Ivens - Stroke Haemoragic
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Transcript of Ivens - Stroke Haemoragic
8/13/2019 Ivens - Stroke Haemoragic
http://slidepdf.com/reader/full/ivens-stroke-haemoragic 1/17
REFERAT
STROKE HEMORAGIK
Pembimbing :
dr. Jan Andries Tangkilisan, MARS
Dissn Ole!:
I"ens #asan$"aria Ad!i%ama
&'()*'+'*+'
KEPANITERAAN KLINIK ILMU SARAF
PERIODE 16 April 2010 – 12 Mei 2012
FAKULTAS KEDOKTERA
UNIVERSITAS KRISTEN INDONESIA
Jakarta
8/13/2019 Ivens - Stroke Haemoragic
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2012
I. PE-DAH/A-
Strke !er"paka# pe#$akit %a#%%"a# pere&ara# &ara' tak $a#%
pali#% (eri#% ter)a&i &i a#tara pe#$akit*pe#$akit (ara+ $a#% lai#, Pali#%
(e&ikit (epar"' &ari !a(ala' pe#$akit #e"rl%ik &i r"!a' (akit a&ala'(trke,
Di #e%ara*#e%ara !a)"- (trke a&ala' )"%a pe#$e.a. ke!atia#
#!r ti%a- (etela' pe#$akit )a#t"#% &a# ka#ker, /ala"p"# &apat ter)a&i
pa&a (e!"a "(ia- (trke pa&a "!"!#$a !e#$era#% ra#% &ea(a &a#
i#(i&e#( i#i !e#i#%kat (e("ai &e#%a# kel!pk "(ia $a#% le.i' t"a, Maki#
ti#%%i "(ia- !aki# .a#$ak ke!"#%ki#a# "#t"k !e#&apatka# (trke,
Strke &apat ter)a&i pa&a (etiap "(ia- #a!"# !e#i#%kat &e#%a#
.erta!.a'#$a "(ia, /ala"p"# pe#%eta'"a# kita te#ta#% pat+i(il%i
(trke .erke!.a#% &e#%a# pe(at- #a!"# &i .i&a#% terapi ke!a)"a##$a
la!.a#, Pa&a ta'ap pe#%eta'"a# kita (aat i#i pree#(i !er"paka# a#&ala#
"ta!a &ala! !e#a#%a#i (trke
Strke pa&a &a(ar#$a a&ala' %a#%%"a# +"#%(i tak aki.at kelai#a#
pa&a pere&ara# &ara' le' .er.a%ai (e.a. $a#% erat kaita##$a &e#%a#
.er.a%ai +aktr $a#% !elatar.elaka#%i#$a, a#%%"a# +"#%(i tak ter(e."t
!a#i+e(ta(i (e.a%ai %e)ala kli#i( $a#% &ikel"'ka# le' pe#&erita ata"
kel"ar%a#$a,
Pe#$akit 3ere.ra(k"ler 45VD ata" (trke $a#% !e#$era#%
kel!pk "(ia &iata( 70 ta'"# a&ala' (etiap kelai#a# tak aki.at pr(e(
patl%i pa&a (i(te! pe!."l"' &ara' tak, Pr(e( i#i &apat .er"pa
pe#$"!.ata# l"!e# pe!."l"' &ara' le' tr!.(i( ata" e!.li-
pe3a'#$a &i#&i#% pe!."l"' &ara' tak- per".a'a# per!ea.ilita( &i#&i#%
pe!."l"' &ara' &a# per".a'a# i(k(ita( !a"p"# k"alita( &ara' (e#&iri,
Per".a'a# &i#&i#% pe!."l"' &ara' tak (erta k!p## lai##$a &apat
.er(i+at pri!er kare#a kelai#a# k#%e#ital !a"p"# &e%e#erati+- ata"
(ek"#&er aki.at pr(e( lai#- (eperti pera&a#%a#- arteri(kler(i(- 'iperte#(i
&a# &ia.ete( !elit"(, Kare#a it" pe#$e.a. (trke &a#%at k!plek(,
II. Ana%$mi dan Reglasi O%ak
Otak &iper&ara'i le' &"a pa(a#% arteri $ait" 8 arteri karotis
interna &a# arteri vertebralis.
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Di &ala! r#%%a kra#i"!- kee!pat arteri i#i (ali#% .er'"."#%a#
&a# !e!.e#t"k (i(te! a#a(t!(i(- $ait" Sirkulus Arteri Willisi. D"a
perti%a )ata' &ara' (ere.ral &ialirka# ke (e.a%ia# .e(ar (ere.r"! &a#
&ie#(e+al# !elal"i (i(te! karti(9 &a# (eperti%a (i(a#$a &ialirka# ke
!e&"la .l#%ata- p#(- tak te#%a'- l."( te!pral .a%ia# !e&ial &a#
i#+erir- l."( parietal- l."( k(ipital- &a# (ere.el"! !elal"i (i(te!
