Ivens - Stroke Haemoragic

8/13/2019 Ivens - Stroke Haemoragic

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REFERAT

STROKE HEMORAGIK

Pembimbing :

dr. Jan Andries Tangkilisan, MARS

Dissn Ole!:

I"ens #asan$"aria Ad!i%ama

&'()*'+'*+'

KEPANITERAAN KLINIK ILMU SARAF

PERIODE 16 April 2010 – 12 Mei 2012

FAKULTAS KEDOKTERA

UNIVERSITAS KRISTEN INDONESIA

Jakarta



2012

I. PE-DAH/A-

Strke !er"paka# pe#$akit %a#%%"a# pere&ara# &ara' tak $a#%

pali#% (eri#% ter)a&i &i a#tara pe#$akit*pe#$akit (ara+ $a#% lai#, Pali#%

(e&ikit (epar"' &ari !a(ala' pe#$akit #e"rl%ik &i r"!a' (akit a&ala'(trke,

Di #e%ara*#e%ara !a)"- (trke a&ala' )"%a pe#$e.a. ke!atia#

#!r ti%a- (etela' pe#$akit )a#t"#% &a# ka#ker, /ala"p"# &apat ter)a&i

pa&a (e!"a "(ia- (trke pa&a "!"!#$a !e#$era#% ra#% &ea(a &a#

i#(i&e#( i#i !e#i#%kat (e("ai &e#%a# kel!pk "(ia $a#% le.i' t"a, Maki#

ti#%%i "(ia- !aki# .a#$ak ke!"#%ki#a# "#t"k !e#&apatka# (trke,

Strke &apat ter)a&i pa&a (etiap "(ia- #a!"# !e#i#%kat &e#%a#

.erta!.a'#$a "(ia, /ala"p"# pe#%eta'"a# kita te#ta#% pat+i(il%i

(trke .erke!.a#% &e#%a# pe(at- #a!"# &i .i&a#% terapi ke!a)"a##$a

la!.a#, Pa&a ta'ap pe#%eta'"a# kita (aat i#i pree#(i !er"paka# a#&ala#

"ta!a &ala! !e#a#%a#i (trke

Strke pa&a &a(ar#$a a&ala' %a#%%"a# +"#%(i tak aki.at kelai#a#

pa&a pere&ara# &ara' le' .er.a%ai (e.a. $a#% erat kaita##$a &e#%a#

.er.a%ai +aktr $a#% !elatar.elaka#%i#$a, a#%%"a# +"#%(i tak ter(e."t

!a#i+e(ta(i (e.a%ai %e)ala kli#i( $a#% &ikel"'ka# le' pe#&erita ata"

kel"ar%a#$a,

Pe#$akit 3ere.ra(k"ler 45VD ata" (trke $a#% !e#$era#%

kel!pk "(ia &iata( 70 ta'"# a&ala' (etiap kelai#a# tak aki.at pr(e(

patl%i pa&a (i(te! pe!."l"' &ara' tak, Pr(e( i#i &apat .er"pa

pe#$"!.ata# l"!e# pe!."l"' &ara' le' tr!.(i( ata" e!.li-

pe3a'#$a &i#&i#% pe!."l"' &ara' tak- per".a'a# per!ea.ilita( &i#&i#%

pe!."l"' &ara' &a# per".a'a# i(k(ita( !a"p"# k"alita( &ara' (e#&iri,

Per".a'a# &i#&i#% pe!."l"' &ara' tak (erta k!p## lai##$a &apat

.er(i+at pri!er kare#a kelai#a# k#%e#ital !a"p"# &e%e#erati+- ata"

(ek"#&er aki.at pr(e( lai#- (eperti pera&a#%a#- arteri(kler(i(- 'iperte#(i

&a# &ia.ete( !elit"(, Kare#a it" pe#$e.a. (trke &a#%at k!plek(,

II. Ana%$mi dan Reglasi O%ak

Otak &iper&ara'i le' &"a pa(a#% arteri $ait" 8 arteri karotis

interna &a# arteri vertebralis.

2



Di &ala! r#%%a kra#i"!- kee!pat arteri i#i (ali#% .er'"."#%a#

&a# !e!.e#t"k (i(te! a#a(t!(i(- $ait" Sirkulus Arteri Willisi. D"a

perti%a )ata' &ara' (ere.ral &ialirka# ke (e.a%ia# .e(ar (ere.r"! &a#

&ie#(e+al# !elal"i (i(te! karti(9 &a# (eperti%a (i(a#$a &ialirka# ke

!e&"la .l#%ata- p#(- tak te#%a'- l."( te!pral .a%ia# !e&ial &a#

i#+erir- l."( parietal- l."( k(ipital- &a# (ere.el"! !elal"i (i(te!

erte.rali(,

Arteri karti( i#ter#a .erak'ir pa&a arteri (ere.ri a#terir &a# arteri

(ere.ri !e&ia, Di &ekat ak'ir arteri karti( i#ter#a- &ari pe!."l"' &ara'

i#i kel"ar arteri k!"#ika#( p(terir $a#% .er(at" ke ara' ka"&al &e#%a#

arteri (ere.ri p(terir, Arteri (ere.ri a#terir (ali#% .er'"."#%a# !elal"i

arteri k!"#ika#( a#terir,

Pe!.eria# &ara' ke krtek( (ere.ri ter"ta!a !elal"i 3a.a#%*

3a.a#% krtikal &ari arteri (ere.ri a#terir- arteri (ere.ri !e&ia &a# arteri

(ere.ri p(terir- $a#% !e#3apai krtek( &i &ala! pia!ater, Per!"kaa#

lateral !a(i#%*!a(i#% 'e!i(+eri"! (ere.ri !e#&apatka# &ara' ter"ta!a

&ari arteri (ere.ri !e&ia, Per!"kaa# !e&ial &a# i#+erir 'e!i(+eri"!

