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8/19/2019 Case Stroke Hemoragik Helena Mayasari
1/23
RSUD ARIFIN ACHMAD
Fakultas Kedokteran UR
SMF/ BAGIAN SARAFSekretariat : SMF Saraf – Irna Medikal Lantai 4
Jl. Diponegoro No. 2 Telp. (0761) 7026225
P K A N ! A R U
S"A"US PASIN
Na#a Koass :Helena Ma$asari
N I M % N U K :&'()4*)*++
"an,,al :') -uli '(&.
Pe#/i#/in,dr0 nn$ Lestari1 S20S
I0 IDN"I"AS PASIN
N! Tn. "#ril
$!%r 6& T'%n 1 B%ln
Jeni# el!in i*li
Al!+Jl. A,i S%-ip+o gg Mnggi# no. e-. Mrpon
D!i*enr%
Ag! I#l!
S++%# per3inn 3in
eer4n e,gng
Tnggl M#% RS 2 J%li 2015
Me,i-l Re-or, 67
1
8/19/2019 Case Stroke Hemoragik Helena Mayasari
2/23
II0 ANAMNSIS (Tnggl 2 J%li 2015)
Allon!ne#i# ,engn i#+ri p#ien
Kelu3an Uta#a
e!' nggo+ ger iri
Ria$at Pen$akit Sekaran,
*S+% 4! SMRS p#ien !er# nggo+ ger iri le!' #e-r +i*+i. 8l ini,ir#n #+ p#ien #e,ng !n,i. #ien +i*+i !er#n +i, i#
%n+% !enggern #er+ !engng+ +ngn ,n i #eel' iri. #ien
4%g +i, %+ %n+% er4ln. #ien 'r%# ,ipp' %n+% er,iri. el%'n
+i, ,i#er+i ,engn e#%li+n %n+% eri-r ,n ping#n.
*Neri epl 4%g ,ir#n ole' p#ien9 el%'n #eper+i !%n+'9 ,e!! ,n
e4ng +i, ,. #ien e!%,in ,i3 e RS A3l Bro# ,n e!%,in
,ir%4% e RS$D AA.
Ria$at Pen$akit Da3ulu
*Ri3+ 'iper+en#i r% ,ie+'%i 5 +'%n ng ll%9 +i, pern' on+rol e
,o+er ,n 'n !in%! 4!% ,n o+ 'erl 4i , el%'n neri epl
,n +eng% +er# +egng. Tenn ,r' #el! ini +i, ,ie+'%i.
*Ri3+ ,ie+e# (*)9 eni+ 4n+%ng (*)9 ri3+ #+roe #eel%!n (*).
*Ri3+ Tr%! +i, ,
Ria$at Pen$akit Keluar,a
*A' ,n #%,r li*li p#ien 4%g !en,eri+ 'iper+en#i.
*Ri3+ el%rg ,engn ,ie+e# ,i#ngl.
*Ri3+ el%rg !en,eri+ #+roe ,i#ngl.
Ria$at Ke/iasaan
Ri3+ !eroo (:) #e4 %#i 15 +'%n9 2 %ng%#/'ri. ei#n !n
2
8/19/2019 Case Stroke Hemoragik Helena Mayasari
3/23
!nn ng erle! ,n #in.
RSUM ANAMNSIS
Tn. "9 6& +'%n9 le!' nggo+ ger iri. #ien !#i' #,r9 +i, i#
!enggern +ngn ,n i nn9 !#i' ,p+ eri-r ,engn 4el#. Ri3+
8T (:) #e4 5 +'%n ng ll%. ei#n !eroo #e4 %#i 17 +'%n9 ei#n
!n !nn ele! ,n #in.
III0 PMRIKSAAN (Tnggl 2 J%li 2015)
A0 KADAAN UMUM
Tenn ,r' nn 10/110 !!8g9 iri 10/110 !!8g
Den%+ n,i nn ; /!eni+9+er+%r
iri ; /!eni+9+er+%r
Jn+%ng 8R ; /!eni+9 ir! reg%ler9 !%r!%r (*)
r% Re#pir#i 20; /!n+ +ipe +'oro*,o!inl
S++%# Gi
8/19/2019 Case Stroke Hemoragik Helena Mayasari
4/23
png pn,ng
engenln 3rn
Nor!l
Nor!l
Nor!l
Nor!l
Nor!l
Nor!l
. N0III 758ulo#otorius9
nn iri e+erngn+o#i#
%pil
Ben+%
$%rn
Ger ol !+
Re@le# p%pil
ng#%ng
Ti, lng#%ng
*
B%l+
2 !!
