Kelainan Vaskuler Otak.ppt

8/18/2019 Kelainan Vaskuler Otak.ppt

1/42

Prof. Dr. H. Basjiruddin A, SpSProf. Dr. H. Basjiruddin A, SpS

(K)(K)Bagian Neurologi FK-UnandBagian Neurologi FK-Unand

PadangPadang


2/42

Oa!Oa! "" #$ %era u%u& ('-',# !g)#$ %era u%u& ('-',# !g)

Buu& Buu& '$ dari ju*la& dara&'$ dari ju*la& dara&

#+$ dari ju*la& o!sigen#+$ dari ju*la& o!sigen

Oa! dialiri dara& +-+ *l'++gr jaringanOa! dialiri dara& +-+ *l'++gr jaringan

oa!*enioa!*eni

Bila suplai dara& %er!urangBila suplai dara& %er!urang pada %aas erenupada %aas erenuBila /ere%ral %lood 0o1 *enurunBila /ere%ral %lood 0o1 *enurun

2s!e*i! oa!2s!e*i! oa!

- gangguan fungsi neurongangguan fungsi neuron

- Kerusa!an sru!ural (%elu* per*anen)Kerusa!an sru!ural (%elu* per*anen)

2s!e*i! la*a2s!e*i! la*a infar! gangguan fungsi daninfar! gangguan fungsi dan

sru!ursru!ur neuron rusa!neuron rusa!


3/42

Gangguan Vaskularisasi Otak Gangguan Vaskularisasi Otak

3Karena !elainan pada dinding 4as!ulerKarena !elainan pada dinding 4as!uler

3 Karena gangguan dara&Karena gangguan dara&

3 Karena !elainan &e*odina*i!Karena !elainan &e*odina*i!

3 dlldll


4/42

The most abnormalities of vascular :The most abnormalities of vascular :

1.1. AtherosclerosisAtherosclerosis is a disease of large is a disease of largeand *ediu*-si5ed *us/ular areries and isand *ediu*-si5ed *us/ular areries and is

/&ara/eri5ed %6 endo&elial d6sfun/ion,/&ara/eri5ed %6 endo&elial d6sfun/ion,

and %uildup of lipids, /&oleserol, /alsiu*and %uildup of lipids, /&oleserol, /alsiu*and /ellular de%ris 1i&in &e ini*a of &eand /ellular de%ris 1i&in &e ini*a of &e

4essel 1all.4essel 1all.

7&is %uildup resuls in pla8ue for*aion, 7&is %uildup resuls in pla8ue for*aion,

4as/ular re*odeling, a/ue and /&roni/4as/ular re*odeling, a/ue and /&roni/lu*inal o%sru/ion, a%nor*aliies of %loodlu*inal o%sru/ion, a%nor*aliies of %lood

0o1, and di*inis&ed o96gen suppl6 o0o1, and di*inis&ed o96gen suppl6 o

arge organsarge organs


5/42

Aeros!lerosis dipi/u ole& %e%erapa fa!or Aeros!lerosis dipi/u ole& %e%erapa fa!or

a. Fa!or 6ang dapa di!endali!an a. Fa!or 6ang dapa di!endali!an - :ero!o!:ero!o!

- Hiper!oleserole*iaHiper!oleserole*ia

- HiperensiHiperensi

- Die%ees :elliusDie%ees :ellius

- Kege*u!anKege*u!an

- Kurangn6a a!i;as ;si!Kurangn6a a!i;as ;si!

%.


6/42


7/42

=ejala Klinis=ejala Klinis

- Sanga %er4ariasi erganung ringanSanga %er4ariasi erganung ringan%eran6a !elainan%eran6a !elainan

- 7erganung arge organ 6ang di!enai 7erganung arge organ 6ang di!enai

- Bila *engenai pe*%ulu& dara& oa! %isaBila *engenai pe*%ulu& dara& oa! %isaerjadierjadi

- 72A (7ransien 2s/&e*i/ Aa/!) 72A (7ransien 2s/&e*i/ Aa/!)

- >2ND (>e4ersi%le 2s/&e*i/ Neurologi/>2ND (>e4ersi%le 2s/&e*i/ Neurologi/

De;si)De;si)

- 7ro*%osis sere%ri 7ro*%osis sere%ri


8/42

Pengobatan :Pengobatan :

Pengobatan dan pencegahan aterosklerosis:Pengobatan dan pencegahan aterosklerosis:

- Pen/ega&an pri*er le%i& peningPen/ega&an pri*er le%i& pening

*engonrol*eng&indari fa!or risi!o seja! dini*engonrol*eng&indari fa!or risi!o seja! dini

!ege*u!an, sres!ege*u!an, sres

- li4e s6le *odi;/aionli4e s6le *odi;/aion

- Ola& raga eraurOla& raga eraur- Kurangi gara*, &eni!an al!o&olKurangi gara*, &eni!an al!o&ol

- Kurangi !onsu*si le*a!Kurangi !onsu*si le*a!

- Heni!an ro!o!Heni!an ro!o!

