CASE REPORT :

NON HAEMORRHAGIC STROKE

Rahayu Priyanti
030.13.159

Moderator :
dr. Ronny Yoesyanto, Sp.S
Introduction

• Stroke is an especially serious problem in Asia, which has more

than 60% of the world’s population, and many of its countries are
“developing” economies.
• About 80 % of strokes happen because of a blockage in an artery.
These are called ischaemic strokes.
• About 50 % of ischaemic strokes are caused by atherosclerosis or
thrombosis, 25% are caused by embolic and 25% are cause by
microartery occlusion, “lacunar stroke”.
Patient’s Identity

• Name : Mr. K
• Age : 67 years old
• Gender : Male
• Address : Setia Budi, Jakarta Selatan
• Job : retiree
• Education : Elementary School
• Marital Status : Married
• Admission date : 29th November 2017
• Room : Numfor Island
Chief Complaint

Based on alloanamnesis, the patient felt weak on the right limb

since a day before admitted to the hospital.

Other Complaints
His family said that he couldn’t communicate properly.
History of Present Illness

The patient came to emergency room with a chief complaint of

suddenly feeling weak on the right limb since a day before admitted
to the hospital. The weakness was felt suddenly and it made him
not able to get up from the chair. Beside that, his family also said
the patient wasn’t able to communicate well. He wasn’t able to
speak clearly and seems to not understand the conversations. He
denied having fever, trauma to the head, feeling nausea and
vomiting.
Past Medical History

• The occurrence of similar complaints (-)

• Trauma (-)
• Hypertension (+)
• Diabetes Mellitus (+)
• Heart Diseases (-)
• Lung Diseases (-)
• Kidney Diseases (-)
• Liver Diseases (-)
• Malignancies (-)
Family’s Medical History

• The occurrence of similar complaints (-)

• Trauma (-)
• Hypertension (+)
• Diabetes Mellitus (+)
• Heart Diseases (-)
• Lung Diseases (-)
• Kidney Diseases (-)
• Liver Diseases (-)
• Malignancies (-)
Social Economy and Habbits

• The patient is a retiree

• Lives with his wife, a son and a daughter
• Family’s income is just enough
• Eats 2 or 3 times a day, patient’s family admits that he never
cares about the health of the food that he eats.
• Doesn’t exercise regularly
Physical Examination

General condition
• Consciousness : GCS E4 M5 Vglobal aphasia
• Body weight : 70 kg
• Height : 168 cm
• BMI : 25 (overweight)

Vital sign
• Blood pressure : 160/110 mmHg
• Pulse : 123x/min
• Respiratory rate : 20x/min
• Temperature : 37ºC
 Physical Examination

• Head : Normocephal, Deformity (-)

• Eyes : Conjunctival pallor (-), Scleral icterus (-), pupils anisochoric

3mm/2mm, DLR (+/-), IDLR (+/-)

• Mouth : Cyanosis (-), Dryness (-)

• Neck : Lymph nodes & thyroid gland are not palpable, Neck stiffness
(-)
 Physical Examination

• Heart : S1 & S2 regular, gallop (-), murmur (-), wheezing (-)

• Lungs : Vesicular breathing sounds (+/+), ronchi -/-, wheezing -/-
• Abdomen : Supple, bowel sounds (+), organ enlargement (-)
• Upper and Lower extremities :
- Warm extremities + +
+ +

- Edema - -
- -
Neurological Examination

 Meningeal Sign  Speech

- Neck Stiffness (-) - Motoric Aphasia (+)
- Brudzinsky I (-) - Sensoric Aphasia (+)
- Brudzinsky II (-)
- Laseque ( -/-)
- Kernig ( -/-)
Neurological examination

 Physiological reflexes  Pathological reflexes

- Biceps ++/++ - Hoffman -/-
- Triceps ++/++ - Tromner -/-
- Patella ++/++ - Babinsky -/-
- Achilles ++/++ - Chaddock -/-
- Schaeffer -/-
- Oppenheim -/-
- Gordon -/-
Neurological Examination

 Sensory  Motor
- Pain : Not examined - Strength : Hemiparesis dextra
- Temperature : Not examined - Muscle trophy : Normal
- Light Touch : Not examined - Muscle tone : Normal
NEUROLOGICAL EXAMINATION

