Case Stroke Hemoragik Helena Mayasari

8/19/2019 Case Stroke Hemoragik Helena Mayasari

1/23

RSUD ARIFIN ACHMAD

Fakultas Kedokteran UR

SMF/ BAGIAN SARAFSekretariat : SMF Saraf – Irna Medikal Lantai 4

Jl. Diponegoro No. 2 Telp. (0761) 7026225

P K A N ! A R U

S"A"US PASIN

Na#a Koass :Helena Ma$asari

N I M % N U K :&'()4*)*++

"an,,al :') -uli '(&.

Pe#/i#/in,dr0 nn$ Lestari1 S20S

I0 IDN"I"AS PASIN

N! Tn. "#ril

$!%r 6& T'%n 1 B%ln

Jeni# el!in i*li

Al!+Jl. A,i S%-ip+o gg Mnggi# no. e-. Mrpon

D!i*enr%

Ag! I#l!

S++%# per3inn 3in

eer4n e,gng

Tnggl M#% RS 2 J%li 2015

Me,i-l Re-or, 67

1


2/23

II0 ANAMNSIS (Tnggl 2 J%li 2015)

Allon!ne#i# ,engn i#+ri p#ien

Kelu3an Uta#a

e!' nggo+ ger iri

Ria$at Pen$akit Sekaran,

*S+% 4! SMRS p#ien !er# nggo+ ger iri le!' #e-r +i*+i. 8l ini,ir#n #+ p#ien #e,ng !n,i. #ien +i*+i !er#n +i, i#

%n+% !enggern #er+ !engng+ +ngn ,n i #eel' iri. #ien

4%g +i, %+ %n+% er4ln. #ien 'r%# ,ipp' %n+% er,iri. el%'n

+i, ,i#er+i ,engn e#%li+n %n+% eri-r ,n ping#n.

*Neri epl 4%g ,ir#n ole' p#ien9 el%'n #eper+i !%n+'9 ,e!! ,n

e4ng +i, ,. #ien e!%,in ,i3 e RS A3l Bro# ,n e!%,in

,ir%4% e RS$D AA.

Ria$at Pen$akit Da3ulu

*Ri3+ 'iper+en#i r% ,ie+'%i 5 +'%n ng ll%9 +i, pern' on+rol e

,o+er ,n 'n !in%! 4!% ,n o+ 'erl 4i , el%'n neri epl

,n +eng% +er# +egng. Tenn ,r' #el! ini +i, ,ie+'%i.

*Ri3+ ,ie+e# (*)9 eni+ 4n+%ng (*)9 ri3+ #+roe #eel%!n (*).

*Ri3+ Tr%! +i, ,

Ria$at Pen$akit Keluar,a

*A' ,n #%,r li*li p#ien 4%g !en,eri+ 'iper+en#i.

*Ri3+ el%rg ,engn ,ie+e# ,i#ngl.

*Ri3+ el%rg !en,eri+ #+roe ,i#ngl.

Ria$at Ke/iasaan

Ri3+ !eroo (:) #e4 %#i 15 +'%n9 2 %ng%#/'ri. ei#n !n

2


3/23

!nn ng erle! ,n #in.

RSUM ANAMNSIS

Tn. "9 6& +'%n9 le!' nggo+ ger iri. #ien !#i' #,r9 +i, i#

!enggern +ngn ,n i nn9 !#i' ,p+ eri-r ,engn 4el#. Ri3+

8T (:) #e4 5 +'%n ng ll%. ei#n !eroo #e4 %#i 17 +'%n9 ei#n

!n !nn ele! ,n #in.

III0 PMRIKSAAN (Tnggl 2 J%li 2015)

A0 KADAAN UMUM

Tenn ,r' nn 10/110 !!8g9 iri 10/110 !!8g

Den%+ n,i nn ; /!eni+9+er+%r

iri ; /!eni+9+er+%r

Jn+%ng 8R ; /!eni+9 ir! reg%ler9 !%r!%r (*)

r% Re#pir#i 20; /!n+ +ipe +'oro*,o!inl

S++%# Gi


4/23

png pn,ng

engenln 3rn

Nor!l

Nor!l

Nor!l

Nor!l

Nor!l

Nor!l

. N0III 758ulo#otorius9

nn iri e+erngn+o#i#

%pil

Ben+%

$%rn

Ger ol !+

Re@le# p%pil

ng#%ng

Ti, lng#%ng

*

B%l+

2 !!