- ?aga e!anan dara& ?aga e!anan dara&- Segera %ero%a %ila - D:Segera %ero%a %ila - D:

- Hiperensi- Hiperensi

- Hiper!oleserol- Hiper!oleserol


9/42

O%a 6ang dapa dipa!ai O%a 6ang dapa dipa!ai

- Golongan 3 hdror!3 methl "#$G%oA&Golongan 3 hdror!3 methl "#$G%oA&reduc fase inhibitor:reduc fase inhibitor:

- Parasain (pra4a/&ol), si*4asain (5o/or),Parasain (pra4a/&ol), si*4asain (5o/or),

lo4asain (alo/or) Arosain (lipior)lo4asain (alo/or) Arosain (lipior)

- Gol. 'bric acid derivativesGol. 'bric acid derivatives feno;%rae feno;%rae

(ri/or) ge*;%ro5il, (lopid)(ri/or) ge*;%ro5il, (lopid)

- Gol. bile acid se(uestrantsGol. bile acid se(uestrants /&oles6ra*ine (8uesran)/&oles6ra*ine (8uesran)

- Gol. anti o)idantsGol. anti o)idants @i 4ia-Plus @i 4ia-Plus

- Gol. nicotinic acid derivativesGol. nicotinic acid derivatives

Nia/in (Niaspan)Nia/in (Niaspan)


10/42

*. Arteriovenous $alformations*. Arteriovenous $alformations

"AV$s&"AV$s&

- 7erdiri dari pe*%ulu& dara& 6ang dilaasi dan 7erdiri dari pe*%ulu& dara& 6ang dilaasi dan

!usu (angle of dilaed 4essels)!usu (angle of dilaed 4essels)

- alu *e*%enu! !o*uni!asi a%nor*al anaraalu *e*%enu! !o*uni!asi a%nor*al anara

sise* areri dan 4ena. Biasan6a se%agaisise* areri dan 4ena. Biasan6a se%agai

peru*%u&an 6ang suda& a%nor*al seja! 1a!uperu*%u&an 6ang suda& a%nor*al seja! 1a!ue*%rioe*%rio

- A@:s %er%eda *enuru u!urann6a 6ang %erjalanA@:s %er%eda *enuru u!urann6a 6ang %erjalan

di !ore!s aau su%sansia al%adi !ore!s aau su%sansia al%a

A@:s ini ida! *enunju!!an gejala !lini! unu!A@:s ini ida! *enunju!!an gejala !lini! unu!

jang!a 1a!u 6ang panjang jang!a 1a!u 6ang panjang

-- Bila A@:s ini pe/a& *a!a erjadila&Bila A@:s ini pe/a& *a!a erjadila& perdarahanperdarahansubarachnoidsubarachnoid dengan segala gejalan6a 6angdengan segala gejalan6a 6ang

prognosan6a C+$ faalprognosan6a C+$ faal


11/42

3.3. Aneurisma intrakranialAneurisma intrakranial"unruptured intracranial"unruptured intracranial

aneursms&aneursms&

Pele%aran a%nor*al pe*%ulu& dara& oa!Pele%aran a%nor*al pe*%ulu& dara& oa!die*pa-e*pa erenu %erupa sa//ulardie*pa-e*pa erenu %erupa sa//ularaneur6s*aneur6s*

- Biasan6a erdiagnosa seela& angiogra;Biasan6a erdiagnosa seela& angiogra;

- Dia*eer ' /* aau le%i& (*ini*al **)Dia*eer ' /* aau le%i& (*ini*al **)

Bila dia*eer le%i& dari #, /*, dise%uBila dia*eer le%i& dari #, /*, dise%u giantgiantaneursmaneursm

- o!asi a. /arois, a. %asilaris, a. /ere%rio!asi a. /arois, a. %asilaris, a. /ere%rianerior dan *ediaanerior dan *edia

- Pengo%aan surgi/alPengo%aan surgi/al


12/42

+.+. $oa moa disease$oa moa disease

- Suau !elainan pe*%ulu& dara& inra!ranialSuau !elainan pe*%ulu& dara& inra!ranial6ang %elu* di!ea&ui pen6e%a%n6a6ang %elu* di!ea&ui pen6e%a%n6a

- 7erjadi senosis aau o!lusi pada a. /arois 7erjadi senosis aau o!lusi pada a. /arois

inerna inra!ranialinerna inra!ranial

- Pada angiogra; a*pa! pe*%enu!an !olaeralPada angiogra; a*pa! pe*%enu!an !olaeral6ang erli&a seperi jaringan &alus pe*%ulu&6ang erli&a seperi jaringan &alus pe*%ulu&

dara& dala* oa! *en6erupai dara& dala* oa! *en6erupai gumpalangumpalanasapasapE (pu-of-s*o!e appearan/e) %enu! inila&E (pu-of-s*o!e appearan/e) %enu! inila&

6ang dise%u *o6a-*o6a, gejala !linisn6a %isa6ang dise%u *o6a-*o6a, gejala !linisn6a %isaseperi gejala-gejala sro!e ro*%osisseperi gejala-gejala sro!e ro*%osis

Pengo%aan operasi areri e!sra !ranial !ePengo%aan operasi areri e!sra !ranial !e

areri inra !ranial %6 passareri inra !ranial %6 pass


13/42

=PDO dise%u juga sro!e *elipui=PDO dise%u juga sro!e *elipui%eraga* pen6a!i 4as!uler 6ang *enjurus%eraga* pen6a!i 4as!uler 6ang *enjurus!epada is!e*i! aau perdara&an oa!!epada is!e*i! aau perdara&an oa!

