Dr. Ida Ratna Nurhidayati, Sp.

S
Bagian Ilmu Penyakit Saraf
Fakultas Kedokteran Universitas YARSI

Stroke
A syndrome characterized by rapidly developing clinical symptoms and/or
signs of focal, and at times global (applied to patients in deep coma and
those with subarachnoid haemorrhage), loss of cerebral functions, with
symptoms lasting more than 24 h or leading to death, with no apparent
cause other than of vascular origin (Bull World Health Organ 1976;54(5):541-53)

TIA
Clinical syndrome characterized by an acute loss of focal cerebral or
monocular function with symptoms lasting less than 24 h and which is
thought to be due to inadequate cerebral or ocular blood supply as a
result of low blood flow, thrombosis or embolism associated with disease
of the arteries, heart, or blood (J Neurol Neurosurg Psychiatry 1991;54(9):793-802)

Executive Summary: Heart Disease

and Stroke Statistics2012 Update
A Report From the American Heart Association

(Circulation 2012;125:188-197)

First attacks
610.000

795.000/year
Recurrent attacks
185.000

3rd leading cause

of death

134.000/year
1 every 18
deaths

Guidelines for the Primary

Prevention of Stroke

A Guideline for Healthcare Professionals From the AHA/ASA

(Stroke 2011;42:517-584)

Death
Rates

Leading cause of
functional
impairment

Incidence

20% of survivors requiring

institutional care after 3
months
15-30% being permanently
disabled

Relationship between the duration of focal neurological symptoms due

to TIA and ischemic stroke and the percentage of patients with an
appropriately sited abnormality on brain imaging with CT
(J Neurol Neurosurg Psychiatry 1992;55(2):95-7)

Clinical Symptoms
and/or Signs

Level of Competence

Decide

Treat

Therapeutic
Window
ISCHEMIC
rtPA 3 h onset

Refer

HEMORRHAGIC
RAF VII 4 h onset

How to Diagnose?

Diagnosis

Treatment Option

Prognosis

The diagnosis of a cerebrovascular event is

usually made at the bedside, not in the
laboratory or in the radiology department

It depends on the history of the sudden

onset of focal neurological symptoms in the
appropriate clinical setting and the exclusion
of other conditions that can present in a
similar way

STROKE

Iskemik

Trombus

Embolus

Hemoragik

PIS

SAH

Two systematic review of stroke incidence

studies
Sudlow et al., 1997 (Stroke 1997;28:491-9)
Feigin et al., 2003 (Lancet Neurol 2003;2:43-53)

Cerebral infarction
Intracerebral
hemorrhage
Subarachnoid
hemorrhage

Uncertain

How to differentiate?

STROKE

Iskemik

Hemoragik

Lateralisasi

TIK

TIK

Lateralisasi

STROKE

Iskemik

Trombus

Embolus

Aktivitas (-)
Progresivitas

Aktivitas (+)
Menetap

STROKE

Hemoragik

PIS

SAH

TRM (-)

TRM (+)

Topis
Korteks
Kekuatan otot
ekstremitas
atas & bawah
berbeda

VS

Subkorteks
Kekuatan otot
ekstremitas
atas & bawah
sama

Pem. Penunjang
Diagnosis (gold standard)
Faktor Risiko

CT-scan Kepala non kontras

Laboratorium
- Profil lipid (kol. total, HDL, LDL, TG)
- Profil gula darah (GDP, GD2PP, HbA1C)
- Asam urat
- Hemostasis lengkap (PT, APTT, D-dimer,
INR, Fibrinogen)
- Kadar hemoglobin
Elektrokardiografi (EKG)

Rontgen Toraks PA/AP

Prognostik

Laboratorium : GDS, kadar leukosit + hitung

jenis

Tata Laksana
Iskemik
Antiagregasi Trombosit
(asam asetil salisilat)
Neuroprotektor
(citicholine)
Stabilisator Plak +
Mencegah Vaskulitis
(simvastatin)
Antihiperhomosisteinemia
(vitamin B6,B12, asam folat)
HT Emergensi
(TDD > 120)

VS

Hemoragik
Neuroprotektor
(citicholine)
Antihiperhomosisteinemia
(vitamin B6,B12, asam folat)

Manajemen TD Fase Akut

Iskemik
MAP > 140

VS

Hemoragik
MAP > 130

Blood Pressure Management

Acute stroke is a medical emergency

Make the right diagnosis, give the initial
treatment, refer soon

Different stroke, different treatment,

prognosis, and risk of recurrence