Case Stroke

7/18/2019 Case Stroke

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FAKULTAS KEDOKTERAN UKRIDA

(UNIVERSITAS KRISTEN KRIDA WACANA)

Jl. Terusan Arjuna No.6 Keon Jeru! " Ja!ar#a $ara#

KEPANITERAAN KLINIK

STATUS ILMU PENYAKIT SARAF

FAKULTAS KEDOKTERAN UKRIDA

RS PANTI WILASA, SEMARANG, JAWA TENGAH

Na%a & 'an uj *us#!a Sar

N% & ++,-++,/-

Tan0a#an1an

............................................

Dr e%%n1 & 0r. 2e3an#o *.4 S5.S

.............................................

IDENTITAS PASIEN

Na%a & N. S S#a#us %en!a7 & *en!a7

U%ur & 86 #a7un Dra9a# 0 ruan1 & Al57a

Jens Kela%n & ere%5uan No. R* & :;;333

A1a%a & Isla% Tan11al %asu! RS & -< Jun -+:

e!erjaan & Iu Ru%a7 Tan11a Tan11al !eluar RS & 8 Jul -+:

Ala%a# & Kal=ar >a

PASIEN DATANG KE RUMAH SAKIT :

asen 0a9a ole7 !eluar1a 0an sa erjalan.

DAFTAR MASALAH

No. *asala7 A!#? Tan11al *asala7 #0a! a!#? Tan11al

+. $=ara 5elo -/@6@-+: 25er#ens -


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le%a7

SUBJEKTIF

Anamnesis

Ana%ness 0la!u!an se=ara au#oana%ness 0an alloana%ness4 #an11al 0an 8 Jul -+:4

ja% +6. WI$ 0an /.: WI$.

1 Ke!"#an "$ama

$=ara 5elo seja! - 7ar S*RS.

% Ri&a'a$ (en'a)i$ se)a*an+

asen 0a#an1 !e IBD 0en1an !elu7an =ara 5elo seja! - 7ar S*RS. Kelu7an

#erseu# %un=ul #a " #a saa# %ala% 7ar. Na%un4 !elu7an #erseu# #0a! 5asen

5e0ul!an. asen ju1a %en1elu7 len1an 0an #un1!a !anan 5asen %ula #erasa le%a7

0an0n1!an len1an 0an #un1!a !r 5asen. Na%un4 5asen %as7 sa un#u! erjalan.

+ 7ar S*RS4 5asen %en1elu7 =ara 5elo se%a!n er#a%a7 era# saa# an1un

#0ur. asen %en1a!u a79a ana!na %el7a# r 5asen %en=on1@%ero# se#ela7

5asen an1un 5a1. asen ju1a %e1elu7 !e5ala #erasa sa!#4 na%un #0a! 0ser#a

0en1an %un#a7. asen ju1a %en1a!u sern1 #erasa #e1an1 5a0a #en1!u! le7er. $AK 0an

$A$ 5asen #0a! a0a !elu7an. Na?su %a!an 5asen ju1a a!. asen %en1a!u 5erna7

%en1elu7 !esul#an un#u! %enelan.

- 7ar sesu0a7 %asu! RS4 5asen %en1elu7 !eluar =aran 0ar #eln1a !r. asen

ju1a %en1elu7 5en0en1aran seela7 !r #er1an11u seja! la%a. a0a #eln1a !anan #0a!

a0a !elu7an.

asen asana 7ana %en0a5a# 5en1oa#an un#u! 0ara7 #n11na.

Ri&a'a$ (en'a)i$ )e!"a*+a

T0a! a0a

- Ri&a'a$ (en'a)i$ .a#"!"

Seelu% n 5asen 5erna7 %en1ala% !elu7an an1 sa%a se5er# n seja! le7 0ar 8

#a7un. asen su0a7 %e%l! r9aa# 75er#ens seja! la%a. R9aa# 0ae#es %el#us

0san1!al.

/ Ri&a'a$ s0sia!, e)0n0mi, (*ia.i

2


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asen #er%asu! 1olon1an an1 er!e=u!u5an.

OBJEKTIF

S$a$"s Pasien

+. Kea0aan u%u% & #a%5a! sa!# se0an14 le%as

-. Kesa0aran & =o%5os %en#s:. Te!anan 0ara7 & +:@/ %%21

. Na0 & / !al@%en#

8. Fre!uens na?as & -- !al@%en#

6. Su7u & :648C

;. Ke5ala & nor%o=e57al4 0e?or%#as (,)

/. *a#a & !onjun1#>a ane%s (,@,)4 s!lera !#er! (,@,)4 se!re# (,@,)4 5u5l ula#

so!or !anan 0an !r4 0a%e#er : %%4 re?le!s =a7aa lan1sun1 0an

#0a! lan1sun1 (@)

as #ra!ea (,)

++. Da0a & s%e#rs 5a0a !ea0aan s#a#s 0an 0na%s4 re#ra!s sela 1a (,)

+-. Jan#un1 & $J I,II re1uler4 %ur%ur (,)4 1allo5 (,)

+:. aru & suara na?as >es!uler4 97een1 (,)4 ron! (,)

+. eru# & su5el4 ner #e!an (,)4 #%5an4 sn1 usus () nor%al

+8. Ala# !ela%n & #0a! 0la!u!an 5e%er!saan

S$a$"s Psi)0!0+is

+. Cara er5!r & a!

-. erasaan 7a# & a!

:. Tn1!a7 la!u & a!

. In1a#an & su0a7 %ula er!uran1

8. Ke=er0asan & a!

S$a$"s Ne"*0!0+is

1 Ke(a!a

a. $en#u! & nor%o=e57al

. Ner #e!an & #0a! a0a=. S%e#rs & s%e#rs

0. ulsas & #eraa

% Le#e*

a. S!a5 & s%e#rs

. er1era!an & eas

=. Ka!u !u0u! & #0a! a0a

Ne*2"s 3*ania!es

N I 4OLFAKTORIUS5 Kanan Ki*iSuje!#? Nor%al Nor%al

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Oje!#? 0en1an a7an T0a! 0la!u!an T0a! 0la!u!an

N II 4OPTI6US5 Kanan Ki*i

Taja% 5en1l7a#an T0a! 0la!u!an T0a! 0la!u!an

La5an1 5en1l7a#an Nor%al Nor%al*el7a# 9arna Nor%al Nor%al

Fun0us o!ul T0a! 0la!u!an T0a! 0la!u!an

NIII 4OKULOMOTORIUS5 Kanan Ki*i

er1era!an ulus Nor%al Nor%al

S#ras%us (,) (,)

Ns#a1%us (,) (,)

E3o5#7al%us (,) (,)

u5l & 0a%e#er

$en#u!

: %%

Iso!or

: %%

Iso!orRe?le!s #er7a0a5 snar () ()

Re?le!s #er7a0a5 !on>er1ens () ()

*el7a# !e%ar (05lo5a) (,) (,)

NI7 4TRO6HLEARIS5 Kanan Ki*i

er1era!an %a#a

(!e a9a7 " !e0ala%)

Nor%al Nor%al

*el7a# !e%ar (05lo5a) (,) (,)

N 7 4TRIGEMINUS5 Kanan Ki*i

*e%u!a %ulu# $a! $a!

*en1una7 $a! $a!

*en111# $a! $a!

Re?le!s !ornea $a! $a!

Sensl#as %u!a $a! $a!

N7I 4ABDU6ENS5 Kanan Ki*i

er1era!an %a#a !e la#eral Nor%al Nor%al

*el7a# !e%ar (05lo5a) (,) (,)

N 7II 4FA6IALIS5 Kanan Ki*i

*en1eru#!an 0a7 Nor%al Nor%al

*en1an1!a# als Nor%al Nor%al

*enu#u5 %a#a Nor%al Nor%al

*e%5erl7a#!an 11 S"!i$ mem(e*!i#a$)an Nor%al

erasaan l0a7 a1an -@:

0e5an

T0a! 0la!u!an T0a! 0la!u!an

N 7III 47ESTIBULO6O66LEARIS5 Kanan Ki*i

4


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Suara ers! $a! Be*)"*an+

Tes# Rnne T0a! 0la!u!an T0a! 0la!u!an

Tes# Weer T0a! 0la!u!an T0a! 0la!u!an

Tes# S9aa=7 T0a! 0la!u!an T0a! 0la!u!an

N I8 4GLOSSOPHARYNGEUS5 Kanan Ki*i

Sensl#as Nor%al Nor%al

erasaan l0a7 +@: ela!an1 T0a! 0la!u!an T0a! 0la!u!an

N 8 47AGUS5 Kanan Ki*i

Ar=us 57arn3 T0a! 0la!u!an T0a! 0la!u!an

*enelan $a! $a!

Na0 $a! $a!

