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7/25/2019 Pengayaan Sdh 2
http://slidepdf.com/reader/full/pengayaan-sdh-2 1/27
PENGAYAAN
DIAGNOSIS SUBDURAL HEMATOM
Oleh :
Wahyuni Ramadhani S 1!"1"111#$
%ali& P' 1!"1#1111!
Pem(im(in) :
d*' R+dhiyan Ra,hma-ia*. S/'S
LAB0SM ILMU %EDO%TERAN NEUROLOGI
RSUD DR' SAIUL ANWAR MALANG
A%ULTAS %EDO%TERAN UNI2ERSITAS BRAWI3AYA
MALANG
41!
DATAR ISI
I. PENDAHULUAN 3
II. INSIDENS DAN EPIDEMIOLOGI 4III. ETIOLOGI 5
IV. ANATOMI DAN FISIOLOGI 5V. PATOFISIOLOGI 9
VI. DIAGNOSIS
a. GAMBARAN KLINIS 11
b. PEMERIKSAAN RADIOLOGI 13
1
7/25/2019 Pengayaan Sdh 2
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7/25/2019 Pengayaan Sdh 2
http://slidepdf.com/reader/full/pengayaan-sdh-2 3/27
'&'&#$!a, 7a(! a, $a'a *&%a#- *a'a- b&b&#aa '-,!. T#a!'a a-(-*
'&#!aa, &a"aa, a7a( "a#!#a( *&%-,a &#$! *&&#a "-(a,a,-. T#a!'a (-'b!$
a-ba( a"a,a aa '&a,- a, *&/a#a $a,*!, '&,%a,(a' &a$a. A-ba(,a
"aa( (&#+a"- #a(!# (!$a, (&,)#a ),(!*-) *&#&b#- $a*&#a*- *&#&b#- "a,
&#"a#a%a, -,(#a#a,-a$ *&&#(- *!b"!#a$ %&'a()' &-"!#a$ %&'a()' a(a!
-,(#a*&#&b#a$ %&'a()'. T#a!'a a-(-* -,- "aa( '&,-'b!$a, (&#+a"-,a &$a-,a,
,&!#)$)- a"a *aa( a7a$ &+a"-a, (-'b!$,a &/a/a(a, a"a &'!"-a, %a#- a(a!
ba%a, a"a a*!* a, b&#a( "aa( '&,-'b!$a, &'a(-a,.13
T#a!'a &a$a b-*a '&,-'b!$a, b&#baa- 'a/a' ),"-*- *&ba-a, "-a,(a#a,a
b-*a b&#a%-# "&,a &'a(-a, a, /&a(. U,(! -(! &,&(a%!a, a, '&$!a* (&,(a,
a* 'a,a+&'&, (#a!'a &a$a a'a( "-&#$!a,. Sa$a% *a(! #)*&"!# &,a,a,a,
(#a!'a &a$a a"a$a% &,&aa, "-a,)*-* a, (&a( '&,&,a- ),"-*- "-a-ba(a,
)$&% (#a!'a &a$a. Ra"-)$)- a'a( '&'ba,(! "a$a' %a$ -,-. P&'&#-*aa, #a"-)$)-
(#a!'a &a$a '&,/a!8 1 )() )$)* /#a,-!' (-a )*-*-: 2 ;T */a, &a$a: "a, 3
A,-)#a-.1
L&*- a, "aa( (-'b!$ a"a (#a!'a &a$a2
i' K!$-( &a$a #)b& a(a! '&,a$a'- &#"a#a%a, *!b!(a,
ii' O()()()( "a, (&,") a"a &a$a '&,a$a'- ),(!*-)
iii' P&#"a#a%a, (&#+a"- "- ba7a% a$&a a),&!#)(-a
i5' T!$a, (&,)#a a(a%
5' G&a# )(a <)')*-) *&#&b#-
5i' E"&'a *&#&b#- (#a!'a(-/
5ii' K),(!*-) *&#&b#-
5iii' P&#"a#a%a, *!ba#a%,)-"a$
i6' P&#"a#a%a, &-"!#a$
6' Pe*da*ahan 7u(du*al
Ga'ba#a, %&'a()'a a"a (#a!'a &a$a '&,/a!8
• E-"!#a$ %&'a()'a
• Su(du*al hema-+ma
3
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• K),(!*-) /&#&b#-
S!b"!#a$ %&'a()'a '&#!aa, &#"a#a%a, a, (&#$&(a "- *!b"!#a$ *a/&.
Daa( '&$!a* "- ba-a, %&'-*%&#& '&,-'b!$a, )'#&*- *&#&b#-. P&#"a#a%a,
"aa( b&#a*a$ "a#- #!(!#& "a#- b-"-, 6&-, #!(!#& #a,!$)*-) Pa//%-),- &#$!a*a,
&#"a#a%a, "a#- )**a -a'a(&# "a, b-*a +!a "a#- &#"a#a%a, ),(!*- *&#&b#-.1
I' INSIDENS DAN EPIDEMIOLOGI
S!b"!#a$ %&'a()'a b-*a (&#+a"- a"a *&'!a (a%a !'!# ,a'!, a, (&#*&#-,
-a$a% a"a a*-&, a, b&#!'!# 0=0 (a%!,. Ha$ -,- a#&,a ')b-$-(a* )(a "- "a$a'
(&,)#a '&,-,a( a-ba( a#(#)- *&,-$& "a, '&'!"a%a, $a- (&#+a"-,a #!(!#&
6&-, +-a (&#+a"-,a (#a!'a(-/ a!(. S!b"!#a$ %&'a()'a $&b-% *&#-, (&#+a"-
b&#ba,"-, &-"!#a$ %&'a()'a "a, "-*&#(a- /&"&#a &a$a ),(!*-) b&#ba,"-, #a(!#
(!$a, (&,)#a.>S!b"!#a$ %&'a()'a #),- a"a a"a 12 &# 100000 )#a,
&#(a%!, <F)&$%)$' &( a$. 19>59
II' ETIOLOGI
E(-)$)- *!b"!#a$ %&'a()' -a$a%8
a T#a!'a
b N),(#a!'a(-/8 <Ma#7a$"&# 19=19
• A#(&#-6a*/!$a# 'a$)#'a*-
• H&')#a- "-a(%&*-*
• N&)$a*'a <'&,-,-)'a '&,-,&a$ /a#/-,)'a()*-*
• S),(a, -,(#a/#a,-a$ %-)(&,*-15
• R!(!#& #a,!$a*-) Pa//%-,-
• K),(!*-) /&#&b#-1
Fa()# #-*-)8
• H-&#(&,*-
• Oba()ba(a,<a,(-)a!$a,
• A(%&#)'a10
• U*-a $a,+!(
4
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III' ANATOMI DAN ISIOLOGI
a. LAPISAN DAN MENINGESO(a "-$-,"!,- "a#- /&"&#a )$&% #a'b!( !$-( "a, (!$a, a,
'&'b!,!*,a. Ta,a &#$-,"!,a, -,- )(a a, $&'b!( a, '&'b!a( -(a
*&&#(- a"a,a aa, '!"a% *&a$- (&#&,a /&"&#a "a, '&,a$a'- &#!*aa,. S&$a-,
-(! *&a$- ,&!#), #)*a (-"a "aa( "-&#ba-- $a- <irreversible. ;&"&#a &a$a "aa(
'&,a-ba(a, a,!a, b&#a( a"a *&*&)#a,.4
Ga'ba# 18 Ga'ba#a, $a-*a,$a-*a, a, '&$-,"!,- &a$a
T&a( "- a(a* (&,)#a (&#$&(a a$&a a),&!#)(-a *!a(! +a#-,a, -b#)*a
a"a( a, b&ba* "aa( '&,&#a "aa &!a(a, (#a!'a. D- a,(a#a !$-( "a, a$&a(&#"aa( *!a(! $a-*a, $&'a "a, $a-*a, '&'b#a,& "a$a' a, '&,a,"!,-
&'b!$!%&'b!$!% "a#a% b&*a#. B-$a #)b& &'b!$!%&'b!$!% -,- *!a#
b&#),*(#-*- "a, '&,&baba, &%-$a,a, "a#a% a, '&,-'b!$a, $a*&#a*- a"a
!$-( &a$a. T&a( "- ba7a% a$&a (&#"aa( #!a, *!ba),&!#)(- a, '&,a,"!,
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6&,a &'-*a#-a "a, "-$)-a. P&'b!$!%&'b!$!% -,- "aa( '&'ba7a -,&*- "a#-
!$-( &a$a *a'a- +a!% & "a$a' (&,)#a.4
;a-#a, *&#&b#)*-,a$ "-#)"!*- "- $&*!* )#)-" "a#- $a(&#a$ 3 #" "a, 6&,(#-&$
&4 "a#- )(a "a, "a!, '&$a$!- (-a )#a'-,a "- a(a 6&,(#-&$ 3. I,- 'a*! & "a$a'
#!a, *!ba#a/%,)-" a,(a#a a#a/%,)-" "a, -a "a, b&#!,*- !,(! '&$-,"!,- )(a
"a, (!$a, b&$aa, ab&$.1>
M&,-,&* -a$a% *a$a% *a(! &$-,"!, a, '&$a-*- )(a. K&(-a $a-*a,
'&,-,&* a"a$a% "!#a 'a(&# a#a,)-" "a, -a 'a(&#. Ma*-,'a*-, '&'!,a-
!,*- (&#*&,"-#- "a, *(#!(!#,a b&#b&"a "a#- *(#!(!# $a-,,a.4
D!#a a"a$a% '&'b#a,& $!a# a, $-a( *&'- (#a,*$!/&,( "a, (-"a &$a*(-/.
