TRANSIENT ISCHEMIC
ATTACK
(TIA)
WAAZALIMAH BINTI WAHID
C11111863
dr. Lilian Triana Limoa
Dr. dr. Nadra Maricar, Sp. S
DEFINISI
Serangan iskemik transien (transient ischemic attack, TIA)
adalah hilangnya fungsi sistem saraf pusat fokal secara cepat
yang berlangsung kurang dari 24 jam
Diduga
diakibatkan
oleh
mekanisme
vaskular
emboli,
thrombosis, atau hemodinamik.
Beberapa episode transien/sementara berlangsung lebih dari 24
jam, tetapi pasien mengalami pemulihan sempurna yang disebut
reversible ischemic neurological deficits (RIND).
[1]REFERENSI
1. Mark H. Beers, MD, Andrew J. Fletcher, MB, Thomas V. Jones, MD (2003), The Merck Manual of Medical Information. United States of America : Merck & CO, Inc. ,Second Edition, pg 457-458.
EPIDEMIOLOGI
Antara 200,000 dan 500,000 TIA didiagnosis setiap tahun di
Amerika Serikat.
TIA membawa risiko jangka pendek yang sangat tinggi terhadap
stroke, dan sekitar 15% dari stroke didiagnosa didahului oleh TIA.
Insiden TIA pada pria (101 kasus per 100.000 penduduk) secara
signifikan lebih tinggi dibanding perempuan (70 per 100.000
REFERENSI
1. Ashish Nanda, MD; Chief Editor : Robert E O’Conner, MD, MPH, Transient Ischemic Attack, Dec 5 2014; accessed Feb 10 2014. Cited by Medscape Reference © 2011 WebMD, LLC. Available at
http://emedicine.medscape.com/article/1910519-overview
2. A. Gregory Sorensen, MD, Transient Ischemic Attack Definition, Diagnosis, and Risk Stratification, NIH Public Access, 2011 May; 21 (2): 303-313.
FAKTOR RISIKO
UNMODIFIED : usia, jenis kelamin, ras, etnis, dan keturunan
MODIFIED : hipertensi, merokok, diabetes mellitus, diet, konsumsi
alkohol, stres psikososial, depresi
REFERENSI
1. Julia Buczeki, Anna Czlonkowska, Stroke and Genetic, Periodicum Biologorum, Vol. 114, No 3, 259-266, received October 2012
ETIOLOGI
Tromboemboli
Lipohialinosis (pembuluh darah kecil intracranial)
Emboli kardiogenik
Etiologi yang lebih jarang adalah vaskulitis atau kelainan
hematologis.
REFERENSI
1. Lionel Ginsberg, Neurology : Bab 11 Strokes, Lecture Notes, Eight Edition, 2005, pg 89-97.
2. Michael Eliasziw, James Kennedy, Micheal D. Hill, Alastair M. Buchan, Henry J.M. Barnett, for the North American Symptomatic Catorid Endarterectomy Trial (NASCET) Group, Early risk of stroke after a transcient ischemic attack in patients with internal carotid artery disease, CMAJ, Mar. 30, 2004; 170 (7) pg 1105-1109.
PATOFISIOLOGI
Faktor risiko
Aterosklerosis
(thrombus atau
ateroma)
Emboli
Penumpukan
thrombus/embol
i di arteri yang
meyuplai darah
ke otak
Penurunan
sementara atau
penghentian
aliran darah
otak
Hipoksia
Hilangnya fungsi
sistem saraf
pusat fokal
REFERENSI1. Ashish Nanda, MD; Chief Editor : Robert E O’Conner, MD, MPH, Transient Ischemic Attack, Dec 5 2014; accessed Feb 10 2014. Cited by Medscape Reference © 2011 WebMD, LLC. Available at
http://emedicine.medscape.com/article/1910519-overview
2. Carine Michiels, Physiological and Pathological Responses to Hypoxia, American Journal of Pathology, Vol. 164, No. 6, June 2004, pg 1875-1882.
GEJALA KLINIS
Karotis
Vertebrobasillar
•
Hemiparesis
•
Hilangnya sensasi hemisensorik
•
Disfasia
•
Kebutaan monocular (amaurosis fugax)
yang disebabkan oleh iskemia retina
•
Vertebrobasillar
•
Paresis atau hilangnya sensasi bilateral
atau alternatif
•
Kebutaan mendadak bilateral (pada
pasien usia lanjut)
•
Diplopia, ataksia, vertigo, disfagia –
setidaknya dua dari tiga gejala ini
terjadi secara bersamaan.
• Hilangnya fungsi fokal Sistem Saraf Pusat secara mendadak
• Durasi kurang dari 24 jam
REFERENSI
1. Lionel Ginsberg, Neurology : Bab 11 Strokes, Lecture Notes, Eight Edition, 2005, pg 89-97.
2. David Rubenstein, David Wayne, John Bradley, Kedokteran Klinis, Lecture Notes, Sixth Edition, 2003, pg 101-103. 3. Mark H. Beers, MD, Andrew J. Fletcher, MB, Thomas V. Jones, MD (2003), The Merck Manual of Medical Information.
