HUBUNGAN KADAR NATRIUM SERUM SAAT MASUK DENGAN KELUARAN MOTORIK PASIEN STROKE ISKEMIK

Background : Motor impairment commonly found in stroke patient. Sodium disorders in the acute phase of ischemic stroke known to be associated with poorer patient outcome. The correlation between serum sodium levels and motoric outcome in ischemic stroke patient has not been studied. Aim : To determine the correlation between serum sodium levels on admission and motoric outcome of ischemic stroke patients. Methods : This analytic observational study used cross sectional design. 33 ischemic stroke patients matching with inclusion and exclusion criteria were included consecutively in this study. Motoric outcome was evaluated using motor assessment score (MAS) on 7th days of hospitalization or on discharge, whereas serum sodium levels was obtained from medical records. Statistics test used One Way ANOVA test and Spearman Correlation test. Results : This study found no significant correlation between serum sodium levels and MAS score in ischemic stroke patients (p=0,938). Serum sodium levels had weak negative correlation to MAS score (r=-0,01). MAS scores between hyponatremia, normonatremia, and hypernatremia ischemic stroke patients was not significantly different (p=0,073). Mean of MAS scores in hyponatremia (24,80) and hypernatremia (13,76) was lower than normonatremia ischemic stroke patients (28,44). Conclusion : Hyponatremia or hypernatremia ischemic stroke patients MAS score was poorer than normonatremia ischemic stroke patients. There was no significant correlation between serum sodium levels on admission and MAS score in ischemic stroke patients. Key Words : ischemic stroke, sodium, stroke motoric outcome, motor assessment scal

The Effect Of Combination Spherical Grip And Kinesio Taping Exercise To Enhance Of Muscle Strength In Ischemic Stroke Patients In Jemursari Islamic Hospital Surabaya

Ischemic stroke patients are the main problem that occurs when disruption of cerebral blood flow. Data Global Burden Disease shows that all populations obtained 80% ischemic stroke and 20% hemorrhagic stroke with physical mobility barriers namely muscle weakness obtained 58%. Nursing actions that can be done, one of which is by giving activity to stroke patients who are useful to increase cerebral blood flow. This study aims to analyze the effect of the combination of spherical grip exercise and Kinesiotaping to the muscle strength of ischemic stroke patients in Jemursari Islamic Hospital Surabaya.This research is designed by Quasi Experiment with approach pre post test control group design. All populations are ischemic stroke patients in the azzahra room 1 as many as 41 people, a sample of 38 respondents divided into 19 treatment and control groups. In the intervention group was given a combination of Spherical Grip and Kinesiotaping Exercise for 20 minutes twice a day for 3 weeks. Whereas in the control group was given training accordance with Hospital procedures. Statistical analysis used Wilcoxon signed rank test and Mann-Whitneyα test< 0,05.The results of this study indicated that the mean increase in muscle constriction in the intervention group 2.83, and a big control group is 1.10. Analysis with Mann Whitney showed p= 0.000. So that H0 rejected this means that there is an effect of a combination of Spherical Grip and Kinesiotaping exercises on increasing muscle strength in ischemic stroke patients in Jemursari Islamic hospitals.The combination of Spherical Grip and Kinesiotaping exercises that are routinely performed can increase muscle strength, resulting in increased muscle strength in ischemic stroke patients. Nurses need to apply Spherical Grips and Kinesiotaping to ischemic stroke patients in the rehabilitation phase. Keyword : Ischemic stroke, Spherical Grip and Kinesiotaping, Muscle Strength.

Gambaran Hematokrit Pada Pasien Stroke Iskemik Di Rumah Sakit Umum Daerah Arifin Ahmad Provinsi Riau

Hematocrit is one of the risk factors of stroke. Elevated hematocrit will cause the increased of blood viscosity. This increased of blooad viscosity will lead to activation of the substance of blooad coagulation and the derivation of cerebral blood flow. This research was to know the profile of hematocrit in ischemic stroke patients in Neurology Department Arifin Ahmad General Hospital of Riau Province during January-December 2013. This was a descriptive retrospective study. Data is used about 89 medical record of ischemic stroke patients. Data obtained from this study that the most ischemic stroke patients were in the age group 50-59 years old (32,58%), with the highest gender was male, which as much 46 patients (51,69%), the number of elevated hematocrit in male were 7 patients (7,87%) and 15 patients in female (16,86%), the number of normal hematocrit in male were 37 patients (41,57%) and in female 24 patients (26,97%), the number of lowered hematocrit in male were 2 patients (2,24%) and 4 patients (4,49%) in female. The result of this study showed that most of the ischemic stroke patients in General Hospital of Riau Province have normal hematocrit

Hubungan Jumlah Neutrofil Absolut dengan Mortalitas pad Stroke Iskemik Akut dengan Komplikasi Pneumonia