erte.rali(,
Arteri karti( i#ter#a .erak'ir pa&a arteri (ere.ri a#terir &a# arteri
(ere.ri !e&ia, Di &ekat ak'ir arteri karti( i#ter#a- &ari pe!."l"' &ara'
i#i kel"ar arteri k!"#ika#( p(terir $a#% .er(at" ke ara' ka"&al &e#%a#
arteri (ere.ri p(terir, Arteri (ere.ri a#terir (ali#% .er'"."#%a# !elal"i
arteri k!"#ika#( a#terir,
Pe!.eria# &ara' ke krtek( (ere.ri ter"ta!a !elal"i 3a.a#%*
3a.a#% krtikal &ari arteri (ere.ri a#terir- arteri (ere.ri !e&ia &a# arteri
(ere.ri p(terir- $a#% !e#3apai krtek( &i &ala! pia!ater, Per!"kaa#
lateral !a(i#%*!a(i#% 'e!i(+eri"! (ere.ri !e#&apatka# &ara' ter"ta!a
&ari arteri (ere.ri !e&ia, Per!"kaa# !e&ial &a# i#+erir 'e!i(+eri"!
(ere.ri &iper&ara'i le' arteri (ere.ri a#terir &a# arteri (ere.ri p(terir,
Arteri (ere.ri a#terir .er)ala# le.i' !e&ial &ari pa#%kal#$a pa&a
arteri karti( i#ter#a- !e#")" ke &ala! +i("ra l#%it"&i#ali( (ere.ri ke
%e#" krp"( 3all("!- &i !a#a arteri i#i .er.elk ke p(terir &ekat
&e#%a# krp"( 3all("!, Arteri (ere.ri a#terir !e#%el"arka# 3a.a#%*
3a.a#%#$a ke l."( +r#tali( !e&i"( &a# l."( parietali(- (erta ke krtek(
$a#% .er&ekata# &i (epa#)a#% per!"kaa# lateral !e&ial &ari l."(*l."(
i#i,Arteri (ere.ri !e&ia- ("at" 3a.a#% ter!i#ali( &ari arteri karti(
i#ter#a- !e!a("ki +i("ra laterali( (ere.ri &a# !e!.a%i &iri !e#)a&i
:
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3a.a#%*3a.a#% krtikal $a#% !e!per&ara'i l."(*l."( +r#tali(-
te!prali(- parietali( &a# k(ipitali(, Pe!."l"'*pe!."l"' #a&i $a#% ke3il-
$ait" arteri le#ti3"l(triata- ti!."l &ari .a%ia# .a(al arteri (ere.ri !e&ia
"#t"k !e!per&ara'i kap("la i#ter#a &a# (tr"kt"r*(tr"kt"r $a#%
.er&ekata#,
Arteri (ere.ri p(terir !"#3"l &ari arteri .a(ilari( pa&a per.ata(a#
r(tral p#ti#"(- lal" !ele#%k"#% ke &r(al &i (ekitar pe&"#3"l"( (ere.ri
(erta !e#%iri!ka# 3a.a#%*3a.a#%#$a ke per!"kaa# !e&ial &a# i#+erir
&ari l."( te!prali( (erta ke l."( k(ipitali( !e&i"(, 5a.a#%*3a.a#%#$a
!elip"ti arteri kalkari#a &a# 3a.a#%*3a.a#% $a#% !e#")" ke tala!"(
p(terir (erta (".tala!"(,
III. DEFE-ISIStrke !e#"r"t &e+i#i(i /;O a&ala' !a#i+e(ta(i kli#ik &ari
%a#%%"a# +"#%(i (ere.ral .aik lkal !a"p"# !e#$el"r"' 4%l.al-
.erla#%("#% 3epat- le.i' &ari 27 )a! ata" .erak'ir &e#%a# !a"t ta#pa
&ite!"ka# pe#$e.a.#$a (elai# %a#%%"a# a(k"ler,
A&ap"# pe#$akit ata" kelai#a# &a# pe#$akit pe!."l"' &ara' tak-
$a#% !e#&a(ari ter)a&i#$a (trke- !i(al#$a arteri(kler(i( tak-
a#e"ri(!a- a#%i!a pe!."l"' &ara' tak &a# (e.a%ai#$a &i(e."t
pe#$akit*pe#$akit pere&ara# &ara' tak 43ere.r(ak"lar &i(ea(e<5VD,
I0. EPIDEMIO/OGI
Di I#&#e(ia (trke !er"paka# (ala' (at" pe#$e.a. ke!atia# &a#
ke3a3ata# #e"rl%i( $a#% "ta!a,
5li++r& R(e &ari I#%%ri( !e!perkiraka# i#(i&e#( (trke
&ike.a#$aka# #e%ara a&ala' (e.e(ar 200 per 100,000 pp"la(i per ta'"#,
I#(i&e#( i#+ark tak &a# per&ara'a# i#tra(ere.ral !e#i#%kat (e("ai &e#%a#
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perta!.a'a# "!"r- (e&a#% per&ara'a# (".arak'#i&al le.i' .a#$ak
ter&apat &i kala#%a# "(ia !"&a,
Se.a%ai pe#$e.a. ke!atia# &a# ke3a3ata#- pe#$akit pere&ara#
&ara' tak !e#e!pati a#%ka $a#% ti#%%a- ter"ta!a pa&a ra#% t"a,
Di#e%ara $a#% tela' !a)" 4U,S,A !e#e!pati ta!pat ke*: (e.a%ai ka"(a
ke!atia# (etela' pe#$akit )a#t"#% kr#er &a# pe#$akit ka#ker,
Dike!"kaka# ter&apat =00,000 (trke .ar" (etiap ta'"##$a &a# 200,000
&ari pa&a#$a !e#i#%%al &"#ia, >ila &i'it"#% &ari (el"r"' (e.a. ke!atia#
&i #e%ara it" !e#&ekati 11?, Perkiraa# preale#(i a&ala' 20 per 1000
pa&a ti#%kat "!"r 7=*=7- 60 per 1000 pa&a %r"p "!"r 6=*@7 ta'"# per
1000 pa&a %r"p "!"r @=*7 ta'"#, Se.a%ai pe#$e.a. !r.i&ita(- (trke
&iperkiraka# ter&apat pa&a 1,6 )"ta pe#&"&"k A!erika- &i!a#a 70?
