Case Stroke Infark Fany FIX

8/19/2019 Case Stroke Infark Fany FIX

1/17

RSUD ARIFIN ACHMAD

Fakultas Kedokteran UNRI

SMF/ BAGIAN SARAFSekretariat : SMF Saraf – Irna Medikal Lantai 3

Jl. Diponegoro No. 2 Telp. (0661) 7026225

P K A N ! A R U

S"A"US PASIN

Na#a Koass Fan$ Fitriani

N I M % N U K &'&'()()*'

"an++al &, Mei )&(-

Pe#.i#.in+ dr/ Riki Sukiandra 0 S1/S

I/ IDN"I"AS PASIN

N! Tn. "

"!#r $% &'#n

Jeni el!in *i+li

Al!& Jl. B#i&r, No. - Tngerng &i!#r + enr#

Ag! Il!

S& perinn in

eern T#ng ng#nn

Tnggl M# RS 06 Mei 201$

Me3i4l Re4or3 %5 2 -5

II/ ANAMNSIS #&on!ne 3n llon!ne 3ri I&ri pien p3

&nggl 06 Mei 201$

Kelu2an Uta#a

*e!' p3 lengn 3n ngi eel' iri

Ria$at Pen$akit Sekaran+

1


2/17

• Se $ 'ri SMRS pien !ern le!' p3 lengn 3n ngi iri.

*e!' !#n4#l & pien e3ng !egen3ri epe3 !o&or. Se&el'

!#n4#l el#'n &ere#& pien &er' 3ri epe3 !o&or ,ng 3ien3ri

e4r peln 3n &i3 &er3i enrn epl p3 & i pien 3r

3n !i' i erln 3engn i &erere& el#'n 3ier&i !#l#&

!en4ong e nn n,eri epl 'e&(+) i4r pelo (8) eng (+) !#l

3n !#n&' (+) e#li&n !eneln (+) gngg#n BAB 3n BA (+). ien

ero& e lini & e!#3in pien 3ir## e RS"D AA

enr#.

• Ria$at Pen$akit Da2ulu

4 el#'n ,ng ! eper&i ini eel#!n, &i3 3

4 Ri,& 'iper&eni 3ie&'#i e $ &'#n ,ng ll# &i3 &eron&rol

4 Ri,& 3ie&e !elli 3ingl

4 en,i& nng 3ingl

4 Ri,& ole&erol &inggi 3ingl

4 Ri,& &r#! epl (+)

Ria$at Pen$akit Keluar+a

• Ti3 3 nggo& el#rg ,ng !en3eri& &roe

Ria$at Ke.iasaan

4 Meroo (8) "i 17 &'#n #3' er'en&i 9 15 &'#n ,ng ll# !in#!+

!in#!n erlo'ol (+).

RSUM ANAMNSIS

Tn. " #i $% &'#n le!' p3 lengn 3n ngi eel' iri e $ 'ri

SMRS. *e!' &er3i & pien er&i:i& pien &e&p 3r 3n !i' i

erln 3engn i &erere& !#l#& !en4ong e nn 3ier&i i4r pelo.

