İskemik Serebrovasküler Hastalık ve İntraserebral Kanama Olgusunda Yoğun Bakım Yönetimi
Özet
55 yaşında erkek hasta; sol kol ve bacakta kuvvet kaybı şikayetiyle acil servise getirilmiş. Glasgow Koma Skoru (GKS):12 (Göz:3 Motor:6 Sözel:3), bilinci açık, kısmi koopere, dizartrik, kas gücü sol üstte ve altta 1/5, Babinsky -/+. Bilgisayarlı Tomografi (BT) Anjio’da sağ internal karotid arter (İCA) oklüzyonu görüldü ve anjio ile sağ İCA’ya balon anjioplasti ve stent; sol İCA ve orta serebral arter (MCA) oklüzyonuna mekanik trombektomi uygulandı. Yoğun bakım ünitesinde (YBÜ) takip edilen hastanın işlem sonrası 12. saatte GKS:13’e (G:4, M:6, S:3) geriledi; kontrol beyin BT’de hemorajik transformasyon, sağ MCA alanında ödem ve orta hatta sola itilme izlendi. Dekompresyon cerrahisi uygulandı. Postoperatif dördüncü saatte ekstübe edildi, GKS:15, koopere, oryante idi. Mannitol %20 4X100 mL İV infüzyon tedavisi başlandı. YBÜ takibinin dördüncü gününde Enoksaparin sodyum 60 mg 1X0,6 mL Subkutan ve Klopidogrel 75 mg tablet 1X1 Peroral tedavisine eklendi. Postoperatif 4. günde kas gücü sol üstte 3/5, sol altta 4/5 olan hasta fizyoterapi programına dahil edildi. YBÜ’de takibinin 11. gününde bilinç açık, oryante, koopere, oda havasında spontan soluyan, fizyoterapi programı devam eden hasta nöroloji servisine devredildi.
55-year-old male patient was brought to the emergency room complaining of loss of strength in his left arm and leg. Glasgow Coma Score (GCS):12 (Eye:3 Motor:6 Verbal:3), conscious, partially cooperative, dysarthric, muscle strength 1/5 in the upper and lower left, Babinsky -/+. Computerized Tomography (CT) Angiography revealed right internal carotid artery (ICA) occlusion, and angiography performed balloon angioplasty and stent to the right ICA; mechanical thrombectomy was performed for left ICA and middle cerebral artery (MCA) occlusion. The GCS of the patient, who was followed up in the intensive care unit (ICU), decreased to 13 (E:4, M:6, V:3) at the 12th hour after the procedure; control brain CT showed hemorrhagic transformation, edema in the right MCA area, and a shift to the left in the midline. Decompression surgery was performed. He was extubated at the fourth postoperative hour, GCS:15, cooperative and oriented. Mannitol 20% 4X100 mL IV infusion treatment was started. On the fourth day of ICU follow-up, Enoxaparin sodium 60 mg 1X0.6 mL Subcutaneous and Clopidogrel 75 mg tablet 1X1 Peroral were added to the treatment. On the 4th postoperative day, the patient, whose muscle strength was 3/5 in the upper left and 4/5 in the lower left, was included in the physiotherapy program. On the 11th day of his follow-up in the ICU, the patient, who was conscious, oriented, cooperative, breathing spontaneously on room air, and whose physiotherapy program was continuing, was transferred to the neurology service.
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