Presus SNH Afasia

8/9/2019 Presus SNH Afasia

1/31

PRESENTASI KASUS

STROKE NON HEMORAGIK DENGAN AFASIA BROCA

DISUSUN OLEH

NUR ANISAH SYAFITRI SETIAWAN - 20090310151

PEMBIMBING

dr Ard!"#$%"&' S( S

KEPANITERAAN KLINIK ILMU PENYAKIT SYARAF

PROGRAM PENDIDIKAN PROFESI DOKTER

FAKULTAS KEDOKTERAN DAN ILMU KESEHATAN

UNI)ERSITAS MUHAMMADIYAH YOGYAKARTA

RSUD SALATIGA

2015


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11/31

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d 7"$"K r $ (r" # r".!$ ?"r " 9 12@ * r,(" "# "r " "r " %"#6 r "! "#

d #6"# (r! "d!"# $ $ r"#6 F,#6$! , "*" r $ (r" r # ".!$ "d"."&

* ." , "# 6!" "# !# . ,". *(. $' r"(" ,#6$! !#6" "#' r"$" "#66,#6

"7" ,# , * ." , "# !#d" "# d"# $! "( %"#6 d"(" d! r!*" . & *"$%"r" " '

!d !d ' (! !r"# %"#6 r " ! ' ( #!."!"#' d"# ("#d"#6"# *"$" d ("#P r"# , "*" r $ ("r! ".!$ "d"."& ("d" 6!" "# ( *r $ $"# d"#

!# 6r"$! !# r*"$! $ #$ r! %"#6 . !& !#66! !#6 " "##%" Ar " $ * $ ! (r!* r

?"r " 1 $"*("! 3@ r. " ("d" 6!r,$ ( $ $ # r".!$ S #$"$! d"r! $ *," "6!"#

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( #d #6"r"# K r $ ( #d #6"r"# (r!* r ?"r " ;1 d"# ;2@ r ,#6$! $ "6"!

( # r!*" $,"r"' $ d"#6 "# r $ "$ $!"$! ( #d #6"r"# ? r, "*" "r " 22@

d!( r., "# ,# , (r $ $ ( *"&"*"# "r " 22 Br d*"##' d! #". d #6"# "r "7 r#!8 K r $ "$ $!"$! ( #d #6"r"# ( # !#6 ,# , * *"&"*! "&"$" ,8" '

d"# . $! d! d" r"& !#! d"(" * #6" ! " "# ( #,r,#"# & " *"*(,"#

* *"&"*! $ r " * #6 r ! $," , "&"$" $ r " $,.! * #6,."#6 " " " " " ",

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7 r#!8 ,8"("# $ $ r"#6 *,#6 !# $ 8"r" # ! d"# " " "&"$" d"."& #"r'

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!d" "d" *" #"#%" K "d""# !#! r d" d #6"# " "$!" r 8" d!*"#"

*"*(,"# * *"&"*! $ $," , !d" r6"#66, "(! r "d! $,.! "#


21/31


22/31

d! "6!"# * d!,$ 6!r,$ r # ". $,( r! r S ."# , #%" r "d! *,#! "$! d"r! "r "

* r! $,(."* # r "r " * r! (r!* rL #6 ,#6 r . $ d"r! "r " r 8" * .".,! "r " $,(."* # r "r " * r!

(r!* r "*(" #%" r "#66,#6 "7" r&"d"( *,.,$"# # r$! !# r*"$! d!

"r " * r! (r!* r * # "d! !*(,.$ %"#6 * *(r d, $! !8"r" ?$( 8&@

C DEFINIS AFASIAA "$!" "d"."& $," , 6"#66,"# r "&"$" %"#6 d!" ! " "# . & r,$" "#

" A "$!" !d" r*"$, 6"#66,"# ( r * "#6"# "&"$" ?d!$ "$!"@' 6"#66,"#

!8"r" * r! *,r#!' " ",(,# 6"#66,"# r "&"$" $ ,#d r " ! " 6"#66,"#

(! !r"# (r!* r *!$".#%" $ ! r #!"A "$!" * #8" ,( 6"#66,"# r "&"$" $ 8"r" * #% .,r,& 7".",(,#

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* * "8" ?".