N 8I 4A66ESORIUS5 Kanan Ki*i

*en1an1!a# a7u Nor%al Nor%al

*e%aln1!an !e5ala Nor%al Nor%al

N 8II 4HYPOGLOSSUS5 Kanan Ki*i

er1era!an l0a7 Bai), .e2iasi )e a*a# )anan

Tre%or l0a7 495

Ar#!ulas Disa*$*ia 45

- Ba.an .an an++0$a +e*a)

Ba.ana M0$0*i)

Res5ras & a0o%no,#7ora=al

Du0u! & a!

$en#u! =ollu%na >e#erals & nor%al

er1era!an =ollu%na >e#erals & nor%al

Sensii!i$as

Sensii!i$as Kanan Ki*i

Ta!#l () ()

Ner () ()

T7er% T0a! 0la!u!an

Lo!alsas $a! $a!

An++0$a +e*a) a$as

a M0$0*i)

M0$0*i) Kanan Ki*i

er1era!an $eas $easKe!ua#an -,-,- 84848

5


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Tonus Nor%o#onus Nor%o#onus

Tro?! Nor%o#ro?! Nor%o#ro?!

Sensii!i$as

Sensii!i$as Kanan Ki*iTa!#l () ()

Ner () ()

T7er% T0a! 0la!u!an

Lo!alsas $a! $a!

3 Re;!e)s

Re;!e)s Kanan Ki*i

$=e5s 45 < ()

Tr=e5s 45 < ()

2o??%an Tro%%er 45 (,)

An++0$a +e*a) a&a#

a M0$0*i)

M0$0*i) Kanan Ki*i

er1era!an $eas $eas

Ke!ua#an -,-,- 84848Tonus Nor%o#onus Nor%o#onus

Tro?! Nor%o#ro?! Nor%o#ro?!

Sensii!i$as

Sensii!i$as Kanan Ki*i

Ta!#l () ()

Ner () ()

T7er% T0a! 0la!u!an

Lo!alsas $a! $a!

3 Re;!e)s

Re;!e)s Kanan Ki*i

Re?le!s 5a#ella 45 < ()

Re?le!s A=7lles 45 < ()

. Re;!e)s (a$0!0+is

Re;!e)s (a$0!0+is Kanan Ki*i

$ans! 45 (,)

C7a000o=! 45 (,)

O55en7e% 45 (,)Bor0on 45 (,)

6


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S=7ae??er 45 (,)

/ K00*.inasi .an )eseiman+an

a. Cara erjalan & #0a! 0la!u!an

. Ro%er1 #es# & #0a! 0la!u!an

= Ge*a)an > +e*a)an an0*ma!

Ge*a)an9+e*a)an an0*ma! Kanan Ki*i

Tre%or (,) (,)

K7orea (,) (,)

*o!lonus (,) (,)

? A!a$ 2e+e$a$i2e

a. *!s & a!

. De?e!as & a!

Peme*i)saan La0*a$0*i"m .an Pen"n@an+ Lainn'a

A Peme*i)saan !a0*a$0*i"m, $an++a! %C=1 @am 11:/-

Pa)e$ Da*a# Len+)a(

2e%o1lon & +-4< 1@0L

Leu!os# & +4;3+:@uL

Di;; 60"n$

Eosno?l & -4

$aso?l & 48

Ne#ro?l & 64-

L%?os# & :48*onos# & 64/

2e%a#o!r# & :/

Er#ros# & 4+ 3 +6@uL

Tro%os# & :


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F0$0 T#0*a AP

Cor & $a#as !r jan#un1 er1eser !e la#eral

Elon1a#o aor#a

ul%o & Cora!an 5aru #a! %enn1!a#

Ta! #a%5a! er=a! 5a0a !e0ua la5an1an 5aru

2e%0a?ra1%a !anan se#n11 =os#a /,< 5os#erorSu0u# =os#o57ren=us !anan lan=54 !r su5er5oss 0en1an aan1an jan#un1

Kesan :Kar0o%e1al

Elon1a#o aor#a

ul%o #enan1

6 Peme*i)saan 6T9s3an )e(a!a $an(a )0n$*as, $an++a! %C=1

+. Ta%5a! les 75o0ens 5a0a lous 5are#al

!r en#u! 9e01n1 sa%5a !e 0aera7

!or#!al4 a#as 1ra,97#e %a##er 0 re1o

#erseu# #a%5a! !aur.

-. Ta%5a! !als?!as 5a0a n#er?al! an#eror.

:. Sul!us !or#!als 0an ?ssure la#erals Sl>

!anan !r #a! %ene%5#.. D??erensas sus#ansa ala 0an 1rsea

a!.

8. Ven#r!el la#erals !anan !r4 III4 0an IV

a!.

6. Ta! #a%5a! %0lne s7?#n1.

;. Ss#e%a 5er%esen=e57al #a! %ene%5#.

/. ons 0an sereelu% a!.

Kesan : In?ar! 0 lous 5are#al !r

8


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Kals?!as 5a0a n#er?al! an#eror

Ta! #a%5a! 5er0ara7an4 %au5un 1a%aran 5enn1!a#an #e!anan n#ra!ranal

5a0a CT s=an !e5ala #an5a !on#ras saa# n

RINGKASAN

1 S"@e)$i;

asen 5ere%5uan erusa 86 #a7un 0a#an1 !e IBD 0en1an !elu7an =ara 5elo seja! -

7ar S*RS. Kelu7an #erseu# %un=ul #a " #a saa# %ala% 7ar 0an 05erera# saa#

an1un #0ur. asen %en1a!u a79a ana!na %el7a# r 5asen %en=on1@%ero#

se#ela7 5asen an1un 5a1. asen ju1a %en1elu7 len1an 0an #un1!a !anan 5asen

%ula #erasa le%a7 0an0n1!an len1an 0an #un1!a !r 5asen. Na%un4 5asen %as7

sa un#u! erjalan. asen ju1a %e1elu7 !e5ala #erasa sa!#4 na%un #0a! 0ser#a 0en1an

%un#a7. asen %en1a!u 5erna7 %en1elu7 !esul#an un#u! %enelan.

% O@e)$i;

a S$a$"s +ene*a!isTe!anan 0ara7 & +:@/ %%21

Teln1a & se!re# ()4 0s=7ar1e %u!o5urulen4 5er?oras ()

S$a$"s ne"*0!0+is

N.VII & Sul# %e%5erl7a#!an 11 seela7 !anan

N.VIII & 5en0en1aran er!uran1 saa# %en0en1ar suara ers! 5a0a seela7 !r

N.GII & l0a7 0e>as !e seela7 !anan4 0sa#ra ()

An11o#a 1era! a#as a1an !anan & !e!ua#an 44 0an re?le!s se5s4 #rse5s4 0an

7o??%an #ro%%er ()

An11o#an 1era! a9a7 a1an !anan & !e!ua#an 44 0an re?le!s 5a#ella 0an A=7lles

()H4 re?le!s 5a#olo1s ans!4 =7a00o=!4

o55en7e%4 1or0on4 s=7ae??er ()

3 Peme*i)saan !a0*a$0*i"m

LED + ja% & // %%@ja% (H)

9


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LED - ja% & ++6 %%@ja% (H)

. Peme*i)saan *a.i0!0+i *0n$+en $#0*a)s

Kar0o%e1al

Elon1a#o aor#a

e Peme*i)saan 6T9s3an )e(a!a

In?ar! 0 lous 5are#al !r

Kals?!as 5a0a n#er?al! an#eror

DIAGNOSIS

+. Da1noss Klns & 7e%5aress 0e3#ra #5e s5as#!4 5arese N. VII #5e sen#ral

0e3#ra4 0sa#ra #5e sen#ral

-. Da1noss #o5s & 7e%s?er =erer sns#ra

:. Da1noss e#olo1! & s#ro!e non 7e%orra1!@s#ro!e s!e%!

DD@ s#ro!e 7e%ora1!

. Da1noss #a%a7an & 5re,75er#ens

O##s *e0a Su5ura#? Krons

Kar0o%e1al

REN6ANA

+. Konsul !e T2T

-. Konsul !e Re7al#as *e0!