!e!erl"ka# pela$a#a# k'"("( &e#%a# 10? !e!erl"ka# peraataa ttal,
0. FAKTOR RESIKO
Faktr re(ik .a%i (trke iala' kelai#a# ata" pe#$akit $a#%
!e!."at (e(era#% le.i' re#ta# ter'a&ap (era#%a# (trke,
Faktr*+aktr re(ik ter)a&i#$a (era#%a# (trke ter&iri ata( 2 .a%ia#
$ait" 8
1, Faktr*+aktr re(ik $a#% !a$r
2, Faktr*+aktr re(ikB$a#% !i#r
1, Faktr*+aktr re(ik $a#% k"at 4!a$r
a, Teka#a# &ara' ti#%%i 4'iperte#(i
., Pe#$akit )a#t"#%
• I#+ark !ikar&
• Elektrkar&i%ra! a.#r!al &i(rit!ia- 'ipertr+i .ilik kiri
• Pe#$akit kat"p )a#t"#%
• a%al )a#t"#% k#%e(ti+
3, S"&a' a&a !a#i+e(ta(i arter(kler(i( (e3ara kli#i(
• a#%%"a# pe!."l"' &ara' kr#er 4a#%i#a pe3tri(
• a#%%"a# pe!."l"' &ara' karti(
&, Dia.ete( !elit"(
e, Pli(ite!ia
=
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+, Per#a' !e#&apat (trke
%, Merkk
2, Faktr*+aktr re(ik $a#% le!a' 4!i#r
a, Ka&ar le!ak $a#% ti#%%i &i &ara'
., ;e!atkrit $a#% ti#%%i
3, Ke%e!"ka#
&, Ka&ar a(a! "rat ti#%%i
e, K"ra#% %erak .a&a#<la'ra%a
+, Fi.r#%e# ti#%%i
0I K/ASIFIKASI STROKE
Kla(i+ika(i !&i+ika(i MARS;ALL a&ala' (e.a%ai .erik"t8
1, >er&a(arka# patl%i a#at!i
• Strke i(ke!ik
a, Tr!.(i( (ere.ri
., E!.li (ere.ri
• Strke 'e!ra%ik
a, Per&ara'a# i#tra(ere.ral
., Per&ara'a# (".ara3'#i&
2, >er&a(arka# (ta&i"!<perti!.a#%a# akt"
a, Tra#(ie#t I(3'e!i3 Atta3k 4TIA
., Reer(i.le I(3'e!i3 Ne"rl%i3al De+i3it 4RIND
3, Strke i# el"ti#
&, 5!plete& (trke
:, >er&a(arka# (i(te! pe!."l"' &ara'
a, Si(te! karti(
., Si(te! erte.r – .a(ilar
Kla(i+ika(i (trke .er&a(arka# Sirira) Strke S3re 4SSS
SSS C 42-= ke(a&ara# 42 !"#ta' 42 (akit kepala 40-1
teka#a# &ara' &ia(tl (aar &ata#% – 4: ater!a – 12,
NilaiKe(a&ara# 8 (a&ar
Deliri"!- (t"pr
0
1
6
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Se!ik!a &a# k!a 2
M"#ta'<(akit kepala &ala! &"a )a! 8 ti&ak
a&a
0
1
Ater!<ria$at &ia.ete( 8 ti&ak a&a
1 ata" le.i'
0
1
SSS &ia%#(a
1 Per&ara'a# (ere.ral
G *1 I#+ark (ere.ral
* 1 (a!pai 1 &ia%#(a ti&ak pa(ti %"#aka# k"ra ke!"#%ki#a#<
5T*S3a#
KLASIFIKASI STROKE >ERDASARKAN
ALORITMA STROKE ADJA; MADA
0II. PATOFISIO/OGI STROKE HEMORAGIK
Stroke Hemoragik
@
Penderita stroke akut
• Penuruna
n kesadaran
• Nyeri
Ketiganya atau 2 dariketiganya ada (+)
Stroke perdarahanintraserebral
Tidak
• Penurunankesadaran (+)
• Nyeri kepala
Tidak
• Penurunan
kesadaran (-)
• Nyeri kepala
Stroke perdarahanintraserebral
Stroke iskemik akut
atau stroke infark
Ya
Ya
Ya
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Me#"r"t /;O- &ala! i#ter#a(i#al (ta(ti3ial 3la((i+i3ati# +
&i(ea(e a#& relate& 'ealt' pr.le! 10 t' rei(i#- (trke 'e!ra%ik &i.a%i
ata( 8
• Per&ara'a# I#tra Sere.ral 4PIS
•
Per&ara'a# S". Arak'#i& 4PSA
PERDARAHA- I-TRASERE1RA/ &PIS
• De2inisi
PIS a&ala' pere&ara# $a#% pri!er .era(al &ari pe!."l"' &ara'
&ala! pare#ki! tak &a# ."ka# &i(e.a.ka# le' tra"!a ,
Per&ara'a# i#tra(ee.ral .ia(a#$a ti!."l kare#a pe3a'#$a
!ikra#e"ri(!a 4>err$ a#e"r$(! aki.at 'iperte#(i !ali%#a, ;al i#i
pali#% (eri#% ter)a&i &i &aera' ("krtikal- (ere.el"!- p#( &a# .ata#%
tak, Pere&ara# &i &aera' krtek( le.i' (eri#% &i(e.a.ka# le' (e.a.
