STROKE AND CEREBROVASCULAR DISEASE

STROKE AND CEREBROVASCULAR DISEASE

• Focal brain lesions consist of groups of different conditions, resulting in cognitive abnormalities and symptoms - symptoms of neuro-psychiatric
• Stroke is the most common cause in the practice of neurology and occupies cause mor-mentality II after heart disease, but occupy the top ranking cause of morbid-itas, including impaired neurobehavior
• Neuropsychiatric symptoms are usually a manifestation of post stroke:
• Major depression occurs in 10-25%
• Minor Depression around 10-40%
• anxiety depression that occurs 20% of patients post-stroke depression
• Anxiety without depression 7-10%
• Apathy occurred in 20% (10% with depression, 10% without depression)
• Anosognosia with denial of illness in 25-45%, especially in the right posterior lesions
• Catastrophic reactions seen in 20% of patients
• Emotions are unstable in 20% of patients

Traumatic Brain Injury (TBI)
Classification of Head Injury
• head injury without brain injury
• Whiplash
• mild TBI / kontusi, PTA <24 hours
• TBI are: loss of consciousness> 30 minutes but less than 24 hours
• severe TBI: loss of consciousness or PTA> 24 hours
• TBI with complications :

1. Fracture of the skull, facial bones,
2. Cerebral injury [contusions, lacerations, diffuse axonal injury]
3. Bleeding [intracerebral, subarachnoid, sudural, epidural]
4. Herniation
5. Neck Injury / neck fracture
6. Stroke

• TBI with secondary complications: post-traumatic hydrocephalus, post traumatic seizure
•  Neuropsychiatric complications: post contusion syndrome, post traumatic syndrome, post traumatic ggn.stres, depression, psychosis, anxiety, mania / euphoria, frontal lobe syndrome
• Post traumatic amnesia
• Dementia [post traumatic encefalopati]
• Persistent Vegetative state

Traumatic Brain Injury (TBI)

• Immediately after the injury, the patient complained of impaired concentration, memory loss, impaired sleep cycle patterns, headache, dizziness, anxiety, irritability and depression
• Symptoms usually resolve symptoms in most pa-patient and after 1 year 85-90% of patients who have experienced significant recovery.
• Patients with age> 55 years or with severe TBI recover more slowly and may have many sequelae
• Psychological Assessment mengungkapakan aten-the deficit in executive function or the disturbance caused by frontal-subcortical circuits or effect of depre-si, anxiety
• Approximately 10-15% of patients develop into a chronic disorder contusions post

Criteria For Disorders Post Contusion 
1. History of trauma that causes cerebral contusions 
2. Neuropsychological test evidence or assessment of cognitive
   difficulties of attention (concentration, shifting the focus of 
   attention, memory) 
3. One or more of the following occur shortly after trauma and 
   end no later than 3 months :

1. Easily tired / fatigue
2. Ganggan sleep
3. Headache
4. Vertigo / dizziness
5. Irratability or aggressive
6. Anxiety, depression or unstable effects
7. Changes in personality
8. Apathetic

4. Symptoms begin to appear following a head injury or showed 
    worsening of symptoms earlier
5. Disruption in the cause of social disruption or job function and  
    showed a significant reduction from previous levels. In school 
    children, the disorder manifests as a deterioration in academic  
    achievement that began from the trauma
6. The symptoms do not meet the criteria of de-mentia due to  
    a head injury and was not well when included as another mental  
   disorder.