HIPERGLIKEMIA DAN EARLY NEUROLOGICAL DETERIORATION SETELAH TROMBOLISIS PADA STROKE ISKEMIK AKUT: LAPORAN KASUS
HYPERGLYCEMIA AND EARLY NEUROLOGIC DETERIORATION AFTER THROMBOLYSIS IN ACUTE ISCHEMIC STROKE: A CASE REPORT
Abstract
Early neurological deterioration (END) merupakan komplikasi yang dapat terjadi setelah intravenous recombinant tissue plasminogen activator (IV-rtPA) pada stroke iskemik akut dan berhubungan dengan luaran klinis yang buruk. Hiperglikemia diketahui berperan dalam memperburuk cedera iskemik dan diduga meningkatkan risiko END, meskipun mekanismenya belum sepenuhnya dipahami. Seorang perempuan berusia 49 tahun datang dengan hemiparesis dekstra dan disartria yang timbul mendadak. Pemeriksaan awal menggunakan National Institutes of Health Stroke Scale (NIHSS) menunjukkan skor 8. Pasien memenuhi kriteria terapi IV-rtPA dan mengalami perbaikan neurologis awal dengan penurunan NIHSS menjadi 3 satu jam setelah trombolisis, kemudian menjadi 1 pada evaluasi 24 jam. Namun, pada hari kelima perawatan terjadi END dengan peningkatan NIHSS menjadi 10 disertai hiperglikemia persisten (HbA1c 8,7% dan glukosa darah tidak terkontrol selama perawatan). Evaluasi klinis dan penunjang tidak menunjukkan bukti perdarahan intrakranial maupun penyebab lain yang jelas terhadap perburukan neurologis. Kasus ini menunjukkan bahwa hiperglikemia persisten dapat berkontribusi terhadap terjadinya END setelah terapi IV-rtPA pada stroke iskemik akut. Pemantauan dan pengendalian glukosa darah secara ketat selama fase akut merupakan bagian penting dari tata laksana pasien untuk mengoptimalkan luaran neurologis.
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