CSS stroke.doc

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CLINICAL SCIENCE SESSION

STROKE

Disusun oleh :

Zahra Fitrianti 130112140624

Preseptor:

Lisda Amalia, dr., SpS

BAGIAN ILMU !N"A#I$ SA%AF

FA#UL$AS #!&'#$!%AN UNI(!%SI$AS A&)A&)A%AN

%UMA* SA#I$ *ASAN SA&I#IN

BAN&UNG

2016



&AF$A% ISI

I. DEFINISI………..……...…………………………………………………..3

II. ANATOMI OTAK…......…………………………………………………...3III. ANATOMI PEMBULU DA!A OTAK.…..……………………………"

I#. $A!AS SISTEM SA!AF MOTO!IK DAN SENSO!IK...………………..%

#. FAKTO! !ISIKO…………………………………………………………..&

#I. KLASIFIKASI…..………………………………………………………….'(

#II. ETIOLO)I DAN PATOFISIOLO)I.……………………………………....'3

#III. )AMBA!AN KLINIS……………………………………………………...*(

I+. PENE)AKKAN DIA)NOSIS……………………………………………...*%

+. PENATALAKSANAAN……………………………………………………*&

+I. KOMPLIKASI……………………………………...…………………….....3*

DAFTA! PUSTAKA………………………………………………………………..3"

*



I. &!FINISI

Stro,e -erup , n su tu ,on/isi 0 n00u n t u /is1un0si ot , 2 n0 ter /i se4 r

-en/ / , /i, ren , n / n2 su tu ,el in n pe-5uluh / r h ot ,6 5 i, tersu-5 tn2 lir n

/ r h ot , t u pe4 hn2 pe-5uluh / r h6 /en0 n /e1isit neurolo0is6 5 i, 1o, l - upun

0lo5 l6 2 n0 5erl n0sun0 le5ih / ri *" - t u ter /i ,e- ti n. Bil /is1un0si sere5r l

se-5uh se-purn / l - 7 ,tu ,ur n0 / ri *" - /in - , n TIA 8 Transient Ischemic

Attack).

II. ANA$'MI '$A#

Ot , 5er / / l - ron00 4r niu- / n -en2 -5un0 ,e -e/ull spin lis -el lui

1or -en - 0nu- . Ot , ter5 0i -en /i 3 5 0i n ut - : hind+rain 8-e/ull o5lon0 t 6

pons6 / n 4ere5ellu-96mid+rain 6 / n -r +rain 8/ien4eph lon / n 4ere5ru-9.

Brainst m 8-e/ull o5lon0 t 6 pons6 / n -i/5r in9 -erup , n 5 0i n ot , 2 n0

tersis setel h 4ere5ru- / n 4ere5ellu- /isin0,ir, n. M d/lla -+l-n ata 5er5entu, ,eru4ut

/ n -en0hu5un0, n pons ,e -e/ull spin lis. Me/ull o5lon0 t -e-ili,i 5 n2 , neuron

/ n 5er1un0si se5 0 i s lur n 5 0i s4en/in0 / n /es4en/in0 ner e 1i5ers. -ns terlet , /i

5 0i n nterior / ri 4ere5ellu-6 in1erior / ri -i/5r in6 / n superior / ri -e/ull o5lon0 t .

Pons -e-ili,i 5 n2 , tr ns erse 1i5ers 2 n0 -en0hu5un0, n ,e/u he-is1er 4ere5ellu-.

Pons u0 -e-ili,i 5 n2 , nu4lei / n s4en/in0 / n /es4en/in0 ner e 1i5ers.

r + ll/m 5er / p / posterior 4r ni l 1oss 6 posterior / ri pons / n -e/ull

o5lon0 t . ;ere5ellu- ter/iri / ri * he-is1er 2 n0 terhu5un0 se4 r l ter l oleh er-is.

3



;ere5ellu- terhu5un0 oleh superior 4ere5ell r pe/un4le ,e -i/5r in6 oleh -i//le 4ere5ell r

pe/un4le ,e pons6 / n oleh in1erior 4ere5ell r pe/un4le ,e -e/ull .

Mid+rain -erup , n 5 0i n ot , 2 n0 -en0hu5un0, n 1ore5r in ,e hin/5r in.

Mi/5r in -en0 n/un0 5 n2 , nu4lei / n ,u-pul n s4en/in0 / n /es4en/in0 ner e 1i5ers.&i n phal-n ter/iri / ri /ors l th l -us6 epith l -us / n entr l h2poth l -us. B 0i n

ter5es r / ri ot ,6 r +r/m 6 ter/iri / ri * he-is1er6 terhu5un0 oleh 4orpus 4 llosu-.

Per-u, n he-is1er6 ,orte,s6 tersusun t s 0r 2 - tter. Korte,s ter5 0i -en /i lip t n t u

0irus6 2 n0 /ipis h, n oleh sul,us.

III. ANA$'MI !MBULU* &A%A* '$A#

Se4 r n to-is6 pe-5uluh / r h sere5r l ter/iri / ri /u siste- 2 itu siste- , rotis

/ n siste- erte5ro5 siler. $ t h / r h ,e ot , '<3 /is lur, n -el lui siste- erte5ro5 siler

/ n *<3 -el lui rteri , rotis intern .

"



$a+ l 1. m+a ian da rah -ta an dip rdarahi p m+/l/h darah s r +ral

Ant ri-r ir /lati-n 5sist m ar-tisAnterior 4horoi/ l ippo4 -pus6 0lo5us p lli/us6 lo7er intern l 4 psuleAnterior 4ere5r l Me/i l 1ront l / n p riet l 4orte= 4ere5ri n/ su5 4ent 7hite

- tter6 nterior 4orpus 4 llosu-Mi//le 4ere5r l L ter l 1ront l6 p riet l6 o44ipit l6 n/ te-por l 4orte= n/

su5 4ent 7hite - tter Lenti4ulostri te 5r n4hes ; u/ te nu4leus6 put -en6 upper intern l 4 psule

-st ri-r ir /lati-n 5sist m 7 rt +r-+asil rPosterior in1erior 4ere5ell r

5 sil r

Me/ull 6 lo7er 4ere5ellu-

Anterior in1erior 4ere5ell r Lo7er n/ -i/ pons6 -i/ 4ere5ellu-Superior 4ere5ell r Upper pons6 lo7er -i/5r in6 upper 4ere5ellu-Posterior 4ere5ell r Me/i l o44ipit l n/ te-por l 4orte= n/ su5 4ent 7hite

- tter6 posterior 4orpus 4 llosu-6 upper -i/5r inTh l -oper1or te 5r n4hes Th l -us

Th l -o0eni4ul te 5r n4hes Th l -us

>



I(. )A%AS SIS$!M SA%AF M'$'%I# &AN S!NS'%I#

Per l n n s r 1 -otori, ter5 0i /u 2 itu siste- pir -i/ lis / n e,str pir -i/ lis.

Sist m iramidalis :

Pus t siste- -otori, terlet , /i 02rus presentr lis 8 re 5ro /- n "9 /ite-p t ini

ter/ p t Motor Homonculus 6 ser 5ut s r 1 ,e-u/i n 5er l n -el lui tr ,tus pir -i/ lis2 n0 /i5entu, oleh neuron sel B t? 2 n0 ter/ p t p / l pis n ,eli- 02rus presentr lis6

5er l n ,on er0en ,e , u/ l ,e , psul intern -ene-p ti *<3 ,rus posterior. Ke-u/i n

5er l n ,e pe/un4ulus o5lon0 t / n -e/ul spin lis. P / ,ornu nterior -e/ul spin lis

se5 0i n ser 5ut s r 1 @ > 5er l n ,e ,ontr l ter l 8/ise5ut tr ,tus ,orti,ospin l l ter l96

persil n0 n ini /ise5ut /e4uss tio p2r -i/ lis6 se/ n0, n ser 5ut 2 n0 l in @'> ti/ ,

-en2il n0 5er ,hir /i ,ornu nterior ho-ol ter l 8/ise5ut tr ,tus ,orti,ospin l nterior9.