Nor!l
:
:
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B%l+
2 !!
Nor!l
:
:
Nor!l
Nor!l
Nor!l
Nor!l
Nor!l
&. N0 I 7"rok3learis9
nn iri e+erngn
Ger ol !+ Nor!l Nor!l Nor!l
5. N0 7"ri,e#inus9
nn iri e+erngn
Mo+ori
Sen#iili+#Re@le# orne
Nor!l
Nor!l Nor!l
Nor!l
Nor!l Nor!l
Nor!l
Nor!l Nor!l
6. N0 I 7A/dus8ens9
nn iri e+erngn
Ger ol !+
S+ri#!%#
Dei#i
Nor!l
*
*
Nor!l
*
*
Nor!l
Nor!l
Nor!l
7. N0 II 7Fa8ialis9
nn iri e+erngn
Ti-
Mo+ori
* !enger%+n
,'i
* !engng+ li#
* !en%+%p !+
* #%,%+ !%l%+
*
nor!l
nor!l
nor!l
nor!l
*
Nor!l
nor!l
nor!l
nor!l
&
8/19/2019 Case Stroke Hemoragik Helena Mayasari
5/23
* lip+n
n#olil
D per#
Tn, -'o#+e
nor!l
Nor!l
*
nor!l
Nor!l
*
. N0 III 7Akustikus9
nn iri e+erngn
en,engrn Nor!l Nor!l Nor!l
. N0 I; 76lossofarin,eus9
nn iri e+erngn
Ar%# @ringD per#
Re@le# !%n+'
Nor!l Nor!l
*
Nor!l Nor!l
*
Nor!l Nor!l
Nor!l
10. N0 ; 7a,us9
nn iri e+erngn
Ar%# @ring
Di#@oni
Nor!l
*
Nor!l
*
Nor!l
Nor!l
11. N0 ;I 7Assesorius9
nn iri e+erngn
Mo+ori
Tro@i
Nor!l
>%+ro@i
Nor!l
>%+ro@i
Nor!l
12. N0 ;II 7Hi2o,lossus9
nn iri e+erngnMo+ori
Tro@i
Tre!or
Di#r+ri
Nor!l
>%+ro@i
*
*
Nor!l
>%+ro@i
*
*
Nor!l
Nor!l
Nor!l
Nor!l
I0 SIS"M M5"5RIK
nn iri e+erngn
>#+re!i+# +#
e%+n
5
8/19/2019 Case Stroke Hemoragik Helena Mayasari
6/23
Di#+l
ro#i!l
Ton%#
Tro@i
Ger.inol%n+er
5
5
Nor!l
>%+ro@i
*
&
&
Nor!l
>%+ro@i
*8e!ipre#i# Sini#+r>#+re!i+# 3'
e%+n
Di#+l
ro#i!l
Ton%#
Tro@i
Ger.inol%n+er
5
5
Nor!l
>%+ro@i
*
&
&
Nor!l
>%+ro@i
*
B,n
Tro@i
Ger. inol%n+er Re@.,in,ing per%+
>%+ro@i
*:
>%+ro@i
*:
Nor!l
0 SIS"M SNS5RIK
Sen##i nn iri e+erngn
R
Neri
S%'%ropio#ep+i@
Nor!l
Nor!l
Nor!l Nor!l
Nor!l
Nor!l
Nor!l Nor!l
Nor!l
Nor!l
Nor!l Nor!l
I0 RFLKS
nn iri e+erngn
Fi#iologi#
Bi#ep#
Tri#ep#
R AR
:
:
::
:
:
::
Nor!l
+ologi#
Bin#i
=',,o-
8o@@!n Tro!er
Re@le pri!i+i@
l!o!en+l
Sno%+
*
*
*
*
*
*
*
*
*
*
Nor!l
6
8/19/2019 Case Stroke Hemoragik Helena Mayasari
7/23
II0 FUN6SI K5RDINASI
nn iri e+erngn
Te#+ +el%n4% 'i,%ng
Te#+ +%!i+ l%+%+
Gi+
Tn,e!