lai#- !i(al#$a t"!r tak $a#% .er&ara'- !al+r!a(i pe!."l"' &ara'
tak pri!er !i(al#$a 5#%p'ili3 a#%ipat'$- tetapi &apat )"%a aki.at
'iperte#(i !ali%#a &e#%a# +reke#(i le.i' ke3il &aripa&a per&ara'a#
(".krtikal,
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e)ala #e"rli%ik ti!."l kare#a ek(traa(a(i &ara' ke )ari#%a#
tak $a#% !e#$e.a.ka#, Ak'ir*ak'ir i#i para a'li' .e&a' &i )epa#%
.erpe#&apat .a'a +a(e aal per&ara'a# tak ek(traa(a(i ti&ak
la#%("#% !e#$e.a.ka# #ekr(i(, Pa&a (aat*(aat perta!a- !"#%ki#
&ara' 'a#$a aka# !e#&e(ak )ari#%a# tak ta#pa !er"(ak#$a- kare#a
(aat it" &i+"(i &ara' ke )ari#%a# .el"! ter)a&i
• Pembagian klinis
L$"#&$k &a# S3'e# !e!.a%i PIS !e#"r"t 3epat#$a %e)ala kli#i(
!e!."r"k- (e.a%ai .erik"t 8
• Ak"t &a# 3epat !e!."r"k &ala! 27 )a!
•
S".ak"t- &e#%a# kri(i ter)a&i a#tara : &a# @ 'ari• S".kr#i(- .ila kri(i(#$a @ 'ari
• Pa%$l$gis dan 3a%$2isi$l$gi
@0? ka("( PIS ter)a&i &i kap("la i#ter#a 20? &i +((ap(terir
4.ata#% tak &a# (ere.el"! &a# 10? &i 'e!i(+er 4&il"ar kap("la
i#ter#a, a!.ara# patl%ik !e#"#)"kka# ek(traa(a(i &ara' kare#a
r.ek#$a pe!."l"' &ara' tak- &iik"ti pe!.e#t"ka# e&e!a &ala!
)ari#%a# tak &i(ekitar 'e!at!a,
Aki.at#$a ter)a&i &i(k#ti#"ita( )ari#%a# &a# k!pre(i le'
'e!at!a &a# e&e!a pa&a (tr"kt"r (ekitar ter!a("k pe!."l"' &ara'
tak &a# !e#$e!pitka#< !e#$"!.at#$a- (e'i#%%a ter)a&i p"ka i(ke!i
pa&a )ari#%a# $a#% &ila$a#i#$a, Maka %e)ala kli#i( $a#% ti!."l
.er("!.er &ari &e(tr"k(i )ari#%a# tak- k!pre(i tak- k!pre(i
pe!."l"' &ara' tak<i(ke!i &a# aki.at#$a k!pre(i pa&a )ari#%a#tak lai##$a,
• Ge4ala5ge4ala klinis
e)ala pr&r!al ti&ak )ela(- ke3"ali #$eri kepala kare#a
'iperte#(i, Sera#%a#8 (eri#%kali &i (ia#% 'ari- akt" .e%riat ata"
e!(i<!era', Si+at #$eri kepala- #$eri $a#% 'e.at (ekali, M"al*
!"#ta'- (eri#% ter&apat pa&a per!"laa# (era#%a#, Ke(a&ara#-
.ia(a#$a !e#"r"# &a# 3epat !a("k k!a 46=? ter)a&i k"ra#% &ari
H
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(ete#%a' )a!- 2:? a#tara * 2 )a!- &a# 12 )a!- &a# 12? ter)a&i
(etela' 2 )a!- (a!pai 1H 'ari,
• Tera3i
Kare#a .ia(a#$a pe#&erita .era&a &ala! k!a- !aka pe#%.ata# &i.a%i &ala! pe#%.ata# "!"! &a# pe#%.ata# (pe(i+ik,
• Pe#%.ata# "!"!
