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STROKE APAKAH
ITU?
Definition
WHO 1995
Stroke is any rapid abnormality of the brain functional,
developing clinical symptoms and sign of focal and at
times global with symptoms lasting more than 24
hours or leading to death which is caused by
cerebrovascular disruption.
SUPARJO RUSTAM
SUHARTO
GUS DUR
PEJABAT, KORUPTOR, GURU,
PENGUSAHA, PEGAWAI, BURUH SAMPAI
TUKANG BECAK BAHKAN ANAK-ANAK
Stroke
Stroke is the third most common cause of death
in the developing countries, which is found in all
groups of age, especially in adult age and the
incidence increases with age.
Divided in to
:
1. Haemorrhage : incidence 15-30 %, ICH, SAH
2. Ischaemic
: incidence 70-85 %
direct-costs $ 27 billion
Risk Factors1
Non modifiable
Age
Race
Gender
Family history of stroke.
Risk Factors-2
Modifiable / treatable
NOMINASI STROKE
Diabetes
Obesity
Genetics
Hypertension
Infection?
Atherosclerosis
Age
Gender
Atherothrombotic Manifestations
(MI, Ischemic Stroke, Vascular Death)
American Heart Association. Heart and Stroke Facts: 1997 Statistical Supplement; Wolf. Stroke
1990;21(suppl 2):II-4II-6; Laurila et al. Arterioscler Thromb Vasc Biol 1997;17:2910-2913; Grau et al.
9 Stroke 1997;28:1724-1729; Graham et al. JAMA 1997;277:1775-1781; Brigden. Postgrad Med
1997;101(5):249-262.
Hypertension
Smoking
Diabetes
Hyperlipidemia
Obesity
INCREASED RISK
X 5-10
X2
X2
X 1,5
X 1,5
Ri s k F
a c t or
Ma n a
g em e
nt
Stroke
CONTOH MANULA
YANG SELAMAT
OCCLUSION (50%)
Atheromatous/thrombotic
Large vessel occlusion or stenosis
Branch vessel occlusion or stenosis
Perforating vessel occlusion
Non-ateromatous diseases of the vessel wall
Collagen diseases (RA, SLE)
Vasculitis (temporal arteritis)
Granulomaous vasculitis
Miscellaneous (syphilitic, trauma,sarcoidosis)
EMBOLISATION (25%) from
- Atheromatous plaque in the intra or extracranial arteries
- The heart
- Miscellaneous (fat emboli, air emboli, tumour emboli)
DISEASES OF BLOOD (COAGULOPATHIES, HAEMOGLOBINOPATHIES)
VENOUS THROMBOSIS
DECREASED CEREBRAL PERFUSION
HAEMORRHAGE
Into the brain subtance-parenchymal (15%)
and/or subarachnoid space (5%)
Hypertension
Amyloid vasculopathy
Aneurisma
Arteriovenous malformation
Neoplasm
Coagulation disorder e.g. haemophilia
Anticoagulan therapy
Vasculitis
Drug abuse e.g. cocaine
Trauma
JENIS STROKE
BERDASARKAN WAKTU
STROKE HEMORAGIK
KURANG
DARAH
KECACATAN
PUSAT
KESADARAN
TIDAK SADAR
PUSAT NAFAS
PUSAT JANTUNG
KEMATIAN
STROKE NON
HEMORAGIK
day 1
2
50
20
A.
KECACATAN
SUMBATAN / EMBOLUS
DAERAH
MATI
B.
C.
D.
