 DEFINISI & EPIDEMIOLOGI  PATOFISIOLOGI  ETIOLOGI  GEJALA & TANDA  TATALAKSANA  PROGNOSIS .

TIDAK ADA SEBAB LAIN SELAIN GANGGUAN VASKULER . DAPAT MENYEBABKAN KECACATAN/KEMATIAN. DEFISIT NEUROLOGI FOKAL/GLOBAL YANG TERJADI TIBA-TIBA. BERLANGSUNG 24 JAM ATAU LEBIH.

4 million survivors.000 die from stroke every year in America  Stroke is the third leading cause of death  Stroke is the leading cause of disability in adults  4.7 billion  14% of persons who survive a first stroke or TIA will have another within one year . only 50-75% of stroke survivors regain functional independence  Estimated direct/indirect costs for 2007.000 strokes in 2009  163.$62. 795.

 Every second 32.2 billion neurons  Blockage of one blood vessel will cause ischemia within 5 minutes .9 million neurons die  Every hour 120 million neurons die  Completed stroke: Loss of 1.000 neurons die  Every minute 1.

SAH. Ischemic: embolic or thrombotic  blocked blood flow to the brain  Hemorrhagic: ICH. ruptured cerebral aneurysm  TIA: This is a stroke. although symptoms resolve within an hour .

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“TIME IS BRAIN: Penumbra SAVE THE PENUMBRA” Penumbra is zone of Core reversible ischemia around core of irreversible infarction—salvageable in first few hours after ischemic stroke onset Penumbra damaged by: • Hypoperfusion • Hyperglycemia Clot in • Fever Artery • Seizure .

Penumbra Core CEREBRAL Normal BLOOD 20 function FLOW (ml/100g/min) 15 Neuronal CBF PENUMBRA dysfunction 8-18 10 5 Neuronal CBF CORE death <8 1 2 3 TIME (hours) Identification of penumbra through MRI perfusion-diffusion mismatch or perfusion CT may replace time as the major indication for emergency acute ischemic stroke therapies. .

trouble speaking or understanding  Sudden trouble seeing in one or both eyes  Sudden dizziness. arm or leg. especially on one side of the body  Sudden confusion. Sudden numbness or weakness of the face. loss of balance or coordination or trouble walking  Sudden severe headache with no known cause .

 Decrease level of consciousness  Difficulty with swallowing and secretions  Respiratory distress  Pupil changes  Convulsions .

 High blood pressure  Carotid artery disease  Physical inactivity  Excess alcohol intake  Atrial fibrillation  Diabetes  Heart disease  Smoking  Family history  Prior stroke/TIA  High cholesterol  Obesity .

(If awoke with symptoms. must go by time when last seen normal)  Immediate head CT (check for blood)  Evaluate for tPA administration (review exclusion/inclusion criteria) . tPA=Thrombolytic agent  Document time of symptom onset.

corkscrew. stenting)  Other trials (thrombolytics. hyperglycemia) . neuroprotective. If symptom onset is greater than 3 hrs consider:  Other interventions (IA.

until swallow eval is completed  Anticipate Neurosurgical consult  Possible administration of blood products . 2005 Guidelines update)  NPO. Do not give antithrombotics or anticoagulants  Monitor and treat blood pressure greater than 150/105 (Table 6.

 Aspiration Pneumonia  Urinary infection  DVT  Pulmonary Embolus  Shoulder subluxation  Depression  Malnourishment  Pressure sores  Falls  Seizures .