PENATALAKSANAAN

+. Tera5 %e0!a%en#osa Neoro#a% : 1r (ers 5ra=e#a%) +3+ .>

en#o!s?ln : %1 +3+ .>

$rana=# 8 %1 (ers =#=olne) 3+ 5er oral

Clo50o1rel ;8 %1 +3+ 5er oral

A%lo05ne + %1 +3+ 5er oral

-. Tera5 non %e0!a %en#osa

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IVFD RL 8 %1 - #e#es@%en#

Fso#era5

PROGNOSIS

+. A0 >#a% & Dua a0 ona%

-. A0 ?un1sona% & Dua a0 ona%

:. A0 sana#ona% & Dua a0 ona%

PEMBAHASAN

$er0asar!an ana%ness an1 05erole7 0ar N. S erusa 86 #a7un 0en1an !elu7an

=ara 5elo seja! - 7ar S*RS 0an !eeso!an 5a1na saa# an1un #0ur4 !elu7an an1

0rasa!an se%a!n la%a se%a!n era# 0en1an 5eruru!an %ulu# %ero#. asen ju1a

%en1elu7 !ele%a7an 5a0a len1an 0an #un1!a seela7 !anan 0an !e5ala #erasa sa!#4 na%un

#0a! 0ser#a 0en1an %un#a7. asen 00a1noss sea1a s#ro!e non 7e%ora1!@s#ro!e

s!e%!4 !arena sesua #eor an#ara 5ere0aan 0ar s#ro!e 7e%ora1! 0en1an s#ro!e non

7e%ora1! sea1a er!u &

Ge@a!a S$*0)e #em0*a+i) S$*0)e n0n #em0*a+i)

Onse# a#au a9#an *en0a0a! *en0a0a!

Saa# onse# Se0an1 a!#? Is#ra7a#

ern1a#an ,

Ner !e5ala @,

*un#a7 ,

enurunan !esa0aran @,

Sesua #eor ju1a4 5asen %en1ala% ?ase " ?ase 5a0a !ea0aan s#ro!e non 7e%ora1!4 sea1a

er!u# &

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+. Seran1an Is!e%a Se5n#as@Transient Ischemic Attack (TIA)

a0a en#u! n 1ejala7 neurolo1! an1 #%ul a!a# 1an11uan 5ere0aran

0ara7 0 o#a! a!an %en17lan1 0ala% 9a!#u - ja%.

-. De?s# Neurolo1! Is!e%a Se5n#as@Reversible Ischemic Neurological Deficit

(RIND).

Bejala neurolo1! an1 #%ul a!an %en17lan1 0ala% 9a!#u le7 0ar - ja%4

#a5 #0a! le7 0ar se%n11u.

:. S#ro!e 5ro1res? (Progressive Stroke/Stroke in evolution)

Bejala neurolo1! %a!n la%a %a!n era#.

. S#ro!e !o%5le# (Comlete! Stroke/Permanent Stroke)

Bejala !lns su0a7 %ene#a5.

$er0asar!an 0ar al1or#%a 0an 5enlaan s!or s#ro!e4 un#u! %en0a1noss s#ro!e

a5a!a7 %eru5a!an 5asen #er%asu! s#ro!e 7e%ora1! a#au non 7e%ora1!4 0a5a# 01una!an -

en#u! a#u srraj s#ro!e s=ore 0an al1or#%a 1a0ja7 %a0a. a0a 5asen n 0la!u!an

!e0uana.

Srraj S#ro!e S=ore (-483!esa0aran) (-3ner !e5ala) (-3%un#a7) (4+3#e!anan 0ara7

0as#ol) " (:3a#ero%a) " +-

(-483) (-3+) (-3) (4+3/) " (:3) " +-

,-

Kes%5ulan4 er0asar!an 0ar srraj s#ro!e s=ore4 5asen %en1ala% n?ar! 5a0a o#a!

se7n11a %en%ul!an 1ejala s#ro!e non 7e%ora1!@s#ro!e s!e%!.

Na%un4 0a5a# 0er!an 0a1noss an0n1 eru5a s#ro!e 7e%ora1! 0en1an 00asar!an

al1or#%a 1a0ja7 %a0a4 a#u 00a5a#!an ner !e5ala () 0an re?le!s ans! ().

asen ju1a %en1ala% 5re,75er#ens4 an1 sesua 0en1an JNC VII a#u &

KLASIFIKASI TD SISTOLIK TD DIASTOLIK

Nor%al +- %%21 0an / %%21

P*e9#i(e*$ensi 1%C91 mmH+ a$a" C9 mmH+

25er#ens s#a0u% + +,+8< %%21 a#au


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TINJAUAN PUSTAKA

I. De?ns

De?ns W2O4 s#ro!e a0ala7 %en?es#as !ln! 0ar 1an11uan ?un1s sereral4 a! ?o!al

%au5un %eneluru7 (1loal)4 an1 erlan1sun1 0en1an =e5a#4 sela%a le7 0ar - ja% a#au

era!7r 0en1an %au#4 #an5a 0#e%u!anna 5enea lan selan 1an11uan >as!uler.+

II. Fa!#or res!o

A. Fa!#or res!o an1 #0a! 0a5a# 0%o0?!as &

+. U%ur

-. Jens !ela%n

:. Ras 0an su!u an1sa

. Fa!#or !e#urunan

$. Fa!#or rs!o an1 0a5a# 0%o0?!as&

+. erla!u&

*ero!o!4

De# #0a! se7a#& le%a!4 1ara% erle7an4 asa% ura#4

Koles#erol4 !uran1 ua74

Al!o7ol!4

Oa#,oa#an& nar!oa (!o!an)4 an# !oa1ulansa4 an# 5la#ele#4

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A%?e#a%n4 5l !on#rase5s4

Kuran1 1era! a0an.

-. Fsolo1s&

ena!# 75er#ens4

ena!# jan#un14

Dae#es %ell#us4

In?e!s@lues4 ar#er#s4 #rau%a#!4 a0s4 lu5us4

Ban11uan 1njal4

Ke1e%u!an (oes#as)4

ols#e%a4 >s!os#as 0ara7 %enn11 0an 5ena!# 5er0ara7an4

Kelanan ano%al 5e%ulu7 0ara74

S#enoss !aro#s as%#o%a#!.+

III. Klas?!as

$er0asar!an a#as jensna4 s#ro!e 0a1 %enja0 &

+. Jens o!lus (s#ro!e non 7e%ora1!@s!e%!)

Da5a# #erja0 !arena e%ol an1 le5as 0ar su%erna4 asana erasal 0ar

jan#un1 a#au 5e%ulu7 ar#er o#a! a! n#ra=ranal %au5un e!s#ra!ranal a#au

#ro%o#!@ ar#ers!lero#! ?o!al 5a0a 5e%ulu7 ar#er o#a! an1 ern1sur,an1sur%ene%5# 0an a!7rna #ersu%a#.

-. Jens 5er0ara7an (s#ro!e 7e%ora1!)

Dsea!an 5e=a7na 5e%ulu7 0ara7 o#a! a! n#ra=ranal %au5un

suara!no0. a0a 5er0ara7an n#ra=ranal4 5e=a7na 5e%ulu7 0ara7 o#a! 0a5a#

!arena err aneurs% a!a# 75er#ens #a! #er!on#rol an1 %en1ua7 %or?olo1

ar#erol o#a! a#au 5e=a7na 5e%ulu7 0ara7 o#a! !arena !elanan =on1en#al 5a0a

5e%ulu7 0ara7 o#a! #erseu#. er0ara7an suara!no0 0sea!an 5e=a7na

aneurs%a =on1en#al 5e%ulu7 ar#er o#a! 0 ruan1 suara!no0.+

IV. a#o?solo1

In?ar! re1onal !or#!al4 su!or#!al a#au5un n?ar! re1onal 0 a#an1 o#a! #erja0 !arena

!a9asan 5er0ara7an sua#u ar#er #0a!@!uran1 %en0a5a# ja#a7 0ara7 la1. Ja#a7 0ara7 #0a!

0sa%5a!an !e 0aera7 #erseu#. Les an1 #erja0 0na%a!an n?ar! s!e%! j!a ar#er

#ersu%a# 0an n?ar! 7e%ora1! j!a ar#er 5e=a7. *a!a 0ar #u MS#ro!e 0a5a# 0a1 0ala% &

14


15/34

S#ro!e s!e%! @ Non 2e%oro1!

S#ro!e s!e%! n 0a1 %enja0 : jens4 a#u &

+. S#ro!e #ro%o#!@a#eros!lero#! ?o!al

Jens s#ro!e n #erja0 !e#!a 1u%5alan 0ara7 (#ro%us) #eren#u! 0 sala7sa#u ar#er an1 %e%aso! 0ara7 !e o#a! an1 eran1sur,an1sur %ene%5# 0an

a!7rna #ersu%a#. $e!uan asana #eren#u! 0 !a9asan an1 rusa! ole7

a#eros!leross a#u 5ena!# 0 %ana ar#er #ersu%a# ole7 #%unan le%a!

(5la!). roses n 0a5a# #erja0 0ala% sa#u 0ar 0ua ar#er !aro#s le7er an1

%e%a9a 0ara7 !e o#a!4 ser#a 0 ar#er lan 0ar le7er a#au o#a!. Tro%oss

(5ena!# #ro%o,o!lus?) %eru5a!an 5enea s#ro!e an1 5aln1 sern1.