,-/0//,-/0//

=angguan fungsi oa! a!u a!i%a ggn=angguan fungsi oa! a!u a!i%a ggnsuplai dara& dioa!, aau perdara&an 6angsuplai dara& dioa!, aau perdara&an 6ang

erjadi *endada! 6ang *en6e%a%!anerjadi *endada! 6ang *en6e%a%!ande;si neurologi! (ringan-%era-!e*aian)de;si neurologi! (ringan-%era-!e*aian)

2. GA0GGA0 P-4-,A4A0 ,A4A# OTA52. GA0GGA0 P-4-,A4A0 ,A4A# OTA5

"GP,O&"GP,O&


14/42Arteri!Arteri erebral


15/42


16/42


17/42

A%TO4 AO%/AT-, 6/T# A0 /0%4-A-, 4/5 OT4O5-

7 -pidemiologi :

- Age lderl6G*iddle-aged or 6oung

adul G /&ildren

- =ender :en G 1o*en in ea/& age group

- >a/e Bla/!s G asians or Hispani/s G 1&ies

- =eograp&i/ region asern urope G esern urope I

Asia G urope or Nor& A*eri/a7 amil #istor Sro!e or &ear disease J age +

7 Other, potentiall modi'able8 factors :

- Diasoli/ or isolaed s6soli/ &6perension

- Dia%ees *elius , 6pe ' or 6pe #

- H6perlipide*ia (&6per/&oleserole*ia)- H6per&o*o/6sene*ia

- S*o!ing

- Al!o&ol a%use

- Drug a%use

- Oral /onra/epi4e use


18/42

/. aktor 4esiko 9ang ,apat ,ikendalikan :/. aktor 4esiko 9ang ,apat ,ikendalikan :

1.1. #/P-4T-0/#/P-4T-0/

Pengaru& HiperensiPengaru& Hiperensi

'. Se%agai fa!or se!under '. Se%agai fa!or se!under

- 72A (7ransien 2s/&e*i/ Aa/!)- 72A (7ransien 2s/&e*i/ Aa/!)

- 7ro*%osis sere%ri- 7ro*%osis sere%ri

#. Se%agai fa!or pri*er#. Se%agai fa!or pri*er

Arerios!lerosisArerios!lerosis *e*pengaru&i areriol oa!*e*pengaru&i areriol oa! rapu&rapu&perdara&an oa!perdara&an oa!

*.*. ,iabetes $elitus,iabetes $elitus :: *e*per/epa a&eros!leroi! dari*e*per/epa a&eros!leroi! dariareri-areri %esar dan areri !e/ilareri-areri %esar dan areri !e/il gejala le%i& %era,gejala le%i& %era,

ou/o*e le%i& %uru!ou/o*e le%i& %uru!3.3. Penakit antungPenakit antung :: ariu* ;%rilasi (6ang le%i& sering) ,ariu* ;%rilasi (6ang le%i& sering) ,

*iral senosis, oronar6 arer6 disease, H6perensi Hear*iral senosis, oronar6 arer6 disease, H6perensi Hear

Disease, @H, reu*ai! HD, endo!ardiis, proese !aupDisease, @H, reu*ai! HD, endo!ardiis, proese !aup

janung janung


19/42

+.+. #iperlipidemia#iperlipidemia !oleserol oal !oleserol oal , D, D ,,HDHD , rigliserida, rigliserida

2.2. ObesitasObesitas &iperagrega%ilias ro*%osi &iperagrega%ilias ro*%osi

;.;. $erokok $erokok !onsenrasi ;%rinogen, pene%alan!onsenrasi ;%rinogen, pene%alandinding areri, 4is!osias dara&dinding areri, 4is!osias dara&

. #perhomocsteinemia#perhomocsteinemia

1?.1?.,rug abuse,rug abuse

//.//. aktor resiko ang tak dapataktor resiko ang tak dapatdikendalikandikendalikan U*ur, &eredier, gender,U*ur, &eredier, gender,ra/era/e