(ere.ri &iper&ara'i le' arteri (ere.ri a#terir &a# arteri (ere.ri p(terir,

Arteri (ere.ri a#terir .er)ala# le.i' !e&ial &ari pa#%kal#$a pa&a

arteri karti( i#ter#a- !e#")" ke &ala! +i("ra l#%it"&i#ali( (ere.ri ke

%e#" krp"( 3all("!- &i !a#a arteri i#i .er.elk ke p(terir &ekat

&e#%a# krp"( 3all("!, Arteri (ere.ri a#terir !e#%el"arka# 3a.a#%*

3a.a#%#$a ke l."( +r#tali( !e&i"( &a# l."( parietali(- (erta ke krtek(

$a#% .er&ekata# &i (epa#)a#% per!"kaa# lateral !e&ial &ari l."(*l."(

i#i,Arteri (ere.ri !e&ia- ("at" 3a.a#% ter!i#ali( &ari arteri karti(

i#ter#a- !e!a("ki +i("ra laterali( (ere.ri &a# !e!.a%i &iri !e#)a&i

:



3a.a#%*3a.a#% krtikal $a#% !e!per&ara'i l."(*l."( +r#tali(-

te!prali(- parietali( &a# k(ipitali(, Pe!."l"'*pe!."l"' #a&i $a#% ke3il-

$ait" arteri le#ti3"l(triata- ti!."l &ari .a%ia# .a(al arteri (ere.ri !e&ia

"#t"k !e!per&ara'i kap("la i#ter#a &a# (tr"kt"r*(tr"kt"r $a#%

.er&ekata#,

Arteri (ere.ri p(terir !"#3"l &ari arteri .a(ilari( pa&a per.ata(a#

r(tral p#ti#"(- lal" !ele#%k"#% ke &r(al &i (ekitar pe&"#3"l"( (ere.ri

(erta !e#%iri!ka# 3a.a#%*3a.a#%#$a ke per!"kaa# !e&ial &a# i#+erir

&ari l."( te!prali( (erta ke l."( k(ipitali( !e&i"(, 5a.a#%*3a.a#%#$a

!elip"ti arteri kalkari#a &a# 3a.a#%*3a.a#% $a#% !e#")" ke tala!"(

p(terir (erta (".tala!"(,

III. DEFE-ISIStrke !e#"r"t &e+i#i(i /;O a&ala' !a#i+e(ta(i kli#ik &ari

%a#%%"a# +"#%(i (ere.ral .aik lkal !a"p"# !e#$el"r"' 4%l.al-

.erla#%("#% 3epat- le.i' &ari 27 )a! ata" .erak'ir &e#%a# !a"t ta#pa

&ite!"ka# pe#$e.a.#$a (elai# %a#%%"a# a(k"ler,

A&ap"# pe#$akit ata" kelai#a# &a# pe#$akit pe!."l"' &ara' tak-

$a#% !e#&a(ari ter)a&i#$a (trke- !i(al#$a arteri(kler(i( tak-

a#e"ri(!a- a#%i!a pe!."l"' &ara' tak &a# (e.a%ai#$a &i(e."t

pe#$akit*pe#$akit pere&ara# &ara' tak 43ere.r(ak"lar &i(ea(e<5VD,

I0. EPIDEMIO/OGI

Di I#&#e(ia (trke !er"paka# (ala' (at" pe#$e.a. ke!atia# &a#

ke3a3ata# #e"rl%i( $a#% "ta!a,

5li++r& R(e &ari I#%%ri( !e!perkiraka# i#(i&e#( (trke

&ike.a#$aka# #e%ara a&ala' (e.e(ar 200 per 100,000 pp"la(i per ta'"#,

I#(i&e#( i#+ark tak &a# per&ara'a# i#tra(ere.ral !e#i#%kat (e("ai &e#%a#

7



perta!.a'a# "!"r- (e&a#% per&ara'a# (".arak'#i&al le.i' .a#$ak

ter&apat &i kala#%a# "(ia !"&a,

Se.a%ai pe#$e.a. ke!atia# &a# ke3a3ata#- pe#$akit pere&ara#

&ara' tak !e#e!pati a#%ka $a#% ti#%%a- ter"ta!a pa&a ra#% t"a,

Di#e%ara $a#% tela' !a)" 4U,S,A !e#e!pati ta!pat ke*: (e.a%ai ka"(a

ke!atia# (etela' pe#$akit )a#t"#% kr#er &a# pe#$akit ka#ker,

Dike!"kaka# ter&apat =00,000 (trke .ar" (etiap ta'"##$a &a# 200,000

&ari pa&a#$a !e#i#%%al &"#ia, >ila &i'it"#% &ari (el"r"' (e.a. ke!atia#

&i #e%ara it" !e#&ekati 11?, Perkiraa# preale#(i a&ala' 20 per 1000

pa&a ti#%kat "!"r 7=*=7- 60 per 1000 pa&a %r"p "!"r 6=*@7 ta'"# per

1000 pa&a %r"p "!"r @=*7 ta'"#, Se.a%ai pe#$e.a. !r.i&ita(- (trke

&iperkiraka# ter&apat pa&a 1,6 )"ta pe#&"&"k A!erika- &i!a#a 70?