III/ PMRIKSAAN

2


3/17

A/ KADAAN UMUM

Tenn 3r' nn 170/-0!!;g iri 170/-0!!;g

Den,#& n3i nn %2


4/17

nn iri e&erngn

Mo&ori

Seniili&

Rele orne

8

8

8

8

8

8

Dl! & nor!l

,/ N/ ;I 8A.dus9ens

nn iri e&erngn

Ger ol !&

S&ri!#

De:ii

8

+

+

8

+

+

Dl! & nor!l


5/17

nn iri e&erngn

Mo&ori

Troi

8

e#&roi

8

@#&roi

Dl! & nor!l

12. N/ =II 8Hi1o+lossus

nn iri e&erngn

Mo&ori

Troi

Tre!or

Dir&ri

N

e#&roi

+

8

Ter3orong e iri

e#&roi

+

8

en ree

N.II iri en&rl

I;/ SIS"M M5"5RIK

nn iri e&erngn

@&re!i& &

e#&n

Di&l

roi!l

Ton#

Troi

Ger.in:ol#n&er

5

5

N

@#&roi

+

$

$

N

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+

en

'e!iprei

ini&r

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e#&nDi&l

roi!l

Ton#

Troi

Ger.in:ol#n&er

5

5

N

@#&roi

+

$

$

N

@#&roi

+

B3n

Troi

Ger. in:ol#n&er

@#&roi

+

@#&roi

+

Nor!l

;/ SIS"M SNS5RIK

Seni nn iri e&erngn

R

N,eri

S#'#

ropioep&i

8

8

8

8

8

8

8

8

Dl! & nor!l

;I/ RFLKS

5


6/17

nn iri e&erngn

Fiiologi

Biep

Triep

R AR

8

8

88

8

8

88

Rele iiologi (8/ 8)

&ologi

Bini

?'33o4

;o!n Tro!er

Rele pri!i&i

l!o!en&l

Sno#&

+

+

+

+

+

+

+

+

+

+

Rele p&ologi (+)

;II/ FUN6SI K5RDINASI

nn iri e&erngn

Te& &el#n# 'i3#ng

Te& !i& l#&

Gi&

Tn3e!

Ro!erg

8

8

SDN

SDN

SDN

8

8

SDN

SDN

SDN

Dl! & nor!l

;III/ SIS"M 5"5N5M

•Mii Dl! & nor!l

• Deei Dl! & nor!l

I=/ PMRIKSAAN KHUSUS%LAIN

. *eE#e Ti3 &er&

. ernig Ti3 &er&

4. &ri4 +/+

3. on&rp&ri4 +/+e. l: &e& +/+

. Br#3>ini I +/+

=/ RSUM PMRIKSAAN

6


7/17

• e3n #!#!

• e3rn ?o!po !en&i G?S : @$ M6 5

• Tenn 3r' nn 170/-0 !!;g

iri 170/-0 !!;g

• ernn 20


8/17

D/ USULAN PMRIKSAAN PNUN>AN6

1. e!erin 3r' r#&in 3n #rin r#&in

2. e!erin i!i 3r' (Gl#o ole&erol re&inin #re#! SGT

SGT ;D* *D*)

. ?T 4n epl &np on&r

$. Fo&o T'or<

5. @G

/ AN>URAN PNA"ALAKSANAAN

U#u#

+ Tir' ring 3engn poii epl 3i&inggin 0°

+ on&rol i&l Sign

+ Moilii 3n re'ili&i !e3i

+ e!erin n#&rii perorl e#i e#'n lori pien

+ IFD R* 20 &e&e/!eni&

K2usus

+ IFD R* 20 &e&e/!eni&

+ In 4i&i4olin 500 !g/%!

+ Apile& &le& %0 !g 2AN6

Dr' r#&in (06 Mei 201$)

; 157 gr

*e#oi& %.$00/!!

Tro!oi& 25.000/!!

;& $71 :ol

%


9/17

i!i 3r' (06 Mei 201$)

Gl# 10- !g/3*

"re 27 !g/3*

?re 16 !g/3*

AST 22% "/*

A*T 20 "/*

B"N 15 !g/3*

?T 4n (06 Mei 201$)

