Stroke Kbm

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STROKESTROKE

TIM UGD TIM UGD


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STROKE APAKAHSTROKE APAKAH

ITU?ITU?


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WHO 1995WHO 1995

Stroke is any rapid abnormality of the brain functional,Stroke is any rapid abnormality of the brain functional,developing clinical symptoms and sign of focal and atdeveloping clinical symptoms and sign of focal and at

times global with symptoms lasting more than !times global with symptoms lasting more than !

hours or leading to death which is caused byhours or leading to death which is caused by

cerebrovascular disruption"cerebrovascular disruption"

DefinitionDefinition


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Stroke merupakan suatuStroke merupakan suatukondisi ketika pasokan darahkondisi ketika pasokan darah

ke otak berkurang sehinggake otak berkurang sehingga

mengurangi oksigen danmengurangi oksigen dannutrisi untuk sel-sel otak yangnutrisi untuk sel-sel otak yang

bila tidak segera ditanganibila tidak segera ditangani

maka sel otak akan matimaka sel otak akan mati

dengan cepat.dengan cepat.

Kondisi ini dapat disebabkanKondisi ini dapat disebabkan

penyumbatan pembuluhpenyumbatan pembuluh

darah atau ecahn adarah atau pecahnya


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ADA APA DENGANMU?ADA APA DENGANMU?

(STROKE)(STROKE)

SUH!T"SUH!T" GUS DU!GUS DU!

#$%&T' K"!U#T"!' GU!U'#$%&T' K"!U#T"!' GU!U'#$(GUSH' #$G)I' &U!UH SM#I#$(GUSH' #$G)I' &U!UH SM#I

TUK(G &$*K &HK( (K-(K TUK(G &$*K &HK( (K-(K

D( SI# +GI M$(,USU+D( SI# +GI M$(,USU+

MU(GKI( KU TUMU(GKI( KMUMU(GKI( KU TUMU(GKI( KMU


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StrokeStroke

# Stroke is the third most common cause of deathStroke is the third most common cause of deathin the developing countries, which is found in allin the developing countries, which is found in all

groups of age, especially in adult age and thegroups of age, especially in adult age and theincidence increases with age"incidence increases with age"

#$ivided in to %$ivided in to %

1" Haemorrhage % incidence 15&'( ), *+H, SH1" Haemorrhage % incidence 15&'( ), *+H, SH" *schaemic % incidence -(&.5 )" *schaemic % incidence -(&.5 )


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KOK BISA KENA STROKEKOK BISA KENA STROKE

??


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7isk 8actors7isk 8actors11

on modifiableon modifiable

ge ge 7ace7ace

:ender :ender

8amily history of stroke"8amily history of stroke"


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7isk 8actors&7isk 8actors&

;odifiable 4 treatable;odifiable 4 treatable HypertensionHypertension atrial fibrillation atrial fibrillation

$iabetes mellitus$iabetes mellitus hyperhomocysteinemia hyperhomocysteinemia HyperlipidemiaHyperlipidemia hypercoagulability hypercoagulability +igarette smoking+igarette smoking oral contraceptive oral contraceptive *nfection% chlamydia, helicobacter, viruses"*nfection% chlamydia, helicobacter, viruses" /rior stroke4


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NOMINASI STROKENOMINASI STROKE


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Risk Factors forRisk Factors for

Athrothro!"osisAthrothro!"osis

therosclerosis therosclerosis

therothrombotic ;anifestations therothrombotic ;anifestations

0;*, *schemic Stroke, =ascular $eath20;*, *schemic Stroke, =ascular $eath2

ge geObesityObesity

$iabetes$iabetes

HyperlipidemiaHyperlipidemiaHypercoagulable statesHypercoagulable states

HypertensionHypertension

:enetics:enetics

*nfection>*nfection>

HomocysteinemiaHomocysteinemia

?ife&style 0e"g",?ife&style 0e"g",smoking, diet, lacksmoking, diet, lackof e@ercise2of e@ercise2