Ar#eros!leross sereral 0an 5erla%a#an sr!ulas sereral a0ala7 5enea

u#a%a #ro%oss sereral. Tan0a,#an0a #ro%oss sereral er>aras4 sa!# !e5ala

a0ala7 a9#an an1 #0a! u%u%. $eera5a 5asen %en1ala% 5usn14 5erua7an

!o1n#? a#au !ejan1 0an eera5a a9#an u%u% lanna. Se=ara u%u% #ro%oss

sereral #0a! #erja0 se=ara #a,#a4 0an !e7lan1an =ara se%en#ara4 7e%5le1a

a#au 5ares#esa 5a0a se#en1a7 #uu7 0a5a# %en0a7ulu a9#an 5aralss era# 5a0a

eera5a ja% a#au 7ar.

roses a#eros!leross 0#an0a ole7 5la! erle%a! 5a0a 5a0a la5san n#%a

ar#er esar. $a1an n#%a ar#er sereer %enja0 #5s 0an erserau#4 se0an1!an

sel " sel o#o#na %en17lan1. La%na elas#!a n#erna roe! 0an erju%a4

se7n11a lu%en 5e%ulu7 sea1an #ers ole7 %a#er s!lero#! #erseu#. la!

=en0erun1 #eren#u! 5a0a 5er=aan1an a#au #e%5a#,#e%5a# an1 %elen1!un1.

Tro% ju1a 0!a#!an 0en1an #e%5a#,#e%5a# !7usus #erseu#. e%ulu7,

5e%ulu7 0ara7 an1 %e%5una res!o 0ala% uru#an an1 %a!n jaran1 a0ala7

sea1a er!u#& ar#era !aro#s n#erna4 >er#erals a1an a#as 0an aslars a9a7.

2lan1na n#%a a!an %e%ua# jarn1an !a# #er5a5ar. Tro%os# %ene%5el 5a0a

5er%u!aan an1 #eru!a se7n11a 5er%u!aan 0n0n1 5e%ulu7 0ara7 %enja0

!asar. Tro%os# a!an %ele5asa!an en%4 a0enosn 0?os?a# an1 %en1a9al

%e!ans%e !oa1ulas. Su%a# ?rno#ro%os# 0a5a# #erle5as 0an %e%en#u!

e%ol4 a#au 0a5a# #e#a5 #n11al 0 #e%5a# 0an a!7rna seluru7 ar#era #u a!an

#ersu%a# 0en1an se%5urna.

-. S#ro!e e%ol!

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16/34

en0er#a e%ols%e asana le7 %u0a 0an0n1 0en1an 5en0er#a

#ro%oss. Keana!an e%ol serer erasal 0ar sua#u #ro%us 0ala% jan#un14

se7n11a %asala7 an1 07a0a5 seenarna a0ala7 5er9uju0an 0ar 5ena!#

jan#un1. Se#a5 a1an o#a! 0a5a# %en1ala% e%ols%e4 #e#a5 e%olus asana

e%olus a!an %enu%a# a1an,a1an an1 se%5#. Te%5a# an1 5aln1 sern1

#erseran1 e%olus sereer a0ala7 ar#era sereer %e0a4 #eru#a%a a1an a#as.

:. 25o5er?us ss#e%! & $er!uran1na alran 0ara7 !e seluru7 a1an #uu7 !arena

a0ana 1an11uan 0enu# jan#un1.

Pa$0;isi0!0+i s$*0)e is)emi) a)"$

a) *asala7 >as!ular4 7e%a#olo14 0an jan#un1 a!a# er!uran1 a#au er7en#na

alran 0ara7.

) *asala7 5erua7an o!%a a!a# s!e%!4 0a5a# #erja0 0e!ross jarn1an

o#a!& neuron4 sel 1la4 0an lan,lan.

J!a #erja0 o!lus a#au 75o5er?us o#a! an1 alran 0ara7 o#a! nor%al +8,

- 0ar car!iac outut4 j!a C$F a#au alran 0ara7 o#a! - %l@%en#@+1r o#a!

%a!a o#a! a!an era0a 0ala% !ea0aan s!e%!4 se7n11a #erja0 1an11uan ?un1s

o#a! 0an 5a0a EEB a!an #%ul 5erla%a#an4 na%un la C$F !e%al nor%al4

%a!a 1an11uan ?un1s a!an 5ul7 !e%al.

$la C$F /,+ %l@%en#@+1r o#a!4 sel o#a! 0ala% !ea0aan n?ar! 0an

la #0a! se1era 0a#as a!an #%ul 0e?s# neurolo1s se7n11a #%ul !e=a=a#an

0an !e%a#an. Daera7 se!elln1 an1 #eran=a% 0seu# 0aera7 5enu%ra4 0 %anasel elu% %a# #a5 ?un1s er!uran1 0an %en1a!a#!an 0e?s# neurolo1!. *a!a

0ar #u4 sasaran #era5 s#ro!e s!e%! a!u# a1ar 0aera7 5enu%ra 0a5a# 0re5er?us

0an sel o#a! 0a5a# er?un1s !e%al. Re>ersl#as #er1an#un1 ?a!#or 9a!#u.

Dse!elln1 0aera7 5enu%ra #er0a5a# area 75ere%! !arena alran 0ara7

!ola#eral@lu"ur# erfusion area.

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17/34

Me)anisme )ema$ian se! 0$a)

+. roses ne!ross4 le0a!an sel a!u# a!a# 5en17an=uran s#os!ele#on sel4 rea!s

n?la%as 0an 5roses ?a1os#oss 0ers ne!ro#!. $er7uun1an 0en1an e"itoto"ic

in$ur# 0anfree ra!ical in$ur#.

-. roses a5o5#oss a#au slen# 0ea#74 s#os!ele#on neuron %en=u# #an5a rea!s

n?la%as seluler. Kas!a0e s!e%!4 la%a#4 0an er7uun1an 5roses 5o%5a on

na#ru% 0an !alu%.

S#ro!e 7e%ora1!

e%ulu7 0ara7 an1 5e=a7 %enea!an 0ara7 %en1alr !e sus#ans a#au

ruan1an suara=7no0 an1 %en%ul!an 5erua7an !o%5onen n#ra=ranal an1

se7arusna !ons#an. A0ana 5erua7an !o%5onen n#ra=ranal an1 #0a! 0a5a#

0!o%5ensas #uu7 a!an %en%ul!an #n1!a#an TIK an1 la erlanju# a!an

%enea!an 7ernas o#a! se7n11a #%ul !e%a#an. Dsa%5n1 #u4 0ara7 an1

%en1alr !e sus#ans o#a! a#au ruan1 suara=7no0 0a5a# %enea!an e0e%a4

s5as%e 5e%ulu7 0ara7 o#a! 0an 5ene!anan 5a0a 0aera7 #erseu# %en%ul!an alran

0ara7 er!uran1 a#au #0a! a0a se7n11a #erja0 ne!ross jarn1an o#a!.-

V. Da1noss

+. $er0asar!an ana%ness

Tael 5ere0aan s#ro!e 7e%ora1! 0an s#ro!e n?ar! er0asar!an ana%ness:

Ge@a!a S$*0)e #em0*a+i) S$*0)e n0n #em0*a+i)

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18/34

Onse# a#au a9#an *en0a0a! *en0a0a!

Saa# onse# Se0an1 a!#? Is#ra7a#

ern1a#an ,

Ner !e5ala @,

Kejan1 ,

*un#a7 ,enurunan !esa0aran @,

-. $er0asar!an 5e%er!saan ?s! neurolo1

Tael 5ere0aan s#ro!e 7e%ora1! 0an s#ro!e n?ar! er0asar!an #an0a,#an0ana

Tan.a S$*0)e #em0*a+i) S$*0)e In;a*) $ra0!ar0 (0ar a9al) @, (7ar !e )

U0e% 5a5l Sern1 ,

Ka!u !u0u! ,

Tan0a !ern14 ru0n! ,

:. Al1or#%a 0an 5enlaan s!or s#ro!e

a. Srraj S#ro!e S=ale

Vers orsnal&

(./ 3 !esa0aran) (.66 3 %un#a7) (.:: 3 sa!# !e5ala) (.::3 #e!anan

0ara7 0as#ol!) " (.


19/34

S!or + & er0ara7an o#a!

,+& In?ar! o#a!

. Al1or#%a Ba0ja7 *a0a8

VI. S#ro!e Non 2e%ora1!@S#ro!e Is!e%!

S#ro!e s!e%! 0a5a# 0ju%5a 0ala% en#u! !lns&

+. Seran1an Is!e%a Se5n#as@Transient Ischemic Attack (TIA)

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20/34

a0a en#u! n 1ejala7 neurolo1! an1 #%ul a!a# 1an11uan 5ere0aran 0ara7

0 o#a! a!an %en17lan1 0ala% 9a!#u - ja%.

-. De?s# Neurolo1! Is!e%a Se5n#as@Reversible Ischemic Neurological Deficit

(RIND). Bejala neurolo1! an1 #%ul a!an %en17lan1 0ala% 9a!#u le7 0ar - ja%4

#a5 #0a! le7 0ar se%n11u.