Ro!erg
Nor!l
Nor!l
Nor!l
Nor!l
Nor!l
Nor!l
S%li+ ,inili
S%li+ ,inili
S%li+ ,inili
III0 SIS"M 5"5N5M
• Mi#i +erp#ng +e+er
• De@e#i el%! , BAB
I;0 PMRIKSAAN KHUSUS%LAIN
. #eC%e Ti, +er+#
. ernig Ti, +er+#
-. +ri- */*
,. on+rp+ri- */*
e. ?l# +e#+ Nor!l
@. Br%,&M6?5
• Tenn ,r' 10/110 !!8g
• ern@#n 22;/ !n+9 +er+%r
• N,i ;/!eni+
• F%ng#i l%'%r Nor!l
• Rng#ng !eningel (*)
• Sr@ rnil Nor!l
•Mo+ori 8e!ipre#i# #ini#+r
7
8/19/2019 Case Stroke Hemoragik Helena Mayasari
8/23
• Sen#ori Nor!l
• oor,in#i S%li+ ,inili
• +ono! Nor!l
• Re@le#
* Fi#iologi# Nor!l
* +ologi# (*)
• Sor g4' !, pen%r%nn e#,rn (*)9 #i+ epl (:)9 re@le
p+ologi (*) #+roe 'e!orgi
C0 DIA6N5SIS KR-ADIA6N5SIS KLINIS : 8e!ipre#e Sini#+r : 8iper+en#i Gr,e II
DIA6N5SIS "5PIK : Si#+e! ro+i# ,e#+r
DIA6N5SIS "I5L56IK : S+roe 'e!orgi
DIA6N5SIS !ANDIN6 : S+roe in@r
DIA6N5SIS SKUNDR : 8iper+en#i gr,e II
D0 USULAN PMRIKSAAN PNUN-AN6
1. e!eri#n ,r' r%+in ,n %rin r%+in
2. e!eri#n i!i ,r'
.=T #-n epl +np on+r#
&. Fo+o Tor#
5. >G
0RNCANA "RAPI
. $!%!
* Tir' ring ,engn po#i#i epl ,i+inggin 0°
* on+rol i+l #ign (#+ili##i n@# E2 il #+%r#i 5H9 #ir%l#i
(nor!oole!i)
* 'in,ri pe!erin-irn gl%o# +% -irn 'ipo+oni
* 8in,ri po#i#i penenn p, en 4%g%lr (le'er)
* Moili##i ,n re'ili+#i !e,i
8/19/2019 Case Stroke Hemoragik Helena Mayasari
9/23
* I?FD (0--/g/'ri) R 20 +e+e#/!eni+
/0 K3usus
* In4 -i+i-olin 250 !g/124!
* In4 A#! +rne#!+ 500 !g/6 4!
* In@%# !ni+ol (0925*0950gr!/g1*gr!/64!)&;100--
F0 HASIL PMRIKSAAN
Dr' r%+in (2 J%li 2015)
8 1&95 gr
e%o#i+ 11.560 /!!
Tro!o#i+ 22.000/!!
8+ &29 ol
i!i ,r'
Gl% 10& !g/,l
re+inin 1926 !g/,l
$re%! 97 !g/,l
AST 25 !g/,l
AT 21 !g/,l
CT scan :
* T!p le#i 'iper,en# p, o+e#-ereri ,e;+r.
* Ti, +!p ,ei#i #+r%+%r gri#
+eng'
* Ti, +!p g!rn S
Kesan:
er,r'n p, or+e# -ereri
,e;+r
8/19/2019 Case Stroke Hemoragik Helena Mayasari
10/23
60 DIA6N5SIS AKHIR
S+roe 'e!orgi (pen,r'n in+r #ererl 'e!i#@er ,e;+r)
H0 F5LL5< UP
"an,,al '= -uli '(&.
S Tngn ,n i iri le!' %n+% ,igern9 p%#ing (:)
e#,rn o!po#!en+i# G=S >&M6?5
TD 160/100 !!8g RR 22 ;/!eni+
N,i 2;/!eni+9 reg%lr T 690=
F%ng#i l%'%r nor!l
Rng#ng !eningel (*)
Sr@ rnil nor!l
Mo+ori 'e!ipre#i# #ini#+r
Sen#ori nor!l
oor,in#i #%li+ ,inili
+ono! nor!l
Re@le# Fi#iologi# nor!l
+ologi# (*)A S+roe 'e!orgi (pen,r'n in+r #ererl 'e!i#@er ,e;+r)
* I?FD R 20 +e+e#/!eni+
* In4 -i+i-olin 250 !g/124!
* In4 rni+i,ine 2; 50 !g
* in4 A#! +rne#!+ 500!g/6 4!
"an,,al +( -uli '(&.