:ender :ender

9

merican Heart ssociation" Heart and Stroke 8acts% 199- Statistical SupplementA Wolf" Stroke merican Heart ssociation" Heart and Stroke 8acts% 199- Statistical SupplementA Wolf" Stroke199(A10suppl 2%**&!B**&3A ?aurila et al" rterioscler


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Major Risk Factors forMajor Risk Factors for

Cerebrovascular AtherosclerosisCerebrovascular Atherosclerosis


SmokingSmoking

$iabetes$iabetes

HyperlipidemiaHyperlipidemia

ObesityObesity

E 5&1(E 5&1(

E E

E E

E 1,5E 1,5

E 1,5E 1,5

FACTOR INCREASED RISK


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#ONTOH MANU$A#ONTOH MANU$A

%ANG SE$AMAT %ANG SE$AMAT


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U&t'k "aar strokU&t'k "aar strok

*r' tah' a&ato!i*r' tah' a&ato!i


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APA SA+A +ENISAPA SA+A +ENIS

STROKE?STROKE? "**+USI"( /0123"**+USI"( /0123

theromatous4thrombotictheromatous4thrombotic

+arge 5essel occlusion or stenosis+arge 5essel occlusion or stenosis

&ranch 5essel occlusion or stenosis&ranch 5essel occlusion or stenosis

#er6orating 5essel occlusion#er6orating 5essel occlusion(on-ateromatous diseases o6 the 5essel 7all(on-ateromatous diseases o6 the 5essel 7all

*ollagen diseases /!' S+$3*ollagen diseases /!' S+$3

8asculitis /temporal arteritis38asculitis /temporal arteritis3

Granulomaous 5asculitisGranulomaous 5asculitis

Miscellaneous /syphilitic' trauma'sarcoidosis3Miscellaneous /syphilitic' trauma'sarcoidosis3

$M&"+ISTI"( /9023 6rom$M&"+ISTI"( /9023 6rom

- theromatous pla:ue in the intra or e;tracranial arteries- theromatous pla:ue in the intra or e;tracranial arteries

- The heart- The heart

- Miscellaneous /6at emboli' air emboli' tumour emboli3- Miscellaneous /6at emboli' air emboli' tumour emboli3

DIS$S$S "< &+""D /*"GU+"#THI$S' H$M"G+"&I("#THI$S3DIS$S$S "< &+""D /*"GU+"#THI$S' H$M"G+"&I("#THI$S3

8$("US TH!"M&"SIS8$("US TH!"M&"SIS

D$*!$S$D *$!$&!+ #$!


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APA SA+A +ENISAPA SA+A +ENIS

STROKE?STROKE? H$M"!!HG$H$M"!!HG$

Into the brain subtance-parenchymal /=023Into the brain subtance-parenchymal /=023

and4or subarachnoid space /023and4or subarachnoid space /023


myloid 5asculopathymyloid 5asculopathy

neurismaneurisma

rterio5enous mal6ormationrterio5enous mal6ormation

(eoplasm(eoplasm

*oagulation disorder e.g. haemophilia*oagulation disorder e.g. haemophilianticoagulan therapynticoagulan therapy

8asculitis8asculitis

Drug abuse e.g. cocaineDrug abuse e.g. cocaine

Trauma Trauma


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+ENIS STROKE +ENIS STROKE

BERDASARKAN ,AKTUBERDASARKAN ,AKTU

TI /serangan sepintas stroke' TI /serangan sepintas stroke'

kurang 9> ?am3kurang 9> ?am3

!I(D /serangan stroke kurang @!I(D /serangan stroke kurang @minggu3minggu3

#!"G!$SSI(G ST!"K$ /ge?ala#!"G!$SSI(G ST!"K$ /ge?ala

stroke masih berlangsung3stroke masih berlangsung3 *"M#+$T ST!"K$ /stroke yang*"M#+$T ST!"K$ /stroke yang

sudah menetap3sudah menetap3


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STROKE HEMORAGIK STROKE HEMORAGIK


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STROKE BERDASARKAN PENYEBABNYA

STROKE HEMORAGIK = STROKE PERDARAHAN

PERDARAHAN OTAK

KURANG

DARAH

KECACATAN

PUSAT

KESADARAN

KEMATIAN

TIDAK SADAR

PUSAT NAFAS

PUSAT JANTUNG


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STROKE NONSTROKE NON

HEMORAGIK HEMORAGIK


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Ischa!ic sio&- ./o*!&t

o& &o&0&ha&c. #T

.a1 2 3 4 35

65


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2. STROKE NON HEMORAGIK = STROKE SUMBATAN

= SUMBATAN OTAK

DAERAH

MATI

A.

