ENGLISH SUMMARY
T I N J A U A N P U S T A K A
CDK 165/vol.35 no.6/September - Oktober 2008
320
CDK 165/vol.35 no.6/September - Oktober 2008
321
Management of
Stroke Intracerebral
Hemorrhage
Ismail Setyopranoto
Dept. of Neurology, Gadjah Mada University,
Yogyakarta, Indonesia
Abstract
Intracerebral hemorrhage (ICH) is a com-
mon cause of stroke, accounting for bet-
ween 5 and 10% of all strokes. Currently,
intracerebral hemorrhage (ICH) has the
highest mortality rate among all stroke
subtypes. Hematoma growth is a main
cause of early neurological deterioration.
Primary ICH develops in the absence of
any underlying vascular malformation or
coagulopathy; and more common than
secondary intracerebral hemorrhage.
Hypertensive arteriosclerosis and cere-
bral amyloid angiopathy are responsible
for 80% of primary hemorrhages.
Initial management should first be direc-
ted toward the basics of airway, breathing,
circulation, and detection of focal neuo-
logical deficits. Particular attention should
be given to detecting signs of external
trauma. A complete examination should
also include looking for complications such
as pressure sores, compartment syn-
dromes, and rhabdomyolysis in patients
with a prolonged depressed level of cons-
ciousness.
Cermin Dunia Kedokt, 2008; 35(6): 321-327
anesthesia because of intractable general
seizure, all mapping were negative, and
no morbidity after surgery.
Conclusion: Awake craniotomy is a safe
procedure for intra-axial brain tumor.
Key words: Awake craniotomy. Intra-axial
tumor. Supratentorial. Eloquent area. Safe
procedure.
Cermin Dunia Kedokt. 2008; 35(6): 345-346
Complement activation
in mechanical skin
injury in kerokan
therapy.
Didik Tamtomo
Anatomy Laboratory, Faculty of Medicine,
Sebelas Maret University, Solo, Indonesia
Background: Javanese people have
traditional therapy called kerokan.This
therapy is applied by rubbing a blunt
object repeatedly on the skin of back,
neck, and chest lubricated with oil. This
action injured skin and caused inflam-
mation. Complement is major chemical
mediator in inflammation reaction. There
are two complement activation pathways,
classic pathway is C1q binding with anti-
body and alternative pathway is C3 binding
with polysaccharide bacteria. The aim of
this research is to determine complement
activation pathway in mechanical skin injury
in kerokan therapy; the special aim is to
measure C1 q and C3 level.
Method: This is an experimental research
with randomized pre test-post test control
group design. The research was done at
Padma Clinic, Solo. Samples consists of
38 patients and were divided into two
groups: 19 patients were in the treatment
group and the rest (19 patients) were in
the control group. This research used
Kolmogorov-Smirnov test, t parametric
test and Mann Whitney nonparametric
test, at the significance level of 5%.
Result: There is no significant difference
on C1q and C3 level between treatment
group and control group.
Key words: Kerokan, complement acti-
vation, C1q, C3.
Cermin Dunia Kedokt. 2008; 35(6): 347-349
Kurang lebih 80% pasien perdarahan intraserebral mempunyai
faktor risiko hipertensi
(3)
. Pemeriksaan CT Scan otak/kepala
merupakan gold standard untuk membedakan apakah stroke
perdarahan intraserebral atau stroke infark
(4)
. Pada orang tua
perdarahan sering terjadi akibat angiopati amiloid
(1)
.
Stroke perdarahan intraserebral menyebabkan kerusakan
melalui dua cara yaitu; (1) Kerusakan otak yang terjadi pada
saat perdarahan, terutama pada kasus dengan perdarahan
yang meluas ke medial dan talamus serta ganglia basalis, dan
(2) Hematoma yang membelah korona radiata menyebabkan
penekanan serta gangguan fungsi neurologis yang mungkin
reversibel
(5,6)
.
Prognosis stroke perdarahan intraserebral tergantung pada
kondisi klinis saat masuk, lokasi perdarahan serta volume
perdarahan; volume perdarahan lebih dari 50 ml mempunyai
prognosis lebih buruk
(7)
.
Pada pasien perdarahan intraserebral yang terlihat dari peme-
riksaan CT Scan kepala, terdapat berbagai permasalahan.
Salah satu masalah yang timbul sebelum melakukan penata-
laksanaan adalah sangat sedikitnya pengetahuan para klinisi
terhadap mekanisme dan perjalanan penyakit saat pasien
datang, apakah sudah mulai terjadi perburukan atau timbul
komplikasi yang tidak terkendali. Masalah lain adalah tindakan
yang harus pertama kali diberikan kepada pasien stroke perda-
rahan intraserebral.
