1.1.

Definitions

Stroke is a collection of symptoms characterized by the development of

clinical manifestations of cerebral function disorders either focal or global (for
the patient in a coma), which happens quickly and more than 24 hours or
ended up with death without being discovered causes other than vascular
disorders. This definition includes stroke due to cerebral infarction (ischemic
stroke), nontraumatic intracerebral hemorrhage, intraventricular hemorrhage
and some cases of subarachnoid hemorrhage
1.2.

Epidemiology

The increasing age of life expectancy will tend to increase the risk of vascular
disease (coronary heart disease, stroke and peripheral artery disease). Data
in Indonesia showed the tendency of an increase in stroke cases both in
terms of mortality, incidence, and disability. The mortality rate based on age is:
15.9% (age 45-55 years) and 26.8% (age 55-64 years) and 23.5% (age 65
years). The incidence of stroke (incidence) amounted to 51.6 / 100,000
population. Sufferers are men more than women and age profile under 45
years of 11.8%, 54.2% aged 45-64 years, and age over 65 years amounted to
33.5%. Stroke attacking reproductive age and the elderly that could potentially
give rise to new problems in health development nationally at a later date

5. Basic management:
- Bed rest and positioned head and body 20-300 to maintain adequate
circulation to the brain.
- Infusion RL 20 drops / minute to maintain the state of euvolumic and needs
glucose.
- Infusion of Mannitol 125 cc / 6 hours to reduce cerebral edema.
- Injection 3x 2500 mg of tranexamic acid to control hemorrhage.
Giving citicolin aiming as a neuroprotective.
.5 Management
Stroke patients should be handled by a multidisciplinary team in conducting
the treatment of.
Management stroke be done by improving the general state of the patient,
treat disease risk factors, and prevent complications
1.6 Complications
Systemic complications often occurs on the first day of stroke. this condition
five time as much causing death than due to lessions. Some circumstances
that should always be monitored for systemic complications :

1. The blood pressure

Rise in blood pressure is usually the compensation the body as a result of a
stroke. This happens because the body's efforts to overcome the existing
shortage of blood supply in the lesion. However, this condition will improve in
2-3 days. Rise in blood pressure does not need to be reduced, but reach very
high values that is systolic> 220mmHg / Diastolic> 130mmHg.
2.

Blood Sugar

Rise in blood sugar in patients with a stroke or a compensation body of stress

mechanism. High blood sugar will aggravate brain damage, so that the rise
blood sugar in the first days of stroke should be lowered.
3.The state of cardiorespiratory
Cardiac disorders often occurs and worsen the stroke. Besides cardiac
disorders, respiratory disorders can also occur, either caused by infection or
the presence of an emphasis on the respiratory center.
4. ulcer stress
ulcer stress is one of the complications that can occurs in stroke patients and
need attention. This situation may lead to haematemesis and melena, and
can be effect on patient survival.
5. Other complications
Other complications that may arise on the state of stroke include: infection
and sepsis, kidney disorders, liver disorders, and pulmonary embolism and /
or deep vein thrombosis. So that the necessary monitoring from the start of
stroke occurs.
1.7 Prognosis
Stroke can cause a variety of morbidity, mortality, and recurrence in the future.
Deaths due to stroke was 41.4% from 100,000 population. A third of patients
who have had a stroke, 5-14% will suffer recurrent stroke within a span of five
years.
Statistical stroke data by the Stroke Association UK shows that 42% disability
caused by stroke is permanent. In 2010, stroke accounted for 7% of all
causes of mortality in men and 10% of all causes of death among women.
Recurrence of stroke increases with the time. The possibility of recurrent
stroke within five years was 26.4% and in ten years was 39.2%.

4. Basic investigations: bhasa inggris pemeriksaan penunjang?

( dasar usul atau asal usul?)
- Routine blood tests: to determine the risk factors for stroke include increased
hematocrit.
- Examination of blood chemistry: to determine stroke risk factors such as
diabetes mellitus, dyslipidemia and useful also for management.
- ECG: determine cardiac abnormalities such as LVH (left ventricel hypertrofi),
atrial fibrillation and myocardial infarction.
- Chest X-ray: know the existence of cardiac abnormalities such as
cardiomegaly.
- Head CT scans: pathologic abnormality diagnosis of stroke (hemorrhagic or
infarction), location and lesion area.
3.4. Basic Differential diagnosis
Gold standard diagnosis of hemorrhagic stroke / non hemorrhagic is with a CT
scan. Considered non-hemorrhagic stroke because of the complaints appear
obtained when patients move lightly in the morning. Also according to the
family, patients had experienced with the mouth oblique, left side 2 years ago
but a few hours later disappears, neurologic deficit that lasted <24 hours
suspicion of a TIA which is a sign of stroke infarction.
3.5. Basic secondary diagnosis
From anamnesis it is known that the patient has a history of hypertension
since 1 year ago and based on a physical examination also obtained the
patient's blood pressure 170/90 mmHg. This is in accordance with the criteria
JNC 8 that in patients aged 60 years said to hypertension if the systolic
blood pressure 150 mmHg or diastolic 90mmHg.
3.6. The basis of the final diagnosis
The final diagnosis of these patients is hemorrhagic stroke + hypertension.
The diagnosis is established based on anamnesis, physical examination, and
are supported by the results of further examination.
From anamnesis it is known that patients experience decrease in
consciousness while on the move. Previously patients vomited 2 times and
spraying. Headache was also felt in all parts of the head. Besides the patient
has a history of hypertension since 1 year ago. a physical examination
obtained from the patient's blood pressure 170/90 mmHg, GCS E1M4Vtube,
pathological reflex positive Babinsky. Examination of head CT scan is the gold
standard for determining the cause of a stroke is happening. Head CT scan
results indicate the presence of intraventricular hemorrhage.