MANIFESTASI KLINIK STROKE

CLINICAL DISORDERS
A. ASYMPTOMATIC B. FOCAL BRAIN DYSFUNCTION 1. TRANSIENT ISCHEMIC ATTACK 2. S T R O K E C. VASCULAR DEMENTIA D. HYPERTENSIVE ENCEPHALOPATY

BOTH 4. VERTEBROBASILAR SYSTEM 3. CAROTID SYSTEM 2.TRANSIENT ISCHEMIC ATTACK 1. UNCERTAIN LOCATION 5. POSSIBLE TIA .

STROKE A. TEMPORAL PROFILE 1. INTRACEREBRAL HEMORRHAGE FROM AVM . WORSENING STROKE 3. STABLE STROKE B. SUBARACHNOIDAL HEMORRHAGE (SAH) 4. TYPE OF STROKE 1. IMPROVING STROKE 2. BRAIN INFARCTION 2. BRAIN HEMORRHAGE 3.

OTHER (ANGIOPATHY. LACUNAR 4. ARTERITIS. DLL) . CARDIOEMBOLIC 3. THROMBOTIC 2. CLINICAL CATEGORIES 1. HEMODYNAMIC B.BRAIN INFARCTION A. ATHEROTHROMBOTIC 2. MECHANISM 1. EMBOLIC 3.

BASILER ARTERY c.BRAIN INFARCTION (LANJ. POSTERIOR CEREBRAL ARTERY . MIDDLE CEREBRAL ARTERY c. SYMPTOMS AND SIGNS BY SITE (DISTRIBUTION) 1. VERTEBRAL ARTERY b.) C. ANTERIOR CEREBRAL ARTERY 2. VERTEBROBASILER SYSTEM a. CAROTID ARTERY SYSTEM a. INTERNAL CAROTID ARTERY b.

GENERAL 2. OPHTHALMOSCOPY . HISTORY B. Auscultation 4. NEUROLOGIC 3. VASCULAR : a. PHYSICAL EXAMINATION 1.CLINICAL ASSESSMENT A. Palpation b.

BRAIN INFARCTION • GENERALLY HAVE ONE OR MORE RISK FACTORS • HEADACHE AND VOMITING ARE UNUSUAL AT THE ONSET • DEFICITS MAY CONTINUE TO WORSENING • USUALLY FOCAL DEFICIT WITH CAROTID DISTRIBUTION .

THROMBOTIC – a thrombus is superimposed on an atherosclerotic plaque – precipitated by an abnormality of blood clotting 2. HEMODINAMIC – stenosis or occlusion of the proximal artery – collateral compensatory blood flow inadequate – global cerebral perfusion is decreased (decreased cardiac output) . EMBOLIC – due to occlusion of an artery by an embolus – inadequate collateral blood flow 3.BRAIN INFARCTION MECHANISMS OF ISCHEMIC INFARCTION 1.

SERINGNYA DISERTAI (SUPERIMPOSED) TROMBOSIS – EMBOLIK. DARI LEPASNYA TROMBUS ATAU FRAGMEN PLAK (ARTERY TO ARTERY EMBOLUS) • RIWAYAT TIA (+) DAN BRUIT SERVIKAL (+) . ATHEROTHROMBOTIC • PADA VASKULER ATEROSKLEROTIK ARTERI EKSTRAKRANIAL DAN INTRAKRANIAL UTAMA • PATOMEKANISME TERJADI INFARK OTAK : – PLAK MEMBESAR DAN OKLUSI VASKULER.CLINICAL CATEGORIES 1.

CLINICAL CATEGORIES (LANJ) 2. CARDIOEMBOLIC • DEFISIT FOKAL. DAPAT WORSENING STROKE • DIAGNOSA ATAS DASAR DITEMUKAN SUMBER EMBOLI KARDIAL DAN TRANSKARDIAL :  KARDIAL # FIBRILASI ATRIAL ATAU ATRIAL FLUTTER # INFARK MIOKARD # GAGAL JANTUNG KONGESTIF # KELAINAN KATUP MITRAL DAN AORTIK  TRANSKARDIAL (PARADOXICAL EMBOLIC) # RIGHT TO LEFT CARDIAC SHUNT # SUMBER EMBOLI : TROMBUS VENA PERIFER • INFARK OTAK MULTIPEL ATAU INFARK SISTEMIK .

DISTRIBUSI CABANG ARTERI SEREBRI MEDIA .CLINICAL CATEGORIES (LANJ) 2. CARDIOEMBOLIC • MANIFESTASI KLINIK ISOLATED : # ISOLATED HEMIANPSOA HOMONIM # ISOLATED APHASIA • KOMPLIKASI : INFARK BERDARAH • INFARK PADA DAERAH KORTIKAL.

LACUNAR LESI PADA PENETRATING ARTERIES PADA PERCABANGAN BELOKAN 90O : # ARTERI LENTIKULOSTRIATA # ARTERI BATANG OTAK ARTERI PENETRANS MISKIN SISTEM KOLATERAL OBSTRUKSI VASKULER OK : # ARTERIAL DISEASE (ANGIOPATHY) # TROMBUS # EMBOLI • • • • .CLINICAL CATEGORIES (LANJ) 3.