%



$ra t/s stra piramidalis

Ter/iri / ri ,orte,s6 0 n0li 5 s lis6 -i/5r in. ) n0li 5 s lis ter/iri / ri 0lo5us p li/us6

put -en6 nu,leus , u/ tus6 su5st nsi ni0r 6 nu,leus su5th l -i,us6 nu,leus ru5r . Put -en/ n nu,leus , u/ tus /ise5ut stri tu-.

C



SIS$!M SA%AF S!NS'%IS

Siste- s r 1 sensoris -e-ili,i /u lur 5er/ s r, n lo, si peneri- n r n0s n0.

Sensibilitas permukaan



! n0s n0 /iteri- /i reseptor ,e-u/i n ser 5ut s r 1 5er l n ,e 0 n0lion

spin le6 ,e-u/i n -el lui r /i= posterior ,e ,ornu posterior6 /ite-p t ini 5er0 nti

neuron ,e-u/i n -en2il n0 line -e/i n -en /i tr ,tus spinoth l -i,us6

,e-u/i n ,e t s ,e th l -us. P / th l -us ser 5ut s r 1 2 n0 5er s l / ri

5 / n 5 0i n 5 7 h 5er l n le5ih l ter l se/ n0, n 5 / n 5 7 h le5ih -e/i l6

,e-u/i n 5er0 nti neuron ,e-5 li / n 5er ,hir /i 02rus sentr lis posterior.

Sensibilitas dalam

Ser 5ut s r 1 5e l n -ul i / ri reseptor ,e 0 n0lion spin le l lu ,e r /i=

posterior6 /i sini ser 5ut -e-5 0i /u -en /i 1uni4ullus 0r 4ilis 8untu, / er h

s ,r lis6 lu-5 lis / n thor , lis 5 7 h9 / n 1uni4ulus 4une tus 8untu, 5 0i n

thor , l t s / n se i, lis9. Ser 5ut ini se4 r 5erurut n -enu u nu,leus 0oll / n

nu,leus 5ur/ 4h se5elu-n2 5er0 nti neuron. Ke-u/i n 5ersil n0 -e-5entu,

le-nis4uss -e/i lis -enu u ,e th l -us 5er0 nti neuron / n 5er ,hir /i /i 02rus

sentr lis posterior.

(. FA#$'% %ISI#'

P / u-u-n2 6 1 ,tor risi,o stro,e /i5 0i -en /i 1 ,tor risi,o 2 n0 ti/ , / p t

/i-o/i1i, si / n 1 ,tor risi,o 2 n0 / p t /i-o/i1i, si. F ,tor risi,o 2 n0 ti/ , / p t

/i-o/i1i, si ter/iri / ri:. U-ur

&



Stro,e p lin0 serin0 ter /i p / usi le5ih / ri %> t hun6 tet pi r n0 ter /i

p / usi /i 5 7 h "( t hun.

5. $enis ,el -in

Pri le5ih 5erisi,o ter,en stro,e /i5 n/in0, n 7 nit 6

4. ! s

! s ,ulit hit - le5ih 5erisi,o -en/erit stro,e is,e-i, / n stro,e he-or 0i,

/i5 n/in0, n r s ,ulit putih / n r s si . ! s ,ulit putih le5ih 5erisi,o

-en/erit stro,e is,e-i, /i5 n/in0 r s si 6 se/ n0, n r s si le5ih 5erisi,o

-en/erit stro,e he-or 0i, /i5 n/in0, n r s ,ulit putih.

/. !i7 2 t -en/erit TIA t u stro,e

Se,it r 3> p sien /en0 n TIA , n -en0 l -i stro,e / l - n0, 7 ,tu >

t hun / n '( stro,e ul n0 ter /i / l - t hun pert - setel h stro,e.

e. !i7 2 t ,elu r0 pen/erit stro,e

F ,tor risi,o stro,e 2 n0 / p t /i-o/i1i, si ter/iri / ri:

. ipertensi

ipertensi -erup , n 1 ,tor 2 n0 p lin0 /i,et hui -en2e5 5, n stro,e. B i,

penin0, t n te, n n sistoli, - upun /i stoli, -e-ili,i potensi 2 n0 s -

5es rn2 . Penurun n te, n n / r h se4 r n2 t / p t -enurun, n n0,

,e /i n stro,e. Di/u0 te, n n / r h 2 n0 tin00i -erus , en/otel / n

-enin0, t, n per-e 5ilit s /in/in0 pe-5uluh / r h terh / p lipoprotein.

Sel in itu6 5e5er p ? t 2 n0 /i,elu r, n tu5uh seperti renin / n n0iotensin

/ p t -en0in/u,si peru5 h n seluler 2 n0 -en2e5 5, n tero0enesis.

5. Mero,o,

Mero,o, -en2e5 5, n penin0, t n ,o 0ul 5ilit s6 is,osit s / r h6

-enin00i, n , / r 1i5rino0en6 -en/oron0 0re0 si pl telet6 -en i,, n

te, n n / r h6 -enin0, t, n he- to,rit6 -enurun, n ,olesterol DL / n-enin0, t, n ,olesterol LDL.

4. Pen2 ,it ntun0 8coronary artery disease, 1i5ril si triu-9

!esi,o ter,en stro,e ser n0 n pert - -enin0, t p / or n0 /en0 n

pen2 ,it s,ul r teros,leroti, non sere5ro s,ul r.

/. Di 5etes

Di 5etes -erup , n 1 ,tor risi,o 2 n0 ,u t untu, se-u - ni1est si ,linis

pen2 ,it s,ul r teros,leroti,. Me, nis-e penin0, t n tero0enesis p / pen/erit DM -eliputi 0 n00u n pro1il lipi/6 0 n00u n -et 5olis-e s -

'(



r ,hi/on t6 penin0, t n 0re0 si tro-5osit6 penin0, t n , / r 1i5rino0en6

0 n00u n 1i5rinolisis6 /is1un0si en/otel.

e. Dislipi/e-i

Kolesterol -erup , n ,o-ponen ut - / l - pl , teros,lerosis. Or n0

or n0 /en0 n ,el in n 0eneti, 2 n0 -en2e5 5, n tin00in2 , / r ,olesterol

/ l - / r h 5i s n2 , n -en0 l -i teros,lerosis pre- tur 5 h, n t np

/ n2 1 ,tor resi,o l in p / or n0 terse5ut.

1. !i7 2 t TIA / n stenosis , rotis t np 0e l ,linis

(I. #LASIFI#ASI

Ber/ s r, n 0 -5 r n ,linis / n pro1il 7 ,tu 8 temporal profile 9 :

1. Improvin Stroke

P / improvin stroke 6 /e1isit neurolo0is se-5uh / l - ,urun 7 ,tu le5ih / ri *"

- s -p i 3 -in00u.

!. "orsenin Stroke

P / #orsenin stroke 6 /e1isit neurolo0is -en /i 5er t se4 r pro0resi16 se4 r

,u ntit ti1 - upun ,u lit ti16 5 i, / ri n -nes - upun follo#$up . Pro0resi1it sn2

ter /i / l - 5e5er p -enit s -p i - 8>( 9. Ber/ s r, n per l n n ,linisn2

/ p t /i5 0i -en /i :

a. Smooth "orsenin

b. Steplike "orsenin

c. %luctuatin "orsenin

&. Stable Stroke

P / stable stroke 6 /e1isit neurolo0isn2 l n0sun0 len0, p6 ti/ , 5 n2 , 5eru5 h l 0i

/ l - per l n n 7 ,tu.

Ber/ s r, n 0 -5 r n p tolo0is intr ,r ni l / n -enun u,, n tipe stro,e6 - , stro,e

/i,l si1i, si, n -en /i :

'. Stroke Infark

Ter /i is,e-i, / n in1 r, p / rin0 n ot ,6 /i- n /ite-u, n ,e- ti n 8ne,rosis9

p / se5 0i n rin0 n ot , /ise5 5, n oleh 5er,ur n0n2 lir n / r h ot ,

8'erebral (lood %lo# '(% 9 ,i5 t stenosis t u o,lusi / ri pe-5uluh / r h.

Ber/ s r, n p to1isiolo0in2 :. Infark Aterotrombotik

''



Ter /i ,eti, tro-5us superi-posisi p / teros,lerosis 8intr e,str ,r ni l9.