$ #d!r!

D ETIOLOGIA "$!" "d"."& $," , "#d" .!#!$ d"# , "# ( #%" ! A "$!" d"(" !* ,.

" ! " 8 d r" " " ", (r $ $ (" . 6! ("d" "r " . ,$ r # ".' *( r".' " ",

("r! ". %"#6 * #6" ,r *"*(,"# r "&"$" %"! , "r " r 8"' "r " 7 r#!8

d"# ".,r %"#6 * #6&, ,#6 "# d,"#%" K d," "r " !#! !"$"#%" r. " d!

& *!$ r !r! " d"# ("d" "#%" "# r"#6 "6!"# & *!$ r !r! * r,(" "#

*(" *"*(,"# r "&"$" d!" ,r

E PATOFISIOLOGIA "$!" r "d! " ! " r,$" "# ("d" "r " ( #6" ,r"# d! " P"d"

*"#,$!"' ,#6$! ( #6" ,r"# "&"$" * #6"."*! ." r".!$"$! & *!$ r !r! "

P"d" ("$! # %"#6 * #6"."*! " "$!" $ "6!"# $"r . $! r. " d! & *!$ r !r!

A "$!" (".!#6 $ r!#6 *,#8,. " ! " $ r ' 8 d r" ("."' ,* r " ' " ",

( #%" ! d 6 # r" ! K r,$" "# !#! r. " ("d" "6!"# " %"#6 * #6" ,r

*"*(,"# r "&"$" %"! , "r " r 8" d"# 7 r#!8Ar " Br 8" " ", "r " ;; d"# ;5 Br "d*"##' r "#66,#6 "7" " "$

( ." $"#""# * r! r !8"r" L $! ("d" "r " !#! " "# * #6" ! " "# r$,.! "#d"."* "r ! ,."$! "(! ( #d r! " !$" * *"&"*! "&"$" d"# ,.!$"#


23/31

Ar " W r#!8 " ", "r " ;1 d"# ;2 Br "d*"##' * r,(" "# "r " $ #$ r!

( # r!*" ,# , !*(,.$ ( #d #6"r"# L $! ("d" "r " !#! " "# * #6" ! " "#

( #,r,#"# & " *"*(,"# * *"&"*! $ r " * #6 r ! $," , "&"$"S 8"r" ,*,* " "$!" *,#8,. " ! " . $! ("d" d," "r " ( #6" ,r"# "&"$"

d! " "$ S ."!# ! , . $! ("d" "r " d!$ ! "r#%" ,6" d"(" * #% " "# " "$!"

r"#$ r ! ". A "$!" ,6" d"(" *,#8,. " ! " . $! ("d" "$! ,.,$ "r ," ,$' %"! ,

( #6&, ,#6 "# "r" "r " Br 8" d"# "r " W r#!8

F KLASIFIKASID"$"r ,# , * #6 ."$! ! "$! " "$!" r"6"*' d!"# "r"#%" "d" %"#6 rd"$"r

("d" *"#!$ $ "$! .!#!$' d!$ r! ,$! "#" *! d"# . $! %"#6 r "#66,#6 "7" "6!

d ' d"# 6" ,#6"# ( #d " "# *"#! $ "$! .!#! d #6"# . $! "#" *!$Ber-asarkan *ani,estasi klinis a,asia -i+e-akan atas

A "$!" !d" ."#8"r " ", # # ., #A "$!" ."#8"r " ", ., #

Ber-asarkan lesi anato*ik a,asia -apat -i+e-akan *en/a-i

Sin rom afasia peri ! sil"ianA "$!" Br 8" ?* r! ' $(r $! @A "$!" W r#!8 ?$ #$ r! ' r $ ( ! @A "$!" #d, $!