Background: Acute ischemic stroke patients with pneumonia experienced inflammation reaction which induces neutrophil invasion to lung tissue as a defense mechanism towards infection. Absolute neutrophil count is suspected to relate with mortality of acute ischemic stroke patients with pneumonia. Methods: This cohort observational perspective research was performed from November 2010 until April 2011 on 34 acute ischemic stroke patients with pneumonia at Dr. Kariadi Hospital Semarang. Correlation analysis was done to investigate whether absolute neutrophil count (ANC) is correlated with mortality. Correlation analysis was also performed to explore whether ANC is correlated with NIHSS score at 7th day post diagnosis of pneumonia on surviving patients. Cut off value 7600/μL from previous research was chosen to determine risk relative of ANC towards mortality. Results: Absolute neutrophil count (ANC) was positively correlated with mortality and showed tendency towards mortality among acute ischemic stroke patients with pneumonia. ANC was also positively correlated with NIHSS score among surviving patients. Cut off value 7600/μL from previous research yielded sensitivity 85,7%; specificity 40,7%; with insignificant p value 0,203 and rho 0,224 in this research. Conclusions: Absolute neutrophil count (ANC) is positively correlated with mortality of acute ischemic stroke patients with pneumonia although insignificantly. It was correlated with neutrophil role in inflammatory response, in which overresponse could hamper mortality and neurological deficit state of patients that measured by NIHSS score. Keywords: Absolute neutrophil count (ANC), acute ischemic stroke, pneumonia, mortality

Perbedaan Kejadian Depresi pada Pasien Stroke Iskemik Lesi Hemisfer Kiri dan Hemisfer Kanan di RSUD Kabupaten Kudus

Intani Mundiartasari, J500100112, 2014. Perbedaan Kejadian Depresi pada Pasien Stroke Iskemik Lesi Hemisfer Kiri dan Hemisfer Kanan di RSUD Kabupaten Kudus. Latar Belakang: Stroke iskemik merupakan kematian jaringan otak akibat pasokan darah yang tidak adekuat. Rusaknya jaringan otak dapat menyebabkan gangguan mental emosional dimana depresi merupakan salah satu yang sering dijumpai. Pasien stroke iskemik lesi hemisfer kiri dan hemisfer kanan dimungkinkan ada perbedaan kejadian depresi. Tujuan Penelitian: Mengetahui perbedaan kejadian depresi pada pasien stroke iskemik lesi hemsifer kiri dan hemisfer kanan di RSUD Kabupaten Kudus. Metode Penelitian: Penelitian ini merupakan penelitian observasional analitik dengan pendekatan cross sectional. Pengambilan sampel dilakukan secara purposive sampling dengan menggunakan 36 sampel di RSUD Kabupaten Kudus yang terbagi menjadi dua kelompok yaitu 18 orang pasien stroke iskemik lesi hemisfer kiri dan 18 orang pasien stroke iskemik lesi hemisfer kanan. Data kemudian dianalisis menggunakan uji t-tidak berpasangan dengan program SPSS 16.0 for Windows. Hasil Penelitian: Dari 18 pasien stroke iskemik lesi hemisfer kiri yang menderita depresi sebanyak 15 orang (83,33%), sedangkan pasien stroke iskemik lesi hemisfer kanan yang menderita depresi sebanyak 11 orang (61,11%). Analisis uji t-tidak berpasangan menunjukkan bahwa nilai p = 0,030 (p < 0,05). Simpulan: Terdapat perbedaan yang signifikan antara kejadian depresi pada pasien stroke iskemik lesi hemisfer kiri dan hemisfer kanan di RSUD Kabupaten Kudus. Depresi lebih banyak terjadi pada pasien stroke iskemik lesi hemisfer kiri daripada lesi hemisfer kanan. Intani Mundiartasari, J500100112, 2014. The Difference of Depression in Left and Right Hemispheric Ischemic Stroke Patients In RSUD Kabupaten Kudus. Background: Ischemic stroke is the death of brain tissue due to inadequate blood supply. Destruction of brain tissue may cause emotional mental disorders where the depression is one that is often encountered. There was a possibility difference incidence between left and right hemispheric ischemic stroke. Objective: Knowing the difference of depression in left and right hemispheric lesion ischemic stroke patients in RSUD Kabupaten Kudus. Method: The research was an analytical observational study with cross sectional approach. Sampling was done by purposive sampling technique using 36 samples in RSUD Kabupaten Kudus which consist of 18 left hemispheric lesion ischemic stroke patients and 18 right left hemispheric lesion ischemic stroke patients. The obtained data was analyzed using unpaired t-test by SPSS16.0 for Windows. Result: From 18 left hemispheric lesion ischemic stroke patients as many as 15 patients (83,33%) was depressed, while the right hemispheric lesion ischemic stroke patients are suffering depression as many as 11 people (61,11%). Unpaired t-test analysis showed that the value of p = 0,030 (p < 0,05). Conclusion: There was a significant difference of depression between the left and right hemispheric lesion ischemic stroke patients in RSUD Kabupaten Kudus. The left hemispheric lesion ischemic stroke patients likely often develop more severe depression than the right on

