case stroke infark agung

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.


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 (


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,$&

'&$rnGer& ol !,

Re8le p$pil

ng#$ng

Ti*& lng#$ng

()

B$l,

: !! N

(


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,-

SDNSDN

SDN

SDNSDN

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


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

(


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 (


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.


8/33


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


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 stroke597

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


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 (SI@) 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

II# Stroke He%ora(ik

%e-n pe!$l$- *r- o,& !ene&n &el$rn *r- &e 3ringn

pren&i! o,&+ r$ng irn #erero#pinl *i#e&i,r o,& ,$ &o!in#i &e*$n.

%er*r-n ,er#e$, !ene&n gngg$n #er$, #r8 o,& !ell$i pene&nn


12/33

#,r$&,$r o,& *n 3$g ole- &ren -e!,o! ng !ene&n i#&e!i& p*

3ringn #e&i,rn. %ening&,n ,e&nn in,r&rnil p* gilirnn &n

!eni!$l&n -erni#i 3ringn o,& *n !ene&n ,ng o,&.2

tiolo(i Stroke He%ora(ik

Perdara$an Intrasere)ral

%er*r-n in,r#ererl *l- per*r-n ng ,er3*i *i *l! 3ringn o,&

&i, pe-n pe!$l$- *r- o,&. Sl- #,$ pene ,er#ering *l-

,e&nn *r- ,inggi (-iper,en#i). %er*r-n in,r#ererl *i,e!$&n p* 10E

*ri #el$r$- &#$# #,ro&e+ ,er*iri *ri 0E *i -e!i#8ere o,& *n #i#n *i ,ng

o,& *n #ereell$!. %* per*r-n o,& ,er3*i e,r##i *r- &e *l!

3ringn o,& ng !ene&n pene&nn+ perge#ern *n pe!i#-n 3ringn

o,& ng er*e&,n ,e,pi ,i*& !er$#& 3ringn o,& #eper,i ng ,er3*i p*

in8r& o,&.1

Ge3l &lini# 1

n#e, per*-n er#i8, !en**&+ ,er$,! #, !el&$&n &,ii,# *n

*p, *i*-$l$i ole- ge3l pro*ro!ler$p pening&,n ,e&nn *r-+ i,$

neri &epl+ !$l *n !$n,-+ gngg$n !e!ori+ ing$ng+ per*r-n re,in

*n epi#,i#.

%en$r$nn &e#*rn ng er, #!pi &o! *i#er,i -e!iplegi/-e!ipre#e

*n *p, *i#er,i &e3ng 8o&l/$!$!. Tn*,n* pene&nn ,ng o,&+ ge3l p$pil $nil,erl+ re8le perger&n

ol !, !eng-ilng *n *e#erer#i.

Dp, *i3$!pi ,e&nn ,inggi in,r&rnil+ !i#ln !$n,- proe&,il+ ppil

$*e!.


13/33

G!r 1.%er*r-n In,r#ererl

Perdara$an su)ara-$noid

%er*r-n #$r-noi* *l- #$,$ &e*n *i!n ,er3*i per*r-n &i,

pe-n pe!$l$- *r- *i r$ngn #$r-noi* (*in,r lpi#n r-noi* *n

pi!,er). %er*r-n #$r-noi* i#n *i#e&n nor!l r,eri p*

lpi#n *#r o,&+ *i#e$, 3$g ne$ri#! ererl. %er*r-n #$r-noi*

*p, ,er3*i in8r& &ren *n #o#p#!e. #o#p#!e ,er3*i p* -ri &e 2

6 -ri #e,el- per*r-n+ *n !ene,p #el! 5 !ingg$. #o#p#!e ,er3*i p*

*er- ne$ri#! ng pe-+ ,e,pi *p, 3$g p* ,e!p, ng 3$- *n

il,erl. Dr- *l! #$r-noi* *p, !eng-ilng p* 412 -ri.1

Ge3l &lini#n+ i,$1

n#e, pen&i, er$p neri &epl !en**& #eper,i !ele*&+ *r!,i#+ erlng#$ng *l! 12 *e,i& -ingg 1 !eni,.

er,igo+ !$l+ !$n,-+ n& &ering,+ !enggigil+ !$*- ,erng#ng+ geli#-

*n &e3ng. Dp, *i,e!$&n pen$r$nn &e#*rn *n &e!$*in #*r *l!

eerp !eni, #!pi eerp 3!.

Di3$!pi ge3lge3l rng#ngn !eningel.

