Upload
indra-fakhreza
View
221
Download
0
Embed Size (px)
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 PASIN
N! "o## Ag$ng %!$ng&#
N I M / N ' " 0501202
%e!i!ing *r. Ri&i S$&in*r+ Sp.S
I# IDN"I"AS PASIN
N! Tn. AR
'!$r 55 ,-$n
Jeni# &el!in &il&i
Al!, Jl. S$& "r T!pn
Ag! I#l!
S,,$# per&inn "in
%e&er3n B$r$-
Tnggl M#$& RS 14 Ag$#,$# 201
Me*il Reor* 6 25 66
II# ANAMNSIS Allon!ne#i# *ri n& p#ien
Kelu$an Uta%a
%en$r$nn &e#*rn
Ri&a'at Pen'akit Sekaran(
1 -ri #eel$! !#$& ng#l #r8+ p#ien !engl!i pen$r$nn &e#*rn#, i#,ir-, 9 :0 !eni, &e!$*in p#ien #*r ,e,pi ,i*& *p, erir *n
,i*& !enger,i p g &i, ir&n+ ll$ *i &e r$!- #&i,. engn *n
,$ng&i #eel- &nn le!- *n ,i*& i# *iger&&n *n *ing&,. M$n,- ,i*&
*+ !$l ,i*& *+ &e3ng ,i*& *+ !$*- lel- #, er3ln ,i*& * *n ,i*&
!$*- #e#&. Seel$!n p#ien ,i*& * !engel$-&n neri &epl.
BAB *n BA" p#ien nor!l.
8/19/2019 CASE Stroke Infark Agung
2/33
%#ien ,i*& #e*ng !eng&on#$!#i o,o,n+ ,i*& * !e!&n !&nn
ng ,i*& l;i! #eel$!n.
Ri&a'at Pen'akit Da$ulu
•%#ien el$! pern- !en*eri, &el$-n #eper,i ini
#eel$!n.
Ri, -iper,en#i (
8/19/2019 CASE Stroke Infark Agung
3/33
) SARAF KRANIAL
1. N# I ,*lfa-torius .
"nn "iri "e,erngn
D pe!$ SDN SDN S$li, *inili (SDN)
2. N#II ,*/ti-us.
"nn "iri "e,erngn
D pengli-,n
png pn*ng
%engenln rn
SDN
SDN
SDN
SDN
SDN
SDN
SDN
:. N#III ,*-ulo%otorius.
"nn "iri "e,erngn
%,o#i#
%$pil
Ben,$&
'&$rnGer& ol !,
Re8le p$pil
ng#$ng
Ti*& lng#$ng
()
B$l,
: !! N
(
8/19/2019 CASE Stroke Infark Agung
4/33
. N# 0III ,Akustikus.
"nn "iri "e,erngn
%en*engrn SDN SDN SDN
4. N# I1 ,+lossofarin(eus.
"nn "iri "e,erngn
Ar&$# 8ring#D per#
Re8le !$n,-
SDNSDN
SDN
SDNSDN
SDN
SDN
10. N# 1 ,0a(us.
"nn "iri "e,erngn
Ar&$# 8ring#
D#8oni
SDN
SDN
SDN
SDN
SDN
11. N# 1I ,Assesorius.
"nn "iri "e,erngn
Mo,ori&
Tro8i
SDN
@$,ro8i
SDN
@$,ro8i
SDN
12. N# 1II ,Hi/o(lossus.
"nn "iri "e,erngn
Mo,ori&
Tro8i
Tre!or
Di#r,ri
SDN
SDN
SDN
SDN
SDN
SDN
SDN
SDN
SDN
I0# SIS"M M*"*RIK
"nn "iri "e,erngn
@,re!i,# ,#
"e&$,n
Di#,l
%roi!l
Ton$#
Tro8i
Ger.inol$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.inol$n,er
SDN
SDN
Nor!l
@$,ro8i
()
SDN
SDN
Nor!l
@$,ro8i
()
"e#n SDN
8/19/2019 CASE Stroke Infark Agung
5/33
B*n
Tro8i
Ger. Inol$n,er
@$,ro8i
()
@$,ro8i
()
Ti*& * &elinn
0# SIS"M SNS*RIK
"nn "iri "e,erngn
R
Neri
S$-$
%ropio#ep,i8
SDN
SDN
SDN
SDN
SDN
SDN
SDN
SDN
SDN
0I# RFLKS
"nn "iri "e,erngn
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# RSUM PMRIKSAAN
"e*n $!$!
