Cadasıl Hastası Olan Olguda Anestezi Yönetimi

Yazarlar

Gamze Küçükosman
Adile Maşalacı

Özet

CADASIL, kalıtsal nedenlerle serebral damarların duvarlarının genişlemesi ve beyne giden kan akışının azalması neticesinde ortaya çıkan kalıtsal bir serebrovasküler hastalıktır. Cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy teriminin kısaltması olan CADASIL hastalığına genlerde meydana gelen bir mutasyon sebep olur (1). Bu hastalıkta serebral otoregülasyon ve serebral kan akımı etkilenmektedir ve anestezi açıdan bazı sıkıntılarla karşılaşılabilmektedir. Sunumumuzda, CADASIL hastası olan olgudaki anestezi deneyimimizi sunmayı amaçladık.

Referanslar

Yamamoto Y., Liao YC, Lee YC, Ihara M., Choi JC Subkortikal enfarktlar ve lökoensefalopati ile serebral otozomal dominant arteriyopatinin epidemiyolojisi, patogenezi ve biyobelirteçleri hakkında güncelleme. J Clin Neurol. 2023;19:12–27. doi: 10.3988/jcn.2023.19.1.12.

Navuluri R, Hoyer M, Osman M, Fergus J. Akut Kolanjit ve Akut Kolesistitin Acil Tedavisi. Semin Intervent Radiol. 2020 Mar;37(1):14-23. doi:10.1055/s-0039-3402016. PMID: 32199696; PMCID: PMC7056346.

Gomi H, Takada T, Hwang TL ve diğerleri. Akut kolanjitli hastalarda kapsamlı epidemiyoloji, mikrobiyoloji ve sonuçların güncellenmesi. J Hepatobiliary Pancreat Sci. 2017;24(06):310–318. doi: 10.1002/jhbp.452.

Ahmed M. Akut kolanjit - bir güncelleme. World J Gastrointest Pathophysiol. 2018 Feb 15;9(1):1-7. doi:10.4291/wjgp.v9.i1.1. PMID: 29487761; PMCID: PMC5823698.

Kinney TP. Management of ascending cholangitis. Gastrointest Endosc Clin N Am. 2007 Apr;17(2):289-306, vi.

Virgile J, Marathi R. Cholangitis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan. PMID: 32644372; Bookshelf ID: NBK558946.

Yokoe M, Hata J, Takada T, ve ark. Tokyo Guidelines 2018 (TG18): diagnostic criteria and severity grading of acute cholangitis. J Hepato¬biliary Pancreat Sci. 2018 Jan;25(1):17–30. doi:10.1002/jhbp.512. PMID: 29032610.

Scott TM, Rosh AJ. Acute cholangitis treatment & management. Medscape [Internet]. 2023 Jul 10 [cited 2025 Jul 11]. Available from: https://emedicine.medscape.com/article/774245-treatment

Buyukasik K, Toros AB, Bektas H, Ari A, Deniz MM. Diagnostic and therapeutic value of ERCP in acute cholangitis. ISRN Gastroenterol. 2013;2013:191729.

Iqbal U, Khara HS, Hu Y, Khan MA, Ovalle A, Siddique O, Sun H, Shellenberger MJ. Emergent versus urgent ERCP in acute cholangitis: a systematic review and meta-analysis. Gastrointest Endosc. 2020 Apr;91(4):753-760.e4.

Van Erpecum KJ. Gallstone disease. Complications of bile-duct stones: Acute cholangitis and pancreatitis. Best Pract Res Clin Gastroenterol. 2006;20(6):1139-52.

ASGE Standards of Practice Committee, Buxbaum JL, Abbas Fehmi SM, Sultan S, Fishman DS, Qumseya BJ, et al. ASGE guideline on the role of endoscopy in the evaluation and management of choledocholithiasis. Gastrointest Endosc. 2021 Aug;94(2):207–21. doi:10.1016/j.gie.2021.04.003.

Akut kolesistitte açık ve laparoskopik kolesistektomi. Sistematik inceleme ve meta-analiz. Coccolini F, Catena F, Pisano M, ve diğerleri. Int J Surg. 2015;18:196–204. doi: 10.1016/j.ijsu.2015.04.083.

Patil M Jr, Gharde P, Reddy K, Nayak K. Belirli Genel Cerrahi Girişimlerinde Laparoskopik ve Açık Prosedürlerin Karşılaştırmalı Analizi. Cureus. 2024 Feb 19;16(2):e54433. doi: 10.7759/cureus.54433. PMID: 38510915; PMCID: PMC10951803.

Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s Clinical Anesthesiology. 7th ed. New York: McGraw-Hill; 2022.

Miller RD, Cohen NH, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Young WL. Miller’s Anesthesia. 9th ed. Philadelphia: Elsevier; 2020.

Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC. Clinical Anesthesia. 8th ed. Wolters Kluwer; 2017.

Juhász M, Molnár L, Fülesdi B, ve diğerleri. Sevofluranın sistemik ve serebral dolaşım, serebral otoregülasyon ve CO(2) reaktivitesi üzerindeki etkisi. BMC Anesthesiol 2019; 19: 109–20190619.

