Stroke Non Hemoragik Pdf
Scottie Marberry
Hemorrhagic strokes make up about 13% of stroke cases. They occur when a weakened vessel ruptures and bleeds into the surrounding brain. The blood accumulates and compresses the surrounding brain tissue.
Normally, arteries carry blood containing oxygen from the heart to the brain, and veins carry blood with less oxygen away from the brain and back to the heart. When an arteriovenous malformation (AVM) occurs, a tangle of blood vessels in the brain bypasses normal brain tissue and directly diverts blood from the arteries to the veins.
Symptoms may vary depending on where the AVM is located. This could include a wide variety of brain functions, such as difficulties with movement, coordination, sensation, thinking or memory, speech or vision. Severity can vary greatly.
Each time blood leaks into the brain, normal brain tissue is damaged. This results in loss of normal function, which may be temporary or permanent. The chance of permanent brain damage is 20% to 30%. The risk of death related to each bleed is 10% to 15%.
Most AVMs are detected with a computed tomography (CT) brain scan or magnetic resonance imaging (MRI) brain scan. For any type of treatment involving an AVM, an angiogram may be needed to better identify the type of AVM.
The best treatment is usually endovascular surgical blocking of the abnormal connections that have caused the fistula. This involves inserting small tubes (catheters) inside the blood vessel with X-ray guidance and blocking off the abnormal connections.
Surgery: If an AVM has bled and/or is in an area that can be easily accessed, then surgery may be recommended. Microsurgery allows the surgeon to work on small structures in the brain using a microscope and small, precise instruments.
Interventional neuroradiology/endovascular embolization: It may be possible to treat part or all AVM by placing a catheter inside the blood vessels and blocking off the abnormal vessels with various materials such as glue or coils.
Aneurysms usually develop at branching points of arteries and are caused by constant pressure from blood flow. They often enlarge slowly and become weaker as they grow, just as a balloon becomes weaker as it stretches. Aneurysms may be associated with other types of blood vessel disorders, such as fibromuscular dysplasia, cerebral arteritis or arterial dissection, but these are very unusual. Some aneurysms are due to infections, drugs such as amphetamines and cocaine or direct brain trauma from an accident. About 30,000 ruptured cerebral aneurysms occur each year in the U.S. Up to 6% of the population may have an unruptured cerebral aneurysm.
Smaller aneurysms may not have symptoms. As an aneurysm enlarges, it can produce headaches or localized pain. If an aneurysm gets very large, it may produce pressure on the normal brain tissue or adjacent nerves. This pressure can cause difficulty with vision, numbness or weakness of an arm or leg, difficulty with memory or speech, seizures, nausea, vomiting or loss of consciousness.
Many factors determine whether an aneurysm is likely to bleed. These include the size, shape and location of the aneurysm and symptoms that it causes. Smaller aneurysms that are uniform in size may be less likely to bleed than larger, irregularly shaped ones.
*Blood thinners (such as warfarin), some medications and prescription drugs (including diet pills that act as stimulants such as ephedrine and amphetamines), and harmful drugs such as cocaine can cause aneurysms to rupture and bleed.
(*Some medications are commonly called blood thinners because they can help reduce a blood clot from forming. Common blood thinners are anticoagulants such as warfarin or heparin that slow down the clotting process and antiplatelet drugs such as aspirin and clopidogrel that prevent platelet blood cells from clumping together to build a clot.)
After blood enters the brain and the space around it, direct damage to the brain tissue and brain function results. The amount of damage is usually related to the amount of blood. Damage is due to the increased pressure and swelling from bleeding directly into the brain tissue, or from local cellular damage to brain tissue from irritation of blood in the space between the brain and the skull.
Blood can also irritate and damage the normal blood vessels and cause vasospasm (constriction). This can interrupt normal blood flow to the healthy brain tissue and can cause even more brain damage. This is called an ischemic stroke.
Special imaging tests can detect a brain aneurysm. In the CTA (computed tomographic angiography), patients are placed on a table that slides into a CT scanner. A special contrast material (dye) is injected into a vein, and images are taken of the blood vessels to look for abnormalities such as an aneurysm. In the second test, called MRA (magnetic resonance angiography), patients are placed on a table that slides into a magnetic resonance scanner, and the blood vessels are imaged to detect a cerebral aneurysm.
Cerebral angiogram is most reliable in identifying the exact location, size and shape of aneurysms, and can be useful to fully map a plan for therapy. In this test, the patient lies on an X-ray table. A small tube (catheter) is inserted through a blood vessel, usually in the leg (groin), and guided into each of the blood vessels in the neck that go to the brain. Contrast is then injected, and pictures are taken of all the blood vessels in the brain. This test is slightly more invasive and less comfortable.
Stroke hemoragik sangat berbahaya karena menyebabkan gejala parah yang memburuk dengan cepat. Tanpa perhatian medis yang cepat, stroke ini sering menyebabkan kerusakan otak permanen atau bahkan kematian.