Gngg$n 8$ng#i o,ono! er$p r*i&r*i ,$ ,&i&r*i+ -ipo,en#i ,$

-iper,en#i+ n& &ering,+ #$-$ *n !ening&,+ ,$ gngg$n pern8#n.

+a%)ar 7# Perdara$an su)ara-$noid4

III# Stroke non $e%ora(ik ,Stroke iske%ik9 Infark otak9 /en'u%)atan.


14/33

S,ro&e i#&e!i& ,er3*i &ren *n #$!,n p* pe!$l$- *r- (r,eri)

#eri&o&rnil ,$ -ipoper8$#i 3ringn o,& ole- ergi 8&,or #eper,i

,ero,ro!o#i#+ e!oli+ ,$ &e,i*,iln -e!o*in!i&.1+

,& !en*p, *r- er#i- *ri 3n,$ng+ *r- !engn*$ng oigen *n

n$,ri#i $n,$& o,&. J$!l- lirn *r- &e o,& *l! &e*n nor!l i#n #e&i,r

5060 !l/100 gr! 3ringn o,&/!eni,+ err,i o,& !e!$,$-&n 20E *r- ng

*ipo!p&n *ri 3n,$ng. Apil r,eri ,er#$!,+ #el o,& (ne$ron) ,i*& *p,

!eng-#il&n energi ng $&$p *n &er3 o,& er-en,i.1

Bil lirn *r- &e o,& ,er-en,i *l! &,$ 6 *e,i& &n ,er3*i gngg$n

!e,oli#!e ne$ron+ lei- *ri :0 *e,i& g!rn @@G !en*,r+ *l! 2 !eni,

,er3*i peng-en,in &,ii,# o,&+ *l! 5 !eni, !$li ,er3*i &er$#&n o,& *n

lei- *ri 4 !eni, !n$#i &n !eninggl. I#&e!i& &e o,& ,er3*i il lirn *r-

&e o,& er&$rng 25:0 !l/100 gr! 3ringn o,& per!eni,.

1

+a%)ar # Stroke infark 4

0# Patofisiolo(i

S,ro&e *p, *i#e&n ole- #,$ *ri eerp pro#e# ng !elip$,i

pe!$l$- *r- *i o,& i,$ 1

• %ro#e# in,rin#i& pe!$l$- *r-+ !i#ln ,ero#&lero#i#+ in8l!#i+ *epo#i,

!iloi*+ *e#ei r,eri+ ,$ ,ro!o#i# en.

• %ro#e# ng er#l *ri ,e!p, lin (ng 3$-) !eni!$l&n e!ol$#+

!i#ln e!oli *ri 3n,$ng ,$ #ir&$l#i e,r&rnil ng !ene&n

gngg$n pe!$l$- *r- in,r&rnil.

• %ro#e# ng ,i!$l &i, lirn *r- &e o,& in*e&$, &i, !en$r$nn

,e&nn per8$#i o,& ,$ !ening&,n i#&o#i,# *r-.


15/33

• %ro#e# ng ,er3*i &i, pe-n pe!$l$- *r- *i r$ng #$r&noi*

,$ 3ringn o,&/in,r#ererl.

Tig pro#e# per,! !ene&n ,i!$ln TIA *n #,ro&e i#&e!i& (in8r&

o,&)+ #e*ng&n ng &ee!p, !ene&n ,er3*in #,ro&e -e!orgi#

(per*r-n in,r#ererl *n per*r-n #$r&noi*).

0I# Faktor Resiko Stroke

Ser $!$! 8&,or re#i&o #,ro&e *p, *igi !en3*i1+:

. F&,or re#i&o ng ,i*& *p, *i!o*i8i&#i+ i,$

1. '#i

2. Jeni# &el!in

:. Gene,i&

. R#

5.

6.

7.

.

. F&,or re#i&o ng *p, *i!o*i8i&#i+ i,$

1. Ri, #,ro&e

2. =iper,en#i

:. %en&i, 3n,$ng

. Die,e# !eli,$#

5. S,eno#i# &ro,i#

6. TIA

7. =iper&ole#,erol

. %engg$nn &on,r#ep#i orl

4. e#i,#

10. Mero&o&

11. Al&o-oli&

12. %engg$nn nr&o,i&

1:. =iper-o!o#i#,eine!i

1. An,io*i n,i 8o#8olipi*

15. =iper$ri#e!i

16. %eninggin -e!,o&ri,

17. %eninggin &*r 8irinogen

5;# 0II# +a%)aran Klinis

56# "a)el 5# Per)edaan Stroke He%ora(ik dan Non

$e%ora(ik


16/33

2. n#

e,

24. M

en

i,/3

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2

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n

(3

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ri

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l

::. =e

,

:. S

ng

,

-e

,

:5. Ri

ng

n

:6. M$

n,-

p*

ln

:7. Se

rin

g

:. Se

rin

g

:4. Ti*

&+

&e

le#i

*i

,

n

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o,

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0. =ip

er,e

n#i

1. =

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pir

#el

l

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2. Bi

#

n

,i*

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:. Ser

ing

&l

i

. %en

$r$

nn

&e#

*r

n

5. A

*

6. A

*

7. Ti*

&

*

. "& 4. Jr 50. A 51. Ti*


17/33

$

&$*

$&

n

g

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52. =e

!ip

re#

i#

5:. Se

rin

g

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ri

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r!

