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    Referat Stroke - Video

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    Firmansah Saputra
    This document provides information about stroke from an adviser named Dr. Imam Suhada from the Neurology Department. It defines stroke, discusses epidemiology and risk factors, classifies strokes, explains the pathophysiology of ischemic stroke, and outlines treatment and complications. Stroke is defined as an acute brain function disorder over 24 hours from interrupted cerebral blood flow not caused by brain circulation issues. Mortality rates in Yogyakarta hospitals are reported.

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    Referat Stroke - Video

    Uploaded by

    Firmansah Saputra
    87 views37 pages
    This document provides information about stroke from an adviser named Dr. Imam Suhada from the Neurology Department. It defines stroke, discusses epidemiology and risk factors, classifies strokes, explains the pathophysiology of ischemic stroke, and outlines treatment and complications. Stroke is defined as an acute brain function disorder over 24 hours from interrupted cerebral blood flow not caused by brain circulation issues. Mortality rates in Yogyakarta hospitals are reported.

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    This document provides information about stroke from an adviser named Dr. Imam Suhada from the Neurology Department. It defines stroke, discusses epidemiology and risk factors, classifies strokes, explains the pathophysiology of ischemic stroke, and outlines treatment and complications. Stroke is defined as an acute brain function disorder over 24 hours from interrupted cerebral blood flow not caused by brain circulation issues. Mortality rates in Yogyakarta hospitals are reported.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    87 views37 pages

    Referat Stroke - Video

    Uploaded by

    Firmansah Saputra
    This document provides information about stroke from an adviser named Dr. Imam Suhada from the Neurology Department. It defines stroke, discusses epidemiology and risk factors, classifies strokes, explains the pathophysiology of ischemic stroke, and outlines treatment and complications. Stroke is defined as an acute brain function disorder over 24 hours from interrupted cerebral blood flow not caused by brain circulation issues. Mortality rates in Yogyakarta hospitals are reported.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 37

    STROKE

    Adviser: dr. Imam Suhada, Sp.S


    Coass of Neurology, April 11 t h May 14 t h 2016 period

    Co-ass
    Anasthasya Giovani G
    Ady Fitrah Saragih

    030.11.023

    Firmansah Saputra
    Nourma Dara Juwita

    030.11.150

    Cindy Amalia
    Sylvia Chandra

    030.11.009
    030.11.217

    030.11.060
    030.11.282

    Yuse Rishna Kania


    030.11.319
    Belyn Kelvina Octaviana 030.10.052

    Definition of Stroke

    Stroke is a disorder of brain function as well as global focal acute,


    more than 24 hours, is derived from the interruption of cerebral
    blood flow and is not caused by circulatory disorders of the brain at
    a glance, brain tumors, stroke secondary to trauma or infection

    Epidemiology
    In 1053 cases of stroke in a hospital in Yogyakarta 5 mortality rate stood at
    28.3%, while in 780 cases of ischemic stroke was 20.4%, more in males.
    Mortality of stroke patients in Dr Sardjito ranks third after coronary heart
    disease and cancer, 51.58% due to hemorrhagic stroke, ischemic stroke as a
    result of 47.37%, and 1.05% due to subarachnoid hemorrhage prospectively .

    Etiology
    Atherosclerosis thrombosis
    Transcient ischemic
    Embolism
    Hypertension
    Arteritis
    Cerebral thrombophlebitis
    Haematologic abnormalities
    Carotid system damage
    Aorta aneurysm
    Complication of angiography

    Classification

    Based on pathology anatomy and causes:

    Classification

    Classification
    Based on clinical syndromes which are related to the locations of brain
    lesions:
    a.

    Total Anterior Circulation Infarct (TACI)

    b.

    Partial Anterior Circulation Infarct (PACI)

    c.

    Posterior Circulation Infarct (POCI)

    d.

