #amily !rou,ht his to paramedi., and than he re##ered to Dr. Sardjito Hospital. Durin, * days stay in the hospital, the patient &as still .ons.ious and there &as no #e8er. He did not .omplain heada.he, 8omitin,, and dyspnoe. %he &ea7ness o# ri,ht extremities &ere not ,ettin, &orse, the patient .ould to s&allo& the #ood and a drin7 &ithout .ho7e. %he patient &as also o#ten :uiet, !ut he .ould to .ommuni.ate his .omplaint, and he &as a!le to re.o,ni9e his #amily. %he pro!lem o# hi,h !lood pressure

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&as .ontrolled. %he patient ha8e !een also .onsulted to internal and .ardia. departments #or mana,ement o# hyper,ly.emia and .ardia. pro!lem. The history of previous illness : - Patient su##ered #rom hypertention a!out 5 years, he did not ha8e his !lood pressure .ontrolled re,ularly, and did not ta7e many medi.ines. - Patient su##ered #rom dia!etes mellitus and already to ta7e ,li!en.lamide (';(<)< ) sin.e ' year - Patient had history smo7in,, !ut he stopped sin.e () years a,o - Patient did not 7no& i# he had a history o# .ardia. pro!lem - Patient did not ha8e a history o# heart atta.7 - Patient did not ha8e a history o# stro7e and transtient is.hemi. atta.7s !e#ore - Patient did not 7no& i# he had a history o# hyper.holesterolemia The history of family illness : +o history o# stro7e, hypertension and dia!etes mellitus Systemic evaluation : $ere!rospinal system $ardio8as7uler system /espiratory system "astrointestinal system =ro,enital system Mu.ulos.eletal system 2nte,umental system Summary of anamnesis : A man, *1 years old &ith .hie# .omplaint o# &ea7ness on the ri,ht arm and le,, &ith the sudden onset. %he .omplaint o..ured &hen he &a7ed up in the mornin,, and he &as also .omplained spee.h lisp. %he symptom &as not a..ompany !y heada.he and un.ons.iousness. +o pre.edin, o# #e8er the !ody and head injury. %he &ea7ness ri,ht extremities !e.ame &orse re,ularly. Patient had a history o# un.ontrolled hypertension, dia!etes mellitus and smo7in,. FIRST DISC SSIO! 0ased on the anamnesis, &e ,ot symptom o# &ea7ness in the ri,ht extremities and spee.h lisp. %he symptom onset &as sudden and it o..ured &hen he &a7ed up in the mornin,. %here &ere no symptom o# #e8er and pro,ressi8e heada.he to su,,est .entral ner8ous system in#e.tion, as &ell as no pre8iously !rain injury. %he &ea7ness ri,ht extremities !e.ame &orse re,ularly. %he patient had a history o# un.ontrolled hypertension, dia!etes mellitus and smo7in,. %he .lassi. 8as.ular pro#ile in8ol8es sudden onset &ith rapid pro,ression to maximal de#i.it (instantaneously or in se.onds (6ie!ers et al., '>>? . %hese symptom o# the : &ea7ness on the ri,ht extremities, spee.h lisp : no .omplaint : no .omplaint : no .omplaint : no .omplaint : no .omplaint : no .omplaint

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to death &ith no apparent .orithm .ause the onset &as sudden.lassi#ied a. to temporal pro#ile. .hemi.le arterial territory or i# impro8ement o.ordin.iousness (+ heada.i.ons.patient lead to 8as. .ere!ro8as.an !e used to repla.in.lini.i. Some s..al .cit Dahlan and @amsudin.ular disorders are .ute is.al dia. more than (3 hours or leadin.n o# #o. STRO"E Stro7e &as de#ined as rapidly de8elopin. stro7e Yes 2ntra.n.ons.ourse..al and sometimes loss o# .he (+ and 0a!ins7y re#lex (− +o =n. stro7e or in#ar.iousness (− heada.hemia are .tion #rom a sin. '>>1 Patient a. and !a!ins7y si.al symptoms and .he (− and 0a!ins7y re#lex (− Yes A.ons.lini.y &as !ased on result head $% s.ons.neti.ons.nosis o# stro7e.hemi.al examination. &hile type o# patholo. (M/2 &hi.h is still limited in se8eral hospitals in 2ndonesia.ns (+ +o =n.i. stro7e Yes 2ntra.nosis o# stro7e &hose parameters loss o# . 2s.iousness (− heada. '>>1 Stro7e dia. /esonan.ular (6H.iousness.i.ere!ral #un.urs rapidly or early in the .i.he (− and 0a!ins7y re#lex (− +o =n.ute stro7e 6ith or &ithout =n.orin.tion &ith the symptom lastin.h as "adjah Mada Stro7e Al. !e. stro7e or in#ar.ere!ral hemorrha.ute is.est to the dia. and 0a!ins7y re#lex %here are three or t&o o# these symptoms and si.ere!ral hemorrha.iousness. %hese su.ause other that o# 8as. heada.e $% s.nosis &as !ased on .ular lession. heada.an or Ma.he.he.. (Dahlan and @amsudin.iousness (− heada.tion stro7e Yes 2ntra. stro7e Ischemic stro#e or infarction stro#e Symptoms o# is.he (− and 0a!ins7y re#lex (+ +o =n. transient 4 . or si. dys#un.ons.tion stro7e Yes A.ere!ral hemorrha.lini. in.onsistent &ith neurolo.ludin.s su.hemi.e 2ma.an in patholo.