• S&r#r lng 4rni#! i

• S#l4i 3n g,ri i

• T!p re 'ipo3en p3 l&erl prie&l 3e


10/17

Ron&gen &'or (06 Mei 201$)

en ?or n p#l!o 3l! & nor!l

@longi or&

6/ DIA6N5SIS AKHIR: Stroke infark

Follo u1

Ra.u0 &< A1ril )&(-

ien p#lng & per!in&n en3iri

10


11/17

PM!AHASAN

I/ Stroke

I/( Definisi Stroke

Men#r#& World Health Organization (H;) &roe 3l' !nie&i

lini 3ri gngg#n #ngi ererl i ol !#p#n !o&ori ,ng

erlng#ng 3engn 4ep& 3n lei' 3ri 2$ ! &# er'ir 3engn e!&in

&np 3i&e!#nn, pen,i& elin 3rip3 gngg#n :#lr.1

I/) Klasifikasi

S&roe 3p& 3iliiin er3rn elinn p&ologi p3 o&

&er3in, 3n loi lei :#ler.2

. Ber3rn elinn p&ologi

1. S&roe 'e!orgi (per3r'n) ,ng 3igi &

1) er3r'n in&rererl

2) er3r'n e&rererl (per3r'n #r4'noi3)

2. S&roe non'e!orgi (&roe ie!i inr o& pen,#!&n) ,ng

3igi &

1) Tro!oi ereri (&ero&ro!o&i)

2) @!oli ereri

) ;ipoper#i i&e!i

. Ber3rn penilin &er'3p &er3in, (temporal profile) ,i

1. Transient Ischemic Attack (TIA) &# erngn &roe e!en&r gel

3eii& ne#rologi 'n, erlng#ng #rng 3ri 2$ !.

2. Reversible Ischemic Neurolagical Deficits (RIND) elinnn, &#

gel ne#rologi !eng'ilng lei' 3ri 2$ ! !pi !ingg#.

. S&roe progrei &# Stroke in volution (SI@) ,i &roe ,ng gel

linin, e4r er&'p ere!ng 3ri ,ng ringn !pi e!in

er&.

$. ?ompleted stroke ,i &roe 3engn 3eii& ne#rologi ,ng !ene&p3n #3' &i3 ere!ng lgi.

4. Ber3rn loi lei :#ler

!" Si&e! ro&i

• Mo&ori 'e!ipree on&rl&erl 3ir&ri.

• Senori 'e!i'ipe&ei on&rl&erl pre&ei.

• Gngg#n :i#l 'e!inopi 'o!oni! on&rl&erl !o#roi

#g


12/17

#" Si&e! :er&eroiler

• Mo&ori 'e!ipree l&ernn 3ir&ri.

• Senori 'e!i'ipe&ei l&ernn pre&ei.

• Gngg#n lin gngg#n eei!ngn :er&igo 3iplopi

I/3 Faktor risiko stroke3

) F&or reio ,ng 3p& 3i!o3iii (modifable)

- ;iper&eni

- en,i& nng (irili &ri#!)

- Die&e !eli

- Meroo

- on#!i lo'ol

- ;iperlipi3e!i

-

#rng &ii&- S&enoi r&eri ro&i

) F&or reio ,ng &i3 3p& 3i!o3iii (nonmodifable)

- "i

- Jeni el!in

- R/##

- Gene&i

I/- Patofisiolo+i

S&roe 3p& 3ien ole' 3ri eerp proe ,ng !elip#&i

pe!#l#' 3r' 3i o& $

1. roe in&rini pe!#l#' 3r' !iln, &eroleroi lipo'ilonoi

inl!i 3epoi& !iloi3 3eei r&eri !lor!i 3il&i ne#ri!

&# &ro!oi :en.

2. roe ,ng erl 3ri &e!p& lin !eni!#ln e!ol# !iln, e!oli

3ri nng &# ir#li e&rrnil ,ng !en,en gngg#n

pe!#l#' 3r' in&rrnil.

. roe ,ng &i!#l ren lirn 3r' e o& in3e#& i&

!en#r#nn, &enn per#i o& &# !ening&n, :ioi& 3r'.

$. roe ,ng &er3i i& pe4'n, pe!#l#' 3r' 3i r#ng #r4'noi3

&# ringn o&/in&rererl.