Nor!l

:

:

*

B%l+

2 !!

Nor!l

:

:

Nor!l

Nor!l

Nor!l

Nor!l

Nor!l

&. N0 I 7"rok3learis9

nn iri e+erngn

Ger ol !+ Nor!l Nor!l Nor!l

5. N0 7"ri,e#inus9

nn iri e+erngn

Mo+ori

Sen#iili+#Re@le# orne

Nor!l

Nor!l Nor!l

Nor!l

Nor!l Nor!l

Nor!l

Nor!l Nor!l

6. N0 I 7A/dus8ens9

nn iri e+erngn

Ger ol !+

S+ri#!%#

Dei#i

Nor!l

*

*

Nor!l

*

*

Nor!l

Nor!l

Nor!l

7. N0 II 7Fa8ialis9

nn iri e+erngn

Ti-

Mo+ori

* !enger%+n

,'i

* !engng+ li#

* !en%+%p !+

* #%,%+ !%l%+

*

nor!l

nor!l

nor!l

nor!l

*

Nor!l

nor!l

nor!l

nor!l

&


5/23

* lip+n

n#olil

D per#

Tn, -'o#+e

nor!l

Nor!l

*

nor!l

Nor!l

*

. N0 III 7Akustikus9

nn iri e+erngn

en,engrn Nor!l Nor!l Nor!l

. N0 I; 76lossofarin,eus9

nn iri e+erngn

Ar%# @ringD per#

Re@le# !%n+'

Nor!l Nor!l

*

Nor!l Nor!l

*

Nor!l Nor!l

Nor!l

10. N0 ; 7a,us9

nn iri e+erngn

Ar%# @ring

Di#@oni

Nor!l

*

Nor!l

*

Nor!l

Nor!l

11. N0 ;I 7Assesorius9

nn iri e+erngn

Mo+ori

Tro@i

Nor!l

>%+ro@i

Nor!l

>%+ro@i

Nor!l

12. N0 ;II 7Hi2o,lossus9

nn iri e+erngnMo+ori

Tro@i

Tre!or

Di#r+ri

Nor!l

>%+ro@i

*

*

Nor!l

>%+ro@i

*

*

Nor!l

Nor!l

Nor!l

Nor!l

I0 SIS"M M5"5RIK

nn iri e+erngn

>#+re!i+# +#

e%+n

5


6/23

Di#+l

ro#i!l

Ton%#

Tro@i

Ger.inol%n+er

5

5

Nor!l

>%+ro@i

*

&

&

Nor!l

>%+ro@i

*8e!ipre#i# Sini#+r>#+re!i+# 3'

e%+n

Di#+l

ro#i!l

Ton%#

Tro@i

Ger.inol%n+er

5

5

Nor!l

>%+ro@i

*

&

&

Nor!l

>%+ro@i

*

B,n

Tro@i

Ger. inol%n+er Re@.,in,ing per%+

>%+ro@i

*:

>%+ro@i

*:

Nor!l

0 SIS"M SNS5RIK

Sen##i nn iri e+erngn

R

Neri

S%'%ropio#ep+i@

Nor!l

Nor!l

Nor!l Nor!l

Nor!l

Nor!l

Nor!l Nor!l

Nor!l

Nor!l

Nor!l Nor!l

I0 RFLKS

nn iri e+erngn

Fi#iologi#

Bi#ep#

Tri#ep#

R AR

:

:

::

:

:

::

Nor!l

+ologi#

Bin#i

=',,o-

8o@@!n Tro!er

Re@le pri!i+i@

l!o!en+l

Sno%+

*

*

*

*

*

*

*

*

*

*

Nor!l

6


7/23

II0 FUN6SI K5RDINASI

nn iri e+erngn

Te#+ +el%n4% 'i,%ng

Te#+ +%!i+ l%+%+

Gi+

Tn,e!

