Stroke Tinjauan Pustaka1Definisi StrokeSindroma KlinisMendadakDefisit Neurologi Fokal/GlobalLebih dari 24 JamGangguan Peredaran Darah Otak Non Traumatik

(Mansjoer , Suprohaita, Wardhani , Setiowulan , 2000)

2DAPAT DIMODIFIKASI RIWAYAT STROKEHIPERTENSI PENYAKIT JANTUNG DIEBETES MELITUS TIA (Transient Ischemic Attack) HIPERKOLESTEROL OBESITAS MEROKOK

FAKTOR RESIKOTIDAK DAPAT DIMODIFIKASI USIA JENIS KELAMIN GENETIKMadiyono B & Suherman SK (2003)Patofisiologi4PatofisiologiGangguan pasokan darahAliran darah ke otak terputusInfark / Kematian jaringanProses patologik yang mendasari :

Keadaan penyakit pada pembuluh darah itu sendiriBerkurangnya perfusi akibat gangguan status aliran darahAkibat bekuan atau embolus infeksi yang berasal dari jantung atau pembuluh ekstrakraniumTINJAUANPUSTAKAPrice SA & Wilson LM (2006)Setyopranoto (2011)

Gambaran klinis9 2009, American Heart Association. All rights reserved.The 5 Key Stroke Syndromes: Classic Signs Referable to Different Cerebral AreasLeft (Dominant Hemisphere)Left gaze preferenceRight visual field deficitRight hemiparesisRight hemisensory lossRight (Nondominant Hemisphere)Right gaze preferenceLeft visual field deficitLeft hemiparesisLeft hemisensory loss neglect (left hemi-inattention) 2009, American Heart Association. All rights reserved.The 5 Key Stroke Syndromes:Classic Signs Referable to Different Cerebral AreasBrainstemNausea and/or vomitingDiplopia, dysconjugate gaze, gaze palsyDysarthria, dysphagiaVertigo, tinnitusHemiparesis or quadriplegiaSensory loss in hemibody or all 4 limbsDecreased consciousnessHiccups, abnormal respirationsCerebellumTruncal/gait ataxiaLimb ataxia neck stiffness

Large Vessel Stroke SyndromesMCA: Arm>leg weaknessLMCA cognitive: AphasiaRMCA cognitive: Neglect,, topographical difficulty, apraxia, constructional impairment

ACA: Leg>arm weakness, graspCognitive: muteness, perseveration, abulia, disinhibition

PCA: HemianopiaCognitive: memory loss/confusion, alexia

Cerebellum: Ipsilateral ataxia

Abulia - Loss or impairment of the ability to make decisions or act independently

Anosonosia - complete unawareness or denial of a neurologic deficit.

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AphasiaBrocas Expressive aphasia Left posterior inferior frontal gyrus

WernickesReceptive aphasiaPosterior part of the superior temporal gyrusLocated on the dominant side (left) of the brain

Diagnosis dan pemeriksaan14Pemeriksaan FisikDiagnosis dan Pemeriksaan TambahanTatalaksana17Slide Perfect!PowerPoint has new layouts that give you more ways to present your words, images and media.

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18Tatalaksana HipertensiStroke Iskemik

>220/>120Diturunkan 15 % dalam 24 jam pertama 130Gejala Peningkatan TDS > 180MAP > 130Tanpa Gejala Peningkatan OAH IV Kontinu Pantau tiap 5 menitOAH IV KontinuAtau Intermitten Tekanan Perfusi Serebral > 60 mmHg OAH IV KontinuAtauIntermitten TD 160/90MAP 110TDS > 180MAP > 130Tanpa Gejala Peningkatan OAH IV KontinuAtauIntermitten TD 160/90MAP 110PERDOSSI, 2011TEKANAN DARAH SISTOLE140-160Mencegah Resiko Vasospasme160-180NimodipinPERDOSSI, 2011SUBARAKHNOID HEMORAGE

Supportive Therapy Glucose ManagementInfarction size and edema increase with acute and chronic hyperglycemiaHyperglycemia is an independent risk factor for hemorrhage when stroke is treated with t-PAAntiepileptic DrugsSeizures are common after hemorrhagic CVAsICH related seizures are generally non-convulsive and are associated to with higher NIHSS scores, a midline shift, and tend to predict poorer outcomesElevated glucose levels at the time of admission predicts an increased 28 day mortality rate in both diabetic and non-diabetic patients.

Study done by Vespa and collegues done in 2003 showed that 18 / 63 patients ( 28% ) of patients in a neuro ICU seized on EEG within 72 hours of admission ICH stroke guidelines recommend IV medications to quickly stop seizures. Benzos tend to be first line choice, followed by IV phenytoin or fos-phenytoin, Brief period of prophylactic AED therapy has been shown to redice the risk of early seizures esp in patient with lobar hemorrhage. 22KomplikasiDemamHipovolemiaHiperglikemia/HipoglikemiaDekubitusInveksi

PROGNOSIS24Di Indonesia, diperkirakan setiap tahun terjadi 500.000 penduduk terkena serangan stroke, dan sekitar 25% atau 125.000 orang meninggal dan sisanya mengalami cacat ringan atau berat. Sebanyak 28,5% penderita stroke meninggal dunia, sisanya menderita kelumpuhan sebagian maupun total. Hanya 15% saja yang dapat sembuh total dari serangan stroke dan kecacatanTERIMA KASIH