Tro-5us ini 5i s n2 ter /i , ren ,el in n pe-5e,u n / r h 8 0re0 si pl telet9.

5. Infark *ardioemboli

Su-5 t n e-5oli 5er s l / ri ntun0 tro-5us 2 n0 ter5entu, 5er s l / ri sel

/ r h -er h / n 1i5rin t u /ise5ut se5 0 ired thrombus 8-u/ h lisis9. Tro-5us ini

5i s n2 ter5entu, ,i5 t lir n / r h 2 n0 l -5 t. In1 r, , r/ioe-5oli 5is ter /i

, ren ,el in n ntun06 2 itu p / :

ir - : 1i5ril si tri l p / or n0 tu

, tup : en/o, r/itis6 -itr l stenosis

/in/in0 : Acute Myocard Infarct 8 AMI 9

rheumatic heart disease p / /e7 s -u/

4. Infark Tromboemboli

Su-5er e-5oli 5er s l / ri 1r 0-en tero- tous pl ue /i leher 85i1ur4 tio

4 rotis9<artery$to$artery emboli. P / te-p t per4 5 n0 n / n 5elo, n / ri

pe-5uluh / r h ter /i penin0, t n tur5ulensi 2 n0 5er ,i5 t p / penin0, t n

shear stress 8lu, 0ese,9. Ter5entu, -i,rolesi /i- n en/otel -en /i ter,o2 ,

ter5entu, pl , , ren / n2 0re0 si pl telet pl , lep s , ren

penin0, t n te, n n / l - pe-5uluh / r h 1r 0-en tero- tous pl ue ini

-enu u rteri 2 n0 le5ih ,e4il tro-5oe-5oli 8 #hite trombus emboli 6 ti/ , 5is

lisis sen/iri9. Tro-5us putih ini tersusun / ri pl telet6 1i5rin6 / n se/i,it sel / r h

-er h6 5i s n2 ter5entu, p / / er h /i- n per-u, n en/otel 5nor- l / n

lir n / r h 4ep t.

/. Infark +akuner

Ter /in2 in1 r, in1 r, ,e4il 2 n0 /ise5 5, n oleh / n2 tro-5osis p / rteri

G rteri ,e4il.Small lesions 8H " --96 -eli5 t, n rteri penetr ns 2 n0 ,e4il / n

let ,n2 pro1un/ . Arteri penetr ns ini -erup , n per4 5 n0 n l n0sun0 / ri

rteri 2 n0 -e-5entu, su/ut &( o6 -is ln2 . Lenti,ulostri t 9. +ar e lesions

8 iant lacunes 96 -erup , n in1 r, ,i5 tmultiple penetratin arteries .

*. Stroke erdarahan

Ber/ s r, n let ,n2 :

. Per/ r h n Intr Sere5r l 8PIS9

'*



Bi s n2 , ren hipertensi 2 n0 ti/ , ter,ontrol. Ter /i terut - p / rteri

penetr ns 8A. ;ere5ri -e/i . Lenti,ulostri t 96 5is -en0en i 0 n0li

5 s lis6 th l -us6 lo5us he-is1er6 pons6 t u 4ere5ellu-.

P / A. Lenti,ulostri t ,i5 t hipertensi ,ronis ter /i penin0, t nte, n n intr lu-enn2 tuni, inti- -en /i rus , ter5entu,

-i,ro neuris- 8@ ' --9 'harcot$(ouchard aneurysm 5il te, n n

/ r h -enin0, t ti5 ti5 5is pe4 h / n 5er ,i5 t per/ r h n.

Bis u0 /ise5 5, n ,i5 t pen2e5 5 l in 2 n0non$hypertensive 2 n0

5i s n2 -en0en i lo5us 1ront l6 -is ln2 :

A-M ter/ p t ,el in n ,on0enit l p / pe-5uluh / r h

intr sere5r l 5erup hu5un0 n l n0sun0 nt r rteriol / n enulet np , piler. Per/ r h n ter /i , ren t , n n / r h / ri rteri le5ih

5es r / rip / en 2 n0 /in/in0n2 le5ih tipis.

uptured arteriosclerotic vessel

Amyloid an iopathy

(lood dyscrasia

Trauma

Anticoa ulant therapy 5. Per/ r h n Su5 Ar ,hnoi/ 8PSA9

Pen2e5 5n2 nt r l inruptured berry aneurysm, ruptured A-M, ruptured

an ioma, t ublood dyscrasia 5i s n2 ruptur ter /i /i sir,ulus illis / n

per4 5 n0 nn2 8 . Ko-uni, ns nterior<posterior9 / r h -en0isi ron00

su5 r ,hnoi/ / n p ren,i- ot , /i se,it rn2 . At u PSA 5is ter /i se,un/er

,i5 t PIS 2 n0 - su, -el lui entri,el.

Ber/ s r, n let , t u lo, si / ri lesi s,uler6 - , stro,e /i,l si1i, si, n -en /i:

a. Ant ri-r ir /lati-n 5sist m ar-tis

Stro,e 2 n0 /ise5 5, n , ren pe-5uluh / r h ini -e-5eri, n t n/ / n

0e l /is1un0si he-is1er sere5ri seperti 1 si 6 pr =i 6 t u 0nosi . Sel in itu / p t

u0 ti-5ul he-ip rese6 0 n00u n he-isensoris6 / n 0 n00u n l p n0 p n/ n0.

+. -st ri-r ir /lati-n 5sist m 7 rt +r-+asil r

Stro,e 2 n0 /ise5 5, n , ren pe-5uluh / r h ini -e-5eri, n t n/ / n

0e l /is1un0si 5 t n0 ot , tersu, ,o- 6 drop attacks 8 tuh ti5 ti5 t np

'3



penurun n ,es / r n96 erti0o6 -u l / n -unt h6 0 n00u n s r 1 ot ,6 t =i 6 /e1isit

siste- sensori-otori, ,ontr l ter l 8he-ip rese ltern ns9. D p t u0 ti-5ul

he-ip rese6 0 n00u n he-isensoris6 / n 0 n00u n l p n0 p n/ n0 tet pi ti/ ,

spesi1i, untu, stro,e 2 n0 /ise5 5, n siste- erte5ro5 siler.

(II. !$I'L'GI &AN A$'FISI'L'GI

8.1 !ti-l- i

Ter/ p t * tipe stro,e:

9. Stro,e is,e-i,

Dise5 5, n oleh interupsi 8o,lusi thro-5oti, t u e-5oli,9 / ri lir n / r h 4ere5r l /i

pe-5uluh / r h.

59. Stro,e per/ r h n

,i5 t per/ r h n ,e rin0 n ot ,

r sio 1 t lit s 2 n0 le5ih tin00i /i5 n/in0, n stro,e is,e-i,

8.1.1 n +a+ /m/m str- is mi

'9 o,lusi thero- tous<thro-5oti,

o,lusi pe-5uluh / r h t u stenosis 84th: rteri , rotis9

o,lusi pe-5uluh / r h 4 5 n0 84th: rteri 4ere5r lis -e/i l9

per1or si 8,e4il9 o,lusi pe-5uluh / r h 8in1 r, l ,un r9

o,lusi en

*9 pen2 ,it non therotro-5oti, /in/in0 pe-5uluh / r h

pen2 ,it ,ol 0en 84th: rheu- toi/ rthritis6 SLE9

# s4ulitis 84th: pol2 rteritis no/os 6 te-por l rteritis9

0r nulo- tous s4ulitis 84th: 7e0enerJs 0r nulo- tous9

l in l in 84th: si1ilis s4ulitis6 1i5ro- s,ul r /ispl si 6 s r4oi/osis6 tr u- 939. e-5olis si6 / ri:

pl , thero- tous /i rteri intr 4r ni l t u e,str 4r ni l / ri 4 5 n0 r4us ort

8 rteri ,e rteri9

ntun0: l ul r he rt /ise se6 rit-i 6 is4he-i4 he rt /ise se6 5 4teri l non

5 4teri l en/o4 r/itis6 tri l -2=o- 6 prostheti4 l es6 p tent 1or -en o le6

4 r/io-2op th2

l in l in: e-5oli le- ,6 e-5oli u/ r 6 e-5oli tu-or

'"





Pelep s n platelet$derived ro#th factor 8PD)F9 oleh - ,ro1 06 tro-5osit / n sel

en/otel -en0 ,i5 t, n -i0r si sel sel otot polos rteri / ri tuni, / entisi ,e tuni,

inti- . A/ n2 ,eterli5 t n sito,in u0 -en0el 5or si proses terse5ut. Sel sel otot polos

terse5ut l lu 5erproli1er si /isert i peni-5un n ,ol 0en / n - tri,s e,str seluler l inn2 .