B.

C.

D.

PENEBALAN DINDING

ALIRAN DARAH LAMBAT

DARAH KENTAL

DAERAH PENUMBRA

(DAERAH SETENGAH MATI)

HARUS DISELAMATKAN

KECACATAN

KECACATAN DIKURANGI

SEMAKSIMAL MUNGKIN

FISIOTERAPI

SUMBATAN / EMBOLUS


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#enumbra#enumbra

#BF 7 35 !8255 9 tiss'8 !i&: 25

#MRO3 : 2;<

7 <OEF : 5


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Maor #i&icaMaor #i&ica

Ma&ifstatio&sMa&ifstatio&s

of Athrothro!"osisof Athrothro!"osis

dapted from% $rouet ?" Cerebrovasc Dis ((A 1'0suppl 12% 1B3"

Transientischeic attack

An!ina"# Stable# #nstable

Ischeicstroke

M$ocar%ialinfarction

&eri'heral arterial%isease"# Interittent clau%ication# Rest &ain# (an!rene# Necrosis


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Athero!enesis an% Atherothrobosis"Athero!enesis an% Atherothrobosis"A &ro!ressive &rocessA &ro!ressive &rocess

NoralNoralFatt$Fatt$

StreakStreakFibrousFibrous&la)ue&la)ue

Athero*Athero*scleroticsclerotic&la)ue&la)ue

&la)ue&la)ueRu'ture+Ru'ture+Fissure ,Fissure ,

ThrobosisThrobosis

M$ocar%ialM$ocar%ial InfarctionInfarction

IscheicIscheic

StrokeStroke

CriticalCritical

-e!-e!

IscheiaIscheiaClinicall$ SilentClinicall$ Silent

Car%iovascular DeathCar%iovascular Death

Increasin! A!eIncreasin! A!e

An!inaAn!ina

Transient Ischeic AttackTransient Ischeic Attack

Clau%ication+&ADClau%ication+&AD

'


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FoaFoaCellsCells

Fatt$Fatt$StreakStreak

Intere%iateIntere%iate-esion-esion AtheroaAtheroa

FibrousFibrous&la)ue&la)ue

Co'licate%Co'licate%-esion+Ru'ture-esion+Ru'ture

En%othelial %$sfunction

Smooth muscleand collagen

Fro first %eca%eFro first %eca%e Fro thir% %eca%eFro thir% %eca%e Fro fourth %eca%eFro fourth %eca%e

(ro.th ainl$ b$ li'i% accuulation Thrombosis,

haematoma

A%a'te% fro Star$ /C et al0 Circulation 1223425"1633*16780

Atherosclerosis TielineAtherosclerosis TielineAtherosclerosis Tieline


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ANAMNESISANAMNESIS

A$O ANAMNESISA$O ANAMNESIS AUTOANAMNESISAUTOANAMNESIS

KE$UHAN UTAMAKE$UHAN UTAMA ONSETONSET K,A$ITAS @ K,ANTITASK,A$ITAS @ K,ANTITAS FAKTOR %ANG MEMPERINGAN ORFAKTOR %ANG MEMPERINGAN OR

MEMPERBERATMEMPERBERAT KRONO$OGISKRONO$OGIS RI,A%AT PEN%AKIT DAHU$URI,A%AT PEN%AKIT DAHU$U SOSEK SOSEK


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/erbedaan Stroke Hemoragik dan/erbedaan Stroke Hemoragik dan