PENEBALAN DINDING
DAERAH PENUMBRA
(DAERAH SETENGAH MATI)
HARUS DISELAMATKAN
DARAH KENTAL
FISIOTERAPI
KECACATAN DIKURANGI
SEMAKSIMAL MUNGKIN
Penumbra
often
Major Clinical
Manifestations
ofIschemic
Atherothrombosis
stroke
Myocardial
infarction
Transient
ischemic attack
Angina:
Stable
Unstable
Peripheral arterial
disease:
Intermittent claudication
Rest Pain
Gangrene
Necrosis
Normal
Fatty
Streak
Fibrous
Plaque
Atherosclerotic
Plaque
Plaque
Rupture/
Fissure &
Thrombosis
Myocardial
Infarction
Ischemic
Stroke
Clinically Silent
Angina
Transient Ischemic Attack
Claudication/PAD
Critical
Leg
Ischemia
Cardiovascular Death
Increasing Age
3
Atherosclerosis Timeline
Foam
Cells
Fatty
Streak
Intermediate
Atheroma
Lesion
Fibrous Complicated
Plaque Lesion/Rupture
Endothelial dysfunction
From first decade
Thrombosis,
haematoma
ANAMNESIS
ALO ANAMNESIS
AUTOANAMNESIS
KELUHAN UTAMA
ONSET
KWALITAS & KWANTITAS
FAKTOR YANG MEMPERINGAN OR
MEMPERBERAT
KRONOLOGIS
RIWAYAT PENYAKIT DAHULU
SOSEK
Saat onset
Stroke
Stroke non
hemoragik
hemoragik
Sedang aktif
Istirahat
Peringatan (warning)
Nyeri kepala
+++
Kejang
Muntah
PEMERIKSAAN FISIK
Tanda (sign)
Stroke Hemoragik
Stroke Non
Hemoragik
Bradikardi
++ (dari awal)
(hari ke-4)
Udem papil
Sering +
Kaku kuduk
Tanda Kernig,Brudzinski
++
Stroke Hemoragik
Stroke Non
Hemoragik
a. Funduskopi
- tekanan
Meningkat
Normal
- warna
Merah
Jernih
c. Arteriografi
Ada shift
Oklusi
d. CT-Scan
Lesi hiperdens
Lesi hipodens
b. Pungsi lumbal
PEMERIKSAAN
PENUNJANG
Diagnosis Stroke
PEMERIKSAAN PENUNJANG
Tujuan :
-menegakkan diagnosis
-mencari faktor risiko
-mencari faktor penyulit
LABORATORIUM DARAH
-
Rutin
Hematokrit
Masa perdarahan dan pembekuan
Gula Darah I / II
Kolesterol total, HDL, LDL
Trigliserid
Asam urat
Ureum , Kreatinin
Elektrolit
Khusus : - Agregasi trombosit -
Homocysteine
Fibrinogen
- APTT
- D-dimer
- Protein C dan S
2. LUMBAL PUNGSI
- perdarahan sub arahnoid
3. X- FOTO TORAKS
- besar jantung, penyakit paru
4. EKG
- fibrilasi atrium, iskemik/infark jantung
EKOKARDIOGRAFI
- sumber emboli di jantung dan aorta proksimal
5. NEUROSONOGRAFI (TCD)
- stenosis, vaso spasme
6. ANGIOGRAFI SEREBRAL
- AVM, anuerisma
Ya
Stroke perdarahan
intraserebral
Ya
Stroke perdarahan
intraserebral
Ya
Stroke perdarahan
intraserebral
Ya
Ya
Tidak
Penurunan kesadaran (-)
Nyeri kepala (-)
Refleks Babinski (-)
GEJALA/TANDA
1.
KESADARAN
2.
MUNTAH
3.
NYERI KEPALA
4.
TEKANAN DARAH
5.
ATEROMA
a. DM
b. Angina pektoris
c. Klaudikasio
Intermiten
KONSTANTE
6.
PENILAIAN
INDEKS
SKOR
X 2,5
X2
X2
X 10 %
X (-3)
- 12
-12
(0) Tidak
(1) Ya
HASIL SSS
CATATAN
DIAGNOSIS STROKE
ANAMNESIS
PEMERIKSAAN FISIK
PEMERIKSAAN PENUNJANG
GOLD STANDAR PAKAI CT SCAN
BILA TIDAK ADA CT SCAN
GUNAKAN SKORING
DIAGNOSIS STROKE
MRI
KONTRAINDIKASI MRI
Kontra indikasi relatif :
1. Artificial joint
2. Middle ear protesis
3. Corpus alienum/benda-benda logam
4. Hamil muda
Kontra indikasi absolut
1. Terhadap penderita dgn alat pemacu jantung
2. terhadap pend. dgn hemostatic clip (cerebral
aneurysma.