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n

,i*

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55. Ser

ing

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56. Gn

gg$

n

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57. Bi

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5. Jr

n

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54. Ser

ing

60. i&

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ere

ro#

pin

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p

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62. Be

r*

r

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6:. Jer

ni-

=4#

=


18/33

ng

!en*

-$l$i

(


19/33

#erero

#pinl

$&n

102. F

o,o

&epl

10:. 10.

Dp,

*i3$

!p

i

perg

e#er

n

gln

*$l

pine

li#

105.

Ti*&

*il&

$&n

106. ?

TSn

&epl

107.

Ter*p,

re

-ipo*

en#i,#

10.

M##

in,r

&rn

il*eng

n

re

-ipe

r*en

#i,#

104.

T!p&

re

-ipo

*en#i,#.

110. A

ngiogr

8i

111.

Dp,

*i3$!

pi

g!rn

pen$

!,

n+

pene

!pi,

n *n

#&$

li,i#

112.

Dp,

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!p

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,$#o

#p#

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11:.

Ti*&

*il&

$&n

11.

55


20/33

an((ua

n 'an(

ter>adi

Karotis 0erte)ro)asile

r

114. M

o,ori&

120. =e!ipre#e

&on,rl,erl+ *i#,ri

121. =e!ip

re#e l,ernn+

*i#r,ri

122. S

en#ori&

12:. =e!i-ipe#,e#i

&on,rl,erl+

pre#,e#i

12. =e!i-i

pe#,e#i

l,ernn+

pre#,e#i

125.

i#$l

126. =e!inop#i

-o!on!

&on,rl,erl+

!$ro#i# 8$g>

127. =e!in

op#i

-o!oni!+

"ortical

#lindness$

#lack out

(TIA)

12. F

$ng#il$-$r

,$

linn

124. A8#i+

nog#i

1:0. Gngg$

n&e#ei!ngn+

er,igo+

*iplopi+

ni#,g!$#+

*i#8gi

55#

57# 0III# Siste% Karotis

1::. Arteri karotis ko%unis dan Arteri karotis interna5+6

1:. "e*$ A. "ro,i# &o!$ni# *engn #r8 #i!p,i#n ,erle,&

er*e&,n *engn . J$g$lri# in,ern+ N H+ *n ple$# #r8 #i!p,i#

#eri&l+ ng er#!#! ni& &e,# #epn3ng ,r&-e *iel&ng M.

S,ernolei*o!#,oi*e$#.

1:5. Se,inggi ,# ,# &r,ilgo ,iroi*+ *i- #$*$, !n*i$l+

A. &ro,i# &o!$ni# erng !en3*i A. &ro,i# in,ern *n e,ern. Se*i&i,

*i gin *i#,l perngn ,er#e$,+ p* A. &ro,i#in,ern ,er*p, #in$#

&ro,i&$# ng n& !engn*$ng rore#ep,or *iper#r8i ole- N IH *n

ro,i* o* ng !engn*$ng &-e!ore#ep,or ,erle,& er*e&,n *engn

#in$# &ro,i&$#+ 3$g !en*p, per#r8n ng #!. Di le-er+ A. &ro,i#

in,ern ,i*& erng.

5=# Arteri karotis eksterna


21/33

i,$ A. ,iroi*e #$perior+ A. 8#ili#+ A. 8ringel #en*en#+ A. ling$li#+ A.

$ri&$lri# po#,erior+ A. oipi,li#+ *n er&-ir #egi A. ,e!porli#

#$per8i#ili# *n A. !ilri#. A. &ro,i# e,ern !e!p$ni -$$ngn

&ol,erl *engn A. &ro,i# in,ern $n,$& !e!per*r-i o,&.

1:.