5 CM)  SINDROMA KLINIK (LOKASI ANATOMIK) : – PURE MOTOR HEMIPARESIS – PURE SENSORY STROKE – ATAXIC HEMIPARESIS – DYSARTHRIA CLUMSY HAND SYNDROME • SINDROMA DAPAT DENGAN IMAGING NORMAL • SINDROMA DAPAT JUGA KARENA PIS KECIL ATAU INFARK KORTIKAL .CLINICAL CATEGORIES (LANJ) 3. LACUNAR • DIAGNOSIS KLINIK BERDASARKAN :  BRAIN IMAGING (LESI < 1.

GAMBARAN KLINIK DITENTUKAN :  LETAK LESI  LUAS LESI .

GAMBARAN KLINIK ARTERI KAROTIS INTERNA  OKLUSI DI SERVIKAL  GMBR KLINIK TAK KHAS  BILA KOLATERAL ADEKUAT  ASIMTOMATIK  BILA SIMTOMATIK : • TIA SAMPAI INFARK LUAS  MEKANISME HEMODINAMIK ARTERY-TO-ARTERY EMBOLIC ATEROTROMBOTIK (PROPAGATION TROMBUS SAMPAI A. SEREBRI MEDIA) .

GAMBARAN KLINIK GEJALA KLINIK :  MONOPARESIS S/D HEMIPARESIS  DENGAN / TANPA HEMIANOPSIA  DISARTRIA DAN DISFASIA  AGNOSIA  HEMIHIPESTESI  AMAUROSIS FUGAX  CERVICAL BRUIT (+) (HIGH-PITCH) .

GAMBARAN KLINIK ARTERI SEREBRI MEDIA LESI PADA BAG.SEREBRI ANTERIOR DAN POSTERIOR)  ETIOLOGI TERSERING : EMBOLIK  GEJALA KLINIK BIASANYA BERAT :  HEMIPLEGIA  HEMIHIPESTESIA  HEMIANOPSIA HOMONIM  CONTALATERAL GAZE PALSY  APHASIA (HEMISFER DOMINAN) . PERTAMA (MI) :  GEJALA KLINIK TERGANTUNG KOLATERAL SIRKULUS WILLISI (A.

GAMBARAN KLINIK ARTERI SEREBRI MEDIA • LESI PADA BATANG ARTERI (ARTERIAL STEM) : GEJALA KLINIK : ¤ DEFISIT MOTORIK KARENA GIANT LACUNE ¤ TERGANTUNG KOLATERAL DIPERMUKAAN OTAK • OKLUSI PADA CABANG ¤ PARTIAL SYNDROME (ISOLATED) .

TERUTAMA TUNGKAI  HEMIHIPESTESI  APRAKSIA (TERUTAMA GAIT APRAXIA)  GANGGUAN FUNGSI LUHUR .GAMBARAN KLINIK ARTERI SEREBRI ANTERIOR GEJALA KLINIK :  HEMIPARESIS.

GAMBARAN KLINIK VERTEBROBASILER SYSTEM MENDARAHI :        MEDULA OBLONGATA PONTIS MESENSEFALON TALAMUS LOBUS OKSIPITALIS TEMPOROCCIPITAL JUNCTION PARIETOOCCIPOITAL JUNCTION .

CEREBELARIS INFERIOR POSTERIOR  LATERAL MEDULLARY INFARCTION  GEJALA KLINIK: • VERTIGO • MUAL / MUNTAH • DISFAGIA • ATAKSIA SEREBELARIS IPSILATERAL • IPSILATERAL HORNER’S SYNDROME •  PAIN AND TEMPERATUR DISCRIMINATION : ≠ IPSILATERAL PADA WAJAH ≠ KONTRALATERAL PADA TUBUH DAN EKSTRIMITAS .GAMBARAN KLINIK ARTERI VERTEBRALIS  OKLUSI A. VERTEBRALIS DAN A.

GAMBARAN KLINIK ARTERI BASILARIS • OKLUSI A. BASILARIS  SATU SISI BO :  LOCALIZED SYNDROME (Sindroma Batang Otak)  ALTERNATING • GEJALA UTAMA :  VERTIGO  NISTAGMUS . BASILARIS :  GGN BATANG OTAK BILATERAL • OKLUSI CABANG A.

GAMBARAN KLINIK ARTERI SEREBRI POSTERIOR  OKLUSI SERINGKALI KARENA EMBOLI  GEJALA KLINIK :  HOMONYMOUS VISUAL FIELD DEFECT :  HEMIANOPSIA  QUADRANOPSIA  DISLEKSIA DAN DISKALKULI (HEMISFER DOMINAN)  SINDROMA LOBUS PARIETALIS (HEMISFER NON-DOMINAN)  BILATERAL :  BUTA KORTIKAL  GANGGUAN TINGKAH LAKU .

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Effects of Stroke Effects depend on area(s) of brain affected Right Hemisphere = Left-sided paralysis = Spatial misperception (falling. dropping things) = Reading difficulty = Impulsiveness = Left-sided neglect = Loss of short-term memory .

Effects of Stroke Effects depend on area(s) of brain affected Left Hemisphere = Right-sided paralysis = Speech/language impairment = Inability to complete tasks without patient instruction = Memory loss .

speech = Bilateral paralysis likely . swallowing. hearing.Effects of Stroke Effects depend on area(s) of brain affected Brain stem = Disruption of breathing = Loss of consciousness = Variable effects on blood pressure = Disruption of eye movements.

vomiting = Disruption of some reflexes. nausea. especially involving head & neck .Effects of Stroke Effects depend on area(s) of brain affected Cerebellum = Balance = Coordination = Dizziness.

Gejala dan Tanda Stroke .

Facial Droop .

Pronater Drift .