RESUMO
In the presented case, clipping of aneurysm of the anterior cerebral artery (A CeA) and the anterior communicating artery (ACoA) in acute subarachnoidal hemorrhage (SAH) was complicated by the development of vasospasm and transient diabetes insipidus (DI). The cause of DI was ischemia of the anterior portions of the hypothalamus due to ACeA and ACoA spasm. The use of the standard triple H-therapy protocol in the presence of DI failed to achieve the optimal parameters of hemodynamics and cerebral perfusion pressure due to the development of severe polyuria. Addition of the standard triple H-therapy protocol by hormonal replacement therapy with desmopressin could yield adequate systemic hemodynamic parameters. During this treatment, the state became stable and vasospasm regressed. The manifestations of DI ceased with the values of cerebral circulation being normal.
Assuntos
Artéria Cerebral Anterior/cirurgia , Diabetes Insípido/diagnóstico , Diabetes Insípido/etiologia , Aneurisma Intracraniano/cirurgia , Hemorragia Subaracnóidea/complicações , Doença Aguda , Adulto , Artéria Cerebral Anterior/diagnóstico por imagem , Artéria Cerebral Anterior/patologia , Angiografia Cerebral , Circulação Cerebrovascular , Diabetes Insípido/terapia , Feminino , Humanos , Aneurisma Intracraniano/patologia , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/patologia , Instrumentos Cirúrgicos , Tomografia Computadorizada por Raios X , VasoconstriçãoAssuntos
Nutrição Parenteral Total/métodos , Cuidados Pós-Operatórios/métodos , Atenção à Saúde/história , Atenção à Saúde/organização & administração , História do Século XVIII , História do Século XIX , História do Século XX , História do Século XXI , Hospitais/história , Humanos , Nutrição Parenteral Total/história , Federação Russa , U.R.S.S. , Ferimentos e Lesões/terapiaRESUMO
Eighty-three patients with severe craniocerebral injuries (CCI) were treated at Institute of Neurosurgery in 1999. Pulmonary infectious complications occurred in 16 of 25 patients with severe CCI. Early nosocomial pneumonia (NP) was diagnosed in 18% and the so-called late NP (associated with artificial ventilation of the lungs) in 35%. Coma longer than 4 days increased the incidence of NP to 62%. The main pathogens of NP are gram-negative aerobic bacteria (61%), the predominant agent being Pseudomonas aeruginosa (18.9%). 76% isolated microorganisms were multiresistant. The most significant risk factors as regards NP in patients with severe CCI were coma combined with bulbar and pseudobulbar disorders.