CEREBRO VASCULAR DISEASE

. CVD is A DISEASE THAT DISTURB

“THE FLOWING OF BLOOD”
INTO THE BRAIN TISSUE
. STROKE IS the MORE POPULAR NAME =
APOPLEXY is THE NOSOLOGIC TERM IN THE
EARLY PART OF CENTURY, meaning TO STRIKE
DOWN, DON’T KNOW THE MECHANISM &
PATHOLOGICAL SUBSTRATE OF THE DISEASE
. CVA = CEREBRO VASCULAR ACCIDENT, IS NOT
EXACTLY CORRECT, IT IS NOT AN ACCIDENT BUT A
DISEASE (arteriosklerosis, aneurisma AVM etc)
 CVD STROKE
CLINICAL MANIFESTION OF DISTURBANCE OF
FOCAL OR GLOBAL CEREBRAL FUNCTION WITH
SUDDEN ONSET, RAPID PROGRESSION TO
MAXIMAL DEFICIT and persist MORE THAN 24
HOURS, OR TERMINATED BY DEATH, WITHOUT
ANY CAUSE EXCEPT VASCULAR

TIA, RIND
Apopleksia cerebri, CVA
ARTERIOSKLEROSIS. ANEURISMA, ANGIOMA
CVD(isease)
-the stressing is: acute & progression to
maximal deficit and persist more than 24 hr
no any cause except VASCULAIR

-TIA: Transient Ischemic Attack, temporary

episode of ischemic neurolofgical defisit that
completely resolves within 24 hours
-RIND: Reversible Ischemic Neurological deficit,
persist longer than 24 hours, but resolves within
3 weeks

THE NEXT STEP AFTER DIAGNOSING STROKE:

AS SOON AS POSSIBLE DECIDE
► HAEMORRHAGE ?
► NON HAEMORRHAGE?
 STROKE UPDATE? STROKE UPDATE?

• The third leading cause of death

• Almost always cause DISABILITY

• Insuffcient treatment

• PREVENTIVE !
 EPIDEMIOLOGY
• 600.000 NEW OR RECURRENT / YEAR (US)
WITH 150.000 DEATH
• IN INDONESIA INCREASING INCIDENCE!
• 200 OF 100.000 POPULATION (ESTIMATED)
• MORE THAN 50% IN NEUROLOGICAL DEPT.
HOSPITAL IN INDONESIA
• 75% - 95% NONHAEMORRHAGE
 PATHOFISIOLOGY
• The Human Brain has a high metabolic demand
for energy. Unlike other organs, the brain uses
only glucose for energy metabolism
• The glucose requirement is about 75-100
mg/min or 125 g/day
• 2 % BW 60 - 65 kg (1300-1400 g)
• 20% CARDIAC OUTPUT
• CBF 800-1000 ml/min
• 10 – 12 sec NO BLOOD ↓ - UNCONSCIOUS
• 2 HOURS - METABOLISM FAILURE →
EDEMA → INFARCT →
PENUMBRA
 PENUMBRA

• DAERAH AREA SEKITAR INFARK YG

BELUM MENGALAMI KERUSAKAN
TOTAL.
• MASIH REVERSIBEL.
• SASARAN/INTERVENSI TERAPETIK/
PENGOBATAN U MENGEMBALIKAN
FUNGSI SEL.
• JENDELA PENGOBATAN !
 THERAPEUTIC WINDOW
JENDELA PENGOBATAN

0 -4- 6 hr : POTENTIAL FULL RECOVERY

6 – 12 hr : POTENSTIAL PARTIAL RECOVERY

12 – 24 hr : POSSIBLE RECOVERY

24 – 36 hr : START OF INFARCTION
THE PATHOFISIOLOGY OF STROKE

TWO SEQUENTIAL PROCESSES:

• (1. )VASCULAR (and) OR CARDIAC
EVENTS
• (2. )HAEMATOLOGICAL: THE
ALTERATION OF CELLULAR AND
CHEMISTRY OF BLOOD
PP
CBF = -----
RCV 1.2.3
– (1) atherothrombosis, embolism from
the heart, atrial fribillation, rheumatic
valvulaar heart disease, other heart
disease that cause lowering of
perfussion pressure, infective
endocarditis, prosthethic heart valves
ect
– (2) hemorheologic factors
 PP (1)
CBF = -----
RCV 1.2.3

PP = CO = BPSYS – BPVN ~ BP (1)

1=Ø cross section of blodd vessel

ARTERIOSKLEROSIS, ARTERITIS (1)
2=λ SPEED, VELOCITY (1)
~length
3=ζ HEMORHEOLOGICAL FACTORS (2)
~VISCOSITY – HYPERVISOSITY, ANEMIA,
LEUKEMIA,
POLICITEMIA, TROMBOCITOSIS,
CHOLESTEROL/LIPID, DM, INFECTION etc
 RCV
ø PENAMPANG

ARTERIOSKLEROSIS
ARTERITIS
λ KECEPATAN ALIRAN ~ PANJANG PEMBULUH
TEKANAN
VOLUME

ζ FAKTOR HEMORHEOLOGI
VISKOSITAS
POLISITEMIA
TROMBOSITOSIS
CHOLESTEROL, GLUCOSA
 Patofisiologi Infark Otak