Stroke Non He#ora+ik

12


13/17

S&roe ie!i &er3i ren 3n, #!&n p3 pe!#l#' 3r'

(r&eri) er:iornil &# 'ipoper#i ringn o& ole' ergi &or eper&i

&ero&ro!oi e!oli &# e&i3&iln 'e!o3in!i.1$

& !en3p& 3r' eri' 3ri nng 3r' !engn3#ng oigen 3n

n#&rii #n o&. J#!l' lirn 3r' e o& 3l! e3n nor!l in,

ei&r 50+60 !l/100 gr! ringn o&/!eni& err&i o& !e!#'n 20

3r' ,ng 3ipo!pn 3ri nng. Apil r&eri &er#!& el o& (ne#ron)

&i3 3p& !eng'iln energi ,ng 4##p 3n er o& er'en&i.1

Bil lirn 3r' e o& &er'en&i 3l! 6 3e&i n &er3i gngg#n

!e&oli!e ne#ron lei' 3ri 0 3e&i g!rn @@G !en3&r 3l! 2 !eni&

&er3i peng'en&in &i:i& o& 3l! 5 !eni& !#li &er3i er#n o& 3n

lei' 3ri - !eni& !n#i n !eninggl. Ie!i e o& &er3i il lirn

3r' e o& er#rng 25+0 !l/100 gr! ringn o& per!eni&.1

"a.el 1er.edaan stroke tro#.osis dan e#.oli 307

S&roe Tro!# S&roe @!oli

*ei' l!& 3n in, 3ill#i TIA Men33 3p& 3ier&i n,eri epl

eerp ! eel#!n,

Ti3 3i&e!#i #!er e!oli &# per3r'n A3 3i&e!#n #!er e!oli !iln,

nng 3n A. ?ro&i

S#!&n i& proe pe!enn &ro!#

3i pe!#l#' 3r' o& i en3iri

S#!&n erl 3ri &e!p& lin

!iln, &ro!# ,ng lep 3ri nng

&#p#n r&eri ro&i

*ei' rng p3 #i !#3 *ei' ering p3 #i !#3

Ter3i p3 & i&ir'& Ter3i & er&i:i&

Ti3 3ier&i pen#r#nn e3rn Dp& &er3i pen#r#nn e3rnDi&ri#i !er& Sering e r&eri ereri !e3i ren lei'

er 3n l#r#

Alo+arit#a 6a?a2 Mada (

en3eri& S&roe A#&è

e&ign, &# 2 3ri e&ign, 3

en#r#nn e3rn (8) i& epl (+) rele p&ologi (+)

1

1. en#r#nn e3rn

2. Si& epl

. Rele p&ologi

S&roe

;e!or i


14/17

en#r#nn e3rn (+) i& epl (8) rele p&ologi (+)

en#r#nn e3rn (+) i& epl (+) rele p&ologi (8)

en#r#nn e3rn (+) i& epl (+) rele p&ologi (+)

Sirira? Stroke S9ore 8SSS

? ?on4io#ne

+ Aler& 0

+ Dro, por 1

+ Se!i4o! 4o! 2

o!i&&ing

+ No 0

+ Ke 1; ;e34'e i&'in 2 'o#r

+ No 0

+ Ke 1

A A&'ero! (Die&i4 'i&or, ngin 4l#3i4&ion)

+ No 0

+ ne or !ore 1

DB Di&oli4 Bloo3 re#re

SSS DIA6N5SIS

L1 ?ererl 'e!or'ge

+ 1 ?ererl inr4&ion

+1 &o 1 "n4er&ine3 3ignoi #e proili&, 4#r:e n3/or ?T S4n

I/7 Penatalaksanaan Stroke Iske#ik 7

1. e!erin n&iog#ln

) An&iog#li ,ng urgent 3engn #n !en4eg' &i!#ln, &roe

#lng l !eng'en&in per#r#n 3eii& ne#rologi &#

!e!perii el#rn e&el' &roe ie!i #& &i3

3ireo!en3in egi pengo&n #n pien 3engn &roe

ie!i #&.

