October 22, 2019 Aibou Anime
1 Definition According to WHO, stroke is a clinical sign that develops rapidly due to impaired brain function (global) with symptoms that last for 24 hours or more that cause death without other obvious causes such as vascular. (Hendro Susilo, 2000)
Intracerebral hemorrhage is an acute focal neurological dysfunction and is caused by primary bleeding of brain substances that occur spontaneously rather than due to capitis trauma, caused by rupture of arteries, veins and capillaries. (UPF, 1994)

2 Anatomy of physiology
a brain The weight of the human brain is about 1,400 grams and is composed of approximately 100 trillion neurons. The brain consists of four major parts, namely the cerebrum (cerebrum), cerebellum (cerebellum), brain stem (brain stem), and diensefalon. (Satyanegara, 1998) The cerebrum consists of two cerebral hemispheres, the corpus colossum and the cerebral cortex. Each hemisphere consists of the frontal lobe which is the primary motor responsible for voluntary movements, the parietal lobe which plays a role in the activity made and the assistance of higher level sensory information, the temporal lobe which is the sensory area for the listener's impulses and the occipital lobe which contains the primary visual cortex, receives vision information and understands color.
The cerebellum is located inside the kranii poster and placed by the duramater which is the roof of the tent ie the tentorium, which is separated from the posterior part of the cerebrum. The convincing function is the center of reflection that coordinates and smoothes muscle movements, and alters tone and strength of contractions to maintain body balance.
Parts of the brain stem from the bottom up are the medulla oblongata, pons and mesensefalon (midbrain). The medulla oblongata is an important reflex center for the heart, vasoconstrictors, breathing, sneezing, coughing, taken, expelled, and excreted. The puncher is an important link in the corticocerebral pathway that joins the cerebellar and cerebellar hemispheres. Mesensefalon is a short part of the brain stem that contains aquedicus sylvius, several ascending and descending nerve fibers tracts and nerve stimulation centers for hearing and vision.
Diensefalon for four regions namely thalamus, subtalamus, epithalamus and hypothalamus. The thalamus is an important subcortical receiving and integrating station. The function of the subtalamus cannot be facilitated yet, but lesions in the subtalamus will cause hemibalismus which is marked by the movement of the leg or hand which is blown strongly on one side of the body. The epithalamus struggles on some of the basic impulses of a person. The hypothalamus is related to the regulation of the peripheral autonomic nervous system that accompanies the expression of behavior and emotions. (Sylvia A. Price, 1995)

b Brain blood circulation The brain receives 17% of cardiac output and uses 20% of the total oxygen consumption of the human body for its aerobics. The brain is hemmed in by two pairs of arteries namely the internal carotid artery and the vertebral artery. In the cranium cavity, these blood vessels are interconnected and form the anastomotic system, the Willisi circulus. (Satyanegara, 1998)
Internal and external carotid arteries branching off from communist carotid arteries about as high as tiroidea prone. The internal carotid artery enters the skull and branches about as high as the optic chiasm, becoming the anterior cerebral artery and the media. In addition, you can add blood to structures such as the caudate nucleus and the basal ganglia putamen, internal capsule, corpus colosum and (special) parts of the frontal lobe and cerebral parietalis, including the somestetic cortex and motor cortex. The cerebral media supplies blood to the temporal lobe, parietalis and frontalis of the cerebral cortex.
Left and right vertebral arteries originate from the same side subclavian artery. The vertebral artery is moved through the foramen magnum, as high as the border of the pons and medulla oblongata. These two arteries unite to form the basilar artery, the basilar artery continues to run up to the level of the midbrain, and here branch off into two to form the posterior cerebral artery opening. These branches of the vertebrobasilar system junction the medulla oblongata, pons, cerebellum, midbrain and partially diensefalon. Posterior cerebral arteries and their branches control some diensefalon, some occipital and temporal lobes, cochlear apparatus and vestibular organs. (Sylvia A. Price, 1995)
Blood in the brain's capillary tissue will flow through venules (which have no name) to the veins and also drainage into the duramatris sinus. From the sinus, through the emisaria vein it will flow into extracranial veins. (Satyanegara, 1998)

3 Pathophysiology Chronic hypertension causes arterial vessels with a diameter of 100-400 meter undergoing pathological changes in blood vessel walls in the form of hypohialinosis, fibrinoid necrosis and the emergence of Bouchard type aneurysms. Arteriol of the lenticulostriate branches, translucent branches of the arteriothalamus and paramedian branches of the vertebro-basilar artery undergo the same degenerative changes. An increase in blood "abrupt" or an increase in the amount that can significantly induce rupture of blood vessels, especially in the morning and evening. If the blood vessels rupture, bleeding can continue for up to 6 hours and if the volume is large it will damage the anatomical structure of the brain and cause clinical symptoms.
If the bleeding that arises is small in size, then the blood mass can only enter and interrupt between the axons of the white mass without damaging it. In this situation blood absorption will be followed by recovery of neurological functions. Whereas in extensive bleeding there is destruction of brain mass, elevated intracranial pressure and more severe can cause brain herniation in the cerebral falk or through the foramen magnum.
Death can be caused by compression of the brain stem, brain hemisphere, and secondary brain stem hemorrhage or bleeding extension to the brain stem. Blood leakage into the brain's ventricles occurs in one third of cases of cerebral hemorrhage in the caudate nucleus, thalamus and pons. In addition to damage to the brain parenchyma, due to the relatively large volume of bleeding will result in an increase in intracranial pressure and cause decreased brain perfusion pressure and disruption of brain drainage.
The vasoactive elements of blood that come out as well as the ischemic cascade due to decreased perfusion pressure, cause neurons in the affected area and surrounding blood to be depressed again. The amount of blood that comes out determines the prognosis. (Jusuf Misbach, 1999)

4 Impact of the problem a In individuals
1) Impaired brain tissue perfusion
As a result of cerebral artery blockage, cerebral hemorrhage, cerebral vasospasm, brain edema
2) Impaired physical mobility
Occurs because of weakness, paralysis and decreased perception / cognitive
3) Verbal communication disorder
As a result of decreased / inhibited cerebral circulation, neuromuscular damage, facial muscle weakness
4) Nutritional disorders
As a result of difficulty swallowing, loss of sensation (soy sauce) on the tongue, decreased appetite
5) Impaired elimination of uri and alvi
Can occur due to client unconsciousness, dehydration, immobilization and loss of urinary control
6) Inability to self-care
As a result of weakness on one side of the body, loss of coordination / control of muscles, decreased cognitive perception.
7) Psychological disorders
Can be emotional instability, irritability, loss of self control, fear, feelings of helplessness and despair.
8) Impaired vision
Can occur due to decreased visual acuity and visual field disturbance.

b To the family
1) Anxiety occurs
2) Cost issues
3) Interference with work