"e#*rn So!nolen
Te&nn *r- &nn 160/110!!=g+ &iri 160/110 !!=g
F$ng#i l$-$r A8#i glol (
8/19/2019 CASE Stroke Infark Agung
7/33
%e!erin n$,ri#i perorl #e#$i &e$,$-n &lori p#ien
)# K$usus
IFD R 20 g,,/i
A#pile, 2 > 0 !g
In3. ?i,ioline 2 > 250 !g
In3. %ire,! : > : gr!
F# HASIL PMRIKSAAN PNUN3AN+
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* gin #ini#,r
"e#n #,ro&e in8r&
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
?RS 1+01 !g/*l
B'N 1:+6 !g/*l
're$! 24 !g/*l
AT 16 I'/
AST 25 I'/
?= 175 !g/*l
8/19/2019 CASE Stroke Infark Agung
10/33
PM!AHASAN
I# Definisi Stroke
Men$r$, World Health Organization (=) #,ro&e *l- !ni8e#,#i &lini&
*ri gngg$n 8$ng#i #ererl+ i& 8o&l !$p$n glol+ ng erlng#$ng *engn
ep, *n lei- *ri 2 3! ,$ er&-ir *engn &e!,in ,np *i,e!$&nn
pen&i, #elin *rip* gngg$n #&$lr.1
II# Klasifikasi stroke597
A Ber*#r&n &elinn p,ologi& p* o,&
1 S,ro&e =e!orgi&
• %er*r-n in,r#ererl
• %er*r-n e,r#ererl (per*r-n #$r&noi*)
2 S,ro&e non -e!orgi& (#,ro&e i#&e!i&+ in8r& o,&+ pen$!,n)
ng *igi ,# #$,ipe
• Tro!o#i# #ereri
• @!oli #ereri
8/19/2019 CASE Stroke Infark Agung
11/33
• =ipoper8$#i #i#,e!i&
B Ber*#r&n penilin ,er-*p &,$ &e3*inn
1 Transient Ischemik Attack (TIA) ,$ #erngn #,ro&e #e!en,r+ ge3l *e8i#i,
ne$rologi# -n erlng#$ng &$rng *ri 2 3!.
2 Reversible Ischemic Neurological Deficits (RIND)+ &elinnn ,$ ge3l
ne$rologi# !eng-ilng lei- *ri 2 3! #!pi : !ingg$.
: S,ro&e progre#i8 ,$ Stroke in volution (SI@) i,$ #,ro&e ng ge3l
&lini#n #er er,-p er&e!ng *ri ng ringn #!pi #e!&in er,.
S,ro&e &o!pli, ,$ com!leted stroke+ i,$ #,ro&e *engn *e8i#i, ne$rologi#
ng !ene,p *n #$*- ,i*& er&e!ng lgi.
? Ber*#r&n lo&#i le#i #&$ler
1. Si#,e! &ro,i#
Mo,ori& -e!ipre#e &on,rl,erl+ *i#r,ri
Sen#ori& -e!i-ipe#,e#i l,ernn#+ pre#,e#i
Gngg$n i#$l -e!inop#i -o!on! &on,rl,erl+ !$ro#i# 8$g
Gngg$n 8$ng#i l$-$r 8#i+ gno#i
2. Si#,e! er,ero#iler
Mo,ori& -e!ipre#e l,ernn#. Di#r,ri
Sen#ori& -e!i-ipe#,e#i l,ernn#+ pre#,e#i
Gngg$n lin gngg$n &e#ei!ngn+ er,igo+ *iplopi
II# Stroke He%ora(ik
%e-n pe!$l$- *r- o,& !ene&n &el$rn *r- &e 3ringn
pren&i! o,&+ r$ng irn #erero#pinl *i#e&i,r o,& ,$ &o!in#i &e*$n.