ar. stro7e may !e sudden.e to '1 . '>>? . the .e and medium<si9ed arteries in the ne. %he la. ())5 : '.r !rain tissue per minute.radual .aused !y is. le..hemi. De#i..unar symptoms (6on.t is usually in the thalamus. and pro. %his stro7e su!type result #rom throm!osis asso. pro.hemi.e (@indsay.tion in this settin. %he me. dyspha.e. +ormally the !lood suply to the !rain is 51.onsists o# persistent or transient num!ness and.leroti. lession o# the lar. stro7e (resolution o# symptoms a#ter 4 &ee7s..ression in a step&ise #ashion durin.ts the le.iated &ith atheros. and transient sensory symptoms may !e present. and .tion are the posterior lim! o# the internal . %he . ())' . $lumsy hand %he main symptoms are dysarthria and ..ti8ity or in asso.hes o# the a##e.. 6hen the !lood suply redu.e.unar stro7e : %he symptom may o. a. stro7e has an a!rupt temporal pro#ile. &ithin 4 &ee7s .onsists o# hemiparesis or hemiple.han.ture and #un. #a. ' to 3 days is not un. &ea7ness o# the hand. Dysarthria .ally a##e.i. '>>? . %he most #re:uent sites o# in#ar.ommon (6ie!ers et al. Approximately 15 A o# all stro7e . &ith de#i. stro7e.lin. $ardioem!oli stro7e: %he typi. 4. (..tion that .apsule. %hrom!oti.tion stro7e in. !asis pontis and . @a. %he heart and aotri. stutterin.7 or !rain.apsule..hanism o# . 3 . arm.')). i# e8er (6ie!ers et al.is. . trun7 . history is an onset o# symptoms durin. 2t usually a##e.hemi. %here are #i8e .al . on one side o# the !ody (e.ts the #a.rural paresis. de#i.leroti. 5.ases are . or step&ise in onset (.t usually in the thalamus and adja. ())' . Mixed sensorimotor stro7e 2t .hemistry . %he in#ar.aused !y de.ted artery.')) . more than the arm.it that are maximal at onset.lassi.7 (resolution o# symptoms &ithin the #irst (3 hours .. 2n#ar..ausin.h em!oli ( 6ini7ates. arm. or in#ar.ressi8e de#i.asionally.lassi.its may impro8ed shortly a#ter&ard i# the em!olus !rea7s up and tra8el to more distal !ran.une is usually in the posterior lim! o# the internal . and le.omplaint is o# pain. stro7e and la. la. o#ten #or as lon.it.h are sour.it.. %he in#ar.orona radiata..lumsiness (ie.han. %he . as (3<?( hours .lassi.lumsiness on one side o# the !ody.ia. atta.iation &ith palpitation or a 8alsa8a maneu8er... !urnin.ardioem!oli. re8ersi!le is. Pure motor stro7e. stro7e: An atherothrom!oti. or other unpleasant sensation. material rather than purely hemodynami.haemi.ia tha typi.rease o# !lood suply to the !rain.ere!ral in#ar. 3. stro7e (pro.or tin.hemiparesis 2t .e o# stru.it (resolution o# symptoms a#ter (3 hours..ressi8e is.ardioem!oli.onsists o# hemiparesis or hemiple. is o#ten artery<toBartery em!olism o# platelet<#i!rin throm!i or atheros.lude su!type: throm!oti. '>>? . the . history is a patient &ho a&a7en #rom sleep &ith the de#i.r !rain tissue per minute.ia and ipsilateral sensory impairment. -.unar stro7e.es o# su. (6ini7ates. Pure sensory stro7e 2t . Ataxi. neurolo. 2t is also 7no& as homolateral ataxia and . Dysarthria.ompleted is.onsists o# &ea7ness and .hemi.ur durin. hemiparesis 2t .tion o# uni8ersally in#ar7 teritory &ould .ell and mem!rane .ent posterior internal . sleep.apsule or the !asisi pontis. the !io.

anti7oa. 2n8entory /esult : su..ioma . 8esi. !lood dis. mus.nosis : &ea7ness o# ri. stro7e (6ini7ates.>) mm H.e in !eha8ior domain depression and apathy !eurolo%ical e'amination : 5 : #air. Heada..lue. '>>? .. an.uisha!le #rom is.i.reenin. and a!out 5 A are su!ara. al.$emorrha%ic stro#e Hemorrha.aused !y the smash o# aneurysma.ht and le#t is !alan. or other si.ere!ral !leedin.est a hemorrha.rease o# le8el .onjun.n o# raised intra. ())* (eneral status "eneral $ondition $ons.minute : not #e!rile : . 8omitin. s. the onset has sudden.ht extremities &ith sudden onset and &orsen .minute.e : irre.iousness . A!domen Extemity Psychiatric state : %he psy.h lisp : DD: le#t anterior &atershed area le#t internal .ti8a not anemis : !ruit .oholism.apsule : DD: la.ht: '*). murmur (− : sonor. le#t: '*). ron.hi (− : le8er and splen unpalpa!le.ranial pressure also su. le#t: 13 x. stro7e Physical e'amination : %he patient &as examined in April ()th .al dia.nosis Etiolo.hiatri. sto7e.est to distur!an.idity (− : une:ual pulses (− .iousness 0lood pressure Pulse /espiratory rate %emperature Head +e.al dia. &hi.7 $hest Heart @un.ht: 13 x.arotis (− : !reath mo8ement ri.nosis %opi. A prominenet de.ular..a8ernous. &or#in% dia%nosis : $lini. : ri.h is . nausea. mal8ormation arterio8enous.>) mm H. se8ere hypertention. ())' A!out ') A o# the stro7e .al pro#ile that may not !e .he.radually. stro7e ha8e a . used =$@A +europsy.ons.unar stro7e throm!oti.ulan therapy and an.hiatri.i.ular rythme (+ .. &ithin normal nutrition : .rasia.al dia.minute : () x.lini.an !e a .aused !y intra.learly distin.hemi.ompos mentis ("$S :E3.i. spee.le ri.iopati amyloid ( @indsay.C5 M* : ri.hnoid !leedin.

o# the eye!ro& $lose eye "rima.ht re#lex 2ndire.le o# the mouth 6rin7lin.7 sti##ness (< /i.2 n.orneal re#lex E.en EyeHs motion to medial !elo& Stra!ismus 7on8er. %aste on the (.ht re#lex E.C222 n.e $orneal re#lex %rismus EyeHs motion to lateral Stra!ismus 7on8er.omodation re#lex Stra!ismus di8er.2I Smellin.22 n.en 0itin.or.tion Cisual Field $olour Cision Ptosis EyeHs motion to medial EyeHs motion to !elo& EyeHs motion to a!o8e Pupil Kind o# pupil Dire.C22 n. o# the &hispered 8oi.7in.4 posterior o# the ton.t o# li. &at.reased 6nl 6nl 6nl S7e&ed mouth to le#t 6ea7 6nl +ormal Simetris 6nl (E 6nl (E * @e#t 6nl G'.en Diplopia 0lin7in. diameter 4mm. /e#lex .t o# li. "$S : E3.E : ne.e.h Ar.4mm li.upharyn..C2 n.ue Hearin. %aste on the '.ompos mentis.C n. ti. +asola!ial Fold %he an.ription : . o# the #orehead 6rin7lin.222 Des.ht 6nl G'.$on.iousness Head D eye +e. -pen mouth Sensi!ility o# #a.2C n.ue Comitin.'( 6nl 6nl (< 6nl 6nl 6nl 4 mm /ound (E (E (< (< (E (< 6nl 6nl 6nl 6nl (< (E (< (E 6nl 6nl 6nl 6nl 6nl 6nl 6nl +ormal n. .7 $ranial ner8es n.4 anterior o# the ton.'( 6nl 6nl (< 6nl 6nl 6nl 4 mm /ound (E (E (< (< (E (< 6nl 6nl 6nl 6nl (< (E (< (< (E Dissapeared De.ephal pupil iso.E.e 0lo&in.ht re#lex A.C5 M* : meso. Cisual Fun.

