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REFERAT
PERDARAHAN SUBARACHNOIDBrenda Shahnaz Q. A. B
030.11.057
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DEFINISI
Perdarahan s!ara"hn#$d%s!ara"hn#$d herrha'e (SAH)ada*ah +eadaan ,er+&-*na
darah d$ ran' s!ara"hn#$d/a$, an,ara -$a&a,er dan&e&!ran ara"hn#$d
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ANATOMI
en$n'e
n
Dra&a,er
Fa*sere!r$
Ten,#r$&
Fa*sere!e**$
R.S!dra*
Ara"hn#$d
&a,erR.
S!ara"hn#$d
Pe&!*h darah
2CS
P$a&a,er
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S$r+*s $*$ss$
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A. Sere!r$ An,er$#r
2#!s Par$e,a*
2#!s Fr#n,a*
A. Sere!r$ ed$a 2a,era* #,a+
A. Sere!r$ P#s,er$#r
2#!s O""$-$,a*
2#!s Te&-#ra*
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EPIDEMIOLOGI
4133.000#ran' -er
,ahn d$ AS
Ras +*$, h$,a&6 +*$, -,$h
089 :0;5,ahn
1589 40:0,ahn
589 40 ,ahn
an$,a 9 -r$a <3 9 4
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ETIOLOGI
Aner$s&aSere!ra* (08)
A= (108) Tra&a
Pene!a!he&a,#*#'$+9
DIC
He>*$a
Tr SSP D$se+s$ ar,er$a*
Per*asan-erdarahan
$n,rasere!ra*
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PATOFISIOLOGIAner$s&
a(e,$#*#'$)
R-,r
PerdarahanS!ara"h#$d
Ir$,as$&en$n'en
Ran'san'
&en$n'e
a* ()
Ner$+e-a*a
a*n,ah
@esadaran
@ean'
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A. C#&&n$"ansAn,er$#r % B$r"a,$# A.
Sere!r$ ed$a
He&$-ares$s
Aas$a
A!*$a
Pers$&-an'an A.C#&&n$"ans P#s,er$#r
den'an A. Car#,$s In,erna
Pares$s N. III
D$*a,as$
--$*
Re. "ahaa()
Ner$ d$ a,as% !e*a+an'
&a,a
Pares$s N.
=I
Pa-$*ede&a
Perdarahans!ha*#$d
A. Sere!r$An,er$#r an'. =$ss
Ar,er$ Cere!e**ar P#s,er$#r
Iner$#r %Ar,er$ Sere!e**ar An,er$#rIner$#r
Ner$ d$#""$-$,a* dan
"er$"a*
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DIAGNOSIS
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ANAMNESIS
Tanda dan gejala perdarahan subaraknoid
Nyeri kepala hebat mendadak 1 atau 2 detik sampai 1 menit
Vertigo, mual, muntah, kejang
Penurunan kesadaran
Gangguan autonom : bradikardia / takikardia, hipotensi / hipertensi
Banyak keringat, suhu badan meningkat, atau gangguan pernapasan
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Skala
Hunt and Hess
Gambaran Klinis13
0 nruptured
! Nyeri kepala minimal atau asimtomatik, kaku kuduk
ringan
!! Nyeri kepala sedang/berat, kaku kuduk, tidak ada
de"isit neurologis, ke#uali parese ner$i kranialis
!!! %engantuk, bingung, de"isit neurologis "okal sedang
!V &tupor, hemiparesis sedang/ berat, mungkin terjadirigiditas deserebrasi dini
V 'oma dalam, rigiditas deserebrasi, mun#ulnya tanda(
tanda end state
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DIANOSIS BANDIN
BTH (Ben$'n Thnder"*a- Heada"he)
Ben$'n Or'as&$" Ce-ha*'$a
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PEMERIKSAAN PENUNJANG
• Pen$n'+a,an dens$,as(h$-erdens) -adaran' s!ara"hn#$d
•
rah/ a+ses dan$n,er-re,as$ &dah
CT S"ann#n
+#n,ras
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Skor
Fisher
Deskrisi !T s"a# kea$a
% T$da+ ,erde,e+s$ adana darah& De-#s$, darah d$s a,a *a-$san er,$+a*
,erda-a, darah +ran 1 &&/ ,$da+ ada
enda*an' Terda-a, enda*an dan% a,a *a-$san
er,$+a*/,erda-a, darah ,e!a* den'an +ran 61
&&( Terda-a, enda*an -ada $n,rasere!ra* a,a
$n,raen,r$+*er se"ara d$s a,a ,$da+ ada
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• G$+a CT ne'a,$/ na&n 'ea*a+*$n$s &end+n'
• Adana er$,r#s$,•
an,#+r#&$a
Pn's$2&!a*
• #*d s,andard• ende,e+s$ aner$s&a•
ende,e+s$ as#s-as&e• ende,e+s$ A=
An'$#'ra>
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TATALAKSANA
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anae&en a?a*
@#ns*,as$den'an d#+,er
s-es$a*$s
!edah sara
Ra?a, d$In,ens$e Care
Un$, (ICU)
#n$,#r
,$n'+a,+esadaran/dan ABC
#n$,#r +era an,n'/ -*se
#$&e,r/,e+anan
darah/ r$n
#,-,
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ed$+a&en,#sa
Ana*'es$+9A"e,a&$n#
en
CCB9N$d$-$n
An,$+#n*san9
Fen$,#$n
An,$e&e,$+9
Pr#&e,haz$n
Os,$+9an$,#*
D$re,$+9Fr#se&$d
e
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Bedah
@ran$#,#&$
As-$ras$s,ere#,a",$"
Ea+as$den'an
end#s+#-$
@hss aner$s&a9
1. End#as"*ar"#$*$n'
4. $"r#sr'$"a*
"*$--$n'
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KOMPLIKASI
=as#s-as&
e
H$dr#"e-ha
*s
Perdarahan!er*an'
E-$*e-s$
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PROGNOSIS
#r,a*$,asna 508 -ada 30har$ -er,a&a
Pas$en an'!er,ahan h$d-
+e!ana+an&ender$,ade>s$,
ner#*#'$s
&ene,a-
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TERIA@ASIH