Ter /i 1i5rosis / n lipi/ ter/eposit -e-5entu, pl , 1i5rolipi/ 2 n0 -en0in si tuni,

inti- 6 -en2e5 r /i sep n n0 /in/in0 rteri / n -en2e5 5, n pene5 l n /in/in0 rteri / n

pen2e-pit n lu-en. Pl , -en /i ne,roti, / n ter, lsi1i, si. Pe-5entu, n pl , /ii,uti

in si / n 0re0 si pl telet 2 n0 -en0inisi si ,o 0ul si / r h / n tro-5osis.

m+ nt/ an tr-m+/s

Tro-5us /i5entu, / ri 1i5rin6 tro-5osit6 / n en/oteliu- pe-5uluh / r h. S t ter /i

e s en/otel6 tro-5osit , n -ene-pel p / en/otel 2 n0 4e/er / n ter ,ti si sehin00

ter /il h 0re0 si tro-5osit. $i, en/oteliu- int ,6 - , perle, t n tro-5osit , n /i4e0 h

oleh / n2 prost si,lin6 nitri4 o=i/e6 / n so-o/ulin.

P / en/otel 2 n0 4e/er 6 tro-5osit 2 n0 ter ,ti si6 5eru5 h 5entu,n2 / n , n

-elep s, n 0r nul . Pelep s n ADP / n tro-5o= n A* , n -ere,rut tro-5osit l inn2

untu, -ene-pel p / en/otel 2 n0 4e/er / n -e-5entu, hemostasis plu . Disusul oleh

, s, /e ,o 0ul si 2 n0 -en2e5 5, n pe-5entu, n tro-5in sert ,on ersi 1i5rino0en

-en /i 1i5rin. A0re0 t pl telet / n 1i5rin -e-5entu, plu 2 n0 soli/ / n per- nen. A/ n2

-e, nis-e counter$re ulatory / ri tissue plasmino en activator -en2e5 5, n tro-5us

h n2 ter5entu, p / / er h e s.

P / stro,e terotro-5oti,6 is,e-i ter /i , ren / n2 0 0 l per1usi 5 0i n /ist l

,i5 t / n2 stenosis 2 n0 pro0resi1. D er h in1 r, ter0 ntun0 / ri lir n ,ol ter l 2 n0

ter/ p t /ise,elilin0 t u p / / er h 5 t s.

8.2.2 Str- ardi- m+-li

Merup , n s l h s tu 5entu, stro,e in1 r, ,i5 t e-5oli 2 n0 5ersu-5er /i ntun0.

P to1isiolo0i /itentu, n oleh pen2 ,it / s r /i ntun0. Me, nis-en2 /ipen0 ruhi

,esei-5 n0 n nt r 1 ,tor pe-5entu, tro-5us 8,erus , n en/o, r/6 st tis lir n / r h

re0ion l / n ,ti si siste- ,o 0ul si siste- intrinsi,9 /en0 n ,e,u t n sir,ul si 2 n0 / p t

-en2e5 5, n - teri l tro-5us ,elu r / n - su, sir,ul si.

E-5oli 2 n0 lep s / ri ntun0 - su, ,e rteri , rotis ,o-unis / n terus 5er0er , ,e

r h /ist l -en4 p i 4 5 n0 ,hir<ter-in l /i ,orte,s t u -en0 l -i lisis. Proses -i0r si/i/u0 ,i5 t re ,si pe-5uluh / r h 5erup rel ,s si /i pro,si- l / n ,onstri,si /i /ist l

'%



/ er h su-5 t n t u , ren 0er , n puls si rteri. !e ,si pe-5uluh / r h ini 5ertu u n

untu, -enin0, t, n te, n n pe-5uluh / r h intr lu-in l 2 n0 tersu-5 t.

Su-5 t n e-5oli /i 4 5 n0 rteri 4ere5ri -en2e5 5, n in1 r, 5er5entu, 5 i /i

/ er h ,orte,s sere5ri. Sel n utn2 / p t ter /i re, n lis si /i / er h su-5 t n. Kel in n

ntun0 2 n0 / p t -en2e5 5, n 0 n00u n 1un0si ot , 2 itu:

'. E-5oli / ri ,el in n , tup6 /in/in06 / n ru n0 ntun0

*. ) n00u n 4ur h ntun0 2 n0 /ese5 5, n ,el in n rit-e

3. Oper si ntun0

F ,tor pre/i,ti1 ntun0 2 n0 5erper n / l - proses e-5oli:

'. Peru5 h n 1un0si triu-

E-5oli p / 5e5er p h ri t u -in00u setel h , r/io ersi 1i5ril si triu- -en /i

ir - sinus. Perlu 7 ,tu le5ih / ri 3 -in00u setel h , r/io ersi 0 r 1un0si triu- ,e-5 li

nor- l.

*. !espon inotropi, 1o, l

Tro-5us 2 n0 -ene-pel /i en/o, r/ rus ,6 -en2e5 5, n respon inotropi, 1o, l

terh / p -io, r/ /i / s rn2 . !espon ini -en2e5 5, n ,ontr ,si 2 n0 ti/ , r t sehin00

ter /i pelep s n e-5oli.

3. Lu sn2 perle, t n tro-5us

!esi,o ter /in2 e-5oli p / tro-5us 2 n0 -ele, t /i per-u, n 2 n0 lu s le5ih

ren/ h / rip / se-pit.

". K r ,teristi, lir n / r h

Ke / n st tis /i- n triu- -erup , n 1 ,tor ter /in2 e-5oli p / pen/erit

1i5ril si triu-6 /e-i,i n pul 1r ,si e e,si 2 n0 ren/ h t u 0 0 l ntun0 2 n0 ter /i p /

in1 r, -io, r/6 , r/io-iop ti /il t si6 / n 1i5ril si triu-.

8.2.3 Str- p rdarahan intras r +ral 5 IS

8.2.3.1 rdarahan intras r +ral prim r 5hip rt nsi

Merup , n per/ r h n intr sere5r l /en0 n hipertensi se5 0 i pen2e5 5 ut - n2 6

terut - hipertensi ti/ , ter,ontrol6 2 n0 -en2e5 5, n rus ,n2 pe-5uluh / r h ,e4il /i

ot , sehin00 -u/ h ruptur. Bi s n2 ter /i /i re 2 n0 /iper/ r hi oleh rteri penetr ns

,e4il seperti th l -us6 put -en6 /eep 4ere5r l 7hite - tter6 pons6 / n 4ere5elu-.

P / or n0 nor- l ter/ p t siste- utore0ul si rteri sere5r l6 /i- n 5il te, n n

/ r h siste-i, -enin0, t - , pe-5uluh / r h sere5r l , n so,onstri,si6 se5 li,n2 5ilte, n n / r h siste-i, -enurun pe-5uluh / r h sere5r l , n so/il t si. Den0 n

'C



/e-i,i n lir n / r h ,e ot , tet p ,onst n. Fun0si utore0ul si / p t 5er l n 5 i, i,

-ABP 5er,is r nt r >( '>( -- 0. Keti, te, n n / r h siste-i, -enin0, t / l - 7 ,tu

l - , n -en2e5 5, n /e0ener si l pis n otot pe-5uluh sere5r l6 sehin00 /i -eter lu-en

pe-5uluh / r h , n sulit 5eru5 h. l ini -en2e5 5, n pe-5uluh / r h sere5r l ti/ ,

/ p t 5er/il t si t u 5er,onstri,si /en0 n lelu s untu, -en0 t si 1lu,tu si te, n n / r h.