DIAGNOSA
Pemeriksaan darah rutin, LED, glukosa darah dan kolesterol, serologi
sifilis
EKG
Rontgen toraks
Ekokardiogram
USG karotis & color doppler
Magnetik resonance angiography dan angiografi serebral
REFERENSI
1. Lionel Ginsberg, Neurology : Bab 11 Strokes, Lecture Notes, Eight Edition, 2005, pg 89-97.
2. Mark H. Beers, MD, Andrew J. Fletcher, MB, Thomas V. Jones, MD (2003), The Merck Manual of Medical Information. United States of America : Merck & CO, Inc. ,Second Edition, pg 457-458.
3. A. Gregory Sorensen, MD, Transient Ischemic Attack Definition, Diagnosis, and Risk Stratification, NIH Public Access, 2011 May; 21 (2): 303-313.
DIAGNOSA BANDING
Migren disertai aura
Epilepsi parsial
Tumor intracranial, malformasi vaskuler, atau hematoma subdural kronik.
Skelarosis multiple
Gangguan vestibuler
Lesi saraf perifer atau radiks saraf (misalnya palsi nervus kranialis)
Hipoglikemia
Hiperventilasi dan proses psikogenik lainnya
REFERENSI
PENATALAKSANAAN
Obat antiplatelet
Antikoagulan (warfarin)
Endarterektomi karotis
REFERENSI
1. David Rubenstein, David Wayne, John Bradley, Kedokteran Klinis, Lecture Notes, Sixth Edition, 2003, pg 101-103 2. A. Gregory Sorensen, MD, Transient Ischemic Attack Definition, Diagnosis, and Risk Stratification, NIH Public Access,
2011 May; 21 (2): 303-313.
3. Yongjun Wang, M.D., Yilong Wang, MD., Clopidogrel with Aspirin in Acute Minor Stroke or Transient Ischemic Attack, Original Article, The New England Journal of MEDICINE, 2013.
PENCEGAHAN
Memodifikasi faktor risiko
Hipertensi, diabetes, alkohol, merokok, obesiti, sindrom metabolik,
aktivitas fisik, kolesterol, diet dan obat-obatan.
Mengobati penyakit jantung yang telah ada.
Memperbaiki kontrol diabetes.
Mengurangi asupan alkohol berlebihan
REFERENSI
1. Lionel Ginsberg, Neurology : Bab 11 Strokes, Lecture Notes, Eight Edition, 2005, pg 89-97.
2. David Rubenstein, David Wayne, John Bradley, Kedokteran Klinis, Lecture Notes, Sixth Edition, 2003, pg 101-103. 3. Karen L. Furie, MD, MPH, FAHA, Chair; Scott E. Kasner, MD, MSCE, FAHA, Vice Chair, AHA/ASA Guideline, Guidelines
for the Prevention of Stroke in Patient With Stroke of Transcient Ischemic Attack, Stroke, cited by American Heart Association, Inc © 2010. Available at http://stroke.ahajournals.org , January, 2011.
PROGNOSIS
Probabilitas stroke pada 5 tahun setelah TIA dilaporkan 24-29%.
Pencegahan stroke harus dilaksanakan dengan segera
Dubia et malam
REFERENSI
1. David Rubenstein, David Wayne, John Bradley, Kedokteran Klinis, Lecture Notes, Sixth Edition, 2003, pg 101-103. 2. Ashish Nanda, MD; Chief Editor : Robert E O’Conner, MD, MPH, Transient Ischemic Attack, Dec 5 2014; accessed
Feb 10 2014. Cited by Medscape Reference © 2011 WebMD, LLC. Available at
http://emedicine.medscape.com/article/1910519-overview
3. A. Gregory Sorensen, MD, Transient Ischemic Attack Definition, Diagnosis, and Risk Stratification, NIH Public Access, 2011 May; 21 (2): 303-313.
KESIMPULAN
TIA mungkin gejala awal stroke iskemik.
Sekitar sepertiga dari orang-orang yang yang memiliki stroke
iskemik, setidaknya satu akan mengalami riwayat TIA; sekitar
setengah dari stroke ini terjadi dalam waktu 1 tahun dari TIA.
Pentingnya identifikasi TIA untuk pencegahan stroke.
REFERENSI
1. Lionel Ginsberg, Neurology : Bab 11 Strokes, Lecture Notes, Eight Edition, 2005, pg 89-97.
2. Mark H. Beers, MD, Andrew J. Fletcher, MB, Thomas V. Jones, MD (2003), The Merck Manual of Medical Information. United States of America : Merck & CO, Inc. ,Second Edition, pg 457-458.
3. Karen L. Furie, MD, MPH, FAHA, Chair; Scott E. Kasner, MD, MSCE, FAHA, Vice Chair, AHA/ASA Guideline, Guidelines for the Prevention of Stroke in Patient With Stroke of Transcient Ischemic Attack, Stroke, cited by American Heart Association, Inc © 2010. Available at http://stroke.ahajournals.org , January, 2011.