Ro!erg

Nor!l

Nor!l

Nor!l

Nor!l

Nor!l

Nor!l

S%li+ ,inili

S%li+ ,inili

S%li+ ,inili

III0 SIS"M 5"5N5M

• Mi#i +erp#ng +e+er

• De@e#i el%! , BAB

I;0 PMRIKSAAN KHUSUS%LAIN

. #eC%e Ti, +er+#

. ernig Ti, +er+#

-. +ri- */*

,. on+rp+ri- */*

e. ?l# +e#+ Nor!l

@. Br%,&M6?5

• Tenn ,r' 10/110 !!8g

• ern@#n 22;/ !n+9 +er+%r

• N,i ;/!eni+

• F%ng#i l%'%r Nor!l

• Rng#ng !eningel (*)

• Sr@ rnil Nor!l

•Mo+ori 8e!ipre#i# #ini#+r

7


8/23

• Sen#ori Nor!l

• oor,in#i S%li+ ,inili

• +ono! Nor!l

• Re@le#

* Fi#iologi# Nor!l

* +ologi# (*)

• Sor g4' !, pen%r%nn e#,rn (*)9 #i+ epl (:)9 re@le

p+ologi (*) #+roe 'e!orgi

C0 DIA6N5SIS KR-ADIA6N5SIS KLINIS : 8e!ipre#e Sini#+r : 8iper+en#i Gr,e II

DIA6N5SIS "5PIK : Si#+e! ro+i# ,e#+r

DIA6N5SIS "I5L56IK : S+roe 'e!orgi

DIA6N5SIS !ANDIN6 : S+roe in@r

DIA6N5SIS SKUNDR : 8iper+en#i gr,e II

D0 USULAN PMRIKSAAN PNUN-AN6

1. e!eri#n ,r' r%+in ,n %rin r%+in

2. e!eri#n i!i ,r'

.=T #-n epl +np on+r#

&. Fo+o Tor#

5. >G

0RNCANA "RAPI

. $!%!

* Tir' ring ,engn po#i#i epl ,i+inggin 0°

* on+rol i+l #ign (#+ili##i n@# E2 il #+%r#i 5H9 #ir%l#i

(nor!oole!i)

* 'in,ri pe!erin-irn gl%o# +% -irn 'ipo+oni

* 8in,ri po#i#i penenn p, en 4%g%lr (le'er)

* Moili##i ,n re'ili+#i !e,i


9/23

* I?FD (0--/g/'ri) R 20 +e+e#/!eni+

/0 K3usus

* In4 -i+i-olin 250 !g/124!

* In4 A#! +rne#!+ 500 !g/6 4!

* In@%# !ni+ol (0925*0950gr!/g1*gr!/64!)&;100--

F0 HASIL PMRIKSAAN

Dr' r%+in (2 J%li 2015)

8 1&95 gr

e%o#i+ 11.560 /!!

Tro!o#i+ 22.000/!!

8+ &29 ol

i!i ,r'

Gl% 10& !g/,l

re+inin 1926 !g/,l

$re%! 97 !g/,l

AST 25 !g/,l

AT 21 !g/,l

CT scan :

* T!p le#i 'iper,en# p, o+e#-ereri ,e;+r.

* Ti, +!p ,ei#i #+r%+%r gri#

+eng'

* Ti, +!p g!rn S

Kesan:

er,r'n p, or+e# -ereri

,e;+r


10/23

60 DIA6N5SIS AKHIR

S+roe 'e!orgi (pen,r'n in+r #ererl 'e!i#@er ,e;+r)

H0 F5LL5< UP

"an,,al '= -uli '(&.

S Tngn ,n i iri le!' %n+% ,igern9 p%#ing (:)

e#,rn o!po#!en+i# G=S >&M6?5

TD 160/100 !!8g RR 22 ;/!eni+

N,i 2;/!eni+9 reg%lr T 690=

F%ng#i l%'%r nor!l

Rng#ng !eningel (*)

Sr@ rnil nor!l

Mo+ori 'e!ipre#i# #ini#+r

Sen#ori nor!l

oor,in#i #%li+ ,inili

+ono! nor!l

Re@le# Fi#iologi# nor!l

+ologi# (*)A S+roe 'e!orgi (pen,r'n in+r #ererl 'e!i#@er ,e;+r)

* I?FD R 20 +e+e#/!eni+

* In4 -i+i-olin 250 !g/124!

* In4 rni+i,ine 2; 50 !g

* in4 A#! +rne#!+ 500!g/6 4!

"an,,al +( -uli '(&.