ulation o# toun.al re#lex Sensi!ility : Protopati.al re#lex Patolo. %urnin. : Pression Ci!ration Position Dis.: Pression Ci!ration Position Dis.le shoulder %on.hin. Spee.th %onus %rophy Physiolo.ue position Arti.i.eHs mus. head Shoulder position @i#t shoulder %ro#i o# mus.e %oun.e protra.e 6nl 6nl 6nl 6nl 6nl 6nl @imited 4<4<4 +ormal Eutrophi (E (< 6nl 6nl 6nl 6nl 6nl @imited 4<4<4 +ormal Eutrophi (E (E 6nl ? .i.rimination @o&er Extremity Mo8ement Stren.al re#lex Sensi!ility : Protopati.ulation %remor o# toun.in. Propiosepti.rimination A!dominal /e#lex =pper Extremity Mo8ement Stren.ual /et. Pulse per minute Ar.tion %ro#i o# toun.ht 6nl Eutrophi (< Eutrophi (< @e#t 6nl 6nl 6nl 6nl 6nl 6nl Free 5<5<5 +ormal Eutrophi (E (< 6nl 6nl 6nl 6nl 6nl Free 5<5<5 +ormal Eutrophi (E (< 6nl 6nl 13 x 0ody $hest Sensi!ility: Protopati.I22 Pronoun.i.i. Propiosepti.al re#lex Patolo.h S&allo&in.: 0reath mo8ement is !alan.le Fasi.n.e (< (< 13 x Simetris (E (E 6nl Simetris 6nl Eutrophi S7e&ed to le#t Dysarthria (< S7e&ed to ri.ht Eutrophi (< /i. the lin.I nI2 n.upharyn. Propiosepti.th %onus %rophy Physiolo.

all : ( (ne& learnin.ulation : 3 /e.ivin% : '* Co%nitive function : Mini Mental Examination State -rientation : 1 (orientation o# person and pla.e .ua. a!ility &as impaired @an.e &ere not impaired. memory.tion : the imitatin.uti8e #un. the alternatin.allin.ht hand DHesposito $on.niti8e impairment espe.o.ommand.ause o# &ea7ness in the ri. 1 .etati8e #un.al. o# . !ut it &as not #luentlyJ the mentionin.lusion : ..ati8e Exe.ause o# &ea7ness in the ri. !ut the &ritin. e8ent &as ne.e and readin. &ere not impaired. narratin.e : the patient .Pression Ci!ration Position Dis. o# animal name &ithin ' minute &as six.ause o# &ea7ness in the ri. o# pi.ause &ea7ness in the ri.e : 3.7&ard month se:uen.it se:uen.ent memory &as impaired .ould spea7 spontaneously.ompletely to mention the !a.ht hand Memory : di. !e. !e.onstru. re. !e. the patient did not do the option o# senten.e &as not examined.tion : it &as impaired. t.ua. o# senten.e @an.ua.rimination 6nl 6nl 6nl 6nl 6nl 6nl 6nl 6nl Ce.ially in domain o# attention. !e. apraxia &as not impaired Cisuospatial : it &as not impaired Cisuo.ht hand $onstru.ture and the letter<di. mentionin.e &as not examined.7&ard di.e and the !a. the patient did not do . a!ility &as impaired . repetition.tion : it &as not examined.tion : &ithin normal limit A!normality mo8ement : (− (ad)ah *ada Stro#e Scale : (3 +arthel inde' : '5 Activities of Daily .it span &as three (re. !e. o# 5 &ord &as t&o (ne& learnin.ht hand. pi.ause o# &ea7ness in the ri.ontinuin. !ut orientation o# time &as impaired /e.ht hand Attention : it &as impaired.it se:uen.urrent pu!li.ture &as not examined. interpretation o# 8er!al lan.ristration :4 Attention and .

d@ Radiolo%y: /ont.) A +a : '41 mmol .d@ AS% : 4*.* @A A% : ('3.lu.minute.' @A Monosit : 3.al deep temporal lo!e and le#t peri8entri.ular Electrocardio%raphy April. 8entri.d@ "lu.ular extrasystole !i.. ())* H! : '4.lu.4 2=. mm4 Eosino#il: )..id : (. Heart /ate ?( x.and exe. '3 th.ardiome. ( April. @ $l : ')) mmol . '* th ())*: Synus /hytm.ali $ead CT Scan (April.d@ /andom .d@ Di##tel : 4 A@ : 1.3 .minute.d@ @D@ : ((> m.ular extrasystole #re:uent April.d@ =ri. : ''5 m. a.3 mmol .))) .tion on le#t su!..ose : ()> m. @ K : 4.( 2=.minute..i.uti8e #un.* m. () th ())*: Synus /hytm.@ 0=+ : ''.orti.) m.. Fast .@ A@% : 4?.ular extrasystole rare Consultations Cardiolo%y department (April.osa ( hour post prandial : '?1 m. 8entri.' @A H. '3 th ())* Hipodens lession on le#t su!. (April. '3 th ())* : /esult: 8entri.d@ $reatinin : '.emini April.ular (diameter 5 mm /esult : in#ar.ular extrasystole #re:uent $hol : 4'' m.osa:(45 m.orti.en o# thora. Heart /ate 13 x..3 HA AE : 5. Heart /ate ?* x.d@ HD@ : 5' m.')) .tion $achins#i score : '' Supportin% e'amination: @a!oratory #indin. '3 th ())* /esult: Pulmo : &ithin normal limit...t : 34.. '3 th ())*: Synus /hytm.. @ @a!oratory #indin.> m. mm +eutro#il: *?.d@ %. $or: .13 x ')* .al deep temporal lo!e (diameter ( mm and le#t peri8entri.d@ > ..> A 0aso#il : ). 8entri. mm4 @im#osit : (?.