P / hipertensi ,ronis6 pe-5uluh / r h rteriol , n -en0 l -i peru5 h n

/e0ener ti1 2 n0 -en2e5 5, n /in/in0n2 -en /i le- h sehin00 -eni-5ul, n

-i,ro neuris- 2 n0 terse5 r /isep n n0 pe-5uluh / r h /ise5ut -i,ro neuris- ;h r4ot

Bou4h r/6 5entu, seperti , ntun0 2 n0 -enon ol -el lui tuni, -e/i 2 n0 le- h.

ipertensi ,ronis , n -en2e5 5, n ,erus , n spesi1i, pe-5uluh / r h -el lui 3

-e, nis-e 2 n0 s lin0 5erhu5un0 n6 2 itu puls tile 1lo76 en/otheli l /enu/ tion6 / n

repli, sel otot polos. N -un 2 n0 / p t -en2e5 5, n PIS / l h -e, nis-e puls tile 1lo76

/i- n te, n n / r h 2 n0 tin00i , n -en2e5 5, n te, n n p / rin0 n ,ol 0en / n

el stin /in/in0 pe-5uluh / r h. l ini -en2e5 5, n ,erus , n 5erup -e/ione,rosis6

neuris- 6 / n per/ r h n.

Bil pe-5uluh / r h pe4 h , n ter /i per/ r h n s -p i - ,si- l % -6 2 n0

, n 5erhenti sen/iri ,i5 t pe-5entu, n 5e,u n / r h / n /it -pon oleh rin0 n

se,it rn2 . $i, per/ r h n 5erl n0sun0 terus /en0 n olu-e 2 n0 5es r6 , n -erus ,

stru,tur n to-i ot ,6 /it -5 h l 0i ter /i e/e- 7 l /i se,it r he- to- ,i5 t pelep s n

/ n ,u-ul si protein seru- ,ti1 os-oti, / ri 5e,u n / r h. A,i5 tn2 6 /estru,si - ss

ot , / n penin0, t n te, n n intr ,r ni l -en2e5 5, n te, n n per1usi ot , -enurun sert

ter0 n00un2 lir n / r h ot ,. L lu6 ter /i , s, /e is,e-i, / n e/e- sitoto,si, 2 n0

, n -en2e5 5, n ,e- ti n sel ot ,. M sss /i / l - ot , , n 5ert -5 h sehin00 / p t

ter /i herni si ot , 2 n0 / p t -en2e5 5, n ,e- ti n.

8.2.3.2 rdarahan intras r +ral s /nd r 5n-n9hip rt nsi

A(M

Merup , n su tu ,el in n ,on0enit l p / pe-5uluh / r h intr sere5r l6 /i- n

ter /i hu5un0 n l n0sun0 nt r rteriol / n enul t np -el lui , piler6 sehin00 ter /i

lir n / r h 2 n0 4ep t p / / er h terse5ut. A,i5 t lir n 2 n0 4ep t ini / n te, n n 2 n0

5es r / ri rteri ter /i penipis n /in/in0 pe-5uluh / r h6 2 n0 / p t -eni-5ul, n

neuris- / n penurun n lir n / r h ot , /i se,it r A#M 2 n0 / p t -en2e5 5, n

,erus , n rin0 n /i se,it rn2 .

'



An /risma

Merup , n ,el in n ,on0enit l p / pe-5uluh / r h /i- n ter /i 0 n00u n

per,e-5 n0 n /in/in0 pe-5uluh / r h 2 itu p / tuni, -e/i / n l -in el sti, . K ren

/ n2 0 n00u n p / tuni, -e/i 6 / n ter /i peru5 h n /e0ener ti1 sehin00 ter /i

/estru,si lo, l p / -e-5r n el sti, intern 2 n0 -en2e5 5, n tuni, inti- -enon ol

/ n -e-5entu, su tu neuris- 5entu, s ,uler. U,ur n neuris- ini r t r t C6> --6 5il

'( -- , n -u/ h ruptur.

Amil-id an i-pati

Sere5r l -ilo/ n0iop ti 84on0ophili4 n0iop ti9 -erup , n ,el in n /in/in0

pe-5uluh / r h ot , ,i5 t /eposit protein 5et -iloi/. Deposit ter /i p / /in/in0 rteri

tuni, -e/i / n tuni, / entisi rteri ,e4il t u se/ n0 2 n0 terlet , /i ,orte,s6

lepto-enin0en / n su5,orti, l su5st nsi l5 . Protein 5et -iloi/ ini -en00 nti, n

rin0 n ,ol 0en / n ele-en ,ontr ,tilit s pe-5uluh / r h -en2e5 5, n ,erus , n p /

tuni, -e/i / n / entisi pe-5uluh / r h ot , pene5 l n -e-5r n 5 s lis stenosis

lu-en pe-5uluh / r h / n 1r 0-ent si<,erus , n p / tuni, l -in el sti, intern

/in/in0 pe-5uluh / r h -en /i r puh / n -u/ h ruptur.

$/m-r -ta

Bi s n2 oleh tu-or 0 n s pri-er t u 5entu, -et st sis /en0 n present si > '( .

tu-or ot , pri-er 2 n0 / p t -en0 l -i per/ r h n / l h 0lio5l sto- 6 oli0o/en/ro- 6

-e/ullo5l sto- 6 he- n0io5l sto- t u -et st se. n -un 2 n0 p lin0 serin0 / l h p /

0lio5l sto- / n -et st se. -et st se / ri tu-or pri-er -el no- 6 , rsino- 5ron,i l6

, rsino- 0in l / n 4horio, rsino- . per/ r h n /i/u0 ,i5 t r puhn2 pe-5uluh / r h

5nor- l / l - tu-or 2 n0 , 2 , n ,o-ponen s,uler.

n alah /naan -+at 5 drug abuse

Ko, in -erup , n s l h s tu o5 t 2 n0 / p t -en2e5 5, n per/ r h n intr sere5r l

/en0 n -enin0, t, n te, n n / r h6 n /i6 te-per tur6 / n -et 5olis-e.

&is rasia darah

Sickle cell ne-i 6 leu,e-i 6 / n he-o1ili 6 sert 0 n00u n ,o 0ul si 2 n0 /i/ p t

/ p t -en2e5 5, n 0 n00u n sintesis 1 ,tor pe-5e,u n6 penin0, t n 1i5rinolisis / ntro-5ositopeni .

'&



Anti -a /lan

Pen00un n hep rin / n 7 r1 rin / p t -en2e5 5, n per/ r h n intr sere5r l

p 5il nti,o 0ul n /i0un , n se4 r 5erle5ih n t u / l - n0, p n n0. F ,tor

pre/isposisi 2 n0 / p t -en2e5 5, n per/ r h n p / p sien / l - ter pi nti,o 0ul n

/ l h -enin0, tn2 u-ur6 in1 r, is,e-i, 2 n0 lu s6 / n / n2 hipertensi 5er t.

$r-m+-liti

Per/ r h n -erup , n 0e l to,sisit s - 2or p / pen00un n o5 t o5 t

tro-5oliti,6 , ren lisisn2 1i5rin p / tro-5in 2 n0 ter5entu, /i pe-5uluh / r h 2 n0 lu,

/ n lisis siste-i, 2 n0 /i ,i5 t, n oleh pe-5entu, n pl s-in6 1i5rinolisis / n /estru,si

1 ,tor 1 ,tor pe-5e,u n. Me, nis-e 2 n0 -en/ s ri ter /in2 per/ r h n ot , ini 5elu-

/i,et hui el s.

(as /litis

Merup , n pen2 ,it in1l - si p / pe-5uluh / r h rteri / n en 6 -is ln2

pen2 ,it SLE6 /it n/ i /en0 n in1l - si 8 iant cell 9 / l - tuni, -e/i / n / entisi rteri

/ n en 5eru,ur n ,e4il / n se/ n0. l ini -en2e5 5, n le- hn2 /in/in0 pe-5uluh

/ r h sehin00 ter5entu, -i,ro neuris- .