S Tngn ,n i iri !#i' +er# le!'9 p%#ing (*)


TD 1&0/100 !!8g RR 22 ;/!eni+

N,i 2;/!eni+9reg%lr T 6950=

F%ng#i l%'%r nor!l

Rng#ng !eningel (*)

Sr@ rnil nor!l


10


11/23

Sen#ori nor!l


+ono! nor!l


+ologi# (*)

A S+roe 'e!orgi (pen,r'n in+r #ererl 'e!i#@er ,e;+r)

* In@%# !ni+ol ;125 --

* In4 -i+i-olin 250 !g/124!

* In4 A#! +rne#!+ 500 !g/6 4!

"an,,al +& -uli '(&.

S Tngn ,n i iri !#i' +er# le!'


TD 10/100 !!8g RR 22 ;/!eni+

N,i ;/!eni+9 reg%lr T 690=

F%ng#i l%'%r nor!l

Rng#ng !eningel (*)

Sr@ rnil nor!l

Mo+ori 'e!ipre#i# #ini#+rSen#ori nor!l


+ono! nor!l


+ologi# (*)


* In@%# !ni+ol ;125 --

* in4. -i+i-olin 250 !g/124!

* In4 A#! +rne#!+ 500 !g/6 4!

* !i-r,i# 2;0 !g

"an,,al & A,ustus '(&.

S Tngn ,n i iri !#i' +er# le!'

e#,rn o!po#!en+i# G=S >& M6?2

TD 1&0/100 !!8g RR 22 ;/!eni+

11


12/23

N,i 2;/!eni+9 ireg%lr T 690=

F%ng#i l%'%r nor!l

Rng#ng !eningel (*)

Sr@ rnil nor!l


Sen#ori nor!l


+ono! nor!l


+ologi# (*)


* In@%# !ni+ol 1;100--

* In4 -i+i-olin 250 !g/124!

* In4 A#! +rne#!+ 500 !g/6 4!

* on#%l re'! !e,i

12


13/23

PM!AHASAN

I0 Stroke

I0& Definisi Stroke

Men%r%+ World Health Organization (8) #+roe ,l' !ni@e#+#i

lini ,ri gngg%n @%ng#i #ererl9 i @ol !%p%n !o+ori9 ng

erlng#%ng ,engn -ep+ ,n lei' ,ri 2& 4! +% er'ir ,engn e!+in

+np ,i+e!%nn peni+ #elin ,rip, gngg%n #%lr.1

I0' Klasifikasi

S+roe ,p+ ,il#i@i#in er,#rn elinn p+ologi p, o+9

3+% +er4,in ,n lo#i le#i #%ler.2

. Ber,#rn elinn p+ologi

1. S+roe 'e!orgi# (per,r'n)9 ng ,igi +#

1) er,r'n in+r#ererl

2) er,r'n e#+r#ererl (per,r'n #%r-'noi,)

2. S+roe non'e!orgi# (#+roe i#e!i9 in@r o+9 pen%!+n)9 ng

,igi +#

1) Tro!o#i# #ereri (+ero+ro!o+i)

2) >!oli #ereri

) 8ipoper@%#i #i#+e!i

. Ber,#rn penilin +er',p 3+% +er4,in (temporal profile)9 i+%

1. Transient Ischemic Attack (TIA) +% #erngn #+roe #e!en+r9 ge4l

,e@i#i+ ne%rologi# 'n erlng#%ng %rng ,ri 2& 4!.

2. Reversible Ischemic Neurolagical Deficits (RIND)9 elinnn +%

ge4l ne%rologi# !eng'ilng lei' ,ri 2& 4! #!pi !ingg%.

. S+roe progre#i@ +% Stroke in volution (SI>)9 i+% #+roe ng ge4l

lini#n #e-r er+'p ere!ng ,ri ng ringn #!pi #e!in

er+.

&. =ompleted stroke9 i+% #+roe ,engn ,e@i#i+ ne%rologi# ng !ene+p

,n #%,' +i, ere!ng lgi.

-. Ber,#rn lo#i le#i #%ler

1


14/23

1. Si#+e! ro+i#

•Mo+ori 'e!ipre#e on+rl+erl9 ,i#r+ri.

•Sen#ori 'e!i'ipe#+e#i on+rl+erl9 pre#+e#i.

•Gngg%n i#%l 'e!inop#i 'o!oni! on+rl+erl9 !o%ro#i#

@%g;.

