RESPONSI Stroke perdarahan

8/18/2019 RESPONSI Stroke perdarahan

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RESPONSI KASUS BAGIAN NEUROLOGI

RSU HAJI SURABAYA

FAKULTAS KEDOKTERAN

UNIVERSITAS MUHAMMADIYAH MALANG

Pembimbing : dr Di!" H!ri# S$S

O%e" : A&i&!" M'(i!r! R)*di!ni +,-./.-0-.-..-.12

A. IDENTITAS PASIEN

. N!m! : N3 S'(ini

, Um'r : 4- (!"'n

5 Jeni* Ke%!min : Perem$'!n

0 A%!m!( : Kend!ng*!ri III607

/ Ag!m! : I*%!m

4 S'8' : J!9!

Pendidi8!n : SD

7 Pe8er;!!n : Ib' R'm!" T!ngg!

1 N) regi*(er : /7457

.- T!ngg!% MRS : / J!n'!ri ,-.4 $'8'% ..-- > Tid!8 !d! n3eri 8e$!%!#

(id!8 !d! 8e;!ng# (id!8 !d! dem!m BAK d!n BAB d!%!m b!(!* n)rm!%

5 Ri9!3!( Pen3!8i( D!"'%' +RPD2

- Hi$er(en*i : (id!8 di8e(!"'i 8!ren! (id!8 $ern!" $eri8*!

- DM : di*!ng8!%

- K)%e*(er)% : di*!ng8!%

-A*!m 'r!( : di*!ng8!%

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- Ri9!3!( *!8i( *e$er(i ini *ebe%'mn3! (id!8 $ern!"

0 Ri9!3!( Pen3!8i( Ke%'!rg! +RPK2

- Hi$er(en*i d!%!m 8e%'!rg! : +?2

-

DM d!%!m 8e%'!rg! : +@2- S(r)8e d!%!m 8e%'!rg! : +?2

/ Ri9!3!( A%ergi: di*!ng8!%

C. PEMERIKSAAN FISIK

I. Keadaan Umum : Lema

Vi(!% Sign

• Ten*i +T2 : .0-6.-- mmHg

• N!di +N2 : 70 6meni( reg'%!r i*i >'8'$

• Pern!C!*!n +RR2 : ,- 6meni(

• S'"' b!d!n +(2 : 5#4-

• BB : // 8g

• TB : ./ >m

• Gi&i : '8'$

II. S!a!us In!e"na Sin#$a!

K6L : A6I66D @6@6@6@

T")r! : P'%m) I: n)rm)>"e*(# *ime(ri*# re(r!8*i +@2

P: $erger!8!n dinding d!d! *ime(ri*

P: *)n)r6*)n)r

A: e*i>'%!r6e*i>'%!r# r)n8"i @6@# 9"ee&ing@6@

)r I: I (id!8 (!m$!8

P: I (id!8 8'!( !ng8!(

P: B!(!* ;!n('ng n)rm!%

A: S.S, ('ngg!%# m'rm'r +@2# g!%%)$ +@2

Abd)men : I: F%!(# *ime(ri*

P: S'$e%# NT +@2# He$!r6Lien : (!8 (er!b! +dbn2

P: Tim$!ni

A: BU +?2 N)rm!%

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E8*(rimi(!* : A8r!%: "!ng!(# 8ering# mer!"

Edem!

III. S!a!us Psi$ia!"i Sin#$a!

Em)*i d!n !Ce8 : !de8'!(

Pr)*e* Ber$i8ir : re!%i*(i*

Ke>erd!*!n : d!%!m b!(!* n)rm!%

Pen3er!$!n : d!%!m b!(!* n)rm!%

Kem!'!n : d!%!m b!(!* n)rm!%

P*i8)m)()r : d!%!m b!(!* n)rm!%

I%. S!a!us Neu"olo#i

. Ke!d!!n Um'm

Pembi>!r!!n : Di*!r(ri! : +?2

Di*$r)*)di6M)n)()n : (id!8 did!$!(8!n

AC!*i! : M)()ri8 +@2 Sen*)ri8 +@2

Ke$!%! : Be*!r : N)rm!%

A*ime(ri : (id!8 did!$!(8!n

Si8!$ P!8*! : (id!8 did!$!(8!n

T)r(i8)%i* : (id!8 did!$!(8!n

M'8! : M!*8ing : (id!8 did!$!(8!n

M3)$!(i8 : (id!8 did!$!(8!n

F'%%m))n : (id!8 did!$!(8!n

L!in@%!in : (id!8 did!$!(8!n

, GS : 554

Ke*!d!r!n : S)mn)%en

5 Meninge!% Sign

- K!8' 8'd'8 : @

- L!*e'e : @6@

- Kernig : @6@

- Br'd&in*8i I#II#III#IV : @6@6@6@

3

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@ @

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0 S!r!C@*!r!C O(!8 +Ner'* r!ni!%i*2

! N I

K!n!n Kiri

Hi$)*mi!6An)*mi! *de *de

P!r)*mi! *de *de

H!%'*in!*i *de *de

b NII

K!n!n Kiri

Vi*'* S'%i( die!%'!*i

L!$!ng P!nd!ng S'%i( die!%'!*i

Membed!8!n 9!rn! S'%i( die!%'!*i

F'nd'*>)$3 TId!8 die!%'!*i

> N III# IV# VI

K!n!n Kiri

Ked'd'8!n B)%! M!(! di(eng!" di(eng!"

Perger!8!n B)%! M!(! Ke N!*!% *de *de

Ke Tem$)r!% *de *de

Ke A(!* *de *de

Ke B!9!" *de *deKe Tem$)r!% B!9!" *de *de

Ke N!*!% A(!* *de *de

E)$"("!%m'* @ @

e%!" M!(! +P()*i*2 @ @

P'$i% Ben('8 B'%!( *ime(ri*

Leb!r 5 mm 5 mm

Perbed!!n Leb!r +@2 i*)8)r

Re!8*i !"!3! L!ng*'ng ? ?