%er*r-n ,er#e$, !ene&n gngg$n #er$, #r8 o,& !ell$i pene&nn
8/19/2019 CASE Stroke Infark Agung
12/33
#,r$&,$r o,& *n 3$g ole- &ren -e!,o! ng !ene&n i#&e!i& p*
3ringn #e&i,rn. %ening&,n ,e&nn in,r&rnil p* gilirnn &n
!eni!$l&n -erni#i 3ringn o,& *n !ene&n ,ng o,&.2
tiolo(i Stroke He%ora(ik
Perdara$an Intrasere)ral
%er*r-n in,r#ererl *l- per*r-n ng ,er3*i *i *l! 3ringn o,&
&i, pe-n pe!$l$- *r- o,&. Sl- #,$ pene ,er#ering *l-
,e&nn *r- ,inggi (-iper,en#i). %er*r-n in,r#ererl *i,e!$&n p* 10E
*ri #el$r$- &#$# #,ro&e+ ,er*iri *ri 0E *i -e!i#8ere o,& *n #i#n *i ,ng
o,& *n #ereell$!. %* per*r-n o,& ,er3*i e,r##i *r- &e *l!
3ringn o,& ng !ene&n pene&nn+ perge#ern *n pe!i#-n 3ringn
o,& ng er*e&,n ,e,pi ,i*& !er$#& 3ringn o,& #eper,i ng ,er3*i p*
in8r& o,&.1
Ge3l &lini# 1
n#e, per*-n er#i8, !en**&+ ,er$,! #, !el&$&n &,ii,# *n
*p, *i*-$l$i ole- ge3l pro*ro!ler$p pening&,n ,e&nn *r-+ i,$
neri &epl+ !$l *n !$n,-+ gngg$n !e!ori+ ing$ng+ per*r-n re,in
*n epi#,i#.
%en$r$nn &e#*rn ng er, #!pi &o! *i#er,i -e!iplegi/-e!ipre#e
*n *p, *i#er,i &e3ng 8o&l/$!$!. Tn*,n* pene&nn ,ng o,&+ ge3l p$pil $nil,erl+ re8le perger&n
ol !, !eng-ilng *n *e#erer#i.
Dp, *i3$!pi ,e&nn ,inggi in,r&rnil+ !i#ln !$n,- proe&,il+ ppil
$*e!.
8/19/2019 CASE Stroke Infark Agung
13/33
G!r 1.%er*r-n In,r#ererl
Perdara$an su)ara-$noid
%er*r-n #$r-noi* *l- #$,$ &e*n *i!n ,er3*i per*r-n &i,
pe-n pe!$l$- *r- *i r$ngn #$r-noi* (*in,r lpi#n r-noi* *n
pi!,er). %er*r-n #$r-noi* i#n *i#e&n nor!l r,eri p*
lpi#n *#r o,&+ *i#e$, 3$g ne$ri#! ererl. %er*r-n #$r-noi*
*p, ,er3*i in8r& &ren *n #o#p#!e. #o#p#!e ,er3*i p* -ri &e 2
6 -ri #e,el- per*r-n+ *n !ene,p #el! 5 !ingg$. #o#p#!e ,er3*i p*
*er- ne$ri#! ng pe-+ ,e,pi *p, 3$g p* ,e!p, ng 3$- *n
il,erl. Dr- *l! #$r-noi* *p, !eng-ilng p* 412 -ri.1
Ge3l &lini#n+ i,$1
n#e, pen&i, er$p neri &epl !en**& #eper,i !ele*&+ *r!,i#+ erlng#$ng *l! 12 *e,i& -ingg 1 !eni,.
er,igo+ !$l+ !$n,-+ n& &ering,+ !enggigil+ !$*- ,erng#ng+ geli#-
*n &e3ng. Dp, *i,e!$&n pen$r$nn &e#*rn *n &e!$*in #*r *l!
eerp !eni, #!pi eerp 3!.
