Akut iskemik inme kliniği ile başvuran glioblastome multiforme olgusu
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Tarih
2023
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
T.C.Maltepe Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Yaklaşık 3 saat önce başlayan bilinç bulanıklığına ek olarak sağ kol ve bacakta güçsüzlük nedeni ile dış merkez acil servise başvuran 82 yaşında kadın hastanın nörolojik muayenesi sonrası yapılan kraniyal bilgisayarlı tomografi (BT) incelemesinde intrakranial hemoraji saptanmaması üzerine hastaya acil serviste intravenöz trombolitik tedavi uygulanmıştır. Eş zamanlı çekilen kraniyal ve servikal BT anjiyografi incelemesinde ise büyük damar oklüzyonu saptanmamıştır. On iki saat içinde nörolojik muayenesi düzelen hasta, 3 gün nöroloji serviste yatışında kontrol kraniyal manyetik rezonans görüntüleme (MRG) yapılmış, ek patolojik bulgu saptanmamış ve asetilsalisilik asit 100 mg/gün şeklinde tedavisi düzenlenerek taburcu edilmiştir. Olaydan 3 ay sonra nörolojik muayene kontrolü yapılmak üzere tarafımıza başvuran hastanın değerlendirmesi sonrası yapılan kraniyal MRG tetkikinde sol frontal alanda boyutları yaklaşık olarak 42x24x41mm ölçülen, ödem etkisi oluşturan ön planda kitle lehine lezyon gözlenmiştir. Bunun üzerine hastaya kontrastlı kraniyal MRG yapıldığında tariflenen alanda yoğun kontrast tutulumu gözlenmiştir. Nöroşirurji konsültasyonu sonucu ön planda glioblastome multiforme düşünülerek acil operasyon planlanmış olan hastaya deksametazon 8 mg/gün ve levetirasetam 1000 mg/gün başlanmıştır. Hastaya 3 ay önce, yapılan kraniyal MRG tetkiki incelendiğinde aslında T2 Flair manyetik rezonans görüntülemede sol frontal alanda şüpheli hiperintensite göze çarpmış olup hastanın iskemik inme olarak değerlendirilen kliniğinin aslında epileptik nöbete bağlı hemipleji olabileceği düşünülmüştür. Bu olgunun tarafımızca sunulmasının amacı özellikle epileptik nöbet sırasında gelişen motor defisitlerin akut iskemik inme kliniği ile karışabileceği; bu sebeple de ayırıcı tamda mutlaka epileptik nöbetlerin dışlanması gerekliliğidir.
An 82-year-old female patient who applied to the emergency department of the outer center with the complaints of confusion and weakness in the right arm and leg that started approximately 3 hours ago. After the neurological examination, cranial computed tomography (CT) was taken and no intracranial hemorrhage was detected. Intravenous thrombolytic therapy was administered to the patient in the emergency department. No large vessel occlusion was detected in the simultaneous cranial and cervical CT angiography examination. The patient's neurological examination improved within 12 hours, control cranial magnetic resonance imaging (MRI) was performed during her hospitalization in the neurology service for 3 days, and no additional pathological finding was detected. Acetylsalicylic acid 100 mg / day treatment was arranged and she was discharged. In the cranial MRI examination performed after the evaluation of the patient who applied to us for a neurological examination 3 months after the event, a lesion in the left frontal area, measuring approximately 42x24x41mm, was observed in favor of a mass in the foreground with the effect of edema. When the patient underwent contrast-enhanced cranial magnetic resonance imaging, intense contrast enhancement was observed in the described area. As a result of neurosurgery consultation, an emergency operation was planned considering glioblastoma multiforme in the foreground. The patient was started on dexamethasone 8 mg/day and levetiracetam 1000 mg/day.When the cranial MRI examination performed 3 months ago was examined, in fact, suspicious hyperintensity in the left frontal area was observed in T2 Flair MRI. It was thought that the clinic of the patient, which was evaluated as ischemic stroke, might actually be hemiplegia due to epileptic seizure.The purpose of presenting this case is that motor deficits developed during epileptic seizures may be confused with acute ischemic stroke clinic; Therefore, it is necessary to exclude epileptic seizures in the differential diagnosis.
An 82-year-old female patient who applied to the emergency department of the outer center with the complaints of confusion and weakness in the right arm and leg that started approximately 3 hours ago. After the neurological examination, cranial computed tomography (CT) was taken and no intracranial hemorrhage was detected. Intravenous thrombolytic therapy was administered to the patient in the emergency department. No large vessel occlusion was detected in the simultaneous cranial and cervical CT angiography examination. The patient's neurological examination improved within 12 hours, control cranial magnetic resonance imaging (MRI) was performed during her hospitalization in the neurology service for 3 days, and no additional pathological finding was detected. Acetylsalicylic acid 100 mg / day treatment was arranged and she was discharged. In the cranial MRI examination performed after the evaluation of the patient who applied to us for a neurological examination 3 months after the event, a lesion in the left frontal area, measuring approximately 42x24x41mm, was observed in favor of a mass in the foreground with the effect of edema. When the patient underwent contrast-enhanced cranial magnetic resonance imaging, intense contrast enhancement was observed in the described area. As a result of neurosurgery consultation, an emergency operation was planned considering glioblastoma multiforme in the foreground. The patient was started on dexamethasone 8 mg/day and levetiracetam 1000 mg/day.When the cranial MRI examination performed 3 months ago was examined, in fact, suspicious hyperintensity in the left frontal area was observed in T2 Flair MRI. It was thought that the clinic of the patient, which was evaluated as ischemic stroke, might actually be hemiplegia due to epileptic seizure.The purpose of presenting this case is that motor deficits developed during epileptic seizures may be confused with acute ischemic stroke clinic; Therefore, it is necessary to exclude epileptic seizures in the differential diagnosis.
Açıklama
Anahtar Kelimeler
Akut iskemik inme, Alteplaz, Glioblastome multiforme, Acute ischemic stroke, Alteplase, Glioblastoma multiforme
Kaynak
EMOS III. Maltepe acil günleri sempozyumu / Acil toksikoloji günleri - Bildiriler / EMOS III. Emergency Medicine Online Symposium / Emergency Toxicology Days
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Yakupoğlu, E., Kendirli A. S., Bolu, N. E., Florentina Ateş, M. ve Çınar, N. (2023). Akut iskemik inme kliniği ile başvuran glioblastome multiforme olgusu, Akgün, Feride Sinem, (ed.). EMOS III. Maltepe acil günleri sempozyumu / Acil toksikoloji günleri - Bildiriler / EMOS III. Emergency Medicine Online Symposium / Emergency Toxicology Days; İstanbul: T.C.Maltepe Üniversitesi. s.87-91.