Re!8*i !"!3! (id!8

%!ng*'ng

? ?

Re!8*i A8)m)d!*i *de *de

Re!8*i K)nergen*i *de *de

d N V

K!n!n Kiri!b!ng M)()ri8 O()( M!**e(er *de *de

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O()( Tem$)r!% *de *de

O()(P(er3g)ide'* e(6in( *de *de

!b!ng Sen*)ri8 I Sde Sde

II Sde Sde

III Sde *de

ReC%e8 K)rne! L!ng*'ng ? ?ReC%e8 K)rne! T!8 L!ng*'ng ? ?

e N VII

K!n!n Kiri

Men'('$ m!(! *ime(ri*

Ber*i'% S'%i( die!%'!*i

Meringi* Si*i 8!n!n (er(ingg!%

Penge>!$!n ,65 de$!n %id!" S'%i( die!%'!*i

Hi$er!8'*i* @ @

Se8re*i !ir m!(! *de *de

C N VIII

K!n!n Kiri

Ve*(ib'%!r Ver(ig) @

N3*(!gm'* 8e @ @

Tinni('* @ @

Te* 8!%)ri Tid!8 die!%'!*i

)>"%e!r "9!b!>" *de

Rinne *de

T'%i 8)nd'8*i Sde Sde

T'%i $er*e$*i *de @*de

g N I#

B!gi!n M)()ri8 S'!r! Bi!*!

Mene%!n dbn

Ked'd'8!n !r>'* *de

Ked'd'8!n ''%!6$"!r3n *de

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Perger!8!n !r>'* $"!r3n6''%! *de

Verne(@Rede!' $"en)men *de

De(!8 ;!n('ng Reg'%!r

Bi*ing '*'* dbn

B!gi!n Sen*)ri8 Penge>!$!n .65 be%!8!ng %id!" *de

ReC%e8 M'n(!" *deReC%e8 P!%!('m M)%%e Tid!8 die!%'!*i

" N I

K!n!n Kiri

Meng!ng8!( b!"' *de *de

Mem!%ing8!n 8e$!%! *de *de

i N II

K!n!n Kiri

Ked'd'8!n %id!" 9!8(' i*(ir!"!( 8e 8iri

Ked'd'8!n %id!" 9!8(' berger!8 8e ? @

A(r)Ci @

F!*i8'%!*i @

Ke8'!(!n %id!" mene8!n b!gi!n d!%!m $i$i *de *de

/ Si*(im M)()ri8

! Be*!r

A(r)Ci : @

P*e'd)!(r)Ci : @

b P!%$!*i

N3eri : @

K)n(r!8('r : @

K)n*i*(en*i : 8en3!%

> Per8'*i

N)rm!% : ?

Re!8*i m3)()ni8 : @

d T)n'*

Leng!n T'ng8!i

K!n!n Kiri K!n!n KiriHi$)()ni @ @ @ @

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S$!*(i8 @ @ @ @

Rigid @ @ @ @

Reb)'nd $"en)men @ @ @ @

e Ke8'!(!nK!n!n Kiri

T'b'" O()( $er'( dbn

O()( $ingg!ng dbn

Ked'd'8!n di!Cr!gm! Sime(ri*

Leng!n M De%()id - /

M Bi>e$* - /

M Tri>e$* - /

F%ei *endi $erge%!ng!n (!ng!n - /

E(en*i *endi $erge%!ng!n (!ng!n - /

Memb'8! ;!ri@;!ri (!ng!n - /Men'('$ ;!ri@;!ri (!ng!n - /

T'ng8!i F%ei !r(i>@>)!e - /

E(en*i !r(i>@>)!e - /

F%ei *endi %'('( - /

E(en*i *endi %'('( - /

F%ei $%!n(!r 8!8i - /

E(en*i d)r*!% 8!8i - /

Ger!8!n ;!ri@;!ri - /

C Ger!8!n in)%'n(er Trem)r : 9!8(' i*(ir!"!( +@2 9!8(' ger!8 +@2

")re! : @

A("e()*e : @

T)r*i)n *$!*me : @

F!*i8'%!*i : @

g K))rdin!*i

K!n!n KiriJ!ri (!ng!n@;!ri (!ng!n Sde *de

J!ri (!ng!n@"id'ng Sde *de

T'mi(@%'('( Sde *de

Pr)n!*i@*'$in!*i Sde *de

T!$$ing ;!ri@;!ri (!ng!n Sde *de

T!$$ing ;!ri 8!8i Sde *de

" G!i( S(!(i)n

J!%!n di!(!* ('mi( : (id!8 die!%'!*i

J!%!n di!(!* ;!ri 8!8i : (id!8 die!%'!*i

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T!ndem 9!%8ing : (id!8 die!%'!*i

J!%!n %'r'* %!%' $'(!r : (id!8 die!%'!*i

J!%!n m'nd'r : (id!8 die!%'!*i

Berdiri deng!n *!(' 8!8i : (id!8 die!%'!*i

Hemi$%egi> g!i( : (id!8 die!%'!*i

erebe%%!r g!i( : (id!8 die!%'!*i

T!be(i> g!i( : (id!8 die!%'!*i

P!r8in*)n g!i( : (id!8 die!%'!*i

R)mberg (e*( ;!('" 8e : (id!8 die!%'!*i

4 Si*(im Sen*)ri8

Leng!n T'ng8!i T'b'"

R!*! E8*(er)>e$(iC: K! Ki K! Ki K! Ki

• R!*! n3eri *'$erCi>i!% @ ? @ ? @ ?

• R!*! *'"' +$!n!*6dingin2 Tid!8 die!%'!*i

• R!*! r!b! ring!n @ ? @ ? @ ?