Tulisan ini bermaksud untuk menjelaskan mekanisme, etiologi
dan berbagai penanganan dalam rangka penatalaksanaan
menyeluruh terhadap pasien stroke perdarahan intraserebral
berdasarkan evidence based medicine.
ETIOLOGI
Stroke perdarahan intraserebral disebabkan oleh perdarahan
arterial langsung ke parenkim jaringan otak. Perdarahan intra-
serebral dapat juga disebabkan oleh aneurisma, malformasi arteri-
vena, malformasi kavernosa, amiloid serebral, atau tumor
(6,8,9)
.
Pendekatan Evidence-Based Medicine
pada Manajemen Stroke Perdarahan
Intraserebral
Ismail Setyopranoto
Bagian Neurologi Fakultas Kedokteran Universitas Gadjah Mada, Yogyakarta, Indonesia
Local data was used to describe the mag-
nitude of the problem. Hypertension was
observed in at least 50% of stroke sur-
vivors. There is some evidence that specific
classes of antihypertensive drugs have
different effects and/or their pharmacolo-
gical actions differ in patient sub-groups.
This review also evaluates the cost of anti-
hypertensive drugs in secondary stroke
prevention.
Key words: hypertension - stroke -
secondary prevention
Cermin Dunia Kedokt. 2008; 35(6): 328-330
Awake Craniotomy,
Alternative for Intraaxial
Tumor Surgery
Eka J. Wahyoepramono
Department of Neurosurgery Medical
Faculty of Universitas Pelita Harapan,
Siloam Hospital, Lippo Karawaci, Indonesia
Abstract
Awake craniotomy has been reserved for
epilepsy surgery and for removal of mass
lesions from areas of eloquent cortex.
This procedure is safe, quite easy, com-
fortable for patients, and more widely
applied; it has been used for any supra-
tentorial intra-axial brain tumor. Recent
evidence showed that it can be applied
for out-patient surgery (one-day surgery),
and proved that it is a safe procedure,
more convenient and psychologically much
better for patient. So far, we have started
awake craniotomy for 3 cases with intra-
axial tumor in our hospital. All patients
fared well, one need conversion to general
Situation Analysis
on Blood Pressure
Management in
Secondary Stroke
Prevention
Rizaldy Pinzon
Dept. of Neurology, Bethesda Hospital,
Yogyakarta, Indonesia
Abstract
High blood pressure (BP) is the most
important modifiable risk factor for stroke
and other vascular diseases. Evidence
from randomized controlled trials supports
the use of antihypertensive drugs to lower
blood pressure for stroke prevention.
PENDAHULUAN
Gambaran klasik stroke perdarahan intraserebral adalah
munculnya (onset) secara tiba-tiba defisit neurologik yang
progresif dari beberapa menit sampai beberapa jam yang
disertai dengan nyeri kepala yang hebat, mual, muntah, penu-
runan kesadaran dan peningkatan tekanan darah
(1)
.
Tabel 1. Penyebab Stroke Perdarahan Intraserebral
(2)
1. Primer
1.1.
Hipertensi
1.2.
Amyloid Angiopathy
2. Sekunder
2.1.
Aneurisma
2.1.1. Saccular
2.1.2.
Fusiform
2.1.3.
Mycotic
2.2.
Malformasi
Vaskuler
2.2.1. Malformasi arteri-venosa
2.2.2.
Malformasi
kavernosus
2.2.3.
Angioma
venosa
2.2.4. Fistula Arteriovenosa dural
2.3.
Neoplasma
2.3.1.
Primer
2.3.2.
Metastatik
2.4.
Koagulopati
2.4.1.
Didapat
2.4.1.1. Antikoagulan (Coumadin, Heparin)
2.4.1.2. Trombolitik (tPA, Urokinase)
2.4.1.3. Diskrasia darah (DIC, Leukemia, Trombositopenia)
2.4.1.4.
Gagal
hepar
2.4.1.5.
Disfungsi
Platelet (gagal ginjal, karena pengobatan)
2.4.2.
Kongenital
2.4.2.1.
Hemofilia
2.4.2.2.
Gangguan
Platelet
2.5. Obat-obatan terlarang atau konsumsi alkohol
2.5.1. Simpatomimetik (Efedrin, Fenilpropanolamin, Pseudoefedrin)
2.5.2.
Kokain,
Amfetamin,
Ecstasy
2.6. Hemorrhagic Ischemic Stroke
2.7. Trombosis Sinus Dural
2.8.
Vaskulitis/Vaskulopati
2.9.
Penyakit
Moya
moya
2.10. Arterial Dissection
2.11.
Kehamilan
2.12.
Eklampsia,
Venous Sinus Thrombosis
2.13.
Tidak
diketahui
* DIC = disseminated intravascular coagulation.