Curriculum Vitae

Nama : Dr. Rinrin Maharani, Sp.S, CFIDN

Tempat/tgl lahir : Kuningan, 02 Februari 1985
Status : Menikah
Alamat : Jl. Otista no.62 Pasapen III, Kuningan
Pekerjaan : Dokter Spesialis Saraf di RSUD Linggajati &
RS Juanda Kab. Kuningan

PENDIDIKAN FORMAL
1. Dokter Umum : FK-Universitas Jenderal Achmad Yani - Cimahi
2. Spesialis Saraf : FK-Universitas Padjadjaran - Bandung

PENDIDIKAN NON FORMAL/KEAHLIAN

1. Functional Integrated Dry Needling – Functional Integrated Dry Needling
Institute
2. Move Kinetic Tape – University Of MKT
 Dr. Rinrin Maharani, Sp.S, CFIDN

INITIAL
MANAGEMENT
FOR ACUTE
STROKE
 CEREBROVASCULAR DISEASE :
1. Asymptomatic
2. Focal brain dysfunction
➢ TIA ( Transient ischemic attack )

➢ STROKE
3. Vascular dementia
4. Hypertensive encephalopathy
 DEFINITION of STROKE
Focal / Global Neurological Deficits

Sudden - very rapid development of

symptoms

> 24 H or Death

No other Cause than primary CVD

Primary CVD = present of risk factors

Global brain dysfunction = unconsciousness
TIA : Complete recovery < 24 H
 Different Types of Stroke

Cerebral
Embolus
24%
Intracerebral
Ischemic Hemorrhage
Stroke 9% Hemorrhagic
Cerebral
85% Thrombosis
Stroke
61% Subarachnoid 12%
Hemorrhage
3%

American Heart Association (AHA). Heart Disease and Stroke Statistics —

2003 Update. 2003. Available at: http://www.americanheart.org/downloadable/heart/
10590179711482003HDSStatsBookREV7-03.pdf. Accessed October 13, 2003.
 RISK FACTORS
Modifiable UnModifiable

Hipertension Age
Cardiac Disease Sex
Diabetes Mellitus Heredity
Renal Disease Race / ethnic
HyperCholesterol
Hyperurisemia
Obesity
Smoking
Drugs + Alcohol
MANAGEMENT OF STROKE

1. FAST
MANAGEMENT OF STROKE

2. Physical Examination

Airway important for

Breathing oxygenation

Cardiovascular system : maintenance CBF

Don’t treat BP if :
- Infarction < 220 / 120 mmHg
- Hemorrhagic < 180 / 105 mmHg
( reactive Hypertension in acute phase)
MANAGEMENT OF STROKE
2. Physical Examination
Sign of impending herniation :
- Decrease of consciousness
- Pupil miosis and reactive
- Cheyne’s stokes respiration
- Bilateral Babinski (Pathologic Reflex)

Sign of Herniation :
- Decrease of consciousness
- Pupil anisocor
- Central Neurogenic Respiration
- Bilateral Babinski
MANAGEMENT OF STROKE

3. Laboratory Examination
Blood :
- Ht, Hb, Leuco, Trombo
- Erythrocyte (Polycytemia Vera, anemia)
- Ur, creat , uric acid (Renal Function impairment)
- Chol : Total, HDL, LDL, & TG (Dislipidemia)
- Glucose : fasting & post prandial ( DM )
- SGOT, SGPT. (Liver Function)
- Electrolytes (Ca, K, Na, Cl)
MANAGEMENT OF STROKE
• Chest X-Ray ( LVH, Pulmonary edema)

• ECG ( LVH, MI, AF)

• Carotid USG ( stenosis of carotid artery )

• Angiography ( Carotid - Vertebrobasilar system)

• CT ( Computerized Tomography )Scanning :

Infarction : Hypo density

Hemorrhage : Hyper density

• MRI ( Magnetic Resonance Imaging )

Brainstem Lesion ( More sensitive)

• LP ( Lumbar Puncture )
If CT Scan or MRI unavailable
MANAGEMENT OF STROKE
3. Initial therapy
Water and electrolyte balance :
- Infus : isotonic water haemodilution,
- Maintenance input, food and drink, Diet
basal metabolism 1500 cal.
( 23 cal/kg/weight ) : orally or NGT.
- Output Control

Brain edema ( impending/ herniation )

Give antiedema (manitol 20 %),
Max for 5 days ( rebound phenomen prohibition)
Manitol Contraindication :
- Hipotension
- Renal Impairment
- Dehydration
- Decompensatio Cordis
MANAGEMENT OF STROKE
• Head elevation 300

• Hyperglycemia : if > 250 mg% give antidiabetic

• Control Complication and Underlying disease

• Control Vegetative function.

• Passive Physiotherapy
“as soon as possible”
for preventing contracture, thrombophlebitis ( DVT )

• Active Physiotherapy
If No complication - Contraindication
MANAGEMENT OF STROKE
Secondary prevention : Antiplatelet agent

a. Asetilosalysilic acid ( ASA )

(cyclooxygenation enzyme inhibitor)
decrease tromboxan A2,
Inhibit platelet agregation
dose ( Varied ) : 250 mg/days

b. Clopidogrel : 1 x 75 mg
c. Cilostazol : 1 x 100 mg

Cardio-embolic Infarction Prevention

- Anticoagulant :
first : heparin iv,
continue with : oral anticoagulant
(Coumarin, Rivaroksaban)
MANAGEMENT OF STROKE
Recanalization thrombosis :
• rTPa, Streptokinase.
Complication : bleeding

Inhibition Vasospasme :
(SAH Complication)
2 - 3 days after onset
Clinically worsening,
decrease level of consciousness
neurological deficit

Vasospasme

Mechanism :
Prostaglandin + cathecolamin accumulation.

Therapy : Ca antagonist ( Nimodipin )

Within 3 days of onset