F!,*-,a !,(!8
1 M&$-,"!,- )(a 2 M&,!(!- *-,!**-,!* 6&,a <a, (&#"-#- a(a* "!#a 'a(&# "a, $a-*a,
&,")(%&$-a$ *a+a(a,a +a#-,a, 6a*/!$a#
3 M&'b&,(! &#-)*(&!' (ab!$a -,(&#,a.
D!#a 'a(&# '&$&a( &#a( "&,a, &#'!aa, "a$a' (&,)#a. ?-a "!#a #)b& "a,
(-"a "-&#ba-- "&,a, *&'!#,a "a, "-b!a( &"a !"a#a aa, (-'b!$ b&#baa-
'a*a$a%.4 D!#a '&'!,a- *!$a- "a#a% a, aa. Ba-a, (&,a% "a, )*(&#-)#
"-*!$a- )$&% a#(&#-a '&,-,&a '&"-a a, b&#/aba, "a#- a#(&#-a 6&(&b#a$-* "a,
a#)(-* -,(&#,a. P&'b!$!% a,(&#-)# "a, &(')-" +!a '&#!aa, /aba, "a#- a#(&#-a
a#)(-* -,(&#,a "a, '&,!$a- )*a a,(&#-)#. A#(&#-a '&,-,&a )*(&#-)# a-! /aba,
"a#- a#(&#-a )*--(a$-* '&'b&a$a, "a#a% & )**a )*(&#-)#.4
R!a, *!b"!#a$ '&#!aa, #!a,a, a, )(&,*-a$. P&#"a#a%a, a,(a#a "!#a
"a, a#a%,)-" "aa( '&,&ba# "&,a, b&ba* "a, %a,a (&#ba(a* )$&% *a7a# a$*
*&#&b#- "a, (&,()#-!'. V&,a6&,a )(a a, '&$&7a(- #!a,a, -,- %a,a '&'!,a-
*&"--( +a#-,a, &,)), "a, '!"a% *&a$- #)b&. A#a/%,)-" a"a$a% '&'b#a,&
%a$!* -b#)*a "a, &$a*(-/ a, (-"a '&,&'&$ a"a "!#a.4 P-a 'a(&# '&,-!(-
),(!# )(a '&,/&$!a, & "a$a' *!$/-.1>
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b. ARTERI INTRA;RANIAL
A#(&#- /a#)(-" -,(&#,a '&'b&a$a, "a#a% & "a&#a% *-#!$a*- *&#&b#a$
a,(&#-)#. A#(&#- 6&#(&b#a$ "a, ba*-$a# '&'b&a$a, "- "a&#a% *-#!$a*- )*(&#-)#. A#(&#-
/a#)(-" &@(&#,a a$-, ba,a '&'b&a$a, "a#a% "- "a&#a% &*(#a#a,-a$ "a,
*(#!(!# $&%&# <&/!a$- a"a "a&#a% )#b-( "a, &,(-, !,(! &'b&a$a, "a#a% "-
'&,-,&a. Ba,a &#(&'!aa, a,a*()')*&* "- a,(a#a a#(&#- a#)(-* &@(&#,a "&,a,
*-#!$a*- a,(&#-)# "a, )*(&#-)#.=
Ga'ba# 28 P&#+a$a,a, A. '&,-,&a '&"-a
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Pa#a a#(&#- '&,-,&a$ '&"-a$ & a(a* '&$&7a(- )#a'&, *-,)*!'. Da$a'
(&,)#a '&$&7a(- $a(&#a$ "a, &'!"-a, ,a- a"a (!$a, (&')#a$ *!a')*a "-
"a$a' a$!# "&,a, 6&,a a, *&*!a-. ;aba, a,(&#-)# '&$&7a(- & a(a* "a, '!,"!#
'&,!+! (-(- "a, /aba, )*(&#-)# '&$&7a(- '!,"!#. I,- '&'a*) "!#a 'a(&# "a,
(!$a,(!$a, (&'!#!, &a$a. S&(&$a% /&"&#a &a$a '!,-, b&#"a#a% !,(!
'&,%a*-$a, *!b"!#a$ &#"a#a%a, &+a$a a, '!,-, (&#(!,"a *&$a'a b&b&#aa
7a(! *&(&$a% /&"&#a.1>
P&#/aba,a, "- "a&#a% )*(&#-)# (&#'a*! a#(&#- )//--(a$. A#(&#- -,-
'&'b&a$a, )()( */a$ "a, "!#a 'a(&# '&$a$!- &#/aba,a, a#(&#- &(#)'a*()-".