Sin rom afasia aerah perbatasan #bor er$one%A "$!" r"#$ r ! ". * r! A "$!" r"#$ r ! ". $ #$ r! A "$!" r"#$ r ! ". 8"*(,r"#

Sin rom afasia subkortikal A "$!" "."*! A "$!" $ r!" ".

Sin rom afasia non ! lokalisasi


24/31

A "$!" "# *! A "$!" 6. ".

S "6"! "* "&"#' "d" %"#6 d!$ , d #6"# ("r" "$!" P"r" "$!" !"."&

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d #6"# " " ."!#' *!$".#%" ,8!#6 d #6"# "# !#6 P"r" "$!" # *! !"."&

* #$, $ ! ,$! $," , ,#%! d #6"# ,#%! ."!#' *!$".#%" !r d #6"# !r

G DIAGNOSISD!"6# $!$ " "$!" !"."& rd"$"r "# "#d" d"# 6 "." .!#!$ %"#6 d! *, "#

("d" ( * r! $""# !$! d"# !7""# S d"#6 "# ( * r! $""# "* "&"# ."!##%"

d!." , "# ,# , * #6 "&,! ( #% " r,$" "# " #%"

"ani,estasi klinisA "$!" !d" ."#8"r P"d" " "$!" !#! , (, " ", .,"r"# !8"r" r " "$ P #d r! "

* #66,#" "# ".!*" ( #d d"# !8"r" d"."* # , $ d r&"#" S r!#6 d!$ r "!

"r ! ,."$! d"# !r"*" !8"r" %"#6 ,r, G"* "r"# .!#!$#%" !"."& +P"$! # "*(" $,.! * *,."! !8"r"P"# "#6 ".!*" $ d! ! ?5 " " " ", ,r"#6 ( r ".!*" @Gr"*" ! " "&"$" r ,r"#6 d"# !d" *(. $Ar ! ,."$! ,*,*#%" r"#66,

Ir"*" !8"r" r6"#66,P *"&"*"# 8, ,( "! ' "(! $,.! * *"&"*! ".!*" %"#6 . !&

*(. $P #6,."#6"# ,r, K *"*(,"# * #"*"!' * #% , #"*" #d" ,r,

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"(! !$! !8"r" !d" r*" #" d"# !d" d"(" d!* #6 r ! "r !#%" P #d r! "

!d" d"(" * #6 r ! "&"$" $ &!#66" !d" d"(" r !8"r" * ".! G"* "r"#

.!#!$#%" !"."& +K .,"r"# !8"r" %"#6 ."#8"r P"# "#6 ".!*" # r*".Ar ! ,."$! d"# !r"*" !8"r" "! T rd"(" ("r" "$!"K *"*(,"# * *"&"*! ( #d #6"r"# d"# * * "8" ,r, R ( !$!$ r6"#66,M #,.!$ ."#8"r "(! !d" "d" "r !

S r"#6 " "$!" %"#6 # #- ., # *,#6 !# " "# * #6" " "# d #6"# !d"."#8"r d"# r 6,#- 6,#+ *"#" r .! S d"#6 "# $ r"#6 " "$!"


25/31

., # *,#6 !# " "# * #6" " "# d #6"# ."#8"r+ r .! * " ", *"#"

$! , "d! 6!*"#" d!" "."#

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",d! ! d"# * * "8" !d" r6"#66, "(! $,.! * #6,#6 "( "# !$! (! !r"#

G"* "r"# .!#!$ " "$!" r 8" !"."& r6"%" " "$!" # # ., #

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."!#"# !#! ( *"&"*"# "&"$" r6"#66, P #d r! " !d" *"*(, * *"&"*!

"&"$" .!$"# d#" ,.!$"# $ &!#66" !" ,6" !d" *"*(, * # "7" d"# !d"

* #6 r ! "(" %"#6 !" $ #d!r! " " "# G"* "r"# .!#!$ " "$!" 7 r#!8 !"."&

r6"%" " "$!" ., #

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"# "r" "r " $ #$ r! ?7 r#!8 @ d #6"# "r " * r! ? r 8"@ L $! !#!

* #% " "# *"*(,"# r "&"$" d"# ( *"&"*"# %"#6 "! "(! d!d"(" !

