CT Scan Infark

STROKE
• Menurut WHO stroke di defenisikan sebagai
suatu gangguan fungsional otak yang terjadi
secara mendadak dengan tanda dan gejala
klinik, baik fokal maupun global yang
berlangsung lebih dari 24 jam dan dapat
menimbilkan kematian.
 Klasifikasi
• Berdasarkan patologi anatomi dan penyebab
– Stroke iskemik
• Transient ischemic attack (TIA)
• Trombosit serebri
• Emboli serebri
– Stroke hemoragik
• Perdarahan intraserebral
• Perdarahan subarakhnoid
 Klasifikasi
• Berdasarkan stadium/perkembangan waktu
– Transient ischemic attack (TIA)
– Stroke-in-evolution
– Completed stoke
• Berdasarkan sistem pembuluh darah
– Sistem karotis
– Sistem vertebro-basiler
 Faktor resiko
• Genetik (tidak dapat di modifikasi )
– Usia
– Jenis kelamin
– Ras
– Riwayat stroke dalam keluarga
• Gaya hidup
– Hipertensi
– DM
– Merokok
– Hiperlipidemia
– Intoksikasi alkohol
 Stroke Iskemik
• Stroke iskemik merupakan tersumbatnya
pembuluh darah sehingga aliran darah ke otak
terhenti baik sebahagian atau keseluruhan.
• Secara umum di sebabkan oleh
aterotrombosisi pembuluh darah serebral
 Epidemiologi
• Stroke adalah penyebab paling umum kedua
dari morbiditas di seluruh dunia (setelah infark
miokard) dan merupakan penyebab utama
kecacatan yang didapat.
• Faktor risiko stroke iskemik sebagian besar
mencerminkan faktor risiko aterosklerosis dan
termasuk usia, jenis kelamin, riwayat keluarga,
merokok, hipertensi, hiperkolesterolemia, dan
diabetes mellitus.
 Manifestasi Klini
• Stroke iskemik biasanya muncul dengan defisit
neurologis onset cepat, yang ditentukan oleh
area otak yang terlibat. Gejala sering
berkembang selama berjam-jam dan dapat
memburuk atau membaik, tergantung pada
nasib penumbra iskemik.
 Patofisio stroke iskemik
• Iskemia fokal akut dan tingkat pengaruh yang
merusak tergantung pada tingkat keparahan
dan durasi penurunan aliran darah
• Stroke aterotrombotik
– Terjadi bertahap di mulai dari penignkatan
manifestasi klinis selama beberapa jam dan hari
dan sering di awali saat tidur
– Di tandai dengan adanya lesi di aterosklerotik di
arteri sisi stroke
• Emboli jantung
– Di awali kondisi awal yang bersifat akut
– Lokasi di area arteri karotis tengah dan biasanya mengenai
ares kortikal-subkortikal berukuran sedang sampai besar
• Stroke hemodinamik
– Onset bersifat akut
– Area di bidang yang sesuai dengan suplai darah
– Ukurannya dari besar sampai kecil
• Infark lakunar
– Lesi kecil akibat oklusi arteri perforans
– Lokasinya di subkortikal, batang otak, basal ganglia, kapsul
internal, korona radiata, dan sekitar white matter.
 CT Scan Imaging
The goals of CT in the acute setting are:
• exclude intracranial hemorrhage, which would preclude thrombolysis
• look for any "early" features of ischemia
• exclude other intracranial pathologies that may mimic a stroke, such
as a tumor
Non-contrast CT has also been used historically to exclude patients
from receiving thrombolysis based on the extent of hypoattenuation at
presentation. This criterion has, however, been removed from the 2018
American Heart Association guidelines. Nonetheless, finding large areas
of established infarction on acute non-contrast CT continues to play an
important role in patient selection and management.
Early hyperacute (0-6 hours)
Within the first few hours, a number of signs are visible
depending on the site of occlusion and the presence of collateral
flow. Early features include:
• loss of grey-white matter differentiation, and hypoattenuation
of deep nuclei:
– lentiform nucleus changes are seen as early as 1 hour after occlusion,
visible in 75% of patients at 3 hours 
• cortical hypodensity with associated parenchymal swelling with
resultant gyral effacement
– cortex which has poor collateral supply (e.g. insular ribbon) is more
vulnerable 
Acute
• With time the hypoattenuation and swelling become more marked
resulting in a significant mass effect. This is a major cause of
secondary damage in large infarcts.
Subacute
• As time goes on the swelling starts to subside and small amounts of
cortical petechial hemorrhages (not to be confused with
hemorrhagic transformation) result in elevation of the attenuation
of the cortex. This is known as the CT fogging phenomenon. Imaging
a stroke at this time can be misleading as the affected cortex will
appear near normal.
Chronic
• Later still the residual swelling passes, and gliosis sets in eventually
appearing as a region of low density with negative mass effect.
Cortical mineralization can also sometimes be seen appearing
hyperdense.
CT-SCAN non kontras
• Computed tomography shows two
regions of ischemic stroke in the territory
of the left middle cerebral artery,
involving the regions supplied by both
the anterior and posterior branches.
• Loss of grey white matter
differentiation with diffuse
hypoattenuation involving right post
central gyrus, right superior parietal
lobule and down into right superior
temporal gyrus. 
• Computed tomography
revealed a hypodensity in left
occipital with effacement of the
sulci. No midline shift is
observed.
• Shows typical features of
subacute infarct in the
anterior cerebral artery
territory with further
evolution.
TERIMAKASIH