VASKULARISASI OTAK dan MEKANISME STROKE

ISCHEMIC

Oleh :
Dr Tirta Mandira Hudhi

2016
 BRAIN & ITS SURROUNDING
STRUCTURES
Pembagian Sistem Saraf

 Secara anatomis
Diencephalon
Cerebrum
Mesencephalon
Encephalon Truncus cerebri
Pons
SNC Cerebellum
Medulla oblongata
Medulla spinalis
SN

Nervi craniales (N I-XII)

SNP C–8
T – 12
Nervi spinales L–5
S–5
Co – 1

Pembagian Encephalon (Otak)

 Secara embriologis

Telencephalon Hemispherium cerebri

C
e
Prosencephalon r
Epithalamus e
Thalamus b
Diencephalon r
Hypothalamus
u
Subthalamus m

Encephalon Mesencephalon Mesencephalon

Pons
Metencephalon
Rhombencephalon Cerebellum

Myelencephalon Medulla oblongata

1. Brain vascularization are Derived from:

- Internal carotid artery:

to anterior 2/3 of the cerebral hemispheres

- Vertebral artery:

to the remaining posterior and medial regions of the hemispheres, most of the diencephalon,
brainstem, cerebellum, and cervical spinal cord.

Arteries of the brain lie in the subarachnoid space

2. The carotid and vertebral-basilar are anatomically interconnected with each other, and with their
counterparts in the opposite site, through the circle of Willis.

These circle usually cannot carry enough blood flow to maintain adequate cerebral circulation if
either a carotid or a vertebral artery is suddenly blocked.

3. Circulus arteriosus Willis :

1. Basilar

2. Posterior cerebral

3. Posterior communicating

4. Internal carotid

5. Anterior cerebral

6. Anterior communicating

4. Branches of Internal Carotid Artery :

• cavernous part

• cerebral part :

• ophthalmic

- anterior cerebral

- middle cerebral

- anterior choroid
 to: globus pallidus, caudate nucleus, amygdala, hypothalamus, red nucleus, substansia
nigra, capsula interna (post. limb), optic radiation, hippocampus.

- posterior communicating

5. Areas supplied by anterior cerebral artery:

• Septal area

• Primary motor cortex for legs, foots, urinary bladder

• Additional motor planning areas in the medial frontal lobe anterior to precentral gyrus

• Most of the corpus callosum except its posterior part

6. Middle Cerebral Artery

 Central branches: Lenticulostriate artery

Through: anterior perforate substance

To: lentiform nucleus, caudate nucleus and internal capsule

 Cortical branches:
- Superior branch to:

*Primary motor cortex for face and arm

*Broca’s area

*Frontal eye fields (for “looking at” eye movements to the opposite site)

*Primary somatosensory cortex for face & arm

*Parts of lateral frontal & parietal lobe for 3-D visual perceptions and for ability to interpret
& express emotion

 Inferior branches to

*Wernick’s area

*Parts of posterior parietal lobe for 3-D visual perceptions and for ability to interpret &
express emotion

*Optic radiation particularly fibers that represent information from the contralateral
superior quadrants of the visual field
 7. Branches of Vertebral & Basilar arteries
 Vertebral:

- posterior & anterior spinal

- posterior inferior cerebellar

 Basilar:

- pontine

- labyrinthine

- anterior inferior cerebellar

- superior cerebellar

- posterior cerebral

- posterior communicating

8. Areas supplied by vertebral-basilar arteries

 Rostral midbrain:

- Pyramidal tract (PT), superior cerebellar peduncle, n. III nucleus, medial longitudinal fasciculus
(MLF), reticular formation (RF)

 Mid pons:

- MLF, RF, PT, middle cerebellar peduncle (MCP), trigeminal sensory & motor nuclei

 Caudal pons:

- n. VI nucleus, motor fibers n. VII, lateral gaze center, PT

- n. VII nucleus, MCP, descending tract nucleus n. V, spinothalamic tract (ST), vestibular &
cochlear nuclei

 Rostral medulla:

- n. XII nucleus, PT, medial lemniscus

- nucleus ambiguus, n. IX & X, descending tract nucleus n. V, ST, Vestibular nuclei, Inferior
cerebellar peduncle

9. Structures supplied by posterior cerebral artery

- Diencephalon

- Midbrain
- Optic radiation & striate cortex (primary visual cortex)

- Splenium of the corpus callosum

- Hippocampal formation & the posterior of fornix (important for new declarative memory)

10. Cerebral Blood flow

- 50 ml/100 g/min

- about 600-700 ml of blood flow through the carotid arteries and their branches

- about 100-200 ml flow through the vertebral-basilar system

11. Signs and symptoms (http://www.nhs.uk/conditions/Stroke/Pages/Introduction.aspx)

The main symptoms of stroke can be remembered with the word FAST: Face-Arms-Speech-Time.

Face – the face may have dropped on one side, the person may not be able to smile or their
mouth or eye may have dropped.

Arms – the person with suspected stroke may not be able to lift both arms and keep them there
because of arm weakness or numbness in one arm.

Speech – their speech may be slurred or garbled, or the person may not be able to talk at all
despite appearing to be awake.

Time – it is time to dial 999 immediately if you see any of these signs or symptoms.
12 Lampiran
Strategi terapi pada stroke

Pendekatan terapi pada fase akut stroke iskemik: restorasi aliran darah otak dengan menghilangkan
sumbatan/clots, dan menghentikan kerusakan seluler yang berkaitan dengan iskemik/hipoksia

Therapeutic window : 12 – 24 jam,

golden period : 3 – 6 jam

kemungkinan daerah di sekitar otak yang mengalami iskemik masih dapat diselamatkan

Pada stroke hemoragik  terapi tergantung pada latar belakang setiap kasus hemoragiknya
 Effect of Piracetam on Recovery and Rehabilitation After Stroke: improvement in aphasia in
patients undergoing rehabilitation after a stroke after 12 weeks' treatment

Citicoline is considered a promoter of neuronal repair.

• Included in the trial, which lasted 10 to 14 days,

• were 123 patients who had an acute stroke within a maximum of 48 hours of the study.

• During the first 5 days, citicoline was administered intravenously (2 g per 24 hours). From
day 6, it was administered intramuscularly (1 g per 24 hours).

• It has been shown in humans to be effective in the treatment of several cerebral pathologic
conditions, including acute stroke.