•Gngg%n @%ng#i l%'%r @#i9 gno#i.

2. Si#+e! er+ero#iler

•Mo+ori 'e!ipre#e l+ernn9 ,i#r+ri.

•Sen#ori 'e!i'ipe#+e#i l+ernn9 pre#+e#i.

•Gngg%n lin gngg%n e#ei!ngn9 er+igo9 ,iplopi

I0+ Faktor risiko stroke+

) F+or re#io ng ,p+ ,i!o,i@i#i (modifable)- 8iper+en#i

- eni+ 4n+%ng (+ril @iril#i)

- Die+e# !eli+%#

- Meroo

- on#%!#i lo'ol

- 8iperlipi,e!i

- %rng +i@i+#

- S+eno#i# r+eri ro+i#

) F+or re#io ng +i, ,p+ ,i!o,i@i#i (nonmodifable)

- $#i

- Jeni# el!in- R#/#%%

- Gene+i

I04 Patofisiolo,i

S+roe ,p+ ,i#en ole' #+% ,ri eerp pro#e# ng !elip%+i

pe!%l%' ,r' ,i o+9&

1. ro#e# in+rin#i pe!%l%' ,r' !i#ln +ero#lero#i#9 lipo'ilono#i#9

in@l!#i9 ,epo#i+ !iloi,9 ,e#e#i r+eri9 !l@or!#i9 ,il+#i ne%ri#!

+% +ro!o#i# en.

2. ro#e# ng er#l ,ri +e!p+ lin !eni!%ln e!ol%# !i#ln e!oli

,ri 4n+%ng +% #ir%l#i e#+rrnil ng !enen gngg%n

pe!%l%' ,r' in+rrnil.

. ro#e# ng +i!%l ren lirn ,r' e o+ in,e%+ i+

!en%r%nn +enn per@%#i o+ +% !ening+n i#o#i+# ,r'.

1&


15/23

&. ro#e# ng +er4,i i+ pe-'n pe!%l%' ,r' ,ir%ng #%r-'noi,

+% 4ringn o+/in+r#ererl.

&0. Patofisiolo,i Stroke He#ora,ik

er,r'n in+rrnil !elip%+i per,r'n ,i preni! o+ ,n

per,r'n #%r-'noi,.In#i,en# per,r'n in+rrnil %rng lei' 20

,l' #+roe 'e!orgi9 ,i!n !#ing*!#ing 10 ,l' per,r'n

#%r-'noi, ,n per,r'n in+r#ererl.596

er,r'n in+r#ererl i#n +i!%l ren pe-'n !irone%ri#!

( !err" aneur"sm) i+ 'iper+en#i !lign.8l ini pling #ering +er4,i ,i ,er'

#%or+il9 #ereel%!9 ,n +ng o+.8iper+en#i roni !enen pe!%l%' r+eriol er,i!e+er 100 &00 !iro!e+er !engl!i per%'n

p+ologi p, ,in,ing pe!%l%' ,r' +er#e%+ er%p lipo'ilino#i#9 nero#i#

@irinoi, #er+ +i!%ln ne%ri#! +ipe Bo%-'r,., enn p#ien9

pening+n +enn ,r' ng +i*+i !enen r%p+%rn pene+r+ing

r+eri ng e-il.el%rn ,r' ,ri pe!%l%' ,r' e-il !e!%+ e@e

penenn p, r+eriole ,n pe!%l%' piler ng 'irn !e!%+

pe!%l%' ini pe-' 4%g.8l ini !engi+n ol%!e per,r'n #e!in

e#r.596

>le!en*ele!en #o+i@ ,r' ng el%r #er+ #,e i#e!i i+

!en%r%nn +enn per@%#i9 !enen ne%ron*ne%ron ,i ,er' ng +eren

,r' ,n #ei+rn lei' +er+en lgi.Ge4l ne%rologi +i!%l ren

e#+r##i ,r' e 4ringn o+ ng !enen nero#i#.596

er,r'n #%r-'noi, (SA) +er4,i i+ pe!%l%' ,r' ,i#ei+r

per!%n o+ pe-'9 #e'ingg +er4,i e#+r##i ,r' e r%ng

#%r-'noi,.er,r'n #%r-'noi, %!%!n ,i#en ole' r%p+%rn

ne%ri#! #%lr +% per,r'n ,ri arteriovenous malformation #A$%&.596

&0* 6a#/aran klinis

"a/el &0 Per/edaan Stroke He#ora,ik dan Non 3e#ora,ik .1*

Klinis PIS PSA Non He#ora,ik

De@i#i+ @ol Ber+ Ringn Ber+ ringn

n#e+ Meni+/4! 1*2 !eni+ eln (4!/'ri)