    Lacunar Infarct (LACI)

    Pathophysiology of Ischemic Stroke

    Pathophysiology of Ischemic Stroke


    Blood supply to the brain is autoregulated
    Blood flow
    If zero leads to death of brain tissue within 4-10min
    <16-18ml/100g tissue/min
    infarction within an hour
    Ischemia leads to development of an ischemic core and an ischemic
    penumbra

    Ischemic Penumbra
    Tissue surrounding the core region of infarction which is
    ischemic but reversibly dysfunctional
    Maintained by collaterals
    Can be salvaged if reperfused in time
    Primary goal of revascuralization therapies

    Thrombus/embolus
    Hypoperfusion
    ATP depletion
    Failure of Na+/K+ ATPase membrane ionic
    pump
    Membrane depolarization & cytotoxic cellular
    edema
    Glutamate
    release

    Calcium entry

    Activation of procoagulant pathways

    Free fatty acid


    release

    Activation of lipid peroxidases, proteases & NO


    synthase
    Destruction of intracellular
    organelles, cell membrane & release
    of free radicals

    Liquefactive
    necrosis

    Subarachnoid Haemorrhage

    Aneurysm,
    Arteriovenous
    Malformation
    (AVM)

    Extravasation of
    blood into
    subarachnoid space
    and LCS

    Increased
    Intracranial
    Pressure

    Intracerebral Haemorrhage

    Risk Factor

    Signs of Stroke

    Supporting Examination
    Laboratory : Blood count and serology
    Thorax Rontgen
    Lumbal Puncture
    USG Carotis
    CT-Scan -> GOLD STANDARD
    Magnetic Resonance Imaging (MRI)
    Angiografi serebrum
    Transcranial Doppler (TCD)

    DIAGNOSIS
    1. ANAMNESIS
    SYMPTOMS

    HAEMORRHAGIC
    STROKE

    NON
    HAEMORRHAGIC
    STROKE

    ONSET

    Sudenly

    Sudenly

    ATTACK

    Daily Activity

    Rest

    WARNING

    HEADACHE

    +++

    CONVULSION

    VOMIT

    LOSS OF
    CONSCIOUSNESS

    +++

    Neurological Examination
    SIGN

    HAEMORRHAGIC
    STROKE

    NON HAEMORRHAGIC
    STROKE

    BRADIKARDI

    ++

    ( DAY 4 )

    PAPIL EDEMA

    Mostly +

    KAKU KUDUK

    KERNIG SIGN,
    BRUDZINSKI

    ++

    ALGORITMA AND STROKE SCORE


    GADJAH MADA

    Djoenaedi Stroke Score


    > 20 SH
    < 20 SNH

    SIRIRAJ SCORE STROKE


    SIGN / SYMPTOMS
    CONSCIOUSNESS

    RATING
    INDEX
    (0) Compos Mentis
    X 2,5
    (1) Somnolen
    (2) Semi koma/koma

    SCORE
    +

    VOMIT

    (0) No
    (1) Yes

    X2

    HEADACHE

    (0) No
    (1) Yes

    X2

    BLOOD PRESSURE
    ATHEROMA:
    A) DM
    B) ANGINA PECTORIS

    Diastolic
    (0) No
    (1) Yes

    X 10 %
    X (-3)

    +
    -

    - 12

    - 12

    CONSTANTA

    SIRIRAJ SCORE
    (2,5 X S) + (2 X M) + (2 X N) + (0,1-D) (3x A) 12
    EXPLANATION:
    S = Consciousness
    M = Vomit
    D = Diastolic
    A = Atheroma
    SSS SCORE > 1 : SH
    SSS SCORE < -1 : Cerebral Infark
    SSS SCORE -1 s/d 1 : Query

    ISCHEMIC STROKE TREATMENT

    ISCHEMIC STROKE TREATMENT

    ISCHEMIC STROKE TREATMENT

    ISCHEMIC STROKE TREATMENT

    HAEMORRHAGIC STROKE
    Emergency treatment of hemorrhagic stroke focuses on controlling your bleeding and reducing
    pressure in your brain. Surgery also may be performed to help reduce future risk.

    Complication
    Acute
    Increased blood pressure
    Increased blood sugar levels
    Heart failure
    Respiratory disorders
    Infection dan sepsis
    Kidney dan liver disorders
    Disorders of fluid, electrolyte, and acid-base
    Ulcer stress

    Chronic
    Pneumonia
    Decubitus
    Incontinensia
    Recurrent stroke
    Social and economic disruption
    Psychological disorders

    Prognosis
    Prognosis for the Stroke patients are based of:
    Type
    Broad attack
    Age of onset of stroke
    Consciosness

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