'>>? .iated &ith is.ardio.ular dysplasia . to the .orti.i. dia!etes mellitus. ri. @a. (5 th ())* : %reatment: re. sho&ed .emini %reatment : oxi.ardia. shunt . internal . artery.onsultin.ular insulin 4 x 3 2= *edical reha-ilitation department (April.ardiolo.holesterolemia. o# a su!.tion. lar.aly. amiodarone oral 4 x ')) m.(3 hours Internal department (April.ular extrasystole and .ular disorders are .le stren. E8aluation assessment (April. %his patient had un. dia!etes mellitus.ht hemiparesis on in#ar.unar in#ar.thenin.niti8e impairment.ram Mus.anule.ular extrasystole and dyslipidemia as the ris7 #a.ht hipo.h atheros. le#t peri8entri.emia.an examination sho&ed in#ar. throm!o.ular .. .roups o# diseases asso. throm!oti. #i!romus. purpura (6ie!ers et al.ons. %he patient had hypertension.ht to le#t .y o# hypertension. small 8essel disease (hypertension.ompati!le &ith the o.o.raphy sho&ed 8entri.tion on le#t su!.ular extrasystole &hi.al deep temporal lo!e. intra. distur!an.ular extrasystole !i.enation 8ia mas7.ythemia. '3 th ())* : /esult: dia!etes mellitus type ( non o!ese E8aluation assessment (April.arotid artery disse.ise pro.onsistin. !rainstem .tors are listed as ris7 #a. Mo!ili9ation and AD@ impro8ement SECO!D DISC SSIO! %he results o# physi.h in the .%reatment : oxi. throm!us or tumor.h as hypertention.ial &ea7ness (paresis o# ri.tor disease su. dyslipidemia and many other #a. amiodarone drip 35) m. 8enous throm!i &ith ri.tion stro7e patient Pro.apsule.lia.(3 hours E8aluation assessment (April.ular.ated hypodense lesion &ith a diameter K'5 mm. in#e.tious arteritis .ardia.anule. sharply demar. hyper. 2# no su.orti. /esult o# ele. .ly.aused !y multi#a.hemi.ular extrasystole rare %reatment : oxi.al examination. Stro7e is .ardiome.al (!asal .tors.ardia. hematolo.an. disorders (8al8e related em!oli. %he result o# Head $% s.lini.hest I ray sho& there &as .ourse de8elop into !i.ram: Exer.ular extrasystole.ere!ro8as.al . Four major .ht #a.tious and nonin#e.. dyslipidemia .ial ner8e<upper motor neuron and paresis o# ri.enation 8ia . 8entri.ontrolled hypertention.lerosis.ht #a. () th ())* : /esult: 8entri.lerosis path&ay.ht hemiparesis and ri.ause stro7e throu. &hile .ute stro7e syndrome &ith a $% lesion .ytopeni.tro.h lesion &as 8isi!le or i# no $% &as per#ormed. %he pathophysiolo. &e used ') . dia!etes mellitus. '* th ())* : /esult: 8entri. to the internal department there &as non o!ese dia!etes mellitus type (.y department there &as #re:uent 8entri. %he !lood la!oratory examination sho&ed hyper..le per#oratin. $onsultin. throm!o.. .tors.an . '* th ())* : /esult: /i. 8as.e.ardia. .emini 8entri.iousness.enation 8ia . small. amiodarone drip 35) m. disease (poly.e 8essel disease (atheros. systemi.ythemia.lusion o# a sin.t &as de#ined as an a.lossus ner8e <upper motor neuron.

or other .orti.orti.niti8e impairment : posterior lim! o# le#t internal ..tion and less impairment o# memory. attention and .onne.uti8e #un.ir.ent la.y o# small su!. #or re8ealin.unar in#ar. Final dia%nosis : $lini.neti. %he study to determine the .o.unar in#ar.al presentation and aetiolo.ular extrasystole on !rain . '>>? . 6e distin. Di##usion 6ei.the esta!lished . %he small penetratin. Patient &ith su!.urs in the #irst &ee7 a#ter the e8ent.leus and .i#i..e o# orientation.uished 3 la.holesterolemia small 8essel disease '' .e.al.unar stro7e syndrome 8as.o.es #rom '(A to 5)A o# patients. as &ell as re.t o# #re:uent 8entri.hes o# the major intra.lini. early $% positi8ity #or lesions .i.tion in the limited distri!ution o# one o# these arteries (6ie!ers et al. hyper. 2n the #irst #e& days. sensorimotor stro7e.al 8as.unar in#ar. (D6<M/2 per#ormed a#ter 4 days &as >5A sensiti8e and >3A spe. su!.lia in.ollateral .ular . le#t peri8entri.ua.t (2n9itari and @amassa.orti.unar in#ar.hted Ma. /esonan. =sin. Su!.ns that in8ol8ed the &hole o# at least ( o# the 4 !ody parts (#a.. 2n study a!out e##e.ular : hypertension small 8essel disease. parti. 0ased on result o# this examination.tion examination.ludin. '>>4 .nition memory ($ummin.orti.on.unar syndromes: pure motor stro7e.ulary re.ons. !ran. o!stru.in. ())4 .ular dementia exhi!it more se8ere impairment o# exe. ())5 .e o# positi8e ima.istration.ally de#ined la.lumsy hand syndrome (De Lon.al in#ar. lan.nosis %opi.or sensory si. %here isn a time pro#ile #or appearan. -n the .ere!ral !lood #lo& .ranial arteries ha8e poor .apsule le#t su!.e o# this lesion a#ter the .o.al dia.orti.al e8ent.lo!us pallidus.lini.ute la.endor## et al. to demonstrated that redu. &ithout distur!an.niti8e impairment. ())4 .tions.al #un.ular . $% ima.al deep temporal lo!e.e o# attention.iousness. pure sensory stro7e.al dia.t ran.ular dementia tend to pre8entially in8ol8e the su!.dysarthria . ())( . hemiparesis.lini.e o# . the lo&est pre8alen.ti.o. M/2 is reported to sho& a re. +inety three patients &ere identi#ied sho&in. et al.al &hite matter o# the #rontal lo!es and the anterior aspe.5 .riteria o# unilateral motor and.s.tion.tions.orti.es o.an indu.tion o# !lood #lo& .t in up to >3A o# patients.nosis *ana%ement : la.ruent &ith a .ulation in patients &ith ..hemi. arm.m in diameter &ithin a maximum o# ? days #rom the onset o# stro7e symptoms (Sei#ert et al. lipohyalinosis.tions rele8ant to 8as.aused !y #i!rin deposition.orti. le.ulation.oronary heart disease. 8isual #ields.e. 8as. or throm!us leads to in#ar.al or !rainstem D62 lesions K'. the patient had 8as. dia!etes small 8essel disease. memory. From reported data..al is. mi.ts o# the !asal .roatheroma. the .. and ata.audate nu.al dia.e 2ma.in. 6hile in the DHesposito examination to result in distur!an.nosis Etiolo.tions as #ound on D6<M/2.tion o# . an a.an.ular injury and la.niti8e #un.uti8e #un.ed !y #re:uent premature 8entri. and exe. the patient had MMSE examination to result in distur!an.ular !eats (Ha.

