CASE Stroke Infark Agung

8/19/2019 CASE Stroke Infark Agung

1/33

RSUD ARIFIN ACHMAD

Fakultas Kedokteran UR  SMF/ BAGIAN SARAF

Sekretariat : SMF Saraf – Irna Medikal Lantai 4

Jl. Diponegoro No. 2 Telp. (0761) 7026225

P  K A N ! A R U

S"A"US PASIN

 N! "o## Ag$ng %!$ng&#

 N I M / N ' " 0501202

%e!i!ing *r. Ri&i S$&in*r+ Sp.S

I# IDN"I"AS PASIN

 N! Tn. AR 

'!$r 55 ,-$n

Jeni# &el!in &il&i

Al!, Jl. S$& "r  T!pn

Ag! I#l!

S,,$# per&inn "in

%e&er3n B$r$-

Tnggl M#$& RS 14 Ag$#,$# 201

Me*il Reor* 6 25 66

II# ANAMNSIS   Allon!ne#i# *ri n& p#ien

Kelu$an Uta%a

%en$r$nn &e#*rn

Ri&a'at Pen'akit Sekaran(

1 -ri #eel$! !#$& ng#l #r8+ p#ien !engl!i pen$r$nn &e#*rn #, i#,ir-, 9 :0 !eni, &e!$*in p#ien #*r ,e,pi ,i*& *p, erir *n

,i*& !enger,i p g &i, ir&n+ ll$ *i  &e r$!- #&i,. engn *n

,$ng&i #eel- &nn le!- *n ,i*& i# *iger&&n *n *ing&,. M$n,- ,i*& 

*+ !$l ,i*& *+ &e3ng ,i*& *+ !$*- lel- #, er3ln ,i*& * *n ,i*& 

!$*- #e#&. Seel$!n p#ien ,i*& * !engel$-&n neri &epl.

BAB *n BA" p#ien nor!l.

8/19/2019 CASE Stroke Infark Agung

2/33

%#ien ,i*& #e*ng !eng&on#$!#i o,o,n+ ,i*& * !e!&n !&nn

ng ,i*& l;i! #eel$!n.

Ri&a'at Pen'akit Da$ulu

•%#ien el$! pern- !en*eri, &el$-n #eper,i ini

#eel$!n.

  Ri, -iper,en#i (

8/19/2019 CASE Stroke Infark Agung

3/33

) SARAF KRANIAL

1. N# I ,*lfa-torius .

"nn "iri "e,erngn

D pe!$ SDN SDN S$li, *inili (SDN)

2. N#II ,*/ti-us.

"nn "iri "e,erngn

D pengli-,n

png pn*ng

%engenln rn

SDN

SDN

SDN

SDN

SDN

SDN

SDN

:. N#III ,*-ulo%otorius.

"nn "iri "e,erngn

%,o#i#

%$pil

  Ben,$& 

  '&$rn Ger& ol !,

Re8le p$pil

  ng#$ng

  Ti*& lng#$ng

()

B$l,

: !!  N

(

8/19/2019 CASE Stroke Infark Agung

4/33

. N# 0III ,Akustikus.

"nn "iri "e,erngn

%en*engrn SDN SDN SDN

4. N# I1 ,+lossofarin(eus.

"nn "iri "e,erngn

Ar&$# 8ring# D per#

Re8le !$n,-

SDN SDN

SDN

SDN SDN

SDN

SDN

10. N# 1 ,0a(us.

"nn "iri "e,erngn

Ar&$# 8ring#

D#8oni

SDN

SDN

SDN

SDN

SDN

11. N# 1I ,Assesorius.

"nn "iri "e,erngn

Mo,ori& 

Tro8i

SDN

@$,ro8i

SDN

@$,ro8i

SDN

12. N# 1II ,Hi/o(lossus.

"nn "iri "e,erngn

Mo,ori& 

Tro8i

Tre!or 

Di#r,ri

SDN

SDN

SDN

SDN

SDN

SDN

SDN

SDN

SDN

I0# SIS"M M*"*RIK 

"nn "iri "e,erngn

@,re!i,# ,#

  "e&$,n

Di#,l

%roi!l

  Ton$#

  Tro8i

  Ger.inol$n,er 

SDN

SDN

 Nor!l

@$,ro8i

()

SDN

SDN

 Nor!l

@$,ro8i

()

"e#n SDN

@,re!i,# -

  "e&$,n

Di#,l

%roi!l

  Ton$#

  Tro8i

  Ger.inol$n,er 

SDN

SDN

 Nor!l

@$,ro8i

()

SDN

SDN

 Nor!l

@$,ro8i

()

"e#n SDN

8/19/2019 CASE Stroke Infark Agung

5/33

B*n

  Tro8i

  Ger. Inol$n,er 

@$,ro8i

 ()

@$,ro8i

 ()

Ti*& * &elinn

0# SIS"M SNS*RIK 

"nn "iri "e,erngn

R

 Neri

S$-$

%ropio#ep,i8 

SDN

SDN

SDN

SDN

SDN

SDN

SDN

SDN

SDN

0I# RFLKS

"nn "iri "e,erngn

Fi#iologi#

  Bi#ep#

  Tri#ep#

  "%R    A%R 

(

8/19/2019 CASE Stroke Infark Agung

6/33

e. l# ,e#,  

8. Br$*;in#&i  /

1# RSUM PMRIKSAAN

"e*n $!$!

