STROKE

STROKE

Definition

According to the WHO Stroke is the clinical manifestation of cerebral function disorders, both focal and overall (global), which progresses rapidly, lasting more than 24 hours, or end in death, without finding the cause other than vascular disorders.

Symptom

• Paralyzed half the members of the BDN

• Headache (existing or No)

• By or without loss of consciousness

• Tingling half the members of the BDN

• Suddenly can not talk

• Accompanied or without pelo / Perot

• Nggliyer, vertigo etc.

Cause

A variety of interchangeable mechanism causing stokes one of them is the presence of an embolus, a blood clot are interchangeable join drh flow to the chest and neck arteries, pd a moment caught on obstruct the arteries supplying the brain SHG SHG drh cause damage to surrounding areas pd. This damage is severe interchangeable, lightweight, permanent, long or temporary.

Risk Factor

1. Can not be changed

Age, male gender, race, family history, coronary heart disease, atrial fibrillation.

2. Can be changed

Hypertension, diabetes mellitus, smoking, alcohol, oral contraceptives, obesity.

Types of stroke

• Ischemic Stroke: focal neurological disorders that arise suddenly and disappear within a few minutes to several hours, often at the break, getting up early.

• Bleeding Stroke: be in for 2, namely, intra-cerebral hemorrhage and subarachnoid hemorrhage

1. Ischemic Stroke

Ischemic strokes can be found in 4 clinical forms, namely:

1. Cursory ischemic attack / transient ischemic attack (TIA), neurologic symptoms resulting from circulatory disorders diotak will disappear within 24 hours.

2. Ischemic Neurologic Deficit At first glance, neurological symptoms that arise will disappear in a time longer than 24 hours, but no more than a week.

3. Progressive stroke, neurological symptoms became more and more weight.

4. Complete stroke, clinical symptoms have settled.

Pathology

In a myocardial pathology can be divided into:

1. Vein thrombosis (cerebral thrombosis).

2. Embolism a.l. from the heart (pulmonary embolism cerebri)

3. As a result of Lues arteritis / temporal arteritis.

Pathophysiology

Ischemic cerebral infarction, is closely related to atherosclerosis and arterioloskerosis. Atherosclerosis can cause various clinical manifestations in a way:

• narrowing of the lumen of blood vessels and lead to insufficiency of blood flow.

• sudden occlusion of blood vessels due to thrombus or hemorrhage aterom

• Is the formation of thrombus is then detached as emboli

• Causing the vessel wall become weak and occurs aneurysms that can then be torn

Symptoms / clinical manifestations:

1. Symptoms of carotid blockage system

a. blockage of the internal carotid system

• sudden blindness

• dysphasia when the disorder is located on the side of the dominant

• contra lateral hemiparesis and Horner's syndrome can be accompanied on the side of the blockage

b. anterior cerebral artery blockage symptoms

• contra lateral hemiparesis with paralysis of the legs are more prominent

• mental disorders

• impaired sensibility in the limbs are paralyzed

• incontinence

• can seizures

c. cerebri media artery blockage symptoms

• If the blockage dipangkal artery, hemiparesis occurred the same, if not then the arm is more prominent dipangkal

• hemihipestesia

• sublime dysfunction in the affected cortex dominant hemifer al aphasia motor / sensory

d. both sides of the pad disorders

• hemiplegi duplex

• difficulty swallowing

• emotional disturbance, crying easily

2. Symptoms Vertebro-basilar system disorders

a. posterior cerebral artery occlusion in

• homonym hemianopsia contra lateral side of the lesion

• Contralateral hemiparesis

• loss of pain, temperature, sensory propioseptik contralateral

b. blockage in the vertebral arteries

If the blockage on the dominant side may occur Wallenberg syndrome, blockage of the side that is not domiana often causes no symptoms.

c. Obstruction in the inferior posterior cerebral artery

• Wallenberg's syndrome of cerebellar ataxia in the arms and legs on the same side, N. II disorders, and corneal reflex is lost on the same side

• Horner's syndrome with lesion sesisi

• Dysphagia, an infarction of the ipsilateral nucleus ambiguous

• nystagmus, if there is infarction of the vestibular nucleus

• Hemihipestesia alternans

d. Obstruction in the small branches of arteries basilaris

Nervi cranial paresis which nucleusnya in the middle of N. III, VI N., and N. XII, accompanied by contralateral hemiparesis.

