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7/24/2019 Case Saraf Stroke Infark MM
1/31
Laporan Kasus
STROKE INFARK
Oleh
Muhammad Maliki
1308468769
Pembimbi!"
d#$ A!u% T#i &'k'( S)$S
KEPANITERAAN K*INIK
+A,IAN I*M- PEN.AKIT SARAF
RS-/ ARIFIN AMA/
FAK-*TAS KE/OKTERAN
-NI2ERSITAS RIA-
PEKAN+AR-
01
1
7/24/2019 Case Saraf Stroke Infark MM
2/31
RS-/ ARIFIN AMA/
Fakul5a% Ked'k5e#a -R
SMF/ BAGIAN SARAFSek#e5a#ia5 " SMF Sa#a I#a Medikal *a5ai 4
Jl. Diponegoro No. 2 Telp. (0761 702622!
P E K A N + A R -
STAT-S PASIEN
Nama K'a%% " Muhammad Maliki
N I M N - K " 1308468769
Ta!!al " 0 Ok5'be# 01
Pembimbi! d#$ A!u% T#i &'k'( S)$S
I$ I/ENTITAS PASIEN
N"#" N$. S
%#&r '1 T"h&n
Jeni )el"#in *ere#p&"n
Al"#"+ *e)"n,"r&
Ag"#" Il"#
S+"+& per)"-in"n "-in
*e)er""n I,& R"h T"ngg"
T"ngg"l M"&) RS 1 O)+o,er 201!
Mei"l Reor 0 '7 '
II$ ANAMNESIS("&+o"n"#nei "n "llo"n"#nei eng"n "n") "n &"#i
p"ien
Keluha -5ama
ele#"h"n p"" "nggo+" ger") e,el"h )"n"n
Ria:a5 Pe:aki5 Seka#a!
Se") 1 h"ri SMRS p"ien #engel&h)"n )ele#"h"n p"" "nggo+"
ger") e,el"h )"n"n. le#"h ir"")"n #en"") ""+ p"ien &&) i
2
7/24/2019 Case Saraf Stroke Infark MM
3/31
r"hn$" e+el"h ,"ng&n +i&r3 p"gi e)i+"r p&)&l 06.'0 4IB. S""+ )e"i"n3
#&l&+ p"ien #enong )e )iri. *"ien +i") #eng"l"#i pen&r&n"n )e""r"n3
n$eri )ep"l" +i") ""3 #&"l "n #&n+"h +i") "". *"ien ,er"l"n eng"n
ip"p"h oleh )el&"rg" p"ien. *"ien ,er,i"r" pelo. *"ien #enger+i
pe#,i"r""n or"ng l"in3 n"#&n l"#,"+ #ereponn$". *"ien l"l& i ,"-" )e
R"h S")i+ *e+"l" Bi. D"ri R"h ")i+ *e+"l" Bi p"ien )e#&i"n
ir&&) eng"n "l""n +i") +erei" Spei"li S"r"5 "n 5"ili+" TS"n.
Se") 1 #ingg& SMRS p"ien #engel&h)"n ,eng)") p"" )e&"
leng"n "n +&ng)"i. Se") n"5" +i") "".
Ria:a5 Pe:aki5 /ahulu
Ri-"$"+ DM (8 i)e+"h&i e") 12 +"h&n +er")hir3 p"ien ,ero,"+ r&+in eng"n
#eng)oni #e+5or#in
Ri-"$"+ +ro)e e,eln$" +i") i)e+"h&i
Ri-"$"+ hiper+eni (8 i)e+"h&i e") 1 +"h&n +er")hir3 p"ien ,ero,"+ r&+in
eng"n #eng)ono#i "p+opril
Ri-"$"+ pen$")i+ gin"l )roni) (8 i)e+"h&i ! ,&l"n $"ng l"l&.
Ri-"$"+ pen$")i+ "n+&ng +i") i)e+"h&i
Ri-"$"+ +r"" )ep"l" (
Ria:a5 Kebia%aa
*"ien #ero)o) e") #&".
Ria:a5 Pe:aki5 Kelua#!a
I,& )"n&ng p"ien pern"h #eneri+" +ro)e.
RES-ME ANAMNESIS
Tn.S3 !! +"h&n3 )ele#"h"n p"" "nggo+" ger") e,el"h )"n"n3 #en"") ""+
p"ien &&) e+el"h ,"ng&n +i&r3 p"gi. *"ien ""r. S""+ )e"i"n3 #&l&+ p"ien
#enong )e )iri. *"ien ,er"l"n eng"n i,"n+& ip"p"h oleh )el&"rg" p"ien. *"ien
,er,i"r" pelo. *"ien #enger+i pe#,i"r""n or"ng l"in3 n"#&n l"#,"+ #ereponn$"..
*"ien i)e+"h&i #e#ili)i ri-"$"+ DM "n hiper+eni. *"ien #e#p&n$"i )e,i"""n
9
7/24/2019 Case Saraf Stroke Infark MM
4/31
#ero)o). I,& )"n&ng p"ien pern"h #eneri+" +ro)e.