Neri epl 8e+ Sng+ 'e+ Ringn

M%n+' p, Sering Sering Ti,9 e- le#i ,i

15


16/23

3ln +ng o+

8iper+en#i 8!pir #ell% Bi#n +i, Sering li

en%r%nn

e#,rn

A, A, Ti, ,

% %,% Jrng A, Ti, ,

8e!ipre#i# Sering ,ri 3l er!%ln +i,

,

Sering ,ri 3l

Gngg%n i-r Bi# , Jrng Sering

i%or

-erero#pinl

Bi# +er,p+

,r'

Ber,r' Jerni'

"a/el '0 Per/edaan ,e>ala klinis stroke infark dan 2erdara3an&

6e>ala atau

2e#eriksaan

Infark otak Perdara3an intra sere/ral

Ge4l ng !en,'%l%i TIA (:) 50 TIA (*)

Ber+ii+#/i#+ir'+ I#+ir'+9 +i,%r +%

#eger #e+el'

ng%n +i,%r

Sering p, 3+% +i@i+#

@i#i

Neri epl ,n !%n+' Jrng Sng+ #ering ,n 'e+

en%r%nn e#,rn

3+% on#e+

Jrng Sering

8iper+en#i Se,ng/ nor!o+en#i Ber+9 ,ng #e,ng

Rng#ngn !eningen Ti, , A,

Ge4l +enn +inggi

in+r-rnil/ppil%,e!

Jrng ppil%,e! pil%,e! ,n per,r'n

#%'iloi,

Dr' ,l! -irn

#erero#pinl

Ti, , A,

Fo+o epl Dp+ ,i4%!pi perge#ern

16


17/23

gln,%l pineli#

=T*S-n epl Ter,p+ re

'ipo,en#i+#

M## in+rrnil ,engn

re 'iper,en#i+#

Angiogr@i Dp+ ,i4%!pi

g!rn

pen%!+n9

pene!pi+n ,n

#%li+i#

Dp+ ,i4%!pi ne%ri#!9

A?M9 !## in+r'e!i#@er

+% #o#p#!e

"a/el +0 Per/edaan ,e>ala klinik siste# 8arotis dan siste# ?erte/ro/asiler&

6an,,uan Siste# Karotis Siste# erte/ro/asiler

Mo+ori 8e!ipre#e on+rl+erl9

,i#+ri

8e!ipre#e l+ernn9

,i#r+ri

Sen#ori 8e!i'ipe#+e#i on+rl+erl9

pre#+e#i

8e!i'ipe#+e#i l+ernn9

pre#+e#i

?i#%l 8e!inop#i'o!oni!

on+rl+erl9 !%ro#i#

@%g;

8e!inop#i 'o!oni!9

'ortical !lindness(

!lack out (TIA)

F%ng#i l%'%r +%

linn

A@#i9 nog#i Gngg%n

e#ei!ngn9 er+igo9

,iplopi9 ni#+g!%#9

,i#@gi

Alo,arit#a 6a>a3 Mada&

1 en%r%nn e#,rn

2 Si+ epl

Re@le# p+ologi

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en,eri+ S+roe A%+ è

e+ign +% 2 ,ri e+ign ,

en%r%nn e#,rn (:)9 #i+ epl (*)9 re@le# p+ologi# (*)

en%r%nn e#,rn (*)9 #i+ epl (:)9 re@le p+ologi (*)

