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Jurnal Neuroanestesi Indonesia

jni
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Published by Indonesian Society of Neuroanesthesia & Critical Care

ISSN : 20889674 EISSN : 24602302 DOI : https://doi.org/10.24244/jni

Core Subject : Health, Science, Education,

Biochemistry, Genetics & Molecular Biology Education Medicine & Pharmacology Neuroscience Public Health

Editor of the magazine Journal of Neuroanestesi Indonesia receives neuroscientific articles in the form of research reports, case reports, literature review, either clinically or to the biomolecular level, as well as letters to the editor. Manuscript under consideration that may be uploaded is a full text of article which has not been published in other national magazines. The manuscript which has been published in proceedings of scientific meetings is acceptable with written permission from the organizers. Our motto as written in orphanet: www.orpha.net is that medicine in progress, perhaps new knowledge, every patient is unique, perhaps the diagnostic is wrong, so that by reading JNI we will be faced with appropriate knowledge of the above motto. This journal is published every 4 months with 8-10 articles (February, June, October) by Indonesian Society of Neuroanesthesia & Critical Care (INA-SNACC). INA-SNACC is associtation of Neuroanesthesia Consultant Anesthesiology and Critical Care (SpAnKNA) and trainees who are following the NACC education. After becoming a Specialist Anesthesiology (SpAn), a SpAn will take another (two) years for NACC education and training in addition to learning from teachers in Indonesia KNA trainee receive education of teachers/ experts in the field of NACC from Singapore.

Arjuna Subject : Kedokteran - Anesthesiology and Pain Medicine

Articles 8 Documents

Search results for , issue "Vol 8, No 2 (2019)" : 8 Documents clear

Manajemen Pasien Stroke Perdarahan Spontan dengan Komorbid Penyakit Paru Obstruktif Kronik yang Terjadi Bronkhospasme Intraoperasi Halimi, Radian Ahmad; Bisri, Dewi Yulianti
Jurnal Neuroanestesi Indonesia Vol 8, No 2 (2019)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Stroke perdarahan spontan dan penyakit paru obstruktif kronik (chronic obstructive pulmonary disease/COPD) merupakan dua penyakit yang memiliki angka morbiditas dan mortalitas yang paling tinggi di dunia. Kondisi COPD akan meningkatkan resiko terjadinya stroke, selain itu dapat mengakibatkan terjadinya hipoksemia dan hiperkapnia. Seorang pria berusia 62 tahun datang ke unit gawat darurat karena mengalami penurunan kesadaran dan tidak dapat menggerakkan anggota tubuh sebelah kiri sejak 1 hari, pasien memiliki riwayat hipertensi namun tidak rutin meminum obat, pasien memiliki riwayat sering sesak, dan berdasarkan pemeriksaan fisik didapatkan kondisi barrel chest. Berdasarkan pemeriksaan CT-scan kepala didapatkan perdarahan intrakranial spontan pada basal ganglia sinistra. Pasien dilakukan tindakan kraniotomi evakuasi, namun 2 jam setelah dilakukan induksi anestesi terjadi kondisi desaturasi, hiperkapnia, peningkatan tekanan jalan nafas, dan ditemukan wheezing pada kedua lapang paru, kemudian diberikan terapi farmakologis dan non farmakologis untuk mengatasi kondisi bronkospasme. Pascabedah dilakukan pemanjangan ventilasi mekanik hingga pasien memenuhi kriteria untuk dilakukan ekstubasi. Penanganan pasien stroke dengan komorbid COPD membutuhkan pemahaman yang lebih mendalam mengenai interaksi otak dengan fungsi pernafasan akibat perubahan fisiologi dan patofisiologi pasien COPD.Management of Spontaneous Intracranial haemorhage with Comorbids Chronic Obstructive Pulmonary Disease Occurring Intraoperative BronchospasmAbstractStroke and chronic obstructive pulmonary disease (COPD) are the two diseases that have the highest morbidity and mortality rates in the world. COPD conditions will increase the risk of stroke, but it can lead to hypoxemia and hypercapnia. A 62-year-old man came to the emergency room because of a decreased consciousness and was unable to move the left limb since 1 day, the patient had a history of hypertension but did not regularly take medication, the patient had a history of frequent tightness, and based on physical examination was obtained barrel chest condition. Based on a head CT scan, spontaneous intracranial hemorrhage occurs in the left basal ganglia. Evacuation craniotomy was performed, but 2 hours after anesthesia induction occurred conditions of desaturation, hypercapnia, increased airway pressure, and wheezing was found in both lung fields, then given pharmacological and non-pharmacological therapy to overcome the condition of bronchospasm. After surgery, lengthening of mechanical ventilation is done until the patient meets the criteria for extubation. The treatment of stroke patients with co-morbid COPD requires a deeper understanding of brain interactions with respiratory function due to changes in physiology and pathophysiology of COPD patients.