Di3$!pi ge3lge3l rng#ngn !eningel.
Gngg$n 8$ng#i o,ono! er$p r*i&r*i ,$ ,&i&r*i+ -ipo,en#i ,$
-iper,en#i+ n& &ering,+ #$-$ *n !ening&,+ ,$ gngg$n pern8#n.
+a%)ar 7# Perdara$an su)ara-$noid4
III# Stroke non $e%ora(ik ,Stroke iske%ik9 Infark otak9 /en'u%)atan.
8/19/2019 CASE Stroke Infark Agung
14/33
S,ro&e i#&e!i& ,er3*i &ren *n #$!,n p* pe!$l$- *r- (r,eri)
#eri&o&rnil ,$ -ipoper8$#i 3ringn o,& ole- ergi 8&,or #eper,i
,ero,ro!o#i#+ e!oli+ ,$ &e,i*,iln -e!o*in!i&.1+
,& !en*p, *r- er#i- *ri 3n,$ng+ *r- !engn*$ng oigen *n
n$,ri#i $n,$& o,&. J$!l- lirn *r- &e o,& *l! &e*n nor!l i#n #e&i,r
5060 !l/100 gr! 3ringn o,&/!eni,+ err,i o,& !e!$,$-&n 20E *r- ng
*ipo!p&n *ri 3n,$ng. Apil r,eri ,er#$!,+ #el o,& (ne$ron) ,i*& *p,
!eng-#il&n energi ng $&$p *n &er3 o,& er-en,i.1
Bil lirn *r- &e o,& ,er-en,i *l! &,$ 6 *e,i& &n ,er3*i gngg$n
!e,oli#!e ne$ron+ lei- *ri :0 *e,i& g!rn @@G !en*,r+ *l! 2 !eni,
,er3*i peng-en,in &,ii,# o,&+ *l! 5 !eni, !$li ,er3*i &er$#&n o,& *n
lei- *ri 4 !eni, !n$#i &n !eninggl. I#&e!i& &e o,& ,er3*i il lirn *r-
&e o,& er&$rng 25:0 !l/100 gr! 3ringn o,& per!eni,.
1
+a%)ar # Stroke infark 4
0# Patofisiolo(i
S,ro&e *p, *i#e&n ole- #,$ *ri eerp pro#e# ng !elip$,i
pe!$l$- *r- *i o,& i,$ 1
• %ro#e# in,rin#i& pe!$l$- *r-+ !i#ln ,ero#&lero#i#+ in8l!#i+ *epo#i,
!iloi*+ *e#ei r,eri+ ,$ ,ro!o#i# en.
• %ro#e# ng er#l *ri ,e!p, lin (ng 3$-) !eni!$l&n e!ol$#+
!i#ln e!oli *ri 3n,$ng ,$ #ir&$l#i e,r&rnil ng !ene&n
gngg$n pe!$l$- *r- in,r&rnil.
• %ro#e# ng ,i!$l &i, lirn *r- &e o,& in*e&$, &i, !en$r$nn
,e&nn per8$#i o,& ,$ !ening&,n i#&o#i,# *r-.
8/19/2019 CASE Stroke Infark Agung
15/33
• %ro#e# ng ,er3*i &i, pe-n pe!$l$- *r- *i r$ng #$r&noi*
,$ 3ringn o,&/in,r#ererl.
Tig pro#e# per,! !ene&n ,i!$ln TIA *n #,ro&e i#&e!i& (in8r&
o,&)+ #e*ng&n ng &ee!p, !ene&n ,er3*in #,ro&e -e!orgi#
(per*r-n in,r#ererl *n per*r-n #$r&noi*).
0I# Faktor Resiko Stroke
Ser $!$! 8&,or re#i&o #,ro&e *p, *igi !en3*i1+:
. F&,or re#i&o ng ,i*& *p, *i!o*i8i&#i+ i,$
1. '#i
2. Jeni# &el!in
:. Gene,i&
. R#
5.