en%r%nn e#,rn (*)9 #i+ epl (*)9 re@le# p+ologi (:) à S+roe In@r

en%r%nn e#,rn (*)9 #i+ epl (*)9 re@le# p+ologi (*) S+roe In@r

Siste# Karotis

Alirn ,r' e o+ ng !ell%i r+eri er+erli# er#er+ -ng*

-ngn ,i#e%+ #i#+e! er+ero#iler9 ,n ng!ell%i r+eri ro+i# in+ern

e#er+ -ng*-ngn ,i#e%+ #i#+e! ro+i#.Si#+e! ro+i# +er,iri ,ri +ig

r+eri !or9 i+% r+eri ro+i# o!%ni#9 ro+i# in+ern9 ,n ro+i# e#+ern.29

Siste# karotis intrakranial'1@

Ar+eri ro+i# in+ern !ene!%# ,#r +engor !ell%i nli# ro+i%#

p, gin pe+ro#%# +%lng +e!porli#.Se+el' !ell%i nli# ro+i%# ng

pn4ngn '!pir 1 -!9 A. ro+i# in+ern !#% r%ng +engor n+r lpi#

,%r!+er ,i 3' gnglion N.? (gnglion G##eri)9 e!%,in ni ,n er4ln

#epn4ng po#+erol+erl #ell +%r#i !#% e ,l! #in%# erno#%#.Dl!

#in%# erno#%#9 A. ro+i# in+ern er4ln e n+erior9 e!%,in e po#+erior

#e'ingg !e!en+% K-ro+i, #ip'onL. Bgin 'ir A. ro+i# in+ern ,in+r N.

II ,n N. III l+erl ,ri pro#e#%# linoi,e%# n+erior ,n in@erior ,ri #%#+n#i

per@or+ n+erior ,n er-ng !en4,i A. #ereri n+erior ,n !e,i.

=ng*-ng A. ro+i# in+ern

1. Dl! nli# ro+i%# A. ro+io+i!pni ,n r+eri*r+eri ,l!nli# p+erigoi,e%#

2. , gin erno#%# er-ng

- Ar+eri e ,in,ing #in%# erno#%#

- Ar+eri e gnglion N.?

- Ar+eri e 'ipo@i#e

- Ar+eri !eninge n+erior

- Ar+eri o@+l!i9 ng !e!p%ni #l' #+% -ng i+% A. #en+rli#

re+in

. , gin 'ir A. ro+i# in+ern9 er-ng

S+roe8e!orgi

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19/23

- A. o!%nin# po#+erior9 ,engn -ng*-ngn e 'ipo+l!%#9

+l!%#9 'ipo@i#e9 'i#! op+i%! ,ll.

- A. 'oroi,e n+erior

- A. #ereri n+erior9 ,engn -ng*-ngn (A. #+ri+ !e,il +%

re%ren# '%ner9 A. o!%nin# po#+erior9 A. @ron+opolri#9 A.

perillo#l9 A. llo#o!rginli#9 A. prie+li#)

- A. #ereri !e,i9 ,engn -ng*-ngn (A. len+i%lo#+ri+ ,n

-ng*-ng e-il linn e gngli #li#9 A. @ron+li# #en,en#9

A. pre*roln,i9 A. roln,i9 A. prie+li# n+erior9 A. prie+li#

po#+erior9 A. ng%lri#9 A. prie+o*+e!porli#9 A. +e!porli# po#+erior

,n n+erior)

G!r 1. Ar+eri =ro+i#

1


20/23

G!r 2. Bgin -ereri ng ,iper,r'i ole' -ng r+eri -ro+i#

20


21/23

' Dasar dia,nosis

a0 Dasar dia,nosis klinis :

Dri n!ne#i# ,ie+'%i '3 p, p#ien ini +er4,i ,e@i#i+ ne%rologi#

ng +er4,i #e-r +i*+i9 n+r lin

Neri epl

ele!'n nggo+ ger

Ri3+ 8iper+en#i +i, +eron+rol.

8l ini #e#%i ,engn ,e@ini#i 8 '3 ge4l lini ,ri #+roe i+%

gngg%n #ererl9 i @ol !%p%n glol ,engn #erngn ,l! 2& 4! +%

lei'9 +np ,i+e!%n peni+ #elin ,ri p, gngg%n #%ler. , p#ien

ini 4%g ,i+e!%n @+or re#io er%p 'iper+en#i ng +i, +eron+rol ,i!n

'iper+en#i!er%pn @+or re#io ,ri #+roe.

/0 Dasar dia,nosis to2ik :

Dri pe!eri#n @i#i ,i+e!%n

Si#+e! ro+i# !eni!%ln ge4l ,n el%'n neri epl ng

'e+ !%n-%l #e-r !en,, #+ er+ii+#.