A#(&#- '&,-,&a$ '&"-a <9>.24 & a(a* '&$&7a(- a#(&#- (&')#a$ *!&#-/-a$ '&$a$!-
)#a'&, *-,)*!' "a, '&'b&,(! a,!$a#. K&'!"-a, &#/aba,a, )*(&#-)# & a#a%
$a'b"a '&$&7a(- (!$a, (&')#a$ *!a')!*. A#(&#- '&,-,&a$ '&"-a '&'b&a$a,
"!#a 'a(&# "a, "a&#a% "a$a' (&,)#a *&#(a a(&#- )(a$'-!*. A#(&#- (&')#a$
*!&#-/-a$ '&#!aa, &'b&a$ !(a'a */a$. K&'!"-a,,a b&#/aba, "- "a&#a%
#)*-'a$ a#(&#- a*-a$ (#a,*6&#*a$ & )'a(- a#/ &#/aba,a, "- a(a* /#a,-!'.=
I2' PATOISIOLOGI
P&#"a#a%a, (&#+a"- "- a,(a#a "!#a 'a(&# "a, a#a,)-"&a. P&#"a#a%a, "aa( (&#+a"-
a-ba( #)b&,a 6&,a +&'ba(a, <b#-"-, 6&-,* a, '&,%!b!,a, 6&,a "-
&#'!aa, )(a "a, *-,!* 6&,)*!* "- "a$a' "!#a'a(&# a(a! a#&,a #)b&,a
a#a,)-"&a. P&#"a#a%a, a, b&*a# aa, '&,-'b!$a, &+a$a&+a$a a!( '&,&#!a-
%&'a()'a &-"!#a$. P&#"a#a%a, a, (-"a (&#$a$! b&*a# aa, '&'b&! "a, "-
*&-(a#,a aa, (!'b!% +a#-,a, -a( a, '&'b&,(! a*!$a. G!'a$a, "a#a%
$a'ba( $a!, '&,/a-# "a, '&,a#- /a-#a, "a#- *&-(a#,a "a, '&,&'b!,
'&'b&#-a, &+a$a&+a$a *&&#(- (!')# *&#&b#- a#&,a (&a,a, -,(#a/#a,-a$ a,
b&#a,*!# '&,-,a(. G&+a$a&+a$a -,- -a$a% ,&#- &a$a #)#&*- (a+a' &,$-%a(a,
'!,"!# a-ba( &"&'a a-$ a, (&#+a"- (a,"a(a,"a "&-/-( ,&!#)$)- "a&#a% )(a
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a, (&#(&a,. G&+a$a&+a$a -,- (-'b!$ b&#'-,!'-,! %-,a b&#b!$a,b!$a,
*&(&$a% (&#+a"-,a (#a!'a &a$a.2
S!b"!#a$ a!( "a, &*(#a"!#a$ %&'a()'a a$-, *&#-, (&#+a"- a"a )*(
(#a!'a(-. Sa,a( +a#a, "-(&'!a, *!b"!#a$ %&'a()'a a-ba( #!(!#& *&#&b#a$
a,&!#-*'& "a#- a#(&#- /)''!,-/a(-, )*(&#-)#. S!b"!#a$ %&'a()'a +!a b-*a (&#+a"-
aab-$a #!(!#& -*(!$a a#(&#-)6&,)!* "!#a$. K#),- *!b"!#a$ %&'a()'a *&#-,
"-(&'!a, b-$a(&#a$ "a, )#a, (!a a, a$)%)$-/ "-*&#(a- a#(#)- )(a a*-&, "&,a,
&,)ba(a, a,(-)a!$a, a(a! %-"#)*&a$!* *%!,(. M&a,-*'a (&#+a"-,a *!b"!#a$
%&'a()' aab-$a (&#+a"-,a (#a!'a '-,)# b&#!$a,!$a, "- a,(a#a 6&,a )#(-a$
*&%-,a b)/)#.=
T#a!'a &#(a'a '&#)b& *a$a% *a(! 6&,a a, '&$&7a(- #!a,a, *!b"!#a$.
Da$a' > *a'a- 10 %a#- *&(&$a% &#"a#a%a, (&#+a"- "a#a% "-&$-$-,- )$&% '&'b#a,&
-b#)*a. D&,a, a"a,a *&$-*-% (&a,a, )*')(-/ a, 'a'! '&,a#- /a-#a, &
"a$a' %&'a()'a (&#+a"- &#!*aa, *&$*&$ "a#a% "a$a' %&'a()'a. P&,a'ba%a,
!!#a, %&'a()'a -,- a, '&,&baba, &#"a#a%a, $&b-% $a,+!( "&,a, '&#)b&
'&'b#a,& a(a! &'b!$!% "a#a% "- *&&$-$-,,a '&,a'ba% !!#a, "a, (&a,a,
%&'a()'a.4
H&'a()' *!b"!#a$ a!( *&/a#a $-,-* "-ba- '&,+a"- (-a &$)') "!a
&$)') &#(a'a b&#%!b!,a, "&,a, ),(!*- "a, $a*&#a*- ba- a-ba( "a#- b&ba,
b&,(!#a, a(a! b&ba, a*&$&#a*- a, a"a, +!a "-*&b!( *&baa- %&'a()' *!b"!#a$
)'$-a(a. K&$)') &(-a '&#!aa, /&"&#a #-'&# a-ba( "-*#!*- &'b!$!%
&'b!$!% "a#a% "- &#'!aa, %!*!*,a 6&,a6&,a +&'ba(a, a, "-*&baba, )$&%
!,/a,a, *&'a(a "a, b!a, b&ba, b&,(!#a. H&'a()' *!b"!#a$ +!a a"a,a"a,
b-*a "-a-(a, "&,a, &#!*aa, %&'-*(&#- a(a! b-%&'-*(&#- *&&#(- /&"&#a a*),a$
"-!*a &#,a '&'!,a- '&a,-*'& a, *a'a.3
STADIUMSTADIUM DALAM PER?ALANAN ALAMIAH HEMATOMA
SUBDURAL NONLETHAL4
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STADIUM PEN?ELASAN
STADIUM I Da#a% ba#,a &$a (&#*&ba# $!a* "-
&#'!aa, )(a "- ba7a% "!#aSTADIUM II B&!a, "a#a% '&,+a"- $&b-% %-(a' (&ba$
"a, &$a(-,)*a <24 %a#-
STADIUM III B&!a, &/a% "a, *&(&$a% 2 '-,! aa,
ba#,a "a, b&#),*-*(&,*- *&&#(-
'-,a &$!'a* '&*-,
STADIUM IV T&#+a"- )#a,-*a*- a, "-'!$a- "a#-
&'b&,(!a, '&'b#a,& $!a# a, (&ba$
"a, &#a* b&#a*a$ "a#- "!#a "a,'&'b#a,& "a$a' a, (--* "a, a#a,)-".
;a-#a,,a '&,+a"- @a,()#)'-.
STADIUM V O#a,-*a*- *!"a% $&,a b&!a, "aa(
'&,a$a'- a$*--a*- a(a! ba%a,
)*--a*- a(a! "aa( "-*&#a
2' DIAGNOSIS
A' GAMBARAN %LINIS
H&'a()'a *!b"!#a$ "--$-% '&,+a"- (-&(-& a, b&#b&"a "a$a' *-'()'a$)-"a, #),)*-*8 a!( *!ba!( "a, #),-.
1. HEMATOMA SUBDURAL AKUT
H&'a()'a *!b"!#a$ a!( '&,-'b!$a, &+a$a ,&!#)$)-/ &,(-, "a, *&#-!*
"a$a' 24 +a' *a'a- 4= +a' *&(&$a% /&"&#a. S&#-,a$- b&#a-(a, "&,a, (#a!'a )(a
b&#a( %&'a()'a -,- +!a '&'!,a- ')#(a$-(a* a, (-,-. Ga,!a, ,&!#)$)-/
#)#&*- "-*&baba, )$&% (&a,a, a"a +a#-,a, )(a "a, %&#,-a*- ba(a, )(a "a$a'
)#a'&, 'a,!' a, *&$a,+!(,a '&,-'b!$a, (&a,a, a"a ba(a, )(a. K&a"aa,
-,- "&,a, /&a( '&,-'b!$a, b&#%&,(-,a &#,aa*a, "a, %-$a,,a &,!a*aa,
a(a* "&,!( ,a"- "a, (&a,a, "a#a%.4
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2. HEMATOMA SUBDURAL SUBAKUT
H&'a()'a *!b"!#a$ *!ba!( '&,&baba, "&-*-( ,&!#)$)- a, b&#'a,a
"a$a' 7a(! $&b-% "a#- 4= +a' (a- !#a, "a#- "!a '-,! *&(&$a% /&"&#a <S/%7a#(
19=9. S&&#(- %&'a()'a *!b"!#a$ a!( %&'a()'a -,- +!a "-*&baba, )$&%
&#"a#a%a, 6&,a "a$a' #!a,a, *!b"!#a$.4
A,a',&*-* $-,-* a, %a* "a#- &,"&#-(a %&'a()'a *!b"!#a$ *!ba!( a"a$a%
a"a,a (#a!'a &a$a a, '&,&baba, &(-"a*a"a#a, *&$a,+!(,a "--!(-
&#ba-a, *(a(!* ,&!#)$)-/ a, &#$a%a,$a%a,. Na'!, *&(&$a% +a,a 7a(!