Manajemen Tekanan Darah Setelah Cedera Sistem Saraf Pusat Radian Ahmad Halimi; Dewi Yulianti Bisri
Jurnal Neuroanestesi Indonesia Vol 8, No 2 (2019)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Hipertensi yang tidak terkontrol sering dijumpai setelah cedera otak. Mekanisme mengenai respon fisiologis dan patologis ini berhubungan dengan respons autoregulasi yang bertujuan untuk mempertahankan aliran darah otak di area yang terkena cedera. Respons hipertensi awal mungkin akan mempercepat/memicu cedera lebih lanjut. Sebaliknya, penurunan tekanan darah secara agresif justru berhubungan dengan kejadian iskemik. Meskipun tekanan darah sudah jelas berperan sebagai modulator dalam cedera otak akut, berbagai penelitian masih menunjukkan kontroversi dan belum ada data-data berkualitas terkait demografis, manajemen optimal terhadap tekanan darah tinggi dam hasil akhir pada pasien yang mengalami cedera otak akut. Deteksi kelainan autoregulasi yang terjadi setelah cedera otak dan kontrol tekanan darah secara hati-hati sangat dibutuhkan dalam manajemen optimal pasien tersebut. Blood Pressure Management After Central Nervous System InjuryAbstractUncontrolled hypertension is often encountered after brain injury. This mechanism related to physiologic and pathologic response are related to autoregulatory responses aimed at preserving the cerebral blood flow in injured areas. The initial hypertensive response may precipitate further injury. Conversely, aggresive blood pressure reduction may be associated with ischemia. Despite the clear role of blood pressure as a modulator of acute brain injury, there is considerable controversy and a lack of high-quality data regarding the demographics, outcomes, and optimal management of high blood pressure in acute brain-injured patients. Recognition of the autoregulatory abnormalities seen after brain injury and careful control of blood pressure are necessary for the optimal management of these patients.