8.2.4 rdarahan s/+ara hn-id 5 SA

Pen2e5 5 terserin0 / l h pe4 hn2berry aneurisma

Pen2e5 5 l in:

A#M

ruptur n0io-

blood dyscrasia

tu-or

ruptur per/ r h n intr sere5r l pri-er ,e / l - siste- entri,uler B rr an /r sma

Dise5ut u0 s 44ul r<4on0enit l neuris- 8, ntun0 seperti 5 lon 2 n0

ter5entu, p / 5 0i n 2 n0 le- h / ri /in/in0 rteri9

Tipe p lin0 u-u- / ri neuris- intr ,r ni l

Ter /i /i pe-5uluh / r h /e, t circle of #illis / n u0 p / per4 5 n0 n rteri

5 siler -en /i * rteri sere5r lis posterior

P / pen/erit hipertensi6 5 0i n 2 n0 le- h terse5ut -elu s / n / p t ruptur6 / r h l lu- su, ,e ron00 su5 r 4hnoi/6 ter /i he- to- su5 r 4hnoi/.

*(



(III. GAMBA%AN #LINIS

Str- In ar

In1 r, sere5ri /i 7 li /en0 n ter /in2 penurun n'erebral (lood %lo# 8;BF9 2 n0

-en2e5 5, n supl i o,si0en ,e ot , , n 5er,ur n0. Der t / n /ur si penurun n 'erebral

(lood %lo# 8;BF9 ,e-un0,in n 5erhu5un0 n /en0 n e s 2 n0 ter /i. $i, supl i / r h ,e

ot , ter0 n00u sel - 3( /eti,6 - , -et 5olis-e /i ot , , n 5eru5 h. Setel h s tu -enit

ter0 n00u6 1un0si neuron , n 5erhenti. Bil > -enit ter0 n00u / p t ter /i in1 r,. N -un6

i, o,si0en si ,e ot , / p t /iper5 i,i /en0 n 4ep t6 ,erus , n / p t 5ersi1 t re ersi5el.

Nil i nor- l 'erebral (lood %lo# 8;BF9 / l h >> -l<'(( 0r - per -enit.

Penurun n ;BF /i 5 7 h '( '* -l<'(( 0r - per -enit / p t -en2e5 5, n in1 r,. Nil i

,ritis ;BF 2 n0 / p t -en2e5 5, n ,erus , n rin0 n / l h /i nt r '> s -p i ' -l<'((

0r - per -enit. P / nil i terse5ut ter /i electrical failure . D l - ,e / n per1usi 2 n0

- r0in l 0ischemic penumbra) 6 , / r , liu- , n -enin0, t /isert i penurun n ATP / n

pelep s n FFA. A, n tet pi6 peru5 h n - sih 5ersi1 t re ersi5el p 5il sir,ul si / p t

,e-5 li nor- l.

Is,e-i , n -en2e5 5, n 0 n00u n he-ost sis ion6 terut - ion , liu- / n

, lsiu-. Ion , liu- 2 n0 -enin00i /i ru n0 e,str seluler , n -en2e5 5, n pe-5en0, , n

sel stro0li 6 sehin00 -en00 n00u tr nsport o,si0en / n 5 h n - , n n ,e ot ,. Sel 2 n0

-en0 l -i is,e-i , n -elep s, n neurotransmitter 0lut - t / n sp rt t 2 n0 , n

-en2e5 5, n influ n triu- / n , lsiu- ,e / l - sel. Ke / n inil h 2 n0 -en/oron0 e s

sel -en /i irre ersi5el.

Nil i ;BF H '( -l<'(( 0r - per -enit 8in1 r,9 /it n/ i /en0 n penurun n ATP6

penin0, t n , liu- e,str seluler6 penin0, t n , lsiu- intr seluler6 / n si/osis seluler.

K lsiu- 2 n0 tin00i /i intr seluler , n -en0h n4ur, n -e-5r n 1os1olipi/ sehin00 ter /i

s - le- , 5e5 s6 nt r l in s - r ,hi/on t. As - r ,hi/on t -erup , n pre,ursor / ri prost si,lin / n tro-5o,s n A*. Prost si,lin -erup , n so/il tor 2 n0 ,u t / n -en4e0 h

0re0 si tro-5osit6 se/ n0, n tro-5o,s n A* -er n0s n0 ter /in2 0re0 si tro-5osit.

P / ,e / n nor- l6 prost si,lin / n tro-5o,s n A* 5er / / l - ,esei-5 n0 n sehin00

0re0 si tro-5osit ti/ , ter /i. Bil ,esei-5 n0 n ini ter0 n00u6 , n ter /i 0re0 si

tro-5osit. Prost 0l n/in6 leu,otrien6 / n r /i, l 5e5 s ter ,u-ul si. Protein / n en?i-

intr seluler ter/en tur si6 setel h itu ter /i e/e- seluler.

*'





• Ser n0 n 7 l terse5ut / p t ter /i / l - rent n0 7 ,tu 5e5er p -enit

hin00 5e5er p -6 u-u-n2 ti/ , le5ih / ri '( -enit.• Stro,e tro-5oti,6 / p t 5er,e-5 n0 /en0 n 5er5 0 i 4 r 6 2 itu:

. Stro,e p rsi l / p t ter /i6 l u 5er,ur n0 se-ent r untu, 5e5er p -6 setel hn2 ter /i peru5 h n 4ep t -enu u stro,e len0, p. Episo/e

7 l / p t 5erl n0sun0 le5ih l - / n 5erul n0 se5elu- ter /i stro,e

2 n0 len0, p.

5. Stro,e tro-5oti, / p t ter /i 7 ,tu ti/ur6 p / s t ter 0 6 p sien

lu-puh p / ten0 h - l - t u p 0i. P sien / p t 5 n0,it / ri te-p t

ti/ur6 l lu ter tuh / n ti/ , 5er/ 2 .•

Tro-5osis rteri l 5 s n2 ti/ , /isert i n2eri ,ep l . Bil / 6 lo, si n2eri 5erhu5un0 n /en0 n lo, si su-5 t n rteri. Intensit s n2eri ti/ , p r h / n

le5ih re0ion l /i5 n/in0, n /en0 n per/ r h n intr sere5r l - upun

per/ r h n su5 r 4hnoi/.• ipertensi6 /i 5etes6 ,e5i s n -ero,o, / n hiperlipi/e-i u-u- /ite-u, n

p / p sien /en0 n stro,e in1 r, therotro-5oti,.

T 5el *. Per5e/ n stro,e p / siste- , rotis / n siste- erte5ro5 siler

B. In ar !m+-li

Stro,e / p t /iti-5ul, n oleh e-5oli 2 n0 5ersu-5er / ri tro-5us /i ntun0.

Tro-5us 2 n0 terlep s , n ter5 7 oleh lir n pe-5uluh / r h s -p i p /

per4 5 n0 n rteri 2 n0 terl lu ,e4il untu, /ile7 ti.

E-5oli 2 n0 5er s l / ri ntun0 / p t /ise5 5, n oleh:

• Fi5ril si tri l / n rit-i l inn2 8/en0 n pen2 ,it ntun0 re- ti,6theros,leroti,6 hipertensi6 ,on0enit l upun si1ilis9

*3



• In1 r, -io, r/ /en0 n tro-5us -ur l

• En/o, r/itis 5 ,teri l ,ut / n su5 ,ut

• Pen2 ,it ntun0 t np rit-i - upun tro-5us -ur l 8stenosis -itr l6

-io, r/itis9• Ko-pli, si 5e/ h ntun0

• K tup ntun0 5u t n

• #e0et si tro-5oti, en/o, r/i l non 5 ,teri l

• Prol ps , tup -itr l

E-5oli 2 n0 ti/ , 5er s l / ri ntun0 nt r l in:• Atheros,lerosis ort / n . 4 rotis

• D ri te-p t pe-5el h n t u /ispl si . 4 rotis / n . erte5ro5 siler

• Tro-5us p / . pul-on lis

• Le- ,6 tu-or6 u/ r

• Ko-pli, si 5e/ h leher / n thor ,s

• Tro-5osis p / p n00ul / n e,stre-it s 5 7 h p / ri ht$to$left

cardiac shunt

G :ala #linis• D ri seluruh enis stro,e6 , r/ioe-5oli -erup , n enis 2 n0 5er,e-5 n0

p lin0 4ep t. Bi s n2 ti-5ul p / s t 5er ,ti it s6 / n ti-5ul -en/ / ,.• K / n0 /ite-u, n isolated homonymous hemianopsia t uisolated aphasia