R!*! Pr)$i)*e$(iC

• R!*! ge(!r *de *de *de *de *de Sde

• R!*! (e8!n Sde *de Sde *de Sde Sde

• R!*! n3eri (e8!n Sde Sde Sde Sde Sde Sde

• R!*! ger!8 $)*i*i *de Sde *de Sde *de Sde

R!*! En(er)*e$(iC: reCCered $!in +@2

R!*! 8)mbin!*i

• S(ere)gn)*i* : *'%i( die!%'!*i

• B!r)gn)*i* : *'%i( die!%'!*i

• Gr!$"e*(e*i! : *'%i( die!%'!*i

• T9) $)in( (!>(i% : *'%i( die!%'!*i

• Sen*)r3 e(in>(i)n : *'%i( die!%'!*i

• L)*( )C b)d3 im!ge: *'%i( die!%'!*i

ReC%e@reC%e

ReC%e8 K'%i( S'$erCi>i!%: K!n!n Kiri

ReC%e8 dinding $er'( @ @ReC%e8 in(er*>!$'%!r Tid!8 die!%'!*i

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ReC%e8 >rem!*(er Tid!8 die!%'!*i

ReC%e8 g%'(e!% Tid!8 die!%'!*i

ReC%e8 !n!% Tid!8 die!%'!*i

ReC%e8 Tend)n

ReC%e8 bi>e$* ?. ?.

ReC%e8 (ri>e$* ?. ?.ReC%e8 $!(e%%! ?. ?.

ReC%e8 !>"i%%e* ?. ?.

ReC%e8 P!()%)gi*

• T'ng8!i B!bin*8i @ @

"!dd)>8 @ @

S>"!eCer @ @

G)rd)n @ @

O$$en"eim @ @

S(r!n*83 @ @

G)nd! @ @Mende%@Be>"(ere9 @ @

R)**)%im) @ @

• Leng!n

H)CCm!n @ @

Tr)mner @ @

Leri @ @

M!3er @ @

ReC%e8 Primi(iC:

P!%m) men(!% reC%e @

Gr!$* reC%e @Sn)'( reC%e @

S'>8ing reC%e @

7 Si*(im S!r!C O()n)m

- Mi8*i : dbn

- DeCe8!*i : dbn

- S!%i!*i : dbn

-Se>re( 8ering!( : dbn

- G!ngg'!n !*)m)()r : @

- Or(")*(!(i> "i$)(en*i : @

- G!ngg'!n (r)$i> : 8'%i( +@2 r!mb'( +@2 8'8' +@2

1 )%'mn! Ver(ebr!%i*

- Ke%!in!n C)8!%:

S>)%i)*i* : @

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K3$")*i* : @

K3$")*>)%i)*i* : @

Gibb'* : @

- Ger!8!n >eri>!%@er(ebr!e:

F%ei : *de

E(en*i : *de

L!(er!% dei!*i : *de

- Ger!8!n d!ri ('b'":

Memb'ng8'8 : *de

E(en*i : *de

L!(er!% dei!*i : *de

Sirir!; *8)r: +,#/.2 ? +,.2 ? +,.2 ? +-#..--2 @ +5.2 @ ., .#/

D. PEMERIKSAAN PENUN&AN'

Lao"a!u"ium (*+,*-+,)

D!r!" Leng8!$:

Hb : .0#1 g6d%

Le'8)*i( : 7,-6mm5

Tr)mb)*i( : ,.----6mm5

Hem!()8ri( : 0/#,

Kimi! K%ini8:

GDA STIK : .-. mg6d%

BUN : , mg6d%

re!(inin *er'm : -#7 mg6d% SGOT : ,5 U6L

SGPT : ,5 U6L

A%b'min : 0#4 g6d%

K6N!6%:

K!%i'm : 5#4 mm)%6L

N!(ri'm : .05 mm)%6L

"%)ride : .- mm)%6L

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CTS/an Ke0ala (1*+,*-+,)

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E. RESUME

Anamnesis

• Ke%'"!n U(!m! : %em!" *e(eng!" b!d!n *ebe%!" 8!n!n

• Ri9!3!( Pen3!8i( Se8!r!ng +RPS2

• P!*ien dib!9! 8e r'm!" *!8i( 8!ren! %em!" *e(eng!" b!d!n *ebe%!" 8!n!n

*e;!8 0 "!ri *ebe%'m MRS# %em!" *e$!r'" b!d!n dir!*!8!n mend!d!8

*e(e%!" b!ng'n (id'r# *!!( i(' $!*ien m!*i" *!d!r d!n bi*! mem!nggi%

8e%'!rg!n3! 'n('8 memin(! b!n('!n %!%' %!m! 8e%!m!!n 8e*!d!r!n

men'r'n Ber*!m!!n deng!n i(' $!*ien ;'g! meng!%!mi m'n(!" *eb!n3!8 .

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8!%i (!n$! di*er(!i m'!%# m'n(!" m!8!n!n = /-- >> Tid!8 !d! n3eri 8e$!%!#

(id!8 !d! 8e;!ng# (id!8 !d! dem!m BAK d!n BAB d!%!m b!(!* n)rm!%

• Ri9!3!( Pen3!8i( D!"'%' +RPD2

-

Hi$er(en*i : (id! (!"' 8!ren! (id!8 $ern!" $eri8*!- DM : di*!ng8!%

- K)%e*(er)% : di*!ng8!%

- A*!m 'r!( : di*!ng8!%

- Ri9!3!( *!8i( *e$er(i ini *ebe%'mn3! (id!8 $ern!"

