Case Report

HAEMORRHAGIC
CEREBROVASCULAR DISEASE

Presented by:
- Ihsan Rasyid Yuldi, S.Ked 04084821618213
- Pepy Annisa, S.Ked 04084821618210
 Patient’s Status
Name : Mr. T
Age : 46 years old
Sex : Male
Occupation : Entrepreneur
Address : Jl. Gentayu No. 75, Lubuk Linggau,
Sumatera Selatan
Religion : Moslem
Admitted : May 4th , 2016
Alloanamnesis (May 4th, 2016)

Patient was admitted to Neurologic Department of

Mohammad Hoesin General Hospital because suddenly getting
loss of consciousness.
Since ± 5 days before admission, the patient has
weakness of left hand and left leg that occurs suddenly with
loss of consciousness for 30 minutes. During the incident, the
patient experienced severe headache and vomiting projectile.
There was no seizure, palpitation, and dispneu. The sensibility
disturbance couldn’t be assessed. The weakness in the left
hand and left leg felt equal weight. The patient work using
the right hand daily. The patient understood the content of
others people’s thoughts, either in orally, writing, and cues.
The patient still able to convey his thoughts, either in orally,
writing, and cues.
 There was history of hypertension since ± 10
years ago, taking medication irregularly. There was
history of smoking and consumption of drugs. There
were no history of diabetes mellitus and heart disease.
This disease suffered for the second time. The
patient had history of stroke since 1 month ago with the
weakness of the left side of the body and got trouble
walking.
• Sens : GCS = 13 (E: 4, M: 5, V: 4)
• Nutrition : Sufficient
• Temp : 36,5°C Heart : HR 111x/m m(-) g(-)
• Pulse : 111 x/m Paru-paru : ves (+) N R(-) W(-)
• Resp : 22 x/m
• Blood Pressure : 190/120 mmHg
• Weight : 90 kg
• Height : 174 cm

Status Psikiatrikus
• Attitude : uncooperative
• Facial Expression : appropriate
• Attention : exist
• Psychological contact : exist
Neurological State
• Head : normal
• Neck : normal
• Cranial nerve:
N. Olfaktorius : no abnormality
N. Optikus : no abnormality
N. Okulomotorius : no abnormality
N. Troklearis : no abnormality
N. Abdusen : no abnormality
N. Trigeminus : no abnormality
N. Facialis : flat nasolabialic fold,
fall of left mouth angle
N. Vestibulokoklearis : no abnormality
N. Glossopharingeus : no abnormality
N. Vagus : no abnormality
N. Accesorius : no abnormality
N. Hipoglosus : left tongue deviation (+),
dysarthria (+)
Motoric function
Motoric Right Left Hand Right leg Left Leg
function hand
Motion
Left lateralization
Power
Tonus N  N 
Klonus - -
Physiologi
N  N 
cal reflex
Pathologi
- - - B (+)
cal reflex
• Sensory function : can’t be assessed
• Limbic function : can’t be assessed
• Vegetative function: catheterized
• Meningeal signs : unexist
• Abnormal movements: unexist
• Gait and balance : can’t be assessed
Diagnosis

Clinical Topical Etiological

diagnosis Diagnosis Diagnosis
• Left hemiparese • Capsula Interna • Haemorrhagic
spastic type • LACS Stroke
• Left N.VII parese
central type
• Left N.XII parese
central type
Head CT Scan
ICH + IVH (Hyperdens lesion in right lateral ventriculus and
ganglia basalis, size 2,8 x 1,9 x 3,5)
Management

General (ABCD)

Non
pharmacology

Pharmacology
Management (con’t)
Non Pharmacology
• Head up 30o
• Liquid diet 2100 kkal (low salt)
• O2 8 L/m via NRM
• Nasogastric Tube
Pharmacology
• IVFD NaCl 0,9% gtt xx/m
• Inj. Tranexamic Acid 3 x 500 mg (i.v)
• Inj. Citicholin 2 x 250 mg (i.v)
• Inj. Tramadol 3 x 100 mg (i.v)
• Candesartan 1 x 16 mg (p.o)
• Drip 2 amp herbesser in 100 cc NaCl gtt dosis 5-15
mcg/kgBB/jam, target sistolik 160 mmHg
Prognosis
LITERATURE REVIEW
 an acute neurologic deficit diseases
Definition caused by disorders of the brain blood
vessels that occurs suddenly and can
cause disability or death.

Stroke occurs when there’s a rapid death of brain tissue due to

disturbance in the blood supply.
 anatomy

Anterior Supply
Posterior Supply
•It originated from
right and left carotid
•It supplies the
artery.
brainstem and back
portion of brain,
•It supplies the
consist from left and
middle and front
right vertebral artery
portion of brain
which form join
together to a single
•Carotid artery 
basillary artery
ACA and MCA
circulus of willis

•Posterior communicating artery

connects 2 artery sources of
blood supply in brain (vertebral
and carotid interna artery)

•If there is a blockage in the

internal carotid or vertebral
artery, the blood flow crosses to
the contralateral side
Classification

• Loss of blood flow

• Ethiology : thrombotic and embolism
ISCHAEMIC

HAEMORRAGHE • bleeding
Bamford classification systems

Lacunar
(LAC)
Patofisiologi
Risk Factors
Can be modified

•Hypertension • Alcohol
•DM •Drug Abuse
•Obesity •Smoking

Can’t be modified

• Age •Etnichity
• Gender •Family history
Sign and Symptoms
Treatment

Golden Period
 Lifestyle
Prevention +
Controlling Risk Factors

Curative Medicamentosa
THANK YOU 