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from. Handbook of Stroke
4 Fundamentals Question
1. Is this Vascular or Non vascular 2. If vascular, ischaemic or haemorrhagics 3. if hemorrhagic where is the lession, if ischaemic what is the artery involved 4. What is the underlying mechanism
Ischaemic or hemorrhagic
Ischaemic Gradual onset no in activity headache, vomiting, decrease of conciousness, seizure (uncommon) Haemorrhagic Abrupt, complete deficit at onset in activity Headache, vomiting, decrease of conciousness, seizure common
Subdural
history of trauma old people lucid interval, mental status detoriation
Subarachnoid
severe headache
Brainstem Cerebellar
IVH
Posterior Circulation
hemiparesis vertigo, ataxia, dizzines is common bulbar palsy diplopia decrease of conciousness tend to progresive
Large vessel
ateroschlerotics disease, Takayasu disease
Small vessel
infection, imunological
Hematologic
hypercoagulation state, polisitemia vera
SDH
trauma, tear in bridging vein (old people)
SAH
AVM, aneurism, trauma, ICH, IVH
ICH
Hipertension, AVM, Aneurism, Amyloid angiopathy, Charcot Boucard microaneurism, Neoplam, Drugs, hematologic disease
Decrease of conciousness
akut atau pelan Bedakan dengan sinkop Penurunan kesadaran pada stroke bisa
Stroke Perdarahan Stroke infark yang:
luas (misal emboli 1 hemisfer dengan edema serebri berat) infark brainstem
Nyeri kepala
Bedakan akut atau kronik progresif Lokasi nyeri kepala SAH sering keluhan hanya nyeri kepala yang hebat, Sentinel headache (Px bisa tahu persis saat serangan nyeri) Hilang-timbul AVM, aneurisma
Vertigo
Central
not severe autonomic symptoms rare nystagmus vertical and rotatory continous tinitus uncomon
Perifer
severe autonomic symptoms prominent nystagmus horizontal or rotatory paroxysmal tinitus common
Visual disturbance
Visual Loss
unilateral:
acut: vascular eg Amaurosis Fugax subacut: inflamation chronic: compresion e.g optic nerve meningioma
Visual Disturbance
Bilateral Visual Loss
complete:
large chiasmal lession, bilateral optic pathway and cortices disturbance
Episodic
posterior circulation disorder
Intermittent
demyelinating
Gradual
neoplasm, aneurism
Diplopia
Binokular diplopia
kelemahan otot ekstraokular neurological
Monokular diplopia
ocular problems
untuk mengetahui bila ada diplopia, tutup satu mata membaik berarti misalignment misal parese n III, tetap diplopia problem ocular
Motor paralyze
Can be
hemiparese/plegia paraparese (lesi parasagital) double hemiparese/plegia bedakan dengan tetraparese pada double hemiparese ada keterlibatan saraf kranial Pure motor paralyze dapat terjadi pada infark lakunar
Sensory
Hipesthesia Rasa nyeri, panas thalamic lesion Sensory seizure: tingling, parestesia sensory hallucination lesi parietal sensory disturbance of the face onion distribution lesi di tractus spinalis n V
Speech
disartria
cortical subcortical cerebellar brainstem
dysfonia
parese plica voklais
Seizure vs Sinkop
Seizure Aura + Gerakan-gerakan saat serangan Post ictal lama ngompol, BAB, ejakulasi + Sinkop Aura Saat serangan lunglia tidak ada aktivitas Cepat bangun tidak ada ngompol, BAB, ejakulasi
Seizure
First time seizure in adult
usually organic
structural
CVA: hemoragic, emboli infection: meningensefalitis, cerebral abscess neoplasm
Metabolic
non ketotic hiperglicemia hiponatremia, hipocalcemia alcohol, benzodiazepine and opiates withdrawal. neuroleptic overdosage, teofilin, antidepresan trisiklik
Cognitif impairment
dominant hemisphere aphasia Gertzman syndrome alexia Speech apraxia Non dominat Constructional aphasia Anosonogsia Prosopagnosia