Subarachnoid hemorrhage is usually caused by rupture of a cerebral aneurysm or AVM. It manifests with sudden severe headache, decreased consciousness, vomiting, and neck stiffness. Diagnosis involves lumbar puncture showing xanthochromic CSF and CT scan. Treatment includes bed rest, analgesics, nimodipine, and surgical clipping or coiling of aneurysms or resection of AVMs. Complications include recurrent hemorrhage and vasospasm.
Subarachnoid hemorrhage is usually caused by rupture of a cerebral aneurysm or AVM. It manifests with sudden severe headache, decreased consciousness, vomiting, and neck stiffness. Diagnosis involves lumbar puncture showing xanthochromic CSF and CT scan. Treatment includes bed rest, analgesics, nimodipine, and surgical clipping or coiling of aneurysms or resection of AVMs. Complications include recurrent hemorrhage and vasospasm.
Subarachnoid hemorrhage is usually caused by rupture of a cerebral aneurysm or AVM. It manifests with sudden severe headache, decreased consciousness, vomiting, and neck stiffness. Diagnosis involves lumbar puncture showing xanthochromic CSF and CT scan. Treatment includes bed rest, analgesics, nimodipine, and surgical clipping or coiling of aneurysms or resection of AVMs. Complications include recurrent hemorrhage and vasospasm.
Subarachnoid hemorrhage is usually caused by rupture of a cerebral aneurysm or AVM. It manifests with sudden severe headache, decreased consciousness, vomiting, and neck stiffness. Diagnosis involves lumbar puncture showing xanthochromic CSF and CT scan. Treatment includes bed rest, analgesics, nimodipine, and surgical clipping or coiling of aneurysms or resection of AVMs. Complications include recurrent hemorrhage and vasospasm.
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Cerebral Cortex
Homunculus Epidural hematom Subarachnoid Hemorrhage • Biasanya akibat ruptur aneurisma A. serebral, AVM • Manifestasi klinis : – Nyeri kepala mendadak yang sangat parah, penurunan kesadaran, muntah, kekakuan leher • Diagnosis : – TD naik, suhu > 39oC selama 2 minggu pertama, rangsang meningeal +, preretinal globular subhyaloid hemorrhage – CT scan, pungsi lumbal (CSF ada darah), supernatan dari sentrifugasi CSF xanthochromic, EKG Greenberg DA, Aminoff MJ, Simon RP. Clinical Neurology. 8th Ed. McGraw-Hill; 2012. • Treatment : – Bed rest with the head elevated 15-20o – Mild sedation – Analgesic – Normal saline if hypotension – Nimodipine 60 mg PO q4h for 21 days – Surgical • Aneurysm clipping the neck of aneurysm or endovascular placement of a coil to induce clotting • AVM en-bloc resection or obliterated by ligation of feeding vessels or by embolization with a local intra-arterial catheter
Greenberg DA, Aminoff MJ, Simon RP. Clinical Neurology. 8th Ed. McGraw-Hill; 2012. • Komplikasi : – Recurrence of hemorrhage – Intraparenchymal extension of hemorrhage – Arterial vasospasm – Acute or subacute hydrocephalus – Seizure
Greenberg DA, Aminoff MJ, Simon RP. Clinical Neurology. 8th Ed. McGraw-Hill; 2012. DEMENSIA, ALZHEIMER, PARKINSON • Dementia with Lewy Bodies progressive and degenerative dementia of unknown etiology motor signs (visual hallucinations and episodes of reduced responsiveness)
http://emedicine.medscape.com/article/1135041-clinical • Patients with DLB usually have imapired cognition consistent with dementia (MMSE) • DLB laboratory studies : – Chemistry panel – CBC – Vitamin B-12 levels
http://emedicine.medscape.com/article/1135041-workup • CSF findings in DLB include the following : – Patients with Alzheimer disease have higher levels of tau protein in their CSF than do patients with DLB – Patients with LB variant of Alzheimer disease (LBV- AD) have intermediate values – CSF levels of beta amyloid are lower than normal in DLB, Alzheimer disease, and LBV-AD; however, CSF beta-amyloid levels in DLB, LBV-AD, and Alzheimer disease do not differ from each other
http://emedicine.medscape.com/article/1135041-treatment • Alzheimer disease is an acquired disorder of cognitive and behavioral impairment that markedly interferes with social and occupational functioning incurable disease with a long and progressive course
http://emedicine.medscape.com/article/1134817-overview • Signs and symptoms : • Problems recognizing friends and family – Mild : members • Memory loss • Difficulty organizing • Confusion thought and thinking • Increased anxiety logicalliy – Moderate : – Severe : • Shortened attention • Weight loss span • Seizures, skin infections, difficulty swallowing • Lack of bladder and bowel control http://emedicine.medscape.com/article/1134817-overview • Initial mental status testing should include evaluation of the following: – Attention and concentration – Recent and remote memory – Language – Praxis (ie, ability to perform skilled motor tasks without nonverbal prompting) – Executive function – Visuospatial function http://emedicine.medscape.com/article/1134817-clinical#b3 • AD can be classified into the following stages: – Preclinical – Mild – Moderate – Severe
http://emedicine.medscape.com/article/1134817-treatment • Parkinson disease is one of the most common neurologic disorders and causing progressive disability that can be slowed but not halted by treatment • 2 Major neuropathologic findings : – Loss of pigmented dopaminergic neurons of the substansia nigra pars compacta – The presence of lewy bodies and lewy neurites
http://emedicine.medscape.com/article/1831191-overview • Signs and symptoms : – Tremor – Decreased facial expression – Sleep disturbances – Decreased sense of smell – Depression or anhedonia – Slowness in thinking
http://emedicine.medscape.com/article/1831191-overview • Non motor symptoms are common in early parkinson disease
• Gejala hanya berlangsung singkat (<1jam) • TIA → “warning-sign” terjadinya stroke di kemudian hari jika tidak ditangani dengan baik. • Patofisiologi pengurangan / penghentian sementara aliran darah serebral dalam distribusi neurovaskular tertentu rendah / aktivitas tromboembolik akut T.I.A
ETIOLOGI FAKTOR RESIKO • Bekuan darah pada arteri di otak • Bekuan darah dari bagian tubuh • Merokok lain (mis: jantung) yang menuju ke • Hipertensi otak • Hiperkolesterol • Trauma pada pembuluh darah • Diabetes • Konstriksi pembuluh darah yang • Gangguan hematologi menuju ke otak • Gangguan hematologi polisitemia, sickle cell anemia, trombositosis, leukemia • Keadaan yang menyebabkan abnormalitas pembuluh darah fibromuscular dysplasia, SLE • Inflamasi pembuluh darah arteritis, poliarteritis • Spasme pembuluh darah kecil di otak T.I.A
GEJALA • TIA terjadi secara tiba-tiba dan biasanya berlangsung selama Gejala lain : 2-30 menit, jarang > 1-2 jam. • Hilangnya rasa atau kelainan • mengenai arteri karotis : sensasi pada lengan atau kebutaan pada salah satu mata tungkai atau salah satu sisi atau kelainan rasa dan tubuh kelemahan • Kelemahan atau kelumpuhan • A. Vertebralis : pusing, pada lengan atau tungkai penglihatan ganda dan atau salah satu sisi tubuh kelemahan menyeluruh • Hilangnya sebagian penglihatan atau pendengaran • Penglihatan ganda