(&#(&,(! &,"&#-(a '&'&#$-%a(a, (a,"a(a,"a *(a(!* ,&!#)$)- a, '&'b!#!.
T-,a( &*a"a#a, '!$a- '&,!#!, &#$a%a,$a%a, "a$a' b&b&#aa +a'. D&,a,
'&,-,a(,a (&a,a, -,(#a#a,-a$ *&-#-, &'b&*a#a, %&'a()'a &,"&#-(a "aa(
'&,a$a'- &*!$-(a, !,(! (&(a *a"a# "a, (-"a '&'b&#-a, #&*),* (&#%a"a
#a,*a, b-/a#a 'a!!, ,&#-. S&&#(- %&'a()'a *!b"!#a$ a!( &#&*a#a, -*-
-,(#a/#a,-a$ "a, &,-,a(a, (&a,a, -,(#a/#a,-a$ a, "-*&baba, )$&% a!'!$a*-
"a#a% aa, '&,-'b!$a, %&#,-a*- !,!* a(a! *&,(#a$ "a, '&$&,a- (a,"a(a,"a
,&!#)$)-/ "a#- )'#&*- ba(a, )(a.4
3. HEMATOMA SUBDURAL KRONIK
H&'a()'a *!b"!#a$ #),- (#a!'a )(a a, '&,+a"- &,&bab *a,a(
#-,a, *&%-,a (&#$!aa,. T-'b!$,a &+a$a a"a !'!',a (&#(!,"a b&b&#aa
'-,! b!$a, "a, ba%a, b&b&#aa (a%!, *&(&$a% /&"&#a% &#(a'a.4
Ta,"a "a, &+a$a a"a %&'a()'a *!b"!#a$ #),-* b-a*a,a (-"a *&*--
(-"a (&#$)a$-*a*- "a, "aa( "-*&baba, )$&% #)*&* &,a-( $a-,. B&b&#aa &,"&#-(a
'&,&$!% *a-( &a$a. Ta,"a "a, &+a$a a$-, %a* a"a$a% &#!ba%a, #)#&*-
"a$a' (-,a( &*a"a#a, (&#'a*! aa(- $&(a#- "a, b&#!#a,,a &#%a(-a, "a,
'&,!#!,,a &'a'!a, !,(! '&'&#!,aa, &'a'!a, ),-(- a, $&b-%
(-,-. H&'-a,)*-a %&'-a#&*-* "a, &$a-,a, !-$ "-(&'!a, !#a, "a#- 50C
a*!*. B-$a (&#"aa( aa*-a a"a !'!',a (-& a,)'- a-(! aa*-a $a,/a# "&,a,
&,!$a,a, "a, &,&#(-a, <;)%&, &( a$. 19=34
11
7/25/2019 Pengayaan Sdh 2
http://slidepdf.com/reader/full/pengayaan-sdh-2 12/27
B' PEMERI%SAAN RADIOLOGI
1. PEMERIKSAAN SKEN KOMPUTER TOMOGRAFI OTAK <;TS;AN
P&'&#-*aa, -,- '&#!aa, '&()"& "-a,)*(-/ *(a,"a# (&#-$-% < gold
standard !,(! a*!* /&"&#a &a$a "a, #)*&"!# -,- (-"a b&#*-a( -,6a*-6& +!a
'&'-$-- &%a,"a$a, a, (-,-. Da#- &'&#-*aa, -,- "aa( "-&#)$&% -,#'a*- a,
$&b-% +&$a* (&,(a, $)a*- "a, a"a,a &#"a#a%a, -,(#a/#a,-a$ &"&'a ),(!*- !"a#a
b&,"a a*-, -,(#a/#a,-a$ *&#(a &#&*&#a, *(#!(!# "- "a$a' #),a (&,)#a.3
A"a &,"aa( a, '&,a(aa, &'&#-*aa, ;T*/a, *&$&a* &+a"-a, aa,
'&'b&#-a, &!(!*a, a, ,&a(-6&. Na'!, -,*-"&,* '&,!,+!a, *a,a( #&,"a%
a-(! 0.02C. O$&% &#a,a -(! -,"-a*- ;T*/a, a"a &'&#-*aa, (#-a& "aa(
"-&#/aa- 100C.13
;T */a, &a$a "aa( "-b!a( "a$a' "!a 7-,")7 $&6&$ a-(!8 7-,")7 +a#-,a,
<7-,")7 ,)#'a$ !,(! '&$-%a( %&'a()'a -,(#a "a, &*(#a#a,-a$: 7-,")7 (!$a,
!,(! '&$-%a( #a(!# ,&!#)/#a,-!' 'aa!!, 6-*/&#)/#a,-!'. D&,*-(a* $&*- "aa(
"-ba- a(a* %-% "&,*-( a(a! %-&#"&,* -*)"&,*-(- "a, $)7 "&,*-( a(a! %-)"&,*&.1
D&,*-(a* ,)#'a$ )(a -a$a% 1= 30 H.5
P&#b&"aa, a'ba#a, *&, /)'!(&# ()')#a- a,(a#a $&*- a!( *!ba!( "a,
#),-* aa *!$-(. K&ba,aa, %&'a()' b&#&'ba, *&&#a *&(&$a% /&"&#a (&(a- a"a
+!a a, ba#! (-'b!$ &'!"-a, *a'a- *a(! '-,!.3
Pa"a %&'a()'a *!b"!#a$ a!( (a'a a'ba#a, hyperdens sickle <*&&#(-
b!$a, *ab-( "&a( (ab!$a -,(&#,a (&#a"a, *!$-( "-b&"aa, "&,a, %&'a()'a
&-"!#a$. Ba(a* '&"-a$ %&'a()' b&#&#--. A"a,a %&'a()'a "- "a&#a% -**!#&
-,(&#%&'-*&# "a, (&,()#-!' +!a '&,!,+!aN a"a,a %&'a()'a *!b"!#a$.1 U!#a,
"&,*-(a* %-&#"&,* -a$a% -#a-#a 50 0 H. B&#b&"a a"a a*-&, a, '&,a$a'-
a,&'-a b&#a( a(a! &%-$a,a, "a#a% 'a**-6& <%&#a!( *!b"!#a$ %&'a()'a aa,
'&,a$a'- -*)"&,* a(a! %-)"&,*.5
12
7/25/2019 Pengayaan Sdh 2
http://slidepdf.com/reader/full/pengayaan-sdh-2 13/27
Ga'ba#a, ;T S/a, !,(! %&'a()' *!b"!#a$ #),- -a$a% )'$&*
&#$&a(a, (#a,*!"a*- a$*--a*- a, "-*&baba, )$&% b&#'a/a''a/a'
&#!ba%a, )$&% a#&,a -(! (-"a a"a )$a (&#(&,(!. Ta'a +!a a#&a %-)"&,*
-*)"&,* a(a! *&"--( %-&#"&,* b&#b&,(! b-),6&* b&#ba(a* (&a* '&$&a( a"a
(ab!$a. ?a"- #-,*-,a a'ba#a, %&'a()'a *!b"!#a$ a!( a"a$a% %-&#"&,*.