Hu Y, Ye C, Cheng S, et al. Propofol downregulates lncRNA MALAT1 to alleviate cerebral ischemia-reperfusion injury. Inflammation 2021; 44: 2580–2591.

Miller AL, Theodore D, Widrich J. İnhalasyon Anestezisi. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 May 1 [cited 2025 Jul 11].

Matta BF, Lam AM. The influence of anesthetics on cerebral blood flow and metabolism. Curr Opin Anaesthesiol. 2000;13(4):477-481.

Pantoni L. Cerebral small vessel disease: From pathogenesis and clinical characteristics to therapeutic challenges. Lancet Neurol 2010; 9(7): 689–701.

Tan RYY, Traylor M, Megy K, et al. NIHR BioResource: Rare Diseases Consortium. How common are single gene mutations as a cause for lacunar stroke? A targeted gene panel study. Neurology 2019; 93(22): e2007–e2020.

Joutel A, Corpechot C, Ducros A, et al. Notch3 mutations in CADASIL, a hereditary adult-onset condition causing stroke and dementia. Nature 1996; 383(6602): 707-710.

Joutel A, Andreux F, Gaulis S, et al. The ectodomain of the Notch3 receptor accumulates within the cerebrovasculature of CADASIL patients. J Clin Invest 2000; 105(5): 597-605.

Baudrimont M, Dubas F, Joutel A, et al. Autosomal dominant leukoencephalopathy and subcortical ischemic stroke. A clinicopathological study. Stroke 1993; 24(1): 122–125.

Rumbaugh JA, LaDuca JR, Shan Y, et al. CADASIL: the dermatologic diagnosis of a neurologic disease. J Am Acad Dermatol 2000; 43: 1128±30

Dziewulska D, Lewandowska E. Pericytes as a new target for pathological processes in CADASIL. Neuropathology 2012; 32(5): 515–521.

Tikka S, Baumann M, Siitonen M, et al. CADASIL and CARASIL. Brain Pathol 2014; 24(5): 525-544.

Dieu JH, Veyckemans F. Perioperative management of a CADASIL type arteriopathy patient. Br J Anaesth. 2003;91(3):442–444. doi:10.1093/bja/aeg182.

Preoperative Management of Medications for Neurologic Diseases. Mayo Clin Proc. 2022;97(5):958–968.

Meschia JF, Worrall BB, Elahi FM, et al. Management of inherited CNS small vessel diseases: The CADASIL example: A scientific statement from the American Heart Association. Stroke. 2021;52(6):e295–e308. doi:10.1161/STR.0000000000000444.

Auer DP, Putz B, Gossl C, et al. Differential lesion patterns in CADASIL and sporadic subcortical arteriosclerotic encephalopathy: MR imaging study with statistical parametric group comparison. Radiology 2001; 218(2): 443–451.

Reyes S, Viswanathan A, Godin O, et al. Apathy: a major symptom in CADASIL. Neurology 2009; 72(10): 905–910.

35)Shindo A, Tabei KI, Taniguchi A, et al. A nationwide survey and multicenter registry-based database of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy in Japan. Front Aging Neurosci 2020; 12: 216.

Muppa J, Yaghi S, Goldstein ED. Antiplatelet use and CADASIL: A retrospective observational analysis. Neurol Sci 2023; 44(8): 2831-2834

Marik PE. Aspiration pneumonitis and aspiration pneumonia. N Engl J Med. 2001 Jan 18;344(9):665-71.

Aminoff MJ, Greenberg DA, Simon RP. Clinical Neurology. 9th ed. New York: McGraw-Hill Education; 2015. p. 458-462.

Metlay JP, Waterer GW, Long AC, Anzueto A, Brozek J, Crothers K, Cooley LA, Dean NC, Fine MJ, Flanders SA, Griffin MR, Metersky ML, Musher DM, Restrepo MI, Whitney CG. Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019 Oct 01;200(7):e45-e67.

Komiya K, Rubin BK, Kadota JI, Mukae H, Akaba T, Moro H, Aoki N, Tsukada H, Noguchi S, Shime N, Takahashi O, Kohno S. Prognostic implications of aspiration pneumonia in patients with community acquired pneumonia: A systematic review with meta-analysis. Sci Rep. 2016 Dec 07;6:38097.

Gupte T, Knack A, Cramer JD. Aspirasyon Pnömonisinden Ölüm: Olay, Eğilimler ve Risk Faktörleri. Disfaji. 2022 Aralık; 37 (6):1493-150

Chabriat H, Lesnik Oberstein S. Cognition, mood and behavior in CADASIL. Cereb Circ Cogn Behav 2022; 3: 100043

Dichgans M, Markus HS, Salloway S, et al. Donepezil in patients with subcortical vascular cognitive impairment: a randomised double-blind trial in CADASIL. Lancet Neurol 2008; 7(4): 310–318.

Chabriat H, Joutel A, Dichgans M, Tournier-Lasserve E, Bousser MG. CADASIL. Lancet Neurol. 2009;8(7):643-653.