• P / pen4itr n ot , :

o Meli5 t, n ,orte,s6 u-u-n2 p / /istri5usi per4 5 n0 n . 4ere5ri

-e/i lo Ter/ p t ,e-un0,in n in1 r, per/ r h n

T 5el 3. Di 0nosis 5 n/in0 stro,e is,e-i,

. In ar La /n r

*"



Stro,e ini -e-pun2 i ,u-pul n 0e l ,linis 2 n0 el s /en0 n / er h ,e4il

2 n0 -en0 l -i is,e-i / n ter5 t s p / / er h pe-5uluh / r h 2 n0

5erpenetr si ,e ot , -ene-5us , psul intern 6 5 s l 0 n0li 6 th l -us6

,oron r /i t 6 / n / er h p r -e/i n / ri 5 t n0 ot ,. Stro,e l ,uner

5i s n2 5erhu5un0 n /en0 n ,o-5in si nt r hipertensi6 theros,lerosis

/en0 n /i 5etes -elitus. Stro,e l ,uner / p t /i/i 0nos h n2 -el lui

, r ,teristi, 0e l ,linisn2 2 itu he-ip resis -otori, -urni6 sin/ro-

sensori, -urni6 clumsy hand 6 /2s rthri 6 he-ip resis /en0 n t ,si 6 sin/ro-

sensori-otor.

Str- rdarahan Intras r +ral 5 IS

Per/ r h n intr sere5ri /it n/ i oleh / n2 per/ r h n ,e / l - p ren,i- ot ,

,i5 t pe4 hn2 rteri penetr ns 2 n0 -erup , n 4 5 n0 / ri pe-5uluh / r h super1i4i l / n

5er l n te0 , lurus -enu u p ren,i- ot , 2 n0 /i 5 0i n /ist ln2 5erup n2 - n , piler.

D r h ini -en/oron0 stru,tur ot , / n -ere-5es ,e se,it rn2 5 h, n / p t - su, ,e

/ l - entri,el t u ,e ru n0 n su5 r ,noi/ 2 n0 , n 5er4 -pur /en0 n 4 ir n

sere5rospin l / n -er n0s n0 -enin0ens.

Onset PIS s n0 t -en/ / ,6 serin0, li ter /i s t 5er ,ti it s / n /isert i n2eri

,ep l 5er t6 -unt h / n penurun n ,es / r n6 , / n0 , / n0 /isert i ,e n0. Distri5usi

u-ur 5i s n2 p / usi perten0 h n s -p i tu / n le5ih serin0 /i u-p i p / l ,i l ,i.

ipertensi -e-e0 n0 per n n pentin0 se5 0 i pen2e5 5 le- hn2 /in/in0 pe-5uluh / r h

/ n pe-5entu, n -i,ro neuris- . Pen2e5 5 l inn2 / p t 5erup -iloi/ n0iop th26

neuris- 6 A#M6 n0iop ti , ernos 6 /is,r si / r h6 ter pi nti,o 0ul n6 ,o, in6

-1et -in6 l,ohol / n tu-or ot ,. D ri h sil n -nes ti/ , / ri7 2 t TIA.

Lo, si per/ r h n u-u-n2 terlet , p / / er h 0 n0li 5 s lis6 pons6 sere5elu-

/ n th l -us. Per/ r h n p / 0 n0li 5 s lis serin0 -elu s hin00 -en0en i , psulintern / n , / n0 - su, ,e / l - entri,el l ter l l lu -en2e5 r -el lui siste- entri,uler

,e / l - ron00 su5 r 4hnoi/. A/ n2 perlu s n intr entri,uler serin0 5er ,i5 t 1 t l.

Per/ r h n p / lo5us he-is1er sere5ri t u sere5elu- 5i s n2 ter5 t s /i p ren,i- ot ,.

) -5 r n ,linis ter0 ntun0 / ri lo, si / n u,ur n he- to- . K r ,teristi,n2

5erup s ,it ,ep l 6 -unt h -unt h / n , / n0 , / n0 ,e n0 p / s t per-ul n.

Kes / r n / p t ter0 n00u p / ,e / n 7 l / n -en /i el s / l - 7 ,tu *" " -

pert - 5il olu-e / r h le5ih / ri >( 44. K ren rin0 n ot , ter/oron06 - , ti-5ul0e l /e1isit neurolo0i, 2 n0 4ep t -en /i 5er t / l - 5e5er p -. D ri h sil

*>





I;. !N!GA##AN &IAGN'SIS

D l - -ene0 ,, n /i 0nosis6 h rus /ite-u, n e-p t h l 5eri,ut:• De1isit neurolo0is 1o, l t u 0lo5 l

• Berl n0sun0 *" - t u -en2e5 5, n ,e- ti n• A,ut t u -en/ / ,

• Di, ren , n se- t - t ,el in n pe-5uluh / r h ot ,

$i, ter/ p t e-p t 4iri ,h s stro,e /i t s6 l n0, h sel n utn2 / l h -enentu, n

/i 0nosis etiolo0i6 lo, lis si6 / n 1 ,tor resi,o stro,e. Untu, itu /iperlu, n n -nes 6

pe-eri,s n 1isi,6 neurolo0is. Beri,ut t 5el 2 n0 -en -pil, n per5e/ n - sin0 - sin0

enis stro,e:T 5el >. Di 0nosis B n/in0 nt r Stro,e In1 r,6 PIS / n PSA

*C



K!ITE!IA INFA!K PIS PSA'. An -nes

TIAIstir h tA,ti it s

N2eri ,ep l*. Pe-eri,s n Fisi, De1isit neurolo0i,Penurun n ,es / r nK ,u ,u/u,Te, n n / r h se/ n0 ri si Se/ n03. Pe-eri,s n t -5 h nPun,si lu-5 l $ernih + nto4hro-e )ross h e-orrh 0i4

T 5el %. Di 0nosis B n/in0 5er/ s r, n An -nesis

ANAMNESIS T!OMBOSIS EMBOLI PIS PSAU-ur >( C( t hun Se-u u-ur "( %( t hun T , tentu 8*(3( t hun9

A7it n B n0un ti/ur A,ti it s A,ti it s A,ti it s)e l Bert h p ;ep t ;ep t ;ep tPerin0 t nS ,it ,ep lMunt hKe n0#erti0o <

T 5el C. Di 0nosis 5 n/in0 5er/ s r, n 0 -5 r n ,linisKlinis Tro-5osis E-5oli PIS PSAKes / r n Nor- l Nor- l Menurun Menurun<Nor- l);S C C H % H %K ,u ,u/u, <Kelu-puh n e-ip rese e-ip rese e-iple0i e-iple0iAph si < <An0io0r 1i O,lusi<stenosis O,lusi<stenosis Mi/line shi1t Aneuris- <A#MP rese N 36"6% <LP <

;T S4 n ipo/ens ,esentr l setel h" C h ri

ipo/ens peri1er ,h s seperti 5 isetel h " C h ri

iper/ensit sseperti - ss/ r h

iper/ensit s /isu5 r 4hnoi/

T 5el . Di 0nosis 5 n/in0 5er/ s r, n 1 ,tor risi,oFAKTO! !ISIKO T!OMBOSIS EMBOLI PIS PSA

ipertensi < T M li0n <K r/i l AS D ! D DDi 5etes MelitusDislipi/e-i

!M!%I#SAAN !NUN)ANG

*







4. /i 0nosis stro,e is,e-i, /ite0 ,, n oleh neurolo0is / n /i/u,un0 oleh ;T s4 n

ot , /en0 n te5 l iris n > G '( -- t np ,ontr s.

/. h rus / persetu u n tertulis / ri pen/erit <,elu r0 setel h /i el s, n ,euntun0 n

/ n risi,o pen0o5 t n

Kriteri E,s,lusi

Bil / ri7 2 t pen00un n hep rin / l - " - se5elu-n2 / n - s

tro-5opl stin p rti l -e- n n0.

