Case Infark Hemoragik

8/19/2019 Case Infark Hemoragik

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CASE REPORT FROM LABUANG BAJI HOSPITAL

Thusrday, March 22nd 200

By ! J"an" N#$%&a I'A((as

Su)"r$%s"d (y !*r'H+'M%snah *' Bas%r S)'S -.


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REGISTRATIONREGISTRATION

Name : Mrs.M

Reg.Number : 105824 Age : 29 year old

Admission date : Feb 16t

200!


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HYSTORY/ANAMNESISHYSTORY/ANAMNESIS

A 29 t year old "oman #onsulted $rom %b&'inde(artment 24 t days (ost (artum )anemia)(uer(uralisse(ti# s o#* )de#rease o$ #ons#iousness

Alloanamnesis :+e#rease o$ #on#iousness gradually " en s e "aslying on t e bed , in -antaeng os(ital/ days be$oreadmission12 ours be$ore admitted to abuang ba3i os(ital (atient

ad no #onta#t "it ot er (eo(le


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No istory o$ : sei ure $e er omiting eada# e andead trauma.y(ertension be$ore and during (regnan#y ,&/istory o$ labour assisted by +u*un7 24 days be$ore

admission to abuang -a3i os(ital , on 22nd anuary200!/.

e (la#enta #ouldn t be dra"n ;us*esmas t e(la#enta "as #om(letely dra"n by mid"i$e


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istory o$ intrauterine bleeding a "ee* a$ter labourolume o$ t e blood about 7sarung7

;atient ad been treated in -antaeng os(ital days ,1 &15 February/ #om(lain o$ di iness andlo"er abdominal (ain.(atient "as trans$used "it 4 bag o$ blood , er b

"as 2 gr


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trans$erred to abuang -a3i os(ital "it (ost(la#enta retention a##om(anied by anemia and se(ti#s o#*7. e (atient adn t de$e#ated sin#e days agoMi#turation "as "it inserted #at eter.


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PHYSICAL EXAMINATIONPHYSICAL EXAMINATION

Internal status :BP: !!/"! mmH# RR: $%/min&t'ora(o a)*ominal t+,eHR : --/min.re#ularBo*+ tem,erature : 0"&1 ! CHea* : Con2un#ti3a : anemis 4/4& I(terus : ./.C'est : 'eart an* lun# : 5it'in normal limits

A)*omen : Li3er an* s,leen 5ere not ,al,a)le6terus 7un*us : $ 7in#er a)o3e s+m,'isisGenitalia : Bloo* 8lu9us 4;& ,us 4;& 7oetor 4;


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Neurolo#i(al status :'=> ? 2 M4 @1

ig er #orti#al $un#tion : di$$#ult to e aluatedMeningeal signs : Ne#* sti$$ness ,&/ ernig sign ,&/=ranial ner es : ;u(il "ere iso#ore B 2 5mm rea#ti e tolig tFundus#o( y on rig t and le$t eyes: "it in normal limits.=orneal Re$leCes : )


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Motori# eCamination :

Mo ement and mus#le strengt "ere di$$i#ult to e aluated, Rig t laterali ation/

Mus#le tone DD D ; ysiologi#al Re$leCes DD D ↓↓ D DD D ;at ologi#al Re$leCes - -

+ +

>ensori# $un#tion : di$$i#ult to e aluated

Autonomi# Fun#tion : Enin ibitted bladder


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LABORATORY 8IN


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THERAPYTHERAPY

G 5- :-reat ing : % $ & 4 l


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Neuro(rote#tor : ;ira#etam gr< 8 ours


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Hea* CT S(anHea* CT S(an

y(odens and y(erdens lesions in rig t (arietalregion and y(odens lesion in le$t #orona radiata "itdensity 21&59 E.Normal gyri >yl ii $issure and #orti#al sul#us.

No midline s i$t.>lig t "idening o$ entri#le system and #ysterna.No abnormalities "ere seen in (ons #erebellum and=;A.

Hm(ression : =erebral in$ar#t "it emorr agi# in rig t(arietal and #erebral in$ar#t in le$t #orona radiata.