• Ri9!3!( Pen3!8i( Ke%'!rg! +RPK2

- Hi$er(en*i d!%!m 8e%'!rg! : +?2

-DM d!%!m 8e%'!rg! : +@2

- S(r)8e d!%!m 8e%'!rg! : +?2

• Ri9!3!( A%ergi: di*!ng8!%

F. PEMERIKSAAN FISIK

%. Keadaan Umum : Lema

Vi(!% Sign

• Ten*i +T2 : .0-61- mmHg

• N!di +N2 : 70 6meni( reg'%!r i*i >'8'$

• Pern!C!*!n +RR2 : ,- 6meni(

• S'"' b!d!n +(2 : 5#4-

• BB : // 8g

• TB : ./ >m

• Gi&i : '8'$

S(!('* In(ern! Sing8!(

K6L : A6I66D @6@6@6@

T")r! : P'%m): n)rm)>"e*(# *ime(ri*# e*i>'%!r6e*i>'%!r# r)n8"i @6@#

9"ee&ing @6@# re(r!8*i +@2

)r: S.S, ('ngg!%# m'rm'r +@2# g!%%)$ +?2

Abd)men : Bi*ing U*'* +?2 N)rm!%# He$!r6Lien : (!8 (er!b! +dbn2

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E8*(rimi(!* : A8r!%: "!ng!(# 8ering# mer!"

Edem!

S(!('* Ne'r)%)gi*:

• GS : 554

• MS : @

• N r!ni!%i* : PBI 5mm65mm R >!"!3! ?6?

• N r!ni!%i* %!in : P!re*e N VII de(r! (i$e *en(r!%

P!re*e N II de(r! (i$e *en(r!%

• M)()ri8 :

--- ///

--- ///

• Sen*)ri8 : dbN

• ReC%e8 Ci*i)%)gi* : BPR ?.6?. KPR ?.6?.

TPR ?.6?. APR ?.6?.

• ReC%e8 P!()%)gi* :

B!bin*8i : @6@

"!dd)>8 : @6@

O$$en"eim : @6@

S>"!eCer : @6@

G)rd)n : @6@

S(r!n*83 : @6@

G)nd! : @6@

Mende%@Be>"(ere9: @6@

R)**)%im) : @6@

H)CCm!n : @6@

Tr)mner : @6@

• ANS : dbn

• V : dbn

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'. ASSESMENT

Di#nosa Klinis : 9!ni(! 4- (!"'n# )mi(# "emi$%egi de8*(r! (i$e UMN#

"emi"i$e*(e*i! de(r!# $!re*e N VII *ini*(r! (i$e *en(r!%# $!re*e

NII *ini*(r! (i$e *en(r!%#

Dia#nosa To0is : S'b K)r(e Serebri Hemi*Cer Sini*(r!

Dia#nosa E!iolo#is : VA Perd!r!"!n In(r!*erebr!%

Ke(er!ng!n Sirir!; S8)r:

+,#/.2 ? +,.2 ? +,.2 ? +-#..--2 @ +5.2 .,

.#/ +VA Perd!r!"!n In(r!*erebr!%2

2. PLANNIN' (C%A Pe"da"aan In!"ase"e"al)

! Di!gn)*i*

. L!b)r!('ri'm:

@ D!r!" Leng8!$ : Hb# Le8)*i(# Tr)mb)*i(# Hem!()8ri(

@ Kimi! K%ini8 :

G'%! D!r!" : BSN# ,JPP

Pr)Ci% Li$id : T)(!% >")%e*(er)%# TG# HDL# LDL

F'ng*i H!(i : SGOT# SGPT#

F'ng*i Gin;!% : BUN# Kre!(inin# Ure'm# A*!m Ur!(

Ser'm E%e8(r)%i(: K!%i'm# N!(ri'm# K%)rid

, R!di)%)gi : T S>!n Ke$!%! T!n$! K)n(r!*

F)() T")r! AP

b Ter!$i

• N)n medi8! men()*! :

- E!%'!*i ABD

. Bre!(" : Men;!g! C'ng*i $ern!$!*!n deng!n b!i8 d!n meng"ind!ri !*$ir!*i

, B%))d : P!n(!' (e8!n!n d!r!" (i!$ , ;!m

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17/32

5 Br!in : He!d '$ 5-)P!n(!' GS# Vi(!% Sign (i!$ , ;!m

0 B)9e% : Die( b'b'r "!%'*

/ B)ne : Meng'b!" $)*i*i (id'r d!n $er!9!(!n 8'%i(

- Re"!bi%i(!*i Medi8 *e(e%!" m!*! !8

- P!*!ng *)nde

- P!*!ng K!(e(er

• Medi8!men()*!

• InC'* : P ,/@5- >> 6 8gBB .0 ($m

• Pen'r'n8!n TIK : M!ni()% ,- .-- m% !(!' -#,/@-#/ gr68gBB6

4 8!%i6 "!ri

• Ne'r)$r)(e8(!n : in;e8*i I(i>)%in 5.--mg +.,/mg6m%2 i

• In;e8*i OM , . gr IV

• In;e8*i Ond!n*e(r)n 5 0 IV

>M)ni()ring

- GS

- Vi(!% *ign +n!di# TD# RR# *'"'2

- Ke%'"!n $!*ien

- DeCi*i( ne'r)%)gi*

- BAK d!n BAB

d Ed'8!*i

- Memberi(!"' $!*ien d!n 8e%'!rg! $!*ien (en(!ng 8e!d!!n $!*ien# d!n $en3!8i(

3!ng dideri(!

- Memberi(!"' $!*ien d!n 8e%'!rg! $!*ien b!"9! $!*ien "!r'* bed re*( ()(!% d!n

(id!8 b)%e" b!ng'n d!ri (em$!( (id'r 'n('8 beber!$! "!ri

- Memberi(!"' $emeri8*!!n d!n (er!$i 3!ng di%!8'8!n 8e$!d! $!*ien

- Memberi(!"' (en(!ng $r)gn)*i* d!n 8em'ng8in!n (er;!din3! ge;!%!@ge;!%! *i*!