Stroke *nfark berdasarkanStroke *nfark berdasarkan

anamnesisanamnesis(ejala+Sito(ejala+Sito StrokeStroke Stroke nonStroke non

heora!ikheora!ik heora!ikheora!ik

Saat onsetSaat onset Se%an! aktif Se%an! aktif IstirahatIstirahat

&erin!atan 9&erin!atan 9warning warning :: ** ;;

N$eri ke'alaN$eri ke'ala ;;;;;; ;;

Kejan!Kejan! ;; **

MuntahMuntah ;; **

&enurunan kesa%aran&enurunan kesa%aran ;;;;;; ;;


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PEMERIKSAAN FISIK PEMERIKSAAN FISIK


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Tan%a 9si!n:Tan%a 9si!n: Stroke /eora!ikStroke /eora!ik Stroke NonStroke Non

/eora!ik /eora!ik


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&eeriksaan&eeriksaan Stroke /eora!ikStroke /eora!ik Stroke NonStroke Non

/eora!ik/eora!ik

a0 Fun%usko'ia0 Fun%usko'i /erdarahan retina dan/erdarahan retina dan +rossing phenomen+rossing phenomen

korpus vitreumkorpus vitreum Silver wire arteriesSilver wire arteries

b0 &un!si lubalb0 &un!si lubal

* tekanan* tekanan ;eningkat;eningkat ormalormal

* .arna* .arna ;erah;erah DernihDernih

c0 Arterio!rafic0 Arterio!rafi da da shift shift OklusiOklusi

%0 CT*Scan%0 CT*Scan ?esi hiperdens?esi hiperdens ?esi hipodens?esi hipodens

&erbe%aan jenis stroke %en!an alat bantu&erbe%aan jenis stroke %en!an alat bantu


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PEMERIKSAANPEMERIKSAAN

PENUN+ANGPENUN+ANG Dia9&osis StrokDia9&osis Strok

00 Br.asarka& t!'a& ki&isBr.asarka& t!'a& ki&is0 P!riksaa& P&'&a&90 P!riksaa& P&'&a&9

PEMERIKSAAN PENUN+ANGPEMERIKSAAN PENUN+ANG

T''a& T''a& 0!&9akka& .ia9&osis0!&9akka& .ia9&osis

0!&cari faktor risiko0!&cari faktor risiko

0!&cari faktor *&1'it0!&cari faktor *&1'it


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LABORATORIUM DARAHLABORATORIUM DARAH

0 R'ti&0 R'ti&

0 H!atokrit0 H!atokrit

0 Masa *r.araha& .a& *!"k'a&0 Masa *r.araha& .a& *!"k'a&

0 G'a Darah I 8 II0 G'a Darah I 8 II0 Kostro tota- HD$- $D$0 Kostro tota- HD$- $D$

0 Tri9isri.0 Tri9isri.

0 Asa! 'rat0 Asa! 'rat

0 Ur'! - Krati&i&0 Ur'! - Krati&i&0 Ektroit0 Ektroit0 Kh's's 0 Kh's's 0 A9r9asi tro!"osit 00 A9r9asi tro!"osit 0

Ho!oc1sti&Ho!oc1sti& 0 APTT0 APTT 00Fi"ri&o9&Fi"ri&o9&

0 D0.i!r0 D0.i!r 0 Proti& # .a& S0 Proti& # .a& S


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3; $UMBA$ PUNGSI3; $UMBA$ PUNGSI

- perdarahan sub arahnoid- perdarahan sub arahnoid

; C0 FOTO TORAKS; C0 FOTO TORAKS- besar ?antung' penyakit paru- besar ?antung' penyakit paru


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/F$F7*


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SIRIRAJ STROKE SCORE (SSS)

No GEJALA/TANDA PENILAIAN INDEKS SKOR

1. KESADARAN (0) Ko!o" #$%&"

(1) M#$'$%*

(2) S#& *o/*o

+ 2,-

2. MUNTAH (0) T&*

(1) Y

+ 2

. NYERI KEPALA (0) T&*

(1) Y

+ 2

. TEKANAN DARAH D&"%o&* + 10 3

-. ATEROMA

. DM

4. A$'&$ !#*%o5&"

6. K&*"&o

I$%#5&%#$

(0) T&*

(1) Y

+ (7) 7

8. KONSTANTE 7 12 712

HASIL SSS

CATATAN 9 1. SSS : 1 = S%5o*# ;#o5'&*

2. SSS < 71 = S%5o*# $o$ ;#o5'&*


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DIAGNOSIS STROKEDIAGNOSIS STROKE

