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    K21 - Stroke Hemoragik (Neurologi)

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    juardy
    This document discusses hemorrhagic stroke, which occurs when a blood vessel in the brain bursts. It describes two main types: intracerebral, where bleeding occurs directly into the brain tissue, and subarachnoid, where bleeding occurs in the space between the brain and the skull. The most common causes are hypertension for intracerebral and aneurysms for subarachnoid hemorrhage. Symptoms can include sudden severe headache, vomiting, loss of consciousness, and neurological deficits depending on the location of bleeding in the brain. Diagnosis involves CT scan, MRI, angiography and lumbar puncture. Treatment involves controlling blood pressure, preventing rebleeding, managing edema, and surgery to clip aneurysms

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    K21 - Stroke Hemoragik (Neurologi)

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    juardy
    10 views34 pages
    This document discusses hemorrhagic stroke, which occurs when a blood vessel in the brain bursts. It describes two main types: intracerebral, where bleeding occurs directly into the brain tissue, and subarachnoid, where bleeding occurs in the space between the brain and the skull. The most common causes are hypertension for intracerebral and aneurysms for subarachnoid hemorrhage. Symptoms can include sudden severe headache, vomiting, loss of consciousness, and neurological deficits depending on the location of bleeding in the brain. Diagnosis involves CT scan, MRI, angiography and lumbar puncture. Treatment involves controlling blood pressure, preventing rebleeding, managing edema, and surgery to clip aneurysms

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    Hemorrhage stroke

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    K21- Stroke Hemoragik (Neurologi)

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    This document discusses hemorrhagic stroke, which occurs when a blood vessel in the brain bursts. It describes two main types: intracerebral, where bleeding occurs directly into the brain tissue, and subarachnoid, where bleeding occurs in the space between the brain and the skull. The most common causes are hypertension for intracerebral and aneurysms for subarachnoid hemorrhage. Symptoms can include sudden severe headache, vomiting, loss of consciousness, and neurological deficits depending on the location of bleeding in the brain. Diagnosis involves CT scan, MRI, angiography and lumbar puncture. Treatment involves controlling blood pressure, preventing rebleeding, managing edema, and surgery to clip aneurysms

    Copyright:

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    Download as pptx, pdf, or txt
    10 views34 pages

    K21 - Stroke Hemoragik (Neurologi)

    Uploaded by

    juardy
    This document discusses hemorrhagic stroke, which occurs when a blood vessel in the brain bursts. It describes two main types: intracerebral, where bleeding occurs directly into the brain tissue, and subarachnoid, where bleeding occurs in the space between the brain and the skull. The most common causes are hypertension for intracerebral and aneurysms for subarachnoid hemorrhage. Symptoms can include sudden severe headache, vomiting, loss of consciousness, and neurological deficits depending on the location of bleeding in the brain. Diagnosis involves CT scan, MRI, angiography and lumbar puncture. Treatment involves controlling blood pressure, preventing rebleeding, managing edema, and surgery to clip aneurysms

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    of 34

    STROKE HEMORAGIK

    Dr Iskandar Nasution SpS, FINS


    Dr Yuneldi Anwar SpS (K)

    Departemen Neurologi FK USU


    How About Hemorrhagic Stroke??

    2
    STROKE HEMORAGIK

    1. PERDARAHAN INTRA SEREBRAL

    2. PERDARAHAN SUB ARACHNOID


    Hemorrhagic Stroke
     1. Intracerebral Hemorrhagic

     Blood leaks directly into brain parenchyma


     Hipertension : most common cause
    Hemorrhagic Stroke
     2.Subarachnoid
    hemorrhagic
     Blood leaks from
    cerebral vessel into
    subarachnoid space
     Sudden and painful
     Aneurysms and AVMs
    Etiologi
     Primer : Hipertensi
    - Cerebral amyloid angiopathy (CAA)

     Sekunder : Non hipertensi


    1. rupture aneurysma/ AVM
    2. antikoagulansia / thrombolitik
    3. trauma
    4. drug abuse/intoksikasi
    5. cerebral venous sinus trombosis
    AVM
     Arteriovenous
    malformasi (AVM)
    adalah kelainan vaskular
    dimana terjadi hubungan
    langsung antara arteri
    dan vena tanpa adanya
    intervening capillary bed
    PIS Hipertensi.
     Penderita hipertensi kronis:
    arteriosklerotik pemb.darah kecil 
    perubahan2 pada dinding pemb.darah 
    aneurisma (Charcot Bouchart aneurysm )
     pecah  PIS

     Lokasi:
    - talamus - kapsula interna
    - basal ganglia - lobar dll.
    GEJALA KLINIS
     Terjadi waktu aktifitas dan tiba-tiba
     Nyeri kepala hebat  kesadaran
    menurun  muntah, koma.
     Defisit neurologis tergantung lokasi dan
    luas hematom
     Kejang ??  perdarahan di lobus frontalis
    & temporalis
     Hemiparese kontralateral
    Prosedur diagnostik
     Head CT Scan/MRI Otak
     CT Angiography/MR Angiography
     Venography
     LP
     Digital substraction angiography (DSA)
    DIAGNOSA BANDING

