MANIFESTASI KLINIK STROKE

CLINICAL DISORDERS
A. ASYMPTOMATIC B. FOCAL BRAIN DYSFUNCTION 1. TRANSIENT ISCHEMIC ATTACK 2. S T R O K E C. VASCULAR DEMENTIA D. HYPERTENSIVE ENCEPHALOPATY

TRANSIENT ISCHEMIC ATTACK

1. CAROTID SYSTEM
2. VERTEBROBASILAR SYSTEM 3. BOTH 4. UNCERTAIN LOCATION 5. POSSIBLE TIA

STROKE
A. TEMPORAL PROFILE 1. IMPROVING STROKE 2. WORSENING STROKE 3. STABLE STROKE

B. TYPE OF STROKE 1. BRAIN INFARCTION 2. BRAIN HEMORRHAGE 3. SUBARACHNOIDAL HEMORRHAGE (SAH) 4. INTRACEREBRAL HEMORRHAGE FROM AVM

BRAIN INFARCTION
A. MECHANISM 1. THROMBOTIC 2. EMBOLIC 3. HEMODYNAMIC

B. CLINICAL CATEGORIES 1. ATHEROTHROMBOTIC 2. CARDIOEMBOLIC 3. LACUNAR 4. OTHER (ANGIOPATHY, ARTERITIS, DLL)

BRAIN INFARCTION (LANJ.)

C. SYMPTOMS AND SIGNS BY SITE (DISTRIBUTION) 1. CAROTID ARTERY SYSTEM a. INTERNAL CAROTID ARTERY b. MIDDLE CEREBRAL ARTERY c. ANTERIOR CEREBRAL ARTERY 2. VERTEBROBASILER SYSTEM a. VERTEBRAL ARTERY b. BASILER ARTERY c. POSTERIOR CEREBRAL ARTERY

CLINICAL ASSESSMENT
A. HISTORY B. PHYSICAL EXAMINATION 1. GENERAL 2. NEUROLOGIC 3. VASCULAR : a. Palpation b. Auscultation 4. OPHTHALMOSCOPY

BRAIN INFARCTION

GENERALLY HAVE ONE OR MORE RISK FACTORS HEADACHE AND VOMITING ARE UNUSUAL AT THE ONSET DEFICITS MAY CONTINUE TO WORSENING USUALLY FOCAL DEFICIT WITH CAROTID DISTRIBUTION

BRAIN INFARCTION
MECHANISMS OF ISCHEMIC INFARCTION

1. THROMBOTIC a thrombus is superimposed on an atherosclerotic plaque precipitated by an abnormality of blood clotting 2. EMBOLIC due to occlusion of an artery by an embolus inadequate collateral blood flow 3. HEMODINAMIC stenosis or occlusion of the proximal artery collateral compensatory blood flow inadequate global cerebral perfusion is decreased (decreased cardiac output)

CLINICAL CATEGORIES
1. ATHEROTHROMBOTIC

PADA VASKULER ATEROSKLEROTIK ARTERI EKSTRAKRANIAL DAN INTRAKRANIAL UTAMA PATOMEKANISME TERJADI INFARK OTAK : PLAK MEMBESAR DAN OKLUSI VASKULER, SERINGNYA DISERTAI (SUPERIMPOSED) TROMBOSIS EMBOLIK, DARI LEPASNYA TROMBUS ATAU FRAGMEN PLAK (ARTERY TO ARTERY EMBOLUS) RIWAYAT TIA (+) DAN BRUIT SERVIKAL (+)

CLINICAL CATEGORIES (LANJ)

2. CARDIOEMBOLIC
DEFISIT FOKAL, DAPAT WORSENING STROKE DIAGNOSA ATAS DASAR DITEMUKAN SUMBER EMBOLI KARDIAL DAN TRANSKARDIAL : KARDIAL # FIBRILASI ATRIAL ATAU ATRIAL FLUTTER # INFARK MIOKARD # GAGAL JANTUNG KONGESTIF # KELAINAN KATUP MITRAL DAN AORTIK TRANSKARDIAL (PARADOXICAL EMBOLIC) # RIGHT TO LEFT CARDIAC SHUNT # SUMBER EMBOLI : TROMBUS VENA PERIFER INFARK OTAK MULTIPEL ATAU INFARK SISTEMIK

CLINICAL CATEGORIES (LANJ)

2. CARDIOEMBOLIC MANIFESTASI KLINIK ISOLATED : # ISOLATED HEMIANPSOA HOMONIM # ISOLATED APHASIA KOMPLIKASI : INFARK BERDARAH INFARK PADA DAERAH KORTIKAL, DISTRIBUSI CABANG ARTERI SEREBRI MEDIA

CLINICAL CATEGORIES (LANJ)

3. LACUNAR LESI PADA PENETRATING ARTERIES PADA PERCABANGAN BELOKAN 90O : # ARTERI LENTIKULOSTRIATA # ARTERI BATANG OTAK ARTERI PENETRANS MISKIN SISTEM KOLATERAL OBSTRUKSI VASKULER OK : # ARTERIAL DISEASE (ANGIOPATHY) # TROMBUS # EMBOLI

CLINICAL CATEGORIES (LANJ)

