Aneurysm
Aneurysm
Aneurysm
Pemeriksaan Fisik
● BP↑, dilated pupils, visual field and/or cranial nerve deficits, mental status changes such as
drowsiness, photophobia, motor or sensory deficits, neck stiffness, and lower back pain with neck
flexion.
Pemeriksaan Penunjang
● IADSA
● CT: positive in 98-100% of cases for up to 12 hours after onset, and is positive in 93% of cases in
the first 24 hours
● MRI sequences (FLAIR, SWI, GRE) may be sensitive enough to show even small amounts of
subarachnoid blood
● CT angiography (CTA) : sensitivity 53% for 2 mm aneurysms, 95% (95% CI: 92-97%) for 7 mm
aneurysms, while the overall specificity was 98.9%
● MRI angiogram (MRA) : sensitivity 95% , specificity 89%
● Digital subtraction angiography (DSA)
DSA
CTA
Tatalaksana
2 categories: surgical and endovascular
Surgical :
Faktor prognostik:
● Usia
● Lokasi aneurisma
● Derajat vasospasme
● Adanya hipertensi dan komorbid lainnya
● Status neurologis pada admission
● Derajat perdarahan intraventrikular
Case Discussion
RPS:
GCS: : E1 M4 V1
TD : 150/80 mmHg
Nadi : 78x/menit
Pernapasan : 24x/menit
Suhu : 36.8 C
Cranial Nerve :
Refleks Fisiologis :
- Pupil anisokor 3.5 mm / 2mm, RCL, RCTL
+/+ - Biceps 2+/2+
- Doll’s eye reflex +/+ - Triceps 2+/2+
- Gag reflex + - Brachioradialis 2+/2+
- Patella 2+/2+
Motorik : - Achilles 2+/2+
- Sulit dikaji
PEMERIKSAAN PENUNJANG
CT INTRACRANIAL/CIRCULULUS WILLISI CTA
Kesan :
- Perdarahan subarachnoid
- Perdarahan intreaventrikel
DIAGNOSA
Subarachnoid Hemorrhage dengan Intraventricular Hemorrhage
TATALAKSANA
Media kontras khusus, atau 'dye disuntikkan agar persediaan darah ke kaki, jantung atau organ
tubuh lainnya mudah dilihat.
Current gold standard for confirmation of aneurysmal obliteration, but it requires invasive
arterial access. Patients undergoing DSA require sedation, thus exposing them to the risk of
anesthetics as well.
CLIPPING
-Clipping adalah prosedur operasi terbuka untuk
menutup aneurisma leher, agar mencegah
pendarahan untuk memasuki aneurisma,
sehingga meng-obliterasi aneurisma
-titanium or cobalt clips
CLIPPING ANEURYSM
VP SHUNT (Ventriculo-Peritoneal Shunt)
A shunt is a hollow tube surgically placed in the brain (or occasionally in the spine) to help drain
cerebrospinal fluid and redirect it to another location in the body where it can be reabsorbed.
Shunt procedures can address pressure on the brain caused by hydrocephalus and relieve its symptoms
such as gait difficulty, mild dementia and lack of bladder control.