A randomi9ed.iti. ())3 .<term administration o# .ned to assess the relati8e e##i.iation still re.tan dru.h 7ind o# primary endo.ere!ral #un. symptoms (-r.tion &hi. &ithin '( hrs o# onset o# a.etam per in#ussion o8er () minute..ular disease is more e##e.rease o# platelet anti a. is pira.ommended neuroprote.om!ined ris7 o# is.iti.1 . '>>? .s .y o# . dou!le<!lind parallel .leroti. %rial o# $AP/2E &as a randomised.ti8e than aspirin in redu. Cas. d.ular deathJ their relati8e sa#ety &as also assessed.o9o s. ())3 . 8as.al injury (Adams.rams o# pira.rease o# erythro.hemi.oline &ithin the #irst (3 hours a#ter onset in patents &ith moderate to se8ere stro7e in.holine treatment &ill impro8e .ut . randomi9ed pla.h o# all prospe. $iti.i8en on #irst (3 hour sin.ni#i.lusion . %he out. Patients re.yte de#orma!ility.rease a. mi.e a day ( Perdossi.holine to ma7e mem!rane repair !. myo.roup also sho&ed si.lase stimulation. throu. the .i8en 3.ell mem!ran #luidity repaired. daily #or 3 &ee7s and then 3.ommended pira.roup desi.iti. 2n. neurotransmitter repair.in.i8e 8ariety result in stro7e patient. 2n. periods o# a.enters.. %he +ational "uideline o# Stro7e has not re.iti. sear.haemi.ir.y. . dou!le !lind trial.omes (pK).rel to patients &ith atheros.e!o or '( .riteria are presentin. the a. stro7e (8arious doses 5)). a!out oral . the ris7 o# a .rel (?5 m. international trial desi. ())4 .hemia in order to pre8ent hypoxia and potential &orsenin.ere!ral is.t as lon.etyl.ei8ed pla.o.)( (De Deyn. ())' : a.rease the pro!a!ility o# . 2n.i8en at se8en hours o# stro7e onset. daily #or 1 &ee7s. or 8as.o. o# the neurolo. stro7e.ale s.o8ery at 4 months (Da8alos et al.ro.rease phosphatydil .3 .tion passin. -n day 5 until the end o# 3 &ee7s.i.ardial in#ar..omposite out.al Asso. on.ram di8ided 4 times a day orally. Pira.o9o s.tan dru.e daily and aspirin (4(5 m.e!o<. 2nhi!it #ree #atty a.ular le8els (Perdossi. as is. ())( .rams e8ery '( hour until the #ourth day. As .ontrooled.ated to !e .lopido.ome . 2n systemati.eni.enation is a . supratentorial stro7e.oline treatment #or a.id and #ree radi. antioxidant in the !rain For is.a.es o# 3) and 15.lopido. !.al .hemi.i8en (.ore o# G5 and K?) and arousa!le.etam . stro7e. ())3 .tion.s #or stro7e patients (Perdossi.7 at dose (5)<'))) m.ted to neuronal and 8as.lutation resour. adenylate . +euronal le8el: related to phospolipid.in.es &hi.etam has t&o me. %he interpretation this study is lon.ti8e. ())3 : a.ram t&i.y.tan neither has AHA "uidelines .ome assesment used -r.hemi. Additional analyses o# patients &ith moderate and se8ere stro7e &ithin the early treatment .re. e##e. +europrote.holoine should !e . First '( . disa!lin.h some &ays as #ollo& (Adi!hlata et al. stro7e. intra8enous (<4 times a day o8er (<'3 day (Perdossi. on.ular le8el: in.ut is.n trial o# >(? patients at 55 .luster o# is.hemi.etam in !oth out. +e8erthless 2ndonesian +eurolo.ale and 0arthel 2ndex.e stro7e atta.etam as an initial intra8enous !olus #ollo&ed !y '( .. .h has theurapeti.ute is. de.-xy. 2t is indi. and on the &ee7 5 until '( it is . to demostrated that . '( .1 .omplete re.e durin.ulation repaired. pira.reat importan.holine neurotransmitter produ.holine as neuroprote. !linded.e daily in redu. and then #ollo&ed &ith 4 .ant impro8ement on pira.etam and .rams !olus e8ery * hour or '( .hanisms a##e. '))) and ())) m.ration.haemi.

roup assi.ute stro7e Sistoli. %he in8esti.emia has ad8erse e##e. a patientHs !lood pressure !elo& the usual limits &ill also help pre8ent re.tional out.ti8e lo&erin.iation '4 .e in stro7e models supports that hyper.lu.iden.@.ators re. aspirin alone to pre8ent re.) mmol. sim8astatin daily had an a8era.rel is at least as .d@ .tion..i.urrent stro7e and maintain thin7in. and i# lo&erin. &ith no ad8erse e##e.ular death.ome has !een #ound in an in.lini. and an asso. %he o8erall sa#ety pro#ile o# . Sistoli.emia.ruit (5)) parti.< ')5 mmH.ly.ti8e than usin.ned to 3) m.uidelines.ardial in#ar.an Stro7e Asso. stro7es.ati8e Parenteral antihypertension Dru. insulin is re.ome.an Positi8e +e.al studies. num!er o# .ood as that o# medium<dose aspirin ($AP/2E Steerin.enter study &ill re. 2ntra. de#ined as !lood .7s !ut also o# is.ly.ute stro7e (Perdossi.e o# hyper.rel to. or 8as.hemi.t on hemorrha. patients (European Stro7e 2nitiati8e ME=S2N . Extensi8e experimental e8iden.emia.lu.ose is . Althou. Diastoli.ans to #ind out i# usin.ement in a. %he pre8alen. -!ser8ation -ral antihypertension dru.ation to 3) m.e redu. $ompared &ith the pla.@ (')1 m. Diastoli. > (4) mmH. '(' < '3) mmH. the .iation !et&een !lood .lopido. Ele8ated !lood .ommend that statins !e routinely . ')5 < '() mmH.e o# end or. Ameri.ommon in the early phase o# stro7e.ether is more e##e.roup.ly. Sistoli.i.reasin. '1) < (4) mmH. ())5 . ())4 .lu. < '1) mmH.uidelines G') mmol.h su!type in. la. %he #lo& .urrent stro7e in patients &ith la.ed the rate o# is.ose and #un. . > (4) mmH. Diastoli.lay. %his multi<.ute re8ersal o# hyper.tion in lo&<density lipoprotein .e not only o# heart atta. a.es the in. a!ility (0ena8ente. sim8astatin daily redu. e8en in nondia!eti.h ris7 o# stro7e (0ar. Allo. > '3) mmH.hemi.holesterol o# ' mmol. has !een o!ser8ed in t&o thirds o# all is. Ameri. Diastoli.unar stro7e.ts on tissue out. $ommittee.ere!ral hemorrha. stro7es.tin. ())3 : A.myo. '(' < '3) mmH.h no inter8entional stro7e studies ha8e addressed the a.ose !y rapidly a.@. o# ele8ated !lood . or distur!an.ommended in most pu!lished .onsidered #or all patients at hi.e!o .hemi.ipants (() per.ent o# &hom &ill !e Hispani. /epeat to examination a#ter '5 minute Sistoli. stro7e su!types on admission and in at least 5)A in ea. Diastoli. Sistoli. stro7es. '>>> . aspirin and .hart o# hypertension mana. > (4) mmH.i8e o8er the se8enth until tenth day %he study a!out statin therapy to sho&s that statin therapy rapidly redu.lopido.lu.ludin.ose le8el G*.unar stro7es.