"e#*rn  So!nolen

  Te&nn *r-  &nn  160/110!!=g+ &iri  160/110 !!=g

F$ng#i l$-$r  A8#i glol (

8/19/2019 CASE Stroke Infark Agung

7/33

 %e!erin n$,ri#i perorl #e#$i &e$,$-n &lori p#ien

)# K$usus

 IFD R 20 g,,/i

 A#pile, 2 > 0 !g

 In3. ?i,ioline 2 > 250 !g

 In3. %ire,! : > : gr!

F# HASIL PMRIKSAAN PNUN3AN+ 

 Head  C"S-an ,tan((al 56 A(ustus 7854.

8/19/2019 CASE Stroke Infark Agung

8/33

8/19/2019 CASE Stroke Infark Agung

9/33

Hasil C" S-an:

 ,!p& re -ipo*en#i,# p* gin #ini#,r

"e#n #,ro&e in8r& 

Dara$ rutin ,56 A(ustus 7854.

  =  1:+7 gr/*l

=,  5+7 E

e$  1.500/!!:

Tro!  :16.000/!!:

Ki%ia dara$ ,56 A(ustus 7854.

 GDS  7 !g/*l

 ?RS  1+01 !g/*l

 B'N  1:+6 !g/*l

 're$!  24 !g/*l

 AT  16 I'/

 AST  25 I'/

?=  175 !g/*l

8/19/2019 CASE Stroke Infark Agung

10/33

PM!AHASAN

I# Definisi Stroke

Men$r$, World Health Organization (=) #,ro&e *l- !ni8e#,#i &lini& 

*ri gngg$n 8$ng#i #ererl+ i& 8o&l !$p$n glol+ ng erlng#$ng *engn

ep, *n lei- *ri 2 3! ,$ er&-ir *engn &e!,in ,np *i,e!$&nn

 pen&i, #elin *rip* gngg$n #&$lr.1

II# Klasifikasi stroke 597

A Ber*#r&n &elinn p,ologi& p* o,& 

1 S,ro&e =e!orgi& 

• %er*r-n in,r#ererl

• %er*r-n e,r#ererl (per*r-n #$r&noi*)

2 S,ro&e non -e!orgi& (#,ro&e i#&e!i&+ in8r& o,&+ pen$!,n)

ng *igi ,# #$,ipe 

• Tro!o#i# #ereri

• @!oli #ereri

8/19/2019 CASE Stroke Infark Agung

11/33

• =ipoper8$#i #i#,e!i& 

B Ber*#r&n penilin ,er-*p &,$ &e3*inn

1 Transient Ischemik Attack  (TIA) ,$ #erngn #,ro&e #e!en,r+ ge3l *e8i#i,

ne$rologi# -n erlng#$ng &$rng *ri 2 3!.

2  Reversible Ischemic Neurological Deficits  (RIND)+ &elinnn ,$ ge3l

ne$rologi# !eng-ilng lei- *ri 2 3! #!pi : !ingg$.

: S,ro&e progre#i8 ,$ Stroke in volution  ([email protected]) i,$ #,ro&e ng ge3l

&lini#n #er er,-p er&e!ng *ri ng ringn #!pi #e!&in er,.

 S,ro&e &o!pli, ,$ com!leted stroke+ i,$ #,ro&e *engn *e8i#i, ne$rologi#

ng !ene,p *n #$*- ,i*& er&e!ng lgi.

? Ber*#r&n lo&#i le#i #&$ler 

1. Si#,e! &ro,i#

 Mo,ori&  -e!ipre#e &on,rl,erl+ *i#r,ri

 Sen#ori&  -e!i-ipe#,e#i l,ernn#+ pre#,e#i

 Gngg$n i#$l  -e!inop#i -o!on! &on,rl,erl+ !$ro#i# 8$g

 Gngg$n 8$ng#i l$-$r  8#i+ gno#i

2. Si#,e! er,ero#iler 

 Mo,ori&  -e!ipre#e l,ernn#. Di#r,ri

 Sen#ori&  -e!i-ipe#,e#i l,ernn#+ pre#,e#i

 Gngg$n lin  gngg$n &e#ei!ngn+ er,igo+ *iplopi