STROKE

Adviser: dr. Imam Suhada, Sp.S

Coass of Neurology, April 11 t h May 14 t h 2016 period

Co-ass
Anasthasya Giovani G
Ady Fitrah Saragih

030.11.023

Firmansah Saputra
Nourma Dara Juwita

030.11.150

Cindy Amalia
Sylvia Chandra

030.11.009
030.11.217

030.11.060
030.11.282

Yuse Rishna Kania

030.11.319
Belyn Kelvina Octaviana 030.10.052

Definition of Stroke

Stroke is a disorder of brain function as well as global focal acute,

more than 24 hours, is derived from the interruption of cerebral
blood flow and is not caused by circulatory disorders of the brain at
a glance, brain tumors, stroke secondary to trauma or infection

Epidemiology
In 1053 cases of stroke in a hospital in Yogyakarta 5 mortality rate stood at
28.3%, while in 780 cases of ischemic stroke was 20.4%, more in males.
Mortality of stroke patients in Dr Sardjito ranks third after coronary heart
disease and cancer, 51.58% due to hemorrhagic stroke, ischemic stroke as a
result of 47.37%, and 1.05% due to subarachnoid hemorrhage prospectively .

Etiology
Atherosclerosis thrombosis
Transcient ischemic
Embolism
Hypertension
Arteritis
Cerebral thrombophlebitis
Haematologic abnormalities
Carotid system damage
Aorta aneurysm
Complication of angiography

Classification

Based on pathology anatomy and causes:

Classification

Classification
Based on clinical syndromes which are related to the locations of brain
lesions:
a.

Total Anterior Circulation Infarct (TACI)

b.

Partial Anterior Circulation Infarct (PACI)

c.

Posterior Circulation Infarct (POCI)

d.

Lacunar Infarct (LACI)

Pathophysiology of Ischemic Stroke

Pathophysiology of Ischemic Stroke

Blood supply to the brain is autoregulated
Blood flow
If zero leads to death of brain tissue within 4-10min
<16-18ml/100g tissue/min
infarction within an hour
Ischemia leads to development of an ischemic core and an ischemic
penumbra

Ischemic Penumbra
Tissue surrounding the core region of infarction which is
ischemic but reversibly dysfunctional
Maintained by collaterals
Can be salvaged if reperfused in time
Primary goal of revascuralization therapies

Thrombus/embolus
Hypoperfusion
ATP depletion
Failure of Na+/K+ ATPase membrane ionic
pump
Membrane depolarization & cytotoxic cellular
edema
Glutamate
release

Calcium entry

Activation of procoagulant pathways

Free fatty acid

release

Activation of lipid peroxidases, proteases & NO

synthase
Destruction of intracellular
organelles, cell membrane & release
of free radicals

Liquefactive
necrosis

Subarachnoid Haemorrhage

Aneurysm,
Arteriovenous
Malformation
(AVM)

Extravasation of
blood into
subarachnoid space
and LCS

Increased
Intracranial
Pressure

Intracerebral Haemorrhage

Risk Factor

Signs of Stroke

Supporting Examination
Laboratory : Blood count and serology
Thorax Rontgen
Lumbal Puncture
USG Carotis
CT-Scan -> GOLD STANDARD
Magnetic Resonance Imaging (MRI)
Angiografi serebrum
Transcranial Doppler (TCD)

DIAGNOSIS
1. ANAMNESIS
SYMPTOMS

HAEMORRHAGIC
STROKE

NON
HAEMORRHAGIC
STROKE

ONSET

Sudenly

Sudenly

ATTACK

Daily Activity

Rest

WARNING

HEADACHE

+++

CONVULSION

VOMIT

LOSS OF
CONSCIOUSNESS

+++

Neurological Examination
SIGN

HAEMORRHAGIC
STROKE

NON HAEMORRHAGIC
STROKE

BRADIKARDI

++

( DAY 4 )

PAPIL EDEMA

Mostly +

KAKU KUDUK

KERNIG SIGN,
BRUDZINSKI

++

ALGORITMA AND STROKE SCORE

GADJAH MADA

 Djoenaedi Stroke Score

> 20 SH
< 20 SNH

SIRIRAJ SCORE STROKE

SIGN / SYMPTOMS
CONSCIOUSNESS

RATING
INDEX
(0) Compos Mentis
X 2,5
(1) Somnolen
(2) Semi koma/koma

SCORE
+

VOMIT

(0) No
(1) Yes

X2

HEADACHE

(0) No
(1) Yes

X2

BLOOD PRESSURE
ATHEROMA:
A) DM
B) ANGINA PECTORIS

Diastolic
(0) No
(1) Yes

X 10 %
X (-3)

+
-

- 12

- 12

CONSTANTA

SIRIRAJ SCORE
(2,5 X S) + (2 X M) + (2 X N) + (0,1-D) (3x A) 12
EXPLANATION:
S = Consciousness
M = Vomit
D = Diastolic
A = Atheroma
SSS SCORE > 1 : SH
SSS SCORE < -1 : Cerebral Infark
SSS SCORE -1 s/d 1 : Query

ISCHEMIC STROKE TREATMENT

ISCHEMIC STROKE TREATMENT

ISCHEMIC STROKE TREATMENT

ISCHEMIC STROKE TREATMENT

HAEMORRHAGIC STROKE
Emergency treatment of hemorrhagic stroke focuses on controlling your bleeding and reducing
pressure in your brain. Surgery also may be performed to help reduce future risk.

Complication
Acute
Increased blood pressure
Increased blood sugar levels
Heart failure
Respiratory disorders
Infection dan sepsis
Kidney dan liver disorders
Disorders of fluid, electrolyte, and acid-base
Ulcer stress

 Chronic
Pneumonia
Decubitus
Incontinensia
Recurrent stroke
Social and economic disruption
Psychological disorders

Prognosis
Prognosis for the Stroke patients are based of:
Type
Broad attack
Age of onset of stroke
Consciosness