Elizabeth

Infark cerebral
Definisi kematian neuron-neuron, sel glia dan sistem pembuluh darah yang
disebabkan kekurangan oksigen dan nutrisi.
Klasifikasi 1. Infark anoksik, disebabkan kekurangan oksigen, walaupun aliran
darahnya normal, misalnya asphyxia
2. Infark hipoglikemik, terjadi bila kadar glukosa darah dibawah batas
kritis untuk waktu yang lama, misalnya koma hipoglikemik
3. Infark iskemik, terjadi gangguan aliran darah yang menyebabkan
berkurangnya aliran oksigen dan nutrisi
etiologi • Atherosclerotic lesion of MAH
• Combination of atherosclerosis with hypertension
• Chronic ischemic heart disease with rhythm disorders
• Combination of atherosclerosis with diabetes
• Rheumatism, heart abnormalities (inborn and acquired)
• Vasculitis
Tanda & Precursors : transient ischemic attacks in the same region where brain
gejala infarction is developed
Focal signs : depend on localization of the infarction, damaged vessel and
state of collateral blood circulation.
Headache, Vomiting, consciousness disorders
Diagnosis • Before stroke period in the previous history ( TIA in anamnesis )
• The beginning of the stroke is gradual
• Data of somatic and neurological status
• Additional methods of diagnostics

Tatalaksana • To renew blood circulation in zone of ischemia (Actilaza 100 mg I / v

by drops every 2 – 3 hours)
• To correct rheologic and coagulative properties of blood, to improve
microcirculation (use cavinton 20 mg I /v by drops)
• To prevent disorders of cerebral metabolism
• To decrease brain edema
• To treat brain hypoxia

Komplikasi 1. Pembengkakan otak : karena peningkatan volume darah

intravaskuler dalam otak
2. Edema serebri : bertambahnya cairan didalam jaringan otak.
 Subarachnoid Hemorrhage
Etiology: Rupture cerebral
Aneurysm,
Arteriovenous DD: Cephalgia, Brain
Malformation Infection
Treatment: Sleep 15-20o
Sedation ,
Clinical feature Thunderclap pain Analgesic,
“Worst Headache of My Nimodipine 60mg
Life” Hypotension,
Unilateral Hyponatremia:
Nausea Saline 3%
Vomiting Surgery
Photophobia Complication: Acute hemorrhage
Nuchal rigidity reccurence
Encephalopathy Arterial Vasospasm
Acute/ Subacute
Hydrocephalus
Seizure  give
Diagnosis: CT-scan, MRI Phenytoin
Lumbal Puncture 
Red/Green/Yellow,
Pleocytosis
ECG = Inverted T-waves,
Tall U, Short PR
 Hematom epidural Hematom subdural
 Perdarahan terjadi pd lap antra tlg tengkorak dgn  Perdarahan terjadi antara lap dura dgn arakhoid
duramater  Hematom ini perlu trauma dg tenaga > bsr
 Sumber perdarahan adlh robek arteri meningea dibndgkn hematom epi
media

Gejala: Gejala:
• Pean kesadaran singkat, diikuti dgn perbaikan • Kompresi korteks serebri/pergeseran midline
kesadaran yg tdk selalu mecapai level awal,
slnjtnya pean kesadaran kembali bbrp jam
(interval lucid)
• Defisit neurologis (hemiparesis kontralateral,
dilatasi pupil ipsilateral, distres pernapasan,
kematian)

Ct scan: Indikasi pembedahan:

 Lesi bikonveks
 Hematom epidural volume >30cm3
 Midline shift > 0,5cm  Indikasi: pembedahan
 Hematoma subdural >1cm pd titik plg tebal
 Midline shift >0,5cm
 Pe an nilsi GCS ≥ 2 antara wktu cedera sampai
masuk RS
 Pupil asimetris, disertai hlg refleks cahaya
dan/atau TIK >20mmHg

Evakuasi secepatnya pada pas dgn GCS <9 dgn pupil Evaluasi hematoma subdural secepatnya
anisokor
Kapita selekta kedokteran ed 4, jilid 2. Jakarta: Media Aesculapius.2014