!e!erl"ka# pela$a#a# k'"("( &e#%a# 10? !e!erl"ka# peraataa ttal,

0. FAKTOR RESIKO

Faktr re(ik .a%i (trke iala' kelai#a# ata" pe#$akit $a#%

!e!."at (e(era#% le.i' re#ta# ter'a&ap (era#%a# (trke,

Faktr*+aktr re(ik ter)a&i#$a (era#%a# (trke ter&iri ata( 2 .a%ia#

$ait" 8

1, Faktr*+aktr re(ik $a#% !a$r

2, Faktr*+aktr re(ikB$a#% !i#r

1, Faktr*+aktr re(ik $a#% k"at 4!a$r

a, Teka#a# &ara' ti#%%i 4'iperte#(i

., Pe#$akit )a#t"#%

• I#+ark !ikar&

• Elektrkar&i%ra! a.#r!al &i(rit!ia- 'ipertr+i .ilik kiri

• Pe#$akit kat"p )a#t"#%

• a%al )a#t"#% k#%e(ti+

3, S"&a' a&a !a#i+e(ta(i arter(kler(i( (e3ara kli#i(

• a#%%"a# pe!."l"' &ara' kr#er 4a#%i#a pe3tri(

• a#%%"a# pe!."l"' &ara' karti(

&, Dia.ete( !elit"(

e, Pli(ite!ia

=



+, Per#a' !e#&apat (trke

%, Merkk

2, Faktr*+aktr re(ik $a#% le!a' 4!i#r

a, Ka&ar le!ak $a#% ti#%%i &i &ara'

., ;e!atkrit $a#% ti#%%i

3, Ke%e!"ka#

&, Ka&ar a(a! "rat ti#%%i

e, K"ra#% %erak .a&a#<la'ra%a

+, Fi.r#%e# ti#%%i

0I K/ASIFIKASI STROKE

Kla(i+ika(i !&i+ika(i MARS;ALL a&ala' (e.a%ai .erik"t8

1, >er&a(arka# patl%i a#at!i

• Strke i(ke!ik

a, Tr!.(i( (ere.ri

., E!.li (ere.ri

• Strke 'e!ra%ik

a, Per&ara'a# i#tra(ere.ral

., Per&ara'a# (".ara3'#i&

2, >er&a(arka# (ta&i"!<perti!.a#%a# akt"

a, Tra#(ie#t I(3'e!i3 Atta3k 4TIA

., Reer(i.le I(3'e!i3 Ne"rl%i3al De+i3it 4RIND

3, Strke i# el"ti#

&, 5!plete& (trke

:, >er&a(arka# (i(te! pe!."l"' &ara'

a, Si(te! karti(

., Si(te! erte.r – .a(ilar

Kla(i+ika(i (trke .er&a(arka# Sirira) Strke S3re 4SSS

SSS C 42-= ke(a&ara# 42 !"#ta' 42 (akit kepala 40-1

teka#a# &ara' &ia(tl (aar &ata#% – 4: ater!a – 12,

NilaiKe(a&ara# 8 (a&ar

Deliri"!- (t"pr

0

1

6



Se!ik!a &a# k!a 2

M"#ta'<(akit kepala &ala! &"a )a! 8 ti&ak

a&a

0

1

Ater!<ria$at &ia.ete( 8 ti&ak a&a

1 ata" le.i'

0

1

SSS &ia%#(a

1 Per&ara'a# (ere.ral

G *1 I#+ark (ere.ral

* 1 (a!pai 1 &ia%#(a ti&ak pa(ti %"#aka# k"ra ke!"#%ki#a#<

5T*S3a#

KLASIFIKASI STROKE >ERDASARKAN

ALORITMA STROKE ADJA; MADA

0II. PATOFISIO/OGI STROKE HEMORAGIK

Stroke Hemoragik

@

Penderita stroke akut

• Penuruna

n kesadaran

• Nyeri

Ketiganya atau 2 dariketiganya ada (+)

Stroke perdarahanintraserebral

Tidak

• Penurunankesadaran (+)

• Nyeri kepala

Tidak

• Penurunan

kesadaran (-)