56#

Siste% karotis intrakranial


22/33

15:. A. #ereri !e*i+ *engn ngngn (A. len,i&$lo#,ri, *n

ngng &eil linn &e gngli #li#+ A. 8ron,li# #en*en#+ A. pre

roln*i&+ A. roln*i&+ A. prie,li# n,erior+ A. prie,li# po#,erior+ A.

ng$lri#+ A. prie,o,e!porli#+ A. ,e!porli# po#,erior *n n,erior)

15.

155.

5


23/33

5=5# Klasifikasi

162. Men$r$, T-e Seen,- Repor, o8 T-e Join, N,ionl ?o!!i,e

n %reen,ion+ De,e,ion+ @l$,ion+ n* Tre,!en, o8 =ig- Bloo* %re##$re

(JN? 7)+ &l#i8i&#i ,e&nn *r- p* orng *e# ,ergi !en3*i

&elo!po& nor!l+ pr-iper,en#i+ -iper,en#i *er3, 1+ *n -iper,en#i *er3, 2.

5=#

Klasifika

si "D

5=4#

Sistol

ik

,

%

%

H

(.

5=


24/33

1. Ggl 3n,$ng

14. 2. ,&

140. S,ro&e

141. :. %en&i, gin3l &roni#

142. . %en&i, r,eri peri8er

14:. 5. Re,inop,i

14. %* peneli,in &lini&+ pengo,n *engn n,i-iper,en#i ,el-

,er$&,i !eng$rngi &e3*in #,ro&e n,r :50 per#en in8r& !io&r*+ 20

25 per#en *n ggl 3n,$ng+ lei- *ri 50 per#en.

145.

56=# Pen(o)atan;

147. 1. Di$re,i&+ ,er$,! 3eni# ,-i;i*e ,$ l*o#,erone

n,goni#,14. 2. Be, lo&er.

144. :. ?li$! ?-nnel Blo&er ,$ li$! n,goni#,

(??B)

200. . Angio,en#in ?oner,ing @n;!e In-ii,or (A?@I)

201. 5. Angio,en#in II Reep,or Blo&er ,$ AT+ reep,or

n,goni#,/lo&er (ARB)

787#

78# "a)el 4# "atalaksana $i/ertensi %enurut 3NC?;

784#

Klasif

ik

as

i

te

ka

na

n

da

ra

$

78


25/33

Nor!

l

K D D

21.

%re-ip

er,

en

#i

215.

1

216.

A

217.

21.

214.

=iper,

en

#i

*e

r3

,

I

220.

1

221.

A

222.

22:. Di

$re,i&

3eni#

,-i;i*e

$n,$&

#egin

e#r

&#$#+

*p,

*iper,i!

ng&n

A?@I+

ARB+ BB+

??B ,$

&o!in#i

22.

=iper,

en

#i

*e

r3

,

2

225.

L

226.

A

227.

22. "o

!in#i 2

o, $n,$&

#egin

e#r

&#$#

$!$!n

*i$re,i&

3eni#

,-i;i*e

*n A?@I

,$ ARB


26/33

,$ BB

,$ ??B

224.

2:0. "o!in#i ng ,el- ,er$&,i e8e&,i8 *n *p, *i,olern#i

p#ien *l-

2:1. Di$re,i& *n A?@I ,$ ARB

2:2. ??B *n BB

2::. ??B *n A?@I ,$ ARB

2:. ??B *n *i$re,i&

2:5. AB *n BB

7=#

7?# 1# Patofisiolo(i stroke 'an( dise)a)kan $i/ertensi

2:. Ni& ,$r$nn ,e&nn *r- ,er3*i #e#$i &,$+ ,e&nn

*r- &n !en$r$n &e,i& !l! -ri+ *n &n !ening&, &e,i& #ing -ri.

"e,i& ,e&nn *r- r,eri !ening&,+ r,eri &eil *i o,& &n !ene!pi,+

*er3, pene!pi,nn ,ergn,$ng *ri pening&,n ,e&nn.7

2:4. "e,i& -l ini ,er3*i #er #ing&, *n ,e&nn ng

!ening&, ,i*& egi,$ e#r+ !& ,i*& * -l ng !e!-&n+

&e,i& pening&,n ,e&nn ,er3*i #er ,er$# !ener$# #el!