) An&iog#li urgent &i3 3ireo!en3in p3 pen3eri& 3engn

&roe #& e3ng !pi er& ren !ening&n o!plii

per3r'n in&rrnil.

4) Iniii pe!erin &erpi n&iog#ln 3l! ng 2$ !

er!n 3engn pe!erin in&r:en r&A &i3 3ireo!en3in.

3) Se4r #!#! pe!erin 'eprin *MH; &# 'eprinoi3 e&el'

&roe ie!i #& &i3 er!n&. N!#n eerp 'li !i'

1$

S&roe

inr

SSS @ )/7 C ) ; ) H &/( D!P 4 3A – ()


15/17

!ereo!en3in 'eprin 3oi pen#' p3 pen3eri& &roe ie!i

#& 3engn riio &inggi &er3i ree!olii 3iei r&eri &# &enoi

er& r&eri ro&i eel#! pe!e3'n. on&rin3ii pe!erin

'eprin #g &er!# inr er L50 'iper&eni ,ng &i3

&eron&rol 3n per#'n !iro:#ler o& ,ng l#.

2. e!erin n&ipl&ele&

) e!erin pirin 3engn 3oi l 25 !g 3l! 2$ !pi $% !

e&el' i&n &roe 3in#rn #n e&ip &roe ie!i #&.

) Apirin &i3 ole' 3ig#nn egi penggn&i &in3n in&er:eni

#& p3 &roe eper&i pe!erin r&A in&r:en.

4) Ji 3iren4nn pe!erin &ro!oli&i pirin ngn 3ierin.

3) engg#nn pirin egi ad$unctive therap% 3l! 2$ ! e&el'

pe!erin o& &ro!oli&i &i3 3ireo!en3in.

e) e!erin lopi3ogrel &# o!ini 3engn pirin p3 &roe

ie!i #& &i3 3in#rn e4#li p3 pien 3 in3ii

peii !iln, ngin pe&ori &i3 &il non&'&(ave )I &#

recent stenting pengo&n 'r# 3ierin !pi - #ln e&el'

e3in.

) e!erin n&ipl&ele& in&er:en ,ng !eng'!& reep&or

gliopro&ein II/ III &i3 3in#rn.

*" e!in o&+o&n ne#ropro&e&n el#! !en#n#n 'il ,ng

ee&i e'ingg !pi & ini el#! 3in#rn. N!#n 4i&i4olin !pi

& ini !e!erin !n& p3 &roe #&. engg#nn 4i&i4olin p3

p3 &roe ie!i #& 3engn 3oi 2 < 1000 g in&r:en 'ri 3n

3iln#&n 3engn orl 2 < 1000 g el! !ingg#. Selin i p3

peneli&in ,ng 3il#n @RDSSI e4r !#l&i4en&er pe!erin

pl!in orl < 500 !g p3 66 pien 3i 6 r#!' i& pen3i3in 3i

In3onei !en#n#n ee poi&i p3 pen3eri& &roe #& er#p

perin !o&ori 4ore MRS 3n +arthel inde,"

II/ Dasar dia+nosis

. Dasar dia+nosis klinis : S&roe

Dri n!nei 3ie&'#i ' gel ,ng 3il!i pien ,i le!'

p3 nggo& ger eel' iri ,ng &i!#l & pien e3ng er&i:i&.

el#'n #g 3ier&i !#l#& !en4ong e nn 3n i4r pelo

15


16/17

Dri pe!erin ii 3i&e!#n e3rn ?o!po !en&i G?S @$M65

en pree N.II ini&r en&rl iri 3n pree N.II 4en&rl iri

i&e! !o&ori en 'e!ipree ini&r.