• Nyeri kepala

Stroke perdarahanintraserebral

Stroke iskemik akut

atau stroke infark

Ya

Ya

Ya



Me#"r"t /;O- &ala! i#ter#a(i#al (ta(ti3ial 3la((i+i3ati# +

&i(ea(e a#& relate& 'ealt' pr.le! 10 t' rei(i#- (trke 'e!ra%ik &i.a%i

ata( 8

• Per&ara'a# I#tra Sere.ral 4PIS

•

Per&ara'a# S". Arak'#i& 4PSA

PERDARAHA- I-TRASERE1RA/ &PIS

• De2inisi

PIS a&ala' pere&ara# $a#% pri!er .era(al &ari pe!."l"' &ara'

&ala! pare#ki! tak &a# ."ka# &i(e.a.ka# le' tra"!a ,

Per&ara'a# i#tra(ee.ral .ia(a#$a ti!."l kare#a pe3a'#$a

!ikra#e"ri(!a 4>err$ a#e"r$(! aki.at 'iperte#(i !ali%#a, ;al i#i

pali#% (eri#% ter)a&i &i &aera' ("krtikal- (ere.el"!- p#( &a# .ata#%

tak, Pere&ara# &i &aera' krtek( le.i' (eri#% &i(e.a.ka# le' (e.a.

lai#- !i(al#$a t"!r tak $a#% .er&ara'- !al+r!a(i pe!."l"' &ara'

tak pri!er !i(al#$a 5#%p'ili3 a#%ipat'$- tetapi &apat )"%a aki.at

'iperte#(i !ali%#a &e#%a# +reke#(i le.i' ke3il &aripa&a per&ara'a#

(".krtikal,



e)ala #e"rli%ik ti!."l kare#a ek(traa(a(i &ara' ke )ari#%a#

tak $a#% !e#$e.a.ka#, Ak'ir*ak'ir i#i para a'li' .e&a' &i )epa#%

.erpe#&apat .a'a +a(e aal per&ara'a# tak ek(traa(a(i ti&ak

la#%("#% !e#$e.a.ka# #ekr(i(, Pa&a (aat*(aat perta!a- !"#%ki#

&ara' 'a#$a aka# !e#&e(ak )ari#%a# tak ta#pa !er"(ak#$a- kare#a

(aat it" &i+"(i &ara' ke )ari#%a# .el"! ter)a&i

• Pembagian klinis

L$"#&$k &a# S3'e# !e!.a%i PIS !e#"r"t 3epat#$a %e)ala kli#i(

!e!."r"k- (e.a%ai .erik"t 8

• Ak"t &a# 3epat !e!."r"k &ala! 27 )a!

•

S".ak"t- &e#%a# kri(i ter)a&i a#tara : &a# @ 'ari• S".kr#i(- .ila kri(i(#$a @ 'ari

• Pa%$l$gis dan 3a%$2isi$l$gi

@0? ka("( PIS ter)a&i &i kap("la i#ter#a 20? &i +((ap(terir

4.ata#% tak &a# (ere.el"! &a# 10? &i 'e!i(+er 4&il"ar kap("la

i#ter#a, a!.ara# patl%ik !e#"#)"kka# ek(traa(a(i &ara' kare#a

r.ek#$a pe!."l"' &ara' tak- &iik"ti pe!.e#t"ka# e&e!a &ala!

)ari#%a# tak &i(ekitar 'e!at!a,

Aki.at#$a ter)a&i &i(k#ti#"ita( )ari#%a# &a# k!pre(i le'

'e!at!a &a# e&e!a pa&a (tr"kt"r (ekitar ter!a("k pe!."l"' &ara'

tak &a# !e#$e!pitka#< !e#$"!.at#$a- (e'i#%%a ter)a&i p"ka i(ke!i

pa&a )ari#%a# $a#% &ila$a#i#$a, Maka %e)ala kli#i( $a#% ti!."l

.er("!.er &ari &e(tr"k(i )ari#%a# tak- k!pre(i tak- k!pre(i

pe!."l"' &ara' tak<i(ke!i &a# aki.at#$a k!pre(i pa&a )ari#%a#tak lai##$a,

• Ge4ala5ge4ala klinis

e)ala pr&r!al ti&ak )ela(- ke3"ali #$eri kepala kare#a

'iperte#(i, Sera#%a#8 (eri#%kali &i (ia#% 'ari- akt" .e%riat ata"

e!(i<!era', Si+at #$eri kepala- #$eri $a#% 'e.at (ekali, M"al*

!"#ta'- (eri#% ter&apat pa&a per!"laa# (era#%a#, Ke(a&ara#-

.ia(a#$a !e#"r"# &a# 3epat !a("k k!a 46=? ter)a&i k"ra#% &ari

H



(ete#%a' )a!- 2:? a#tara * 2 )a!- &a# 12 )a!- &a# 12? ter)a&i

(etela' 2 )a!- (a!pai 1H 'ari,

• Tera3i

Kare#a .ia(a#$a pe#&erita .era&a &ala! k!a- !aka pe#%.ata# &i.a%i &ala! pe#%.ata# "!"! &a# pe#%.ata# (pe(i+ik,

• Pe#%.ata# "!"!