S&'a-, $a'a "&,*-(a* -,- *&'a-, '&,!#!, *&%-,a '&,+a"- -*)"&,*& ba%a,
a%-#,a '&,+a"- %-)"&,*.1
13
Ga'ba# 48 Ga'ba#a, *!b"!#a$ %&'a()'a
*&(&$a% 3 '-,!. G!'a$a, "a#a% (&$a%(&#*&#a "a, "&,*-( #&,"a%.10
Ga'ba# 38 Ga'ba#a, /#&*/&,( *%a&
a, %-&#"&,* "a, b-$a(&#a$
7/25/2019 Pengayaan Sdh 2
http://slidepdf.com/reader/full/pengayaan-sdh-2 14/27
A"a 4 'a/a' (a'-$a, ;T*/a, !,(! H&'a()'a *!b"!#a$ #),- a-(!81. T-& I H-)"&,* #),- *!b"!#a$ H&'a()'a
2. T-& II K#),- *!b"!#a$ %&'a()'a "&,*-(a* -,%)')&,
3. T-& III I*)"&,* #),- *!b"!#a$ %&'a()'a <2 4 '-,!4. T-& IV S$-%($ %-&#"&,* #),- *!b"!#a$ %&'a()'a
14
Ga'ba# 58 ;T S/a, )(),a, a@-a$
a"a %&'a()'a *!b"!#a$ a!("-*&#(a- )'#&*- 6&,(#-&$ $a(&#a$
-#-.>
Ga'ba# 8 a'ba#a, *!b"!#a$%&'a()'a -*)"&,* a"a &'&#-*aa,
;(*/a, ),(#a*
7/25/2019 Pengayaan Sdh 2
http://slidepdf.com/reader/full/pengayaan-sdh-2 15/27
D&,*-(a* %&'a()'a *!b"!#a$ '&,-,a( &#,a a"a,a /$)( #&(#a*-. D&,*-(a*
*&'a-, '&,!#!, &#a,a b&#$a!,a "&#a"a*- #)(&-, "- "a$a' %&'a()'a. ?-a
(&#+a"-,a &#"a#a% !$a, a"a *aa( %&'a()'a '!$a- b&#&6)$!*- aa, (&#$-%a(
a'ba#a, "&,a, "&,*-(a* a, b&#b&"a. E& %&'a()#-( aa, (&#a'ba# a"a
&#"a#a%a, !$a, a(a! a*-&* "&,a, a,!a, &'b&!a, "a#a%.5
?-a %&'a()'a *!b"!#a$ (&#$&(a "- "a&#a% 6&#(&@ a"a )(),a, a@-a$ (-"a aa,
"aa( (&#a'ba# )$&% -(! "-&#$!a, )(),a, /)#),a$ !,(! a'ba#a, a, +&$a*.>
P&,&'!a, *&*-- a, "aa( "-(&'!a, a"a %&'a()'a *!b"!#a$ #),-
-a$a% &'-,"a%a, a#&,-' )(a +a)% "a#- (!$a, /#a,-!' "a, ba(a* /),6&@ '&,+a"-
#a(a ba%a, ),a6&. B-$a(&#a$ %&'a()'a b-*a '&,&baba, )'#&*- '&"-a$ a"a
&"!a"!a 6&,(#-&$ %-,a (&#a'ba# 6&,(#-&$ a, '&,&'-( a(a! b&#b&,(!
a#-*a,<#abb-(* &a# *-,. G&+a$a&+a$a $a-, a, "aa( '&'ba,(! '&,"-a,)*a -a$a%
15
Ga'ba# >8 S!b"!#a$ %&'a()'a a"a
;( */a, )(),a, a@-a$ "&,a,
a'ba#a, %-&#"&,* "- "a&#a%#),()a#-&(a$ *-,-*(#a. V&,(#-&$ -#-
(&#")#), *&%-,a 6&,(#-&$ a,a,
"-$a(a*-.>
Ga'ba# =8 K#),- *!b"!#a$
%&'a()' a"a a'ba#a, ;T */a,
"&,a, )(),a, /)#),a$>
7/25/2019 Pengayaan Sdh 2
http://slidepdf.com/reader/full/pengayaan-sdh-2 16/27
%-$a,,a a'ba#a, *!$/- (&#+a"-,a '-"$-,& *%-( "&)#'-(a* a,a()' 6&,(#-&$ "a,
)b$-(&#a*- *-*(&#, ba*a$. S&'!a &+a$a -,- "aa( '&,&aa, "-a,)*& +-a $)a*-,a "-
*&&#)$a(&#a$$-.14
2. PEMERIKSAAN MRI < MAGNETIC RESONANCE IMAGING
P&'&#-*aa, MRI '&'-$-- &!,!$a, !,(! '&$-%a( &#"a#a%a, #),-*
'a!!, &#!*aa, )(a a, #),-*. Da$a' %a$ -,- MRI T2 'a'! '&,!,+!a,
a'ba#a, a, $&b-% +&$a* (&#!(a'a $&*- %-)"&,* a"a ;T S/a, a(a! $&*- a, *!$-(
"-b&"aa, "&,*-(a*,a "&,a, )#(&*.2
Ga'ba#a, %&'a()'a *!b"!#a$ a"a MRI (&#a,(!, a"a *(a(!* b-)&'-a$
%&')$)b-,,a a, b&#b&"ab&"a '&,-!( !*-a %&'a()'a. H&'a()'a *!b"!#a$
a!( -*)-,(&,* a"a T11 b&#ba,"-, )(a "a, %-)-,(&,* a"a T21. MRI
'&'ba,(! a"a a*& *!ba!( "-'a,a %&'a()'a (a'a -*)"&,* a(a! %-)"&,* "-
a'ba#a, ;T */a,. K&7!+!"a, '&(%&')$)b-, "- %&'a()'a *!b"!#a$ '&'b&#-a,
*-,a$ -,(&,*-( a, (-,-. S-,a$ (-,- "aa( "-b&"aa, *&/a#a +&$a* a"a
&,!'!$a, /a-#a, ,),%&')#a-.5
H&'a()'a a!( '&'b&#-a, a'ba#a, TR a, &$a &#a,a && *!*&(-b&$.
Pa"a a7a$ a*& *!ba!( a'ba#a, &#-&# a, (&#a, "&,a, *&,(#a$ a, %-)-,(&,*
&#,a a"a,a (&#b&,(!,a &@(#a/&$$!$a# '&(%&')$)b-, "- ba-a, &#-&#. Pa"a a*&
$a,+!( *!ba!( &'b&!a, aa, (&#+a"- *&/a#a '&,&$!#!% %-&#-,(&,*. Aab-$a "a#a%
'!$a "-*&#a &'ba$- *&/a#a &#$a%a,$a%a, *-,a$ -,(&,*-(a* aa, b&#!#a, a"a T1
'&,+a"- %-)-,(&,* a(a! -*)-,(&,* b&#ba,"-, 7%-(& 'a((&# (a- $&b-% -,(&,* "a#-
/a-#a, /&#&b#)*-,a$ &#,a a,"!,a, #)(&-,.5 Pa"a a*& #),- MRI "aa(
'&,$a*--a*-a, &a"a $-'a (-& a-(!: low high !i"ed intensity isointensity "a,
layered .
16
Ga'ba# 98 a'ba#a, MRI <T1
7&-%(&" *!b"!#a$ %&'a()'a a"a
%&'-*&#a -#-10
7/25/2019 Pengayaan Sdh 2
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MRI "aa( '&'b&#-a, a'ba#a, $&,(-)#' a(a! a'ba#a, b-/),6&@ +-a
"-a'b-$ "a#- )(),a, /)#),a$ b&#ba,"-, a'ba#a, /#&*/&,(*%a&" a&a#a,/&
a"a )(),a, a@-a$ ;T S/a,. Ga'ba#a, MRI a, '!$(-$a,a# "aa( '&'ba,(!
