Yürüme güçlüğü ile başvuran hastada normal basınçlı hidrosefali
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Date
2017-11-15
Authors
Köse, Ataman
Bozkurt, Seyran
Kartal, Seçil
Toker, İbrahim
Yılmaz, Arda
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Yürüyüş bozukluğunun santral nedenler arasında diğer önemli nedeni olan normal basınç hidrosefali hastalarda olduğu gibi ventriküler genişlemedir. Bu çalışmamızda 63 yaşında acil servise yürüme güçlülüğü ile başvuran görüntüleme tetkiklerinde ventiküler genişlemenin olduğu normal basınçlı hidrosefali olgusu sunmak istiyoruz. 63 yaşında kadın hasta yürüyeme güçlüğü ve baş ağrısı şikayeti ile acil servise başvurdu. Nörolojik muayenesinde alt ekstrmiteler bilateral parezik (1/5-1/5). Hastanın kognitif etkilenmesi de mevcuttu. İdrar kaçırması şikayeti eşlik ediyordu. Hastanın diğer sistem muayenesi doğaldı. Çekilen BT’sinde ventikülerde belirgin gelişme ve hidrosefaliye sekonder parankim alanlarının inceldiği tespit edildi. Çekilen hastanın torakal ve servikal MRG'si normal olarak yorumlandı. Serebral MRG’da hidrosefali tespit edilmesi üzerine nöroloji kliniğine konsülte edildi ve nöroloji tarafından normal basınçlı hidrosefali olarak yatırıldı. Hastaya beyin cerrahisi tarafından ventriküloperitoneal şant takıldı. Hastanın yürüme güçlüğünde belirgin değişiklik olmadı, ancak ajitasyonları, konuşma bozukluğunda düzelme görüldü. Hasta yaklaşık 3 hafta takip ve tedavinin sonunda önerilerle nöroloji polikliniğine gelmek üzere taburcu edildi. Yürüyememe veya yürüme güçlüğü ile acil servise başvuran özellikle yaşlı hastalarda altta yatan sekonder santral patoloji (kafa travması, stroke vb.) olmadığı durumda normal basınçlı hidrosefali akla getirilmeli ve buna göre ileri görüntüleme tetkikleri ve tedavileri planlanmalıdır.
Another important neurological cause among the central causes of gait impairment is ventricular dilatation as in patients with normal pressure hydrocephalus. In this study, we would like to present a 63-year-old patient with normal pressure hydrocephalus presented to emergency department with gait disturbance and whose imaging studies showed ventricular dilatation. A 63-year-old woman was admitted to the emergency department with a complaint of gait disturbance and headache. In her neurologic examination, lower extremities exhibited bilateral paresis (1/5-1/5). The complaint of urinary incontinence was accompanying. The other system examination of the patient was natural. Significant dilatation in the ventricles and thinning of parenchymal areas secondary to hydrocephalus were observed on CT performed. Patient’s thoracic and cervical MRI images were interpreted as normal. Upon hydrocephalus was detected in cerebral MRI, consultation was carried out with neurology clinic and the patient was admitted as normal pressure hydrocephalus by the neurology department. Ventriculoperitoneal shunt was attached to the patient by neurosurgery department. There was no significant change in the patient's gait disturbance, but there was improvements in her agitations and speech impairment. The patient was discharged at the end of follow-up and treatment processes for 3 weeks with recommendation as to come to the neurology.
Another important neurological cause among the central causes of gait impairment is ventricular dilatation as in patients with normal pressure hydrocephalus. In this study, we would like to present a 63-year-old patient with normal pressure hydrocephalus presented to emergency department with gait disturbance and whose imaging studies showed ventricular dilatation. A 63-year-old woman was admitted to the emergency department with a complaint of gait disturbance and headache. In her neurologic examination, lower extremities exhibited bilateral paresis (1/5-1/5). The complaint of urinary incontinence was accompanying. The other system examination of the patient was natural. Significant dilatation in the ventricles and thinning of parenchymal areas secondary to hydrocephalus were observed on CT performed. Patient’s thoracic and cervical MRI images were interpreted as normal. Upon hydrocephalus was detected in cerebral MRI, consultation was carried out with neurology clinic and the patient was admitted as normal pressure hydrocephalus by the neurology department. Ventriculoperitoneal shunt was attached to the patient by neurosurgery department. There was no significant change in the patient's gait disturbance, but there was improvements in her agitations and speech impairment. The patient was discharged at the end of follow-up and treatment processes for 3 weeks with recommendation as to come to the neurology.
Description
Keywords
Santral, Hidrosefali, Hydrocephalus, Yürüme güçlüğü, Gait disturbance, Central
Citation
Köse, A. vd. (2018). ''Yürüme güçlüğü ile başvuran hastada normal basınçlı hidrosefali''. Uludağ Üniversitesi Tıp Fakültesi Dergisi, 44(1), 53-55.