Per'atika# pe&!a# .erik"t i#i8

- Napa( )ala# #apa( 'ar"( .e.a( "#t"k !e#)a!i#

keperl"a# k(i%e#

- Dara' &i)a%a a%ar teka#a# &ara' tetap 3"k"p

4ti#%%i "#t"k !e#%alirka# &ara' 4per+"(i ke tak &a# !e#)a%a

k!p(i(i &ara' 402- ;.- %l"k(a tetap pti!al "#t"k

!eta.li(!e tak

- Otak- !e#3e%a' ter)a&i#$a e&e!a tak &a#

ti!."l#$a ke)a#% &e#%a# krtik(teri&- %li(erl ata" !a#itl

"#t"k e&e!a &a# ali"! i, pela#*pela# ter'a&ap ke)a#%*ke)a#%

- i#)al- (al"ra# ke!i' &a# .ala#( 3aira#

&iper'atika#

- a(tri#te(ti#"!- +"#%(i &e+eka(i<pe#3er#aa#

&a##"tri(i )a#%a# &ia.aika#,

2, Pe#%.ata# (pe(i+ik

pe#%.ata# iala' pe#%.ata# ka"(al, Pe#%.ata# ter'a&ap

per&ara'a# &i tak &e#%a# t")"a# 'e!(tati(- !i(al#$a a(a!

tra#ek(a!at 1 %a!<7 )a! i, pela#*pela# (ela!a : !i#%%"-

ke!"&ia# &(i( .era#%("r*a#%("r &it"r"#ka#, K'a(iat#$a a&ala'

a#ti+i.ri#litik- (e'i#%%a !e#3e%a' li(i#$a .ek"a# &ara'- )a&i

!e#3e%a' per&ara'a# "la#%,

PERDARAHA- S1ARAK-OIDA &PSA

• De2inisi

10



PSA a&ala' kea&aa# ter&apat#$a<!a("k#$a &ara' ke&ala!

r"a#%a# (".arak'#i&,

Pe!.a%ia#8

1, PSA (p#ta# pri!er- $ak#i

PSA $a#% ."ka# aki.at tra"!a ata" PIS

• PSA (ek"#&er- a&ala' per&ara'a# $a#% .era(al &i l"ar

(".arak'#i&- "!pa!a#$a &ari PIS ata" &ari t"!r tak,

• Ge4ala dan %anda5%anda klinis

1, e)ala pr&r!al8 #$eri

kepala 'e.at perak"t- 'a#$a 10?- H0? ta#pa kel"'a# (akit kepala

2, Ke(a&ara# (eri#% ter%a#%%"

&a# (a#%at .eraria(i &ari tak (a&ar (e.e#tar- (e&ikit &eliri"!

(a!pai k!a

:, e)ala<ta#&a ra#%(a#%a#

!e#i#%eal8 kak" k"&"k- ta#&a ker#i a&a

7, F"#&"( k"li 8 10?

pe#&erita !e#%ala!i e&e!a papil .e.erapa )a! (etela' per&ara'a#,

Seri#% ter&apat per&ara'a# (".'iali& kare#a pe3a'#$a a#e"ri(!a

pa&a a, K!"#ika(i a#terir ata" a, Karti( i#ter#a

=, e)ala*%e)ala #e"rl%ik

+kal8 >er%a#t"#% pa&a lka(i le(i

6, a#%%"a# +"#%(i (ara+

t#!

De!a! (etela' 27 )a! - &e!a! ri#%a# kare#a ra#%(a#%a#

!e#i#%eal &a# &e!a! ti#%%i .ila &ili'atka# 'iptala!"(,

>e%it"p"# !"#ta'- .erkeri#%at- !e#%%i%il &a# takikar&ia- a&a

'"."#%a##$a &e#%a# 'iptala!"(, >ila .erat- !aka ter)a&i ilk"(

peptik"! &i(ertai pe#i#%kata# ka&ar %"la &ara'- %l"k("ria-

al."!i#"ria &a# per".a'a# pa&a EK

• Tera3i

5ara pe#%.ata# $a#% &i%"#aka# "#t"k PIS- &ipakai "#t"k

PSA pa&a +a(e ak"t, Setela' +a(e ak"t leat- &ia#)"rka#

11



a#%i!a%ra+i "#t"k !e#3ari le(i 4a#e"ri(!a ata" a#%i!a ("!.er

PSA, >ila &ite!"ka#- !aka .i(a &ilak"ka# pera(i .e&a' (ara+

4klipi#%- li%a(i- &a# (e.a%ai#$a,

0III. GEJA/A5

GEJA/A

STROKE

e)ala $a#% &i(e.a.ka# le' i#+ark ata" per&ara'a#- !a(i#%*

!a(i#% !e#"#)"kka# per.e&aa# $a#% #$ata

1, I#+ark tak

O#(et .ia(a#$a !e#&a&akka&a#%*ka&a#% .erta'ap ata"