Manajemen Neuroanestesi pada Sindrom Dandy Walker dengan Hiperkalemia Kulsum, Kulsum; Mafiana, Rose; Gaus, Syafruddin
Jurnal Neuroanestesi Indonesia Vol 8, No 2 (2019)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Sindrom Dandy Walker termasuk hidrosefalus yang sangat jarang terjadi dengan insiden 1 kasus dari 65 kasus hidrosefalus berdasarkan penelitian profil hidrosefalus di RSUDZA Banda Aceh. Insiden di Indonesia sebanyak 5060% kasus dari operasi bedah saraf. Kasus berikut seorang bayi laki-laki lahir prematur, umur 1 bulan, berat badan 3,5 kg, ukuran lingkar kepala 45 cm, muntah dan kejang. CT-Scan terdapat kista, kalium 7 mmol/l ditegakkan diagnosa sindrom Dandy Walker dengan hiperkalemia. Manajemen neuroanestesi dengan cara premedikasi dan pemasangan kateter intravena 24G dengan sevofluran via masker O2 100% setelah jalur vena terpasang, diberikan fentanil 10 mcg sebagai analgetik dan induksi propofol 10 mg. Rocuronium 3,5 mg sebagai fasilitas intubasi. Pemeliharaan anestesi dengan sevofluran dan oksigen. Ventilasi frekuensi nafas 30 x/menit dilakukan manual dan kemudian dengan ventilator TV 30 ml, I:E = 1:1,5, RR 30 kali per menit, FiO2 100%. Monitoring hasil frekuensi nadi 100 130 kali per menit, SpO2 100%, suhu afebris, CO2 30 mmHg. Simpulan: sindrom Dandy Walker kasus yang sangat jarang terjadi dan hidrosefalus sering bersamaan dengan hiperkalemia terjadi pada bayi prematur karena gangguan reaborbsi kalium dan terjadi perpindahan kompartemen dari intraseluler ke ekstraseluler sehingga kalium banyak di ekstraseluler, maka diperlukan manajemen neuroanestesi pediatrik yang adekuat.Neuroanesthesia Management in Dandy Walker Syndrome with HyperkalemiaAbstractDandy Walker syndrome including hydrocephalus which is a very rare case with the incidence of 1 case out of 65 cases of hydrocephalus based on a study of hydrocephalus profile at Zainal Abidin Hospital, Banda Aceh. The incidence of Dandy-Walker syndrome in Indonesia are about 50 - 60% cases from all of neurosurgical cases. The following case was a premature baby, 1 month old, weight 3.5 kg, head cicumference 45 cm, vomit and seizure. Cyst was found in the head CT scan and the potassium level of 7 mmol/l. The patient was diagnosed with Dandy-Walker Syndrome with hyperkalemia. Neuroanesthesia management by premedication and infusion using intravenous cathether 24G with sevoflurane and 100% O2 mask After succesful intravenous cathether, given fentanyl 10 mcg as analgesic and propofol 10 mg as induction. Rocuronium 3.5 mg as a facility for intubation. Maintenance of anesthesia with sevoflurane and oxygen. Respiratory rate 30 breaths per minute with ventilation that was done manually and then with TV on ventilator 30 ml, I: E = 1: 1.5, RR 30x/min, FiO2 100%. Monitoring pulse frequency results of 100130 beats per minute, 100% SpO2, temperature afebrile, CO2 30 mmHg. Conclusions: Dandy-Walker Syndrome was a very rare case and hydrocephalus was often followed with hyperkalemia that occur in premature infants due to potassium reaboration disorder and the displacement of compartment from intracellular to extracellular so that potassium was abundant at extracellular, hence adequate pediatric neuroanesthesia management was needed.

