PREFACE.

I wrote this A STROKE IN YOUNG ADULTS to fulfill the assignment in connection with 3rd English lecture in the 10th semester at the Faculty of MedicineTrisakti University, Jakarta. First, I would like to express my deep gratitude to Allah SWT, for all of the mercy to me. So, my assignment could be finished exactly in time. I would like to express my thanks to dr. Sulaiman Sutanto, M.S, who has been my supervisor, a constat source of ideas and encouragement, and his insights into this assignment appear throughout the paper. I would also like to express my thanks to my family, my friends, and anyone for their helps. Without their helps and support, I wouldnt to able to finish this paper. This paper is far from perfect. There are a lot of mistake in the writings, whether the grammar or the theory. I hope after reading this paper, readers could give me some advice and critics. Hopefully, with the critics and advice, I will be able to develop my self. I apologize for all the mistakes Ive made in this paper. I hope this paper could be useful to all the readers. Thank you. Jakarta, January 2011

CONTENTS

Preface .. 1 Contents .... 2 Abstract . 3 Introduction ... 4 Literature Study . 5 Discussion .. 7 Conclusion . 11 Bibliography .. 12

ABSTRACT
Stroke is a major health problem in society because of the risk of stroke increases with age, so the main strategy is to improve the quality of care in the handling of stroke, not only treating but mainly to prevent a stroke at an early age. Despite the young age have a lower risk, but a stroke in this age group has a big impact in the community, including the associated view periods of productivity loss.4 The incidence of stroke in children about 2 per 100,000 children per year, while the incidence rate in infants up to 25 per 100,000 infants per year. At a young age, etiology of stroke is more varied than the elderly who are usually due to atherosclerosis factor. Therefore, an understanding of a variety of other specific risk factors at a young age is absolutely necessary. 1

INTRODUCTION
There is a big number of people with stroke in Indonesia. A stroke can be affect for a people life. In this condition they need an intensive treatment to cure the disease or sometimes it will need surgery. Hippocrates was the first person to describe stroke-like symptoms. Stroke are the leading cause of serious long-term disability and the third leading cause of death. The American Heart Association reports that about 3,000 children and young adults die of stroke each year in the United States. In Indonesia, the incidence of stroke in young adult is very high. This is due to various factors that underlie the occurrence of stroke. Lack of knowledge of the community about stroke in children and in young adults, causing delays in handling. We are often unconscious of the symptoms that arise as a matter that must be wary of. If children or young adults often complain of dizziness, headaches in certain parts, should receive special attention. Moreover, if the headache gets worse, with vomiting, hemiplegi, seizures, and decreased awareness. One of the things that often becomes an error in diagnosing a stroke is the problem of patient age. Most people still believe that stroke is a disease suffered by the elderly. This is related to a too simple understanding that stroke is associated with a state of chronic hypertension and narrowing of blood vessels due to the process of atherosclerosis. And in fact, there is a change of behavior in society, causing a shift in the age of stroke cases. As we all know that cases of dyslipidemia, obesity, hypertension, drug abuse, more and more happens at a young age.

LITERATURE STUDY
Blood vessels that carry blood to the brain from the heart are called arteries. The brain needs a constant supply of blood, which carries the oxygen and nutrients it needs to function. Each artery supplies blood to specific areas of the brain. A stroke occurs when one of these arteries to the brain either is blocked or bursts. As a result, part of the brain does not get the blood it needs, so it starts to die.2 The human brain is divided into several areas that control movement and sensory function, or how the body moves and feels. When a stroke damages a certain part of the brain, that area may no longer work as well as it did before the stroke. This can cause problems with walking, speaking, seeing or feeling. 2 The two main types of stroke include ischemic stroke and hemorrhagic stroke. Ischemic stroke accounts for about 75% of all strokes and occurs when a blood clot, or thrombus, forms that blocks blood flow to part of the brain. If a blood clot forms somewhere in the body and breaks off to become free-floating, it is called an embolus. This wandering clot may be carried through the bloodstream to the brain where it can cause ischemic stroke. A hemorrhagic stroke occurs when a blood vessel on the brain's surface ruptures and fills the space between the brain and skull with blood (subarachnoid hemorrhage) or when a defective artery in the brain bursts and fills the surrounding tissue with blood (cerebral hemorrhage). Both result in a lack of blood flow to the brain and a buildup of blood that puts too much pressure on the brain.6 Most strokes at a young age are to be ischemic. Of ischemic stroke, most are just a form of partial infarction and TIA (Transient Ischemic Attack). The cause of stroke at a young age generally varied, it is not easy to give precise sequence of cause of infarction

