Jawaban tutor sken d

1f. What is the mechanism of headache in this case?

Answer:
Emotional stress → ↑ secretion of the hormones epinephrine and norepinephrine →
vasocontriction of blood vessels → ↑ Blood pressure, in addition to long and uncontrolled
hypertension → endothelial damage of blood vessels → tunika intima damaged → sclerosis of
blood vessels → weakness of the walls of blood vessels → weakness of the walls of blood
vessels. ↑ Blood pressure and weakness of the walls of blood vessels → rupture of intracerebral
blood vessels → ↓ blood supply (↓ O2 and nutrients) → formation of ATP ↓ → disruption of
pump Na-K → interstisial edema (neuron cells) → ischemic → potential tissue death → the
release of pain mediators (bradykine, histamine, serotonin) → nosiseptor stimulation pain →
headaches (Anindhita, 2022).

Source:
Anindhita T, Wiratman W. 2022. Buku Ajar Neurologi. Jilid 1. Edisi Kedua. Jakarta:
Departemen Neurologi FK UI.

2b. What are the complications of hypertension?

Answer: Uncontrolled hypertension will lead to some complications. Those are:
1. Hardening and thickening of the arteries (atherosclerosis) —> stroke & heart attack
2. Weakening and bulging blood vessels —> aneurysm
3. Heart failure
4. Weakened and narrowed blood vessels in kidneys
5. Thickened, narrowed or torn blood vessels in the eyes —> vision loss
6. Metabolic syndromediabetes, heart disease, stroke
7. Trouble with memory or understanding
8. Narrowed or blocked arteris  limit blood flow to brain —> Dementia (Abel et al., 2015)

Source:
Abel, N., Contino, K., Jain, N., Grewal, N., Grand, E., Hagans, I., Hunter, K. and Roy, S., 2015.
Eighth joint national committee (JNC-8) guidelines and the outpatient management of
hypertension in the African-American population. North American journal of medical sciences,
7(10), p.438.

5. How to diagnose in this (sriraj dan gajahmada)

Answer: Siriraj Stroke Score = (2.5 X Degrees of Consciousness) + (2 X vomiting) + (2 X
headaches) + (0.1 X diastole blood pressure) – (3 X ateroma) – 12 .
If the score obtained < 1 (less than) then the diagnosis is non-hemmoragic stroke and if the score
is ≥ 1 (greater than) then the diagnosis is hemmorragic stroke.
Variabel Clinical Sign Score
Conciousness (0) Compos mentis
(1) Drowsiness and +
stupor
(2) Semi coma and coma
Vomiting (0) None
(1) Yes +
Headache (0) None
(in 2 hours) (1) Yes +
Diastole blood pressure ..mmHg +
Atheroma (0) None -
(diabetes, angina) (1) More than 1
- 12
Based on the case : (2.5 X Degrees of Consciousness) + (2 X vomiting) + (2 X headaches) + (0.1
X diastol blood pressure) – (3 X ateroma) – 12
= (2,5 X 1) + (2 X 1) + (2 X 1) + (0,1 X 100) - (3 X 0) - 12
= 2,5+2+2+10-0-12
= 4,5 (hemmoragic stroke) (Chukwuonye, et al., 2015)

Source:
Chukwuonye II, Ohagwu KA, Uche EO, Chuku A, Nwanke RI, Ohagwu CC, Ezeani IU,
Nwabuko CO, Nnoli MA, Oviasu E, Ogah OS. Validation of Siriraj Stroke Score in southeast
Nigeria. Int J Gen Med. 2015 Oct 23;8:349-53. doi: 10.2147/IJGM.S87293. PMID: 26604813;
PMCID: PMC4629972.

8e. Clinical manifestation

Answer: The usual clinical symptoms or complaints consist of focal neurologic deficits with
sudden onset. Decreased level of
1. consciousness,
2. vomiting,
3. headaches,
4. seizures,
5. and very high blood pressure may indicate a hemorrhagic stroke.
Headache is the initial symptom most often experienced by patients along with the expansion of
the hematoma which causes an increase in ICP and a space-occupying effect on the brain. Other
symptoms that can appear are neck stiffness that occurs due to bleeding in the thalamus, caudate,
and cerebellum (Aninditha, et al., 2022).

Source:
Anindhita T, Wiratman W. 2022. Buku Ajar Neurologi. Jilid 1. Edisi Kedua. Jakarta:
Departemen Neurologi FK UI.