III$ PEMERIKSAAN ;10 Mei 014 ;2a!u%II ;i)'!l'%%u%ole +",le+ 9 = 1
Ter"pi o)&p"i
Ta!!al 17 Mei 014
S: T"ng"n )"n"n "n )")i )"n"n ,i" iger"))"n +e+"pi #"ih le#"h3 ,eng)")
p"" )")i3 ,""n le#"3 #&"l (8 hil"ng +i#,&l
O: e""r"n )o#po#en+i3 GS : @'M6 !
TD :170/100 ##
7/24/2019 Case Saraf Stroke Infark MM
18/31
oorin"i : &li+ inil"i
O+ono# : nor#"l
Re5le) Fiiologi : nor#"l3 *"+ologi : (/
i#i" "r"h:
Gl&)o" D"r"h *&"" : 22; #g/l
%re : 196 #g/l
re"+inin: 63'' #g/l
AST: 120 I%/
AST: 70; %/
A: S+ro)e in5"r) e. +ro#,o+i) 8 D +"ge 8 hiper+eni gr"e II8DM +ipe II
*: In i+iolin 2!0 #g/;"#
Ine)i F&roe#i 1=1 "#p
Apile+ ;0 #g 2=1
A"# 5ol"+ 2=1
"l"r+"n ;0 #g 1=1
ole +",le+ 9 = 1
In.Noer"pi 9=6 &ni+
Ter"pi o)&p"i
Ta!!al 18 Mei 014
S: T"ng"n )"n"n "n )")i )"n"n ,i" iger"))"n +e+"pi #"ih le#"h3 ,eng)")
p"" )")i3 ,""n le#".
O: e""r"n )o#po#en+i3 GS : @'M6 !
TD :160/0 ##
7/24/2019 Case Saraf Stroke Infark MM
19/31
*ro)i#"l
Ton&
Tro5i
Ger.inol&n+er
'
N
@&+ro5i
!
N
@&+ro5i
ing/
1
7/24/2019 Case Saraf Stroke Infark MM
20/31
F&ngi l&h&r: nor#"l
R"ng"ng #eninge"l: (
S"r"5 )r"ni"l: ,n
Mo+ori)
"n"n iri e+er"ng"n
@)+re#i+" "+"
e)&"+"n
Di+"l
*ro)i#"l
Ton&
Tro5i
Ger.inol&n+er
'
'
N
@&+ro5i
!
!
N
@&+ro5i
7/24/2019 Case Saraf Stroke Infark MM
21/31
PEM+AASAN
I$ /eii%i
De5inii +ro)e #en&r&+ 4
7/24/2019 Case Saraf Stroke Infark MM
22/31
9. S+ro)e progrei5 "+"& stroke in evolution $"i+& +ro)e $"ng ge"l"
)linin$" e"r" ,er+"h"p ,er)e#,"ng "ri $"ng ring"n "#p"i e#")in
,er"+.
'. S+ro)e )o#pli+ "+"& completed stroke3 $"i+& +ro)e eng"n e5ii+
ne&rologi $"ng #ene+"p "n &"h +i") ,er)e#,"ng l"gi.
. Ber""r)"n lo)"i lei ")&ler
1. Si+e# )"ro+i1. Mo+ori): he#ip"ree )on+r"l"+er"l3 i"r+ri"
2. Senori): he#ihipe+ei )on+r"l"+er"l3 p"re+ei"
9. G"ngg&"n i&"l: he#i"nopi" ho#on$# )on+r"l"+er"l
'. G"ngg&"n 5&ngi l&h&r: "5"i"3 "gnoi"
2. Si+e# er+e,ro,"iler
1. Mo+ori): he#ip"ree "l+ern"n3 i"r+ri"
2. Senori): he#ihipe+ei" "l+ern"n3 p"re+ei"
9. G"ngg&"n i&"l : he#i"nopi" ho#ini#3 or+i"l ,linne3 TIA
'. G"ngg&"n l"in: g"ngg&"n )eei#,"ng"n3 er+igo3 iplopi"
I2$ ,e@ala S5#'ke
Se"r" ge"l" +ro)e ,er&p" er"ng"n #en"")3 ,er&p" :139
1. ee#&+"n "n )ele#"h"n p"" -""h3 leng"n "+"& +&ng)"i3+er&+"#" p""
"+& ii +&,&h
2. Confuse3 g"ngg&"n ,i"r" "+"& #enger+i pe#,i"r""n
9. G"ngg&"n penglih"+"n "+& "+"& )e&" #"+"
'. e&li+"n ,er"l"n3 p&ing3 g"ngg&"n )eei#,"ng"n "n )oorin"i
!. N$eri )ep"l" he,"+ $"ng ,el el" pen$e,",n$"
S5#'ke em'#a!ik
*e"hn$" pe#,&l&h "r"h o+") #en$e,",)"n )el&"rn$" "r"h )e "ring"n
p"ren)i# o+")3 r&"ng "ir"n ere,ropin"li ie)i+"r o+") "+"& )o#,in"i )e&"n$".