Servito T, Gill I, Durbin J, El Diasty M. Management of coronary artery disease in CADASIL patients: review of current literature. Medicina. 2023;59(3):586.

Rubin CB, Hahn V., Kobayashi T., Litwack A. Subkortikal Enfarktüsler ve Lökoensefalopati ile Serebral Otozomal Dominant Arteriopati ile İlişkili Hızlandırılmış Koroner Arter Hastalığı Raporu. Vaka Rep. Cardiol. 2015;2015:167513.

Tsanaxidis N., Elshafie S., Munir S. Subkortikal enfarktlar ve lökoensefalopatisendromu olan serebral otozomal dominant arteriyopatili bir hastada spontan koroner arter diseksiyonu: Bir olgu sunumu. Eur. Heart J.-Case Rep. 2019;3:ytz136. doi:10.1093/ehjcr/ytz136.

Tikka S, Jokinen S, Paetau A, et al. CADASIL and anesthesia: case reports and review of the literature. J Neurol Sci. 2014 Sep 15;344(1-2):229-32. doi:10.1016/j.jns.2014.06.016.

Logvinova AV, Litt L, Young WL, Lee CZ. Anesthetic concerns in patients with cerebrovascular insufficiency. Anesthesiol Clin. 2010;28(1):1–12.

Hemphill JC 3rd, Muralidharan R, Rao VK. Neurologic considerations in anesthesia. Continuum (Minneap Minn). 2017 Aug;23(4):1039-1059.

Hudetz AG. Suppression of brain metabolism by volatile anesthetics: Effects on cerebral blood flow and metabolism. Curr Opin Anaesthesiol. 2012;25(4):406-413.

Mashour GA. Neuroanesthesia and cognitive outcomes: a review of clinical and preclinical studies. J Neurosurg Anesthesiol. 2013;25(4):367–375.

Logvinova AV, Litt L, Young WL, Lee CZ. Anesthetic considerations for patients with cerebrovascular insufficiency. Anesthesiol Clin. 2010;28(1):1–12.

Kenny GN, Hughes D, Shafer SL, Brown EN. Substance Specific Differences in Human Electroencephalographic Burst Suppression Patterns During Anesthesia: Sevoflurane, Isoflurane, and Propofol. Front Hum Neurosci. 2018;12:368.

Chao JY, Tam M, Ferrera A, Ivenitsky D, Gizzo L, Schwartz R, Legatt AD, Yozawitz EG, Lo Y, Li G, Shinnar S. Epileptiform discharges, electrographic seizures, and electroclinical seizures during paediatric sevoflurane anaesthesia: a systematic review and proposal for standard definitions. Br J Anaesth. 2023;130(1):e18–e21.

Errando CL, Navarro L, Vila M, Pallardó MA. Anesthetic management of a patient diagnosed with CADASIL (cerebral arteriopathy, autosomal dominant, with subcortical infarcts and leukoencephalopathy). Rev Esp Anestesiol Reanim. 2012;59(2):102–106. doi:10.1016/j.redar.2012.02.021

Poterman M, Kalmar AF, Buisman PL, Struys MMRF, Scheeren TWL. Improved haemodynamic stability and cerebral tissue oxygenation after induction of anaesthesia with sufentanil compared to remifentanil: a randomised controlled trial. BMC Anesthesiol. 2020;20:258

Burnol L, Payen JF, Francony G, Skarica K, Manet R, Morel J, Bosson JL, Gergele L. Impact of head-of-bed posture on brain oxygenation in patients with acute brain injury: a prospective cohort study. Neurocrit Care. 2021 Jul;35(3):662–8. doi:10.1007/s12028-021-01240-1. PMID: 34317289.

Murkin JM, Arango M. Near-infrared spectroscopy as an index of brain and tissue oxygenation. Br J Anaesth. 2009;103 Suppl 1:i3–13.

Singhal S, Rich P, Topol EJ. Microvascular function in CADASIL and other small vessel diseases. Circulation. 2005;112(17):2569–75.

Domingues RC, et al. Cerebral blood flow regulation in CADASIL patients. Stroke. 2006;37(2):407–10.

Parati EA, et al. CADASIL: mechanisms of brain damage and therapeutic perspectives. Curr Med Chem. 2007;14(6):661–76.

Dichgans M, Mayer M, Uttner I, et al. The phenotypic spectrum of CADASIL: clinical findings in 102 cases. Ann Neurol. 1998;44(5):731–9.

Pescini F, et al. CADASIL: a model of pure vascular dementia. J Alzheimers Dis. 2009;17(4):889–98.

Kim S, Lee KS, Song IU, et al. Causes of death in CADASIL patients: a retrospective cohort study. Eur Neurol. 2021;84(5):326–30.

Jung KH, Chu K, Roh JK. Clinical progression in CADASIL. Stroke. 2010;41(3):618–23.

Di Donato I, Bianchi S, De Stefano N, et al. Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL): current understanding and proposed diagnostic criteria. J Alzheimers Dis. 2017;59(4):1289–1302.

Yayınlanan

15 Aralık 2025

Lisans

Lisans