6.
7.
.
. F&,or re#i&o ng *p, *i!o*i8i&#i+ i,$
1. Ri, #,ro&e
2. =iper,en#i
:. %en&i, 3n,$ng
. Die,e# !eli,$#
5. S,eno#i# &ro,i#
6. TIA
7. =iper&ole#,erol
. %engg$nn &on,r#ep#i orl
4. e#i,#
10. Mero&o&
11. Al&o-oli&
12. %engg$nn nr&o,i&
1:. =iper-o!o#i#,eine!i
1. An,io*i n,i 8o#8olipi*
15. =iper$ri#e!i
16. %eninggin -e!,o&ri,
17. %eninggin &*r 8irinogen
5;# 0II# +a%)aran Klinis
56# "a)el 5# Per)edaan Stroke He%ora(ik dan Non
$e%ora(ik
8/19/2019 CASE Stroke Infark Agung
16/33
2. n#
e,
24. M
en
i,/3
!
:0. 1
2
!
en
i,
:1. %el
n
(3
!/
-r
i):2. Ne
ri
&ep
l
::. =e
,
:. S
ng
,
-e
,
:5. Ri
ng
n
:6. M$
n,-
p*
ln
:7. Se
rin
g
:. Se
rin
g
:4. Ti*
&+
&e
le#i
*i
,
n
g
o,
&
0. =ip
er,e
n#i
1. =
!
pir
#el
l
$
2. Bi
#
n
,i*
&
:. Ser
ing
&l
i
. %en
$r$
nn
&e#
*r
n
5. A
*
6. A
*
7. Ti*
&
*
. "& 4. Jr 50. A 51. Ti*
8/19/2019 CASE Stroke Infark Agung
17/33
$
&$*
$&
n
g
* &
*
52. =e
!ip
re#
i#
5:. Se
rin
g
*
ri
l
5. %e
r!
$l
n
,i*
&
*
55. Ser
ing
*r
i
l
56. Gn
gg$
n
i
r
57. Bi
#
*
5. Jr
n
g
54. Ser
ing
60. i&
$or
ere
ro#
pin
l
61. Bi
#
,er
*
p
,
*
r
-
62. Be
r*
r
-
6:. Jer
ni-
=4#
=
8/19/2019 CASE Stroke Infark Agung
18/33
ng
!en*
-$l$i
(
8/19/2019 CASE Stroke Infark Agung
19/33
#erero
#pinl
$&n
102. F
o,o
&epl
10:. 10.
Dp,
*i3$
!p
i
perg
e#er
n
gln
*$l
pine
li#
105.
Ti*&
*il&
$&n
106. ?
TSn
&epl
107.
Ter*p,
re
-ipo*
en#i,#
10.
M##
in,r
&rn
il*eng
n
re
-ipe
r*en
#i,#
104.
T!p&
re
-ipo
*en#i,#.
110. A
ngiogr
8i
111.
Dp,
*i3$!
pi
g!rn
pen$
!,
n+
pene
!pi,
n *n
#&$
li,i#
112.
Dp,
*i3$
!p
ine$
ri#!
+
A
M+
!#
#
in,r
-e!
i#8er
,$#o
#p#
!e
11:.
Ti*&
*il&
$&n
11.
55
8/19/2019 CASE Stroke Infark Agung
20/33
an((ua
n 'an(
ter>adi
Karotis 0erte)ro)asile
r
114. M
o,ori&
120. =e!ipre#e
&on,rl,erl+ *i#,ri
121. =e!ip
re#e l,ernn+
*i#r,ri
122. S
en#ori&
12:. =e!i-ipe#,e#i
&on,rl,erl+
pre#,e#i
12. =e!i-i
pe#,e#i
l,ernn+
pre#,e#i
125.
i#$l
126. =e!inop#i
-o!on!