$!d! $!*ien

- Memberi(!"'8!n $!*ien d!n 8e%'!rg!n3! (en(!ng C!>()r ri*i8) 3!ng dimi%i8i

$!*ien d!n diberi(!"' 'n('8 meng)n(r)% *e>!r! (er!('r

17


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- Memberi(!"' b!"9! $en3emb'"!n d!ri $en3!8i( 3!ng dideri(! $!*ien

memb'('"8!n ;!ng8! 9!8(' 3!ng %!m! *e"ingg! 8e%'!rg! $!*ien d!n $!*ien

"!r'* ber*!b!r d!n i8'( *er(! d!%!m $em'%i"!n 8)ndi*i $!*ien

-

Meng!;!ri 8e%'!rg! $!*ien 'n('8 meng'b!" $)*i*i (id'r $!*ien miring 8e 8irid!n 8e 8!n!n 'n('8 meng"ind!ri 8)m$%i8!*i %!n;'(!n

- Men;e%!*8!n mengen!i ren>!n! re"!bi%i(!*i d!n memin(! b!n('!n 8e%'!rg! 'n('8

memb!n(' d!%!m $r)*e* re"!bi%i(!*i (er*eb'(

@ Memb!n(' $!*ien miring 8!n!n miring 8iri *e(i!$ , ;!m

@ Memb!n(' $!*ien 'n('8 $)*i*i *e(eng!" d'd'8

@ Memb!n(' $!*ien me%!8'8!n %!(i"!n ger!8 *endi

I. PR3'N3SIS

D'bi! e( m!%!m

18


19/32

S 3 A P

H!ri6T!ngg!

%S O A P

R!b'#

46-.6,-.4

Ke%em!"!n

('b'" *ebe%!"

8!n!n# m'n(!"

+@2# n3eri

8e$!%! +@2#

dem!m +@2

KU : %em!"Vi(!% Sign:TD: .0-6.--mmHg N!di :7-6mRR:,- 6m (:54#0 -

S(!('* gener!%i*:K6L: A6I66D @6@6@6@

T")r! : P'%m):

n)rm)>"e*(# *ime(ri*# 6#

r" @6@# 9" @6@

)r: S.S, ('ngg!%# m +@2# g

+?2

Abd)men: me(e)ri*m'*

+@2 He$!r6Lien ((b

E8*(remi(!*:

AH

? ?

? ?Edem!

@ @

@ @

S(!('* ne'r)%)gi*:

• GS : 554

• MS: @

• N r!ni!%i* : PBI

5mm65mm R >!"!3!?6?

• N r!ni!%i* %!in:

P!re*e N VII de8*(r!(i$e *en(r!%# P!re*e NII de8*(r! (i$e*en(r!%#

• M)()ri8 :

--- ///

--- ///

• Sen*)ri8: dbN

• R Fi*i)%)gi*:

BPR?. 6?.TPR ?.6?.

KPR ?.6?.

APR ?.6?.• R P!()%)gi*:

B!bin*8i @6@

D K%ini*:

@ Hemi$%egi D @

P!re*e N VII D

(i$e *en(r!%

@ P!re*e N II D

(i$e *en(r!%

D T)$i* :

S'b K)r(e Serebri

Hemi*Cer Sini*(r!

D E(i)%)gi*:

VA Perd!r!"!n

In(r!*erebr!% "!ri

8e@,

- He!d '$ 5-

dr!;!(- InC'*e P .0

($m- P!*!ng *)nde

die( TKTP

- P!*!ng K!(e(er

- M!ni()% / .--

>>-

In; An(r!in5. gr IV

- In; OM ,.

gr IVIn;Ond!n*e(r)n50 IV

19


20/32

"!dd)>8 @6@

O$$en"eim @6@

G)rd)n @6@

G)nd! @6@

S>"!eCer @6@

R)*)%im) @6@S(r!n*8i @6@

Mende% Be>"(ere9

@6@H)CCm!nn @6@Tr)mner @6@

• V6ANS:

BAK +?2 8!(e(er

BAB +@2

L!bGDP 71

GDA 7,A*'r!( /#5T)(!% $r)(ein #

A%b'min 0#,G%)b'%in 5#/T)(!% 8)%e*(er)% .,TG /1HDL /.LDL ..

ULB; .#-,-PH /#-

Pr)(ein ,/Ur)bi%in 0

Bi%ir'bin .Sd eri .@/

K!mi*

6-.6,-.4

- Se$er(i

!8!n

b!ng'n#

m'n(!" +@2#

dem!m +@2#

n3eri

8e$!%! +@2#

%em!"

b!d!n

*ebe%!"

8!n!n

KU : %em!"Vi(!% Sign:TD: .0-61- mmHg N!di :76mRR:,7 6m (:5 -

S(!('* gener!%i*:K6L: A6I66D @6@6@6@

T")r! : P'%m):

n)rm)>"e*(# *ime(ri*# 6#

r" @6@# 9" @6@

)r: S.S, ('ngg!%# m +@2# g

+?2


+@2 He$!r6Lien ((b

E8*(rimi(!*:

AH

? ?

? ?Edem!

D K%ini*:

@ Hemi$%egi D @

P!re*e N VII S (i$e

*en(r!%

@ P!re*e N II S

(i$e *en(r!%

D T)$i* :

S'b K)r(e Serebri

Hemi*Cer Sini*(r!

D E(i)%)gi*:

VA Perd!r!"!n

In(r!*erebr!% "!ri

- He!d '$ 5-

dr!;!(- InC'*e P .0

($m- P!*!ng *)nde

die( TKTP

- P!*!ng K!(e(er

- M!ni()% / .--

>>

-In; An(r!in

5. gr IV- In; OM ,.

gr IV- In;

Ond!n*e(r)n50 IV

20


21/32

@ @

@ @

S(!('* ne'r%)gi*:

• GS : 554

• MS: @


,mm6,mm R >!"!3!?6?

