뇌동맥류 조기 재출혈을 보인 환자에서 수술 전 두개내압 감소로 인한 국소 신경학적 손상 역전
Reversal of Focal Neurologic Deficit due to Preoperative Intracranial Pressure Reduction in a Patient with Early Rebleeding of Cerebral Aneurysm
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In the first hours after initial hemorrhage, up to 15% of patients with subarachnoid hemorrhage (SAH) due to aneurysmal rupture may have a sudden episode of clinical deterioration resulting from rebleeding. In patients suffering from an aneurismal rebleeding, the prognosis becomes much poor. Early detection of rebleeding and preoperatively appropriate medical treatment for increased intracranial pressure (IICP) might be crucial to decrease the overall mortality and morbidity rate in a patient with aneurismal rebleeding. We report a case of a successful reversal of focal neurological deficit showed in a patient with abrupt rebleeding of ruptured aneurysm whose intracranial pressure was preoperatively reduced with hyperventilation, and thiopental and mannitol administration under general anesthesia in angiography suite, although the patient ended up in death due to postoperative IICP.
Abstract
In the first hours after initial hemorrhage, up to 15% of patients with subarachnoid hemorrhage (SAH) due to aneurysmal rupture may have a sudden episode of clinical deterioration resulting from rebleeding. In patients suffering from an aneurismal rebleeding, the prognosis becomes much poor. Early detection of rebleeding and preoperatively appropriate medical treatment for increased intracranial pressure (IICP) might be crucial to decrease the overall mortality and morbidity rate in a patient with aneurismal rebleeding. We report a case of a successful reversal of focal neurological deficit showed in a patient with abrupt rebleeding of ruptured aneurysm whose intracranial pressure was preoperatively reduced with hyperventilation, and thiopental and mannitol administration under general anesthesia in angiography suite, although the patient ended up in death due to postoperative IICP.
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