20/42

- Pol6/6&e*ia ru%ra 4eraPol6/6&e*ia ru%ra 4era

- Proein or S de;/ien/6Proein or S de;/ien/6

- Anip&osp&olipid ani/ardiolipinAnip&osp&olipid ani/ardiolipinani%odiesani%odies

- Nep&roi/ s6ndro*eNep&roi/ s6ndro*e

-:alignan/6:alignan/6

- Oral /onra/epi4esOral /onra/epi4es

- De&6draionDe&6draion

#-$ATO@OG/% O4 %OAG@AT/O0#-$ATO@OG/% O4 %OAG@AT/O0

,/O4,-4 %A/0G /%#-$/% T4O5-,/O4,-4 %A/0G /%#-$/% T4O5-


21/42


22/42

Persons 1i& &e follo1ing /ondiions arePersons 1i& &e follo1ing /ondiions are

a &e &ig&es ris! is/&e*i/ sro!e a &e &ig&es ris! is/&e*i/ sro!e

- Arial Fi%rillaionArial Fi%rillaion- As6*po*ai/ senosis of &e /aroidAs6*po*ai/ senosis of &e /aroid

arer6arer6

- A*ourosis Fuga9A*ourosis Fuga9

- 72A 72A

- Pre4ious is/&e*i/ sro!ePre4ious is/&e*i/ sro!e

PAT/-0T AT #/G#-T 4/5 PAT/-0T AT #/G#-T 4/5


23/42

Berdasar!an lesi pada oa!, sro!e di%agi #

1. /nfark "non hemoragik stroke&

- 72A >2ND

- 7ro*%osis sere%ri

- *%oli sere%ri

*. Perdarahan otak "hemoragik stroke&

- Perdara&an inrasere%ralsere%eller

- Perdara&an su%ara/&noid

P-$AG/A0 T4O5-P-$AG/A0 T4O5-


24/42

Non He*or&agi! Non He*or&agi!

T/A "Transient /schemic Attack&T/A "Transient /schemic Attack& ,e'nisi,e'nisi

=angguan peredaran dara& oa! sepinas, 6ang=angguan peredaran dara& oa! sepinas, 6ang*eni*%ul!an ggn fungsi oa! se%enar, *e*%ai!*eni*%ul!an ggn fungsi oa! se%enar, *e*%ai!

s%l* #M ja*s%l* #M ja*PatogenesePatogenese li&a %u!u ajar neurologi li&a %u!u ajar neurologi

-tio :-tio :

- Spas*e pe*%ulu& dara& 6g suda& aeros!leroi!- Spas*e pe*%ulu& dara& 6g suda& aeros!leroi!

- :i!roe*%oli dari janung- :i!roe*%oli dari janung- Polisie*ia- Polisie*ia

- Kelainan paru- Kelainan paru

- Seal sindro* (dari a. !arois !e su%!la4ia )- Seal sindro* (dari a. !arois !e su%!la4ia )


25/42

'.'. Sise* arois Sise* arois A*aorosis fuga9, disarri,A*aorosis fuga9, disarri,&e*iparesis, re0e! paologi!", &e*i&ipesesia, afasia&e*iparesis, re0e! paologi!", &e*i&ipesesia, afasia(&e* do*inan)(&e* do*inan)

#.#. Sise* @ere%ro%asilerSise* @ere%ro%asiler

Drop aa/! (!&as), parese se!iar *ulu, %uaDrop aa/! (!&as), parese se!iar *ulu, %ua

sepinas, diplopia, disfagia, disfungsi sere%elu* (dgnsepinas, diplopia, disfagia, disfungsi sere%elu* (dgngejala sp aa!sia , disarri, nisag*us, &ipooni,gejala sp aa!sia , disarri, nisag*us, &ipooni,re0e! *enurun, 4erigo dlre0e! *enurun, 4erigo dlll))

TerapiTerapi

'.'. Ani plaele agregasi Aspirin, dipirida*ol,Ani plaele agregasi Aspirin, dipirida*ol,peno!si;lin, indo%ufen, i!lopidin, /ilosa5ol,peno!si;lin, indo%ufen, i!lopidin, /ilosa5ol,/lopidogrel/lopidogrel

#.#. O%ai fa!or rO%ai fa!or riisi!osi!o

.. Pe*%erian o%a jang!a panjang (%isa %era&un-a&un)Pe*%erian o%a jang!a panjang (%isa %era&un-a&un)

GeBala 5linisGeBala 5linis erganung lo!asi erganung lo!asi


26/42

Pao;siologi li&a %u!u ajare9 %oo!Pao;siologi li&a %u!u ajare9 %oo!

=ejala !lini! =ejala !lini! 3 De;si neurologi! a!usu% a!uprogresif, !esadaranDe;si neurologi! a!usu% a!uprogresif, !esadaran

%iasa %ai!%iasa %ai!