• N r!ni!%i* %!in:

P!re*e N VII de(r!(i$e *en(r!%P!re*e NII *en(r!%

• M)()ri8 :

--- ///

--- ///

• Sen*)ri8:

"emi"i$e*(e*i de8*(r!

• R Fi*i)%)gi*:

BPR?. 6?.

TPR ?.6?.KPR ?.6?.APR ?.6?.

• R P!()%)gi*:

B!bin*8i @6@"!dd)>8 @6@H)CCm!nn @6@Tr)mner @6@

• V6ANS:

BAK +dbn2

BAB +dbn2

8e@5

JUm!(#

76.6,-.4

Lem!" ('b'"

*ebe%!" 8!n!n#

m'n(!" +@2#

$!*ien (id!8

bi*! (id'r

*em!%!m!n#

*em$!( ingin

men!ri8

inC'*n3!#

n3eri 8e$!%! +@2

KU : %em!"Vi(!% Sign:

TD: ./-6.-- mmHg N!di :146mRR:,76m (:57 -S(!('* gener!%i*:K6L: A6I66D @6@6@6@

T")r! : P'%m):

n)rm)>"e*(# *ime(ri*# 6#

r" @6@# 9" @6@)r: S.S, ('ngg!%# m +@2# g

+@2


+@2 He$!r6Lien ((b

E8*(rimi(!*:

AH

? ?

? ?Edem!

@ @

D K%ini*:

@ Hemi$%egi D @

P!re*e N VII D

(i$e *en(r!%

@ P!re*e N II D

(i$e *en(r!%

D T)$i* :

S'b K)r(e Serebri

Hemi*Cer Sini*(r!

D E(i)%)gi*:

VA Perd!r!"!n

In(r!*erebr!% "!ri

8e@0

- He!d '$ 5-

dr!;!(- InC'*e P .0

($m- M!ni()% / .--

>>

- i(i>")%in 5

/-- >>- IN; OM ,. gr

IV

- In; Ond!n*e(r)n

50 IV

21


22/32

@ @

S(!('* ne'r%)gi*:

• GS : 554

• MS: @


,mm6,mm R >!"!3!?6?

• N r!ni!%i* %!in:

P!re*e N VII de8*(r!(i$e *en(r!%P!re*e NII de8*(r!

(i$e *en(r!%

• M)()ri8 :

--- ///

--- ///

• Sen*)ri8:

"emi"i$e*(e*i de8*(r!

• R Fi*i)%)gi*:BPR?. 6?.TPR ?.6?.KPR ?.6?.APR ?.6?.

• R P!()%)gi*:

B!bin*8i @6@"!dd)>8 @6@

H)CCm!nn @6@Tr)mner @6@

• V6ANS:

BAK +?2

BAB +?2

S!b('#

16.6,-.4

P!*ien mer!*!

ge%i*!"

Lem!" ('b'"

*ebe%!" 8!n!n

N3eri 8e$!%!

+ @ 2

M'n(!" +@2

KU : %em!"Vi(!% Sign:TD: ./-6.-- mmHg N!di :146m

RR:,, 6m (:5#7 -S(!('* gener!%i*:K6L: A6I66D @6@6@6@

T")r! : P'%m):

n)rm)>"e*(# *ime(ri*# 6#

r" @6@# 9" @6@

)r: S.S, ('ngg!%# m +@2# g

+@2


+@2 He$!r6Lien ((b

E8*(rimi(!*:

AH

? ?

? ?

Edem!

@ @

D K%ini*:

@ Hemi$%egi D @

P!re*e N VII D

(i$e *en(r!%

@ P!re*e N II D

(i$e *en(r!%

D T)$i* :

S'b K)r(e Serebri

Hemi*Cer Sini*(r!

D E(i)%)gi*:

VA Perd!r!"!n

In(r!*erebr!% "!ri

8e@/

- He!d '$ 5-

dr!;!(- InC'*e P .0

($m- M!ni()% 0 .--

>>- i(i>")%in 5

/-- >>- In; OM ,.

gr IV- In;

Ond!n*e(r)n50 IV

22


23/32

@ @

S(!('* ne'r%)gi*:

• GS : 554

• MS: @


,mm6,mm R >!"!3!?6?

• N r!ni!%i* %!in:


• M)()ri8 :

--- ///

--- ///

• Sen*)ri8:

"emi"i$e*(e*i de(r!

• R Fi*i)%)gi*:

BPR?. 6?.TPR ?.6?.KPR ?.6?.APR ?.6?.

• R P!()%)gi*:

B!bin*8i @6@"!dd)>8 @6@H)CCm!nn @6@

Tr)mner @6@

• V6ANS:

BAK +?2BAB +@2

Senin#

..6-.6,-.4

Lem!" *e$!r'"

b!d!n 8!n!n

M'n(!"

P'*ing

N!C*' m!8!n

b!i8

KU : %em!"Vi(!% Sign:TD: .0-67- mmHg N!di :46mRR:,, 6m (:5 -

S(!('* gener!%i*:K6L: A6I66D @6@6@6@

T")r! : P'%m):

n)rm)>"e*(# *ime(ri*# 6#

r" @6@# 9" @6@

)r: S.S, ('ngg!%# m +@2# g

+@2


+@2 He$!r6Lien ((b

E8*(rimi(!*:

AH

? ?

? ?Edem!

D K%ini*:

@ Hemi$%egi D @

P!re*e N VII D

(i$e *en(r!%

@ P!re*e N II D

(i$e *en(r!%

D T)$i* :

S'b K)r(e Serebri

Hemi*Cer SIni*(r!

