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STROKE, KOMA,
MATI BATANG OTAK
Dr Aris Catur Bintoro,SpS
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KEGAWATAN NEUROLOGI
(PENYEBAB)
Stroke Akut
Status Epileptikus
Infeksi SSP
Trauma SSP Sindroma Guillain Barre
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KEGAWATAN NEUROLOGI
(GEJALA)
Kesadaran Menurun
Kejang
Gagal Nafas
Kenaikan TIK
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STROKE
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Insiden stroke masih tinggi di Indonesia
Stroke merupakan salah satu pene!a!
kematian dan ke"a"atanang utama di
Indonesia
Stroke adalah serangan otak ang
merupakan kega#atdaruratan medik
ang harus ditangani segera$ tepat dan
"ermat%
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ARTERIAL TERRRITORIES OF THE
CEREBRAL HEMISPHERES
= anterir !ere"ra# arter$% = &i''#e !ere"ra# arter$
= terir !ere"ra# arter$% = anterir !*ri'a# arter$
B#+e Re'
Ye##, Green
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ARTERIAL TERRITORRIES OF CEREBRAL HEMISPHERES
LEFT (FRONTAL)% RIGHT (HORI-ONTAL)
.
/0
0
/
.
0 = n+!#e+ #enti1r&i% / = t*a#a&+% . = n+!#e+ !a+'at+
Re' =a2!ere"ri ant2 Green =a2!ere"ri &e'2 Ye##, =a2!ere"ri t2 Li3*t "#+e =a2!*ri'ea ant24ar5 3reen =a2!*ri'ea t2 4ar5 "#+e =a2!&&+n2t
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STROKE (BRAIN ATTACK)(Adams Jr 2003)
S lurred speech, difficulty understanding others
L
OW
H
E
A
D
egs clumsy or numb
ne side of body affected
eakness
eadache, unusually severe (or facial numbness)
yes: loss of sight (in one eye or both eyes)
rms clumsy or numb AND/O
i!!iness
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9/644IFFERENT KIN4S OF STROKE
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INCI4ENCE OF THE MAIN CAUSES OF STROKE
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STROKE ISKEMIK
(SUMBATAN)
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(CT6!an)
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PERDARAHAN INTRA
SEREBRAL Perdarahan yan ter!adi da"a# paren$i# ota$
Ter!adi saat a$ti%tas, ter$ait denanpenin$atan te$anan darah dan a"iran darah$e ota$ &CBF'
(o$asi pa"in serin ter!adi )
* Gan"ia +asa"is &-.'* Kapsu"a interna / tha"a#us &0.'
* Pons &0-.'
* Sere+e"u# &0-.'
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HYPERTENSION
OTHER
AV-AL!ORATION
ANE"RYS
O#$%r &a's%s *%%d+, +,#. #'m.r/ $1.&.a'*a*% s#a#%/$%m.rr$a+& +,ar+.,/ +a#r.%,+&/ a,d #ra'ma
INTRACEREBRAL HEMORRHAGENON TRAUMATIC
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1e#ato#yan ter!adi #en2apai u$uran
#a$si#a" 034- #enit se!a$ onset5
Perta#+ahan u$uran +eri$utnya sanatsedi$it, $e2ua"i perdarahan u"an5
Bi"a +er$e#+an sanat 2epat dan#asi6 +era$i+at $erusa$an !arinan ota$dan ruptur $e 7entri$e", serta
penin$atan TIK5 Ke#atian a$i+at pene$anan8 pereseran
+atan ota$#e"a"ui tentoriu#5
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INTRACEREBRAL HEMORRHAGE
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$esadaran #enurun
hipertensi denan 8 tanpa+radi$ardi
nyeri $epa"a, #untah
$e"u#puhan sara6 9I ede#a papi"
KENAIKAN TIK
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hi"annya rea$ti7itas pupi"
$eaa"an perera$an +o"a #ata
hiper7enti"asi
posisi #otori$ &:e$si ataue$stensi'
peru+ahan pada perna6asan
pupi" yan #ene2i"5
&E'NIASI (TAK
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PER4ARAHAN SUB
ARAHNOI4
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CLINICAL SIGNS OF SUBARACHNOI4 HEMORRHAGE
