View
216
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,$&
'&$rn Ger& 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,-
SDN SDN
SDN
SDN SDN
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 #&$lr.1
II# Klasifikasi stroke 597
A Ber*#r&n &elinn p,ologi& p* o,&
1 S,ro&e =e!orgi&
• %er*r-n in,r#ererl
• %er*r-n e,r#ererl (per*r-n #$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 ([email protected]) 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