-"&,(--a*- /),6&@ a, &/-$ "a, 6&#(&@ %&'a()' a, '!,-, (-"a "aa(
(&#"&(&*- a"a ;T S/a, )(),a, a@-a$ a(a! /)#),a$.5
U,(! '&'b&"aa, %&'a()'a *!b"!#a$ "a, %#)'a *!b"!#a$ &'&#-*aa,
proton#density weighted se$%ences a(a! FLAIR "-&#$!a,. H&'a()'a *!b"!#a$
"aa( "-b&"aa, "&,a, ;SF$-& *!b*(a,*- '&$a$!- *-,a$ #)(), T1 "a, T2
*&!&,/&. Na'!, "a$a' a'ba#a, FLAIR %&'a()'a aa, (&#a'ba# $&b-% +&$a*
(-,- -,(&,*,a "a#- /a-#a, *&#&b#)*-,a$.9
3. DIFFUSIONEIGHTED IMAGING <DI
17
Ga'ba# 108 Ga'ba#a, *!b"!#a$
%&'a()'a b-$a(&#a$
Ga'ba# 118 Ga'ba#a, %&'a()'a
*!b"!#a$ #),- a"a &'&#-*aa,
MRI <FLAIR a, %-&#-,(&,*&
7/25/2019 Pengayaan Sdh 2
http://slidepdf.com/reader/full/pengayaan-sdh-2 18/27
DI '&'b&#-a, a'ba#a, %&'a()'a *!b"!#a$ "&,a, -,(&,*-(a* a,
b&#b&"a (&#a,(!, !*- %&'a()'a. K&$&b-%a, &,!,aa, DI -a$a% &'a'!a,,a
!,(! "&(&*- '&,"a*a#- a(a! (&#a-( $&*- a#&,/%'a$.
Ga'ba# 128 Ga'ba#a, &#"a#a%a, *!b"!#a$ 2 '-,! *&(&$a% ),*&( a T17&-%(&" b T27&-%(&" /
"a, " %-&#-,(&,*& DI & %-)-,(&,* $&*- a'ba#a, /)#),a$ %-&#-,(&,*
4. ANGIOGRAFI
Pa"a a*!* )*(#a!'a(- %&'a()'a *!b"!#a$ *a,a( +a#a, "-!,aa,
a,-)#a- !,(! '&,"aa(a, "-a,)*(-/. T&(a- a,-)#a- "aa( '&'ba,(!
'&,&aa, "-a,)*-* +-a &(-)$)- (&#+a"-,a %&'a()'a *!b"!#a$ a-ba( a,!a,
a"a 6&**&$ "- *&#&b#a$ *&&#(- #!(!#& "-,"-, 6&,a )*(#a!'a a,&!#-*'& a#(&#-)6&,)!* 'a$)#'a(-), a(a! -*(!$a. P&'&#-*aa, -,- "aa( '&'b&"aa, )$&*- "a#a%
a, '-$"$ %-&#"&,* "&,a, (!$a,(!$a, a"+a/&,( a, %-&#"&,*-(.
18
7/25/2019 Pengayaan Sdh 2
http://slidepdf.com/reader/full/pengayaan-sdh-2 19/27
2I' DIERENSIAL DIAGNOSIS
1. EPIDURAL HEMATOM>
H&'a()' &-"!#a$ a, a"a, *!$-( "-b&"aa, "a#- *!b"!#a$ '&'!,a- /-#-
a'ba#a, %a* b&#!a b&,(! b-),6&* a(a! $&,(-!$&# <a"a &#$&a(a, a, &#a(
a,(a#a "!#a "&,a, (ab!$a -,(&#,a *&%-,a %&'a()' '&,+a"- (&#ba(a*. H&'a()'
*!b"!#a$ /&,"&#!, $&b-% "-!* b&#ba,"-, "&,a, %&'a()' &-"!#a$ "a, '&'!,a-
(a'-$a, ba(a* "a$a' a, ),a6 *&*!a- "&,a, &#'!aa, )(a.3
EPIDURAL HEMATOM SUBDURAL HEMATOM
INSIDEN 14C a*!* (#a!'a:
10C a*!* (#a!'a a(a$
1020C *&'!a a*!*
(#a!'a:
30C a*!* (#a!'a a(a$
ETIOLOGI =595C "-*&#(a- #a(!#:
>0=0C $a*&#a*- A#(&#- '&,-,&a$
'&"-a*-,!* "!#a$ 6&,)!*
V&,a )#(-a$ "- ), #)b&
SITE D-a,(a#a (!$a, /#a,-a$ "a, "!#a
'a(&#:
M&$-,(a*- "!#a 'a(&# (a- (-"a *!(!#a
/#a,-a$,a:
95C *!#a(&,()#-a$
5C *!b(&,()#-a$
5C b-$a(&#a$
D-a,(a#a "!#a 'a(&# "a,
a#a/%,)-" 'a(&#:
M&$-,(a*- *!(!#a /#a,-a$ (a-
(-"a "!#a 'a(&#:
95C *!#a(&,()#-a$
5C b-$a(&#a$
PENEMUAN
;T
B&,(! b-/),6&@:
P&,")#),a, white#gray !atter a"a
"a&#a% a, (&#a,!:
C %-&#"&,*:
33C /a'!#a, <%-&#%-)"&,*
A!(8 0C %-&#"&,*:
40C /a'!#a,
<%-&#%-)"&,*
S!ba!(8 -*)"&,*
;%#),-/8 %-)"&,*&
19
7/25/2019 Pengayaan Sdh 2
http://slidepdf.com/reader/full/pengayaan-sdh-2 20/27
Crescent shape:
Ga'ba# 138 ;T S/a, '&,!,+!a, &-"!#a$ %&'a()'a <a,a a,a% !(-% *!b"!#a$ %&'a()'a <a,a
a,a% %-(a' -,(#a/&#&b#a$ %&'a()'a <a,a a,a% !(-% &/-$ "a, *!ba#a/%,)-" %&')#a& <a,a
a,a% %-(a' &/-$.
?-a &+a$a&+a$a %-$a,,a a'ba#a, *!$/- (&#+a"-,a '-"$-,& *%-(
"&)#'-(a* a,a()' 6&,(#-&$ "a, )b$-(&#a*- *-*(&#, ba*a$ "- $)a*- a, $&b-% a,(&#-)#
"a, '&"-a$ -,(&,*-( a, %-&#"&,* "-*&$a!(- a*!$ a, (&ba$ *&#(a
b&#&'!,-,a, b&,(! b-),6& '&,&$-#!a, "&,a, &*(#a"!#a$ %&'a()'a.
U,(! '&'b&"aa,,a &'&#-*aa, MRI "-&#$!a,.14
2. NEOPLASMA
I,(#a/#a,-a$ ,&)$a*'a "a, %&'a()'a *!b"!#a$ #),- a'a( *!a# "-b&"aa,
(a,a ba,(!a, ,&!#)-'a-,. M&,-&*(a*- $-,-* !,(! ,&)$a*'a *&&#(- ,&#- &a$a
a,!a, *(a(!* '&,(a$ b&#!ba% "a, (a,"a ,&!#)$)-/ )a$ *a'a "&,a, %&'a()'a
*!b"!#a$. U,(! '&'b&"aa,,a &'&#-*aa, ;T*/a, a(a! MRI "-&#$!a,.1
20
7/25/2019 Pengayaan Sdh 2
http://slidepdf.com/reader/full/pengayaan-sdh-2 21/27
3. EKSTRADURAL HEMATOMA
E@(#a"!#a$ %&'a()'a -,- "-a,"a, *&baa- /&'b!, a,"aa, %-%"&,*-(
"a&#a% *&&#a (&#$&(a "- ba7a% & !ba%. Pa$-, *&#-, "- "a&#a% #),()a#-&(a$
(&(a- '!,-, (&#+a"- "- )**a )*(&#-)#. Ka"a,a"a, "a&#a% !#a, a"a(
'!,/!$ '!,-, a#&,a "a#a% (-"a '&'b&! "a, +-a '&#&a %a#!* a'b!%
*&(&$a% )&#a*- b&,(! $a*- '!,-, aa, %-$a,. V&,(#-&$ $a(&#a$ a, %a*
'&,!,*- & *-*- ),(#a$a(&#a$ "a, b-a*a,a a"a b&b&#aa &'b&,aa, a"a
b&$a%a, )(a a, (&#&,a '&*-!, &"&'a a, +&$a* '!,-, (-"a (&#$-%a(.