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MENINGEAL SIGNS IN SUBARACHNOI4 HEMORRHAGE
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SUBHYALOI4 HEMORRHAGE
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ANEURYSMS RUPTURE
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S+r3er$ trn3#$ in'i!ate'
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KOMP(IKASI
Perdarahan u"an
9asospas#e
Ke!an
1idrose6a"us
Ganuan $esei#+anan 2airan dane"e$tro"it
Ganuan $ardia$ dan pu"#ona" neuroeni$
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PENATA(AKSANAAN
KEADAAN K1;S;S
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1IPERTENSI
Te$anan darah yan #enin$at pada stro$e a$ut+iasanya turun sete"ah
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E#erensi
SN1 ) Sisto"i$ ? 4
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PERDARA1AN GASTRO INTESTINA(
Perdarahan intra sere+ra" u$uran #ediu#dan "uas serin #eni#+u"$an $o#p"i$asiperdarahan "a#+un &he#ate#esis'
Pasien stro$e is$e#i$ a$ut denan terapi antip"ate"et, anti$oau"an, %+rino"iti$ atau antiin:a3#asi non steroid tida$ !aran yan#ena"a#i iritasi pada #u$osa "a#+un5
Penaasan ter!adinya perdarahan "a#+unharus di"a$u$an denan pe#asanan NGT5
Preparat 14 re2eptor antaonist dapatdi+eri$an5
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KEJAN
(esi yan #e"i+at$an daerah $orti$a"#otori$di ota$ dapat #eni#+u"$an $e!an5
Ke!an dapat #e#per+uru$ proses is$e#i$
da"a# neuron $arena $e+utuhan o$siena$an +erta#+ah5
Se$a"i $e!an te"ah +erhenti di"an!ut$an
denan pe#+erian phenytoinintra7ena5
Pro%"a$sis pe#+erian anti $e!an padapasien stro$e tida$ di"a$u$an5
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HIPERGLIKEMI
1iper"i$e#i dapat se+aai +entu$rea$ti6 terhadap ter!adinya stro$e a$ut
Pada pasien stro$e a$ut denan 6a$torrisi$o DM, penurunan $adar u"a darahdenan Insu"in +erdasar s$a"a "un2ur )
3 0- * 4-- #8d" ) unit
3 4-0 * 4- #8d" ) 0- unit
3 40 *
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KOMA
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KESADARAN
;NGSI OTAK TERPENTING ADA(A1
SEBAGAI P;SAT PENGAT;R KESADARAN
DAN P;SAT KOORDINASI SE(;R;1KEGIATAN
KESADARAN ADA(A1 KONDISIPENGINTEGRASIAN RANGSANG AEREN
DAN EEREN
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CONSCIOUSNESS
A conscious state depends on :
Intactcerebral hemispheres
Interactingwith the ascending reticularactivating system in the Brainstem,Midbrain, Hypothalamus, and Thalamus
esion di!uselya!ecting the cerebralhemispheres or directly a!ecting the"A# cause impairment o$ consciouslevel
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AWARENESS
Higher%level integrationo$ multiplesensory inputs that permit meaning$ul
understandingo$ sel$ and environment
The mechanisms o$ awareness residedi!usely in the cerebral corte&
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COMA
NO SPEECH
NO EYE OPENING
NO MOTOR RESPONSE
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KOMA
Koma Supra Tentorial
) *esak ruang g meningkatkan TIK
)+esi sindroma unkus
) Sindr% kompresi rostrokaudal !atang otak
Koma Infra Tentorial
) Proses patologis !atang otak) Proses patologis di luar !atang otak
Koma Bihemisferium *ifus
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NON NE;RO(OG
3 Meta+o"i2 En2epha"opathy
3 1ypoi2 En2epha"opathy
3 Intoi2ation
3 1ypoter#y8 hyperther#y
3 De%2ien2y &7it5 B0'
NE;RO(OG
9as2u"ar
Trau#a
In6e2tion
Tu#or
Epi"epsy