=T*S-n !en%n4%n per,r'n ,i region +e!poroprie+l ,e#+r

80 Dasar dia,nosis etiolo,ik :

Dri n!ne#i# ,n pe!eri#n @i#i p, p#ien ini ,i,p+n

Neri epl (:)

n#e+ p, 3+% #e,ng er+ii+#

% %,% (*)

Re@le p+ologi (*)

Ber,#rn lgori+! #+roe g4' !, e!%nginn #+roe p,

p#ien ini ,l' #+roe i+ per,r'n.

d0 Dasar dia,nosis /andin,

S+roe non 'e!orgi

S+roe non 'e!orgi ren el%'n !%n-%l !en,, ,n +er,p+ ,e@i#i+

ne%rologi#.

21


22/23

!0 Dasar Usulan Pe#eriksaan Penun>an,

1. e!eri#n lor+ori%! %n+% !enge+'%i !enge+'%i @+or re#io

+er4,in #+roe ,n on,i#i %!%! p#ien

2. e!eri#n =T*#-n %n+% ,igno#i# p#+i p+ologi #+roe ('e!orgi

+% in@r)9 lo#i ,n l%# le#i.

. Fo+o ron+gen +or !eli'+ ,/+i,n pe!e#rn 4n+%ng (i+

'iper+en#i l!)

&. >G !eli'+ ,n elinn 4n+%ng ng !er%pn @+or re#io

#+roe

C0 Dasar Penatalaksanaan

1. Tir' ring ,n po#i#in epl ,n ,n 20*00 %n+%

!e!per+'nn #ir%l#i ng ,e%+ e o+

2. In@%# R20 +e+e#/!eni+ %n+% !e!per+'nn e,n e%ol%!i ,n

e%+%'n gl%o#

. In@%# Mni+ol 100 --/ 4! %n+% !eng%rngi e,e! #ereri

&. In4e#i +rne;!i- -i, &; 500 !g %n+% !engen,lin per,r'n

.0 e!erin -i+i-olin er+%4%n #egi ne%ropro+e+or.

Dia,nosis Ak3ir

Digno#i# 'ir p#ien ini ,l' #+roe 'e!orgi e.- per,r'n

in+ren+riel ,e#+r. Di+egn #e+el' !el%n pe!eri#n pen%n4ng

8e, =T #-n9 ng !n !er%pn gol, #+n,r %n+% !enen+%n pene

#+roe ng +er4,i. 8#il 8e, =T #-n !en%n4%n ,n per,r'n

in+ren+ri%ler.

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23/23

DAF"AR PUS"AKA1. R%!n+ir =$. Gngg%n pere,rn ,r' o+. enr% SMF Sr@

RS$D Ari@in A-'!,/ F $NRI. enr% 2007.2. Be'r M9 Fro+#-'er M. Bloo, S%ppl n, ?#-%ler Di#or,er o@ T'e

=en+rl =en+rl S#+e!.In D%%# Topi-l Digno#i# in Ne%rolog. & +'>,i+ion.

Ne3 "or. 2005. &&*5.

. Bro3n R89 Ropper A8. A,!# n, ?i-+or#*=erero#-%lr ,i#e#e.

In rin-iple# o@ Ne%rolog. +' >,i+ion. Ne3 "or M-gR3*8ill. 2005 660*

7&0.

&. R%!n+ir =$. ol pen,eri+ S+roe Di /$F Il!% eni+ Sr@

F%l+# e,o+ern ,4,4rn R%!' Si+ 8#n S,iin Bn,%ng

perio,e 1&*15. porn eneli+in engl!n Bel4r Ri#e+ Do+er

Spe#ili# Bi,ng Il!% Sr@. 16.

5. Ber DM. Ri# F-+or in S+roe.In S+roe reen+ion in =lini-l

r-+i-e Springer. on,on9 200.

6. =pln R. S+roe -lini-l ppro-'. r, e,i+ion. Bo#+on

B%++er3or+'*8eine!nn9 2000

7. G%i,eline S+roe 2011. o,i #+roe. er'i!p%nn Do+er Spe#ili# Sr@

In,one#i (>RDSSI). Jr+ 2011.. Snell RS. Ne%ron+o!i lini. >,i#i 5. Jr+ >G=. 2005 525*5.

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Case Stroke Hemoragik Helena Mayasari