sex feminin varsta 29 ani simptomatologie · pdf fileexamen general in limite normale examen...
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Sex feminin
Varsta 29 ani
Simptomatologie
› Comemorativa criza de pierdere a constientei (GCS 15 pct)
› Plaga muscata la nivelul obrazului si buzei
› Echimoza periorbitara dreapta
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Antecedent personale patologice › Comemorativa criza cu pierderea
constientei in urma cu 6 luni
› Nodul mamar operat in urma cu 7 ani
Examen general in limite normale
Examen neurologic in limite normale
Examen oftalmologic: aspect papilar normal
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Examen C.T. cerebral nativ
› Proces expansiv intracranian, intranevraxial,
temporo-parietal drept, cu dimensiuni 14/23mm transaxial
› Heterodens cu densitati hematice
› Edem perilezional minim asociat
› Osteom fronto-parietal drept
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Examen IRM cerebral nativ si cu contrast
(gadolinium):
› Hematom intraparenchimatos temporal
drept cu dimensiuni 23/28/27 mm, fara priza
de contrast, net conturat (posibil cavernom sangerat)
› Efect de masa discret
› Edem perilezional de mici dimensiuni
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Radiografie cerebrala
› Osteom fronto-parietal drept
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Sindrom comitial
› Comemorativa criza cu pierderea constientei
Proces expansiv intracranian confirmat IRM si CT cu
sangerare intralezionala
Masa cerebrala heterodensa, cu densitati hematice
(probrabil cavernom)
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Terapie medicamentoasa
› Antiepileptice: fenitoina injectabil
Indicatie neurochirurgicala
› Scop
Diagnostic histologic
Prognostic si plan de tratament ulterior
Rezectia tumorala completa in scopul
ameliorarii simptomatologiei
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Analize uzuale biochimice
› Hlg, coagulograma, functie hepatica si
renala in limite normale
Ekg: ritm sinusal,
Rx pulmonara
› Fara leziuni pleuro-pulmonare evolutive
Informarea pacientului si cererea
consimtamantului
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Incizie tegumentara "in semn de intrebare" frontotemporala dreapta.
Se rabate voletul cutanat si se realizeaza un volet osos liber frontotemporal drept, care se ridica fara incidente.
Se incizeaza dura mater arcuat, cu pedicul anteroinferior.
Se patrunde intradural.
Se descopera un cavernom temporal drept cu hemoragie intra si paracavernomatoasa, cu dimensiuni de circa 23 / 28 / 27 mm, care se ableaza in totalitate.
Hemostaza.
Sutura etansa a durei mater si suspendarea acesteia
Drenaj epidural extern inchis.
Repunerea si fixarea voletului osos.
Sutura in planuri.
Pansament.
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Incizie tegumentara frontoparietala
dreapta.
Se rabate voletul cutanat si se observa
hiperostoza fronto-parietala data de un
osteom, de dimensiuni (2.8,2.5,2 cm)
care se rezeca in totalitate.
Hemostaza.
Sutura in planuri.
Pansament.
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Hemangiom cavernos
› Tesutul cerebral adiacent prezinta infiltrate
hematice asociate cu abundent pigment hemosiderinic
Osteom
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Favorabila
Vindecat chirurgical si ameliorat
neurologic
Recomandari la externare :
› Medicatie: Oxacilin (10 zile), Fenitoin
(cronic), Panadol (7 zile)
› Reevaluare neurochirurgicala la 3 luni
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La 6 luni de la interventie se prezinta cu simptomatologie caracteristica cu debut brusc: › Cefalee
› Ameteli
› Comemorativa criza de pierdere a starii de constienta
Examenul clinic general normal
Examen neurologic normal
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Evidentierea voletulul fronto-temporal
drept
Elemente patologice absente
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Se recomanda:
› Evitarea eforturilor fizice, locurilor cu
periculozitate, expunere la frig si umezeala si
ridicarea de greutati
› Se interzice consumul de alcool si fumatul
› Se prezinta pentru reevaluare
neurochirurgicala peste 6 luni
Tratament medicamentos:
› Fenobarbital -1cp (100 mg) seara/21 zile
› Depakine crono 1cp (500mg) x 3 cronic
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