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c CVD
Non Hemorrhage
Aulia Alvianti Akbar, S.Ked
Cahaya Intan, S.Ked
Pembimbing:
dr. H. A. R. Toyo, Sp.S (K)
Neurolgy Deparment
RUMAH SAKIT MOHAMMAD HOESIN PALEMBANG
FAKULTAS KEDOKTERAN UNIVERSITAS SRIWIJAYA
Introduction
• Cerebrovascular disease refers to a group of conditions that can lead to a
cerebrovascular event, such as a stroke. These events affect the blood supply
to the brain.
• According to Depkes (2011), stroke is the highest cause of death with the
proportion of incidence rate is 15,4% and Approximately 2.85% of people with
stroke in Indonesia died due to stroke
CASE REPORT
Identification
Nation : Indonesia
Medical History
Physical Examination
Physical Examination
Head Neck
Deformity : no Position : Normal
Fracture : no Torticolis : No
Fr. Pain : no Nuchal rigidity : No
Vessel : no widening Deformity : No
Pulsation : no Tumor : No
Vessels : No widening (-)
Physical Examination
Pupil
-Shape Round Round
-Size d=3 mm d=3 mm
-Isochor/anisochor Isochor Isochor
-Midriasis/miosis - -
Physical Examination
Light reflex
-Direct Positive Positive
-Consensuil Positive Positive
-Accomodation Positive Positive
Sensory:
-Forehead Not yet Not yet
-Cheek Not yet Not yet
-Chin Not yet Not yet
Physical Examination
Sensory
- 2/3 anterior tongue Not yet Not yet
Autonomy
-Salivation Not yet Not yet
-Lacrimation Not yet Not yet
-Chovstek’s sign No No
Physical Examination
Physiological Reflex
-KPR Increased Normal
-APR Increased Normal
Physical Examination
MOTORIC Right Lef
Pathological Reflex
- Babinsky Positive Positive
- Chaddock Negative Negative
-Oppenheim Negative Negative
- Gordon Negative Negative
-Schaeffer Negative Negative
-Rossolimo Negative Negative
- Mendel Bechterew Negative Negative
Abnormal skin reflex
-Upper No abnormalities No abnormalities
-Middle No abnormalities No abnormalities
-Lower No abnormalities No abnormalities
-Tropik No abnormalities No abnormalities
SENSORY
Not yet
Physical Examination
VEGETATIVE Right Lef
FUNCTION
Micturition Catheter
Defecation Not yet
VERTEBRAL
COLUMN
- Kyphosis No
-Lordosis No
-Gibbus No
-Deformity No
-Tumor No
-Meningocele No
-Hematome No
-Tenderness No
Physical Examination
• DC 0/0/44/52/4 %
Cardiomegaly
PROGNOSIS
Anamnesis
Physical examination
Neurologic physical examination
Additional examination
Anamnesis
Ask the patient for the course of his/her illness
(Autoanamnesis / Alloanamnesis)
a. Time, surroundings.
Patient age is an important part of anamnesis. In previously healthy patients,
younger age, conscious decline occurs abruptly, the possible cause of drug
poisoning, subarachnoid hemorrhage, or head trauma. While in old age, a
sudden decrease in consciousness is more likely due to cerebral bleeding or
infarction.
b. Symptoms that precede in detail (confusion, headache, weakness,
dizziness, vomiting, or seizures), focal symptoms such as difficulty speaking,
unable to read, memory changes, disorientation, numbness or pain, motor
weakness, reduced encephalitis, vision changes, difficulty in swallowing,
hearing loss, step or balance disorders, tremor.
c. Use of drugs or alcohol.
d. History of heart disease, lung, liver, kidney, or anything else
Physical examination
3). Pupil
• Checked: size, light reactivity
• Symmetrical / normal light reactivity, a hint that the mesensefalon integrity is good.
• Funduscopy
Oculovestibular / oculocephalic reflex (dolls eye maneuver)
Airway
Breathing
Circulation
STROKE
Definition
A serious medical condition where one part of the brain is damaged by a lack of blood supply or
bleeding into the brain from a burst blood vessel
A hemorrhagic stroke occurs when a blood vessel in part of the brain becomes weak and
bursts open, causing blood to leak into the brain. This puts pressure on the brain tissue, causing
tissue damage. The hemorrhage can also cause a loss of blood supply to other parts of the
brain
An embolism happens when a clot breaks off from elsewhere in the body and travels
up to the brain to block a smaller artery. This may cause an embolic stroke. This is
more common in people who have arrhythmias, such as atrial fibrillation.
STROKE
Clinical Manifestation
Anamnesa
How to calculate:
SSS = (2.5 x consciousness) + (2 x vomiting) + (2 x
headache) + (0.1 x diastolic pressure) - (3 x atheroma) -
12
- Nilai SSS Diagnosa
- >1 Perdarahan otak
- < -1 Infark otak
- -1 < SSS < 1 Diagnosa meragukan (Gunakan kurva atau CT Scan)
STROKE
Diagnosis
Physical Examination
Additional Examination
CT Scan
MRI
Angiography
USG
Lumbal Puncture
Examination to determine risk factors such as routine blood, blood chemistry components (urea,
creatinine, uric acid, lipid profile, blood sugar, hepatic function), blood electrolytes, Photo
Thorax, EKG, Echocardiography.
STROKE
Management of stroke non hemorraghe
a. Fluid
Give an isotonic fluid such as 0.9% saline with the goal
of maintaining euvolemia. Giving hypotonic or glucose-
containing fluids should be avoided except in the state of
hypoglycemia
b. Nutrition
The lateral enteral nutrition should be given within 48
hours, oral nutrition should only be given after the
swallow function test results are good. If there is a
swallowing disorder or decreased awareness of food is
given through NGT
STROKE
Management of stroke non hemorraghe
Aphasia
and
there is impaired motor and / or sensory function.
Topical diagnosis
• CT
Ssan
Citicolin • Neuroprotector
Tranexamat • Antifibrinolitic
acid