Armenia

2012

STROKE IS A LEADING KILLER AND CAUSE

OF ADULT DISABILITY
STROKE RISK INCREASES BY 1,6 TIMES
EVERY 10 MMHG INCREASE IN SYSTOLIC
BLOOD PRESSURE (GOFIR, 2009).
BP CONTROL IS AN IMPORTANT ROLE TO
PREVENT RECURRENT STROKE.
ANTI HYPERTENSIVE THERAPY WILL
DECREASE RECURRENT STROKE RISK BY
40% (LAWES, , ET AL, 2004).

Stroke is a syndrome
indicated by a rapid
development of focal or
global neural
dysfunction for more
than 24 hours (except
if there is a surgery
intervention or ending
to death), caused by
vascular diseases.

(Warlow et al., 2007)

Blood supply to the brain is suddenly

disrupted
Occurs in 2 main ways:
(1) Ischaemic stroke (blocked artery)
(2) Haemorrhagic stroke (bleed in brain)

Focal Brain Dysfunction

Intracerebral
Hemorrhage

Ischemic
Stroke

85%

Clot occluding
artery

Subarachnoid
Hemorrhage

10%

Bleeding
into brain

5%

Bleeding
around brain

Diffuse Brain Dysfunction

enabling a person with an impairment:

optimal physical,
optimal cognitive,
optimal emotional,
optimal communicative and/or
optimal social functional
Heart and Stroke Foundation of Ontario

Impairments: problems in body function or

structure such as a significant deviation or loss
(eg weakness)
Activity limitations: are difficulties an
individual may have in executing activities (eg
reaching for a cup, walking)
Participation restrictions: are problems an
individual may experience in involvement in
life situations (eg going shopping, playing
sport)

Effective intervention aims to promote

maximal recovery and prevent costly
complications and subsequent stroke

multidisciplinary team
Safe transfer of care from hospital to
community
Carer training
Community rehab and follow-up services
Long term rehabilitation

S-pecific
M-easurable
A-ttainable
R-ealistic
T-ime frame

make informed decisions about their care and

treatment, in partnership with their healthcare
professionals
Good communication between healthcare
professionals and people with acute stroke or
TIA, as well as their families and carers, is
essential
dysphasia or additional needs such as physical,
sensory or learning disabilities, and to people
who do not speak or read SHOULD BE
ACCESSED.

Families and carers should also be given the

information and support they need.
Stroke NICE clinical guideline 68

All people with suspected stroke should be

admitted directly to a specialist acute stroke
unit[7] following initial assessment,.
Brain imaging should be performed
immediately for people with acute stroke if any
of the following apply:

indications for thrombolysis or early

anticoagulation treatment
on anticoagulant treatment
a known bleeding tendency
a depressed level of consciousness (Glasgow
Coma Score below 13)
unexplained progressive or fluctuating
symptoms
papilloedema, neck stiffness or fever severe
headache at onset of stroke symptoms.

Established papilloedema (acute)

VA - usually normal
Severe disc elevation and hyperaemia
Very indistinct disc margins
Obscuration of small vessels on disc
Marked venous engorgement
Reduced or absent optic cup
Haemorrhages + cotton-wool spots
Macular star

Structured to provide as much practice as

possible within first 6 months after stroke
Minimum of one hour of active practice a day
at least 5 days a week
Early mobilisation, as frequently as possible
Upper limb training should commence early

Weakness strengthening exercises

Dysphagia (swallowing difficulty) modified
diet, monitor, speech pathology intervention
Loss of sensation sensory specific training
Visual field loss

showering, toileting, dressing

Task specific practice
Training in use of appropriate aids

Aphasia impairment of language affecting

production or comprehension of speech and
ability to read and write
Talk time group at Royal Rehab
Enhance communication by using alternative
methods

thinking,
memory,
problem solving

 Nutrition and hydration

Reduced cardiovascular fitness
Fatigue
Incontinence
Mood
Behavioural change
Falls

In 6 hours
24 hours
48 hours
7 days
1 months
3 months
1 year
5 year etc

After First Stroke

3% to 10%
30-Day
5% to 14%
1-Year
25% to 40% 5-Year

Knowledge
Behaviour

(can be changed)
smoking
alcohol
Blood cholesterol levels
Diabetes
No Exercise
Hight sodium diet
Hight fat diet
circulation problems (Hypertension, coagulation)
Patient complience

Cant be changed:

Being over age 55

Being a man

Being African American

Someone in your family has had a stroke

Having diabetes

Control your blood pressure

Find out if you have atrial
fibrillation (an irregular heartbeat which allows
blood to pool in the heart and cause blood
clots)
Patient adherence

Quit smoking
Limit alcohol
Monitor your cholesterol levels
Manage your diabetes
Exercise often
Eat foods low in sodium (salt)
and fat
Monitor circulation problems with the help
of your doctor or pharmacist

 Commence as early as possible

Involves a team of health professionals
Practice, practice, practice (use of allied health
assistants)
Continues after discharge from hospital
Prevent recurrent Stroke incident
Pharmacist participation in patient complence
Home care

Seorang wanita 56 thun dilarikan ke IGD

karena mendadak pingsan setelah mengeluh
sakit kepala yang tidak tertahankan. Pasien
juga mengalami kejang . Hasil CT scan
menunjukkan adanya perdarah traserebral. Di
RS ia mendapatkan infus mannitol. Keesokan
harinya pasien sadar, dan diberi terapi
parasetamol dan nimodipin melalui nasal
sonde.
Bahaslah DRP dan pelayanan anda pada kasus
tersebut!

Clinical Guidelines for stroke Management

2010