3 He*iparese&e*i&ipesesidisarri%a%ins!iHe*iparese&e*i&ipesesidisarri%a%ins!i ""

3 Neurogeni/ %ladder (jenis un in&i%ied %ladder)Neurogeni/ %ladder (jenis un in&i%ied %ladder)

3 Serangan 1a!u isira&a, sering usia ua G+ &Serangan 1a!u isira&a, sering usia ua G+ &3 Bila infar! luasBila infar! luas ede*aede*a 72K 72K %isa &erniasi%isa &erniasi

enorial dala* # ja* aau le%i&enorial dala* # ja* aau le%i& !e*aian!e*aian

3 Nn !ranial @22, 22 er!ena (dipersara; ole& sau &e*isfer)Nn !ranial @22, 22 er!ena (dipersara; ole& sau &e*isfer)nn !ranialnn !ranial lain a! !ena (dipersara; dua &e*isfer)lain a! !ena (dipersara; dua &e*isfer)

Diagnosis Diagnosis

epa, epa, %eda!an dgn perdara&an, peri!sa la%epa, epa, %eda!an dgn perdara&an, peri!sa la%er!ai , 7er!ai , 7 S/an !epala ( a*pa! %a6angan &ipodens ),S/an !epala ( a*pa! %a6angan &ipodens ),:>2, 7 doppler, !alau perlu P:>2, 7 doppler, !alau perlu P

T4O$O/ -4-4/T4O$O/ -4-4/


27/42

7>AP2 7>AP2

U*u*U*u* sesuai dengan penanganan pada sro!e a!u Isesuai dengan penanganan pada sro!e a!u I jalan nafas, o!sigenasi, aur ina!e /airan, sesuai!an jalan nafas, o!sigenasi, aur ina!e /airan, sesuai!an!alori, ele!roli , aasi de*a* *a!anan erganung!alori, ele!roli , aasi de*a* *a!anan erganung!ondisi u*pa*a >=, die renda& le*a! dll!ondisi u*pa*a >=, die renda& le*a! dll

K&usus K&usus

'.'. Aniede*a gliserol, *aniol, !ori!oseroidAniede*a gliserol, *aniol, !ori!oseroid#.#. O%a sioproe!if u! *elindungi jaringan penu*%raO%a sioproe!if u! *elindungi jaringan penu*%ra gol a anagonisgol a anagonis

.. Aniplaele agregasiAniplaele agregasi

M.M. Ani !oagulan (ro*%olii!), re/o*%inan 7issueAni !oagulan (ro*%olii!), re/o*%inan 7issue

Plas*inogen A/i4aor (r7PA)Plas*inogen A/i4aor (r7PA).. :ea%oli! a!i4aor:ea%oli! a!i4aor

.. O%ai fa!or resi!o pen6 pen6eraO%ai fa!or resi!o pen6 pen6era


28/42

-- Bila &iperensi - &ari pera*a a! diurun!anBila &iperensi - &ari pera*a a! diurun!an!e/uali &iperensi e*ergensi ( dias G '#+ aau!e/uali &iperensi e*ergensi ( dias G '#+ aau:ABP G 'M+ **Hg):ABP G 'M+ **Hg)

- >e&a%iliasi, ;sioerapi pasifa!if- >e&a%iliasi, ;sioerapi pasifa!if

- >esosialisasi>esosialisasi

- Bila *engenai !edua &e*isfere ( 6g !iri disusul- Bila *engenai !edua &e*isfere ( 6g !iri disusul

6g !anan)6g !anan)

&e*iparese duple!&e*iparese duple!

esi ra/ p6r !iesi ra/ p6r !i &e*ip !a He*ip&e*ip !a He*ip

esi ra/ p6r !aesi ra/ p6r !a &e*ip !i duple9&e*ip !i duple9

Nn !ranialis !i-!a ( @22,2,,2,22) i!u lesiNn !ranialis !i-!a ( @22,2,,2,22) i!u lesi

gangguan *enelan, %i/ara, *i*i!,gangguan *enelan, %i/ara, *i*i!, afasiaafasia

*u!a openg (pseudo%ul%er*u!a openg (pseudo%ul%er paralise)paralise) ....tipe $0tipe $0

Beda!an dengan %ul%er paraliseBeda!an dengan %ul%er paralise QQ tipetipe@$0@$0


29/42

-$O@/ -4-4/-$O@/ -4-4/

- G C+ $ dari- G C+ $ dari !elainan!elainan janung janung

-- Pari!elpla8 ro*%us 6g ne*pel di !aup janung lepasPari!elpla8 ro*%us 6g ne*pel di !aup janung lepas

!e oa!!e oa! o!lusi areri oa!o!lusi areri oa!

=ejala !linis=ejala !linis =ejala *oori! sensori! sesuai lesi dll=ejala *oori! sensori! sesuai lesi dllseperi pada ro*%osis sere%ri. Bila e*%olus %esarseperi pada ro*%osis sere%ri. Bila e*%olus %esar %isa%isa

deliriu*, pingsan, gelisa& , !esadaran *enurun, !ejangdeliriu*, pingsan, gelisa& , !esadaran *enurun, !ejang

DiagnosaDiagnosa-Ada su*%er e*%oliAda su*%er e*%oli daridari ( !elainan janung )( !elainan janung )

-=ej 1a!u serangan suda& *a!si*al=ej 1a!u serangan suda& *a!si*alII gga*%aran !linis spa*%aran !linis sp

ro*%osisro*%osis- 7anda 7anda !linis!linis e*%oli pada organ laine*%oli pada organ lain

