Based on the pathology and clinical symptoms of stroke can be classified into:
1. hemorrhagic stroke
Cerebral hemorrhage and subarachnoid hemorrhage may also Yeng caused the outbreak of the brain blood vessels. Generally occurs at the time of activity, but also can occur at rest. Awareness is generally declining, and causes the most are the result of uncontrolled hypertension.
2. non-haemorrhagic stroke
Can be ischemia, embolism, thrombus, or spasm of cerebral blood vessels. Generally occurs after a long rest or sleep angun. No hemorrhage, consciousness is generally good and there is a process of the brain edema due to brain tissue hypoxia.
Non-haemorrhagic stroke can also be classified on the basis of travel sickness, namely:
1. ? € S TIA (Trans Ischemic Attack)
Disorders neurologist is a moment, a few minutes or several hours and the symptoms will disappear perfect in less than 24 hours.
1. Rind (Reversible Ischemic Neurological Defict)
Disruption of local neurologist who will disappear completely within 1 week and a maximum of 3 weeks ..
1. stroke in Volution
Stroke is happening is still growing where the interference that appears increasingly severe and getting worse. This process is usually run in a few hours or several days.
1. Complete stroke
Disruption arising neurologist is settled or permanent.
There are some stroke risk factors are often identified, namely;
1. Hypertension, can be caused by atherosclerosis or vice versa. This process can lead to rupture of blood vessels or the incidence of thrombus that may interfere with cerebral blood flow.
2. Cerebral vascular aneurysms
Vascular abnormalities in the form of thickening in one place followed by the depletion elsewhere. In the depletion region with a particular maneuver can cause bleeding.
3. Heart defects / heart disease
Most common in post MCI patients, atrial fibrillation, and endocarditis. Damage to the heart of work will decrease cardiac output and decrease blood flow to the brain. It can happen Ddisamping embolization process is based on heart failure and blood vessels.
4. Diabetes mellitus (DM)
DM patients had a stroke because of the potential 2 reasons, yeitu an increase of blood viscosity thus slowing blood flow and cerebral especially microvaskuler abnormalities that affect the disorder also occurs in cerebral blood vessels.
5. Elderly
In old age there is a process of blood vessel calcification, including the brain blood vessels.
6. Polocitemia
In policitemia increased blood viscosity and blood flow slows down so that the brain perfusion decreases.
7. Increased cholesterol (total lipid)
High body cholesterol can cause atherosclerosis and the formation of fat embolus.
8. Obesity
In obesity hypertension can occur and elevated levels of cholesterol that can cause interference with the blood vessels, one vessel brain.
9. Smokers
Will occur in smokers plaques in blood vessels by atherosclerosis, causing nicotine.
10. lack of physical activity
Lack of physical activity can also reduce physical flexibility, including flexibility of blood vessels (blood embuluh stiff), one of the brain blood vessels.
D. Pathophysiology
1. Non-haemorrhagic stroke
Ischemia caused by the blockage of cerebral blood flow by a thrombus or embolus. Thrombus usually occurs because of the development of atherosclerosis in blood vessel walls, so that arteries become clogged, blood flow to areas of thrombus is reduced, causing ischemia and then become complex finally happened myocardial ischemia in brain tissue. Embolism caused by embolus who walked into the cerebral arteries through the carotid artery. Block the occurrence of these arteries causes ischemia which develops suddenly and happen quickly focal disorders neurologist. Cerebral hemorrhage can ddisebabkan by breaking the walls of blood vessels by emboli.
2. Hemorrhagic stroke
Brain blood vessels that rupture cause blood to flow into the substance or subarachnoid space causing changes in intracranial component that should be constant. Intracranial component changes that can not be compensated body will lead to an increase of ICT which if continued will lead to herniation of the brain causing death. In addition, blood flow to the brain substance or subarachnoid space can cause edema, spasm of brain blood vessels and the emphasis on these areas caused the blood flow is reduced or not resulting in necrosis of brain tissue.
E. Signs of stroke and stroke symptoms
Signs and symptoms appear is highly dependent on the area and extent of the affected brain regions.
1. The influence of mental status
? ? Not aware: 30% – 40%
? ? Konfuse: 45% of the patients are usually aware
1. Regional media cerebral artery, internal carotid artery will lead to:
? ? contralateral hemiplegia accompanied hemianesthesia (30% -80%)
Aphasia ? ? when the dominant hemisphere (35% -50%)
? ? Apraksia if the non-dominant hemisphere (30%)
1. Anterior cerebral artery area will cause symptoms:
? ? hemianesthesia contralateral hemiplegia and especially legs (30% -80%)
Urinary incontinence ? ?, Aphasia, or apraksia depending where the affected hemisphere
1. Posterior cerebral artery area
? ? spontaneous pain in the head
Aphasia ? ? when the dominant hemisphere (35-50%)
1. Regional basiler vertebrae will cause:
? ? often fatal because of the vital centers in the brain stem
? ? alternans hemiplegia or tetraplegia
? ? pseudobulbar palsy (paralysis of eye muscles, difficulty swallowing, emotional instability)
If the views of where the affected hemisphere, stroke symptoms may include:
1. Right hemisphere stroke
? ? body left Hemiparese
Assessment ? ? bad
Having ? ? vulnerability to the contralateral side as the possibility of falling into the opposite side
1. left hemisphere stroke
? ? experiencing right hemiparese
? ? behavior is very slow and careful
? ?
Abnormalities ? ? right field of view
? ? global dysphagia
? ? Aphasia
? ? easily frustrated
F. Diagnostic tests
Disgnostik Investigations can be done is:
1. Laboratory: lead to a complete blood examination, electrolytes, cholesterol, and if necessary, blood gas analysis, blood sugar and so on.
2. CT scan of the head to know the location and extent of hemorrhage or infarction
3. MRI to determine the existence of edema, infarction, hematoma and the shifting structure of the brain
4. angiography to determine the cause and a clear picture of the affected blood vessels
G. Medical Treatment
In general, treatment of stroke patients are:
1. The position of the head and body of 20-30 degrees, on his side if vomiting and may begin a gradual mobilization if hemodinamika stable
2. Waive the airway and maintain adequate ventilation, if necessary, given as needed ogsigen
3. Vital signs stable cultivated
4. Bed rest
5. Correction of hyperglycemia or hypoglycemia
6. Maintain fluid and electrolyte balance
7. A full bladder is emptied, if necessary to do catheterization
8. Giving intravenous fluids in the form of crystalloid or colloid and avoid the use of pure glucose or hypotonic fluid
9. Avoid increase in temperature, cough, constipation, or excessive suction that can improve ICT
10. Nutrition per oral was given only if a good swallowing function. If consciousness is decreased or swallowing disorders should be installed NGT
11. Specific Treatment of:
? ? non-haemorrhagic stroke: asetosal, neuroprotektor, thrombolysis, anticoagulation, drug hemorrhagic
? ? hemorrhagic stroke: treat the cause, neuroprotektor, surgical intervention, reducing the high ICT.