:. S#ro!e 5ro1res? (Progressive Stroke/Stroke in evolution)

Bejala neurolo1! %a!n la%a %a!n era#.

. S#ro!e !o%5le# (Comlete! Stroke/Permanent Stroke)

Bejala !lns su0a7 %ene#a5.+

Bejala s#ro!e non 7e%ora1! &

Bejala s#ro!e non 7e%ora1! an1 #%ul a!a# 1an11uan 5ere0aran 0ara7 0 o#a!

er1an#un1 5a0a era# rn1anna 1an11uan 5e%ulu7 0ara7 0an lo!as #e%5a# 1an11uan

5ere0aran 0ara7 #erja04 %a!a 1ejala,1ejala #erseu# a0ala7&6

+. Bejala a!a# 5enu%a#an ar#er !aro#s n#erna.

$u#a %en0a0a! (amaurosis fugaks).

Ke#0a!%a%5uan un#u! er=ara a#au %en1er# a7asa lsan (!isfasia) la

1an11uan #erle#a! 5a0a ss 0o%nan.

Kelu%5u7an 5a0a ss #uu7 an1 erla9anan (hemiaresis kontralateral) 0an

0a5a# 0ser#a sn0ro% 2orner 5a0a ss su%a#an.

-. Bejala a!a# 5enu%a#an ar#er serer an#eror.

%emiaresis kontralateral 0en1an !elu%5u7an #un1!a le7 %enonjol. Ban11uan %en#al.

Ban11uan sensl#as 5a0a #un1!a an1 lu%5u7.

Ke#0a!%a%5uan 0ala% %en1en0al!an uan1 ar.

$sa #erja0 !ejan1,!ejan1.

:. Bejala a!a# 5enu%a#an ar#er serer %e0a.

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21/34

$la su%a#an 0 5an1!al ar#er4 #erja0 !elu%5u7an an1 le7 rn1an. $la #0a!

0 5an1!al %a!a len1an le7 %enonjol.

Ban11uan sara? 5erasa 5a0a sa#u ss #uu7.

2lan1na !e%a%5uan 0ala% era7asa (ahasia).

. Bejala a!a# 5enu%a#an ss#e% >er#eroaslar. Kelu%5u7an 0 sa#u sa%5a !ee%5a# e!s#re%#as.

*enn1!a#na re?le!s #en0on.

Ban11uan 0ala% !oor0nas 1era!an #uu7.

Bejala,1ejala serelu% se5er# 1e%e#ar 5a0a #an1an (tremor)4 !e5ala er5u#ar

(vertigo).

Ke#0a!%a%5uan un#u! %enelan (!isfagia).

Ban11uan %o#ors 5a0a l0a74 %ulu#4 ra7an1 0an 5#a suara se7n11a 5asen sul#

=ara (!isatria)

Ke7lan1an !esa0aran se5n#as (sinko)4 5enurunan !esa0aran se=ara len1!a5

(struor)4 !o%a4 5usn14 1an11uan 0aa n1a#4 !e7lan1an 0aa n1a# #er7a0a5

ln1!un1an (!isorientasi).

Ban11uan 5en1l7a#an4 se5er# 5en1l7a#an 1an0a (!iloia)4 1era!an ara7 ola

%a#a an1 #0a! 0!e7en0a! (nistagmus)4 5enurunan !elo5a! %a#a (tosis)4

!uran1na 0aa 1era! %a#a4 !eu#aan se#en1a7 la5an1 5an0an1 5a0a ela7an

!anan a#au !r !e0ua %a#a (hemianoia homonim).

Ban11uan 5en0en1aran.

Rasa !a!u 0 9aja74 %ulu# a#au l0a7.

8. Bejala a!a# 5enu%a#an ar#er serer 5os#eror

Ko%a

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%emiaresis kontra lateral.

Ke#0a!%a%5uan %e%a=a (aleksia).

Kelu%5u7an sara? !ranals !e#1a.

Bejala a!a# 1an11uan ?un1s lu7ur

Ahasia a#u 7lan1na !e%a%5uan 0ala% era7asa& Ahasia 0a1 0ua a#u4

Ahasia motorik a0ala7 !e#0a!%a%5uan un#u! er=ara4 %en1eluar!an s

5!ran %elalu 5er!a#aanna sen0r4 se%en#ara !e%a%5uanna un#u! %en1er#

=ara oran1 lan #e#a5 a!& Ahasiasensorik a0ala7 !e#0a!%a%5uan un#u!

%en1er# 5e%=araan oran1 lan4 na%un %as7 %a%5u %en1eluar!an 5er!a#aan

0en1an lan=ar4 9alau sea1an 0an#arana #0a! %e%l! ar#4 #er1an#un1 0ar

luasna !erusa!an o#a!.

Ale"ia a0ala7 7lan1na !e%a%5uan %e%a=a !arena !erusa!an o#a!.

De0a!an 0ar Dsle3a (an1 %e%an1 a0a se=ara !on1en#al)4 a#u 'erbal

ale"ia a0ala7 !e#0a!%a%5uan %e%a=a !a#a4 #e#a5 0a5a# %e%a=a 7uru?.

ateral ale"ia a0ala7 !e#0a!%a%5uan %e%a=a 7uru?4 #e#a5 %as7 0a5a#

%e%a=a !a#a. J!a #erja0 !e#0a!%a%5uan !e0uana 0seu# lobal ale"ia&

Agrahia a0ala7 7lan1na !e%a%5uan %enuls a!a# a0ana !erusa!an o#a!.

Acalculia a0ala7 7lan1na !e%a%5uan er7#un1 0an %en1enal an1!a se#ela7

#erja0na !erusa!an o#a!.

Right*eft Disorientation + Agnosia $ari (,o!# Image) a0ala7 seju%la7 #n1!a#

!e%a%5uan an1 san1a# !o%5le!s4 se5er# 5ena%aan4 %ela!u!an 1era!an an1

sesua 0en1an 5ern#a7 a#au %enru!an 1era!an,1era!an #er#en#u. Kelanan n

sern1 ersa%aan 0en1an A1nosa jar (0a5a# 0l7a# 0ar 0suru7 %eneu#!an

na%a jar an1 0sen#u7 se%en#ara 5en0er#a #0a! ole7 %el7a# jarna).

%emi satial neglect ('iso satial agnosia) a0ala7 7lan1na !e%a%5uan

%ela!sana!an er%a=a% 5ern#a7 an1 er7uun1an 0en1an ruan1.

S#n!rome obus -rontal4 n er7uun1an 0en1an #n1!a7 la!u a!a# !erusa!an

5a0a !or#e3 %o#or 0an 5re%o#or 0ar 7e%s57ere 0o%nan an1 %enea!an

#erja0na 1an11uan =ara.

Amnesia a0ala7 1an11uan %en1n1a# an1 0a5a# #erja0 5a0a #rau%a =a5#s4

n?e!s >rus4 s#ro!e4 ano3a 0an 5as=a o5eras 5en1an1!a#an %assa 0 o#a!.

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Dementia a0ala7 7lan1na ?un1s n#ele!#ual an1 %en=a!u5 seju%la7

!e%a%5uan.

e$ala lesi !i corte".

- 2e%5le1a !on#rala#eral

- A?asa

- A0a ?ase so!@?ase a!u# a#u 0%ana 1ejala !elu%5u7an U*N elu% %enunju!!an

1an11uan !elu%5u7an #5e U*N.

e$ala lesi !i subcorte"&

- 2e%5le1a 0 !on#rala#eral

- A?asa

e$ala lesi !i casula interna.

- 2e%5le1a

- T0a! a0a a?asa

- Dser#a 1an11uan e!s#ra5ra%0al eru5a r10#as a#au 75ere?le!s, un#u!

%e%e0a!an 0en1an les 0 =or#e3.

- Bejala !elu%5u7an #5e U*N su0a7 #a%5a! 5a0a ?ase a!u#.

e$ala lesi !i batang otak.

2e%5le1a !on#rala#eral&

o Sn0ro%a Weer

o Sn0ro%a *llar0 " Buler

o Sn0ro%a Wallener1

VII.S#ro!e 2e%ora1!

*enuru# W2O4 0ala% International Statistical Classification of Diseases an! Relate!