Tro-5osit H '((.(((<--

Stro,e se5elu-n2 t u tr u- , pitis he5 t 3 5ul n se5elu-n2

Oper si 5es r / l - 7 ,tu '" h ri

Sistoli, se5elu- pen0o5 t n ' > -- 0 t u /i stoli, ''( -- 0

De1isit neurolo0is rin0 n

!i7 2 t per/ r h n intr ,r ni l

)lu,os / r h H >( -0</L t u "(( -0</L

Ke n0 p / per-ul n stro,e

Per/ r h n )I t u urin / l - *' h ri

In1 r, -io, r/ 5 ru

Per-ul n stro,e ti/ , / p t /ip sti, n

Dosis rtPA I# (6& -0<,0 BB 8- ,si- l &( -09. '( / ri /osis se5 0 i 5olus p / -enit

pert - 6 sis n2 se5 0 i in1us sel - %( -enit -onitor terus /i I;U *" - , n / n2

per5uru, n neurolo0is / n per/ r h n.

Per n n neuroprote,ti1 p / stro,e is,e-i, ,ut

O5 t o5 t ini /iper,ir , n / p t -elin/un0i neuron / ri ? t ? t /estru,ti1 2 n0

/ih sil, n oleh proses 5io,i-i 2 n0 ter /i p / ,e- ti n neuron l6 seperti 0lut - t6 , ln t/ n l in l in 2 n0 to,si, terh / p neuron. Di s -pin0 itu ,erus , n sel sel neuron / p t

-en2e5 5, n 0 n00u n -e-5r n sel ,i5 t ,erus , n p / po-p ion ; 6 N 6 K.

A/ /u enis neuroprote,si6 2 itu neuroprote,si 2 n0 -en4e0 h ,e- ti n sel ,i5 t

is,e-i, in ur2 / n neuroprote,t n 2 n0 -en4e0 h reper1usi in ur2. Neuroprote,t n 2 n0 /

/i In/onesi 6 / l h Pir 4et - / n ;iti4holin

Ter pi 5e/ h:; roti/ en/ rtere4to-2

3'



An0iopl st2

; theter e-5ole4to-2

B. Str- rdarahan

Per/ r h n intr sere5r l -erup , n enis stro,e 2 n0 serin0 5er t / n 5 n2 , pen2e5 5n2 .

Tu u n ter pi nt r l in -en4 ,up:

'. Men4e0 h ,i5 t 5uru, / ri -enin0, tn2 te, n n intr ,r ni l.

*. Men4e0 h ,o-pli, si se,un/er ,i5 t -enurunn2 ,es / r n6 -is ln2 0 n00u n

pern p s n6 spir si6 hipo entil si.

3. I/enti1i, si su-5er per/ r h n 2 n0 -un0,in / p t /iper5 i,i /en0 n tin/ , n

5e/ h.

$ rapi Um/m

'. Tir h 5 rin0 tot l /en0 n ,ep l /itin00i, n p lin0 se/i,it '> 3( 6 p lin0 se/i,it /u

-in00u

*. Fisioter pi p si1 5e5er p , li seh ri6 1isioter pi ,ti1 ti/ , /i n ur, n / l - /u

-in00u pert -

3. Diet - , n n sesu i 1 ,tor resi,o

". Monitorin0 t n/ t n/ it l

$ rapi *ip rt nsi pada Str- rdarahan

Te, n n / r h p / 1 se ,ut ti/ , 5oleh /iturun, n *( . Penurun n te, n n / r h r t

r t ti/ , 5oleh le5ih / ri *> / ri -ABP. Kriteri penurun n:

'. Bil te, n n sistoli, ' ( -- 0 t u te, n n /i stoli, '(> -- 0 5eri, n

l 5et lol in e,si t u en l pril.

*. Bil te, n n sistoli, H ' ( -- 0 / n te, n n /i stoli, H '(> -- 06 - , pe-5eri n o5 t nti hipertensi /it n00uh, n.

$ rapi #h/s/s

'. Pe-5eri n - nitol *( ' 0r<,0BB /i5eri, n / l - *( -enit /ii,uti (6*> 0r<,0BB

ti p " - p / e/e- sere5ri untu, -en4e0 h herni si.

Kontr in/i, si: hipotensi6 0 n00u n ren l6 /e4o-p 4or/is rade I-, /ehi/r si

*. Pe-5eri n se/ si -is ln2 /i ?ep - > -0 ti p % - t u pheno5 r5it l 3( %(-0<p.o t u I# ti p % - untu, p sien 0elis h / n n l0eti, untu, n2eri ,ep l .

3*



3. Pe- , i n o5 t 2 n0 -e-pen0 ruhi 1un0si pl telet se5 i,n2 /ihin/ ri , ren / p t

-e-perp n n0 per/ r h n.

". Bil ter/ p t 1 silit s pe- nt u n te, n n intr ,r ni l6 te, n n per1usi ot , h rus

/ipert h n, n le5ih / ri C( -- 0.

>. Untu, -u l -unt h / p t /i5eri, n ntie-eti,.

%. D p t /i5eri, n o5 t 0olon0 n nt 0onis , lsiu-6 2 itu ni-o/ipin.

C. Bil ,e n0 / p t /i5eri, n nti ,on uls n : 1enitoin '( '> -0<,0 I# 8lo /in0 /ose96

,e-u/i n /iturun, n -en /i '(( -0 per - t u pheno5 r5it l 3( %( -0 ti p %

-.

$ rapi m+ dahan

Di,elu r, n / l - ,e / n / rur t untu, pen n0 n n te, n n tin00i intr ,r ni l6

-en0elu r, n he- to- / n pen n0 n n hi/rose1 lus ,ut6 u0 untu, -en4e0 h

per/ r h n ul n0 / n -e-ini- l, n ter /in2 sosp s-e.

;I. #'M LI#ASI

1. #-mpli asi N /r-l- i =

A. E/e- ot , 8herni si ot ,9

Merup , n ,o-pli, si 2 n0 pentin0 stor, ,i5 t in1 r, - upun , ren per/ r h n.

B. In1 r, 5er/ r h 8p / e-5oli ot ,9

;. # sosp s-e 8terut - p / PSA9

D. i/rose1 lus

E. i0ro-

2. #-mpli asi N-n9n /r-l- i 5A i+at r-s s di 'ta =

A. Te, n n / r h -enin00iPenin00i n te, n n / r h p / 1 se ,ut -erup , n respon 1isiolo0is terh / p

is,e-i ot ,6 / n te, n n / r h , n turun ,e-5 li setel h 1un0si ot , -e-5 i,.

B. iper0li,e-i

;. Kel in n ntun0

D. Kel in n EK)

E. S2n/ro-e In ppropi te Anti Diureti, or-on 8SIAD 9

F. N triuresis.). !etensi 4 ir n tu5uh.

33



. ipon tre-i .

#-mpli asi n-n9n /r-l- i 5A i+at im-+ilisasi =

A. Bron,opneu-oni

B.Tro-5ople5itis

;. E-5oli p ru

D. Depresi

E. N2eri / n , ,u p / 5 hu

F. Sp stisit s u-u-

). ! / n0 , n/un0 ,e-ih

. Kelu-puh n s r 1 tepi

I. Kontr ,tur / n /e1or-it s

$. De,u5itus

K. Atro1i otot

3"



&AF$A% US$A#A

B su,i6 A6 Di n6 S. 8e/.9. 4eurolo y in 2aily ractice. *('*. B n/un0: B 0i n<UPF

Il-u Pen2 ,it S r 1 F ,ult s Ke/o,ter n UNPAD<!S s n S /i,in.

MerrittJs Te=t5oo, o1 Neurolo02 &th E/. illi -s il,ins. '&&>.

Mos52 ;lini4 l Neurolo02 ;D!OM.

PE!DOSSI. 5uideline Stroke Tahun !611. *(''.

#i4tor6 M6 !opper6 A. Adams and -ictor3s rinciples 7f 4eurolo y 8 th 9d . M4)r 7

ill. *(('.

CSS stroke.doc

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