L-Arginine, Suatu Peluang Neuroproteksi terhadap Pasien Preeklampsia yang mendapat Problem Neurologis Utami, Niken Asri; Jasa, Zafrullah Kany
Jurnal Neuroanestesi Indonesia Vol 8, No 2 (2019)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Preeklampsia mengakibatkan komplikasi pada 35% dari seluruh kehamilan. Dihubungkan dengan persalinan prematur, solusio plasenta dan lahir mati serta komplikasi stroke iskemik, stroke perdarahan, edema serebri serta kejang. Pasien dengan preeklampsia menunjukkan peningkatan tekanan perfusi otak pada arteri serebri media, anterior dan posterior, disertai perubahan indeks resistensi arteri serebri. Insiden komplikasi serebrovaskuler menyumbangkan 40% kematian maternal. Terjadi gangguan autoregulasi dan pembentukan edema. Gangguan autoregulasi dihubungkan dengan penurunan resistensi serebrovaskuler, hipoperfusi otak, disrupsi sawar darah otak serta edema vasogenik. Terjadi peningkatan sitokin pro inflamasi dan aktivasi sel-sel glia otak. L-Arginine adalah kompleks asam amino yang memiliki bentuk aktif dalam bentuk L-Arginine (2 amino 5 guanidino pentanoic acid). Substrat L-Arginine untuk membentuk nitric oxide (NO) memiliki peran penting pada pembuluh darah. Pemberian L-Arginine secara intravena 5 menit setelah terjadinya cedera mengembalikan nilai aliran darah otak, memperbaiki sirkulasi serebral serta secara signifikan mereduksi volume otak yang memar. Efek neuroprotektif yang sama telah diamati terjadi pada percobaan lain model cedera otak traumatik dan pada beberapa model iskemia serebri dengan pemberian dini L-Arginine. L-Arginine dapat menjadi agen neuroproteksi potensial yang sangat menarik untuk memperbaiki serebral setelah cedera otak.L-Arginine, a Neuroprotection Chance for Preeclampsia Patients with Neurological ProblemAbstractPreeclampsia complicates 3 5% of all pregnancies. Preeclampsia is associated with premature delivery, placental abruption and stillbirth and can lead to complications, such as ischemic stroke, hemorrhagic stroke, cerebral edema and seizures. Patients with preeclampsia shows an increase in cerebral perfussion pressure (CPP) in anterior, middle and posterior cerebral arteries, with accompanying changes in cerebral artery resistance indices. The incident of cerebrovascular complications contributes to 40% of maternal death. Disturbance in autoregulation and subsequent edema formation. Disturbance in CBF autoregulation also associated with decrease in cerebrovascular resistance, brain hypoperfusion, blood brain barrier (BBB) disruption and vasogenic edema. There is also an increase in release of pro inflammatory cytokines and glial cells activation. L- Arginine is an amino acid complex, with active form in L-Arginine (2 amino 5 guanidino pentanoic acid) found in vegetable and animal origin proteins, such as dairy, meat and most of all in fish and nuts. L-Arginine substrate creating Nitric Oxide (NO) plays important role in vascular. Intravenous administration of L-Arginine 5 minutes after brain injury restores cerebral blood flow (CBF) level, improves cerebral circulation and significantly reduces the contused brain volume. The same neuroprotective effect on another traumatic brain injury (TBI) model was observed and also found in cerebral ischaemia model with early administration of L-Arginine. L-Arginine can be a potential neuroprotective agent to improve of cerebral circulation after brain injury

Perbandingan Mini Mental State Examination (MMSE) dan Clock Drawing Test (CDT) untuk Mendeteksi Disfungsi Kognitif pada Cedera Otak Traumatik Ringan dan Sedang Oktivia, Wenny; Fuadi, Iwan
Jurnal Neuroanestesi Indonesia Vol 8, No 2 (2019)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