based on the frequency ever happened. Some research, get the most important cause is embolism, while the second is atherosclerosis. In another study, it was found that most often is the dissection of blood vessels, and the second is atherosclerosis. Research on other central also give different results, is cardioembolism and followed by dissection in the second. 6 When brain cells are deprived of oxygen, they cease to perform their usual tasks. The symptoms that follow a stroke depend on the area of the brain that has been affected and the amount of brain tissue damage. Small strokes may not cause any symptoms, but can still damage brain tissue. These strokes that do not cause symptoms are referred to as silent strokes. According to The U.S. National Institute of Neurological Disorders and Stroke (NINDS), these are the five major signs of stroke: Sudden numbness or weakness of the face, arm or leg, especially on one side of the body. The loss of voluntary movement and/or sensation may be complete or partial. There may an associated tingling sensation in the affected area. Sudden confusion or trouble speaking or understanding. Sometimes weakness in the muscles of the face can cause drooling. Sudden trouble seeing in one or both eyes. Sudden trouble walking, dizziness, loss of balance or coordination. Sudden, severe headache with no known cause. 7

DISCUSSION

Stroke is defined as an abrupt onset of focal neurological deficit, secondary to a vascular event in the brain. The vascular insult can either be due to ischemia or hemorrhage. The common causes for ischemic infarction of the brain are embolic or thrombolytic occlusion, of the arteries supplying the brain. The cause for the hemorrhagic stroke would be intercerebral bleed, subarachnoid hemorrhage, atc. 1 Stroke is the end of the pathological impairment of the vessels manifestation, which gradually for a long time before the stroke it self emerge. The brain vessels underwent the degeneration processgradually due to the systemic disease so called risk factor. When somebody has the risk factor such as hypertension, cardiac disease, diabetes mellitus, hyperlipidemia, polycytemia,stc, the pathological course will be more fast following the amount of the risk factors that he or she has. Anyone suspected of having a stroke should be taken to a medical facility immediately for evaluation and treatment. Initially, the doctor takes a medical history from the patient if possible or from others familiar with the patient if they are available. Important questions include what the symptoms were, when they began, if they were getting better, worse or staying the same. Past medical history adds important information looking for risk factors for stroke and for medications that can cause bleeding (for example, warfarin [Coumadin], clopidogrel [Plavix], prasugrel [Effient]).

Physical examination is key in confirming the parts of the body that have stopped functioning and may help determine what part of the brain has lost its blood supply. If available, a neurologist, a doctor specializing in disorders of the nervous system and diseases of the brain, can assist in the diagnosis and management of stroke patients. Just because a person has slurred speech or weakness on one side of the body does not necessarily signal the occurrence of a stroke. Stroke is diagnosed through several techniques: a neurological examination (such as the Nihss), CT scans or MRI scans, Doppler ultrasound, and arteriography. The diagnosis of stroke itself is clinical, with assistance from the imaging techniques. Imaging techniques also assist in determining the subtypes and cause of stroke. For the treatment, Stroke can be a matter that threatens lives and provide lifelong sequelae, because it required immediate and intensive treatment. In this case, the problem of time interval between events and time to obtain first aid is very important. Maintain airway, breathing, and circulation to keep the patent should always be the main focus in the treatment of stroke. An ischemic stroke is caused by a thrombus (blood clot) occluding blood flow to an artery supplying the brain. Definitive therapy is aimed at removing the blockage by breaking the clot down (thrombolysis), or by removing it mechanically (thrombectomy). The more rapidly blood flow is restored to the brain, the fewer brain cells die.