"d"#%" 6"#66,"# r ( !$! " ", ( #6,."#6"#

A "$!" r"#$ r ! ". D!$ " "# . $! d! $ ! "r (!#66!r"# "r " ( #6" ,r"# "&"$"

P"d" d"$"r#%" " "$!" r"#$ r ! ". d! "#d"! . & r6"#66,#%" ,#6$! r "&"$"

"(! d!d"(" ! r ( !$! "&"$" %"#6 "! d"# r( .!&"r"

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# # ., # ' "(! r ( $! " ", *"*(,"# * #6,."#6#%" "! d"# r( .!&"r"

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7 r#!8 P #d r! " !8"r" # # ., # "(! ,6" d!$ r "! *"*(,"#

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A "$!" "."*! ' d!$ " "# . $! ("d" "."*,$ d"# " "$!" $ r!" ". d!$ " "# . $!

("d" 8"($,."r $ r!" ".' %"#6 d,"#%" ,6" r( r"# d"."* ( #6" ,r"# "&"$"

P"d" d," " "$!" !#! rd"(" "#d" " "$!" "# *!

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6r"*" ! "' d"# !r"*" ."#8"r "(! $ r!#6 r 6,# ! " * #8"r! " " d"#

* #6 #". #"*"


26/31

A "$!" 6. ".' "d"."& # , " "$!" %"#6 (".!#6 r" D!$ " "# . $! %"#6 .,"$

d"# * r,$" $ "6!"# $"r " ", $ *," "r " "&"$" ("d" " K "d""# !#!

d! "#d"! . & !d" "d" ."6! " ", r ,r"#6 $ ".! "&"$" $( # "# d"# * # "d!

r"(" (" "& " " %"#6 d!,8"( "# $ 8"r" r,."#6 ,."#6 P *"&"*"# "&"$"&!."#6 " ", r ,r"#6 R ( !$!' * * "8"' d"# * #,.!$ ,6" r6"#66, r"

A "$!" 6. ". &"*(!r $ ."., d!$ r "! d #6"# & *!("r $ " ", & *!(. 6!"

H PENATALAKSANAAN

P #" "." $"#""# " "$!" r. !& d"&,., d!d"$"r "# ("d" ( #% " #%"'

*!$".#%" $ r ' ( rd"r"&"# " , ' ,* r " ' d"# $ "6"!#%" T!d" "d"

( #"#6"#"# " ", r"(! ,# , " "$!" %"#6 #"r- #"r ! d"# r , !

* #6 " ! S"" !#!' ( #"#6"#"# %"#6 (".!#6 ! ,# , * #6 " ! " "$!"

"d"."& d #6"# * ." , "# r"(! 7!8"r"= !#" 7!8"r" Pr!#$!( ,*,* d"r! r"(!

7!8"r" "d"."&+

T r. ("$ d"r! #!$ r"(! " "$!" %"#6 d!6,#" "#' &"$!.#%" " "# . !& "!

! " !# #$! "$ r"(! d! !#6 " "# D #6"# " " ."!#' &"$!. r"(! " "# . !&

"! ! " ("$! # * ." , "# r"(" $ $! r"(! $ ."*" r"(" &"r!

d! "#d!#6 "# d #6"# * ." , "# "#%" $ $! r"(! d"."* $ &"r! d #6"#

,*."& &"r! %"#6 . !& "#%" (,."

E ! ! "$ r"(! " "$!" " "# * #!#6 " ! " r"(!$ * #66,#" "#

r "6"! # , $ !*,.,$ $ #$ r! S "6"! 8 # &' $ !*,.,$ ",d! d"."*

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d!6,#" "# +

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* #6!# r(r "$! "# "r" r!$ ! d"r! $,"r" d #6"# #"d" * $! %"#6 r d"-

d" Ad" ,6" %"#6 * *!# " ("$! # * #d $ r!($! "# "r ! " " $ ( r ! " "


27/31

Q6 * !r" Q L" !&"#-." !&"# $ ( r ! !#! " "# * * "# , ("$! # * *(r" "#

*"*(,"# *(r & #$! $ * # "r" "( ,$ ("d" ( *"&"*"# *( # #

* $! d"r! "&"$"

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#!$ r"(! !#! * #66,#" "# r "6"! * d".! "$ $ #$ r! T r*"$,

6"* "r-6"* "r d"# *,$! Pr 6r"* !#! d!( r #". "# d ##6"# !#6 " $, "r"#

%"#6 * #!#6 " d"r! !#6 " %"#6 *,d"& !#6 " %"#6 $,.!