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Latar Belakang dan Tujuan: Disfungsi kognitif sering terjadi pada pasien cedera otak traumatik (COT). Gangguan neuropsikologik yang disebabkan oleh cedera otak traumatik ringan dan sedang berupa penurunan kecepatan memproses informasi, gangguan perhatian, orientasi, dan fungsi eksekutif. Pemeriksaan disfungsi kognitif yang sering digunakan adalah Mini Mental State Examination (MMSE). Saat ini sedang dicari pemeriksaan lain yang lebih mudah dilakukan dan memiliki sensitifitas dan spesifisitas yang lebih baik, yaitu dengan Clock Drawing Test (CDT). Penelitian ini bertujuan membandingkan MMSE dan CDT dalam mendeteksi disfungsi kognitif pada COT ringan dan sedang. Subjek dan Metode: Penelitian menggunakan observasi analitik cross sectional, dilakukan di Rumah Sakit Dr. Hasan Sadikin (RSHS) Bandung pada bulan Januari hingga April 2018. Pasien dibagi menjadi kelompok COT ringan (n=16) dan sedang (n=16) yang masing-masing dilakukan pemeriksaan MMSE dan CDT. Hasil: Dengan nilai cut-off MMSE 26,5 didapatkan sensitivitas 93,8% dan nilai spesifisitas 81,3%, sedangkan menggunakan nilai cut-off CDT 2,5 didapatkan sensitifitas dan spesifisitas CDT 100%. Simpulan: CDT memiliki sensitivitas dan spesifisitas yang lebih baik untuk mendeteksi disfungsi kognitif pada COT ringan dan sedang.Comparison of Mini Mental State Examination (MMSE) and Clock Drawing Test (CDT) on Detecting Cognitive Dysfunction on Mild and Moderate Traumatic Brain InjuryAbstractBackground and Objective: Cognitive dysfunction often found in Traumatic Brain Injury (TBI). TBI can triggers neurophysicological, such as slower information processing, attention deficit, orientation disturbance, and executive function. There are methods to evaluate cognitive dysfunction, but none are showing 100% sensitivity and specificity. The frequently used method is Mini Mental State Examination (MMSE). Currently, other examinations are being sought that are easier to do and have better sensitivity and specificity, namely the Clock Drawing Test (CDT). This study is aimed to compare MMSE and CDT to detect cognitive dysfunction in Mild and Moderate TBI. Subject and Method: This study is using analytical observation and cross-sectional study design, it was held in Hasan Sadikin Hospital Bandung throughout January 2017 to April 2018. Subjects are divided into Mild TBI group (n=16) and Moderate TBI group (n=16), both groups were given MMSE and CDT. Result: Using cut-off point 26,5 for MMSE the sensitivity and specificity are 93.8% and 81.3%, while CDT achieved 100% sensitivity and specificity. Conclusion: CDT has a better sensitivity and specificity on detecting cognitive dysfunction in Mild and Moderate TBI.

Pengelolaan Central Diabetes Insipidus Pasca Cedera Kepala Berat Fithrah, Bona Akhmad; Rasman, Marsudi; Saleh, Siti Chasnak
Jurnal Neuroanestesi Indonesia Vol 8, No 2 (2019)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Cedera otak traumatika adalah salah satu penyebab kematian dan kesakitan tersering pada kelompok masyarakat muda. Hasil akhir dari cedera kepala berat dapat menyebabkan gangguan kognitif, perilaku, psikologi dan sosial. Salah satu konsekuensi dari cedera kepala berat adalah terjadinya disfungsi hormonal baik dari hipofise anterior maupun posterior. Angka kejadian disfungsi hormonal ini sekitar 20-50%. Salah satu yang paling menantang dan sering terjadi adalah diabetes insipidus (DI) dan Syndrome inappropriate antidiuretic hormone (SIADH). Angka kejadian diabetes insipidus pasca cedera kepala diduga sebesar 1-2,9% dengan berbagai tingkatannya. Pada beberapa kasus bersifat sementara tapi beberapa kasus terjadi bersifat menetap. Pada laporan kasus ini akan dibawakan sebuah kasus diabetes insipidus pasca cedera kepala berat. Pasien mengalami cedera kepala berat, hingga dilakukan decompressive craniectomi dan trakeostomi. Untuk perawatan lanjutan pasien dirujuk ke Jakarta. Saat menjalani terapi lanjutan ini pasien terdiagnosis diabetes insipidus Pada kasus ini diabetes insipidus tidak timbul langsung setelah cedera kepala tetapi baru timbul lebih kurang satu bulan setelah cedera kepala. Diabetes insipidus dikelola dengan menggunakan desmopressin spray dan oral disamping mengganti cairan yang hilang. Pada kasus ini desmopressin sempat di stop sebelum akhirnya diberikan terus menerus dan pasien diterapi sebagai diabetes insipidus yang menetap.Managing Central Diabetes Insipidus in Post Severe Head Injury PatientAbstractTraumatic brain injury is the cause of mortality and morbidity in society mostly in male-young generation. The last outcome of traumatic brain injury might be deficit in cognitive, behavioral, psychological and social. the consequences of traumatic brain injury might be hormonal disfunction from anterior and posterior pituitary. The incidence around 20-50%. The most challenging problem is diabetes insipidus (DI) and syndrome of inappropriate antidiuretic hormone (SIADH). The incident of post traumatic diabetes insipidus around 1-2,9% with several degree. In certain case its only occurred transiently but some report it could be permanent. In this case report will find one case post traumatic diabetes insipidus. This pasien had severe traumatic brain injury and underwent decompressive craniectomy and tracheostomy. For further therapy patient was referred to Jakarta. In this further treatment patient diagnosed with diabetes insipidus. Diabetes insipidus doesnt occurred since the first day of injury but occurred almost one month after. Diabetes insipidus managed with desmopressin spray and oral beside replace water loss. For a few days desmopressin stop but diabetes insipidus occurred again so desmopressin given daily both spray and oral and the patient had therapy as diabetes insipidus permanent.

