STROKE

Intan Purnamasari

STIKes Surya Mitra Husada

Intanpurnamashari@gmail.com

Abstract

Stroke is a disease of acute neurological deficits caused by cerebral vascular disorders

that occur suddenly and cause symptoms and signs that are in accordance with the
affected brain region. Risk factors for stroke that have been identified can be
hypertension, diabetes mellitus, history of stroke before, obesity, and smoking habits.
In addition, there are also several factors suspected to be related to stroke such as
alcohol, hormonal contraception, trauma, and shingles. stroke prevention can by
changing lifestyle, environment, biology, and utilization of health services

Keywords: stroke

1. Background dysfunction caused by vascular

Stroke is a disease of acute neurological disorders and arises suddenly (in a few
deficits caused by sudden cerebral seconds) or fast (within a few hours)
vascular disorders that cause symptoms with symptoms and signs that
and signs that correspond to the affected correspond to the affected focal area of
brain region. Stroke is a serious health the brain.
problem because it is characterized by In general, dysfunction is in the form of
high morbidity and mortality. In hemiparalysis or hemiparesis which is
addition, there is an increasing tendency accompanied by sensory deficits with or
for incidents (Bustan, 2007). without impaired noble function. In
Limitations put forward by WHO Task practice, stroke (English) is commonly
Force in Stroke and Other used as a synonym for Cerebro Vascular
Cerebrovascular Diseases in 1989, Disease (CVD) and the Core Curriculum
clinical stroke is acute neurological of Medical Education in Indonesia

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(KIPD), terming stroke as a disease due
to cerebral circulatory disorders (GPDO).
Regarding the classification of strokes,
many institutions have proposed various
classifications of strokes. As made by
Bank Stroke Data, World Health
Organization (WHO, 1989) and National
Institute of Neurological Disease and
Stroke (NINDS, 1990). Basically the
classification is grouped on the basis of
clinical manifestations, pathological
processes that occur in the brain and
lesions. This is related to a neurological
diagnosis approach that performs
clinical diagnosis, causal diagnosis, and
topical diagnosis (Bustan, 2007).
2. Literature Review
A. Epidemiology
Stroke is found in all age groups, but
most will be found at the age above 55
years. It was found that the incidence of
stroke increased exponentially with
increasing age, where there would be a
100-fold increase in those aged 80-90
years. The incidence of age 80-90 years
is 300 / 10,000 compared to 3 / 10,000
in the age group 30-40 years. Stroke is
found in men compared to women. This
gender variation survives without the
influence of age (Bustan, 2007). But
women, especially women who at
menopause (age 40-55 years) are more
at risk of stroke than men (Utama, 2008).
Stroke cases are increasing in developed
countries such as America, where
obesity and junk food are endemic.
Based on statistical data in America,
every year there are 750,000 new stroke
cases in America. From these data
shows that every 45 minutes, there is
one person in America who has a stroke
(anonym, 2007). In Indonesia, it is
estimated that every year there are
500,000 people affected by stroke,
around 2.5% or 125,000 people die, and
the rest are mild or severe disabilities
(anonym, 2008). Stroke is the third
deadly disease after heart and cancer.
Even according to a survey in 2004,
stroke was the number one killer in
government hospitals throughout
Indonesia (anonym, 2007). The number
of stroke patients in Syaiful Anwar
Hospital (RSSA) Malang was 56 people
in January and 63 people in February
2007. This number increased again in
May to reach 76 people (Bintariadi,
2007). B. Risk Factors In its prevention
efforts it is necessary to identify the
epidemiological characteristics that can
be a risk factor for stroke. This risk
factor causes people to become more
susceptible or easily have a stroke. Risk
factors that have been identified can
include hypertension, diabetes mellitus,
a history of previous stroke, obesity, and
smoking habits. In addition, there are
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also several factors suspected to be
related to stroke such as alcohol,
hormonal contraception, trauma, and
shingles. Some stroke risk factors that
can be mentioned, namely:
1. Age: Rate increases according to age.
2. Race: higher black than white.
3. Sex: male> woman.
4. Hypertension: the highest risk factor
for stroke.
5. Diabetes (> 120mg / 100ml): strong
association, brittle capillaries.
6. Previous heart disease: increased risk
up to 3 x.
7. Atrial fibrilation / TIA: a strong risk
factor.
8. Obesity: inconsistent findings.
9. Cigarettes: no large effects, stiff
capillaries.
10. Cholesterol and triglycerides:
inconsistent.
Among the above risk factors, you can
mention 4 major risk factors from a
stroke:
1. Hypertension
2. Transient ischemic attack
3. Hypercholesterolemia
4. DM
Sidharta (1985) warns
Cerebrovascular Disease is a disease of
people over 50 years of age, because in
those groups there is cerebral
arterioslerosis. Atherosclerosis process
is caused and determined by heredity,
hypertension and way of life. All factors
that determine the onset of stroke
manifestations are known as stroke risk
factors, also known as stroke profiles; so
that people who have a stroke profile are
called stroke prone persons, namely
people who have a tendency to have a
stroke (Bustan, 2007).
B. Clinical Descriptions and Diagnosis
Most cases of stroke occur suddenly,
very quickly and cause brain damage
within minutes (completed stroke). Then
the stroke becomes worse in a few hours
to 1-2 days due to the increasing extent
of brain tissue that dies (stroke in
evolution).
Disease progression is usually (but not
always) interspersed with a stable period,
in which the expansion of dead tissue
stops temporarily or some improvement
occurs. Symptoms of a stroke appear
depending on the part of the brain
affected.
Reading stroke signals can be done by
observing some of the following stroke
symptoms:
a. Weakness or paralysis of the arm or
leg or one side of the body.
that b. Partial loss of vision or hearing.
c. Double vision.
d. Dizzy
e. Speak unclear (rero).
f. It's hard to think or say the right
words.
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g. Not able to recognize parts of the Stroke is divided into two types, namely
body. ischemic stroke and hemorrhagic stroke.
h. Unusual movement. In ischemic stroke, blood flow to the
i. Loss of control of the bladder. brain stops because of atherosclerosis
j. Imbalance (cholesterol buildup in blood vessel
k. Fainted walls) or a blood clot that has blocked a
Diagnosis of stroke is usually based on blood vessel to the brain. Blockage can
the course of the disease and the results occur along arterial blood vessels
of physical examination. Physical leading to the brain. Blood to the brain is
examination can help determine the supplied by two internal carotid arteries
location of damage to the brain. There and two vertebral arteries. These arteries
are two types of imaging (imaging) are branches of the aortic arch of the
techniques for evaluating cases of stroke heart. An atheroma (fatty deposits) can
or cerebrovascular disease (CVD), form in the carotid arteries causing a
namely Computed Tomography decrease in blood flow. This situation is
Scanning (CT Scan) and Magnetic very serious because each carotid artery
Resonance Imaging (MRI). in a normal state gives blood to most of
CT scan is known as the easiest, the brain. Fat deposits can also be
quickest and relatively inexpensive released from the arterial wall and flow
imaging detector for stroke cases. But in in the blood, then clog the smaller
some cases, CT scans are less sensitive arteries.
than MRI, for example in cases of In hemorrhagic strokes, blood vessels
hyperacute stroke. rupture which inhibits normal blood
To strengthen the diagnosis is usually a flow and blood seeps into an area of the
CT scan or MRI examination. Both tests brain and damages it.
can also help determine the cause of a Stroke can also occur if an inflammation
stroke, whether bleeding or brain tumor. or infection causes a narrowing of the
Sometimes angiography is carried out, blood vessels leading to the brain. Drugs
which is the determination of the (such as cocaine and amphetamines) can
arrangement of blood vessels / lymph also narrow blood vessels in the brain
through capilaroscopy or fluoroscopy and cause strokes (anonym, 2007).
(anonym, 2007). D. Prevention
C. Mechanism Among the many risk factors for stroke,
hypertension is considered the most

