Gangguan Peredaran Darah Otak

Gangguan Peredaran Darah OtakM. Ardiansyah Adi Nugraha

Prinsip utama.STROKE=BRAIN ATTACK

DefinisiSindrom yang muncul secara mendadak dan ditandai dengan gejala / tanda klinis yang berkembang dengan cepat berupa gangguan fokal maupun global yang berlangsung lebih dari 24 jamGejalaFOKALGejala akibat gangguan didaerah yang terlokalisir/teridentifikasiGLOBALGejala bersifat menyeluruh akibat gangguan diarea yang lebih luasGejala FokalHemipareseDisfagiaDisartria AfasiaHemihipestesi HemianopsiaGejala GlobalGangguan kesadaran

PoinDefisit neurologis akut yang bersifat suddenTerdapat gangguan fungsional otakHanya disebabkan gangguan vaskuler otakBlood Vessels in the Brain

8Blood is supplied to the brain, face, and scalp via two major sets of vessels: the right and left common carotid arteries and the right and left vertebral arteries.The common carotid arteries have two divisions. External carotid arteries supply the face and scalp Internal carotid arteries supply blood to the anterior three-fifths of cerebrum, except for parts of the temporal and occipital lobes.

Vertebrobasilar arteries supply the posterior two-fifths of the cerebrum, part of the cerebellum, and the brain stem.Any decrease in the flow of blood through one of the internal carotid arteries brings about some impairment in the function of the frontal lobes. This impairment may result in numbness, weakness, or paralysis on the side of the body opposite to the obstruction of the artery.Occlusion of one of the vertebral arteries can cause many serious consequences, ranging from blindness to paralysis.

Sistem Vaskularisasi OtakPembuluh darah ekstrakranial a. carotis comunis (anterior)a. basilaris (posterior)

Arteri intrakranial besara. cerebri mediasirkulasi wilisisirkulasi choroid arteri-arteri perforantes(a. lenticulostriata)

Anterior Cerebral Artery (ACA)

10supplies the frontal lobes and legs- stroke here will contralateral weakness in leg >arm, behavioural changes

Middle Cerebral Artery (MCA)

MCA cont.Largest branch of Internal Carotid.Supplies portion of frontal lobe and lateral surface of Temporal and Parietal lobes.Primary Motor and Sensory areas for face, throat , hand and arm.Dominant hemisphere, supplies area controlling speech.Is the Artery most often occluded in stroke.

Posterior Cerebral Artery (PCA)

13Supplies: Occipital lobeinferior and medial portion of temporal lobe

Occlusion causes: Contralateral homonymous hemianopiaVisual hallucinationsAgnosias

When infarction occurs in the territory of the posterior cerebral artery, it is usually secondary to embolism from lower segments of the vertebral basilar system or heart. Clinical symptoms associated with occlusion of the posterior cerebral artery, depend on the location of the occlusion and may include thalamic syndrome, thalamic perforate syndrome, Weber's syndrome, contralateral hemplegia, hemianopsia and a variety of other symptoms, including including color blindness, failure to see to-and-fro movements, verbal dyslexia, and hallucinations. The most common finding is occipital lobe infarction leading to an opposite visual field defect.

POSTERIOR CEREBRAL ARTERY (PCA)Involves the brainstem, cerebellum, thalamus & occipital lobesPresent with bilateral limb weakness or sensory disturbances, cranial nerve defisit, ataxia, nausea, and vomiting or comaocclusion of the basilar artery trunk : Present with hemianopia, memory disturbance, mild personality disturbanceRarely; bilateral thalamus : a state of decreased responsiveness and apathy without motor, sensory or visual impairmentArteri perforan (lacunar)

15Small, deep penetrating arteries known as the lenticulostriate arteries branch from the middle cerebral artery

- chronic hypertension and in the elderly- Often only minor deficits are seen. When the infarction is critically located, however, more severe manifestations may develop, including paralysis and sensory loss.

Within a few months of the infarction, the necrotic brains cells are reabsorbed by macrophage activity, leaving a very small cavity a lake or lacune in French.

Strokes occur in the brain and affect the opposite side of the body

Strokes can affect different parts of the brain, this results in patients experiencing different symptoms

CONTROL CENTER OF BRAINRisk Factors for StrokeNon-Modifiable Risk Factors for Stroke

Age Sex Low weight baby birth historyRace/ethnicity Family history / genetic

Modifiable Risk Factors for Stroke6HypertensionDiabetesSmokingHyperlipidemiaCarotid stenosisAtrial fibrillationObesityTIA historyOthers Risk Factors for StrokeUnidentify(weak evidence)MigrenAlcohol consumptionDrugs abuseHyperhomocysteineHypercoagulabilityInflamation markerLipoprotein (a) increaseetcALGORITMA STROKE GADJAH MADA

penderita stroke akutpenurunan kes., nyeri kepala, refleks babinski1 dari ketiganyaada3 atau 2 dariketiganya adatidak adaketiganyastroke perdarahanstroke iskemik akut(stroke infark)penurunan kes. ada, nyeri kepaladan refleks babinski tidak adaataunyeri kepala ada, penurunan kes.,dan refleks babinski tidak adarefleks babinski ada,penurunan kes. dannyeri kepala tidak adadengan atau tanpaSKOR STROKE SIRIRAJ2,5 X derajat kesadaran+2 X vomitus+2 X nyeri kepala+0,1 X tekanan diastolik-3 X petanda ateroma-12KeteranganDerajat kesadaran: 0=CM, 1=somn, 2= < somnVomitus: 0=tidak ada, 1=adaNyeri kepala: 0=tidak ada, 1=adaAteroma: 0=tidak ada, 1=salah satu/lebih (DM, angina, AF, penyakit pemb. darah)

HASILSkor >1 : terdapat perdarahanSkor -1 s/d 1 : perlu dipastikan dengan CT ScanSkor < -1 : infark

Stroke Strikes F.A.S.T. You Should, Too. Call 9-1-1 F = Face: ask the person to smile A = Arm: ask the person to raise both arms S = Speech: ask the person to speak a simple sentence T = Time: to call 911

Every minute matters!2525One way to help remember the symptoms of stroke and what to do, is to learn the Face, Arms, Speech Test, otherwise knows as F.A.S.T.:

F = Face: ask the person to smile do both sides of the face move equally? (Normal) Or does one side of the face not move at all? (Abnormal)

A = Arm: ask the person to raise both arms do both arms move equally? (Normal) Or does one arm drift downward compared to the other? (Abnormal)

S = Speech: ask the person to speak a simple sentence Does the person use correct words with no slurring? (Normal) Or do they slur their speech, use inappropriate words or is unable to speak at all? (Abnormal)

T = Time: to call 911 if you observe any of these symptoms, call 911 immediately. Every minute matters!

References: National Stroke Association. The Complete Guide to Stroke. 2003. At: http://www.stroke.org/site/DocServer/NSA_complete_guide.pdf?docID=341.

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