-7 S/an infar! *ulipel, se!iar infar! a*pa! pee/&ie7 S/an infar! *ulipel, se!iar infar! a*pa! pee/&ie

-:uda& *eluas *enjadi infar! &e*oragi! ( dgn gejala-:uda& *eluas *enjadi infar! &e*oragi! ( dgn gejala-gejala seperi perdara&an oa! )gejala seperi perdara&an oa! )


30/42

7 7>AP2>AP2

K&usus ani ede*a, ani!oagulan (ro*%olii!), lo1K&usus ani ede*a, ani!oagulan (ro*%olii!), lo1

*ole/uler 1eig& &eparin (nadroparin, eno9aperin),*ole/uler 1eig& &eparin (nadroparin, eno9aperin),srepo!inase , r7PA, /ega& e*%oli ulang,srepo!inase , r7PA, /ega& e*%oli ulang, o%aio%ai

pen6a!i janungpen6a!i janung lainlainnn6a sp ro*% sere%ri6a sp ro*% sere%ri

S2 BA7AN= O7AK S2 BA7AN= O7AK -- :esensefalon:esensefalon Sindro*a e%er &e*iplegi spasSindro*a e%er &e*iplegi spas

!onralaeral, parese N 222 ipsilaeral!onralaeral, parese N 222 ipsilaeral ((ipeipe infrainfra nu!lear)nu!lear)

-- PonsPons

Sindro*a Fo4ille &e*iparese !onralaeral,Sindro*a Fo4ille &e*iparese !onralaeral,!onjugasi !esisi lesi.!onjugasi !esisi lesi.

Sindro*a :illard =oe%ler de4iasi !onjugae !esisiSindro*a :illard =oe%ler de4iasi !onjugae !esisi

lesi, Parese @22 ipsilaeral ipelesi, Parese @22 ipsilaeral ipe infra nu!learinfra nu!lear


31/42

- :edula O%longaa:edula O%longaa Sindro*a allen%ergSindro*a allen%erg(ro*%osis a. 4ere%ral) aau a. sere%elli pos.(ro*%osis a. 4ere%ral) aau a. sere%elli pos.

inferiorinferior

- 4erigo, *una&, /e!u!an, disfagi4erigo, *una&, /e!u!an, disfagi

- Analgesi, er*o anasesi 1aja& &o*o laeralAnalgesi, er*o anasesi 1aja& &o*o laeral- He*iparese !onralaeralHe*iparese !onralaeral

- Sindro*a &orner ( *iosis, posis,enopal*us)Sindro*a &orner ( *iosis, posis,enopal*us)

- =ejala sere%elu* aa9ia, &ipooni,=ejala sere%elu* aa9ia, &ipooni,nisag*us, 4erigonisag*us, 4erigo


32/42

#emorhagik troke#emorhagik troke

1. Perdarahan /ntra erebral1. Perdarahan /ntra erebral

- He*isfer (!ore! aau su%!ore9 L+$) Sere%elu*He*isfer (!ore! aau su%!ore9 L+$) Sere%elu*

#+$#+$

- Bila perdara&an !e/il %isa gejalan6a sp ro*%osisBila perdara&an !e/il %isa gejalan6a sp ro*%osis

7 S/an %aru !ea&uan (a*pa! %a6angan &iperdens)7 S/an %aru !ea&uan (a*pa! %a6angan &iperdens)

=ejala Klinis=ejala Klinis

- Kesadaran *enurun $ langsung !o*a, # $ R - #Kesadaran *enurun $ langsung !o*a, # $ R - #

ja* !e*udian, '# $ # ja* %%rp &ari ja* !e*udian, '# $ # ja* %%rp &ari

- :ual, *una&, nafas ngoro!, !ejang:ual, *una&, nafas ngoro!, !ejang- He*iparese &e*i &ipesesi !onra laeralHe*iparese &e*i &ipesesi !onra laeral

- Parese nn !ranialis (sesuai opi! lesi)Parese nn !ranialis (sesuai opi! lesi)


33/42

*. Perdarahan /ntra erebeller*. Perdarahan /ntra erebeller

- Dara& *endesa! di fossa poseriorDara& *endesa! di fossa poserior- Pening!aan 72K, pusing, *una&, singulus, ggnPening!aan 72K, pusing, *una&, singulus, ggn

o!ulo*ooriuso!ulo*oorius

-- =ejala lesi sere%eler aa9i, nisag*us, re0e!=ejala lesi sere%eler aa9i, nisag*us, re0e!

