Anda di halaman 1dari 95

| ||


|| 
  

|| 
  
 || 


  !"#$%&''
()'*'+'
,'-++'
 ,''()'*'+'#
",'.)'#*./
+

)0/
  
 || 

 1 2


2 | 

  2| ||   ||  


 3 2  
2  |  |2  |2 |2
4 |2

)0/
  
 || 

 |2
| |  |42

|42  |  || | 


4 |2 |2| 
|
 54 

)0/
  
 || 

 2 

 || |   || |   ||  |


 |2 |2| 
4|2| 4 |2|

)0/


2  |
 |2

 ||    ||  


 |2  |2

 ||    ||  


|2 |2

4 0 
|62 2

 

2  | 
2  |
4 |2 4 |2

 ||    ||  


4 |2 4 |2

 2 
  
 || 

2'()78 -6,##4(#9-0:# 4" :)&;<="'>#$ 


22  21
22  21 ||

2A
B2 

 2*+
 2*
 ?'?@)'

8|302 

 8)",?)'
 8)"'+
2'()78 -6,##4(#9-0:# 4" :)&;<="'>#$ 
 ||2|0
 ||2|04| 
2A
B2 
|

824| | 21  |2 2 B2 

2 | || 2


824| 242|2

 |2

 A
2

 8 2

8 2 | 

4 |2   2

Guidelines for the Early Management of Adults With Ischemic Stroke. AHA
2'()78 -6,##4(#9-0:# 4" :)&;<="'>#$ 
 ||2|04| 
2A
B2 C|D

 |2|0324  |

2 2| 2| 24 2 4 


| | 2|4
B| &;E

| F
| |4| | 
4| 5||=;E

4
| 
2 2| 28 
| 
; !4| $ $;
Guidelines for the Early Management of Adults With Ischemic Stroke. AHA
2'()78 -6,##4(#9-0:# 4" :)&;<="'>#$ 
 ||2|04| 
2A
B2 C8D

| 2
| ; !|| 

824| | 21 
2 1 2 2 
Guidelines for the Early Management of Adults With Ischemic Stroke. AHA
2'()78 -6,##4(#9-0:# 4" :)&;<="'>#$ 
 ||2|04| 
2A
B2 CD
2 || 422|$G| || 
2|0|| 

8 H $ | || 91| |

 || |2

2
21 4 A
| 25 ||
0
 21 

5|I | 21 | 2  |  | 4


0


Guidelines for the Early Management of Adults With Ischemic Stroke. AHA
2'()78 -6,##4(#9-0:# 4" :)&;<="'>#$ 
 ||2|04| 
2A
B2 C824| 242|2D

| | 2|0
|  2| 
& !

 2|04
 || |2

2
21 |  | 2 

Guidelines for the Early Management of Adults With Ischemic Stroke. AHA
2'()78 -6,##4(#9-0:# 4" :)&;<="'>#$ 
 ||2|04| 
2A
B2 C  A
2D

| | 2|0| 

& !

8

2
21 4 A
| 2

Guidelines for the Early Management of Adults With Ischemic Stroke. AHA
2'()78 -6,##4(#9-0:# 4" :)&;<="'>#$ 
 ||2|04| 
2A
B2 C 8 2D

|4| 2| || 2

2 0| 0
|2 | J

 8
 2 2

|| 4 | 2 9

2'()78 -6,##4(#9-0:# 4" :)&;<="'>#


$ 
 ||2|04| 
2A
B2 C8 2 | D



4
|   2|| 2 2 

|2 2| 2|2 2  =# H$5


  

|| |  | K2


| 2 | | 82   |


2'()78 -6,##4(#9-0:# 4" :)&;<="'>#


$ 
 ||2|04| 
2A
B2 C42   2D

4 |2 | 2

4 |  | 2

 |4|2 2 2
 || |2
2'()78 -6,##4(#9-0:# 4" :)&;<="'>#
$ 
| 2 05
224  0
| 2 0
''' |*)
"' )+ ,?M'-'' '''
'

)+''  ''' |''


,)+'

|)+L -, )' '


 )

)+') 4''). ''

, ',
'?@) ''

)-
224  0
4|

 4I2| |H& "