Per'atika# pe&!a# .erik"t i#i8
- Napa( )ala# #apa( 'ar"( .e.a( "#t"k !e#)a!i#
keperl"a# k(i%e#
- Dara' &i)a%a a%ar teka#a# &ara' tetap 3"k"p
4ti#%%i "#t"k !e#%alirka# &ara' 4per+"(i ke tak &a# !e#)a%a
k!p(i(i &ara' 402- ;.- %l"k(a tetap pti!al "#t"k
!eta.li(!e tak
- Otak- !e#3e%a' ter)a&i#$a e&e!a tak &a#
ti!."l#$a ke)a#% &e#%a# krtik(teri&- %li(erl ata" !a#itl
"#t"k e&e!a &a# ali"! i, pela#*pela# ter'a&ap ke)a#%*ke)a#%
- i#)al- (al"ra# ke!i' &a# .ala#( 3aira#
&iper'atika#
- a(tri#te(ti#"!- +"#%(i &e+eka(i<pe#3er#aa#
&a##"tri(i )a#%a# &ia.aika#,
2, Pe#%.ata# (pe(i+ik
pe#%.ata# iala' pe#%.ata# ka"(al, Pe#%.ata# ter'a&ap
per&ara'a# &i tak &e#%a# t")"a# 'e!(tati(- !i(al#$a a(a!
tra#ek(a!at 1 %a!<7 )a! i, pela#*pela# (ela!a : !i#%%"-
ke!"&ia# &(i( .era#%("r*a#%("r &it"r"#ka#, K'a(iat#$a a&ala'
a#ti+i.ri#litik- (e'i#%%a !e#3e%a' li(i#$a .ek"a# &ara'- )a&i
!e#3e%a' per&ara'a# "la#%,
PERDARAHA- S1ARAK-OIDA &PSA
• De2inisi
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PSA a&ala' kea&aa# ter&apat#$a<!a("k#$a &ara' ke&ala!
r"a#%a# (".arak'#i&,
Pe!.a%ia#8
1, PSA (p#ta# pri!er- $ak#i
PSA $a#% ."ka# aki.at tra"!a ata" PIS
• PSA (ek"#&er- a&ala' per&ara'a# $a#% .era(al &i l"ar
(".arak'#i&- "!pa!a#$a &ari PIS ata" &ari t"!r tak,
• Ge4ala dan %anda5%anda klinis
1, e)ala pr&r!al8 #$eri
kepala 'e.at perak"t- 'a#$a 10?- H0? ta#pa kel"'a# (akit kepala
2, Ke(a&ara# (eri#% ter%a#%%"
&a# (a#%at .eraria(i &ari tak (a&ar (e.e#tar- (e&ikit &eliri"!
(a!pai k!a
:, e)ala<ta#&a ra#%(a#%a#
!e#i#%eal8 kak" k"&"k- ta#&a ker#i a&a
7, F"#&"( k"li 8 10?
pe#&erita !e#%ala!i e&e!a papil .e.erapa )a! (etela' per&ara'a#,
Seri#% ter&apat per&ara'a# (".'iali& kare#a pe3a'#$a a#e"ri(!a
pa&a a, K!"#ika(i a#terir ata" a, Karti( i#ter#a
=, e)ala*%e)ala #e"rl%ik
+kal8 >er%a#t"#% pa&a lka(i le(i
6, a#%%"a# +"#%(i (ara+
t#!
De!a! (etela' 27 )a! - &e!a! ri#%a# kare#a ra#%(a#%a#
!e#i#%eal &a# &e!a! ti#%%i .ila &ili'atka# 'iptala!"(,
>e%it"p"# !"#ta'- .erkeri#%at- !e#%%i%il &a# takikar&ia- a&a
'"."#%a##$a &e#%a# 'iptala!"(, >ila .erat- !aka ter)a&i ilk"(
peptik"! &i(ertai pe#i#%kata# ka&ar %"la &ara'- %l"k("ria-
al."!i#"ria &a# per".a'a# pa&a EK
• Tera3i
5ara pe#%.ata# $a#% &i%"#aka# "#t"k PIS- &ipakai "#t"k
PSA pa&a +a(e ak"t, Setela' +a(e ak"t leat- &ia#)"rka#
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a#%i!a%ra+i "#t"k !e#3ari le(i 4a#e"ri(!a ata" a#%i!a ("!.er
PSA, >ila &ite!"ka#- !aka .i(a &ilak"ka# pera(i .e&a' (ara+
4klipi#%- li%a(i- &a# (e.a%ai#$a,
0III. GEJA/A5
GEJA/A
STROKE
e)ala $a#% &i(e.a.ka# le' i#+ark ata" per&ara'a#- !a(i#%*
!a(i#% !e#"#)"kka# per.e&aa# $a#% #$ata
1, I#+ark tak
O#(et .ia(a#$a !e#&a&ak- ka&a#%*ka&a#% .erta'ap ata"
&i&a'"l"i TIA, Pe#&erita (eri#% !e#%el"' (akit kepala &i(ertai
!"#ta', U!"!#$a &e+i(it #e"rl%ik &ira(aka# pa&a akt" .a#%"#