S Tngn ,n i iri !#i' +er# le!'9 p%#ing (*)
e#,rn o!po#!en+i# G=S >&M6?5
TD 1&0/100 !!8g RR 22 ;/!eni+
N,i 2;/!eni+9reg%lr T 6950=
F%ng#i l%'%r nor!l
Rng#ng !eningel (*)
Sr@ rnil nor!l
Mo+ori 'e!ipre#i# #ini#+r
10
8/19/2019 Case Stroke Hemoragik Helena Mayasari
11/23
Sen#ori nor!l
oor,in#i #%li+ ,inili
+ono! nor!l
Re@le# Fi#iologi# nor!l
+ologi# (*)
A S+roe 'e!orgi (pen,r'n in+r #ererl 'e!i#@er ,e;+r)
* In@%# !ni+ol ;125 --
* In4 -i+i-olin 250 !g/124!
* In4 A#! +rne#!+ 500 !g/6 4!
"an,,al +& -uli '(&.
S Tngn ,n i iri !#i' +er# le!'
e#,rn o!po#!en+i# G=S >&M6?5
TD 10/100 !!8g RR 22 ;/!eni+
N,i ;/!eni+9 reg%lr T 690=
F%ng#i l%'%r nor!l
Rng#ng !eningel (*)
Sr@ rnil nor!l
Mo+ori 'e!ipre#i# #ini#+rSen#ori nor!l
oor,in#i #%li+ ,inili
+ono! nor!l
Re@le# Fi#iologi# nor!l
+ologi# (*)
A S+roe 'e!orgi (pen,r'n in+r #ererl 'e!i#@er ,e;+r)
* In@%# !ni+ol ;125 --
* in4. -i+i-olin 250 !g/124!
* In4 A#! +rne#!+ 500 !g/6 4!
* !i-r,i# 2;0 !g
"an,,al & A,ustus '(&.
S Tngn ,n i iri !#i' +er# le!'
e#,rn o!po#!en+i# G=S >& M6?2
TD 1&0/100 !!8g RR 22 ;/!eni+
11
8/19/2019 Case Stroke Hemoragik Helena Mayasari
12/23
N,i 2;/!eni+9 ireg%lr T 690=
F%ng#i l%'%r nor!l
Rng#ng !eningel (*)
Sr@ rnil nor!l
Mo+ori 'e!ipre#i# #ini#+r
Sen#ori nor!l
oor,in#i #%li+ ,inili
+ono! nor!l
Re@le# Fi#iologi# nor!l
+ologi# (*)
A S+roe 'e!orgi (pen,r'n in+r #ererl 'e!i#@er ,e;+r)
* In@%# !ni+ol 1;100--
* In4 -i+i-olin 250 !g/124!
* In4 A#! +rne#!+ 500 !g/6 4!
* on#%l re'! !e,i
12
8/19/2019 Case Stroke Hemoragik Helena Mayasari
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PM!AHASAN
I0 Stroke
I0& Definisi Stroke
Men%r%+ World Health Organization (8) #+roe ,l' !ni@e#+#i
lini ,ri gngg%n @%ng#i #ererl9 i @ol !%p%n !o+ori9 ng
erlng#%ng ,engn -ep+ ,n lei' ,ri 2& 4! +% er'ir ,engn e!+in
+np ,i+e!%nn peni+ #elin ,rip, gngg%n #%lr.1
I0' Klasifikasi
S+roe ,p+ ,il#i@i#in er,#rn elinn p+ologi p, o+9
3+% +er4,in ,n lo#i le#i #%ler.2
. Ber,#rn elinn p+ologi
1. S+roe 'e!orgi# (per,r'n)9 ng ,igi +#
1) er,r'n in+r#ererl
2) er,r'n e#+r#ererl (per,r'n #%r-'noi,)
2. S+roe non'e!orgi# (#+roe i#e!i9 in@r o+9 pen%!+n)9 ng
,igi +#
1) Tro!o#i# #ereri (+ero+ro!o+i)
2) >!oli #ereri
) 8ipoper@%#i #i#+e!i
. Ber,#rn penilin +er',p 3+% +er4,in (temporal profile)9 i+%
1. Transient Ischemic Attack (TIA) +% #erngn #+roe #e!en+r9 ge4l
,e@i#i+ ne%rologi# 'n erlng#%ng %rng ,ri 2& 4!.
2. Reversible Ischemic Neurolagical Deficits (RIND)9 elinnn +%
ge4l ne%rologi# !eng'ilng lei' ,ri 2& 4! #!pi !ingg%.