Diagnosis:

1. History

• Especially the occurrence of complaints / symptoms of a sudden neurologic deficit

• No head trauma

• There is a risk factor for circulatory disorders of the brain

2. Physical examination

• Presence of focal neurologic deficit

• Discovered risk factors (hypertension, cardiac disorders, etc.)

• Noise on auscultation or other vascular abnormalities.

3. Examination Support

• tomography scan of

• Cerebral Angiography

• Examination of cerebrospinal liquor

• Routine Blood

• Components of blood chemistry

• ECG, Ekhokardiografi, etc..

Therapy

• Stabilisasai patients with ABC action.

• Oxygenation.

• Prevent deterioration of neurological stroke are associated with the still evolving.

• High blood pressure should not be rapidly lowered.

• Anti cerebral edema (10% perinfus glycerol, 1 g / kg / day in 6 hours, corticosteroids)

• Anti-platelet aggregation (with low-dose aspirin 80-300 mg / day)

• Antikoagulansia (heparin), etc..

Preventive Therapy

• Treatment of hypertension

• Treating DM

• Avoiding smoking, obesity, stress, etc.

• Exercise regularly.

2. Haemorrhagic Stroke

Divided into two namely:

1. Intra Cerebral Hemorrhage (PIS)

Is derived primary bleeding from blood vessels in the brain parenchyma and not caused by trauma

Division of Clinical:

• Acute and rapidly deteriorated in 24 hours

• Subacute, with clinically occurs between 3 and 7 days

• Subkronis, when krisinya 7 days.

Pathology

Ektravasasi showed rupture of blood because the blood vessels of the brain, followed by the formation of edema in brain tissue surrounding the hematoma, resulting in tissue discontinuities and compression by the hematoma and edema in the surrounding structures including the brain and blood vessels constrict / menyumbatnya resulting in ischemia.

Clinical Symptoms:

• Symptoms are not obvious unless prodormal headache due to hypertension

• Attacks are often in the daytime, when spicy, or emotional / angry

• Awareness of decreased

• Hemiplegi / hemiparesis

Diagnosis

Based on symptoms and clinical signs, and the results of scan of

Tomografik.

Therapy:

• Stabilisasai patients with ABC action.

• Oxygenation.

• Prevent deterioration of neurological stroke are associated with the still evolving.

• High blood pressure should not be rapidly lowered.

• Acid traneksanat 1 gm / 4 hour iv slowly for 3 weeks then the dose was gradually reduced, which is useful for antifibrinolitik.

2. Bleeding Subaraknoidal (PSA)

Is the state of the presence or the entry of blood into the subarachnoid space.

Distribution:

• primary spontaneous PSA, PSA is not due to trauma / PIS

• Secondary PSA, which comes out subarachnoid hemorrhage (PIS or brain tumor).

Symptoms and clinical signs

• severe headache and perakut only 10%, 90% without the headaches

• Awareness is often disturbed, from the unconscious for a while, a little delir to coma

• Stiff neck, no Kernig sign

• Impaired function of the autonomic nervous

Diagnosis

Based:

• Symptoms and clinical signs

• Liquor, nearly 100% bloody, with erythrocytes 150.000/mm3.

• Angiography

• scan of tomografik

Therapy

• Stabilisasai patients with ABC action.

• Oxygenation.

• Prevent deterioration of neurological stroke are associated with the still evolving.

• High blood pressure should not be rapidly lowered.

• Acid traneksanat 1 gm / 4 hour iv slowly for 3 weeks then the dose was gradually reduced, which is useful for antifibrinolitik

• After the acute phase through dianjurka angiography to locate the lesion, if found then the operation can be performed neurosurgery (clipping, ligation, etc.).

Stroke Prevention:

Reduce risk factors such as:

• Hypertension

• Smoking

• Foods that contain cholesterol

• Foods contain lots of salt

• Weight loss if overweight

• Early detection of stroke patients with flair