Sti*ulation 0 Fas1ilitation T2erap3

#!$ r"(! " "$!" !#! . !& ,$ ("d" $ *"# ! ?"r !@ d"# $!# " $!$ ?$,$,$"#

".!*" @ d"r! "&"$" S !*,.,$ , "*" %"#6 d!6,#" "# $ ."*" r"(! "d"."&

$ !*,.,$ ",d! Pr!#$!( r"(! !#! %"! ,' ( #!#6 " "# *"*(,"# r "&"$" " "#

. !& "! ! " d!." , "# d #6"# ( #6,."#6"#

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D"."* r"(! !#!' ("$! # d!$ d!" "# # $ $ $!". ,# , * *(r" "#

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I#! * r,(" "# # , r"(! (r"6*" ! %"#6 (".!#6 r #". #!$ r"(!

" "$!" !#! r , ,"# * #!#6 " "# *"*(,"# r *,#! "$! d #6"#

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* #%"*("! "# !d -!d * r "

Trans1ranial "a neti1 Sti*ulation 4T"S5

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28/31

" "# $ *" !# 8 (" B r"(" $ ,d! ."& * #,# , "# &"$!. %"#6

* #66 * !r" "# T "(!' *"$!& d!( r., "# $ ,d! %"#6 . !& $"r ,# ,

* * , ! "# ! ! "$ r"(! !#!

I PROGNOSIS

Pr 6# $" &!d,( ,# , ( #d r !" " "$!" r6"# ,#6 ("d" ( #% " " "$!"

S," , ,* r " d"(" d!&, ,#6 "# d #6"# "#6 " &"r"("# &!d,( %"#6 8!.'

$ d"#6 "# " "$!" d #6"# $ r *!# r *,#6 !# * *!.! ! (r 6# $!$ %"#6 $"#6"

"! Pr 6# $!$ &!d,( d! # , "# . & ( #% " " "$!" r$ ,

Pr 6# $!$ $ * ,&"# *"*(,"# r "&"$" r "r!"$!' r6"# ,#6 ("d"

, ,r"# . $! d"# ,*,r $ r " "d""# ,*,* ("$! # S 8"r" ,*,*' ("$! # d #6"#

"#d" .!#!$ %"#6 . !& r!#6"# * *!.! ! *,#6 !#"# $ * ,& %"#6 . !& "!

A "$!" Br 8" $ 8"r" ,#6$! #". * *!.! ! (r 6# $!$ %"#6 . !& "! d"r!("d"

" "$!" W r#!8 T r" &!r' " "$!" " ! " ( #%" ! %"#6 !d" d"(" " ", $,.!

d!$ * ,& "#' *!$".#%" ,* r " ' * *!.! ! !#6 " (r 6# $!$ %"#6 ,r,


29/31

BAB III

PE"BA$ASAN

P"d" ("$! # !#! d!d!"6# $!$ d #6"# $ r # # & * r"6! d #6"# " "$!" r 8"

D!"6# $!$ $ r d! 6" "# rd"$"r "# &"$!. CT S8"# d!*"#" rd"(" 6"* "r"# !# "r

("d" 8"($,." < r#" $!#!$ r" B rd"$"r "# &"$!. $!r!r" $8 r d!d"(" "# &"$!. -;'9 d!*"#"

&"$!. r$ , * #,# , "# $ r !$ *! d"# rd"$"r "# A.6 r! *" G"d "& M"d"

d!d"(" "# &"$!. $ r !$ *!

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