     Penyebab koma/ kesadaran menurun lain


     Space Occupying Lesion (SOL)
     Infark serebri
     Migrain
    PENGOBATAN
    1. Konservatif
     Perawatan koma
     Kontrol hipertensi: TD yg tinggi 
    perdarahan & edema serebri
     MAP 110 mmHg mulai terapi.
     Mannitol: edema serebri
    Pencegahan ekspansi hematom
     Managemen tek darah  TD sistolik diturunkan
    < 140 pada fase akut mengurangi ekspansi
    hematom
     Anti hipertensi pilihan
    - Labetolol
    - Esmolol
    - Nicardipin
    - Hydralazine
    - Nitroprusside
    Managemen edema atau herniasi
     Kepala ditinggikan 30 derajat dengan leher posisi netral
     Osmoterapi
    - Mannitol 20%  0,25 – 0,5 gr/kgbb
    - Saline hypertonik  NaCl 3 % bolus IV 250 cc/ 20 mnt
     Barbiturat
    - Pentobarbital 10 mg/kg
    - Thiopental 1,5 – 3,5 mg/kg
     Hiperventilasi
    Seizure prevention
     Phenytoin 20 mg/kg IV
     Valproate 10 – 15 mg/kg
     Levetiracetam 500 – 1500 mg IV
     Phenobarbital 20 mg/kg IV
    The ICH Score: Prediction of
    30-days mortality

    Hematoma volume > 30 ml


    Glasgow Coma Scale Score < 8
    Infra tentorial location
    Intraventricular hemorrhage
    Age
    Calculating the ICH Score
    Glasgow Coma Scale (GCS) Score
    3–4 2
    5 – 12 1
    13 – 15 0

    ICH Volume (cc)


    > 30 1
    < 30 0
    Intra ventricular Hemorrhage (IVH)
    Yes 1
    No 0
    Infra tentorial Origin of ICH
    Yes 1
    N0 0
    Age (years) > 80 1
    < 80 0 Total Score: 6
    Interpretasi
    ICH Score 0 : no mortality
    ICH Score 1 : 13%
    ICH Score 2 : 26%
    ICH Score 3 : 72%
    ICH Score 4 : 97%
    ICH Score 5 : 100%
    ICH Score 6 : 100%
    2. 0PERATIF
     Indikasi tindakan operatif :
    - perdarahan intra serebellar > 3 cm
    - perdarahan lobar + diameter > 3 cm +
    tanda2 peninggian TIK yg cepat
    perburukan klinis  tindakan operatif
    untuk life saving

    !!! Sebelum koma dalam + pupil dilatasi


    maksimal
    Perdarahan Sub Arakhnoid
    Penyebab paling sering :

    1. Trauma
    2. Spontan
    2.1. Perdarahan intraserebral ruang
    subarakhnoid
    2.2. Primer: - Aneurisma
    - AVM
    21
    Time Bomb in the Head
    Gejala klinis
     Sakit kepala yg hebat : thunderclap
    headache
     Muntah
     Kesadaran menurun
     Tanda rangsangan meningeal: kaku kuduk
     Funduskopi: dapat di jumpai perdarahan
    retina
     Kadang di sertai kejang
    Hunt & Hess Grading

    Grade I. Sakit kepala ringan, sadar dan


    kaku kuduk ringan (jika ada)
    Grade II. Sakit kepala sedang berat, kaku
    kuduk , sadar, tanpa gejala
    neurologik fokal
    Grade III. Drowsiness, confuse dan defisit
    neurologik fokal ringan
    Grade IV. Stupor, more severe focal deficit
    early decerebrate
    Grade V. koma, deserebrasi
    Prosedur diagnostik

     LP
     Head CT Scan/ MRI Brain
     Angiografi
     DSA
    DIAGNOSA BANDING

     Migraine
     Infeksi sistemik
     Meningitis / ensefalitis
     Hipertensif ensefalopati
     Arthritis cervicalis
     Infark serebri
    Komplikasi
     Perdarahan ulang, rebleeding

     Vasospasme

     Hidrosefalus akut
    Pengobatan
     Kesadaran menurun  perawatan koma
     Perawatan umum
     Bed rest
     Pengobatan simtomatik utk sakit kepala /
    gelisah
     Edema serebri: mannitol
     Pencegahan vasospasme :
    calsium entry blocker “nimodipine”
    Hidrosefalus: EVD/ Shunt
    Pencegahan re bleeding
     Systolic BP to < 160 mmHg
     Tindakan operatif  clipping
     Endovascular coiling

    Prognosa:
    Mortalitas masih tinggi.
    Coil
    Coiling
    Clipping
    34

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