. S+roe progre#i@ +% Stroke in volution (SI>)9 i+% #+roe ng ge4l
lini#n #e-r er+'p ere!ng ,ri ng ringn #!pi #e!in
er+.
&. =ompleted stroke9 i+% #+roe ,engn ,e@i#i+ ne%rologi# ng !ene+p
,n #%,' +i, ere!ng lgi.
-. Ber,#rn lo#i le#i #%ler
1
8/19/2019 Case Stroke Hemoragik Helena Mayasari
14/23
1. Si#+e! ro+i#
•Mo+ori 'e!ipre#e on+rl+erl9 ,i#r+ri.
•Sen#ori 'e!i'ipe#+e#i on+rl+erl9 pre#+e#i.
•Gngg%n i#%l 'e!inop#i 'o!oni! on+rl+erl9 !o%ro#i#
@%g;.
•Gngg%n @%ng#i l%'%r @#i9 gno#i.
2. Si#+e! er+ero#iler
•Mo+ori 'e!ipre#e l+ernn9 ,i#r+ri.
•Sen#ori 'e!i'ipe#+e#i l+ernn9 pre#+e#i.
•Gngg%n lin gngg%n e#ei!ngn9 er+igo9 ,iplopi
I0+ Faktor risiko stroke+
) F+or re#io ng ,p+ ,i!o,i@i#i (modifable)- 8iper+en#i
- eni+ 4n+%ng (+ril @iril#i)
- Die+e# !eli+%#
- Meroo
- on#%!#i lo'ol
- 8iperlipi,e!i
- %rng +i@i+#
- S+eno#i# r+eri ro+i#
) F+or re#io ng +i, ,p+ ,i!o,i@i#i (nonmodifable)
- $#i
- Jeni# el!in- R#/#%%
- Gene+i
I04 Patofisiolo,i
S+roe ,p+ ,i#en ole' #+% ,ri eerp pro#e# ng !elip%+i
pe!%l%' ,r' ,i o+9&
1. ro#e# in+rin#i pe!%l%' ,r' !i#ln +ero#lero#i#9 lipo'ilono#i#9
in@l!#i9 ,epo#i+ !iloi,9 ,e#e#i r+eri9 !l@or!#i9 ,il+#i ne%ri#!
+% +ro!o#i# en.
2. ro#e# ng er#l ,ri +e!p+ lin !eni!%ln e!ol%# !i#ln e!oli
,ri 4n+%ng +% #ir%l#i e#+rrnil ng !enen gngg%n
pe!%l%' ,r' in+rrnil.
. ro#e# ng +i!%l ren lirn ,r' e o+ in,e%+ i+
!en%r%nn +enn per@%#i o+ +% !ening+n i#o#i+# ,r'.
1&
8/19/2019 Case Stroke Hemoragik Helena Mayasari
15/23
&. ro#e# ng +er4,i i+ pe-'n pe!%l%' ,r' ,ir%ng #%r-'noi,
+% 4ringn o+/in+r#ererl.
&0. Patofisiolo,i Stroke He#ora,ik
er,r'n in+rrnil !elip%+i per,r'n ,i preni! o+ ,n
per,r'n #%r-'noi,.In#i,en# per,r'n in+rrnil %rng lei' 20
,l' #+roe 'e!orgi9 ,i!n !#ing*!#ing 10 ,l' per,r'n
#%r-'noi, ,n per,r'n in+r#ererl.596
er,r'n in+r#ererl i#n +i!%l ren pe-'n !irone%ri#!