Analysis of Gray Matter Volume (GMV) and White Matter Hyperintensity (WMH) in Ischemic Stroke Patients with Fluid Attenuated Inversion Recovery (FLAIR) Imaging

Stroke is a serious health problem faced by almost all over the world. The occurrence of ischemic stroke could affect the gray matter volume (GMV) in the human brain. In Magnetic Resonance imaging of an ischemic stroke with a FLAIR sequence, a white lesion known as the white matter hyperintensity (WMH) is often found. We studied correlation between gray matter volume (GMV) and white matter hyperintensity (WMH) in ischemic stroke patients using fluid attenuated inversion recovery (FLAIR) sequences. The MRI data were taken randomly from ten ischemic stroke patients (mean age 46.9 years) and ten normal patients (mean age 36.8 years). FLAIR axial image parameters, i.e. TE (time echo), TR (time repetition), and TI (time inversion) were analyzed. The results reveal that the TE and TR values in FLAIR images of normal and ischemic stroke patients are classified as long TE (more than 70 ms), long TR  (more than 1500 ms) and long TI (more than 1700 ms). The mean GMV of ischemic stroke patients (1.371 cm3) is smaller than the GMV of normal patients (2.267 cm3). This is related to the presence of white matter hyperintensity (WMH) in ischemic stroke patient

Linear and nonlinear parameters of heart rate variability in ischemic stroke patients

Introduction Cardiovascular system presents cortical modulation. Post-stroke outcome can be highly influenced by autonomic nervous system disruption. Heart rate variability (HRV) analysis is a simple non-invasive method to assess sympatho-vagal balance. Objectives The purpose of this study was to investigate cardiac autonomic activity in ischemic stroke patients and to asses HRV nonlinear parameters beside linear ones. Methods We analyzed HRV parameters in 15 right and 15 left middle cerebral artery ischemic stroke patients, in rest condition and during challenge (standing and deep breathing). Data were compared with 15 age- and sex-matched healthy controls. Results There was an asymmetric response after autonomic stimulation tests depending on the cortical lateralization in ischemic stroke patients. In resting state, left hemisphere stroke patients presented enhanced parasympathetic control of the heart rate (higher values for RMSSD, pNN50 and HF in normalized units). Right hemisphere ischemic stroke patients displayed a reduced cardiac parasympathetic modulation during deep breathing test. Beside time and frequency domain, using short-term ECG monitoring, cardiac parasympathetic modulation can also be assessed by nonlinear parameter SD1, that presented strong positive correlation with time and frequency domain parameters RMSSD, pNN50, HFnu, while DFA α1 index presented negative correlation with the same indices and positive correlation with the LFnu and LF/HF ratio, indicating a positive association with the sympatho-vagal balance. Conclusions Cardiac monitoring in clinical routine using HRV analysis in order to identify autonomic imbalance may highlight cardiac dysfunctions, thus helping preventing potential cardiovascular complications, especially in right hemisphere ischemic stroke patients with sympathetic hyperactivation

Expression of Tie2 (angiopoietin receptor) on the monocyte subpopulations from ischemic stroke patients: Histological and flowcytometric studies

Introduction. Different subpopulations of monocytes play roles in phagocytosis, inflammation, and angiogenic processes e.g., Tie2-expressing monocytes (TEMs). The brain is flooded with macrophages that are derived from monocytes within 3-7 days after a stroke. This study aimed to determine the expression level of Tie2 (an angiopoietin receptor) on monocytes and their subpopulations in ischemic stroke patients using the histological and immunohistological study of bone marrow biopsies and blood flow cytometry examination. Methods. Ischemic stroke patients within two days were selected. Participants in the control group were healthy volunteers of matched age and gender. Sample collection was performed within 24 to 48 hours after medical consultants confirmed the stroke diagnosis. An iliac crest bone marrow biopsy was obtained and fixed for histological and immunohistological staining with antiCD14 and antiCD68. Flow cytometry was used to determine the total monocyte population, monocyte subpopulations, and TEMs after staining with monoclonal antibodies to CD45, CD14, CD16, and Tie2. Results. Post-stroke patients' bone marrow cells were hypercellular. There was an apparent increase in CD68 and CD14-positive cells. Ischemic stroke patients exhibited low percentages of nonclassical monocytes CD14lowCD16++, with an increase in intermediate monocytes CD14highCD16+. Moreover, ischemic stroke patients had significantly higher levels of TEMs than control group. Conclusions. The results of this study demonstrate dysregulation of angiogenesis in monocyte subsets in ischemic stroke patients, which could be used as an early diagnostic marker of neurovascular damage and may need angiogenic therapy or improved medications to prevent further damage of blood vessel