Postpartum dönemde gelişen posterior reversibl ensefalopati sendromlu (PRES) bir olgu
Küçük Resim Yok
Tarih
2007
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Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Bilimsel zemin: Posterior reversibl ensefalopati sendromu (PRES), eklampsi-preeklampsi, hipertansiyon, ilaç intoksikasyonları ve birçok metabolik hastalığa bağlı olarak gelişebilen bir tablodur. Etiyolojik faktörlere bağlı olarak beyin dokusunda gelişen vazojenik ödem, patofizyolojinin temelini oluşturur. Beyni akut kan basıncı yüksekliklerinden koruyan sempatik uyarım, beyin arka dolaşım sisteminde ön dolaşım sistemine göre daha yetersizdir. Öykü, klinik bulgular ve nöroradyolojik incelemeler ile tanı konur. Kranial manyetik rezonans görüntülemelerde (MRG) T2 ağırlıklı kesitlerde beynin arka bölgelerinde gözlenen hiperintens lezyonlar, ADC (apparent diffusion coefficient) görüntülerde gelişen ödemin türüne göre hipo ya da hiperintens görülebilir. Ender olarak serebellum, beyin sapı, bazal ganglionlar ve frontal alanlarda da ödem saptanabilir. OLGU: 28 yaşında kadın olgu, ikinci gebeliğinde uygulanan sezaryen operasyonu sonrası kadın hastalıkları doğum kliniğinde izlenirken, postpartum on birinci saatte jeneralize tonik klonik nöbet (JTKN) geçirme şikâyeti ile kliniğimizce konsülte edildi ve üçüncü JTKN ardından status tablosu gelişmesi üzerine yoğun bakım ünitemize nakledildi. Öz ve soy geçmişinde özellik saptanmadı. Her iki gebeliğinde de doktor kontrolünde olan olgunun takiplerinde herhangi bir patolojik bulgu saptanmadığı, sezaryen operasyonu sırasında bir kez tansiyon arteryelin yüksek saptandığı (180/100 mmHg), ancak daha sonra normale döndüğü belirtildi. AMAÇ: Bu yazıda, postpartum dönemde status epileptikus tablosuna giren ve klinik, nöroradyolojik bulguları ile PRES tanısı konan, ancak tek bir hipertansif atak dışında hiçbir risk faktörü olmayan bir olgu sunulmakta ve literatür eşliğinde tartışılmaktadır.
Scientific BACKGROUND: Posterior reversible encephalopathy syndrome (PRES) is a clinical picture that may develop due to eclampsia-preeclampsia, hypertension, drug intoxications and many metabolic diseases. Vasogenic edema developing on brain tissue due to etiologic factors constitutes the basis of pathophysiology. The sympathetic stimulation which defends brain against high acute blood pressure is more insufficient in the posterior circulation system of the brain than the anterior system. Diagnosis is made through history, clinical findings and neuroradiological examinations. Hyperintense lesions observed in posterior regions of brain on T2 weighted sections in cranial magnetic resonance imaging (MRI) may appear as hypo or hyperintense in ADC (apparent diffusion coefficient) images depending on the type of edema. Edema may rarely be detected in cerebellum, brain stem, basal ganglions and frontal regions. CASE: A 28 year-old female case was hospitalized in our clinic with diagnosis of status epilepticus developing at the eleventh postpartum hour while she was being followed up in obstetrics and gynecology clinic following cesarean operation in her second pregnancy. No pathological finding was detected in follow up of the case who was under physician control in both of her pregnancies, high tension arterial (180/100 mmHg) was detected once during the cesarean operation but then it got back to normal values. OBJECTIVE: This paper presents a case diagnosed as PRES with clinical and radiological findings and status epilepticus during the postpartum period, but with no risk factor other than a single hypertensive attack, and discusses the case along with the literature.
Scientific BACKGROUND: Posterior reversible encephalopathy syndrome (PRES) is a clinical picture that may develop due to eclampsia-preeclampsia, hypertension, drug intoxications and many metabolic diseases. Vasogenic edema developing on brain tissue due to etiologic factors constitutes the basis of pathophysiology. The sympathetic stimulation which defends brain against high acute blood pressure is more insufficient in the posterior circulation system of the brain than the anterior system. Diagnosis is made through history, clinical findings and neuroradiological examinations. Hyperintense lesions observed in posterior regions of brain on T2 weighted sections in cranial magnetic resonance imaging (MRI) may appear as hypo or hyperintense in ADC (apparent diffusion coefficient) images depending on the type of edema. Edema may rarely be detected in cerebellum, brain stem, basal ganglions and frontal regions. CASE: A 28 year-old female case was hospitalized in our clinic with diagnosis of status epilepticus developing at the eleventh postpartum hour while she was being followed up in obstetrics and gynecology clinic following cesarean operation in her second pregnancy. No pathological finding was detected in follow up of the case who was under physician control in both of her pregnancies, high tension arterial (180/100 mmHg) was detected once during the cesarean operation but then it got back to normal values. OBJECTIVE: This paper presents a case diagnosed as PRES with clinical and radiological findings and status epilepticus during the postpartum period, but with no risk factor other than a single hypertensive attack, and discusses the case along with the literature.
Açıklama
Anahtar Kelimeler
Nörolojik Bilimler
Kaynak
Türk Nöroloji Dergisi
WoS Q Değeri
Scopus Q Değeri
Cilt
13
Sayı
4