ti&"r ata" (e&a#% i(tira'at, I#+ark tak pali#% (eri#% ter)a&i pa&a "(ia
t"a &e#%a# 'iperte#(i ata" "(ia $a#% le.i' !"&a &e#%a# kelai#a#
)a#t"#% (e.a%ai ("!.er e!.li, Pa&a per!"laa# (akit- ke(a&ara#
"!"!#$a ti&ak ter%a#%%", Faktr ri(ik (a#%at .erpera# pa&a i#+ark
tak- &a# aka# !e#i!."lka# 3iri*3iri kli#i( $a#% (e("ai, I#+ark tak
.ia(a#$a ti&ak !e#"#)"kka# kelai#a# pa&a lik"r (ere.r(pi#ali(,
2, Per&ara'a# tak
O#(et (a#%at !e#&a&ak &iik"ti ra(a (akit kepala 'e.at- !"#ta'*
!"#ta' &a# ka&a#%*ka&a#% &i(ertai ke)a#%, Seri#% ter)a&i pa&a
pe#&erita $a#% (e&a#% akti+ ata" e!(i#al, Per&ara'a# tak
"!"!#$a ter)a&i pa&a "(ia t"a ata" (ete#%a' t"a &e#%a# ata" ta#pa
'iperte#(i- ter%a#t"#% &ari +aktr pe#$e.a.#$a, Li"r $a#% .er&ara'
.era(al &ari per&ara'a# ek(tra(ere.ral pri!er ata" per&ara'a#
i#tra(ere.ral $a#% !ere!.a( ke &ala! e#trikel ata" r"a#%a#
(".arak'#i&- i#i aka# !e#i!."lka# %e)ala kak" k"&"k,
Ge4ala 3erdara!an in%raserebral a%a sbarak!n$idal
1, Per&ara'a# &ala! pare#ki! tak i#i a&ala' aki.at pe3a'#$a
!ikra#e"ri(!a le' 'iperte#(i, >ila &ara' !ere!.e( i#trae#trik"ler
ata" ker"a#%a# (".arak'#i&- aka# .er3a!p"r &e#%a# lik"r &a#!era#%(a#% !e#i#%(, >ia(a#$a per&ara'a# i#tra(ere.ral ter)a&i (a#%at
!e#&a&ak pa&a ra#% t"a &e#%a# te#(i ti#%%i, Kare#a )ari#%a# tak
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ter&r#%- !aka ti!."l %e)ala &e+i(it #e"rl%ik $a#% 3epat !e#)a&i
.erat &ala! .e.erapa )a!, Ke(a&ara# !e#"r"# (a!pai k!a- .ila
l"!e &ara' le.i' &ari =0 33, Pa&a (aat per!"laa# per&ara'a#
pe#&erita !era(a (akit kepala 'e.at- !"#ta' &a# ka&a#%*ka&a#%
!e#%ala!i ke)a#%,
2, Per&ara'a# (".arak'#i&al
A#e"ri(!a iala' pele.ara# pe!."l"' &ara' arteri (ete!pat $a#%
(i+at#$a k#%e#ital &i (irk"l"( /illi(i ata" per3a.a#%a# arteri lai#,
A#e"ri(!a .e(ar (eri#% !e#$e.a.ka# (akit kepala k'r#ik ata"
!e#eka# r%a# (ekitar#$a, A#e"ri(!a i#i !"&a' pe3a' pa&a ra#%
$a#% (e&a#% akti+ ata" 'iperte#(i- !e#&a&ak &ira(aka# (akit kepala
'e.at- !"#ta' &a# !"#%ki# pe#"r"#a# ke(a&ara#, Kak" k"&"k
&i(e.a.ka# le' a&a#$a &ara' &ala! lik"r, Kala" a&a &e+i(it
#e"rl%ik +kal- i#i &i(e.a.ka# le' a((pa(!e $a#% .ia(a#$a
ter)a&i .e.erapa 'ari ke!"&ia#, Per&ara'a# (".arak'#i&al i#i
ke.a#$aka# ter)a&i pa&a "(ia :0 – 60 ta'"#, Per&ara'a#
(".arak'#i&al kare#a AVM pe3a'- %e)ala#$a (a!a- 'a#$a le.i'
(eri#% ter&apat pa&a "(ia k"ra#% &ari 20 ta'"#
I6. DIAG-OSA
STROKE
Me#e%akka# &ia%#(a (trke ter%a#t"#% ter"ta!a &ari 8
1, I#ter#preta(i a#a!#e(a $a#% teliti &a# tepat
2, Pe!erik(aa# +i(ik "!"! &a# #e"rl%ik $a#% .aik
:, Melkali(a(i te!pat le(i
7, Me#3ari pe#$e.a. (erta +aktr ri(ik
Anamnesa
A#a!#e(i( &ite!"ka# k"!p"la# kele!a'a# a#%%ta %erak (e.ela'
.a&a#- !e#3#% ata" .i3ara pel- &a# ti&ak &apat .erk!"#ika(i &e#%a#
.aik kea&aa# i#i ti!."l (a#%at !e#&a&ak &apat (eakt" .a#%"# ti&"r-
(e&a#% .eker)a- ata" (eakt" i(tira'at,
