MANAGEMENT

OF
STROKE

Nelly Y Rumpaisum dr,Sp.S

Neurological Department
Medical Faculty Cendrawasih University
Papua-Jayapura
1
 1. Laboratory Examination
 Blood :
- Hematocrit, Hb, Leucocyte, Erythrocyte.
(Polycytemia Vera, anemia)
- Ureum, creatinine, uric acid.
(Renal impairment function)
- Cholesterol, triglyceride, LDL, HDL.
(Dislipidemia)
- Glucose (fasting & post prandial :
2 hours) (Diabetic Mellitus)
2
 - SGOT, SGPT.
(Liver Function)
- Electrolytes (Ca, K, Na, Cl)
 Thorax Photo
(Left Ventricular Hypertrophy, Pulmonary
edema)
 ECG
(LVH, Myocardial Infarction, Atrial
Fibrillation)
 Ultra Sonography
Determine stenosis of a. carotid 3
 Angiography
Carotid system and Vertebrobasilar
system.
 Computed Tomography Scanning
Hemispheric Lesion (Infarction :
Hypodens, Haemorrhage : Hyperdens)
 Magnetic Resonance Imaging
Determine Brainstem Lesion ( Very
sensitive)
 Lumbal Puncture
(If unavailable CT Scan and MRI)
4
 2. Treatment
 Check airway : important for
oxygenation
 Cardiovascular system :
maintenance CBF
 Don’t disturbed Blood pressure
<200/120 mmHg (Hypertension
reactive in acute phase)
5
 Water and electrolyte balance : Infuse
with isotonic water haemodilution,
maintenance input, food and drink, Diet
basal metabolism 1500 cal.(approximate
23 cal/kg/weight) If need with NGT.
 Control output
 Present brain edema(impending
herniation, herniation : control with
antiedema (manitol 20 %), usually give
for 5 days, rebound phenomen
prohibition 6
 Sign of impending herniation :
- Decrease of conciousnes
- Pupil myosis and reactive
- Cheyne’s stokes respiration
- Bilateral Babinski (Pathologic Reflex)
 Sign of Herniation :
- Decrease of conciousnes
- Pupil anisocor
- Cheyne’s stokes respiration
- Bilateral Babinski
7
 Manitol Contraindication :
- Hipotension
- Renal Impairment
- Dehydration
- Decompensatio Cordis
 Head elevation 300
 Hyperglycemia : if > 250 mg% give
antidiabetica
 Control Complication and
Underlying disease
8
 Control Vegetative function.

 PassivePhysiotherapy as soon as
possible, for preventing
contracture, thrombophlebitis
(Deep Vein Thrombosis)

 Active
Physiotherapy if complication
disappear
9
 Drugs : For secondary prevention
Atherothrombotic Infarction
- Antiplatelet agent
a.Asetilosalysilic acid (inhibition
cyclooxygenation enzyme) can
cause tromboxan A2 decrease,
Inhibit platelet agregation
dose : variation, in Hasan Sadikin
Hospital 250 mg/days

10
 b.Pentoxyfilin 400 mg, twice daily
inhibition cAmp
c.Ticlopidin and Copidogrel
(expensive)
 Prevention Cardioembolic Infarction
- Anticoagulant : first with heparin
intravenous, continuosly with oral
anticoagulant (Cuomarin)
11
 Recanalization thrombosis :
- In atherothrombotic infarction
RTPa, Streptokinase.
Complication : bleeding
 Inhibition Vasospasme :
Vasospasme (subarachnoid
bleeding complication)
- Found 2 - 3 days after onset
- Clinically become worse, maybe
decrease of conciousnes,
neurological deficit 12
 Vasospasme mechanism : cause by
accumulation prostaglandin and
cathecolamin.
 Prohibition Vasospasme :
- Give Ca antagonist before 3
days onset ( Nimodipin )

HATUR NUHUN
13