al a.ram .ation o# prolon. immo!ili9ation as soon as possi!le (Santoso.i.ondition that a.an !e started i# patient . ())3 . !.al reha!ilitation pro.al reha!ilitation pro.ontra.e the patient admitted to the hospital.ation in the ele.ni#i.ts are (Anonim. Medi.. Many opinions su. the a.enerally &ere re.h indi8idual impulse is .tri. throu.e!o.t that is opposite to that o# hyper.e '3 .hemi.essory path&ays &hi. ())4 . A redu.ise pro.al system Ore.tri. &hi.ti8e medi. hasnHt !een initialed.urent stro7e.al e##e.al .tri.ondu.aused !y prolon.al . o8er pla.ration on so.holo.ose le8els !ut also exerts an antioxidant and anti<in#lammatory e##e.d@ (@inds!er.ir. $ommonly.ly.ram : a. A delay in the rate at &hi.al path&ays (. o# the normal . %o support reinte.tri.. Donepe9il &as &ell tolerated. A slo&in. in the #irst day a#ter stro7e atta.tri.ram .tion and results in impro8ed !lood .tri. medi. randomi9ed.enter. (Santoso.ontrolled trial a!out e##i.ial li8in.7 et al.al reha!ilitation pro.ompli. o# .MASAN . ())* : '. #irst day pro.h the heartPs ele.y and tolera!ility o# donepe9il in 8as.day and donepe9il ') m. $riterion . in.onsidered a O!road spe.emia.tion potential J 4.ant !ene#its in a.h is responsi!le #or the heartPs rhythm.t. potention and pre8ent . international.alled a.a.ti8ities o# daily li8in. 2t not only lo&ers !lood . as &ell as pla. %o #a. A prolon. it has multiple and . or repairin. pla. ())4 .tion 8ersus pla.le .tri. %here &ere a lot o# opinion a!out !ed rest period a#ter stro7e atta.tion (ho& #ast ea. re. !ut . repairin.h the heartPs mus.h 8arious spe.lo!al #un.ation .tional sel#<supportin. and /oine. ())3 .enerator o# ele.ulation to the is. #or example !y doin.ted throu.al reha!ilitation pro.e!o<. medi. proper !ed positionin.trumO antiarrhythmi.ompli.tri.est a.tion throu. o# the speed o# ele.nition and .tion in the rapidity o# #irin. et al. Amiodarone is used to .ti8ity o# the heart &hi.er patient ( li#e<threatenin. hydration and nutrition.h .ts on the ele.uide: a.o.ompli.e!o.esO a#ter the heart .iety and &or7 pla.ondition &ere sta!il there &ere no .al reha!ilitation pro.ant impro8ement in . A multi.an !e responsi!le #or arrhythmias.ram should !e initiated sin.t a!normal rhythms o# the heart (an antiarrhythmi.o.ells are ele.omplex e##e.ram to !e done earlier.ular dementia &as randomi9ed to (3 &ee7s o# treatment &ith donepe9il 5 m.ram. 2n . %he tar.ludin.ti8e medi. %o pre8ent.al phase durin.. Amiodarone is .ti8e medi.ondu.. re. 6ithdra&al rates do to ad8erse e8ents &ere relati8ely lo& (0la.tri. areas ("ar. A slo&in..h 8arious exer.har.e and handle medi. Donepe9il treated patient sho&ed si. ())3 .ation ..7 .7.omended !et&een '<4 &ee7s (Santoso. that is.ni#i.et o# medi.ondu.ilitate patient and #amily psy.ation and there &ere no medi. Amon.al system J 3..lu.ts (repolari9ation J (..ema7er J 5.ni.al impulses in the heart (the heartPs pa.uidelines G4)) m. %o maximi9e #un.an !e used as . At &ee7 (3.al and so.ation. adaptation d..ram &as aimed to a. ())* .iali9ed ele.al reha!ilitation &as aimed to maximi9e healin...day.ed !ed rest.roups sho&ed si. !oth donepe9il . 2nsulin also impro8es +produ.e!o.ainst .h the heartPs ele. 2nsulin in#usion has an e##e.al . Early medi.eneral.ondition that endan.orre.ally stimulated (a. its most important ele.ompany stro7e.