&on,rl,erl+
!$ro#i# 8$g>
127. =e!in
op#i
-o!oni!+
"ortical
#lindness$
#lack out
(TIA)
12. F
$ng#il$-$r
,$
linn
124. A8#i+
nog#i
1:0. Gngg$
n&e#ei!ngn+
er,igo+
*iplopi+
ni#,g!$#+
*i#8gi
55#
57# 0III# Siste% Karotis
1::. Arteri karotis ko%unis dan Arteri karotis interna5+6
1:. "e*$ A. "ro,i# &o!$ni# *engn #r8 #i!p,i#n ,erle,&
er*e&,n *engn . J$g$lri# in,ern+ N H+ *n ple$# #r8 #i!p,i#
#eri&l+ ng er#!#! ni& &e,# #epn3ng ,r&-e *iel&ng M.
S,ernolei*o!#,oi*e$#.
1:5. Se,inggi ,# ,# &r,ilgo ,iroi*+ *i- #$*$, !n*i$l+
A. &ro,i# &o!$ni# erng !en3*i A. &ro,i# in,ern *n e,ern. Se*i&i,
*i gin *i#,l perngn ,er#e$,+ p* A. &ro,i#in,ern ,er*p, #in$#
&ro,i&$# ng n& !engn*$ng rore#ep,or *iper#r8i ole- N IH *n
ro,i* o* ng !engn*$ng &-e!ore#ep,or ,erle,& er*e&,n *engn
#in$# &ro,i&$#+ 3$g !en*p, per#r8n ng #!. Di le-er+ A. &ro,i#
in,ern ,i*& erng.
5=# Arteri karotis eksterna
8/19/2019 CASE Stroke Infark Agung
21/33
i,$ A. ,iroi*e #$perior+ A. 8#ili#+ A. 8ringel #en*en#+ A. ling$li#+ A.
$ri&$lri# po#,erior+ A. oipi,li#+ *n er&-ir #egi A. ,e!porli#
#$per8i#ili# *n A. !ilri#. A. &ro,i# e,ern !e!p$ni -$$ngn
&ol,erl *engn A. &ro,i# in,ern $n,$& !e!per*r-i o,&.
1:.
56#
Siste% karotis intrakranial
8/19/2019 CASE Stroke Infark Agung
22/33
15:. A. #ereri !e*i+ *engn ngngn (A. len,i&$lo#,ri, *n
ngng &eil linn &e gngli #li#+ A. 8ron,li# #en*en#+ A. pre
roln*i&+ A. roln*i&+ A. prie,li# n,erior+ A. prie,li# po#,erior+ A.
ng$lri#+ A. prie,o,e!porli#+ A. ,e!porli# po#,erior *n n,erior)
15.
155.
5
8/19/2019 CASE Stroke Infark Agung
23/33
5=5# Klasifikasi
162. Men$r$, T-e Seen,- Repor, o8 T-e Join, N,ionl ?o!!i,e
n %reen,ion+ De,e,ion+ @l$,ion+ n* Tre,!en, o8 =ig- Bloo* %re##$re
(JN? 7)+ &l#i8i&#i ,e&nn *r- p* orng *e# ,ergi !en3*i
&elo!po& nor!l+ pr-iper,en#i+ -iper,en#i *er3, 1+ *n -iper,en#i *er3, 2.
5=#
Klasifika
si "D
5=4#
Sistol
ik
,
%
%
H
(.
5=
8/19/2019 CASE Stroke Infark Agung
24/33
1. Ggl 3n,$ng
14. 2. ,&
140. S,ro&e
141. :. %en&i, gin3l &roni#
142. . %en&i, r,eri peri8er
14:. 5. Re,inop,i
14. %* peneli,in &lini&+ pengo,n *engn n,i-iper,en#i ,el-
,er$&,i !eng$rngi &e3*in #,ro&e n,r :50 per#en in8r& !io&r*+ 20
25 per#en *n ggl 3n,$ng+ lei- *ri 50 per#en.
145.
56=# Pen(o)atan;
147. 1. Di$re,i&+ ,er$,! 3eni# ,-i;i*e ,$ l*o#,erone
n,goni#,14. 2. Be, lo&er.