 Coordination, gait and balance  Abnormal movements

• Gait : not examined • Tremor : (-)
• Romberg test : not examined • Athetose : (-)
• Dysdiadokokinesis: not examined • Myoclonic : (-)
• Finger to nose : not examined • Chorea : (-)
• Dix-Hallpike : not examined

 Autonomic reflexes
• Micturition : not examined
• Defecation : not examined
• Anal reflex : not examined
 Cranial Nerves Examination

N I (olfactory nerve) Not examined

N II (optic nerve) Pupils anisochoric 3mm/2mm, DLR (+/-),
IDLR (+/-)
N III, N IV, N VI (oculomotor, trochlear, Ptosis (-), eye movement (+/+), strabismus
abducen nerves) (-)
N V (trigeminal nerve) Not examined
N VII (facial nerve) No lateralization
N VIII (vestibulocochlear nerve) Not examined
N IX (glossopharyngeal nerve) Not examined
N X (vagus nerve) Not examined
N XI (accessory nerve) Not examined
N XII (hypoglossal nerve) Not examined
 Laboratory Examination

Examination Result Reference Value

HEMATOLOGY

Leukocytes 13.600 /μL 5.000 - 10.000

Erythrocytes 6,11 Juta /μL 4,6 - 6,2

Hemoglobin 17.1 g/dL 14 – 16

Hematocrit 49 % 42 – 48

Platelets 299,000 /μL 150.000 - 450.000

CHEMICAL CLINICS

Blood ketones 0,9 mmol/L < 0,5 = negative

> 1 = positive
Random blood glucose level 470 mg/dL < 200
 Laboratory Examination
Examination Result Reference Value

LIPID PROFILE

Trigliceryde 313 mg/dL 60 - 170

Total Cholesterol 273 mg/dL < 200

LIVER ENZYME

AST 91 U/I < 35

ALT 40 U/I < 50

RENAL FUNCTION

Ureum 51 mg/dL 17 - 43

Creatinin 1.7 mg/dL 0.7 – 1.3

Uric acid 12.2 mg/dL 3.5 – 7.2

 Laboratory Examination
Examination Result Reference Value

ELECTROLYTES

Sodium (Na) 137 mmol/L 134 – 146

Potassium (K) 4.53 mmol/L 3.4 – 4.5

Chloride (Cl) 106 mmol/L 96 – 108

Imaging CT-Scan

Infarction of
Cerebral Hemisphere Sinistra
 Summary

Mr. K, 67 years old, came to emergency room with a chief complaint of suddenly feeling
weak on the right limb since a day before admitted to the hospital. The weakness was felt suddenly
and it made him not able to get up from the chair. Beside that, his family also said the patient
wasn’t able to communicate well. He wasn’t able to speak clearly and seems to not understand the
conversations.
During physical examination, patient’s consciousness is somnolen, GCS E4M5Vglobal
aphasia. From his vital signs, blood pressure and pulse were increased. Blood pressure 160/110, HR
123x/min, RR 20x/min and T 37ºC.
The patient’s neurological examination shows that he had hemiparesis dextra, global
aphasia and lesion of Nerve II sinistra.
The laboratory findings shows increase in leukocytes (13.600 /μL), hemoglobin (17,1 g/dL)
and hematocrit (49%). There were significant increase of random blood glucose level (470 mg/dL),
trigliceryde (313 mg/dL), AST (91 U/I). The renal function was increased (ureum 51 mg/dL,
creatinine 1,72 mg/ dL and uric acid 12,2 mg/dL). There was increase in potassium level (4,53
mmol/L).
Assesment

AX1
• Clinical : hemiparesis dextra, global aphasia
• Etiological : non haemorrhagic stroke
• Topical : cerebral hemisphere sinistra
• Pathological : ischemic

AX2 : type II diabetes mellitus

AX3 : hypertension
Treatment

• IVFD NaCl 0,9% 14 drops a minute

• Aspilet 1 x 80 mg
• Inj. Citicoline 2 x 500mg
• Inj. Lovemir 1 x 16 UI
• Valsartan 1 x 160 mg
• Amlodipin 1 x 10 mg
• Simvastatin 1 x 10 mg
• Allopurinol 1 x 100 mg
THANK YOU