İntrakranyal hipotansiyon olgusunda epidural kan yaması tedavisi sonrası gelişen serebral venöz infarkt
Küçük Resim Yok
Tarih
2014
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Maltepe Üniversitesi
Erişim Hakkı
Attribution-NonCommercial-NoDerivs 3.0 United States
info:eu-repo/semantics/openAccess
info:eu-repo/semantics/openAccess
Özet
Amaç: Epidural kan yaması tedavisi, intrakranyal hipotansiyon olgularında çeşitli nörolojik komplikasyonlara neden olabilir. Burada nadir bir komplikasyon olarak serebral venöz tromboz olgusu tanımlanmıştır. Olgu Sunumu: Kırk altı yaşındaki kadın hastaya L4 seviyesinde disk hernisine yönelik laminektomi yapıldı. Operasyondan on beş gün sonra, ağrısı devam eden hastanın lomber L4 kök bölgesine lokal anestezik ve kortikosteroid enjeksiyonu yapıldı. İşlemden sonra şiddetli ortostatik baş ağrısı gelişen hastaya, beyin omurilik sıvısı kaçağına bağlı intrakranyal hipotansiyon tanısı konulmuşdu. Konservatif tedaviden yarar görmeyen hastaya 5cc venöz kan ile epidural kan yaması yapıldı. İşlemden 2 gün sonra hastada şuur bozukluğu ve epileptik nöbetler başladı. Beyin MRG incelemesinde bilateral frontal bölgelerde venöz infarktla uyumlu görünüm saptandı. MR venografi incelemesinde sagittal venöz sinüsün tromboze olduğu görüldü. Koagülasyon testleri normal sınırlarda bulundu. Antikoagülan ve anti-ödem tedavi verildi. Hastanın nörolojik bulguları bir ay sonra tama yakın düzeldi. Tartışma: Lomber disk cerrahisini takiben gelişen intrakranyal hipotansiyon ve epidural kan yaması tedavisi sonrası gelişen serebral venöz infarkt literatürde ilk kez tarafımızca rapor edilmektedir. Bu ciddi komplikasyon, olguların takibinde göz önünde bulundurulmalıdır.
Aim: Intracranial hypotension and epidural blood patch treatment for cerebrospinal fluid leakage can cause a variety of neurological complications. Herein, we aimed to describe a case of cerebral venous thrombosis as a rare complication. Case Report: Forty-six year old female underwent open laminectomy at L4 level for disc herniation. After surgery, local anesthetic and corticosteroid injection was done for persistent back and extremity pain. After the procedure, severe orthostatic headache was developed. Despite brain magnetic resonance imaging (MRI) was found in normal limits, the diagnosis of intracranial hypotension was established with the clinical findings. Epidural blood patch application with 5cc venous blood was done for peristant headache which made her headache free. Two days after the procedure, she became unconcious and started having epileptic seizures. Brain MRI showed ischemia in bilateral frontal regions. MR venography showed total occlusion at sagittal superior venous sinus. Coagulation tests were found within normal limits. Anticoagulant and anti-oedematous medications was started. Her neurological findings were resolved at the end of first month. Conclusion: We report here the first case of cerebral venous infarction caused by intracranial hypotension and epidural blood patch treatment after lumbar disc surgery. This serious complication should be considered in patients with intracranial hypotention who require epidural blood patch treatment
Aim: Intracranial hypotension and epidural blood patch treatment for cerebrospinal fluid leakage can cause a variety of neurological complications. Herein, we aimed to describe a case of cerebral venous thrombosis as a rare complication. Case Report: Forty-six year old female underwent open laminectomy at L4 level for disc herniation. After surgery, local anesthetic and corticosteroid injection was done for persistent back and extremity pain. After the procedure, severe orthostatic headache was developed. Despite brain magnetic resonance imaging (MRI) was found in normal limits, the diagnosis of intracranial hypotension was established with the clinical findings. Epidural blood patch application with 5cc venous blood was done for peristant headache which made her headache free. Two days after the procedure, she became unconcious and started having epileptic seizures. Brain MRI showed ischemia in bilateral frontal regions. MR venography showed total occlusion at sagittal superior venous sinus. Coagulation tests were found within normal limits. Anticoagulant and anti-oedematous medications was started. Her neurological findings were resolved at the end of first month. Conclusion: We report here the first case of cerebral venous infarction caused by intracranial hypotension and epidural blood patch treatment after lumbar disc surgery. This serious complication should be considered in patients with intracranial hypotention who require epidural blood patch treatment
Açıklama
Anahtar Kelimeler
epidural kan yaması, BOS kaçağı, venöz tromboz, epidural blood patch, CSF leakage, venous thrombosis
Kaynak
Maltepe Tıp Dergisi
WoS Q Değeri
Scopus Q Değeri
Cilt
6
Sayı
1
Künye
Çakmak, M. A., Şahin, Ş., Çınar, N., Kelten, B. ve Karşıdağ, S. (2014). İntrakranyal hipotansiyon olgusunda epidural kan yaması tedavisi sonrası gelişen serebral venöz infarkt / Cerebral venous infarction after epidural blood patch treatment in a patient with intracranial hypotension. Maltepe Tıp Dergisi. 6(1), s. 20-23.