4 | 0
 |42


H 

I0| 

 &L;)%H ":+),)

0


 ;#L #=)"%H ":+),)

2'()78 -6,##4(#9-0:# 4" :)&;<="'>#


$ 
224  0

2 | 2

4|| 2|

 21 2
 21 
  |

2'()78 -6,##4(#9-0:# 4" :)&;<="'>#


$ 
224  0

 ; L  )
;;)%H "%)

 H L  K
$&)%H "%) ,)+

 N  M'
H>)%H "%) -'+

2'()78 -6,##4(#9-0:# 4" :)&;<="'>#


$ 
224  0


 21
'H '" '& '" ) ';)'J
4@  -'' )+'
- +)+ . -'+'
@ '/,' .# "'
 /,@ )' '
* * ' M#
'''  '?@) )
,@ 

2'()78 -6,##4(#9-0:# 4" :)&;<="'>#


$ 
224  0

@'
-'
P)'
'"'J M'
*,)
""#
'''/,
P))"
O+
,'222#2#<
(,),<,
'< @'
47:
+

2'()78 -6,##4(#9-0:# 4" :)&;<="'>#


$ 
224  0

| |


2|4| | |

21  2
 21 

   |

 |
A
|
2 
| 2 
| | 
E| 
2  

2'()78 -6,##4(#9-0:# 4" :)&;<="'>#


$ 
224  0

4|| 2| 
| 2 2

 |  2 |
| |
 2  2A
|2

 |
A
|
2 
| 2 
| | 
E| 
2  

2'()78 -6,##4(#9-0:# 4" :)&;<="'>#


$ 
224  0

2
| 2  |

824I2 824|0
|2

 |
A
|
2 
| 2   |  21 
824| |2 | |  |   
E| 
2  

2'()78 -6,##4(#9-0:# 4" :)&;<="'>#


$ 
224  0

I0| | 82I2 


2 0 |

4|1I2
| 
4|1I2
8210| 
2  |
2 |

2'()78 -6,##4(#9-0:# 4" :)&;<="'>#


$ 
È    

'
 


„ 
%

 ˜„
 

„ 
&







 

  
 
!
 
"#
 $ ˜ 



Ô  

È 
   
 
  



  2 

  2 

||   • | 2 2 |
| 
 |2 42| 
• 
2# 8| 2#
2  2 | 2
• 2 5| 2 
   2  
• 4I2|2|  3 2 
2KA
2|

2'()78 -6,##4(#9-0:# 4" :)&;<="'>#


$ 

  2 
 |2 ||  |2

20| • 8|2 42


• 8|24|2 3 258|2 | |2
• 20   
• 4I2|  | 0
9|C |21 2KA
2|D
• |0 20| 22
|4 2 C |21 || 8D

 
4|2 • 2|  
21 C |21 2KA
2|D
• 0 24I22
|4 2 |C |21 || 8D

 2 |2 • 2|6| 2 Q|


•
  4281 2
4|2

| 2  4


| • 8|24|20|
• 2   0| 2 2 ||

2'()78 -6,##4(#9-0:# 4" :)&;<="'>#


$ 

  2 
 |2 ||  4 |2

4I2 • 8|2|22  |J |I2#02#0 2   8|2 4281 2


|| 8
• 8|2|2 2  |J2
0 2

2  | • |0
|  2  C ||  D

K  22 || | • 2


0 2
|| |  • 4I2


02 0
2  | • 0 2| |
• |2|  21 || 8L2KA
2|
•  
2502C ||0|  D

2'()78 -6,##4(#9-0:# 4" :)&;<="'>#


$ 
 |92 |0
 |92 2 2 | 2A
B2 

| | 422K| 


 2|  
4|2| 2 
| |
| 
| |

Guidelines for the Early Management of Adults With Ischemic Stroke. AHA 2007
 |92 2 2 | 2A
B2 

| | 21  |   22| | 20 5 ||

| 2   2| 2 ||||0| 2B2 

| |0   4 |4


5  22  21  842  || 2

4
|   20|2 |2 | | |4 | |||0| 2

   |
 21 | 
0| 2#   2#  

|2 21  20 1 2 5|2 2 | ||   2| 

|2 |   2 2  21 | |2 | 5%2 || 2 |


|


Guidelines for the Early Management of Adults With Ischemic Stroke. AHA 2007
|
 |9
4|842  2
4 2  21 | 
4|  4B2 

|  4 2 |
| | |  0| |

|  4|842  2
| | | 2 2  2

Guidelines for the Early Management of Adults With Ischemic Stroke. AHA 2007
|  484 2 |||
| |  0| |
R 2 21 | A
|| 4 2| |||    2 ||2   0
| 8J8J