4. SUBDURAL HGROMA
H-#)'a *!b"!#a$ a"a$a% !'!$a, /a-#a, *&#&b#)*-,a$ (-"a b&#"a#a% a, (&#$&(a
"- #!a, *!b"!#a$ '-#- "&,a, %&'a()'a. D&,a, &'&#-*aa, ;T*/a, *!b"!#a$
%&'a()'a #),-* "aa( "-b&"aa, "a#- %#)'a *!b"!#a$. Na'!, -,(&,*-(a* "-,"-,
%#)'a* (-"a '&,-,a(a,. MRI '&,!,+!a, ba%7a %#)'a* '&'-$--
21
Ga'ba# 148 a'ba#a, ,&)$a*'a
a"a &'&#-*aa, ;( */a, a,%-&#"&,*&.
Gam(a* 1!: E*(#a"!#a$ %&'a()'aa!( a"a ;T S/a, a'ba#a,
b-/),6&@ a"a #),()a#-&(a$ a,a,.>
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-,(&,*-(a* *-,a$ a, *a,a( '-#- "&,a, ;SF a"a *&'!a !#!(a, (&#'a*!
&'!$-%a, -,6&#*- a(&,!a*- /a-#a, <FLAIR a'ba#. S&/a#a a*a# *&&#$-'a "a#-
*&'!a a*-&, "&,a, %#)'a *!b"!#a$ '&,!,+!a, $&*- (#a!'a(-* "- )(a.10
2II' PENATALA%SANAAN
A. OPERATIF
K&ba,aa, (&,-* a, "-!,aa, a"a &,a,a,a, %&'a()'a *!b"!#a$
-a$a% *-*(&' "#a-,a&. A,(a#a a, a$-, *&#-, "-$a*a,aa, -a$a% advokat twist
drill craniosto!y b%rr hole s%rgery a(a! cranioto!y. Car!el et al& '&$a)#a, a"a
)&#a*- twist drill craniosto!y *&ba,a =C "&,a, #),)*-* ba-. Na'!, ba,a *!'b&# '&,a(aa, -$-%a, *!#&# a, )(-'a$ -a$a% b%rr#hole trepanation s%rgery
"&,a, *-*(&' "#a-,a& (&#(!(!. S&ba,a =0C #),)*-*,a ba-.11
O&#a*- /#a,-)()' +!a 'a*-% "-a,a *&baa- (&#a- #-,/-a$. ;#a,-)()'
(&')#a$ &/-$ "- 'a,a $a-*a, "!#a "-b-a#a, (&#b!a.11
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Ba- a"a a*!* a!( 'a!!, #),- aab-$a "-&(&'!a, a"a,a &+a$a &+a$a
a, #)#&*- 'aa +&$a* "-&#$!a, (-,"aa, )&#a*- !,(! '&$a!a, &,&$!a#a,
%&'a()'a. T&(a- *&b&$!' "-a'b-$ &!(!*a, !,(! "-$a!a, (-,"aa, )&#a*- a,
(&(a %a#!* -(a &#%a(-a, a"a$a% a-#7a b#&a(%-, "a, /-#/!$a(-), <AB;*. T-,"aa,
)&#a*- "-(!+!a, &a"a8
a. E6a!a*- *&$!#!% SDH
b. M&#a7a( *!'b&# &#"a#a%a,
/. R&*&*- a#&,-' )(a a, nonviable
". M&,&$!a#a, I;H a, a"a.
K#-(&#-a &,"&#-(a SDH "-$a!a, )&#a*- a"a$a%8
a. Pa*-&, SDH (a,a '&$-%a( G;S "&,a, &(&ba$a, J 10 '' a(a! &#&*&#a,
'-"$-,& *%-( J 5 '' a"a ;T*/a,
b. S&'!a a*-&, SDH "&,a, G;S 9 %a#!* "-$a!a, '),-()#-, TIK
/. Pa*-&, SDH "&,a, G;S 9 "&,a, &(&ba$a, &#"a#a%a, 10 '' "a,
&#&&#a, *(#!(!# '-"$-,& *%-(. ?-a '&,a$a'- &,!#!,a, G;S J 2 )-,
a,(a#a *aa( &+a"-a, *a'a- *aa( 'a*! #!'a% *a-(
". Pa*-&, SDH "&,a, G;S 9 "a,a(a! "-"aa(a, !-$ "-$a(a*-
a*-'&(#-*-@&"
&. Pa*-&, SDH "&,a, G;S 9 "a,a(a! TIK J 20 ''H.
B. FARMAKOTERAPI
T&#a- ),*a(- a, "-b&#-a, (&#a,(!, &a"a a*-&, "&,a, &+a$a
,&!#)$)-/ *&&#(- ,&#- &a$a (a,a &+a$a $a-, &+a$a )a$ ,&!#)$)-/ a(a!
a,!a, '&')#-. P&'b&#-a, a, "-b&#-a, -a$a% *(&#)-" a(a! 'a,,-()$. P&'b&#-a,
!ba( a#'a)(&#a- *a,a( +a#a, &#,a b-a*a,a a*-&, aa, '&'ba- *&(&$a%
23
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"-)&#a*-. D&@a'&(%a*), 1'%a#- "aa( "-b&#-a, a"a a*-&, (a,a '-"$-,& *%-(
*&$a'a "!a '-,!.1
H&'a()'a &/-$ aa, '&,a$a'- #&*)$!*- *&/a#a *),(a, b-$a "-b-a#a, '&,-!(
a$a'-a%. Pa"a &,"&#-(a "&,a, %&'a()'a &/-$ (a,a (a,"a(a,"a ,&!#)$)-/ 'aa
(-,"aa, &,)ba(a, a, (&#ba- '!,-, %a,a$a% '&$a!a, &'a,(a!a, &(a(.4
2III' PROGNOSIS
M)#(a$-(- a"a *!b"!#a$ %&'a()'a "aa( '&,/&/a% 30C. Fa()# a, '&'&,a#!%-
-a$a% G$a)7 ;)'a S/a$& > !'!# J=0 (a%!, "!#a*- a, a!( "a, #a,-)()'-.
G&+a$a ,&!#)$)-/ "a, '-"$-,& *%-( (-"a '&'&,a#!%- a"a# ')#(a$-(. Ga'ba#a,
-*)"&,*-(- a"a ;T */a, "-a,a *&baa- #),)*-* a, ba- "a, a'ba#a,
%-)"&,*-(- a()# #),)*-* b!#!.1
I8' %ESIMPULAN
S!b"!#a$ %&'a()'a -a$a% &#"a#a%a, a, (&#$&(a "- #!a, *!b"!#a$. P&#"a#a%a,
-,- "aa( '&$!a* "- ba-a, %&'-*%&#& '&,-b!$a, )'#&*- a"a *&#&b#-.