3. LACUNAR DIAGNOSIS KLINIK BERDASARKAN : BRAIN IMAGING (LESI < 1,5 CM) SINDROMA KLINIK (LOKASI ANATOMIK) : PURE MOTOR HEMIPARESIS PURE SENSORY STROKE ATAXIC HEMIPARESIS DYSARTHRIA CLUMSY HAND SYNDROME SINDROMA DAPAT DENGAN IMAGING NORMAL SINDROMA DAPAT JUGA KARENA PIS KECIL ATAU INFARK KORTIKAL

GAMBARAN KLINIK DITENTUKAN :

LETAK LESI LUAS LESI

GAMBARAN KLINIK
ARTERI KAROTIS INTERNA
OKLUSI DI SERVIKAL GMBR KLINIK TAK KHAS BILA KOLATERAL ADEKUAT ASIMTOMATIK BILA SIMTOMATIK : TIA SAMPAI INFARK LUAS MEKANISME HEMODINAMIK ARTERY-TO-ARTERY EMBOLIC ATEROTROMBOTIK (PROPAGATION TROMBUS SAMPAI A. SEREBRI MEDIA)

GAMBARAN KLINIK

GEJALA KLINIK : MONOPARESIS S/D HEMIPARESIS DENGAN / TANPA HEMIANOPSIA DISARTRIA DAN DISFASIA AGNOSIA HEMIHIPESTESI AMAUROSIS FUGAX CERVICAL BRUIT (+) (HIGH-PITCH)

GAMBARAN KLINIK ARTERI SEREBRI MEDIA

LESI PADA BAG. PERTAMA (MI) :
GEJALA KLINIK TERGANTUNG KOLATERAL SIRKULUS WILLISI (A.SEREBRI ANTERIOR DAN POSTERIOR) ETIOLOGI TERSERING : EMBOLIK GEJALA KLINIK BIASANYA BERAT : HEMIPLEGIA HEMIHIPESTESIA HEMIANOPSIA HOMONIM CONTALATERAL GAZE PALSY APHASIA (HEMISFER DOMINAN)

GAMBARAN KLINIK
ARTERI SEREBRI MEDIA
LESI PADA BATANG ARTERI (ARTERIAL STEM) : GEJALA KLINIK : DEFISIT MOTORIK KARENA GIANT LACUNE TERGANTUNG KOLATERAL DIPERMUKAAN OTAK OKLUSI PADA CABANG PARTIAL SYNDROME (ISOLATED)

GAMBARAN KLINIK
ARTERI SEREBRI ANTERIOR
GEJALA KLINIK : HEMIPARESIS, TERUTAMA TUNGKAI HEMIHIPESTESI APRAKSIA (TERUTAMA GAIT APRAXIA) GANGGUAN FUNGSI LUHUR

GAMBARAN KLINIK
VERTEBROBASILER SYSTEM
MENDARAHI : MEDULA OBLONGATA PONTIS MESENSEFALON TALAMUS LOBUS OKSIPITALIS TEMPOROCCIPITAL JUNCTION PARIETOOCCIPOITAL JUNCTION

GAMBARAN KLINIK
ARTERI VERTEBRALIS
OKLUSI A. VERTEBRALIS DAN A. CEREBELARIS INFERIOR POSTERIOR LATERAL MEDULLARY INFARCTION GEJALA KLINIK: VERTIGO MUAL / MUNTAH DISFAGIA ATAKSIA SEREBELARIS IPSILATERAL IPSILATERAL HORNERS SYNDROME PAIN AND TEMPERATUR DISCRIMINATION : IPSILATERAL PADA WAJAH KONTRALATERAL PADA TUBUH DAN EKSTRIMITAS

GAMBARAN KLINIK
ARTERI BASILARIS
OKLUSI A. BASILARIS : GGN BATANG OTAK BILATERAL OKLUSI CABANG A. BASILARIS SATU SISI BO : LOCALIZED SYNDROME (Sindroma Batang Otak) ALTERNATING GEJALA UTAMA : VERTIGO NISTAGMUS

GAMBARAN KLINIK
ARTERI SEREBRI POSTERIOR
OKLUSI SERINGKALI KARENA EMBOLI GEJALA KLINIK : HOMONYMOUS VISUAL FIELD DEFECT : HEMIANOPSIA QUADRANOPSIA DISLEKSIA DAN DISKALKULI (HEMISFER DOMINAN) SINDROMA LOBUS PARIETALIS (HEMISFER NON-DOMINAN) BILATERAL : BUTA KORTIKAL GANGGUAN TINGKAH LAKU

Effects of Stroke
Effects depend on area(s) of brain affected
Right Hemisphere = Left-sided paralysis = Spatial misperception (falling, dropping things) = Reading difficulty = Impulsiveness = Left-sided neglect = Loss of short-term memory

Effects of Stroke
Effects depend on area(s) of brain affected
Left Hemisphere = Right-sided paralysis = Speech/language impairment = Inability to complete tasks without patient instruction = Memory loss

Effects of Stroke
Effects depend on area(s) of brain affected
Brain stem = Disruption of breathing = Loss of consciousness = Variable effects on blood pressure = Disruption of eye movements, swallowing, hearing, speech = Bilateral paralysis likely

Effects of Stroke
Effects depend on area(s) of brain affected
Cerebellum = Balance = Coordination = Dizziness, nausea, vomiting = Disruption of some reflexes, especially involving head & neck

Gejala dan Tanda Stroke

Facial Droop

Pronater Drift