Other medical therapies are aimed at minimizing clot enlargement or preventing new clots from forming. To this end, treatment with medications such as aspirin, clopidogrel and dipyridamole may be given to prevent platelets from aggregating. In addition to definitive therapies, management of acute stroke includes control of blood sugars, ensuring the patient has adequate oxygenation and adequate intravenous fluids. Patients may be positioned with their heads flat on the stretcher, rather than sitting up, to increase blood flow to the brain. It is common for the blood pressure to be elevated immediately following a stroke. Although high blood pressure may cause some strokes, hypertension during acute stroke is desirable to allow adequate blood flow to the brain. Stroke rehabilitation is the process by which patients with disabling strokes undergo treatment to help them return to normal life as much as possible by regaining and relearning the skills of everyday living. It also aims to help the survivor understand and adapt to difficulties, prevent secondary complications and educate family members to play a supporting role. 3 A rehabilitation team is usually multidisciplinary as it involves staff with different skills working together to help the patient. These include nursing staff, physiotherapy, occupational therapy, speech and language therapy, and usually a physician trained in rehabilitation medicine. Some teams may also include psychologists, social workers, and pharmacists since at least one third of the patients manifest post stroke depression. Validated instruments such as the Barthel scale may be used to assess the likelihood of a stroke patient being able to manage at home with or without support subsequent to discharge from hospital.3

Good nursing care is fundamental in maintaining skin care, feeding, hydration, positioning, and monitoring vital signs such as temperature, pulse, and blood pressure. Stroke rehabilitation begins almost immediately. 3

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CONCLUSION
It is very difficult to regenerate brain cells when they have died. There has been a lot of work done in this area and there are glimmers of hope. Strokes damage brain cells and the amount of damage and the severity can vary enormously. At one extreme it could be physical movement affected, but at the other memory and reasoning are lost. The final danger will always be the death of the victim from the effects of the stroke. Part of the physical examination monitoring the patient's vital signs, performing blood tests, and performing an electrocardiogram (EKG or ECG) that is becoming standardized is the use of a stroke scale. Knowing the symptoms of stroke can lead to earlier treatment and better recovery. Much of stroke prevention is based on living a healthy lifestyle. This includes: Knowing and controlling blood pressure, Finding out if you have atrial fibrillation, have agood life style, following a healthy diet, treating diabetes properly, exercising regularly, not using drugs, A study found that drinking three cups of tea per day reduces the risk of stroke, Taking preventive medications such as antiplatelet and anticoagulant drugs to prevent blood clots, Cholesterol lowering drugs can prevent stroke recurrence

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BIBLIOGRAPHY
1. Stroke pada anak dan dewasa muda. Available at : http://medicineforthesoul.multiply.com/journal/item/3/Stroke_pada_Anak_dan_D ewasa_Muda. Accessed January 2, 2011 2. Explaining stroke. http://www.stroke.org/site/PageServer? pagename=explainingstroke. Accessed January 2, 2011 3. 4. Stroke. http://en.wikipedia.org/wiki/Stroke. Accessed January 2, 2011 Wahjoepramono EJ. Stroke tata laksana fase akut. Fakultas Kedokteran Universitas Pelita Harapan, Karawaci. 2005 5. Wahjoepramono EJ. Kegawatdaruratan saraf dan bedah saraf. Fakultas Kedokteran Universitas Pelita Harapan, Karawaci. 2005 6. what is stroke? http://www.medicalnewstoday.com/articles/7624.php. Accessed January 2, 2011 7. Stroke. http://www.medicinenet.com/stroke/page3.htm#toces. Accessed January 2, 2011

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