Iskemia Kerusakan Gangguan Nekrosis

Ca Influk
Membran Sel Sel

Asam lemak bebas

CDP Cholin Asam arakhidonat

Prostaglandin
Thomboksan
lekotrin

Free radical

( Dikutip dari Hacke W. Hennerici M 1991 )

Aterosklerosis
Ischemic Stroke
 PRINSIP PENGOBATAN FAKTOR
HEMOREOLOGI
• Meningkatkan fleksibilitas eritrosit:
OKSIPENTIFILIN
• Menurunkan viskositas plasma (mengatasi
hiperlipidemi, hiperchromocysteinemi, dan
diabetes mellitus)
• Menurunkan agregasi trombosit/platelet
(ASPIRIN, TICLOPIDIN OKSIPENTIFILIN, DLL)
• Mencegah stase darah dan hemokonsentrasi
(melancarkan aliran darah)
 STROKE HIPERTENSI
• HYPERTENSI?
• - MBAP 130 - 140 mmHg
• severe hypertensi
• (syst >220 diast >120)
• - 48 -72 HR after INSULT
• - 12 – 24 hr spontan lowering?
• - the first 4 hr 5 - 10 mmHg
• - 4 hr following 5 - 10 mmHg
• - TARGET 20 - 25% MBAP
 DM

PERHATIKAN KADAR GULA DARAH

KOREKSI BILA:
BSS > 250mG%
HIPOGLIKEMI
 RISK FACTORS
STROKE PRONE
Modifiable.controlable.treatable non-modifiable
ARTERIAL HYPERTENSION AGE
HEART DISEASES RACE
CIGARETTE SMOKING GENDER
DRUGS family history
LIPID
OBESITY, DM
ORAL CONTRACEPTIVES
 CVD AKUT

• 1. HAEMORRAGIA CEREBRI
- HIPERTENSI
- terjadi waktu AKTIVITAS
- KK . 30’
2. EMBOLIA CEREBRI
- ATRIAL FIBRILASI
- KK ± 30’
3. THROMBOSIS CEREBRI
- ARTERIOSKLEROSIS
- TERJADI WAKTU ISTIRAHAT
- TIDAK ADA KK
 LESI TR PY
KELUMPUHAN SEPARO BADAN
N.N. CRANIALES
1. korteks cerebri
• IRITATIF-FOKAL-DEFISIT SENSORIK

2. subkorteks
• KALAU H DOMINAN: AFASI MURNI

3. capsula interna
• HEMIPLEGI TIPIKA
 PENGELOLAAN

• 1. PENCEGAHAN
PERILAKU GAYA HIDUP SEHAT
AKTIVITAS FISIK , BERAT BADAN , GIZI
BERHENTI MEROKOK, HIPERTENSI DLL
PENYALAHGUNAAN OBAT, ALKOHOL, NARKOBA
PENGOBATAN FAKTOR RISIKO

• 2. PENGOBATAN
PRINSIP ETIOLOGI
JENDELA PENGOBATAN, PENUMBRA
LATAR BELAKANG PATOFISIOLOGI CBF F HEMORHEOLOGI
FISIOTERAPI
PERAWATAN
• 3. REHABILITASI
 PENCEGAHAN

● 6 FAKTOR RISIKO:
1. HIPERTENSI
2. MCI
3. AF
4. DM
5. HIPERLIPIDEMIA
6. RIWAYAT TIA

● 4 FAKTOR POLA HIDUP

1. MEROKOK (TINGKATKAN KOGUALITAS,VISKOSITAS)
2. ALKOHOL DAN NARKOBA
3. AKTIVITAS FISIK, BB, Øpinggang ♂90cm ♀80CM
4. DIET
 POLA MAKAN SEHAT
1. BIJI-2AN SERAT LARUT: BERAS MERAH, BULGUR, JAGUNG DAN
GANDUM
2. OAT (HAVERMOUT): MENURUNKAM KADAR CHOLESTEROL TOTAL
DAN LDL, MENURUNKAN TEKANAN DARAH, MENURUNKAN NAFSU
MAKAN (U SARAPAN PAGI, MEMPERLAMBAT PENGOSONGAN
USUS)
3. KACANG KEDELE DAN SEMUA PRODUK OLAHANNYA:
MENURUNKAN LIPID SERUM, CHOLESTEROL TOTAL, LDL DAN TG,
(TIDAK HDL!)
4. KACANG-2AN (KENARI, KACANG MEDE); MENURUNKAN LDL,
MENCEGAH ARTERIOSKELORIS
MEKANISME KERJA: TAMBAH EKSCRESI ASAM EMPEDU,
MEMPERBAIKI ELASTISITAS PEMBULUH DARAH, TINGKATKAN
AKTIVITAS ANTIOKSIDAN.
LAIN-2:
-CEGAH PENINGKATAN HOMOSISTEIN: ASAM FOLAT, VIT B6 B12
-SUSU DGN PROTEIN, CALCIUM, ZINC, B12
-IKAN TUNA, IKAN SALMON (OMEGA3, EPA, DHA):-RISIKO ARITMIA
-BUAH-2AN DAN SAYUR-2AN, PISANG (SUMBER KALIUM), APEL
-TEH HITAM DAN TEH HIJAU (ANTIOKSIDAN)