D E(i)%)gi*:

VA Perd!r!"!n

In(r!*erebr!% "!ri8e@

- He!d '$ 5-

dr!;!(- InC'*e P .0

($m- M!ni()% 5 .--

>>- !n(r!in 5 . gr

- in; >i(i>")%in 5

/-- i- in; OM , .

gr i- in; Ond!n 50

i

23


24/32

@ @

@ @

S(!('* ne'r%)gi*:

• GS : 554

• MS: @


,mm6,mm R >!"!3!?6?

• N r!ni!%i* %!in:


• M)()ri8 :

--- ///

--- ///

• Sen*)ri8:

"emi"i$e*(e*i de(r!

• R Fi*i)%)gi*:

BPR?.6?.

TPR ?.6?.KPR ?.6?.APR ?.6?.

• R P!()%-gi*:


• V6ANS:

BAK +?2

BAB +?2

Se%!*!#

.,6.6,-.4

Lem!" *e$!r'" b!d!n 8!n!n

P'*ing

M'n(!" @

KU : %em!"Vi(!% Sign:TD: .0-61- mmHg N!di :4,6mRR:,, 6m (:5 -

S(!('* gener!%i*:K6L: A6I66D @6@6@6@

T")r! : P'%m):

n)rm)>"e*(# *ime(ri*# 6#

r" @6@# 9" @6@

)r: S.S, ('ngg!%# m +@2# g

+@2


+@2 He$!r6Lien ((b

E8*(rimi(!*:

AH

? ?

? ?

Edem!

@ @

D K%ini*:

@ Hemi$%egi D @

P!re*e N VII D

(i$e *en(r!%

@ P!re*e N II D

(i$e *en(r!%

D T)$i* :

S'b K)r(e Serebri

Hemi*Cer SIni*(r!

D E(i)%)gi*:

VA Perd!r!"!n

In(r!*erebr!% "!ri

8e@7

- He!d '$ 5-

dr!;!(- InC'*e P .0

($m

-M!ni()% 5 .-->>

- !n(r!in 5 . gr

- in; >i(i>")%in 5

/-- i- in; OM , .

gr i- in; Ond!n 50

i

24


25/32

@ @

S(!('* ne'r%)gi*:

• GS : 554

• MS: @


,mm6,mm R >!"!3!?6?

• N r!ni!%i* %!in:


• M)()ri8 :

--- ///

--- ///

• Sen*)ri8:

"emi"i$e*(e*i de(r!

• R Fi*i)%)gi*:

BPR?.6?.TPR ?.6?.KPR ?.6?.APR ?.6?.

• R P!()%-gi*:

B!bin*8i @6@"!dd)>8 @6@H)CCm!nn @6@

Tr)mner @6@

• V6ANS:

BAK +?2BAB +?2

K!mi*

.06.6,-.4

Lem!" *e$!r'"

b!d!n 8!n!n

T!ng!n 8iri

men!ri8 inC'*

(!ng!n 8!n!n

M'!%

P'*ing @

KU : %em!"Vi(!% Sign:TD: .0-61- mmHg

N!di :4,6mRR:,, 6m (:5 -S(!('* gener!%i*:K6L: A6I66D @6@6@6@

T")r! : P'%m):

n)rm)>"e*(# *ime(ri*# 6#

r" @6@# 9" @6@

)r: S.S, ('ngg!%# m +@2# g

+@2


+@2 He$!r6Lien ((b

E8*(rimi(!*:

AH

? ?

? ?Edem!

@ @@ @

D K%ini*:

@ Hemi$%egi D @

P!re*e N VII D

(i$e *en(r!%

@ P!re*e N II D

(i$e *en(r!%

D T)$i* :

S'b K)r(e Serebri

Hemi*Cer SIni*(r!

D E(i)%)gi*:

VA Perd!r!"!n

In(r!*erebr!% "!ri

[email protected]

- He!d '$ 5-

dr!;!(

- InC'*e P .0

($m- M!ni()% . .--

>>- !n(r!in 5 . gr

- in; >i(i>")%in 5

/-- i- in; OM , .

gr i- in; Ond!n 50

i

25


26/32

S(!('* ne'r%)gi*:

• GS : 554

• MS: @


,mm6,mm R >!"!3!

?6?• N r!ni!%i* %!in:


• M)()ri8 :

--- ///

--- ///

• Sen*)ri8:

"emi"i$e*(e*i de(rA

• R Fi*i)%)gi*:

BPR?.6?.

TPR ?.6?.KPR ?.6?.APR ?.6?.

• R P!()%-gi*:


• V6ANS:

BAK +?2BAB +?2

JUm!(#

./6.6,-.4

Lem!" *e$!r'"

b!d!n 8!n!n

M'!%

M'n(!"

KU : %em!"Vi(!% Sign:TD: .-6.-- mmHg N!di :4,6mRR:,, 6m (:5 -

S(!('* gener!%i*:K6L: A6I66D @6@6@6@

T")r! : P'%m):

n)rm)>"e*(# *ime(ri*# 6#

r" @6@# 9" @6@

)r: S.S, ('ngg!%# m +@2# g

+@2


+@2 He$!r6Lien ((b

E8*(rimi(!*:

AH

? ?

? ?Edem!

@ @

@ @S(!('* ne'r%)gi*:

D K%ini*:

@ Hemi$%egi D @

P!re*e N VII D

(i$e *en(r!%

@ P!re*e N II D

(i$e *en(r!%

D T)$i* :

S'b K)r(e Serebri

Hemi*Cer SIni*(r!

D E(i)%)gi*:

VA Perd!r!"!n

In(r!*erebr!% "!ri

8e@..

- He!d '$ 5-

dr!;!(- InC'*e P .0

($m- M!ni()% . .--

>>- !n(r!in 5 . gr

- in; >i(i>")%in 5

/-- i- in; OM , .

gr i- in; Ond!n 50

i

26


27/32

• GS : 554

• MS: @


,mm6,mm R >!"!3!?6?