144. :. ?li$! ?-nnel Blo&er ,$ li$! n,goni#,
(??B)
200. . Angio,en#in ?oner,ing @n;!e In-ii,or (A?@I)
201. 5. Angio,en#in II Reep,or Blo&er ,$ AT+ reep,or
n,goni#,/lo&er (ARB)
787#
78# "a)el 4# "atalaksana $i/ertensi %enurut 3NC?;
784#
Klasif
ik
as
i
te
ka
na
n
da
ra
$
78
8/19/2019 CASE Stroke Infark Agung
25/33
Nor!
l
K D D
21.
%re-ip
er,
en
#i
215.
1
216.
A
217.
21.
214.
=iper,
en
#i
*e
r3
,
I
220.
1
221.
A
222.
22:. Di
$re,i&
3eni#
,-i;i*e
$n,$&
#egin
e#r
&#$#+
*p,
*iper,i!
ng&n
A?@I+
ARB+ BB+
??B ,$
&o!in#i
22.
=iper,
en
#i
*e
r3
,
2
225.
L
226.
A
227.
22. "o
!in#i 2
o, $n,$&
#egin
e#r
&#$#
$!$!n
*i$re,i&
3eni#
,-i;i*e
*n A?@I
,$ ARB
8/19/2019 CASE Stroke Infark Agung
26/33
,$ BB
,$ ??B
224.
2:0. "o!in#i ng ,el- ,er$&,i e8e&,i8 *n *p, *i,olern#i
p#ien *l-
2:1. Di$re,i& *n A?@I ,$ ARB
2:2. ??B *n BB
2::. ??B *n A?@I ,$ ARB
2:. ??B *n *i$re,i&
2:5. AB *n BB
7=#
7?# 1# Patofisiolo(i stroke 'an( dise)a)kan $i/ertensi
2:. Ni& ,$r$nn ,e&nn *r- ,er3*i #e#$i &,$+ ,e&nn
*r- &n !en$r$n &e,i& !l! -ri+ *n &n !ening&, &e,i& #ing -ri.
"e,i& ,e&nn *r- r,eri !ening&,+ r,eri &eil *i o,& &n !ene!pi,+
*er3, pene!pi,nn ,ergn,$ng *ri pening&,n ,e&nn.7
2:4. "e,i& -l ini ,er3*i #er #ing&, *n ,e&nn ng
!ening&, ,i*& egi,$ e#r+ !& ,i*& * -l ng !e!-&n+
&e,i& pening&,n ,e&nn ,er3*i #er ,er$# !ener$# #el!
er$ln$ln ,$ er,-$n,-$n+ &n ,er3*i -ilini##i *i ,$ni&
!$#&$lri# *n *in*ing pe!$l$- &n !en3*i &&$. =l ini
!er$p&n #i,$#i ng er-+ &ren !ene&n r,erir,eri *i
o,& ,i*& *p, lgi er*il,#i ,$ er&on#,rii $n,$& !ene#$i&n
*iri *engn ,e&nn *r- #i#,e!i&.7
20. %en$r$nn ,e&nn *r- &n !ene&n ,er3*in per8$#i
ng ,i*& *eC$, *i o,& *n !ene&n ,er3*in i#&e!i 3ringn+ *n
pening&,n ,e&nn *r- &n !ene&n pening&,n ,e&nn per8$#i *i
&piler *n !eni!$l&n -ipere!i+ e*e! *n &e!$ng&inn per*r-n.7
21. "o!pli&#i erero#&$lr *ri -iper,en#i *l- !illir
ne$r#!+ in,rererl -e!orr-gi&+ !e!perep, ,er3*in ,-ero#&lero#i#+
saccular arterial aneur%sm$ lacunar infarction *n hi!ertensive
ence!halo!ath%.7
747#
8/19/2019 CASE Stroke Infark Agung
27/33
74# 1I# Ri&a'at keluar(a 'an( %enderita stroke se)a(ai
faktor risiko stroke
2. %eneli,in io *&& ng !en,&n - #e#eorng ng
!e!p$ni ri, &el$rg #,ro&e po#i,i8 &n !e!p$ni ri#i&o lei-
,inggi $n,$& !en*p, #,ro&e *in*ing *engn orng ng
!e!p$ni ri, &el$rg #,ro&e neg,i8+ #e,el- *i#e#$i&n
*engn $!$r+ #$&$ *n 3eni# &el!in *i*p,&n R 2 (45 E ?I 1+1:
0 :+5) $n,$& ri, &el$rg po#i,i8 *ri pi-& A- *n *i*p,&n
R 1+1 (45 E ?I 0+0 2+50) $n,$& ri, &el$rg po#i,i8 I$.4
25.