(M($SIS(M($SIS

#$M$!IKS(


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DIAGNOSIS STROKEDIAGNOSIS STROKE

DIG("SIS K+I(IS /berdasar padaDIG("SIS K+I(IS /berdasar pada

temuan klinis3temuan klinis3

DIG"("SIS (T"MIS /berdasarDIG"("SIS (T"MIS /berdasar

pada letak kelainan anatomis3pada letak kelainan anatomis3

DIG("SIS $TI"+"GIS /berdasarDIG("SIS $TI"+"GIS /berdasar

pada penyakitnya3pada penyakitnya3


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Kontra indikasi relati6 BKontra indikasi relati6 B

=. rtiAcial ?oint=. rtiAcial ?oint

9. Middle ear protesis9. Middle ear protesis

@. *orpus alienum4benda-benda logam@. *orpus alienum4benda-benda logam

>. Hamil muda>. Hamil muda

Kontra indikasi absolutKontra indikasi absolut

=. Terhadap penderita dgn alat pemacu ?antung=. Terhadap penderita dgn alat pemacu ?antung

9. terhadap pend. dgn hemostatic clip /cerebral9. terhadap pend. dgn hemostatic clip /cerebralaneurysma.aneurysma.

KONTRAINDIKASI MRIKONTRAINDIKASI MRI


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T''a& *&a&9a&a&T''a& *&a&9a&a&

!r9&si *a.a strok!r9&si *a.a strok

Menyelamatkan penumbraMenyelamatkan penumbra

Menghindari akibat kecacatanMenghindari akibat kecacatan

berikutnyaberikutnya Mengendalikan 6aktor risikoMengendalikan 6aktor risiko


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Thra*'tic i&.oThra*'tic i&.o

)aktu antara saat serangan stroke)aktu antara saat serangan stroke

hingga penderita mendapatkanhingga penderita mendapatkan

pertolongan sesuai dengan ?enispertolongan sesuai dengan ?enispatologis strokenyapatologis strokenya

&er5ariasiB&er5ariasiB

H C @ ?amH C @ ?am$USI C 1 menit$USI C 1 menit

#erdossi C 9> ?am#erdossi C 9> ?am


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+&is *atoo9is Strok +&is *atoo9is Strok


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Patosioo9i strokPatosioo9i strok

isk!ik isk!ik


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Pra& #itichoi& *a.aPra& #itichoi& *a.a

StrokStrok Meningkatkan sintesis 6os6atidilkolin' yang merupakan

komponen utama dari membran neuronal.

Meningkatkan sintesis asetilkolin' memperbaikige?alayang disebabkan oleh hilangnya neuron kolinergik olehkarena iskemia.

Mendukung sintesis beberapa membran 6os6olipidlainnya' termasuk phosphatidylethanol- amina danphosphatidylserine' yang mengarah kepada perbaikandan regenerasi akson dan sinapsis.

mencegah akumulasi asam lemak bebas dan generasiradikal bebas di lokasi iskemia' sehingga mencegahinisiasi kaskade ke?adian proinFamasi. /D"rlando. =03


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P&itia& ohP&itia& oh

A/ar0Sa"i&A/ar0Sa"i&

&erdasarkan hasil penelitian inipeneliti menyimpulkan bah7a

pemberian citicoline selama =9bulan pada pasien yangmendapatkan stroke iskemik

pertama kali terbukti aman dandapat e6ekti6 dalam memperbaikipenurunan kogniti6 pasca-stroke


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*iticoline dapat membantumeminimalkan lesi iskemik

dengan menstabilkan membrandan mengurangi pembentukanradikal bebas


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Documents

Stroke Kbm