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important. Intervention against
hypertension proved to be able to
influence the reduction of stroke in the
community. However, efforts to prevent
stroke are not solely aimed
hypertensive strokes. There is
approach that combines the three forms
of prevention efforts with four main
factors that influence disease (lifestyle,
environment, biology, and health
services), (Bustan, 2007).
1. Primary Prevention
a. Lifestyle: stress reduction, low salt,
fat and calorie eating, exercise, no
smoking, and vitamins.
b. Environment: Awareness of work
stress.
c. Biology: Attention to biological risk
factors (gender, family history), effects
of aspirin.
d. Health services: Health Education and
tension checks.
2. Secondary Prevention
a. Lifestyle: Stress management,
low-salt food, stop smoking, lifestyle
adjustments.
b. Environment: Replacement of work if
needed, family counseling.
c. Biology: Treatment that is compliant
and prevents side effects.
d. Health services: Patient education and
evaluation of secondary causes.
3. Tertiary Prevention
a. Lifestyle: Reduction of stress,
moderate exercise, stop smoking.
b. Environment: Take care of security
and safety (first floor house, use
at wheel-chair) and familiy support.
an c. Biology: Compliance with medication,
physical therapy and speech therapy.
d. Health services: Emergency medical
technic, insurance.
E. Countermeasures
Stroke can be treated with the latest
stroke therapy concept. Stroke sufferers
will be saved from death and disability if
treatment is done quickly, precisely and
accurately at the time of the attack,
especially stroke that is not bleeding.
There are several stages of stroke
therapy, especially acute stroke. These
stages include the introduction of
symptoms and signs of stroke by the
patient, family or people around the
patient, a good communication system
between the community and the hospital
and facilities for sending patients to the
hospital. Based on the results of the
study stated that emergency ambulance
services are the most significant
component associated with the speed of
stroke patients arriving at the hospital.
No less important is the triage section of
the emergency department, which must
immediately conduct an evaluation.
patients, including CT scan of the head,
determination of diagnosis and plan of
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treatment, and general treatment 4. References
including surgical procedures if needed Anonym. 2008. Ten Steps to Prevent
(Fadilah, 2004). Stroke. (on line).
(http://www.kompas.com/read/php.
3. Conclusion Accessed 24 October 2018).
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suddenly due to blockage or rupture of Productive Age. (on line).
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of the most serious health problems in 24 October 2018).
modern life today. The number of stroke Bintariadi, B., 2007. Stroke Sufferers in
patients continues to increase every year, RSSA Malang Continue to Increase. (on
not only attacking those who are old, but line). (http://www.tempointeraktif.com.
also young people in productive age. Accessed October 2018).
Research data on treatment of stroke has Bustan, M. N., 2007. Epidemiology of
not been satisfactory even though much Non-Communicable Diseases. Jakarta:
has been achieved, the end result of Rineka Cipta.
treatment if it does not die almost Fadilah, H., 2004. 7 Stages of Acute
always leaves disability. Presumably Stroke Therapy. (on line). (http:
early / early treatment such as //www.redaksibi@gemari.or.id.
prevention is very useful, but must be Retrieved 30 October 2018).
accompanied by the introduction and Utama, S., 2003. Risk of Stroke and
understanding of stroke in all walks of Heart Disease of Menopausal Women.
life and communities in society. (on line). (http://www.pdpersi.co.id.
Accessible 30 October 2018)