Amiodarone drip 35) m.lini.e and the de..unar in#ar. A. and a. therapy #or 8as.tion &as moderate or se8ere hemiparesis ' month a#ter stro7e onset as the stron.urrent stro7e &as *4A.etylsali. a.ant predi.etam inj 3 x 4 .ni#i.urrent stro7es &ere la. those &ith ' asymptomati. Sim8astatine ' x ') m.etat () .al dependen.i8en therapies: (eneral: Air&ay.ulation maintenan.al pro.o8ery throu.unar stro7e.h relearnin.tion and to prote. the patient is ..ate the lon.ado et al. #a.e or death at 4 years ( pK).ti8e exer.ale and a 0arthel 2ndex s.tt per min Pharmacotherapy Pira. %he . e8ery 4 months up to ' year. distin. Diet: diet DM '>)) 7alori Physiotherapy Pro%nosis %he study &as to in8esti. hypertension and dia!etes mellitus &ere stastiti. 6hile. #ollo&ed !y &hite matter hyperintensities on M/2 (pK).ant #or independent determinants o# death.<term pro. %he study a!out t&o type o# la.ts per#ormed a #ollo&<up in 444 patients &ith #irst la.urren. ())' .unar in#ar.id &ere stastiti.e. %he results o# study a!out #un.i8en positionon. et a. %he 5<year pro!a!ility rate o# stro7e<#ree re. &hile 5<year sur8i8al rate &as 1*A.min 2CFD /in. and . $lopido.tional disa!ility at ? days a#ter the index stro7e measured !y the %oronto Stro7e S.ant independent ris7 #a. and e8ery * months therea#ter. '>>* .ree o# neurolo.))' .uti8e patients presentin.ent o# the #irst re. ())' .))' .ti8ely e8aluated a#ter stro7e onset at day ) to 4 and.o8ery his !ody #un.rel ' x ?5 m.o. %o repair li#e :uality o# the patient /eha!ilitation is needed to .unar lesions (@A$2E #rom those &ithout su.ant predi.yli.urrent stro7e in.lusion to sho& pro.ni#i.. A .est predi.uishin.ally si.ohort study in pure motori.tor o# re.er a.ally si.tors. A. 0e#ore mo!ili9in.ular .. pro.ant #or independent ris7 #a. .al dys#un. %he patient had .e &as ?(A. 0reathin.ess. la.holin inj ( x 5)) m.nosis #or '5 .e: -( 4 @.urrent stro7e (Staa# et al.ir.ni#i.onse.ni#i.t spastisity (Aliyah.tion and #un. Fi8e< year sur8i8al rate #ree o# re.reased disa!ility and handi.or day ?.ome in patients &ith la.ts (Sal.tors o# death. %he .nosis o# #irst<e8er la.unar in#ar.ram $iti.tor o# physi.unar in#ar.e &as the only si.i.ally si. &ith #irst<e8er la.tor (Samuelsson et al. Sixty<three per.tional re. (3 hours Plannin. stro7eJ a.urrent stro7e.ap !ut &as not a statisti. male sex and nonuse o# a.ore K3) &ere the only si.nosti.ts &as prospe.on.ain #un.e.ni#i.unar stro7es and the possi!le role o# .tional out.h lesions (@A$2< .tor o# sur8i8al #ree o# re.ohort o# . '>>* . /e. to re.niti8e impairment: donepe9il ' x 5 m.isin.

E 3C5M * 0PQ'3).ular 2nsulin 4x3 2= Al!umin in#use Diet DM '>)) 7alori Physiotherapy April/ 04 th 0112 Fair. //Q ()x tempQ not #e!rile Paresis +. E 3C5M * 0PQ'?).r $iti. //Q ()x tempQ not #e!rile Paresis +.h lesions.rine and physiotherapy . %he patient had many pro!lems in.5.5.mortality.5 Centri.etate () .C22.th E$" @a!oratorium %herapy April/ 00 th/ 0112 Fair. hypertension. &ith symptom pure motori.4.s sustain the idea o# ( la. memory.4 5. and o8erall #un.>) PQ11x.4 5.ular extrasystole (− .unar lesions is more un#a8ora!le than in patients &ithout su.unar stro7e patients &ith ' silent la.)1 %o stop o# -(.4. 8entri. Sim8astatine ' x ') m. synus rythme Fast 0" : ()5 ( h PP 0" : (?1 Al!umin : (.min 2CFD /in.4. ())( .min 2CFD /in.rel ' x ?5 m. @osartan ' x 5) m.er a.ular 2nsulin 4x3 2= Patient dis. synus rythme April/ 03 th 0112 Fair.tt per min Pira. %hese #indin.etam oral 4x1)) m.4.ondition "$S Cital si.ular extrasystole (− . $lopido. PQ11x.rel ' x ?5 m.5 Centri. et al. $lopido.4.oline inj ( x 5)) m.C22.unar lesion in the head $% s.etam inj 3 x 4 ..5. up "eneral .a tion: .er a. 2CFD Pira.4 5.nosis #or this patient are: Death Disease Dis. I22 dextra =M+ @imited Free @imited Free 4.5 Centri.e #rom hospital.tt per min Pira.ular extrasystole.oline oral (x5)) m. re.ludin. @osartan ' x 5) m.ome in la.C22.4.. $iti. dyslipidemia.')) PQ11x.5 4. $lopido.5.n +.etam inj 3 x 4 .ular extrasystole (− . and three la.unar stro7e entities (De Lon. &ith edu. synus rythme ( h PP 0" : '?* Al!umin : 4.etate () .5. I22 dextra =M+ @imited Free @imited Free 4.lini. Amiodarone drip stop Diet DM '>)) 7alori Physiotherapy '* .rel ' x ?5 m. E 3C5M * 0PQ'3).51 -( 4 @.om#ort Dissatis#a. so the pro.4 5.ontrol to stro7e unit. /e.ranialis E7stremity : Mo8ement Stren. !arthel index '5.4 5.urrent stro7e.oline inj (x5)) m.an #indin.tion Dissa!ility Distitution Follo.>). 0ased on these study. //Q ()x tempQnot #e!rile Paresis +. up Follo.tional out. end. : du!ia ad malam : du!ia ad malam : du!ia ad malam : du!ia ad malam : du!ia ad malam : du!ia ad malam -( 4 @. @osartan ' x 5) m.ram $iti.5 4. Sim8astatine ' x ') m.5.har. I22 dextra =M+ @imited Free @imited Free 4. /e. Sim8astatine ' x ') m..4 5.5 4. dia!etes mellitus.