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8OLLO= 6P8OLLO= 6P

8e)& ? t' $!!?BP: !/"! mmH# RR: $%/min&t'ora(o a)*ominal t+,eHR : -!/min.re#ular Bo*+ tem,erature : 0- ! C

GCS E 0 M1 @

Mo3ement an* mus(le stren#t' 5ere *i77i(ult toe3aluate* Ri#'t laterali ation;

Mus(le tone P'+siolo#i(al Re7le9es

Pat'olo#i(al Re7le9es . . 4 4

H) : "&0#r/*l


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era(y :5-Neuro(rote#tor : ;ira#etam gr< 8 ours


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8e)& > t' $!!?-;: 100


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era(y :

H@F+ R 20 dro(s


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8e)& $$n* $!!?-;: 110


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era(y H@F+ R 20 dro(s


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8e)& $%t' $!!?-;: 110


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Therapy IVFD RL 20 drops/min Neuroprotector : Piracetam 2 !200m" #e$ota ime !"r/!2 hours/IV

%etronida&o'e (00m"/) hours/IV *u'$ous Ferrosus 2 ! %etami&o'e !amp/)hours/IV FT


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Mar('& st $!!?-;: 120

R : 80


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era(y : ;ira#etam 2 C1200mg =e$adroCyl C 500mg Metronida ole C 500mg

>ul$ous Ferrosus 2 J 1 F

On March 5 th 2007, the patientdischarges from

hospital


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-e#ause t e redu#tion in blood $lo" is global all (art

o$ t e brain may be a$$e#ted es(e#ially "aters ed7areas border one regions su((lied by t e ma3or#erebral arteries.t is (atient ad de#rease o$ #onsiousness t ato##ured during admission in -antaeng os(ital "it

istory o$ intra uterine bleeding as mu# as sarung7. %n eCamination t e bleeding still (ersisted.


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Neurologi#al eCamination laterali ation to t e rig tand bilateral -abins*i sign

aboratory $indings : b : 5 gr#an s o"ed #erebral in$ar#t "it emorr agi#in rig t (arietal and #erebral in$ar#t in le$t #oronaradiata.


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-ased on anamnesis neurologi#al eCaminationlaboratory $indings and ead = >#an +C double

emi(aresis due to emorr agi# in$ar#tion due tosystemi# y(o(er$usion.


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redu#ed blood $lo" to t e #erebral emis( ere atenden#y $or $o#al in$ar#tion to o##ur in t e regions o$lo"est "aters ed in$ar#tion -lood su((ly disturban#e on t at area #an ra(idlydestru#t brain tissue in#luding neuron glia and

as#ulature


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=olateral as#ulari ation on t at area #an beim(ro ed but "it a ris* t at blood su((lied tot e area o$ destru#tion "ould a##umulateeCtra as#ularly be#ause o$ y(oCemi#degeneration o$ t e blood essel "all

t ere "as miC area o$ in$ar#t "it emorr age emorr agi# in$ar#tion


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e main syndromes a$ter t e (atient a"a*ens are :1. @isual agnosia in#luding -alint >yndrome and #orti#al

blindness re(resenting in$ar#tion o$ t e "aters edbet"een t e middle and (osterior #erebtral artery.

2. ;roCimal arms and s oulder "ea*ness sometimea##om(anied by i( "ea*nes re$le#ting in$ar#tion int e territory bet"een t e middle and anterior #erebralarteries. ese (atients are able to "al* but t eir armsdangle and t eir i( is may be "ea*


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reatment (re ention o$ $urt er y(oCi# in3ury. %Cyen may be o$ alue during t e $irst ours but(robably o$ little user a$ter t e blood be#omes "elloCygenated.=orti#osteroid allay brain (ossibly #elluler s"elling

but again t eir t era(euti# bene$it as not been#orroborated by #lini#al trials


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;rognosis All o$ t em in#or(orate se eral sim(le

#lini#al $eatures in ol ing loss o$ motor erbal and(u(illary $un#tion in arious #ombinations. AnoCi# (atients inta#t brain stem $un#tion as indi#ated

normal (u(illary lig t and doll s ead eye mo ementsand o#ulo estibular re$leCes more $a orable out loo*to re#o ery o$ #onsiousness and (er a(s all t eir$a#ulties.


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=on ersely t e absen#e o$ t ese brainstemre$leCes e en a$ter #ir#ulation and oCygenationa e been restored (arti#ularly (u(il t at

un# anged to lig t im(lies a gra e on most#ir#umstan#es.


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is (atient as eC#ellent (rognosis e ent oug

during admission t e (atient "as un#ons#ious neurologi#al eCamination (ositi e sign o$ lig tre$leC #orneal re$leCes and (ositi e +oll s eyemo ement indi#ate t at t e brainstem stillinta#t.


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Case Infark Hemoragik