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Korean J Crit Care Med > Volume 23(1); 2008 > Article
Korean Journal of Critical Care Medicine 2008;23(1): 40-43. doi: https://doi.org/10.4266/kjccm.2008.23.1.40
뇌동맥류 조기 재출혈을 보인 환자에서 수술 전 두개내압 감소로 인한 국소 신경학적 손상 역전 -증례 보고-
나효석*ㆍ박상헌*ㆍ전영태*ㆍ도상환*ㆍ김환희ㆍ이상철ㆍ박희평
서울대학교병원, *분당서울대학교병원 마취통증의학과, 서울대학교 의과대학 마취통증의학교실
Reversal of Focal Neurologic Deficit due to Preoperative Intracranial Pressure Reduction in a Patient with Early Rebleeding of Cerebral Aneurysm: A Case Report
Hyo Seok Na, Sang Hyun Park, Young Tae Jeon, Song Hwan Do, Hwan Hee Kim, Sang Chul Lee, Hee Pyoung Park
1Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea. hppark@snu.ac.kr
2Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
ABSTRACT
In the first hours after initial hemorrhage, up to 15% of patients with subarachnoid hemorrhage (SAH) due to aneurysmal rupture may have a sudden episode of clinical deterioration resulting from rebleeding. In patients suffering from an aneurismal rebleeding, the prognosis becomes much poor. Early detection of rebleeding and preoperatively appropriate medical treatment for increased intracranial pressure (IICP) might be crucial to decrease the overall mortality and morbidity rate in a patient with aneurismal rebleeding. We report a case of a successful reversal of focal neurological deficit showed in a patient with abrupt rebleeding of ruptured aneurysm whose intracranial pressure was preoperatively reduced with hyperventilation, and thiopental and mannitol administration under general anesthesia in angiography suite, although the patient ended up in death due to postoperative IICP.
Key Words: Cerebral aneurysm; Focal neurological deficit; Intracranial pressure control; Rebleeding
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