• N r!ni!%i* %!in:


• M)()ri8 :

--- ///

--- ///

• Sen*)ri8:

"emi"i$e*(e*i de(r!

• R Fi*i)%)gi*:

BPR?.6?.TPR ?.6?.KPR ?.6?.

APR ?.6?.• R P!()%-gi*:


• V6ANS:

BAK +?2BAB +?2

S!b('#

.46.6,-.4

Lem!" *e$!r'"

b!d!n 8!n!n

T!ng!n *ebe%!"

8iri %ebi" !8(iC

KU : %em!"Vi(!% Sign:TD: .-6.-- mmHg N!di :4,6mRR:,, 6m (:5 -

S(!('* gener!%i*:K6L: A6I66D @6@6@6@

T")r! : P'%m):

n)rm)>"e*(# *ime(ri*# 6#

r" @6@# 9" @6@

)r: S.S, ('ngg!%# m +@2# g

+@2


+@2 He$!r6Lien ((b

E8*(rimi(!*:

AH

? ?

? ?Edem!

@ @

@ @

S(!('* ne'r%)gi*:• GS : 554

D K%ini*:

@ Hemi$%egi D @

P!re*e N VII D

(i$e *en(r!%

@ P!re*e N II D

(i$e *en(r!%

D T)$i* :

S'b K)r(e Serebri

Hemi*Cer SIni*(r!

D E(i)%)gi*:

VA Perd!r!"!n

In(r!*erebr!% "!ri

8e@.,

- He!d '$ 5-

dr!;!(- InC'*e P .0

($m

- M!ni()% . .--

>>- !n(r!in 5 . gr

-in; >i(i>")%in 5 /-- i

- in; OM , .

gr i- in; Ond!n 50

i- !m%)di$ine .-

mg

27


28/32

• MS: @


,mm6,mm R >!"!3!?6?

• N r!ni!%i* %!in:

P!re*e N VII de8*(r!

(i$e *en(r!%P!re*e NII de8*(r!

• M)()ri8 :

--- ///

--- ///

• Sen*)ri8:

"emi"i$e*(e*i de(r!

• R Fi*i)%)gi*:

BPR?.6?.TPR ?.6?.

KPR ?.6?.APR ?.6?.

• R P!()%-gi*:B!bin*8i @6@"!dd)>8 @6@


• V6ANS:

BAK +?2

BAB +?2

MIngg'#

.6.6,-.4

Lem!" *e$!r'"

b!d!n 8!n!n

M'!% P'*ing

KU : %em!"

Vi(!% Sign:TD: .0-67- mmHg N!di :76mRR:,- 6m (:5 -S(!('* gener!%i*:K6L: A6I66D @6@6@6@

T")r! : P'%m):

n)rm)>"e*(# *ime(ri*# 6#

r" @6@# 9" @6@

)r: S.S, ('ngg!%# m +@2# g

+@2


+@2 He$!r6Lien ((b

E8*(rimi(!*:

AH

? ?

? ?Edem!

@ @

@ @

S(!('* ne'r%)gi*:

• GS : 054

• MS: @

D K%ini*:

@ Hemi$%egi D @

P!re*e N VII D

(i$e *en(r!%

@ P!re*e N II D

(i$e *en(r!%

D T)$i* :S'b K)r(e Serebri

Hemi*Cer SIni*(r!

D E(i)%)gi*:

VA Perd!r!"!n

In(r!*erebr!% "!ri

[email protected]

- He!d '$ 5-

dr!;!(- InC'*e P .0

($m- in; >i(i>")%in 5

/-- i

- in; OM , .

gr iin; Ond!n 50 i- !m%)di$ine .-

mg

28


29/32


,mm6,mm R >!"!3!?6?

• N r!ni!%i* %!in:

P!re*e N VII de8*(r!(i$e *en(r!%

P!re*e NII de8*(r!• M)()ri8 :

--- ///

--- ///

• Sen*)ri8:

"emi"i$e*(e*i de(r!

• R Fi*i)%)gi*:

BPR?.6?.TPR ?.6?.KPR ?.6?.APR ?.6?.

• R P!()%-gi*:


• V6ANS:

BAK +?2BAB +?2

Senin#

.76.6,-.4

Lem!" *e$!r'"

b!d!n 8!n!n

P'*ing

M'!%

KU : %em!"Vi(!% Sign:TD: .0-67- mmHg N!di :76m

RR:,- 6m (:5 -S(!('* gener!%i*:K6L: A6I66D @6@6@6@

T")r! : P'%m):

n)rm)>"e*(# *ime(ri*# 6#

r" @6@# 9" @6@

)r: S.S, ('ngg!%# m +@2# g

+@2


+@2 He$!r6Lien ((bE8*(rimi(!*:

AH

? ?

? ?

Edem!

@ @

@ @

S(!('* ne'r%)gi*:

• GS : 054

• MS: @


D K%ini*:

@ Hemi$%egi D @

P!re*e N VII D

(i$e *en(r!%

@ P!re*e N II D

(i$e *en(r!%

D T)$i* :

S'b K)r(e Serebri

Hemi*Cer SIni*(r!

D E(i)%)gi*:

VA Perd!r!"!n

In(r!*erebr!% "!ri

[email protected]

- He!d '$ 5-

dr!;!(- InC'*e P .0

($m- in; >i(i>")%in 5

/-- i

-in; OM , .gr i

in; Ond!n 50 i- !m%)di$ine .-

mg

29


30/32

,mm6,mm R >!"!3!?6?

• N r!ni!%i* %!in:

P!re*e N VII de8*(r!

(i$e *en(r!%P!re*e NII de8*(r!

• M)()ri8 :--- ///

--- ///

• Sen*)ri8:

"emi"i)e*(e*i de(r!

• R Fi*i)%)gi*:

BPR?.6?.

TPR ?.6?.KPR ?.6?.APR ?.6?.

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RESPONSI Stroke perdarahan