%ealth Problem 0th Revision1 s#ro!e 7e%ora1! 0a1 a#as&6

a. er0ara7an In#rasereral (IS)

er0ara7an In#rasereral (IS) a0ala7 5er0ara7an an1 5r%er erasal 0ar

5e%ulu7 0ara7 0ala% 5aren!% o#a! 0an u!an 0sea!an ole7 #rau%a.er0ara7an

n ana! 0sea!an ole7 75er#ens4 selan #u ?a!#or 5enea lanna a0ala7

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24/34

aneurs%a !r5#o1en!4 0s!rasa 0ara74 5ena!# 0ara7 se5er# 7e%o?la4 leu!e%a4

#ro%os#o5ena4 5e%a!aan an#!oa1ulan an1o%a#osa 0ala% o#a!4 #u%or o#a! an1

#u%u7 =e5a#4 a%lo0oss serero>as!ular.

aln1 sern1 !arena 5e=a7na %!roaneurs%a 5a0a ar#er 5ene%us 0

=a5sula n#erna 0an 1an1la asales. Fa!#ro,?a!#or 5enea& usa lanju#4

ar#eros!leross4 75er#ens !rons4 #e!anan 0ara7 na! %en0a0a!4 !eja0an asana

0ala% !ea0aan sa0ar 0an a!#?.

Ge@a!a "m"m:

Bejala #%ul %en0a0a! er!e%an1 0ala% eera5a %en#,ja%4 7e%a#o%

%e%esar4 %ene!an4 %ene%us4 %erusa! 0aera7 se!#arna. Te!anan n#ra!ranu%

%enn11P sa!# !e5ala4 %un#a74 !esa0ran %enurun. Dara7 %asu! !e ruan1

suara=7no0al P %enn1s%us.Dara7 %asu! !e >en#r!el P 0e=ereras(5ro1nosa

uru!)4#%ulna #e1an1@!a!u.

Ge@a!a ;0)a!:

Ter1an#un1 #e%5a# 7e%a#o% o0e% !ola#eral4 5er1eseran 0an #e!anan 5a0a

s#ru!#ur lan (7ernas). Da1nosa #e5a# 5un1s lu%al (0ulu)4 se!aran1 0en1an CT

s=an. er0ara7an n#ra=ereral 0a5a# 0sea!an n?ar! 7e%ora1s4 #rau%a4 #u%or4

%al?or%as4 5e%ulu7 0ara7 (AV*)4 >as!ul#s4 !oa1ulo5a#.

. er0ara7an Suara!7no0al (SA)

er0ara7an Suara!7no0al (SA) a0ala7 !ea0aan #er0a5a#na@%asu!na

0ara7 !e 0ala% ruan1an suara!7no0al. er0ara7an n #erja0 !arena 5e=a7na

aneurs%a (8)4 5e=a7na %al?or%as ar#ero>ena a#au *AV (8)4 erasal 0ar IS

(-) 0an -8 !ausana #0a! 0!e#a7u.

Sea & 5e=a7na !on1en#al aneurs%a4 AV*4 5ena!# 7ae%ora1!.

en0er#a le7 %u0a (:,8 #7n).*en0a0a! sa!# !e5ala san1a#4 %un#a7,%un#a74

%enn1s%us4 !ejan14 5enurunan !esa0aran =e5a# !o%a P !e%a#an.

Bejala ?o!al jaran1 #er1an#un1 s#ru!#ur se!#ar aneurs%a. Aneurs%a

asana #er0a5a# 5a0a anas#o%ose 0 =r=ulus ar#erosus Wlls.

Da1nosa&

- un1s lu%al4analsa =aran =ereros5nal (0ulu).

- C# s=an 0ara7 0 sul=.

- An1o1ra?

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=. er0ara7an Su0ural

er0ara7an su0ural a0ala7 5er0ara7an an1 #erja0 a!a# roe!na >ena

je%a#an ( bri!ging veins) an1 %en17uun1!an >ena 0 5er%u!aan o#a! 0an snus

>enosus 0 0ala% 0ura%e#er a#au !arena roe!na ara!no0ea.

a0a 5en0er#a 5er0ara7an su0ural a!an 0ju%5a 1ejala& ner !e5ala4 #aja%

5en1l7a#an %un0ur a!a# e0e%a 5a5l an1 #erja04 #an0a,#an0a 0e?s# neurolo1!

0aera7 o#a! an1 #er#e!an. Bejala n #%ul er%n11u,%n11u 7n11a erulan,

ulan se#ela7 #erja0na #rau%a !e5ala.

Deraja# 5er0ara7an suara!7no0 (2un# 0an 2ess);

Deraja# & #0a! a0a 1ejala 0an aneurs%a elu% ru5#ur

Deraja# + & sa!# !e5ala rn1an

Deraja# - & sa!# !e5ala 7ea#4 #an0a ran1san1 %enn1eal4 0an !e%un1!nan

a0ana 0e?s# sara? !ranals

Deraja# : & !esa0aran %enurun4 0e?s# ?o!al neurolo1 rn1an

Deraja# & s#u5or4 7e%5aress se0an1 sa%a5a era#4 a9al 0esereras

Deraja# 8 & !o%a 0ala%4 0esereras

VIII. en1oa#an

A Pena$a!a)sanaan .i *"an+ +a&a$ .a*"*a$?

+. E>aluas =e5a# 0an 0a1noss

Ole7 !arena jen0ela #era5 s#ro!e a!u# san1a# 5en0e!4 e>aluas 0an 0a1noss !ln!

7arus =e5a#. E>aluas 1ejala 0an #an0a !ln! %el5u#&

Ana%ness

e%er!saan ?s!

e%er!saan neurolo1! 0an s!ala s#ro!e

S#u0 0a1nos#! s#ro!e a!u# %el5u# CT s=an #an5a !on#ras4 KBD4 ele!#rol# 0ara74

#es ?un1s 1njal4 EKB4 5enan0a s!e%! jan#un14 0ara7 ru#n4 T@INR4 aTT4 0an

sa#uras o!s1en.

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-. Tera5 u%u%

S#alsas jalan na?as 0an 5erna?asan

Oser>as s#a#us neurolo1s4 na04 #e!anan 0ara74 su7u #uu74 0an sa#uraso!s1en

era!an jalan na?as 0en1an 5e%asan1an 55a oro?arn1@ETT4 la 0ua

%n11u 0anjur!an #ra!eos#o%

a0a 5asen 75o!sa sa#uras O- ena (7n0ar =aran 75o#on!)

O5#%alsas #e!anan 0ara7

$la #e!anan 0ara7 ss#ol! +- %%21 0an =aran su0a7 %en=u!u54 0a5a#

0er!an oa#,oa# >aso5ressor ##ras 0en1an #ar1e# TD ss#ol! + %%21

e%an#auan jan#un1 7arus 0la!u!an sela%a - ja% 5er#a%a

$la #er0a5a# C2F4 !onsul !e !ar0olo1

e%er!saan a9al ?s! u%u%

Te!anan 0ara7

e%er!saan jan#un1

e%er!saan neurolo1 u%u% a9al&

+. Deraja# !esa0aran

-. e%er!saaan 5u5l 0an o!ulo%o#or

:. Ke5ara7an 7e%5aress

en1en0alan 5enn11an TIK

e%an#auan !e#a# #er7a0a5 rs!o e0e%a serer 7arus 0la!u!an 0en1an

%e%5er7a#!an 5eruru!an 1ejala 0an #an0a neurolo1! 5a0a 7ar 5er#a%a

s#ro!e

*on#or TIK 7arus 05asan1 5a0a 5asen 0en1an BCS < 0an 5asen an1

%en1ala% 5enurunan !esa0aran

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Sasaran #era5 TIK - %%21

Ele>as !e5ala -,:Q

2n0ar 5ene!anan >ena ju1ulare

2n0ar 5e%eran =aran 1lu!osa a#au =aran 75o#on!

2n0ar 75er#er%a

Ja1a nor%o>ole%a

Os%o#era5 a#as n0!as& %an#ol 4-8,48 1r@!1$$4 sela%a - %en#4

0ulan1 se#a5 ,6 ja%4 !alau 5erlu 0er!an ?urose%0e 0en1an 0oss nsal +

%1@!1$$ IV

In#uas un#u! %enja1a nor%o>en#las.

Dranase >en#r!uler 0anjur!an 5a0a 70rose?alus a!u# a!a# s#ro!e s!e%!

sereelar

en1en0alan Kejan1

$la !ejan14 er!an 0ae5a% olus la%a# IV 8,- %1 0an 0!u# ?en#on

loa0n1 0ose +8,- %1@!1 olus 0en1an !e=e5a#an %a!s%u% 8 %1@%en#. a0a

s#ro!e 5er0ara7an n#rasereral 0a5a# 0er!an oa# an#e5le5s 5ro?la!ss4 sela%a

+ ulan 0an !e%u0an 0#urun!an 0an 07en#!an la !ejan1 #0a! a0a.

en1en0alan su7u #uu7

Se#a5 5en0er#a s#ro!e an1 0ser#a 0e%a% 7arus 0oa# 0en1an an#5re#!a 0an

0a#as 5eneana. $er Ase#a%no57en 68 %1 la su7u le7 0ar :/48QC.

e%er!saan 5enunjan1

EKB

Laora#oru%& !%a 0ara74 ?un1s 1njal4 7e%a#olo1 0an ?aal 7e%os#ass4 KBD4

analsa urn4 ABDA 0an ele!#rol#

$la =ur1a SA la!u!an 5un!s lu%al

e%er!saan ra0olo1 se5er# CT s=an 0an ron#1en 0a0a

B

Pena$a!a)sanaan "m"m .i *"an+ *a&a$ ina(+. Caran

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$er!an =aran so#ons se5er# 4< saln4 CV 5er#a7an!an an#ara 8,+- %%21

Keu#u7an =aran : %l@!1$$

$alans =aran 05er7#un1!an 0en1an %en1u!ur 5ro0u!s urn se7ar 0#a%a7

5en1eluaran =aran ann1 #0a! 0rasa!an.