;siologis *enurun, dll, &e*iparese (-);siologis *enurun, dll, &e*iparese (-)- Pene!anan pada pons rigidias, de!ori!asi, pupilPene!anan pada pons rigidias, de!ori!asi, pupil

pin poinpin poin

- Pene!anan pada *edula o%longaa gejala le%i&Pene!anan pada *edula o%longaa gejala le%i&

%era%era *engenai ini-ini ner4i !ranialis 4ial,*engenai ini-ini ner4i !ranialis 4ial,rigidias desere%rasirigidias desere%rasi !e*aian!e*aian


34/42

Klinis, 7 S/an, :>2, P %ila perluKlinis, 7 S/an, :>2, P %ila perlu

leu!osi *ening!a '-#++++, &ipergli!e*i! rea/ionleu!osi *ening!a '-#++++, &ipergli!e*i! rea/ion 7erapi 7erapi

-- Pen/ega&an 72K *ening!aPen/ega&an 72K *ening!a &erniasi (%eri ani ede*a)&erniasi (%eri ani ede*a)

- Ani !on4ulsi, %ila 7D *ening!aAni !on4ulsi, %ila 7D *ening!a ede*a *ening!aede*a *ening!a

72K *ening!a, &ai-&ai *enurun!an 7D 72K *ening!a, &ai-&ai *enurun!an 7D- %ila 7D *enurun%ila 7D *enurun is!e*i! *ening!ais!e*i! *ening!a segera aasisegera aasi *enjaga !erusa!an neuron*enjaga !erusa!an neuron

O%a &e*osasis rane9a*i/ a/id gr&r 2@ *ganiO%a &e*osasis rane9a*i/ a/id gr&r 2@ *gani;%rinolii!, /ega& perdara&an ulang;%rinolii!, /ega& perdara&an ulang

-- Prognosis '+ $ *eninggal s%l* pengo%aanPrognosis '+ $ *eninggal s%l* pengo%aan M+ $ *eninggal anpa per%ai!anM+ $ *eninggal anpa per%ai!an

- :oralias:oralias "" + $ pen6e%a% er%an6a! perdara&an+ $ pen6e%a% er%an6a! perdara&anulangulang

DiagnosaDiagnosa


35/42

3. Perdarahan ubarahnoid3. Perdarahan ubarahnoid

ioio - Aneuris*a inra!ranial 6g pe/a&- Aneuris*a inra!ranial 6g pe/a&

- A@ *alfor*asi pe/a&- A@ *alfor*asi pe/a&

- Se!under er&adap P2S- Se!under er&adap P2S

=ejala !linis=ejala !linis

-- Aneuris*a pe/a&Aneuris*a pe/a& s.!ep &e%a, *ual, *una&s.!ep &e%a, *ual, *una&

- >gs *eningen>gs *eningen !a!u !udu!, %rud5ins!i, !ernig!a!u !udu!, %rud5ins!i, !ernig- Fundus!opi perdara&an su%&ialoid ("), ede*a papilFundus!opi perdara&an su%&ialoid ("), ede*a papil

'+$'+$

- =ejala *oori!sensori! sesuai lesi=ejala *oori!sensori! sesuai lesi

- =gn !esadaran 4ariasi ringan-!o*a=gn !esadaran 4ariasi ringan-!o*a- Oono* !eringa *ening!a, a!i!ardiOono* !eringa *ening!a, a!i!ardi

- Sres ul/erSres ul/er &e*ae*esis&e*ae*esis

- Se!iar perdara&anSe!iar perdara&an 4asospas*e4asospas*e is!e*i!is!e*i! infar!infar!


36/42

7erapi

3 Anispas*e dise!iar perdara&an, dp di%eri!an a

anagonis3 ega& perdara&an ulang (&e*os agens%g

ani;%rinolii!, ani !on4ulsan, aasi !egelisa&an)

3 Aniede*a

3 Ani!on4ulsi

3 N6eri !epala " /e*as analg sedaif

3 a9ansia

3Ani &iperensi

Diagnosis

- Klinis

- 7 S/an !epala, %ila perlu P


37/42

2nfor*aion o %e 7aug& o &e Pu%li/ 2nfor*aion o %e 7aug& o &e Pu%li/

- Sudden onse of &e s6*po*sSudden onse of &e s6*po*s

- ea!ness, /lu*siness, &ea4iness, or nu*%ness oneea!ness, /lu*siness, &ea4iness, or nu*%ness oneside of &e %od6 &and or fa/eside of &e %od6 &and or fa/e

- Drooping of one side of &e fa/eDrooping of one side of &e fa/e

- Slurred spee/& of diT/ul6 undersanding languageSlurred spee/& of diT/ul6 undersanding language

- oss of or %lurred 4ision in one or %o& e6esoss of or %lurred 4ision in one or %o& e6es- Di55iness or in %alan/eDi55iness or in %alan/e

- Unusuall6 se4ere &eada/&eUnusuall6 se4ere &eada/&e

Pu%li/ *us learn &e /orre/ response o a sro!ePu%li/ *us learn &e /orre/ response o a sro!e

o see! *edi/al aenion i**ediael6o see! *edi/al aenion i**ediael6

B>A2N A77AKE O::ON SOKB>A2N A77AKE O::ON SOK


38/42

- 7i*e of onse of neurologi/ s6*po*s 7i*e of onse of neurologi/ s6*po*s- Deer*ine naure of neurologi/ s6*po*s Deer*ine naure of neurologi/ s6*po*s

ea!ness of ar* or fa/eea!ness of ar* or fa/e

Slurring of spee/& or a%nor*al languageSlurring of spee/& or a%nor*al language- >ae =S s/ore >ae =S s/ore

anguageanguage

6e *o4e*en6e *o4e*en

:oor response:oor response

- Hisor6 of re/en illness, surger6, or rau*aHisor6 of re/en illness, surger6, or rau*a