2 |2
|SG;E 2 ||   | 
   | |$G 2 ||   | 
8||
21

4  21 4|2 2 ||   | 

  21  2  |2 21 8 2  |2 21 8 2 


|| 8 2KA
2|


|K| 4
E  | 2 2|| 8 | 2 22KA
2|


|K|  K  | 2 2|| 8 | 2 22KA
2|

4|| 2|| 2 2 2 

2  |

Guidelines for the Early Management of Adults With Ischemic Stroke. AHA 2007
|  | 2 2  2

mESVIACIÓN FACIAL:
• NORMAL: AMBOS LAmOS mE LA CARA SE MUEVEN EN FORMA SIMÉTRICA.
• ANORMAL: UN LAmO mE LA CARA NO SE MUEVE TAN BIEN COMO EL OTRO.

BRAZOS:
• NORMAL: AMBOS BRAZOSSE MUEVEN mE IGUAL FORMA O NO SE MUEVEN BAJO NINGUNA CIRCUNSTANCIA.
• ANORMAL: ALGÚN BRAZO NO SE MUEVE O HAY mIFERENCIA mE FUERZA ENTRE ESTOS.

HABLA:
• NORMAL: HABLA EN FORMA CORRECTA SIN ARRASTRAR
• ANORMAL: ARRASTRA PALABRAS, mICE PALABRAS INCORRECTAS, NO HABLA.

Guidelines for the Early Management of Adults With Ischemic Stroke. AHA 2007
 |92 2 2 |   |

0| 2
# #

 4 |   2 |


842   2 
|  5 4K  2

4  | |

 22      |


4|  | | | 

Guidelines for the Early Management of Adults With Ischemic Stroke. AHA 2007
 |92 2 2 |   |

0| 2

4| 8|
|

422
 20
 A
|
 2

||

Guidelines for the Early Management of Adults With Ischemic Stroke. AHA 2007
20 1 2 | 
0| 2

 2| 
|


|  
|4B
2 

20 1 2 4


Guidelines for the Early Management of Adults With Ischemic Stroke. AHA 2007
20 1 2 | 
0| 2
 2|4|42 21 |  

82 2  2 

 || 

2 242|2
824| | 21  |2 2 B2 
2|0 

2 | || 2
$
8 2 |2 |2
2
   A
2

 |I4  21  4 | |  |K5


| 
|I4  21  C
 20
 |I4  21
| 
#4   |D
| 4| 2
2   |I4  21 |42| 5|I |2|

Guidelines for the Early Management of Adults With Ischemic Stroke. AHA 2007
28

Guidelines for the Early Management of Adults With Ischemic Stroke. AHA 2007
28

Guidelines for the Early Management of Adults With Ischemic Stroke. AHA 2007
28

Guidelines for the Early Management of Adults With Ischemic Stroke. AHA 2007
28

Guidelines for the Early Management of Adults With Ischemic Stroke. AHA 2007
20 1 2 2|| 2
TRANSTORNO CONVERSIVO • AUSENCIA mE HALLAZGOS mE NERVIOS CRANEALES.
• HALLAZGOS NEUROLÓGICOS FUERA mE mISTRIBUCIÓN VASCULAR.
• EXPLORACIÓN INCONSISTENTE.

ENCEFALOPATÍA HIPERTENSIVA • | |


• | 22
• 824| | 21  |2 
• || ||  

HIPOGLUCEMIA •  | || ||2 | |


• 0
 42 | | )"%

MIGRAÑA COMPLICAmA • 82 24|2


• 4|| 2|

• | |

CRISIS CONVULSIVAS •  | || || 22  


2
•  22  
24|| 2
• 4|24 2  

Guidelines for the Early Management of Adults With Ischemic Stroke. AHA 2007
|
2 4 || 2
TOmOS LOS PACIENTES • TAC SIMPLE mE CRÁNEO.
• GLUCOSA SÉRICA.
• ELECTROLITOS SÉRICOS Y PRUEBAS mE FUNCIÓN RENAL.
• ECG.
• ENZIMAS CARmIACAS.
• BIOMETRÍA HEMÁTICA COMPLETA.
• TP, TPT.
• OXIMETRÍA mE PULSO.