( !err" aneur"sm) i+ 'iper+en#i !lign.8l ini pling #ering +er4,i ,i ,er'
#%or+il9 #ereel%!9 ,n +ng o+.8iper+en#i roni !enen pe!%l%' r+eriol er,i!e+er 100 &00 !iro!e+er !engl!i per%'n
p+ologi p, ,in,ing pe!%l%' ,r' +er#e%+ er%p lipo'ilino#i#9 nero#i#
@irinoi, #er+ +i!%ln ne%ri#! +ipe Bo%-'r,., enn p#ien9
pening+n +enn ,r' ng +i*+i !enen r%p+%rn pene+r+ing
r+eri ng e-il.el%rn ,r' ,ri pe!%l%' ,r' e-il !e!%+ e@e
penenn p, r+eriole ,n pe!%l%' piler ng 'irn !e!%+
pe!%l%' ini pe-' 4%g.8l ini !engi+n ol%!e per,r'n #e!in
e#r.596
>le!en*ele!en #o+i@ ,r' ng el%r #er+ #,e i#e!i i+
!en%r%nn +enn per@%#i9 !enen ne%ron*ne%ron ,i ,er' ng +eren
,r' ,n #ei+rn lei' +er+en lgi.Ge4l ne%rologi +i!%l ren
e#+r##i ,r' e 4ringn o+ ng !enen nero#i#.596
er,r'n #%r-'noi, (SA) +er4,i i+ pe!%l%' ,r' ,i#ei+r
per!%n o+ pe-'9 #e'ingg +er4,i e#+r##i ,r' e r%ng
#%r-'noi,.er,r'n #%r-'noi, %!%!n ,i#en ole' r%p+%rn
ne%ri#! #%lr +% per,r'n ,ri arteriovenous malformation #A$%&.596
&0* 6a#/aran klinis
"a/el &0 Per/edaan Stroke He#ora,ik dan Non 3e#ora,ik .1*
Klinis PIS PSA Non He#ora,ik
De@i#i+ @ol Ber+ Ringn Ber+ ringn
n#e+ Meni+/4! 1*2 !eni+ eln (4!/'ri)
Neri epl 8e+ Sng+ 'e+ Ringn
M%n+' p, Sering Sering Ti,9 e- le#i ,i
15
8/19/2019 Case Stroke Hemoragik Helena Mayasari
16/23
3ln +ng o+
8iper+en#i 8!pir #ell% Bi#n +i, Sering li
en%r%nn
e#,rn
A, A, Ti, ,
% %,% Jrng A, Ti, ,
8e!ipre#i# Sering ,ri 3l er!%ln +i,
,
Sering ,ri 3l
Gngg%n i-r Bi# , Jrng Sering
i%or
-erero#pinl
Bi# +er,p+
,r'
Ber,r' Jerni'
"a/el '0 Per/edaan ,e>ala klinis stroke infark dan 2erdara3an&
6e>ala atau
2e#eriksaan
Infark otak Perdara3an intra sere/ral
Ge4l ng !en,'%l%i TIA (:) 50 TIA (*)
Ber+ii+#/i#+ir'+ I#+ir'+9 +i,%r +%
#eger #e+el'
ng%n +i,%r
Sering p, 3+% +i@i+#
@i#i
Neri epl ,n !%n+' Jrng Sng+ #ering ,n 'e+
en%r%nn e#,rn
3+% on#e+
Jrng Sering
8iper+en#i Se,ng/ nor!o+en#i Ber+9 ,ng #e,ng
Rng#ngn !eningen Ti, , A,
Ge4l +enn +inggi
in+r-rnil/ppil%,e!
Jrng ppil%,e! pil%,e! ,n per,r'n
#%'iloi,
Dr' ,l! -irn
#erero#pinl
Ti, , A,
Fo+o epl Dp+ ,i4%!pi perge#ern
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gln,%l pineli#
=T*S-n epl Ter,p+ re
'ipo,en#i+#
M## in+rrnil ,engn
re 'iper,en#i+#
Angiogr@i Dp+ ,i4%!pi
g!rn
pen%!+n9
pene!pi+n ,n
#%li+i#
Dp+ ,i4%!pi ne%ri#!9
A?M9 !## in+r'e!i#@er
+% #o#p#!e
"a/el +0 Per/edaan ,e>ala klinik siste# 8arotis dan siste# ?erte/ro/asiler&
6an,,uan Siste# Karotis Siste# erte/ro/asiler
Mo+ori 8e!ipre#e on+rl+erl9
,i#+ri
8e!ipre#e l+ernn9
,i#r+ri
Sen#ori 8e!i'ipe#+e#i on+rl+erl9
pre#+e#i
8e!i'ipe#+e#i l+ernn9
pre#+e#i
?i#%l 8e!inop#i'o!oni!
