Öz
İntrakranial kavitedeki gaz varlığı “pnömosefali” olarak adlandırılır ve genellikle invaziv cerrahi işlemlerden sonra görülür. Baş ağrısı gibi spesifik olmayan semptomlar görülse de nörolojik bozulma, koma ve ölüme neden olabilir. Oksijen tedavisi, pnömosefaliyi tedavi etmenin en etkili yoludur ve havanın rezolüsyonunu hızlandırır. Hiperbarik oksijen tedavisi (HBOT), doğrudan yüksek basınç etkisiyle hava kütlesinin küçülmesine neden olur. Bu yazıda bildirilen olguda pnömosefali ani bilinç kaybı semptomu ile kendini göstermiş ve etiyolojisinde; hastanın oturur pozisyonda iken diyaliz katateri yerleştirilmesine yönelik invaziv bir girişim yer almaktadır. Acil tedavi olarak HBOT uygulanan vakada, tedavi sonrası bilgisayarlı tomografi ile dramatik radyolojik düzelme saptandı. Bu hastada en iyi sonucun alınabilmesi için ardışık HBOT seanslarına ihtiyaç duyulmasına rağmen hastanemizin yoğun bakım ünitesinde yer olmaması nedeniyle başka bir hastanenin yoğun bakım ünitesinde müşahede altında olduğu için sadece tek seans HBOT uygulanabildi. Ana noktalardan biri, klinisyenlerin HBOT’ni sadece ilk seanstan sonra bırakma kararı vermemeleri gerektiğidir. Bu vakalarda ardışık HBOT seansları radyolojik ve klinik bulguları önemli ölçüde iyileştirebilir.
Anahtar Kelimeler
Kaynakça
- Jain KK, eds. 4th ed. Hogrefe&Huber Publishers; 2004:101-108.
- Pearson RR. Diagnosis and treatment of gas embolism. The Physician’s Guide to Diving Medicine. Shilling CW, Cartstom CB, Mathias RA, eds. New York: Plenum Press; 1984:333-367.
- Kaichi Y, Kakeda S, Korogi Y, et al. Changes over time in intracranial air in patient with cerebral air embolism: radiological study in two cases. Case Rep Neurol Med. 2015;2015:491017.
- Moon R. Air or Gas Embolism. The Hyperbaric Oxygen Therapy Committee Report 2003: Indications and Results. Undersea Hyperb Med. 2003:5-11.
- Lin HY, Wu HS, Peng TH, et al. Pneumocephalus and respiratory depression after accidental dural puncture during epidural analgesia–a case report. Acta Anaesthesiol Sin. 1997;35(2):119-123.
- Paiva WS, Andrade AF, Figueiredo EG, Amorim RL, Prudente M, Jacobsen T. Effects of hyperbaric oxygenation therapy on symptomatic pneumocephalus. Ther Clin Risk Manag. 2014;10:769-773.
- Popa D, Grover I, Hayden S, Witucki P. Iatrogenic arterial gas embolism from esophagogastroduodenoscopy. J Emerg Med. 2019;57(5):683-688.
- Shih CC, Tsai SH, Liao WI, Wang CJ, Hsu CW. Successful treatment of epidural anesthesia-induced severe pneumocephalus by hyperbaric oxygen therapy. Am J Emerg Med. 2015;33(8):1116.e1-3.
- Çimşit M. Hyperbaric Medicine. 1st ed. Ankara: Eflatun Publisher; 2009:198-199.
Öz
The presence of gas in the cranial cavity is called “pneumocephalus”, and is usually seen after invasive surgical procedures. Although symptoms are non-specific, such as headache, it can cause neurological distortion, coma, and death. Oxygen therapy is the most effective way to treat pneumocephalus and accelerates the reabsorption of the air. Hyperbaric oxygen treatment (HBOT), with its direct high pressure effect, causes the air mass to shrink. In the case reported in this paper, the pneumocephalus manifested with the symptom of sudden loss of consciousness and the etiology was an invasive intervention of dialysis catheter placement while the patient was in a sitting position. HBOT was applied as an emergency treatment, after which a dramatic radiological improvement was detected with computed tomography. Although this patient needed consecutive HBOT sessions for the best result, only a single session of HBOT could be applied because she was under the observation in the intensive care unit of another hospital due to the lack of space in the intensive care unit of our hospital. One of the main points is that the clinicians should not decide to cease HBOT only after the first session. Consecutive HBOT sessions can dramatically improve the radiological and clinical findings in these case
Anahtar Kelimeler
Kaynakça
- Jain KK, eds. 4th ed. Hogrefe&Huber Publishers; 2004:101-108.
- Pearson RR. Diagnosis and treatment of gas embolism. The Physician’s Guide to Diving Medicine. Shilling CW, Cartstom CB, Mathias RA, eds. New York: Plenum Press; 1984:333-367.
- Kaichi Y, Kakeda S, Korogi Y, et al. Changes over time in intracranial air in patient with cerebral air embolism: radiological study in two cases. Case Rep Neurol Med. 2015;2015:491017.
- Moon R. Air or Gas Embolism. The Hyperbaric Oxygen Therapy Committee Report 2003: Indications and Results. Undersea Hyperb Med. 2003:5-11.
- Lin HY, Wu HS, Peng TH, et al. Pneumocephalus and respiratory depression after accidental dural puncture during epidural analgesia–a case report. Acta Anaesthesiol Sin. 1997;35(2):119-123.
- Paiva WS, Andrade AF, Figueiredo EG, Amorim RL, Prudente M, Jacobsen T. Effects of hyperbaric oxygenation therapy on symptomatic pneumocephalus. Ther Clin Risk Manag. 2014;10:769-773.
- Popa D, Grover I, Hayden S, Witucki P. Iatrogenic arterial gas embolism from esophagogastroduodenoscopy. J Emerg Med. 2019;57(5):683-688.
- Shih CC, Tsai SH, Liao WI, Wang CJ, Hsu CW. Successful treatment of epidural anesthesia-induced severe pneumocephalus by hyperbaric oxygen therapy. Am J Emerg Med. 2015;33(8):1116.e1-3.
- Çimşit M. Hyperbaric Medicine. 1st ed. Ankara: Eflatun Publisher; 2009:198-199.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Olgu Sunumu |
| Yazarlar | |
| Yayımlanma Tarihi | 31 Aralık 2021 |
| Gönderilme Tarihi | 12 Temmuz 2021 |
| Yayımlandığı Sayı | Yıl 2021 Cilt: 2 Sayı: 3 |
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