P&#"a#a%a, "aa( b&#a*a$ "a#- #!(!#,a b#-"-, 6&-, #!(!#& #a,!$)*-a Pa//%-),-
&#$!a*aa, &#"a#a%a, "a#- )**a -a 'a(&# "a, +!a &#"a#a%a, ),(!*-) /&#&b#-.1
P&'-,"aa, ;T '&#!aa, &'&#-*aa, &,!,+a, -$-%a, a, "aa(
'&,"&(&*- &#"a#a%a, ba#! "&,a, $&b-% (&a( "-ba,"-,a, "&,a, MRI. ;T "aa(
'&,!,+!a, a"a,a $)a*- "a, a"a,a &#"a#a%a, -,(#a/#a,-a$ &"&'a ),(!*-
!"a#a b&,"a a*-, -,(#a/#a,-a$ *&#(a &#&*&#a, *(#!(!# "- "a$a' #),a (&,)#a. 3.
A#(&#-)#a- "-b!(!%a, a"a a*!* &#"a#a%a, *!b"!#a$ *),(a, !,(! '&,"&(&*-
*!'b&# "a, $)a*- &#"a#a%a,.
P&,)ba(a, a"a$a% &6a!a*- b&"a% %&'a()'a "a, '&,a(a*- &#"a#a%a, "a#- 6&,a
a, (&#)a. I,(&,*- b&"a% %a#!* "-&#+aa, "-,- "a, *&b&$!' (&a,a, *&#-!*
a"a +a#-,a, )(a '&,-'b!$a, &#!*aa,.4
24
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DATAR PUSTA%A
1. R!*" G%aa$- Ma$!&a: Radiologi 'iagnostik( )aa#(a: P!*(aa
;&,"&-a P#&** )aa#(a: A#-$ 2011: Ha$a'a, 140 14>
2. Ha#*),) DSS: )apita Selekta Ne%rologi: Fa!$(a* K&")(&#a, U,-6&#*-(a*
Ga"+a% Ma"a: Ga"+a% Ma"a U,-6&#*-( P#&**: Ha$a'a, 309 3153. Sa(a,&a#a "a, $a-,$a-,: Il!% *edah Sara+ E"-*- IV: ?aa#(a: P&,&#b-( PT
G#a'&"-a P!*(aa U(a'a: Ha$a'a, 212213
4. S$6-a A,"&#*), P#-/& "a, L)##a-,& M/;a#( -$*),: ,ATO-ISIO.OGI/
)onsep )linis ,roses#,roses ,enyakit E"-*- 4 B!! 2: P&,&#b-( B!!
K&")(&#a,: 1994: Ha$a'a, 101410195. B#a,( -$$-a' E. "a, H&$'* ;$"& A.: -%nda!entals o+ 'iagnostic
Radiology 3#" &"-(-),: L--,/)(( -$$-a'* -$-,*: 200>: Ha$a'a, 5 1
. T. M)#-(a,- S. E%)$' P. L &*(&**),: 'i++%sion#0eighted MR I!aging o+
The *rain: G&#'a,: S#-,&#V&#$a B&#$-, H&-"&$b&#: 2005: Ha$a'a, 4
15 15> 209>. T. S/a#ab-,) U. Sa$6),- ?.R. ?-,-,*: E!ergency Ne%roradiology: G&#'a,:
S#-,&# B&#$-, H&-"&$b&#: 200: Ha$a'a, 59 11= 139 14 150 154
=. R.G G#a-,&# D. ?. A$$-*), A. A"a' A. K. D-@),: Grainger 1 Allison2s
'iagnostic Radiology/ A Te"tbook Medical I!aging 4(% E"-(-),: Ha#/)!#(
P!b$-*%&#* L-'-(&": 2001.9. R!"-&# 6), K!''&# T)b-a* Ba/: Magnetic Resonance I!aging in
Ische!ic Stroke: G&#'a,: S#-,&#V&#$a B&#$-, H&-"&$b&#: 200: Ha$a'a,
14 1510. Da6-" S!((),: Te"tbook o+ Radiology and I!aging 3ol%!e 4: >(% E"-(-),:
E$*&6-&# S/-&,/& L(".: 2003: Ha$a'a, 1>> 1>9 1>>9 1>=2
11. ?a'&* L. A!*'a,: Chronic S%bd%ral 5e!ato!as and The elderly/ S%rgical
res%lts +ro! a series o+ 647 cases/ Old 8horses9 are not to be shot: : 14(%
D&/&'b&# 2012 /-(&" A#-$ 09(% 2013: A6a-$ab$& #)'8
%((8777.*!#-/a$,&!#)$)-,(./)'
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12. S&#& Ma#ba/%&# O((a6-) T)'a*- a," ?a6-&# Fa,"-,): Review Article/
Manage!ent o+ ,atients ,resenting with Ac%te S%bd%ral 5e!ato!a d%e to
R%pt%red Intracranial Ane%rys!( 2=(% N)6&'b&# 2011: /-(&" A#-$ 09(%
2013: A6a-$ab$& #)'8 %((8777.%-,"a7-./)'+)!#,a$*-+6'2012>5359
13. Ma#/ E,&$&, Pa!$ ? N&"&#))#, Ma#-), S'-(* a," D-&"&#- 6a, "& B&/:
'elayed li+e threatening s%bd%ral he!ato!a a+ter !inor head in;%ry in
patient with severe coag%lopathhy/ A case report : 10(% A!!*( 2009: /-(&"
A#-$ 09(% 2013: A6a-$ab$& #)'8
%((8777./a*&*+)!#,a$./)'/),(&,(21>5=> 14. A'-( A#a7a$: *ilateral *iconve" -ronal Chronic S%bd%ral 5e!ato!a
Mi!icking E"trad%ral 5e!ato!a( /-(&" A#-$ 09(% 2013: A6a-$ab$& #)'8
%((8777.+*(/#.)# 15. A,-(a S%-#$& ?)*&$, G#a/& K)#!$a S'-(%* E$-ab&(% G&)#& Sa#a6a,a,
P.A.: Spontaneo%s Intracranial 5ypotension < A ca%se +or rec%rrent chronic
s%bd%ral he!ato!a( 4=6=( /-(& A#-$ 09(% 2013 A6a-$ab$& #)'8
%((8777.+)a/.)#
1. B&#,a#" Ka#,a(%: S%bd%ral 5e!ato!a/ ,resentation and Manage!ent in
Older Ad%lts( ?!$ 2004: /-(&" 14(% A#-$ 2013: A6a-$ab$& a(8 %((*8**$
703",,03>4.7&b*-(&*&!#)./)' 1>. O'a# Fa- Da6-" M)a(: Anato!y at a Glance: 2002: B$a/7&$$*/-&,/&.(":
UK: Ha$a'a, 133 135
1=. Ga'ba# 18 <B$!'&,&$" N&!#)a,a()' (%#)!% ;$-,-/a$ /a*&* S-,a!&# A**)/.
I,/ 2002 122
19. Ga'ba# 2 8 <H!,a#-a, A/a"&' ) S/-&,/&
20. Ga'ba# 3 8 <P&(&# M. Ba$a* K.K:.E'&#&,/ Ra"-)$) S&''&$7-*
U,-6&#*-( D&a#('&,( ) Ra"-)$) "a, O,/)(%&#a B!"a&*(
21. Ga'ba# 8 <S'-(% ?#. P Ba(,-( S R&,a/%a# SS. A/!(& -*)"&,*&
*!b"!#a$ %&'a()'a*8 a #)b$&' -, a,&'-/ a(-&,(* A?R 19=1:13854354
22. Ga'ba# 10 8 <777.6-*!a$ %)()*./)'
23. Ga'ba# 11 8 <D#. R)b&#( S/%!b&#( 777.#a"-)&"-a.)#24. Ga'ba# 13 8 777.'&"*/a&./)': Ma((-&$$) ?A M!, M: I'a&* -, /$-,-/a$
'&"-/-,&8 )!# (&* ) a/!(& )*( (#a!'a(-/ -,(#a/#a,-a$ %&')#a&: N E,$ ?
M&" 200:3445=0
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25. Ga'ba# 14 8 777.#a"-)$)(!()#-a$*./)'