&i&a'"l"i TIA, Pe#&erita (eri#% !e#%el"' (akit kepala &i(ertai

!"#ta', U!"!#$a &e+i(it #e"rl%ik &ira(aka# pa&a akt" .a#%"#

ti&"r ata" (e&a#% i(tira'at, I#+ark tak pali#% (eri#% ter)a&i pa&a "(ia

t"a &e#%a# 'iperte#(i ata" "(ia $a#% le.i' !"&a &e#%a# kelai#a#

)a#t"#% (e.a%ai ("!.er e!.li, Pa&a per!"laa# (akit- ke(a&ara#

"!"!#$a ti&ak ter%a#%%", Faktr ri(ik (a#%at .erpera# pa&a i#+ark

tak- &a# aka# !e#i!."lka# 3iri*3iri kli#i( $a#% (e("ai, I#+ark tak

.ia(a#$a ti&ak !e#"#)"kka# kelai#a# pa&a lik"r (ere.r(pi#ali(,

2, Per&ara'a# tak

O#(et (a#%at !e#&a&ak &iik"ti ra(a (akit kepala 'e.at- !"#ta'*

!"#ta' &a# ka&a#%*ka&a#% &i(ertai ke)a#%, Seri#% ter)a&i pa&a

pe#&erita $a#% (e&a#% akti+ ata" e!(i#al, Per&ara'a# tak

"!"!#$a ter)a&i pa&a "(ia t"a ata" (ete#%a' t"a &e#%a# ata" ta#pa

'iperte#(i- ter%a#t"#% &ari +aktr pe#$e.a.#$a, Li"r $a#% .er&ara'

.era(al &ari per&ara'a# ek(tra(ere.ral pri!er ata" per&ara'a#

i#tra(ere.ral $a#% !ere!.a( ke &ala! e#trikel ata" r"a#%a#

(".arak'#i&- i#i aka# !e#i!."lka# %e)ala kak" k"&"k,

Ge4ala 3erdara!an in%raserebral a%a sbarak!n$idal

1, Per&ara'a# &ala! pare#ki! tak i#i a&ala' aki.at pe3a'#$a

!ikra#e"ri(!a le' 'iperte#(i, >ila &ara' !ere!.e( i#trae#trik"ler

ata" ker"a#%a# (".arak'#i&- aka# .er3a!p"r &e#%a# lik"r &a#!era#%(a#% !e#i#%(, >ia(a#$a per&ara'a# i#tra(ere.ral ter)a&i (a#%at

!e#&a&ak pa&a ra#% t"a &e#%a# te#(i ti#%%i, Kare#a )ari#%a# tak

12



ter&r#%- !aka ti!."l %e)ala &e+i(it #e"rl%ik $a#% 3epat !e#)a&i

.erat &ala! .e.erapa )a!, Ke(a&ara# !e#"r"# (a!pai k!a- .ila

l"!e &ara' le.i' &ari =0 33, Pa&a (aat per!"laa# per&ara'a#

pe#&erita !era(a (akit kepala 'e.at- !"#ta' &a# ka&a#%*ka&a#%

!e#%ala!i ke)a#%,

2, Per&ara'a# (".arak'#i&al

A#e"ri(!a iala' pele.ara# pe!."l"' &ara' arteri (ete!pat $a#%

(i+at#$a k#%e#ital &i (irk"l"( /illi(i ata" per3a.a#%a# arteri lai#,

A#e"ri(!a .e(ar (eri#% !e#$e.a.ka# (akit kepala k'r#ik ata"

!e#eka# r%a# (ekitar#$a, A#e"ri(!a i#i !"&a' pe3a' pa&a ra#%

$a#% (e&a#% akti+ ata" 'iperte#(i- !e#&a&ak &ira(aka# (akit kepala

'e.at- !"#ta' &a# !"#%ki# pe#"r"#a# ke(a&ara#, Kak" k"&"k

&i(e.a.ka# le' a&a#$a &ara' &ala! lik"r, Kala" a&a &e+i(it

#e"rl%ik +kal- i#i &i(e.a.ka# le' a((pa(!e $a#% .ia(a#$a

ter)a&i .e.erapa 'ari ke!"&ia#, Per&ara'a# (".arak'#i&al i#i

ke.a#$aka# ter)a&i pa&a "(ia :0 – 60 ta'"#, Per&ara'a#

(".arak'#i&al kare#a AVM pe3a'- %e)ala#$a (a!a- 'a#$a le.i'

(eri#% ter&apat pa&a "(ia k"ra#% &ari 20 ta'"#

I6. DIAG-OSA

STROKE

Me#e%akka# &ia%#(a (trke ter%a#t"#% ter"ta!a &ari 8

1, I#ter#preta(i a#a!#e(a $a#% teliti &a# tepat

2, Pe!erik(aa# +i(ik "!"! &a# #e"rl%ik $a#% .aik

:, Melkali(a(i te!pat le(i

7, Me#3ari pe#$e.a. (erta +aktr ri(ik

Anamnesa

A#a!#e(i( &ite!"ka# k"!p"la# kele!a'a# a#%%ta %erak (e.ela'

.a&a#- !e#3#% ata" .i3ara pel- &a# ti&ak &apat .erk!"#ika(i &e#%a#

.aik kea&aa# i#i ti!."l (a#%at !e#&a&ak &apat (eakt" .a#%"# ti&"r-

(e&a#% .eker)a- ata" (eakt" i(tira'at,

Mi(al#$a !"la +aktr*+aktr re(ik $a#% !e#$a#tai (rke- &a#&ilak"ka# pe#3atata# perke!.a#%a# ke(a&ara# (e)ak (era#%a# ter)a&i,