on+rl+erl9 !%ro#i#
@%g;
8e!inop#i 'o!oni!9
'ortical !lindness(
!lack out (TIA)
F%ng#i l%'%r +%
linn
A@#i9 nog#i Gngg%n
e#ei!ngn9 er+igo9
,iplopi9 ni#+g!%#9
,i#@gi
Alo,arit#a 6a>a3 Mada&
1 en%r%nn e#,rn
2 Si+ epl
Re@le# p+ologi
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en,eri+ S+roe A%+ è
e+ign +% 2 ,ri e+ign ,
en%r%nn e#,rn (:)9 #i+ epl (*)9 re@le# p+ologi# (*)
en%r%nn e#,rn (*)9 #i+ epl (:)9 re@le p+ologi (*)
en%r%nn e#,rn (*)9 #i+ epl (*)9 re@le# p+ologi (:) à S+roe In@r
en%r%nn e#,rn (*)9 #i+ epl (*)9 re@le# p+ologi (*) S+roe In@r
Siste# Karotis
Alirn ,r' e o+ ng !ell%i r+eri er+erli# er#er+ -ng*
-ngn ,i#e%+ #i#+e! er+ero#iler9 ,n ng!ell%i r+eri ro+i# in+ern
e#er+ -ng*-ngn ,i#e%+ #i#+e! ro+i#.Si#+e! ro+i# +er,iri ,ri +ig
r+eri !or9 i+% r+eri ro+i# o!%ni#9 ro+i# in+ern9 ,n ro+i# e#+ern.29
Siste# karotis intrakranial'1@
Ar+eri ro+i# in+ern !ene!%# ,#r +engor !ell%i nli# ro+i%#
p, gin pe+ro#%# +%lng +e!porli#.Se+el' !ell%i nli# ro+i%# ng
pn4ngn '!pir 1 -!9 A. ro+i# in+ern !#% r%ng +engor n+r lpi#
,%r!+er ,i 3' gnglion N.? (gnglion G##eri)9 e!%,in ni ,n er4ln
#epn4ng po#+erol+erl #ell +%r#i !#% e ,l! #in%# erno#%#.Dl!
#in%# erno#%#9 A. ro+i# in+ern er4ln e n+erior9 e!%,in e po#+erior
#e'ingg !e!en+% K-ro+i, #ip'onL. Bgin 'ir A. ro+i# in+ern ,in+r N.
II ,n N. III l+erl ,ri pro#e#%# linoi,e%# n+erior ,n in@erior ,ri #%#+n#i
per@or+ n+erior ,n er-ng !en4,i A. #ereri n+erior ,n !e,i.
=ng*-ng A. ro+i# in+ern
1. Dl! nli# ro+i%# A. ro+io+i!pni ,n r+eri*r+eri ,l!nli# p+erigoi,e%#
2. , gin erno#%# er-ng
- Ar+eri e ,in,ing #in%# erno#%#
- Ar+eri e gnglion N.?
- Ar+eri e 'ipo@i#e
- Ar+eri !eninge n+erior
- Ar+eri o@+l!i9 ng !e!p%ni #l' #+% -ng i+% A. #en+rli#
re+in
. , gin 'ir A. ro+i# in+ern9 er-ng
S+roe8e!orgi
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- A. o!%nin# po#+erior9 ,engn -ng*-ngn e 'ipo+l!%#9
+l!%#9 'ipo@i#e9 'i#! op+i%! ,ll.
- A. 'oroi,e n+erior
- A. #ereri n+erior9 ,engn -ng*-ngn (A. #+ri+ !e,il +%
re%ren# '%ner9 A. o!%nin# po#+erior9 A. @ron+opolri#9 A.
perillo#l9 A. llo#o!rginli#9 A. prie+li#)
- A. #ereri !e,i9 ,engn -ng*-ngn (A. len+i%lo#+ri+ ,n
-ng*-ng e-il linn e gngli #li#9 A. @ron+li# #en,en#9
A. pre*roln,i9 A. roln,i9 A. prie+li# n+erior9 A. prie+li#
po#+erior9 A. ng%lri#9 A. prie+o*+e!porli#9 A. +e!porli# po#+erior
,n n+erior)
G!r 1. Ar+eri =ro+i#
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G!r 2. Bgin -ereri ng ,iper,r'i ole' -ng r+eri -ro+i#
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' Dasar dia,nosis
a0 Dasar dia,nosis klinis :
Dri n!ne#i# ,ie+'%i '3 p, p#ien ini +er4,i ,e@i#i+ ne%rologi#
ng +er4,i #e-r +i*+i9 n+r lin
Neri epl
ele!'n nggo+ ger
Ri3+ 8iper+en#i +i, +eron+rol.
8l ini #e#%i ,engn ,e@ini#i 8 '3 ge4l lini ,ri #+roe i+%
gngg%n #ererl9 i @ol !%p%n glol ,engn #erngn ,l! 2& 4! +%
lei'9 +np ,i+e!%n peni+ #elin ,ri p, gngg%n #%ler. , p#ien
ini 4%g ,i+e!%n @+or re#io er%p 'iper+en#i ng +i, +eron+rol ,i!n
'iper+en#i!er%pn @+or re#io ,ri #+roe.