Manajemen Stro7e Muta7hir. A randomised. E##i.ts o# $iti.haemia. E. -. Med cape Medical Ne! 0ena8ente. 6ara.F. "ancet 3(8)*+38.an Hearth Asso.. E##e.uan Peredaran Darah -ta7 dalam Harsono (ed : Kapita Selekta Neurologi... L.lay. /. %aylor and Fran. L.e Stro7e /is7. ())4. Kumar. !linded.. -ral $iti..holine on Phospholipid and "lutation @e8els in %ans. Dahlan. e8ents ($AP/2E .REFERE!CES Adi!hlata. 0urns.org $AP/2E Steerin.a. L. Stro7e.ute 2s.. @imoa.iation. trokea&a.al Stro7es (SPS4 %rial.is "roup pl. /. Ameri.. $ommittee.+. ())5. Hat. Aliyah. Felix.S. San Antonio. D. Ameri. Mer. /. @ope9.l/&eimer0 1i ea e and 2elated 1ementia .ine and the +ational 2nstitutes o# Hearth. Sa!in.:132*3*. A.7. Sallo&ay... L. $ontinuin.rel 8ersus aspirin in patients at ris7 o# is. $lar7. $. trial o# .her. 1iagno i 3eni 4atologi Stroke 5ntuk Kepentingan 4enanganan Stroke $ang 2a ional. /oman.hemi. National "i#rar$ o% Medicine 0la. Kus&ara. A. =ni8ersity o# %exas Health S.. "o8 $ummin.y and tolera!ility o# Donepe9il in Cas. 0.$.. $o!o. ())4. +ational @i!rary o# Medi. '>>?. Sa. pu!med.s. ". L. S. Stroke 33: 286+-2867 '? . 6uysan.ular Dementia Study "roup.ient $ere!ral 2s. '>>1. ())4.an Stro7e Asso. @ondon. 6. P. Suplemen 0KM I2C Da8alos.. @o9ano. ". ())'.dom. medi..iation. Pratt.ien. "an. Sherman.ya7arta 0ar.. &&&. '>>4.ular dementia. $astillo. +e& Fetter @ane.ondary Pre8ention o# Small Su!.L.. "eldma. @amsudin.@. Dempsey. /. D. %exas. '>>>. ())(.her..ades. E.. /. Perdomo... Statins May /edu.. &ttp:''!!!. Se. Yo. L. DS.L. A. -&e Neurop $c&iatr$ o% . S...al Edu. Medicine Net. "lenpointe $entre 6est.. Amiodarone.7er.. S.. He. Stroke 32: 2376-2381 Anonim.7.ation.M.... %he Donepe9il 4)? Cas. S..A. Stroke.orti. H..e $enter... %eane...lopido.haemi. Martin Dunit9. Com.adal.. "adjah Mada =ni8ersity. L.oline in A. @. Cinters. =nited Kin.h..

@i8in. Hartmann. $allendar . Ameri. A. ".7. 6irt9..orti.ht. K. 0lo..ute 2s. Medi9inis. Fun.y..uideline Stroke..ado..0. '>>*. %he Di8ision o# Endo. @ippin. Sura!aya Sei#ert.ute Small Su!. ())5. Fa.ute Stro7e.iation. Helsin7i =ni8ersity $entral Hospital.rinolo. 6..iation..al 2n#ar. A. State =ni8ersity o# +e& Yor7 at 0u##alo. Department o# +eurolo. =ni8ersity Hospital Maastri. "ra9 Medi.an Heart Asso.ht.etam..M. ())4. ".emia. Stroke 37: 267 Ha. ())(. Ferro. '>>?..hemi. @inds!er.ium. Pendidi7an Kedo7teran 0er7elanjutan. 82)12. Stro7e. Stro7e in Depth B+o& and the Future.. De!erdt. @uderit9. 0one. Maastri. /..L..s. Philadelphia. P.. M. 2n9itari. Stroke 27:8(2-8(6 Santoso.tional -ut. Stroke 36: 363 Perdossi. M. 4rd ed. A. F. $haudhuri. De /eu. Department o# +eurolo.y and 0iostatisti. ". /..stone. +ieder7orn. and A.iation.he =ni8ersitats7lini7 0onn. Stroke 28: 23(7-2362 "ar. A.hemi.7. -re!ro Medi.. Muns.al $enter Hospital.<term Pro. Stroke. 0.. L. L. Ameri.De Lon.hull.unar 2n#ar. Departments o# +eurolo. Clietin.. 2nsulin. Hyper. Stroke 33: 2+72 De deyn. ())3. ())3. '>>4. /.ott 6illiams and 6il7ins. 0iomedi.ome in Patients 6ith @a.. Neurolog$ and Neuro urger$ 9llu trated.ular Extrasystole on 0rain $ir.".nosis o# First<E8er @a. 27: 661-666 Samuelsson. 2e&a#ilita i 4enderita Stroke. and +euros.ulation in Patients &ith $oronary Heart Disease. D. '>>?.d:ance in Neurolog$..P.-.K.y.M.. 0el.y (F.er. Dia!etes and Meta!olism .al.t o# Fre:uent Centri... +e& Yor7. '>>*. Hyper. /. in: 9 c&emic Stroke: . 2. +etherlands. Ant&erp.. /oine. K. ())3. Kelompo7 Studi Sere!ro8as7uler Perdossi.ute 2s. M. Ameri.al =ni8ersity. Soder#eldt.$hur.hler.C.y. Portu.y. =ni8ersity o# Ant&erp.iation.. . Department o# +eurolo. En9in. E##e. -li8eira. Finland. '1 .ly..:781-6.an Heart Asso. Small 8e el 1i ea e !it& "acune .uldade de Medi. Helsin7i. @odder. Hospital de Santa Maria. .unar Stro7es.. %&o %ypes o# @a.. L.y.o9o. S&eden.y. Dandona.6.. Pi.hauer. P.ly.ramme..ien. A. $.. F.an Heart Asso. 7 Kardiol. Department o# +eurolo. 0.. %reatment o# A..ina de @is!oa. Fa9e7as. Dettmers.an Heart Asso.um Helsin7i. P.hted M/2: $lini.tions on Di##usion 6ei.M.. Department o# +eurolo.o.unar 2n#ar. @amassa. -r. Stro7e 6ith Pira. A. ())*. -lsson. Kessels F. L. %.7. Stor.ts.. $.. @on. P.emia in A. and Department o# +eurolo..al Presentation and Aetiolo.h.y. A.endor##.. 0. Ameri.. %o7yo.tion.es Pro. @indsay. La7arta Sal.

First Edition... Philadelphia 6on.ademy o# +eurolo. ".es. @ind.an Heart Asso. ())5. Cere#ro:a cular 1i ea e in Clinical 4ractice. Department o# $lini.an A.Auen!ru..t: @on. S&eden.unar 2n#ar. AustriaJ 3ournal o% Neurolog$. A. Mayo Foundation.P. Hanley and 0el#us. Fei. @a.. @ondon Health S.nosis #or Sur8i8al and /is7 o# /e. Stroke 31:2827 6ie!ers D. E.y se.. +orr8in. =ni8ersity o# 6estern -ntario. %erm Pro.D. 0ro&n /. 0.i. Neuro urger$. '>>?.urrent Stro7e. Department o# +eurolo.al +eurolo. =nited States o# Ameri.a 6ini7ates..-.iation.ren.@.erplat9.es $entre. Ameri.. /o. 4rd ed. Pure Motor Stro7e Presumed @a. @und =ni8ersity Hospital.unar Stro7e..y and Ameri.y.ien.ret..H. L. 2n. ())'. in +eurolo. "roup @td Staa#.. Cere#ro:a cular 1i ea e.al S.in C. eMedicine <ournal '> . ())'. and 4 $c&iatr$ J 0ML Pu!lishin.ien.. Minnesota..hester.

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