Ele!#rol# (Na4 K4 Ca4 *1) 7arus selalu 05er!saa 0an 01an# la #erja0

!e!uran1an

As0oss 0an al!aloss 7arus 0!ore!s sesua 0en1an 7asl ABD.

2n0ar =aran 75o#on! 0an 1lu!osa !e=ual 75o1l!e%a.

-. Nu#rs

Nu#rs en#eral 5aln1 la%a# 0ala% / ja%

$er %a!anan le9a# 55a oro1as#r! la #er0a5a# 1an11uan %enelan a#au !esa0aran

%enurun

a0a !ea0aan a!u# !eu#u7an !alor -8,: !!al@!1@7ar.

:. en=e1a7an 0an %en1a#as !o%5l!as

*olsas 0an 5enlaan 0n un#u! %en=e1a7 !o%5l!as sua!u# (as5ras4

%alnu#rs4 5neu%ona4 DVT4 e%ol 5aru4 0e!u#us4 !o%5l!as or#o5e0! 0an

?ra!#ur)

$er!an an#o#! sesua n0!as 0an usa7a!an #es !ul#ur 0an sens#>#as !u%an

en=e1a7an 0e!u#us 0en1an %olsas #era#as.

. ena#ala!sanaan %e0! an1 lan

25er1l!e%a BD +/ %1@0L 5a0a s#ro!e a!u# 7arus 0oa#4 ##ras nsuln4 0an

#erja1a nor%o1l!e%a. 25o1l!e%a era# BD 8 %1@0L4 er!an 0e!s#rosa

> a#au n?us 1lu!osa +,-

J!a 1elsa7 0a5a# 0er!an eno0ae5n a#au oa# an# =e%as lanna

Anal1es! 0an an# %un#a7 sesua n0!as

$er!an 2-an#a1ons#4 a5ala a0a n0!as

*olsas er#a7a5 la 7e%o0na%! 0an 5erna?asan s#al

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Re7al#as

E0u!as !eluar1a

Discharge lanning

6 Ta$a!a)sana S$*0)e A)"$ se3a*a K#"s"s

ena#ala!sanaan !7usus s#ro!e s!e%!

+. en1oa#an 75er#ens 5a0a s#ro!e a!u#

-. en1oa#an 75er@75o1l!e%a

:. Tro%olss 5a0a s#ro!e a!u#

. An#!oa1ulan&

An#!oa1ulan 5en#n1 un#u! %en=e1a7 seran1an s#ro!e ulan14 %en17en#!an

5eruru!an 0e?s# neurolo14 %e%5era! !eluaran se#ela7 s#ro!e s!e%! a!u#

(#0a! 0re!o%en0as!an un#u! s#ro!e 7e%ora1! a!u#)

T0a! 0re!o%en0as!an 5en0er#a s#ro!e a!u# se0an1 sa%5a era#4 !arena res!o

!o%5l!as 5er0ara7an n#ra!ranal %en1n1!a#

2e5arn4 L*W24 7e5arno0 un#u! #era5 s#ro!e s!e%! a!u# 0an =e1a7

ree%olsas4 0se!s ar#er4 s#enoss era# ar#er !aro#s 5re e0a7.

KI 7e5arn& n?ar! esar 84 75er#ens #a! #er!on#rol4 0an 5erua7an

%!ro>as!uler o#a! an1 luas

8. An#5la#ele# Clo50ro1el

As5rn 0oss a9al :-8 %1 0ala% -,/ ja% se#ela7 a9#an s#ro!e s!e%! a!u#

As5rn jan1an 0er!an la a!an 0er!an #ro%ol#!

T0a! ole7 01an# sea1a 5en11an# #n0a!an n#er>ens a!u#4 a#u r#A

n#ra>ena.

Clo50o1rel sa7aja a#au !o%nas 0en1an as5rn #0a! 0anjur!an !e=ual 5a0a

5asen 0en1an n0!as s5es?! se5er# non,,9a>e *I4 re=en# s#en#n14

5en1oa#an 7arus 0er!an sa%5a < ulan 5en1oa#an.

e%eran an#5la#le# n#ra>ena an1 %en17a%ar rese5#or 1l!o5ro#en II@IIa

#0a! 0anjur!an.

6. C#=olne -3+ %1 : 7ar > lanju# 0en1an -3+ %1 : %n11u oral. e%a!aan

oa#,oa#an neuro5ro#e!#an elu% %enunju!!an 7asl an1 e?e!#? se7n11a sa%5a

29


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saa# n elu% 0anjur!an. Na%un sa%5a saa# n %as7 %e%er!an %an?aa# 5a0a

s#ro!e a!u#.

;. en1oa#an #er7a0a5 75er#ens 5a0a s#ro!e a!u#

asen s#ro!e s!e%! a!u#4 #e!anan 0ara7 0#urun!an +8 (ss#ol! %au5un0as#ol!) 0ala% - ja% 5er#a%a se#ela7 a9#an a5ala #e!anan 0ara7 ss#ol!

(TDS) -- %%21 a#au #e!anan 0as#ol! +- %%21. a0a 5asen s#ro!e

s!e%! a!u#4 a!an 0er #era5 #ro%ol#! (r#A)4 su5aa #e!anan 0ara7

0#urun!an se7n11a TDS +/8 %%21 0an TDD ++ %%21. Selanju#na

#e!anan 0ara7 7arus 05an#au se7n11a TDS +/ %%21 0an TDD +8

%%21 sela%a - ja% se#ela7 5e%eran r#A. Oa# an# 75er#ens an1

01una!an a0ala7 la#alol4 n#ro5as#e4 n#ro5us04 n!ar05un4 a#au 0#ale%

n#ra>ena.

A5alan TDS +/ %%21 a#au *A +: %%214 0ser#a 0en1an 1ejala 0an

#an0a 5enn1!a#an #e!anan n#ra!ranal4 0la!u!an 5e%an#auan #e!anan

n#ra!ranal. Te!anan 0ara7 0#urun!an 0en1an %en11una!an oa# an#75er#ens

n#ra>ena se=ara !on#nu a#au n#er%#en 0en1an 5e%an#auan #e!anan 5er?us

sereral 6%%21.

A5ala TDS +/ %%21 a#au *A +: %%21 #an5a 0ser#a 1ejala 0an

#an0a 5enn1!a#an #e!anan n#ra!ranal4 #e!anan 0ara7 0#urun!an se=ara 7a#,7a#

0en1an %en11una!an oa# an#75er#ens n#ra>ena !on#nu a#au n#er%#en

0en1an 5e%an#auan #e!anan 0ara7 se#a5 +8 %en# 7n11a *A ++ %%21

a#au #e!anan 0ara7 +6@ena 05a!a

0ala% u5aa 0 a#as.

20ralasn 0an n#ro5us0 sea!na #0a! 05a!a !arena %enea!an

5enn1!a#an #e!anan n#ra!ranal %es!5un u!an !on#ran0!as %u#la!.

e%eran oa# an1 0a5a# %enea!an 75er#ens #0a! 0re!o%en0as!an

0er!an 5a0a !eana!an s#ro!e s!e%!./. en1oa#an #er7a0a5 75o1l!e%a a#au 75er1l!e%a

25er1l!e%a #erja0 7a%5r 6 5a#en# s#ro!e a!u non 0ae#es.

25er1l!e%a an1 #erja0 er7uun1an 0en1an luasna >olu%e n?ar! 0an

1an11uan !or#!al 0an er7uun1an 0en1an uru!na !eluaran. T0a! ana!

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0a#a 5enel#an an1 %eneu#!an a79a 0en1an %enurun!an !a0ar 1ula 0ara7

se=ara a!#? a!an %e%5era! !eluaran.

2n0ar 1ula 0ara7 le7 +/ %1@0L4 0saran!an 0en1an n?use salne 0an

%en17n0ar laru#an 1lu!osa 0ala% - ja% 5er#a%a se#ela7 seran1an s#ro!e.