er$ln$ln ,$ er,-$n,-$n+ &n ,er3*i -ilini##i *i ,$ni&

!$#&$lri# *n *in*ing pe!$l$- &n !en3*i &&$. =l ini

!er$p&n #i,$#i ng er-+ &ren !ene&n r,erir,eri *i

o,& ,i*& *p, lgi er*il,#i ,$ er&on#,rii $n,$& !ene#$i&n

*iri *engn ,e&nn *r- #i#,e!i&.7

20. %en$r$nn ,e&nn *r- &n !ene&n ,er3*in per8$#i

ng ,i*& *eC$, *i o,& *n !ene&n ,er3*in i#&e!i 3ringn+ *n

pening&,n ,e&nn *r- &n !ene&n pening&,n ,e&nn per8$#i *i

&piler *n !eni!$l&n -ipere!i+ e*e! *n &e!$ng&inn per*r-n.7

21. "o!pli&#i erero#&$lr *ri -iper,en#i *l- !illir

ne$r#!+ in,rererl -e!orr-gi&+ !e!perep, ,er3*in ,-ero#&lero#i#+

saccular arterial aneur%sm$ lacunar infarction *n hi!ertensive

ence!halo!ath%.7

747#


27/33

74# 1I# Ri&a'at keluar(a 'an( %enderita stroke se)a(ai

faktor risiko stroke

2. %eneli,in io *&& ng !en,&n - #e#eorng ng

!e!p$ni ri, &el$rg #,ro&e po#i,i8 &n !e!p$ni ri#i&o lei-

,inggi $n,$& !en*p, #,ro&e *in*ing *engn orng ng

!e!p$ni ri, &el$rg #,ro&e neg,i8+ #e,el- *i#e#$i&n

*engn $!$r+ #$&$ *n 3eni# &el!in *i*p,&n R 2 (45 E ?I 1+1:

0 :+5) $n,$& ri, &el$rg po#i,i8 *ri pi-& A- *n *i*p,&n

R 1+1 (45 E ?I 0+0 2+50) $n,$& ri, &el$rg po#i,i8 I$.4

25.

74=# 1II# Merokok se)a(ai faktor risiko stroke

27. Mero&o& !er$p&n 8&,or re#i&o ng in*epen*en.

Me&ni#!e ,er3*in ,ero! ,er#e$, el$! *i&e,-$i #er p#,i+ ,e,pi&e!$ng&inn &i,10

. S,i!$l#i #i#,i! #r8 #i!p,i# ole- ni&o,on *n i&,n 2 *engn -e!ogloin

&n *ign,i&n *engn "ron!onoi*.

. Rei i!$nologi *ire& p* *in*ing pe!$l$- *r-.

. %ening&,n greg#i ,ro!o#i,.

*. %ening&,n per!eili,# en*o,el ,er-*p lipi* &i, ;,;, ng ,er*p, *i

*l! ro&o&.

2.

746#

7


28/33

7=5#

7=7#

7=#

7=4#

7=,r.274.

- Dasar dia(nosis etiolo(ik

7;8# Per)andin(an stroke infark e%)oli9 stroke infark

tro%)otik dan kasus

7;5# 7;7#

Stroke

7;#

Stroke

7;4#

Pada


29/33

infar

k

e%)o

li

infark

tro%)o

tik

/as

ien

ini

7;


30/33

(

i

76?#

"ek

a

n

a

n

d

a

r

a

$

24.

Nor!l

244.

Sering

-iper,en

#i

88#

Hi/ert

ensi

85#

Pen

e

%

u

a

n

k

$

u

s

u

s

:02.

Nor!l

:0:.

%en&i,

3n,$ng

,ero#&l

ero#i#

84#

!elu%

dila

kuk

an

/e

%e

riks

aan

le)i

$

lan>

ut

8


31/33

d Dasar dia(nosis )andin(

S,ro&e -e!orgi& &ren ,er3*i #er !en**&+ &ele!-n nggo,

ger&+ ,er*p, 8&,or ri#i&o !e!p$ni &el$rg ng !en*eri,

#,ro&e+ &ei#n !ero&o&+ -iper&ole#,erole!i.

58#

55# Dasar Dia(nosis Ak$ir

:12. Digno#i# &-ir *i,eg&&n er*#r&n

5# Ana%nesis:

:1. "ele!-n p* nggo, ger& #eel- &nn

:15. %en$r$nn &e#*rn

:16. n#e, !en**& #, p#ien ng$n ,i*$r

:17. A8#i glol

:1. Me!p$ni &ei#n !ero&o&.

:14. A- &n*$ng p#ien pern- !en*eri, #,ro&e.

78# Pe%eriksaan fisik :

:21. "e#*rn So!nolen

:22. Te&nn *r- 160/110 !!=g

:2:. Sr8 &rnil S$li, *inili:2. Mo,ori& S$li, *inili

7


32/33


33/33

6#

:0.
http://stroke.ahajournals.org/content/28/10/1908.fullhttp://repository.usu.ac.id/handle/123456789/1982http://www.strokecenter.org/patients/about-stroke/ischemic-stroke/

case stroke infark agung

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