ALGUNOS PACIENTES • 48


• 4|2  I2  102 
• 2| |B2 | 8 
• 42|
• 0|  |2 
• 20| 1I
• 4
21 
 
• ||0

Guidelines for the Early Management of Adults With Ischemic Stroke. AHA 2007
  21  032 
| 2 2 2 |  
4|| 2|8|02

 22A
B2 4 |2
$G8

20  |4 |2A


|2TT

Guidelines for the Early Management of Adults With Ischemic Stroke. AHA 2007
 |2 ||  |2
824|| 
824| 22 

2| |
 

20| | |5 |9|
4 2  2 |0


 2
 21 4
| |2|| |
  | | |  21 
|2 2| ||2| 2
B| UV
  |9|824I2  
$
4 || 2 |
2 2| ||2| 2UV

Guidelines for the Early Management of Adults With Ischemic Stroke. AHA 2007

20| | |5 |9|
4 2  2 |0


 2 2  21 | 242B 2 


| 4 2| || 2 |
| |  21  |2 2| |
|2| 2UV

2| |  3 || | 21 


4 |  | |  21 
|2 2| ||2| 2UV
 2="%
 |
21 | $=W G8
4 |2|L

Guidelines for the Early Management of Adults With Ischemic Stroke. AHA 2007

20| | |5 |9|
4 2  2 |0


 | |3| 2K|| 

2 2

 | 42|
 2 | $G| 4 2| |  
2  | | |  21 
|2 2| |
|2| 2U V

Guidelines for the Early Management of Adults With Ischemic Stroke. AHA 2007
 |9|824| | 21  |2

  |   H L$ )"2
2 1 2   2 4 8||H$
S 4
0
HF;))8"  2 242 | 2 
21 
;)"%( )$;;
2 1 2  -'H;)''
SHH ))8" ).X)H;)"%(')
&)"%( + '

Guidelines for the Early Management of Adults With Ischemic Stroke. AHA 2007
 |9|824| | 21  |2

2 1 2    |   H L$ )"2#
H& L ,H $ 
$& ))8" )'').X)
2 1 2  & )"<
H ;L *'  |   
H$ ))8" $F)"%)

Guidelines for the Early Management of Adults With Ischemic Stroke. AHA 2007
 |9|824| | 21  |2

2 1 2    |   H L$ )"2#,
H $ )'').X)
S & )"<*'
$& ))8"  |   $F)"%)
 2 242 | 2 
21 
2 1 2  ;)"%( )$;;
-'H;)''
H$HL ).X)H;)"%(')
HG ))8" &)"%( + '

Guidelines for the Early Management of Adults With Ischemic Stroke. AHA 2007

20| | |5 |9|
4 2  2 |0


|2 824|0
|2

|2 8240
|2

Guidelines for the Early Management of Adults With Ischemic Stroke. AHA 2007
  222 | 

4 C >)"%7"#'').X)
> )"D

Guidelines for the Early Management of Adults With Ischemic Stroke. AHA 2007
2 |2|2
21 4

|4
Edad mayor a 18 años.

miagnóstico de infarto cerebral con déficit neurológico clínico evidente.

Inicio de síntomas < a 3h de iniciado el tratamiento.

Sin antecedentes de TCE o EVC en 3 meses previos.

Sin antecedentes de cirugía en los 14 días previos.

Sin antecedentes de hemorragia cerebral.

TA sistólica < 185mmHg.

TA diastólica < 110mmHg.

Guidelines for the Early Management of Adults With Ischemic Stroke. AHA 2007
2 |2|2
21 4

|4
Ausencia de resolución rápida de la sintomatología.

Ausencia de síntomas sugestivos de HS.

Sin antecedentes de hemorragia gastrointestinal en 21 días previos.

Sin antecedentes de punciones arteriales en un sitio no compresivo en 7 días previos.