25o1l!e%a (8 %1@0L) %un1!n a!an %e%5erl7a#!an 1ejala %r5 0en1an

s#ro!e n?ar!4 0an 0a5a# 0a#as 0en1an 5e%eran olus 0e!s#rosa a#au n?us

1lu!osa +,- sa%5a !a0ar 1ula 0ara7 /,++ %1@0L

Sara#,sara# 5e%eran nsuln a0ala7 s#ro!e 7e%ora1! 0an non 7e%ora1!

0en1an IDD* a#au NIDD*. $u!an s#ro!e la!unar 0en1an 0ae#es %ell#us.

Kon#rol 1ula 0ara7 sela%a ?ase a!u# s#ro!e 0en1an 5e%eran nsuln su!u#an

%en1!u# sli!ing scale. Sasaran 1ula 0ara7 /,+/ %1@0L (/,++ un#u! ICU).

S#an0ar0 0r5 nsuln + U@+%L .a n?use (+ U@%L). In?us nsuln

7arus 07en#!an a5ala 5en0er#a %a!an 0an %ener%a 0oss 5er#a%a 0ar

nsuln su!u#an.

*e%an#au 1ula 0ara7 0en1an %e%er!sa 1ula 0ara7 !a5ler #a5 ja% sa%5a 5a0a

#ar1e# 1ula 0ara7 sela%a ja%4 !e%u0an 0#urun!an #a5 - ja%. $la 1ula 0ara7

#e#a5 s#al4 n?use nsuln 0a5a# 0!uran1 #a5 ja%. e%an#auan #a5 ja% un#u!

5en0er#a sa!# !r#s 9alau5un 1ula 0ara7 s#al.enase!s 0an e!s5ans >olu%e #0a! 0anjur!an

0ala% #era5 s#ro!e s!e%! a!u#.+. e%a!aan >aso0la#or se5er# 5en#o!s?ln #0a! 0anjur!an 0ala% #era5 s!e%!

a!u#.++. Dala% !ea0aan #er#en#u >aso5ressor #er!a0an1 01una!an un#u! %e%5era! alran

0ara7 !e o#a!. a0a !ea0aan #erseu#4 5e%an#auan !on0s neurolo1s 0an jan#un1

7arus 0la!u!an se=ara !e#a#.+-. Tn0a!an en0ar#ere!#o% =aro#0 5a0a s#ro!e s!e%! a!u# 0a5a# %en1a!a#!an rs!o

serus 0an !eluaran an1 #0a! %enenan1!an. Tn0a!an en0o>as=ular elu%

%enunju!!an 7aslan1 er%an?aa#4 se7n11a #0a! 0anjur!an.6,+-

ena#ala!sanaan !7usus s#ro!e 7e%ora1!

er0ara7an In#ra Sereral (IC2)

+. Da1noss 0an 5enlaan 1a9a# 0arura# 5er0ara7an n#ra!ranal 0an 5eneana

0la!u!an 0en1an&

CT a#au *RI (0re!o%en0as!an 5a0a s#ro!e s!e%! 0en1an 5er0ara7an n#ra!ranal)

An1o1ra? CT S=an a#au CT S=an 0en1an !on#ras4 %e%an#u 0en#?!as 5asen

res!o 5erluasan 7e%a#o%

-. Tera5 %e0! 5a0a 5er0ara7an n#ra!ranal

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asen 0en1an 0e?sens ?a!#or !oa1ulas era# a#au #ro%os#o5ena era#& #era5

5en11an#an ?a!#or !oa1ulas a#au #ro%os#

asen 0en1an 5er0ara7an n#ra!ranal 0an 5enn1!a#an INR #er!a# oa# an#!oa1ulan

oral4 sea!ana jan1an 0er!an 9ar?arn. Tera5 01an# V#a%n K4 5e%eranKonsen#ra# Ko%5le!s ro#ro%n un#u! %en1uran1 !o%5l!as4 FF.

asen 0en1an 1an11uan !oa1ulas&

, V# K + %1@ > 0en1an 5enn1!a#an INR

, FF -,6 un# un#u! !ore!s 0e?sens ?a!#or 5e%e!uan 0ara7@?a!#or !oa1ulas4

%e%5era! INR a#au aTT 0en1an =e5a#.

Fa!#or VIIa

L*W2 0an UF2 ssu!u#an 0oss ren0a7 0a5a# 05er#%an1!an un#u! %en=e1a7

#ro%oe%ol >ena se#ela7 5er0ara7an er7en#.

E?e! 7e5arn 0a#as 0en1an 5ro#a%n sul?a#4 oser>as #an0a,#an0a 75ersens#?

:. Te!anan 0ara7

S#ro!e 7e%ora1!& sea!na ICU

Blu!osa 0ara7

Oa# !ejan1 0an an#e5le5s

. enan1anan 0 ru%a7 sa!# 0an 5en=e1a7an #erja0 !erusa!an o#a! se!un0er

8. rose0ur @ o5eras&

enan1anan 0an 5e%an#auan& TIK4 BCS /4 #an0a !lns 7ernas

#rans#en#oral4 5er0ara7an n#ra>en#r!uler luas4 70rose?alus. Dranase >en#r!uler

0en1an s#ro!e s!e%! 0en1an 70rose?alus an1 0ser#a 5enurunan !esa0aran

er0ara7an n#ra>en#r!uler

E>a!uas 7e%a#o%

re0!s !eluaran 0an 5en17en#an 0u!un1an #e!nolo1

*en=e1a7 5er0ara7an n#ra!ranal erulan1

Re7al#as 0an 5e%ul7an

ena#ala!sanaan er0ara7an Suara!7o0 (SA)

+. Da1noss SA

Ba9a# 0arura# neurolo1

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Bejala !a0an1 #0a! !7as4 5a#u# =ur1a SA la ner !e5ala 7ea# an1 5aln1 sa!#

se%asa 70u5 0an %un=ul #a,#a

CT s=an !e5ala4 la 7asl SA (") na%un !lns =ur1a SA4 5un!s lu%al 0an

analss LCS

An1o1ra? =ereral un#u! %e%as#!an aneurs%a 5a0a 5asen SA. *RA4 CT

an1o1ra?

-. Ta#ala!sana u%u% SA

$er0asar!an 2UNT 0an 2ESS4 SA 0eraja# I 0an II&

, I0en#?!as 0an a#as ner !e5ala se0n %un1!n

, Tra7 arn1 #o#al4 5oss !e5ala 0#n11!an :4 O--,: L@%

, 2a#,7a# 5en11unaan se0a#?4 0a5a# !esul#an %enla #n1!a# !esa0aran

, In?us 0ar UBD4 eu>ole%a4 %on#or =ar0o5ul%oner 0an !elanan neuro1 an1

#%ul

Deraja# SA III4 IV4 V 5era9a#an le7 n#ens?&

, A$C

, ICU a#au se%,ICU, er#%an1!an n#uas 0an ETT =e1a7 as5ras 0an ar9a

, 2n0ar se0a#? erle7an

:. Ce1a7 5er0ara7an ulan1 se#ela7 SA

*on#or 0an !on#rol Te!anan Dara7

$e0 res# #o#ral

An# ?rnol#!

L1as !aro#s !uran1 er%an?aa#

. Tn0a!an o5eras 5a0a ru5#ur aneurs%a

Cl55n1 a#au en0o>as!uler =olln1 un#u! %en1uran1 5er0ara7an ulan1 (e0a7

sara?4 0o!#er en0o>as!uler)

Res!o 5en0ara7an ulan1 SA () 9alau #ela7 0 o5eras

O5eras ol#eras aneurs%a !o%5l# un#u! aneurs%a an1 n=o%5le#l =l55e0.

8. Ce1a7 0an #era5 >asos5as%e

N%o05n

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er#a7an!an >olu%e 0ara7 sr!ulas nor%al4 7n0ar 75o>ole%a

6. Kelola #e!anan 0ara7

;. 25ona#re%

/. Kejan1en#r!ulos#o%@0ranase e!s#ernal

>en#r!el un#u! os#ru!s 70rose?alus a!u#4 0an >en#r!ulo 5er#oneal s7un# un#u!

70rose?alus !ron!@!o%un!an

+. Tera5 #a%a7an& la!sansa4 anal1es! ase#a%no?en4 !o0en ?os?a#4

#lanol 0an !o0en4 7n0ar ase#osal4 oa# 5enenan1 un#u! 5asen san1a# 1elsa7&

7alo5er0ol4 5e#0n4 %0aola%4 5ro5o?ol.

DAFTAR PUSTAKA

+. Ras0 A4 Soer#0e9 L Un# S#ro!e4 *anaje%en S#ro!e Se=ara Ko%5re7ens? =e#a!an

!e0ua. Ja!ar#a & Fa!ul#as Ke0o!#eran Un>ers#as In0onesa -;.

-. *ar0jono *4 S07ar#a . *e!ans%e Ban11uan Vas!ular Susunan Sara?& Neurolo1

Klns Dasar. Ce#a!an !e,+. Ja!ar#a & ener# Dan Ra!a# -

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