Stroke

Arvin Manuel
1215012
Preceptor : dr.Yenny Limyati,
Sp.KFR

Identity

Name : Mr.D
Age : 54 years old
Sex : Male
Address : Bandung
Occupation : Pensionary
Religion : Moeslem
Marital status : Married
Examination date : 27th October 2016

Anamnesis
Autoanamnesis & Heteroanamnesis
Chief complaint: right sided weakness
Patient presented with right sided weakness from
8 days prior, which occurred suddenly when
patient woke up in the morning. Patient could not
move his right extremities at all, mouth deviation
to the left, and had a slurred speech, whereas the
day before the patients condition was fine.
The patient denies temporary loss of sight in both
eyes, seeing double, feeling dizzines, headache,
nausea, vomitting, ringing of the ear, seizures,
head injury, and loss of consciousness.

- Past Medical History:

-

ischemic stroke 4 months ago

Hypertension (+)
Heart disease (-)
Hypercholesterolemia (-)
DM (-)

- Family Medical History : -

- Patient habits : smoking 1 pack/day but

after
stroke 4 months ago,
patient
had stopped smoking,
drink alchohol (-)
- Allergies : drugs (-), foods (-)

PHYSICAL EXAMINATION
Consciousness : Compos mentis (E4V5M6)
Vital Sign
Blood Pressure : 140/90 mmHg
Heart Rate : 76x/ minute
Respiration Rate : 20 x/minute
Temperature : 36,3oC,
Head
: Within normal limits
Neck : Within normal limits
Thorax
: Within normal limits
Abdomen : Within normal limits
Extremity : Within normal limits
Blood vessel : Within normal limits

NEUROLOGICAL
EXAMINATION
Appearance :
Head Normal size and shape
Vertebral column No abnormalities

Meningeal Signs:
Nuchal rigidity (-)
Brudzinky I -/ Brudzinky II -/ Brudzinky III -/ Laseque -/ Kernig -/-

 Cranial Nerves
CN. I :
Olfactory : normosmia

CN. II :
Visual acuity test : good
Confrontation test : good
Funduscopy : not performed

CN. III, IV, VI

Ptosis (-)
Pupil round, isochors, 3 mm
Indirect light reflex (+/+), Direct light
reflex(+/+)
Position : central
Eye movement : good in every direction

 CN. V :
Sensory of ophtalmic, maxillary, and
mandibular : good
Motoric : good

CN. VII :

Eyebrow movement : good, symmetrical

Eye closure : good
Nasolabial plica : the right side is more flat
Facial movement : not symmetrical
2/3 Anterior tasting : good

CN. VIII :
Hearing : good
Balance : not perfomed

 CN. IX, X :

Voice : dysfoni (-)

Swallowing : good
Pharyngeal arched : symmetrical
Uvula
: central
Palatal contraction : good
Pharyngeal reflex : not performed
1/3 posterior tasting
: good

CN. XI :
Shoulder lift: good
Left and right head movements : good

CN. XII :
Tongue movements: good, no deviation
Atrophy : Fasiculations/tremor : -

 Motoric Examination
4

Sensoric:
left arm : good
right arm : good
trunk
: good
left leg : good
right leg : good
Coordination : speech=rero

 Physiological Reflex:
Biceps
: +/+
Triceps
: +/+
Radius
: +/+
Ulnar
: +/+
KPR
: +/+
APR
: +/+
Epigastric :+
Mesogastric : +
Hypogastric: +
Cremaster : not examined

 Pathological Reflex:
Hofman trommer : -/ Babinsky
: -/ Chaddock
: -/ Oppenheim
: -/ Gordon
: -/ Schaeffer
: -/ Clonus
: -/ Primitive reflex : glabella ()
rooting ()
palmo mental ()

 Cognitive Examination
Psychological connection
: good
Motoric aphasia
: Sensory aphasia
: Short memory term
: good
Long memory term
: good
Calculation ability
: good

RESUME
Chief Complaint: right sided weakness
Specific history: Patient presented with right
sided weakness from 8 days prior, which
occurred suddenly when patient woke up in
the morning. Patient could not move his right
extremities at all, mouth deviation to the left,
and had a slurred speech.
The patient denies temporary loss of sight in
both eyes, seeing double, nor darkness like
curtains closing, feeling dizzines, headache,
nausea, vomitting, ringing of the ear, seizures,
head injury, and loss of consciousness.