/0 Dasar dia,nosis to2ik :
Dri pe!eri#n @i#i ,i+e!%n
Si#+e! ro+i# !eni!%ln ge4l ,n el%'n neri epl ng
'e+ !%n-%l #e-r !en,, #+ er+ii+#.
=T*S-n !en%n4%n per,r'n ,i region +e!poroprie+l ,e#+r
80 Dasar dia,nosis etiolo,ik :
Dri n!ne#i# ,n pe!eri#n @i#i p, p#ien ini ,i,p+n
Neri epl (:)
n#e+ p, 3+% #e,ng er+ii+#
% %,% (*)
Re@le p+ologi (*)
Ber,#rn lgori+! #+roe g4' !, e!%nginn #+roe p,
p#ien ini ,l' #+roe i+ per,r'n.
d0 Dasar dia,nosis /andin,
S+roe non 'e!orgi
S+roe non 'e!orgi ren el%'n !%n-%l !en,, ,n +er,p+ ,e@i#i+
ne%rologi#.
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!0 Dasar Usulan Pe#eriksaan Penun>an,
1. e!eri#n lor+ori%! %n+% !enge+'%i !enge+'%i @+or re#io
+er4,in #+roe ,n on,i#i %!%! p#ien
2. e!eri#n =T*#-n %n+% ,igno#i# p#+i p+ologi #+roe ('e!orgi
+% in@r)9 lo#i ,n l%# le#i.
. Fo+o ron+gen +or !eli'+ ,/+i,n pe!e#rn 4n+%ng (i+
'iper+en#i l!)
&. >G !eli'+ ,n elinn 4n+%ng ng !er%pn @+or re#io
#+roe
C0 Dasar Penatalaksanaan
1. Tir' ring ,n po#i#in epl ,n ,n 20*00 %n+%
!e!per+'nn #ir%l#i ng ,e%+ e o+
2. In@%# R20 +e+e#/!eni+ %n+% !e!per+'nn e,n e%ol%!i ,n
e%+%'n gl%o#
. In@%# Mni+ol 100 --/ 4! %n+% !eng%rngi e,e! #ereri
&. In4e#i +rne;!i- -i, &; 500 !g %n+% !engen,lin per,r'n
.0 e!erin -i+i-olin er+%4%n #egi ne%ropro+e+or.
Dia,nosis Ak3ir
Digno#i# 'ir p#ien ini ,l' #+roe 'e!orgi e.- per,r'n
in+ren+riel ,e#+r. Di+egn #e+el' !el%n pe!eri#n pen%n4ng
8e, =T #-n9 ng !n !er%pn gol, #+n,r %n+% !enen+%n pene
#+roe ng +er4,i. 8#il 8e, =T #-n !en%n4%n ,n per,r'n
in+ren+ri%ler.
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DAF"AR PUS"AKA1. R%!n+ir =$. Gngg%n pere,rn ,r' o+. enr% SMF Sr@
RS$D Ari@in A-'!,/ F $NRI. enr% 2007.2. Be'r M9 Fro+#-'er M. Bloo, S%ppl n, ?#-%ler Di#or,er o@ T'e
=en+rl =en+rl S#+e!.In D%%# Topi-l Digno#i# in Ne%rolog. & +'>,i+ion.
Ne3 "or. 2005. &&*5.
. Bro3n R89 Ropper A8. A,!# n, ?i-+or#*=erero#-%lr ,i#e#e.
In rin-iple# o@ Ne%rolog. +' >,i+ion. Ne3 "or M-gR3*8ill. 2005 660*
7&0.
&. R%!n+ir =$. ol pen,eri+ S+roe Di /$F Il!% eni+ Sr@
F%l+# e,o+ern ,4,4rn R%!' Si+ 8#n S,iin Bn,%ng
perio,e 1&*15. porn eneli+in engl!n Bel4r Ri#e+ Do+er
Spe#ili# Bi,ng Il!% Sr@. 16.
5. Ber DM. Ri# F-+or in S+roe.In S+roe reen+ion in =lini-l
r-+i-e Springer. on,on9 200.
6. =pln R. S+roe -lini-l ppro-'. r, e,i+ion. Bo#+on
B%++er3or+'*8eine!nn9 2000
7. G%i,eline S+roe 2011. o,i #+roe. er'i!p%nn Do+er Spe#ili# Sr@
In,one#i (>RDSSI). Jr+ 2011.. Snell RS. Ne%ron+o!i lini. >,i#i 5. Jr+ >G=. 2005 525*5.
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