. Dasar dia+nosis to1ik : i&e! ro&i 3e&rTopi i&e! ro&i 3ipiirn p3 pien 3i&e!#n 3n, 'e!ipree

3engn gngg#n r 4rnil p3 ii ,ng !. Si&e! ro&i

3e&r 3ipiirn e lei p3 i&e! ro&i n !e!erin

3eii& ne#rologi ,ng eri& on&rl&erl 3n el#!p#'n r 4rnil

eii 3engn el#!p#'n !o&ori p3 lengn 3n ngi. Ber3rn

n!nei 3n pe!erin ii gngg#n !o&ori 3i&e!#n p3 ii

iri 3n pree r 4rnil ner:# II 3n II en&rl #g 3i&e!#n p3

ii iri e'ingg lei 3ipiirn er3 p3 'e!ier nn ereri.

4. Dasar dia+nosis etiolo+ik : #pe4& inr

Dignoi &roe inr 3ipiirn ren er3rn n!nei 3i&e!#n

ele!'n ,ng !#n4#l !en33 &e&pi &i3 3ii#&i 3engn 3n,

pen#r#nn e3rn 3n n,eri epl 'e&.

3. Dasar dia+nosis .andin+ : S&roe 'e!orgi.

S&roe 'e!orgi 3ipiirn ren &er3i !en33 & pien e3ng

er&i:i& 3n &er3p& &or riio ,i ri,& !eroo 3engn

3e!iin 3p& 3i3in egi 3ignoi n3ing..

III/ Dasar usulan 1e#eriksaan 1enun?an+

• e!erin 3r' r#&in #n !enge&'#i &or reio &roe er#p

'e!&ori& !ening& irinogen &inggi.

• e!erin 3r' lengp #n !enge&'#i &or reio &roe

er#p DM 'iperole&erole!i 3n #g erg#n 3l! !enenn

pen&lnnn,.

• Ron&gen &or !enge&'#i 3n, elinn nng er#p pe!ern

nng.

• ;e3 ?T 4n !enegn 3ignoi elinn p&ologi &roe

('e!orgi &# inr) loi 3n l# lei.

• @G !enge&'#i elinn nng ,ng !er#pn &or reio &roe.

I; Dasar 1enatalaksanaan

+ Tir' ring 3engn poii epl 3i&inggin 00 #n !e!per&'nn

ir#li ,ng 3e#& e o&.

16


17/17

+ e!erin pile& er#n !eng#rngi gregi &ro!oi& 3'ei

pl&ele& pe!enn &'ro!# !ell#i penenn &ro!on A2 3l!

&ro!oi&.

+ e!erin 4i&i4olin egi gen ne#ropro&e&or.

DAF"AR PUS"AKA1. R#!n&ir ?". Gngg#n pere3rn 3r' o&. enr# SMF Sr

RS"D Ariin A4'!3/ F "NRI. enr# 2006.

2. Be'r M Fro&4'er M. Bloo3 S#ppl, n3 4#ler Dior3er o T'e

?en&rl ?en&rl S,&e!. In D## Topi4l Dignoi in Ne#rolog,. $&' @3i&ion.

Ne Kor. 2005. $$+5.

. Bron R; Ropper A;. A3! n3 i4&or+?erero:4#lr 3iee.

In rin4iple o Ne#rolog,. %&' @3i&ion. Ne Kor M4gR+;ill. 2005= 660+

7$0.

$. R#!n&ir ?". ol pen3eri& S&roe Di */"F Il!# en,i& Sr

F#l& e3o&ern 33rn R#!' Si& ;n S3iin Bn3#ng

perio3e 1-%$+1-%5. *porn eneli&in engl!n Belr Rie& Do&er

Speili Bi3ng Il!# Sr. 1-%6.

5. G#i3eline S&roe 2011. o3i &roe. er'i!p#nn Do&er Speili Sr

In3onei (@RDSSI). Jr& 2011.

6. Snell RS. Ne#ron&o!i lini. @3ii 5. Jr& @G?. 2005= 525+5.

17

Documents

Case Stroke Infark Fany FIX