- >e/en use of *edi/aions>e/en use of *edi/aions

/0O4$AT/O0 TO - OTA/0-, /0 T#-/0O4$AT/O0 TO - OTA/0-, /0 T#-

/-@, 9 -$-4G-0%9 $-,/%A@ -4V/%-/-@, 9 -$-4G-0%9 $-,/%A@ -4V/%-

@-V-@ O -V/,-0%- -, A G/,-@/0- O4 T4-AT$-0T O@-V-@ O -V/,-0%- -, A G/,-@/0- O4 T4-AT$-0T O


39/42

@-V-@ O -V/,-0%- -, A G/,-@/0- O4 T4-AT$-0T O@-V-@ O -V/,-0%- -, A G/,-@/0- O4 T4-AT$-0T O

%-4-4OVA%@A4 ,/-A-%-4-4OVA%@A4 ,/-A-

@evel /@evel /

Daa /olle/ed fro* large, rando*i5ed, /onrolled /lini/al rials 1&i/& pro4ideDaa /olle/ed fro* large, rando*i5ed, /onrolled /lini/al rials 1&i/& pro4ide

/lear e4iden/e of rea*en ee/. Daa fro* *ea-anal6ses /an %e used as/lear e4iden/e of rea*en ee/. Daa fro* *ea-anal6ses /an %e used assupporing infor*aion. 7&is le4el of e4iden/e /an %e used as &e %asis for &esupporing infor*aion. 7&is le4el of e4iden/e /an %e used as &e %asis for &esronges re/o**endaions (grade A)sronges re/o**endaions (grade A)

@evel //@evel //

Daa /olle/ed fro* rando*i5ed, /onrolled /lini/al rials 1&i/& pro4ideDaa /olle/ed fro* rando*i5ed, /onrolled /lini/al rials 1&i/& pro4idee4iden/e of rea*en ee/. Daa fro* *ea-anal6ses /an %e used ase4iden/e of rea*en ee/. Daa fro* *ea-anal6ses /an %e used as

supporing infor*aion. 7&is le4el of e4iden/e /an %e used as &e %asissupporing infor*aion. 7&is le4el of e4iden/e /an %e used as &e %asisre/o**endaions of iner*ediae sreng& (grade B)re/o**endaions of iner*ediae sreng& (grade B)

@evel ///@evel ///

Daa /olle/ed fro* nonrando*i5ed sudies &a /o*pare resul of rea*enDaa /olle/ed fro* nonrando*i5ed sudies &a /o*pare resul of rea*en

1i& /on/urren paiens 1&o do no re/ei4e &e rea*en.1i& /on/urren paiens 1&o do no re/ei4e &e rea*en.

@evel /V@evel /V

Daa /olle/ed fro* nonrando*i5ed sudies &a /o*pare resul of rea*enDaa /olle/ed fro* nonrando*i5ed sudies &a /o*pare resul of rea*en1i& /on/urren paiens 1&o did no re/ei4e &e rea*en in &e pas (&isori/al1i& /on/urren paiens 1&o did no re/ei4e &e rea*en in &e pas (&isori/al

/onrols)/onrols)

@evel V@evel V

Daa /olle/ed fro* /ase series or repors. 7&e 1ea!es re/o**endaionsDaa /olle/ed fro* /ase series or repors. 7&e 1ea!es re/o**endaions

( =rade ) are %ased on le4els 222-@ e4iden/e( =rade ) are %ased on le4els 222-@ e4iden/e


40/42

ieraur ieraur

- Ada*s >D. Prin/iples of neurolog6 Ada*s >D. Prin/iples of neurolog6 && ed :/ =ra1 Hilled :/ =ra1 Hill'CC'CC

- aplan >. Sro!e. A lini/al Approa/& #aplan >. Sro!e. A lini/al Approa/& #ndnd ededBuer1or& Heine*ann 'CCBuer1or& Heine*ann 'CC

- =uidelines Sro!e #++M (P>DOSS2)=uidelines Sro!e #++M (P>DOSS2)

- Harsono (ed), Bu!u Ajar Neurologi Klinis (P>DOSS2)Harsono (ed), Bu!u Ajar Neurologi Klinis (P>DOSS2)=adja& :ada Uni4ersi6 Press. DOSS2)=adja& :ada Uni4ersi6 Press. P, A*inof :?, lini/al Neurologi

- Ada*s HP. ?r e al. :anage*en of Sro!e # nd ed.Ada*s HP. ?r e al. :anage*en of Sro!e # nd ed.ProfessionalProfessional o**uni/aions. 2n/o**uni/aions. 2n/ #++##++#


41/42


42/42

Documents

Kelainan Vaskuler Otak.ppt