1:



Pemeriksaan 2isik

De+i(it #e"rl%ik $a#% ("&a' )ela( !"&a' &ike#al ter"ta!a

'e!ipare(i( $a#% )ela(, Selai# it" ter&apat p"la ta#&a*ta#&a pe#%iri#%

'e!ipare(i( $a#% &i#a!aka# ta#&a*ta#&a %a#%%"a# Upper Mtr

Ne"r# 4UMN iala'8

a, T#"( tt pa&a le(i $a#% l"!p"' !e#i#%%i

., Re+lek( te#&# !e#i#%kat pa&a (i(i $a#% l"!p"'

3, Re+lek( patl%i( p(iti+ pa&a (i(i $a#% l"!p"'

Me#%e#al !a#i+e(ta(i (trke $a#% (a#%at ri#%a# a&ala' le.i'

pe#ti#% &aripa&a !e#%e#al 'e!ipare(i( $a#% ("&a' )ela(, Ma#i+e(ta(i

(trke $a#% pali#% ri#%a# (eri#% .er"pa %a#%%"a# keta#%ka(a# %erak !aka

&ari it" "r"ta# pe!erik(aa# ("("#a# !trik (e.a%ai .erik"t 8

• Pe!erik(aa# keta#%ka(a# %erak

• Pe#ilaia# te#a%a tt*tt

• Pe#ilaia# re+lek( te#&#

• Pe#ilaia# re+lek( patl%i(- (eperti8

Re+lek( .a.i#(ki

Re+lek( pppe#'ei!

Re+lek( %r&#

Re+lek( (3'ae+er Re+lek( %#&a &a# lai#*lai#

Pemeriksaan 3enn4ang

De#%a# pe!erik(aa# 5T*S3a# tak- kita &apat le.i' !e!a(tika#

apaka' (trke#$a .er&a(ar ata" i(ke!ik, ;al i#i (a#%at pe#ti#% kare#a

pe#a#%a#a##$a .er.e&a,

Kita !e#%eta'"i .a'a (trke a&ala' %a#%%"a# pa(ka# &ara' &i

tak &a# +aktr $a#% .a#$ak pera#a##$a pa&a pere&ara# &ara' tak a&ala'

)a#t"#%- pe!."l"' &ara' &a# &ara', Pa&a pe!erik(aa# pe#"#)a#% 'al i#i

&iteliti, Dilak"ka# pe!erik(aa# )a#t"#% 4!i(al#$a &e#%a# alat

elektrkar&i%ra!- &a# .ila perl" &e#%a# alat ekkar&i%ra!, Ka&a#%*

ka&a#% &i."t"'ka# p"la pe!erik(aa# pe!."l"' &ara' Dppler,

/ab$ra%$rim :

17



• ;e!%l.i#- 'e!atkrit- eritr(it- lek(it- 'it"#% )e#i(- tr!.(it-

!a(a per&ara'a# &a# pe!.ek"a#- la)" e#&ap &ara'

• Ure"!- kreati#i#- +"#%(i 'ati- "ri# le#%kap

• >ila perl"- elektrlit 4#atri"!- kali"! &a# %a( &ara'

• R#t%e# trak(

• Elektrkar&i%ra+i

• A(a! "rat

• Kle(terl- tri%li(eri&

U#t"k !e#&ia%#(i( (trke- k#(e#("( #a(i#al pe#%la'a# (trke &i

I#&#e(ia- 1HHH- a#tara lai# !e#%e!"kaka# 'al .erik"t 8

• Dia%#(i( (trke &ite%akka# .er&a(arka# te!"a# kli#i(

• 5T*S3a# ta#pa k#tra( !er"paka# pe!erik(aa# .ak" e!a( "#t"k

!e#e#t"ka# )e#i( patl%i (trke- lka(i &a# ek(te#(i le(i (erta

!e#$i#%kirka# le(i ## a(k"ler

• P"#%(i l"!.al &apat &ilak"ka# .ila a&a i#&ika(i k'"("(

• MRI &ilak"ka# "#t"k !e#e#t"ka# le(i patl%ik (trke (e3ara

le.i' ta)a!,

• Ne"r(#%ra+i &ilak"ka# "#t"k !e#&etek(i a&a#$a (te#(i(

pe!."l"' &ara' ek(trakra#ial &a# i#trakra#ial &ala! !e!.a#t"