74=# 1II# Merokok se)a(ai faktor risiko stroke
27. Mero&o& !er$p&n 8&,or re#i&o ng in*epen*en.
Me&ni#!e ,er3*in ,ero! ,er#e$, el$! *i&e,-$i #er p#,i+ ,e,pi&e!$ng&inn &i,10
. S,i!$l#i #i#,i! #r8 #i!p,i# ole- ni&o,on *n i&,n 2 *engn -e!ogloin
&n *ign,i&n *engn "ron!onoi*.
. Rei i!$nologi *ire& p* *in*ing pe!$l$- *r-.
. %ening&,n greg#i ,ro!o#i,.
*. %ening&,n per!eili,# en*o,el ,er-*p lipi* &i, ;,;, ng ,er*p, *i
*l! ro&o&.
2.
746#
7
8/19/2019 CASE Stroke Infark Agung
28/33
7=5#
7=7#
7=#
7=4#
7=,r.274.
- Dasar dia(nosis etiolo(ik
7;8# Per)andin(an stroke infark e%)oli9 stroke infark
tro%)otik dan kasus
7;5# 7;7#
Stroke
7;#
Stroke
7;4#
Pada
8/19/2019 CASE Stroke Infark Agung
29/33
infar
k
e%)o
li
infark
tro%)o
tik
/as
ien
ini
7;
8/19/2019 CASE Stroke Infark Agung
30/33
(
i
76?#
"ek
a
n
a
n
d
a
r
a
$
24.
Nor!l
244.
Sering
-iper,en
#i
88#
Hi/ert
ensi
85#
Pen
e
%
u
a
n
k
$
u
s
u
s
:02.
Nor!l
:0:.
%en&i,
3n,$ng
,ero#&l
ero#i#
84#
!elu%
dila
kuk
an
/e
%e
riks
aan
le)i
$
lan>
ut
8
8/19/2019 CASE Stroke Infark Agung
31/33
d Dasar dia(nosis )andin(
S,ro&e -e!orgi& &ren ,er3*i #er !en**&+ &ele!-n nggo,
ger&+ ,er*p, 8&,or ri#i&o !e!p$ni &el$rg ng !en*eri,
#,ro&e+ &ei#n !ero&o&+ -iper&ole#,erole!i.
58#
55# Dasar Dia(nosis Ak$ir
:12. Digno#i# &-ir *i,eg&&n er*#r&n
5# Ana%nesis:
:1. "ele!-n p* nggo, ger& #eel- &nn
:15. %en$r$nn &e#*rn
:16. n#e, !en**& #, p#ien ng$n ,i*$r
:17. A8#i glol
:1. Me!p$ni &ei#n !ero&o&.
:14. A- &n*$ng p#ien pern- !en*eri, #,ro&e.
78# Pe%eriksaan fisik :
:21. "e#*rn So!nolen
:22. Te&nn *r- 160/110 !!=g
:2:. Sr8 &rnil S$li, *inili:2. Mo,ori& S$li, *inili
7
8/19/2019 CASE Stroke Infark Agung
32/33
8/19/2019 CASE Stroke Infark Agung
33/33
6#
:0.
http://stroke.ahajournals.org/content/28/10/1908.fullhttp://repository.usu.ac.id/handle/123456789/1982http://www.strokecenter.org/patients/about-stroke/ischemic-stroke/