Hubungan Parameter Koagulasi dengan Tipe, Ukuran, dan Jumlah Perdarahan pada Operasi Tumor Otak Supratentorial Sugiyanto, Endy; Bisri, Dewi Yulianti
Jurnal Neuroanestesi Indonesia Vol 8, No 2 (2019)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Latar Belakang dan Tujuan: Tumor otak memiliki angka kejadian 3,8-5,5% dari semua kasus tumor di Indonesia. Kebanyakan kasus tumor otak mengalami hiperkoagulasi, meskipun terdapat pengecualian pada beberapa kasus. Tujuan penelitian untuk mengetahui hubungan koagulopati dengan tipe, ukuran, dan jumlah perdarahan pada operasi tumor otak supratentorialSubyek dan Metode: Penelitian observasional analitik pada 30 pasien dengan rancangan cross-sectional pengukuran berulang untuk menganalisis hubungan antara koagulopati dengan tipe, ukuran, dan perdarahan tumor otak. Pengambilan sampel penelitian dilakukan secara consecutive samplingHasil: Terdapat 17 orang pasien dengan meningioma, 2 orang pasien dengan oligodendroglioma, 3 orang pasien dengan metastase dan 8 orang dengan tumor lain. Rata-rata bleeding time, clotting time, protrombin time (PT), dan activated partial thromboplastin time (APTT) preoperatif, 2 jam dan 6 jam post operatif berada dalam rentang nilai normal. Ditemukan penurunan yang konstan pada data APTT. Terdapat hubungan negatif yang signifikan antara ukuran tumor dengan bleeding time preoperatif serta hubungan yang signifikan antara jumlah pendarahan dengan APTT preoperatif.Simpulan: Pasien tumor otak mungkin mengalami kondisi hiperkoagulasi dari hasil pemeriksaan faktor koagulasi sederhana, terdapat hubungan negatif antara ukuran tumor dan bleeding time sehingga semakin besar ukuran tumor semakin besar juga risiko hiperkoagulasi yang mungkin dialami pasien.Correlation between Coagulation Parameter and Type, Size, and Blood Loss in Supratentorial Brain Tumor SurgeryAbstractBackground and Objective: The incidence rate of brain tumor 3.8-5.5% of all tumor cases in Indonesia. Most of brain tumor patients experience hypercoagulation, although there are exception in some cases. The purpose of this study to know the relationship between coagulopathy and brain tumor supratentorial type, size, and number of bleeding on operation.Subject and Methods: This is an observational analytical cross-sectional design for 30 patient to analyze correlation between coagulopathy and brain tumor type, size, and bleeding. The sampling methods were consecutive samplingResult: There were 17 patients with meningioma, 2 patients with oligodendroglioma, 3 patients with metastasis and 8 patients with other type of tumor. The average of bleeding time, clotting time, protrombin time (PT), dan activated partial thromboplastin time (APTT) in preoperative, 2 hours and 6 hours were normal. There were constant decline of APTT. Negative correlation between tumor size and preoperative bleeding time and significant correlation between amount of bleeding and preoperative APTT were also found.Conclusion: From simple coagulation factor test result, it is very like for a brain tumor patient to experience hypercoagulative state, a negative correlation between tumor size and bleeding time, meaning the bigger the tumor size, the higer hypercoagulation risk possesed by the patient.