Mi(al#$a !"la +aktr*+aktr re(ik $a#% !e#$a#tai (rke- &a#&ilak"ka# pe#3atata# perke!.a#%a# ke(a&ara# (e)ak (era#%a# ter)a&i,
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Pemeriksaan 2isik
De+i(it #e"rl%ik $a#% ("&a' )ela( !"&a' &ike#al ter"ta!a
'e!ipare(i( $a#% )ela(, Selai# it" ter&apat p"la ta#&a*ta#&a pe#%iri#%
'e!ipare(i( $a#% &i#a!aka# ta#&a*ta#&a %a#%%"a# Upper Mtr
Ne"r# 4UMN iala'8
a, T#"( tt pa&a le(i $a#% l"!p"' !e#i#%%i
., Re+lek( te#&# !e#i#%kat pa&a (i(i $a#% l"!p"'
3, Re+lek( patl%i( p(iti+ pa&a (i(i $a#% l"!p"'
Me#%e#al !a#i+e(ta(i (trke $a#% (a#%at ri#%a# a&ala' le.i'
pe#ti#% &aripa&a !e#%e#al 'e!ipare(i( $a#% ("&a' )ela(, Ma#i+e(ta(i
(trke $a#% pali#% ri#%a# (eri#% .er"pa %a#%%"a# keta#%ka(a# %erak !aka
&ari it" "r"ta# pe!erik(aa# ("("#a# !trik (e.a%ai .erik"t 8
• Pe!erik(aa# keta#%ka(a# %erak
• Pe#ilaia# te#a%a tt*tt
• Pe#ilaia# re+lek( te#&#
• Pe#ilaia# re+lek( patl%i(- (eperti8
Re+lek( .a.i#(ki
Re+lek( pppe#'ei!
Re+lek( %r&#
Re+lek( (3'ae+er Re+lek( %#&a &a# lai#*lai#
Pemeriksaan 3enn4ang
De#%a# pe!erik(aa# 5T*S3a# tak- kita &apat le.i' !e!a(tika#
apaka' (trke#$a .er&a(ar ata" i(ke!ik, ;al i#i (a#%at pe#ti#% kare#a
pe#a#%a#a##$a .er.e&a,
Kita !e#%eta'"i .a'a (trke a&ala' %a#%%"a# pa(ka# &ara' &i
tak &a# +aktr $a#% .a#$ak pera#a##$a pa&a pere&ara# &ara' tak a&ala'
)a#t"#%- pe!."l"' &ara' &a# &ara', Pa&a pe!erik(aa# pe#"#)a#% 'al i#i
&iteliti, Dilak"ka# pe!erik(aa# )a#t"#% 4!i(al#$a &e#%a# alat
elektrkar&i%ra!- &a# .ila perl" &e#%a# alat ekkar&i%ra!, Ka&a#%*
ka&a#% &i."t"'ka# p"la pe!erik(aa# pe!."l"' &ara' Dppler,
/ab$ra%$rim :
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• ;e!%l.i#- 'e!atkrit- eritr(it- lek(it- 'it"#% )e#i(- tr!.(it-
!a(a per&ara'a# &a# pe!.ek"a#- la)" e#&ap &ara'
• Ure"!- kreati#i#- +"#%(i 'ati- "ri# le#%kap
• >ila perl"- elektrlit 4#atri"!- kali"! &a# %a( &ara'
• R#t%e# trak(
• Elektrkar&i%ra+i
• A(a! "rat
• Kle(terl- tri%li(eri&
U#t"k !e#&ia%#(i( (trke- k#(e#("( #a(i#al pe#%la'a# (trke &i
I#&#e(ia- 1HHH- a#tara lai# !e#%e!"kaka# 'al .erik"t 8
• Dia%#(i( (trke &ite%akka# .er&a(arka# te!"a# kli#i(
• 5T*S3a# ta#pa k#tra( !er"paka# pe!erik(aa# .ak" e!a( "#t"k
!e#e#t"ka# )e#i( patl%i (trke- lka(i &a# ek(te#(i le(i (erta
!e#$i#%kirka# le(i ## a(k"ler
• P"#%(i l"!.al &apat &ilak"ka# .ila a&a i#&ika(i k'"("(
• MRI &ilak"ka# "#t"k !e#e#t"ka# le(i patl%ik (trke (e3ara
le.i' ta)a!,
• Ne"r(#%ra+i &ilak"ka# "#t"k !e#&etek(i a&a#$a (te#(i(
pe!."l"' &ara' ek(trakra#ial &a# i#trakra#ial &ala! !e!.a#t"
eal"a(i &ia%#(tik- etil%ik- terapi &a# pr%#(tik,
6. PE-7EGAHA- STROKE
>a#$ak pe#&erita (trke $a#% !e#i#%%al- !e#)a&i 3a3at ata" i#ali&
(e"!"r 'i&"p, Strke &apat &i3e%a' (eti&ak*ti&ak#$a &apat &i"#&"rka#
!"#3"l#$a &e#%a# .er.a%ai pe#3e%a'a#- a#tara lai# 8
a, Pe#3e%a'a# pri!er
Me!a($arakatka# %a$a 'i&"p (e'at .e.a( (trke8