eal"a(i &ia%#(tik- etil%ikterapi &a# pr%#(tik,

6. PE-7EGAHA- STROKE

>a#$ak pe#&erita (trke $a#% !e#i#%%al- !e#)a&i 3a3at ata" i#ali&

(e"!"r 'i&"p, Strke &apat &i3e%a' (eti&ak*ti&ak#$a &apat &i"#&"rka#

!"#3"l#$a &e#%a# .er.a%ai pe#3e%a'a#- a#tara lai# 8

a, Pe#3e%a'a# pri!er

Me!a($arakatka# %a$a 'i&"p (e'at .e.a( (trke8

• Me#%'i#&ari 8 rkk- (tre(( !e#tal- alk'l- ke%e!"ka#-

k#("!(i %ara! .erle.i'a#- .at*.at %l#%a#

a!+eta!i#- kkai# &a# (e)e#i(#$a

• Me#%"ra#%i8 kle(terl &a# le!ak &ala! !aka#a#

• Me#%e#&alika#8 'iperte#(i- &ia.ete( !elit"(- pe#$akit

)a#t"#% !i(al#$a +i.rila(i atri"!- i#+ark !ikar& ak"t-

1=



pe#$akit )a#t"#% re"!atik- pe#$akit a(k"lar

ater(klertik lai##$a

., Pe#3e%a'a# (ek"#&er

M&i+ika(i %a$a 'i&"p .ere(ik (trke &a# +aktr re(ik- !i(al#$a8

• ;iperte#(i8 &iet- .at a#ti 'iperte#(i $a#% (e("ai

• Dia.ete( !elit"(8 &iet- .at 'ip%like!ik ral<i#("li#

• Pe#$akit )a#t"#% arit!ia ##al"lar 4a#tika%"la# ral

• Di(lipi&e!ia 8 &iet re#&a' le!ak &a# .at a#ti &i(lipi&e!ia

• >er'e#ti !erkk

• ;i#&ari alk'l- ke%e!"ka# &a# k"ra#% %erak

• ;iper"ri(e!ia8 &iet &a# a#ti'iper"ri(e!ia

2, Meli.atka# pera# (erta kel"ar%a (epti!al !"#%ki#

Pe#3e%a'a# (trke !er"paka# (ala' (at" t")"a# "ta!a &ari

pr%ra! ke(e'ata#, Pe#%e#ala# +aktr re(ik &a# ti#&aka# "#t"k

!e#%'ila#%ka# ata" !e#"r"#ka# .er.a%ai aki.at $a#%

&iti!."lka##$a !er"paka# "pa$a "ta!a %"#a !e#%"ra#%i ti#%kat

ke(akita# &a# ke!atia# $a#% &iaki.atka# le' (trke,

6I. REHA1I/ITASI

T")"a# re'a.ilita(i iala' !e#)a%a ata" !e#i#%katka# ke!a!p"a#

)a(!a#i- r'a#i- ((ial- kea&aa# ek#!i-&a# ke!a!p"a# ker)a (e!a!p"

!"#%ki#, >er.a%ai "(a'a "#t"k !e#3apai t")"a# i#i- &ia#tara#$a9 terapi

+i(ik<+i(iterapi- lati'a# .i3ara-lati'a# !e#tal- terapi k"pa(i- p(ikterapi-

!e!.eri alat .a#t"- rtti pr(tet- la' ra%a,

>e#t"k ti#&aka# $a#% &i(e."t &iata( te#t"#$a &i(e("aika# .erat

ri#%a##$a 3a3at- ke!a!p"a# ata" ti#%kat !e#tal pe#&erita, Pe#a#%a#a#

re'a.ilita(i i#i !er"paka# pe#&ekata# !"lti&i(ipli#,

M.ili(a(i &ilak"ka# (e3epat kea&aa# !e#%ii#ka#, Se3ara

.erta'ap pe#&erita &i("r"'&"&"k pa(i+- &"&"k akti+- .er&iri

&ipapa'-.erala# &ipapa'- .er&iri &e#%a# alat .a#t"- )ala# &e#%a# alat

.a#t"- &a# .ila !"#%ki# .er)ala# !a#&iri, Lati'a# !elak"ka# ke%iata#

(e'ari*'ari (e3ara !a#&iri,

16



DAFTAR PSTAKA

1, L"!.a# T.i#% SM- Pr+,DR,&r- Stroke Bencana Peredaran Darah di Otak,

>alai Pe#er.it Fak"la( Ke&ktera# U#ier(ita( I#&#e(ia- Jakarta- 1HH7

2, Guideline Stroke 2004, (eri Keti%a- Kel!pk St"&i Sere.ra(k"ler &a#

Ne"r%eriatri- Per'i!p"#a# Dr, Sp,Sara+ I#&#e(ia PERDOSSI

:, Alia'- A!ir"&i#- F, K"(ara- R, Ari+i# Li!a /a$(a#% Gambaran Umum

Tentang Peredaran Darah Otak , Kapita Selekta Ne"rl%i- a&)a' Ma&a

Pre(( %$akarta 1HH6

7, 5'"(i& J,- Neuroanatomi orelati! dan Neurologi "ung#ional, Jili& 2-

%$akarta- UM Pre((- 1HH:9 ;al 6HH – @17

=, Ma'ar Mar)#- Pri%"#a S- Neurologi lini# Da#ar , Dia# Rak$at

6, L"!.a# T.i#%- SM- Pr+,DR,&r- $Neurogeriatri% >alai Pe#er.it Fak"lta(

Ke&ktera# U#ier(ita( I#&#e(ia- 2001

@, National Stroke &##ication- 'ttp8<<,(trke,r%<

, Stroke' 3ee"(trke3li#i3al 'ttp8<<,repl#&#,a3,"k<p".(<.k(

1@

http://www.stroke.org/

http://www.replondon.ac.uk/pubs/books

http://www.stroke.org/

http://www.replondon.ac.uk/pubs/books

Documents

Ivens - Stroke Haemoragic