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A5 Pri#ary +rain in!ury or disease
usua""y asso2iated ith de#onstra+"e stru2tura" "esion
B5 Syste#i2 2auses
AFe2tin the +rain se2ondari"y
A505 TRA;MA
Con2ussion
Contusion
(a2eration or trau#ati2 intra2ere+ra"he#orrhae
Su+dura" he#ato#a
Epidura" he#ato#a
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A545 9ASC;(AR DISEASE
INTRACEREBRA( 1EMORR1AGE
* 1ypertensi7e, A9M, +"eedin disorder
S;BARAC1NOID 1EMORR1AGE* ruptured aneurys#, A9M, 4ndto trau#a
INARCT
*Thro#+osis, e#+o"is#, 7as2u"itis, #a"aria
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A5
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B505 METABO(IC ENCEP1A(OPAT1
1ypo"y2e#ia
Dia+eti2 $etoa2idosis
1yper"y2e#i2 non$etoti2 hyperos#o"er
;re#ia 1epati2 en2epha"opathy
1yponatre#ia
Myede#a 1yper2a"2e#ia and hypo2a"2e#ia
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B545 1POHIC ENCEP1A(OPAT1
Se7ere 2onesti7e heart 6ai"ure Chroni2 o+stru2ti7e pu"#onary disease
ith de2o#pensation
1ypertensi7e en2epha"opathy
B5
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B5=5 P1SICA( CA;SES
1eat stro$e 1ypother#ia
B55 DIICIENC STATES erni2$eJs en2epha"opathy
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MATI BATANG OTAK
(MBO)
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Mati otak,kematian otak total- adalah!erhentina fungsi otak keseluruhan
se"ara ire.ersi!el ang meliputi /
sere!rum$ diensefalon$
!atang otak dan
Sere!elum
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Mati otakdapat dise!a!kan oleh!erhentina se"ara total aliran darah otakaki!at kegagalan kardiopulmonal ataukelainan primer pada otakseperti tumor$
perdarahan intrasere!ral$ trauma$ dll%
Se"ara klinis mati otak ditunjukkandengan keadaan komadan apneu
ire.ersi!el dan hilangna refleks !atangotak%
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Mati !atang otak ,MB(-adalah
!erhentina fungsi !atang otak se"ara
ire.ersi!el ang ditandai dengan
hilangna refleks0refleks !atang otak
ang meliputi daerah /
mesensefalon$
pons$
medula o!longata
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*iagnosis mati !atang otak harus
memenuhi !e!erapa sarat a%l% /
pasien tidak menggunakan o!at0o!at
ang menekan kerja SSP
tidak terdapat keadaan hipotermi
tidak mengalami gangguan meta!olik$
endokrin$ danelektrolit
tidak menggunakan neuromuscular
blocking agent%
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Pra kondisiang harus dilihat se!elummelakukan tes fungsi !atang otak /
Koma
Tidak ada sikap a!normal
,dekortikasiatau desere!rasi-
Tidak ada nafas spontan
Tidak ada reflek !atang otak
TES 12NGSI BATANG (TAK
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NO REFLEK TES BRAIN 4EATH NN KRANIAL
3 Pupil Pupil disinari 'eaksi pupilnegatif
II$III,mesen"ephalon-
4 Kornea Sentuh kornea dengankapas
Mata tidak!erkedip
5 dan 5II ,pons-
6 (kulosefalik Kepala diputar ke kirikanan$ perhatikangerakan mata
Tak adagerakan mata,doll7s ee-
5III$ 1+M
,Pons danmesen"ephalon-
8 (kulo.esti!ular Irigasi telinga denganair es 9: ""$ perhati0kan gerakan mata
Nistagmusnegatif
5III ,Pons-
9 (ropharngeal,muntah$ !atuk-
Sentuh faring ; gerak0kan endotra"heal tu!e
Muntah ; !atuknegatif
I
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Tes penunjang ang dapat dilakukanuntuk diagnosis mati !atang otak
adalah /
Tes henti nafas ,apneu-
Elektro ensefalografi ,EEG-
E.oked potential ,BAEP dan SSEP-
Trans kranial dopler ,T>*-
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