Defisit Neurologis Iskemik Tertunda pada Perdarahan Subaraknoid akibat Rupture Aneurisma yang dilakukan Tindakan Coiling Rahmatisa, Dimas; Prihatno, MM Rudi
Jurnal Neuroanestesi Indonesia Vol 8, No 2 (2019)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Stroke dapat terjadi akibat terhentinya aliran darah ke otak, yang terjadi secara mendadak. Penyebab terbanyak stroke adalah berkurangnya pasokan darah ke otak (stroke iskemik). Penyebab stroke lainnya adalah perdarahan (stroke hemoragik). Perdarahan subaraknoid (SAH) biasanya dapat terjadi baik karena ruptur aneurisma, atau karena trauma. Perempuan, 46 tahun dengan GCS 14 (E4M6V4) dengan hipertensi tidak terkontrol mengalami nyeri kepala hebat. Dari pemeriksaan CT scan memperlihatkan adanya perdarahan subaraknoid dan edema sereberi. Pasien ini dilakukan tindakan coiling aneurisma cito dengan anestesia umum. Pasca coiling pasien dirawat di ruang intensive care unit (ICU). Pasca perawatan 1 hari di ICU, pasien dipindahkan ke ruang high care unit (HCU), dengan kondisi stabil. Penurunan kesadaran mulai terjadi saat perawatan hari kedua, sempat dilakukan pemasangan lumbar drain pada hari ketiga, untuk membantu mengurangi hidrosefalus dan juga menurunkan tekanan intra kranial. Pada perawatan hari ketigabelas kesadaran menurun drastis menjadi E1M1V1, pasien dipindahkan ke ruang ICU, dan meninggal esok harinya. Penurunan kesadaran pasca coiling diakibatkan oleh peningkatan tekanan intra kranial, yang pada kasus ini disebabkan oleh edema sereberi luas. Early Brain Injury ditambah dengan adanya vasopasme menyebabkan terjadinya delayed ischemic neurological deficit. Terapi yang sudah dikerjakan baik farmakologis maupun non farmakologis, tetap tidak bisa memperbaiki keadaan pasien.Delayed Ischemic Neurological Defisit (DIND) Pasca Coiling Subarachnoid Hemorrhage (SAH) e.c Ruptur AneurismaAbstractStroke can occur due to the cessation of blood flow to the brain, which occurs suddenly. The most common cause of stroke is reduced blood supply to the brain (ischemic stroke). Another cause of stroke is bleeding in the brain (hemorrhagic stroke). Subarachnoid hemorrhage (SAH) usually results from ruptured aneurysms or because of trauma. Women, 46 years old with GCS 14 (E4M6V4) with uncontrolled hypertension experienced severe headache since 2 days before admitted to the hospital. The CT scan examination showed subarachnoid hemorrhage and edema of the brain. This patient then performed emergency coiling of aneurysm with general anesthesia. During the procedure the patient is in stable condition. Post coiling the patient was sent to the ICU room. After 1 day in ICU, the patient was transferred to high care unit (HCU) room, with stable condition. Decreased of consciousness began to occur during the second day of treatment, had done lumbar drain installation on the third day, to help reduce the hydrocephalus and also improve intra-cranial pressure. On the thirteenth day care GCS was decrease suddenly to E1M1V1, the patient was transferred to the ICU room, the next day the patient was declared dead. The decrease of consciousness post coiling results from an increase in intra-cranial pressure, which in this case is due to severe brain edema. Earlu brain injury along with the occurence of vasospasm lead to delayed ischemic neurological deficit. Pharmacological and non-pharmacological therapy had been given to the patient still couldnt improve the patient condition

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