*er"r"h"n +ere,&+ #en$e,",)"n g"ngg&"n er",&+ "r"5 o+") #el"l&i pene)"n"n
+r&)+&r o+") "n &g" oleh he#"+o# $"ng #en$e,",)"n i)e#i" p"" "ring"n
e)i+"rn$". *ening)"+"n +e)"n"n in+r")r"ni"l p"" gilir"nn$" ")"n #eni#,&l)"n
herni"i "ring"n o+") "n #ene)"n ,"+"ng o+").!
E5i'l'!i da#i S5#'ke em'#a!ik "
1< Pe#da#aha i5#a%e#eb#al
22
7/24/2019 Case Saraf Stroke Infark MM
23/31
*er"r"h"n in+r"ere,r"l i+e#&)"n p"" 10 "ri el&r&h )"& +ro)e3 +eriri "ri
;0 i he#i5er o+") "n i"n$" i ,"+"ng o+") "n ere,el. 6
Ge"l" )lini :
One+ per"r"h"n ,eri5"+ #en"")3 +er&+"#" e-")+& #el")&)"n ")+ii+" "n
"p"+ i"h&l&i oleh ge"l" proro#"l ,er&p" pening)"+"n +e)"n"n "r"h $"i+&
n$eri )ep"l"3 #&"l3 #&n+"h3 g"ngg&"n #e#ori3 ,ing&ng3 per"rh"n re+in"3 "n
epi+")i.
*en&r&n"n )e""r"n $"ng ,er"+ "#p"i )o#" ier+"i he#iplegi"/he#ip"ree
"n "p"+ ier+"i )e"ng 5o)"l / .
T"n"+"n" pene)"n"n ,"+"ng o+")3 ge"l" p&pil &nil"+er"l3 re5le) perger")"n
,ol" #"+" #enghil"ng "n eere,r"i
D"p"+ ip"i +"n"+"n" +e)"n"n +inggi in+r")r"ni"l (TTI3 #i"ln$"
p"pilee#" "n per"r"h"n &,hi"loi.
< Pe#da#aha %uba#akh'id
*er"r"h"n &,"r")hnoi ""l"h &"+& )e"""n i#"n" +er"i per"r"h"n i r&"ng
&,"r")hnoi $"ng +i#,&l e"r" pri#er.6
Ge"l" )lini :
One+ pen$")i+ ,er&p" n$eri )ep"l" #en"") eper+i #ele")3 r"#"+i3
,erl"ng&ng "l"# 1 H 2 e+i) "#p"i 1 #eni+. er+igo3 #&"l3 #&n+"h3 ,"n$") )ering"+3 #engigil3 #&"h +er"ng"ng3 geli"h
"n )e"ng.
D"p"+ i+e#&)"n pen&r&n"n )e""r"n "n )e#&i"n ""r "l"# ,e,er"p"
#eni+ "#p"i ,e,er"p" "#.
Dip"i ge"l"ge"l" r"ng"ng #eningen
*er"r"h"n re+in" ,er&p" per"r"h"n &,hi"li #er&p")"n ge"l" )"r")+eri+i)
per"r"h"n &,"r")hnoi.
G"ngg&"n 5&ngi o+ono# ,er&p" ,r"i)"ri "+"& +")i)"ri3 hipo+eni "+"&
hiper+eni3 ,"n$") )ering"+3 &h& ,""n #ening)"+3 "+"& g"ngg&"n
pern"5""n.!
S5#'ke N'em'#a!ik
*er,e""n per"r"h"n in+r"ere,r"l3 in5"r) +ro#,oi "n e#,oli7
29
7/24/2019 Case Saraf Stroke Infark MM
24/31
*er"r"h"n
in+r"ere,ri
In5"r) +hro#,oi @#,oli
One+ %#n$" +er"i
""+ ,er")+ii+"
S""+ i+ir"h"+3
Bi""n$" i"-"li
ge"l" proor#"l
p&ing (TIA
eng"n e5ii+
ne&rologi
Ter"i ""+
,er")+ii+"3
ge"l" #&n&l
"l"#
-")+& ,e,er"p"
e+i)
"+"& #eni+
Ge"l"
7/24/2019 Case Saraf Stroke Infark MM
25/31
B"+""n pen$")i+ gin"l )roni)
1. er&")"n gin"l 9 ,&l"n3 $"i+& )el"in"n +r&)+&r "+"& 5&ngi gin"l3 eng"n "+"& +"np"
pen&r&n"n l"& 5il+r"i glo#er&l& ,er""r)"n:
el"in"n p"+ologi)
*e+"n" )er&")"n gin"l eper+i pro+ein&ri" "+"& )el"in"n p"" pe#eri)""n peni+r""n
2. "& 5il+r"i glo#er&l& K 60 #l/#eni+/1379# el"#" 9 ,&l"n eng"n "+"& +"np" )er&")"n
gin"l
"& 5il+r"i glo#er&l& (FG "n +"i pen$")i+ gin"l )roni) ""l"h:
S5adium /e%k#i)%i *F, ;m*mei51$73 mB