- Past Medical History:

- Ischemic stroke 4 months ago
- Hypertension (+)
- Heart disease (-)
- Hypercholesterolemia (-)
- DM (-)
- Family Medical History : -

- Patient habits : smoking 1 pack/day but after

stroke 4 months ago, patient had stopped
smoking,
drink alchohol (-)
- Allergies : drugs (-), foods (-)

PHYSICAL EXAMINATION
Vital Sign:
HR=76x/minute, RR=20x/minute, BP=140/90 mmHg, T=36,3 oC
Consciousness : Compos mentis (E4V5M6)
General Examination : within normal limits
Neurological Examination
Meningeal Signs : Cranial Nerves : parese n.VII dextra central
Motorical Examination :
4

Sensorical Examination : good

Coordination Test: speech=rero
Physiological Reflexes : +/+
Pathological Reflexes : -/Cognitive Examination: good

Diagnosis

Clinical
: Stroke
Etiology
: Cerebral infarct
Localization
: Left carotid system
Additional
: Hypertension
Functional
: Right motoric parese
Working diagnosis:
Stroke ec infarct left carotid system

Medication
Non medikamentosa:
Admit to hospital
Bed rest
Low salt diet
Medical Rehabilitation
Medikamentosa :
Aspirin 80-160 mg/day

Prognosa
Quo ad vitam
: ad bonam
Quo ad functionam
: dubia ad bonam
Quo ad sanationam : dubia ad bonam

Medical Rehabilitation
Programs
The goal of stroke rehabilitation: restore as
much independence as possible by
improving physical, mental and emotional
Rehabilitation should start in the hospital,
as soon as possible after the stroke. If the
patient is medically stable, rehabilitation
may begin within one day after the stroke,
and should be continued after release from
the hospital, if needed. For others,
rehabilitation can take place months or
years later as your condition improves, or in
some cases, worsens.

 Stroke rehabilitation options will

depend on several factors, including
ability to tolerate intensity of
rehabilitation (hours/stamina),
degree of disability, available
funding, insurance coverage, and
your geographical area.

Rehabilitation Health Care Team

During all phases of the rehabilitation and
recovery, patient will most likely work with
a team of professionals from different
specialties. Its important that patient get
to know the patients health care team and
feel comfortable addressing any recovery
issue with them.
Services delivered during rehabilitation
may include physical, occupational, speech
and language therapies, therapeutic
recreation, and specialty medical or
psychological services.

 Physical Therapy
Physical therapy (PT) helps restore
physical functioning and skills like
walking and range of motion, and
addresses issues such as partial or
one-sided paralysis, faulty balance
and foot drop
Occupational Therapy
Occupational therapy (OT) involves relearning the skills needed for
everyday living including eating, going
to the bathroom, dressing and taking
care of themself.

 Speech Therapy
As a result of stroke, patient may have problems
communicating, thinking or swallowing. Speech and
language therapy (SLT or ST) will involve techniques to
reduce and compensate for these problems.
Two conditions dysarthria and aphasia can cause
speech problems among stroke survivors. With dysarthria,
a person is no longer able to pronounce speech sound
properly because of weakness or trouble controlling the
face and mouth muscles. With aphasia, a person thinks
clearly but is unable to process language to either talk or
understand others. Speech and language therapy can
teach patients family methods for coping with these
communication challenges. If patient communication
difficulties are severe, a therapist may suggest alternative
ways of communicating, such as using gestures or
pictures.
Speech and language therapists also work with memory
loss and other thinking problems brought about by the
stroke.

 Recreational Therapy
Therapeutic recreation reintroduces
leisure and social activities to patientss
life. Activities might include swimming,
going to museums, plays and libraries,
or taking music and art lessons. An
important factor within this therapy is
patient getting back into the community
and developing social skills again. A
therapeutic recreation specialist may be
available in hospitals, in communitybased programs/organizations, and
adult day programs.

Discharge Planning
The process of preparing patient to live
independently in the home.
The purpose is to help maintain the
benefits of rehabilitation after patient
have been released from the program.
It begins early during rehabilitation and
involves patient, patients family and
the stroke rehab team. Patient should
be discharged from rehab soon after
patients goals have been reached.

 Discharge planning can include:

Making sure patient have a safe place to live
after discharge.
Deciding what care, assistance, or special
equipment patient will need.
Arranging for more rehab services or for other
services in the home.
Choosing the health care provider who will
monitor patients health and medical needs.
Determining the caregivers who will provide
daily care, supervision, and assistance at home.
Determining which community services may be
helpful now or after some time. Examples
include meal delivery, volunteer rides to the
rehab center, visitor programs and caregiver
relief programs.

Social Support
Socializing with family and friends is an important part of
stroke recovery. Everyone needs support. And, stroke
survivors are no exception. There are many ways to get
the support they need
Support Group
A support group allows patient to interact with other
stroke survivors who know what patient is going through.
People in a support group can:
Help patient find ways to solve problems related to patients
stroke.
Share information about products that may help your recovery.
Encourage patient to try new things.
Listen to patients concerns and frustrations.
Give patient a chance to get out of the house.
Give patient a chance to share patients story.
Become patients new friends.

 Family and Friends

Friends and family can also provide support.
They can:
Involve patient in their activities.
Encourage patient to join community recreation
programs or support groups.
Arrange for patient to attend social gatherings
and fun activities.
List all the phone numbers of the people patient
care most about, allowing patient easy access to
them when patient need it most.
Help patient buy and write cards or letters to
send to people.
Give patient rides to social events.

Exercise Program I
For those mildly affected by stroke

Exercise Program II
For the person moderately affected by stroke

Getting Up from a Fall

Bibliography
HOPE: A Stroke Recovery Guide.
National Stroke Association

Thank You