• Me#%'i#&ari 8 rkk- (tre(( !e#tal- alk'l- ke%e!"ka#-
k#("!(i %ara! .erle.i'a#- .at*.at %l#%a#
a!+eta!i#- kkai# &a# (e)e#i(#$a
• Me#%"ra#%i8 kle(terl &a# le!ak &ala! !aka#a#
• Me#%e#&alika#8 'iperte#(i- &ia.ete( !elit"(- pe#$akit
)a#t"#% !i(al#$a +i.rila(i atri"!- i#+ark !ikar& ak"t-
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pe#$akit )a#t"#% re"!atik- pe#$akit a(k"lar
ater(klertik lai##$a
., Pe#3e%a'a# (ek"#&er
M&i+ika(i %a$a 'i&"p .ere(ik (trke &a# +aktr re(ik- !i(al#$a8
• ;iperte#(i8 &iet- .at a#ti 'iperte#(i $a#% (e("ai
• Dia.ete( !elit"(8 &iet- .at 'ip%like!ik ral<i#("li#
• Pe#$akit )a#t"#% arit!ia ##al"lar 4a#tika%"la# ral
• Di(lipi&e!ia 8 &iet re#&a' le!ak &a# .at a#ti &i(lipi&e!ia
• >er'e#ti !erkk
• ;i#&ari alk'l- ke%e!"ka# &a# k"ra#% %erak
• ;iper"ri(e!ia8 &iet &a# a#ti'iper"ri(e!ia
2, Meli.atka# pera# (erta kel"ar%a (epti!al !"#%ki#
Pe#3e%a'a# (trke !er"paka# (ala' (at" t")"a# "ta!a &ari
pr%ra! ke(e'ata#, Pe#%e#ala# +aktr re(ik &a# ti#&aka# "#t"k
!e#%'ila#%ka# ata" !e#"r"#ka# .er.a%ai aki.at $a#%
&iti!."lka##$a !er"paka# "pa$a "ta!a %"#a !e#%"ra#%i ti#%kat
ke(akita# &a# ke!atia# $a#% &iaki.atka# le' (trke,
6I. REHA1I/ITASI
T")"a# re'a.ilita(i iala' !e#)a%a ata" !e#i#%katka# ke!a!p"a#
)a(!a#i- r'a#i- ((ial- kea&aa# ek#!i-&a# ke!a!p"a# ker)a (e!a!p"
!"#%ki#, >er.a%ai "(a'a "#t"k !e#3apai t")"a# i#i- &ia#tara#$a9 terapi
+i(ik<+i(iterapi- lati'a# .i3ara-lati'a# !e#tal- terapi k"pa(i- p(ikterapi-
!e!.eri alat .a#t"- rtti pr(tet- la' ra%a,
>e#t"k ti#&aka# $a#% &i(e."t &iata( te#t"#$a &i(e("aika# .erat
ri#%a##$a 3a3at- ke!a!p"a# ata" ti#%kat !e#tal pe#&erita, Pe#a#%a#a#
re'a.ilita(i i#i !er"paka# pe#&ekata# !"lti&i(ipli#,
M.ili(a(i &ilak"ka# (e3epat kea&aa# !e#%ii#ka#, Se3ara
.erta'ap pe#&erita &i("r"'&"&"k pa(i+- &"&"k akti+- .er&iri
&ipapa'-.erala# &ipapa'- .er&iri &e#%a# alat .a#t"- )ala# &e#%a# alat
.a#t"- &a# .ila !"#%ki# .er)ala# !a#&iri, Lati'a# !elak"ka# ke%iata#
(e'ari*'ari (e3ara !a#&iri,
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DAFTAR PSTAKA
1, L"!.a# T.i#% SM- Pr+,DR,&r- Stroke Bencana Peredaran Darah di Otak,
>alai Pe#er.it Fak"la( Ke&ktera# U#ier(ita( I#&#e(ia- Jakarta- 1HH7
2, Guideline Stroke 2004, (eri Keti%a- Kel!pk St"&i Sere.ra(k"ler &a#
Ne"r%eriatri- Per'i!p"#a# Dr, Sp,Sara+ I#&#e(ia PERDOSSI
:, Alia'- A!ir"&i#- F, K"(ara- R, Ari+i# Li!a /a$(a#% Gambaran Umum
Tentang Peredaran Darah Otak , Kapita Selekta Ne"rl%i- a&)a' Ma&a
Pre(( %$akarta 1HH6
7, 5'"(i& J,- Neuroanatomi orelati! dan Neurologi "ung#ional, Jili& 2-
%$akarta- UM Pre((- 1HH:9 ;al 6HH – @17
=, Ma'ar Mar)#- Pri%"#a S- Neurologi lini# Da#ar , Dia# Rak$at
6, L"!.a# T.i#%- SM- Pr+,DR,&r- $Neurogeriatri% >alai Pe#er.it Fak"lta(
Ke&ktera# U#ier(ita( I#&#e(ia- 2001
@, National Stroke &##ication- 'ttp8<<,(trke,r%<
, Stroke' 3ee"(trke3li#i3al 'ttp8<<,repl#&#,a3,"k<p".(<.k(
1@