CVD (Cerebro Vaskular Disease)

Definisi
Penyakit pembuluh darah yg mensuplai otak. Implikasi:
Stroke kerusakan sel otak krn kurangnya suplai darah. TIA (transient ischaemic attack) kerusakan sementara pd penglihatan, kemampuan berbicara, rasa / gerakan.

Gejala stroke
Wajah, tangan & kaki melemah, seringkali pd satu sisi tubuh. Mati rasa di wajah, tangan & kaki Bingung Sulit berbicara & memahami pembicaraan Sulit melihat dgn sebelah / kedua mata Sulit berjalan Pusing Hilang keseimbangan Sakit kepala parah tanpa sebab Pingsan

Faktor risiko
Tidak dpt dikendalikan Usia Jenis kelamin Riwayat penyakit dlm keluarga Dpt dikendalikan Gaya hidup (kurang gerak, merokok, alkohol) Kadar kolesterol yg tinggi Hipertensi DM

Pathogenesis
Ischemic stroke is caused by focal cerebral ischemia, a localized reduction in blood flow sufficient to disrupt neuronal metabolism and function. Cerebral infarction appears as focal pan necrosis of neurons, glia and blood vessels.

Klasifikasi etiologi
Cardioembolic stroke (15-30%)
Emboli jantung dpt masuk ke sirkulasi serebral & menyumbat aliran darah serebral melalui material emboli yg masuk ke dlm arteri dgn ukuran yg sama dgn diameter lumen.

Atherosclerotic stroke (14-25%)

Akumulasi plak ateroskerotik pd lumen arteri yg besar / medium.

Klasifikasi etiologi
Lacunar stroke (15-30%)
Diameter infark < 1 cm & menyebabkan penyumbatan kecil yg dpt penetrasi ke arteri yg mensuplai struktur di otak.

Cryptogenic stroke (20-40%)

Infark sering timbul jika ada penyebab emboli, tetapi pd evaluasi diagnostik, tidak ditemukan ada sumber emboli.

Klasifikasi etiologi

Pemeriksaan Lab
Complete blood count PT & PTT Basic metabolic panel & fingerstick blood glucose level Cardiac enzymes: cardiac troponin & creatine kinase-MB fraction Other tests

Pemeriksaan penunjang
CT Scan MRI USG EEG (Electro Encephalo Gram)

DD
Spontaneous intracerebral hemorrhage Seizures Migraine Hypertensive encephalopathy Head trauma Toxic or metabolic encephalopathy

Treatment
Thrombolysis IV rt-PA Aspirin (ASA) menurunkan mortalitas yg diikuti stroke iskemik akut ketika dimulai dlm onset 48 jam. Heparin & other anticoagulants Antihypertensive therapy

Complication
Hemorrhagic transformation Brain edema Seizures Medical complications

Prevention
Hypertension
Diuretics, -blockers & ACE inhibitors

Cardiac disease
Antiplatelet therapy, lipid lowering agent, ACE inhibitors, exercise

Diabetes
Glycemic control

Hyperlipidemia Smoking Carotid artery stenosis

Hemorrhagic Stroke

Pathogenesis
Intraparenchymal hemorrhage (IPH) can occur anywhere in the brain. The hematoma spreads between white matter tracts, resulting in islands of viable brain tissue within the hematoma itself.