Ausencia de convulsiones al inicio de EVC.

INR < 1.7 sin anticoagulantes.

Plaquetas > 100 000

Guidelines for the Early Management of Adults With Ischemic Stroke. AHA 2007

|8|42 

 ()'
+*'
 ''
8|42  ,)'$G('
 | |  21 
|222 2| |
|2| 2UV

Guidelines for the Early Management of Adults With Ischemic Stroke. AHA 2007
 20|0 |4 A
| 2

 R)
 $GLGF('
 ''&$;)"
  | |  21 
|2 2| |
|2| 2UV
4|0
5 | 2
| 8|302 
 ||2|0
824| | 21  |2 2 B2 

 A
2


| 8 


|   

 | || |||  242A


B2 

SPONTANEOUS INTRACEREBRAL HEMORRHAGE   2A


|82 # |" 9#&GG# H>
/ H #$ H

|| 8|302 
 024 2 2|

  2 | |2| 

 |
2

 02 | 

 02| 

 2|| | 

|4 22   | |

0
4 


2 2

SPONTANEOUS INTRACEREBRAL HEMORRHAGE   2A


|82 # |" 9#&GG# H>
/ H #$ H
2 2 
||8|02

ƒ J)''
'+'
ƒ JP'+'
ƒ J.)
ƒ J)'
+'
ƒ |J'
+''

SPONTANEOUS INTRACEREBRAL HEMORRHAGE   2A


|82 # |" 9#&GG# H>
/ H #$ H
  2K 21 | |
2

+/')'9(  ')##9 Q"##-6 Y# |" 9


$ =<&;;J>$FL&>
224  0
ƒ '())',?)'' '"
,,','*'
-'

ƒ |X'),' "
',()"

SPONTANEOUS INTRACEREBRAL HEMORRHAGE   2A


|82 # |" 9#&GG# H>
/ H #$ H
224  0

|| |


8|  
| 
|42

+/')'9(  ')##9 Q"##-6 Y# |" 9


$ =<&;;J>$FL&>
|21 422


4
  8| 



+/')'9(  ')##9 Q"##-6 Y# |" 9


$ =<&;;J>$FL&>
|21 |
2

2A
|2
 ||  |I4|21 
4|2 |2   4|21  | 
| 3 2 
|7

2 | 21 |
4 |  4 4 2
1 2 | |
 2

+/')'9(  ')##9 Q"##-6 Y# |" 9


$ =<&;;J>$FL&>
8|02
 2|

4|| 2| 0|| | 


|4 2
 2|

2|| 2 0

 
3 2 
 
4
| |
2
+/')'9(  ')##9 Q"##-6 Y# |" 9
$ =<&;;J>$FL&>

  2 

| |  '),'*
-

  *

202|K  Q"
 O'7/
|
  
+/')'9(  ')##9 Q"##-6 Y# |" 9
$ =<&;;J>$FL&>
22  21 8
58|

+/')'9(  ')##9 Q"##-6 Y# |" 9


$ =<&;;J>$FL&>
4
| 20 1 2 

 24 || 3 |



4
21 
 
 24 || 3 |
22  21 |28|

+/')'9(  ')##9 Q"##-6 Y# |" 9


$ =<&;;J>$FL&>
28|22
28|222
28|2
4
21 
 
4
21 
 

 |  |4| 8


| |
2 | 21 
 4| 8|8
2 2  2 |  2 5| 21 ||2|
  |# | |2#
 2 21 2 #A
22 |42
 | 9|| 
4
21 
 

 2 | 21 | | 2 2
|4
21 
 2 2
 2 2  2 |
 

 0
 |
 |||442 
 | B

|42  
 2| 
|2 |4

 2242 = )"G('$H'

824| | 21

 ,"+

824| |2

 4 FLH$)8$

8|2
21

 8)'& !

+/')'9(  ')##9 Q"##-6 Y# |" 9


$ =<&;;J>$FL&>
 2| | 8|302 

# # 

 | 2 0

2 2  2 |A
2R02 

 42 
 '-'')S;))
 8))*','S&)

Guidelines for the Management of Spontaneous Intracerebral Hemorrhage. AHA. 2010


4|0
5 | 2