Penyebab paling umum dari stroke hemoragik adalah tekanan darah tinggi (hipertensi). Ini terutama benar ketika tekanan darah seseorang sangat tinggi, tetap tinggi untuk waktu yang lama, atau keduanya.
Gejala stroke hemoragik bervariasi tergantung dari lokasi pecahnya pembuluh darah atau jenis stroke hemoragik yang dialami pengidap. Perdarahan intraserebral umumnya timbul tanpa peringatan dan memburuk setelah 30-90 menit.
Dokter akan mendiagnosis stroke hemoragik dengan diawali suatu wawancara medis lengkap dengan kerabat pengidap. Ini karena saat sampai di rumah sakit umumnya pengidap dalam kondisi tidak sadarkan diri.
Stroke hemoragik adalah pecahnya pembuluh darah dalam otak yang menyebabkan perdarahan dan terhentinya asupan nutrisi dan oksigen pada area tertentu di dalam otak. Kondisi ini selanjutnya akan merusak sel-sel dan jaringan otak.
Stroke hemoragik terjadi ketika pembuluh darah di dalam atau sekitar otak pecah. Kondisi ini menyebabkan darah mengalir ke dalam rongga tengkorak kepala. Akibatnya, tekanan di dalam kepala meningkat dan jaringan otak pun mengalami kerusakan.
Stroke hemoragik subarachnoid menimbulkan gejala awal berupa penglihatan ganda, nyeri di mata, dan sakit kepala atau pusing berputar. Keluhan tersebut dapat terjadi beberapa menit hingga minggu sebelum pembuluh darah pecah.
Kerusakan jaringan otak akibat perdarahan pada stroke hemoragik dapat terjadi dengan cepat. Dalam hitungan menit atau jam, kerusakan sel otak akibat stroke hemoragik bisa berkembang menjadi gangguan permanen. Oleh sebab itu, stroke hemoragik harus ditangani dengan cepat.
Selain dengan Se-Ge-Ra-Ke-RS, singkatan berikut juga bisa membantu menduga seseorang mengalami stroke. Dengan begitu, orang yang mengalaminya bisa segera dibawa ke IGD untuk ditangani. Singkatan yang bisa membantu mengenali tanda stroke adalah FAST, yaitu:
Menelepon 119 (ambulans) sesegera mungkin adalah tindakan yang paling tepat untuk menolong penderita stroke hemoragik. Dengan begitu, penderita bisa segera mendapatkan pertolongan dari petugas medis dan dokter.
Penderita stroke hemoragik akan dirawat di unit rawat intensif agar kondisinya dapat dipantau secara ketat. Penanganan untuk kondisi ini umumnya akan berfokus pada pengendalian perdarahan dan pencegahan komplikasi, seperti yang dijelaskan berikut ini:
Untuk kasus stroke hemoragik dengan perdarahan yang sangat banyak, terkadang diperlukan tindakan operasi guna mengeluarkan tumpukan darah yang terjebak di dalam otak dan menurunkan tekanan di dalam kepala. Operasi juga bertujuan untuk menghentikan perdarahan.
Obat pereda nyeri juga bisa diberikan kepada pasien guna meredakan sakit kepala. Namun, obat antiinflamasi nonsteroid (OAINS) tidak dianjurkan pada pasien stroke hemoragik, karena dapat memperburuk perdarahan.
Setelah kesadaran pasien kembali, terapi rehabilitasi dapat dilakukan sesegera mungkin. Terapi pascastroke yang dapat dilakukan antara lain fisioterapi, terapi okupasi, atau terapi bicara. Terapi-terapi tersebut tidak hanya dilakukan di rumah sakit, tetapi juga perlu diteruskan meski pasien sudah kembali ke rumah.
Meski begitu, tidak semua penderita stroke hemoragik mengalami gangguan di atas untuk seumur hidup. Kondisi ini dapat membaik dengan kontrol ke dokter dan terapi rehabilitasi pascastroke secara rutin.
Stroke hemoragik juga bisa disebabkan oleh cedera kepala. Oleh sebab itu, berhati-hatilah saat beraktivitas di dalam atau di luar rumah. Sebagai contoh, selalu pakai helm dan taati peraturan lalu lintas ketika mengendarai sepeda motor. Jika sedang mengemudikan mobil, gunakan sabuk pengaman dan hati-hati dalam berkendara.
Terkait dengan risiko stroke hemoragik bagi pengguna warfarin, selalu taati aturan dan dosis yang telah ditetapkan oleh dokter untuk meminimalkan risiko terjadinya perdarahan pada pembuluh darah otak.
Hemorrhagic stroke is due to bleeding into the brain by the rupture of a blood vessel. Hemorrhagic stroke may be further subdivided into intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH). Hemorrhagic stroke is associated with severe morbidity and high mortality. Progression of hemorrhagic stroke is associated with worse outcomes. Early diagnosis and treatment are essential given the usual rapid expansion of hemorrhage, causing sudden deterioration of consciousness and neurological dysfunction. This activity highlights the role of the interprofessional team in the evaluation and treatment of hemorrhagic stroke.
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