ANALYSIS OF THE CLINICAL CASE OF SEVERE STROKE IN A PATIENT WITH ADVERSE PROGNOSTIC FACTOR
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Abstract
Objective – demonstration of a clinical case of management patient with severe stroke and severe comorbid pathology.
Methods. There is a retrospective analysis of the medical history of a 74-year-old female patient. She was admitted to the department for patients with acute cerebrovascular accident Novokuznetsk State Hospital N 1 with a diagnosis of ischemic stroke was carried out. The diagnosis was verified by spiral computed tomography (SCT) of the brain. Assessment of the severity of neurological deficit was conducted on the scales: NIHSS (National Institutes of Health Stroke Scale), modified Rankin Scale, Index Rivermead mobility.
Results. The severity of the patient's condition was due to the extensive ischemic zone, which captures two basins of cerebral circulation. Neurological deficit – NIHSS 19. Treatment according to the ischemic stroke protocol was started. On the 5th day after the acute event, due to the increase in edema and dislocation syndrome, the patient's condition worsened – focal neurological symptoms increased – NIHSS 34, consciousness was depressed to the level of coma 1. The patient was transferred to the ventilator through the ETT. After 4 days, against the background of the therapy, there was a positive trend - cerebral symptoms regressed to sopor, minimal movements appeared in the distal parts of the right extremities. Hemodynamics has stabilized. Subsequently, the cerebral symptoms regressed - the level of consciousness was normal, the strength in the right extremities increased, and attempts to swallow independently appeared. After 20 days, the patient did not need respiratory support and was transferred to spontaneous breathing. After 31 days from the acute event, the patient was transferred to continue treatment at the local neurological department (NIHSS-15).
Conclusions. In the presented clinical case, a complete complex personalized treatment made it possible to achieve a significant result, despite the prevalence of factors suggesting an unfavorable outcome.
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Barkhatov YuD, Kadykov AS. Prognostic factors for recovery of motor dysfunction following ischemic stroke. Annals of Clinical and Experimental Neurology. 2017; 11(1): 80-89. Russian (Бархатов Ю.Д., Кадыков А.С. Прогностические факторы восстановления нарушенных в результате ишемического инсульта двигательных функций //Анналы клинической и экспериментальной неврологии. 2017. № 11(1). С. 80-89)
Barkhatov YuD, Kadykov AS. Prognostic Factors for Recovery of Motor Functions in Patients with Hemispheric Stroke of Various Locations. The Journal of Nervous Diseases. 2018; (4): 41-49. Russian (Бархатов Ю.Д., Кадыков А.С. Факторы, влияющие на восстановление двигательных функций у больных с полушарным инфарктом мозга различной локализации //Нервные болезни. 2018. № 4. С. 41-49)
Acciarresi M, Caso V, Venti M et al. First-ever stroke and outcome in patients admitted to Perugia Stroke Unit: predictors for death, dependency, and recurrence of stroke within the first three months. Clin Exp Hypertens. 2006; 28(3-4): 287-294
Turhan N, Atalay A, Muderrisoglu H. Predictors of functional outcome in first-ever ischemic stroke: a special interest to ischemic subtypes, comorbidity and age. NeuroRehabilitation. 2009; 24(4): 321-326
Sehweil Salah MM, Goncharova ZA. Massive ischemic stroke (brief literature review). Journal of new medical technologies. 2019;(1): 48-52. Russian (Сехвейл Салах М.М., Гончарова З.А. Массивный ишемический инсульт (краткий обзор литературы) //Вестник новых медицинских технологий. 2019. № 1. С. 48-52)
Lutokhin GM, Geraskina LA, Fonyakin AV, Maksimova MYu. The impact of sleep–disordered breathing on early functional recovery in ischemic stroke. Neurology, Neuropsychiatry, Psychosomatics. 2017; (1): 20-26. Russian (Лутохин Г.М., Гераскина Л. А., Фонякин А.В., Максимова М.Ю. Влияние нарушений дыхания во сне на раннее функциональное восстановление при ишемическом инсульте //Неврология, нейропсихиатрия, психосоматика. 2017. № 1. С. 20-26)
Poluektov MG, Tsenteradze SL. The impact of sleep disorders on the occurrence and course of cerebral stroke. Medical Council. 2015; (2): 10-15. Russian (Полуэктов М.Г., Центерадзе С.Л. Влияние нарушений сна на возникновение и течение мозгового инсульта //Медицинский совет. 2015. № 2. С. 10-15)
Kovalchuk VV, Shvartsman GI, Gusev AO. The reasons and ways of neglekta and «repulsion» syndromes elimination in patients after stroke – factors, which prevent adequate rehabilitation. Medical and Social Expert Evaluation and Rehabilitation. 2013; (2): 50-53. Russian (Ковальчук В.В., Шварцман Г.И., Гусев А.О. Причины необходимости и способы устранения синдромов неглекта и «отталкивания» у пациентов после инсульта – факторов, препятствующих проведению адекватной реабилитации //Медико-социальная экспертиза и реабилитация. 2013. № 2. C. 50-53)
Sidyakina IV, Tsarenko SV, Dobrushina OR, et al. Prognostic model of evaluation of lethality and functional recovery after severe and extremely severe stroke. The Neurological Journal. 2012; (2): 10-14. Russian (Сидякин И.В., Царенко С.В., Добрушина О.Р. и др. Прогностическая модель оценки летальности и функционального восстановления после тяжелого и крайне тяжелого инсульта //Неврологический журнал. 2012. № 2. С. 10-14)
Peganova MA, Chechenin AG, Vereshchagin MA, Peganov AI, Pisareva IA, Bondarenko NA. Successful experience of thrombectomy in postpartum period. Far Eastern Medical Journal. 2019; (1): 91-93. Russian (Пеганова М.А., Чеченин А.Г., Верещагин М.А., Пеганов А.И., Писарева И.А., Бондаренко Н.А. Успешный опыт тромбэктомии при окклюзии левой позвоночной артерии у женщины в послеродовом периоде //Дальневосточный медицинский журнал. 2019. № 1. С. 91-93)
Peganova MA, Peganov AI, Vereshagin MA, Bondarenko NA, Chechenin AG. Experience of endovascular treatment in the regional stroke center of Novokuznetsk. Journal of neurology and psychiatry. Materials of the Congress. 2019; (119): 572. Russian (Пеганова М.А., Пеганов А.И., Верещагин М.А., Бондаренко Н.А., Чеченин А.Г. Опыт эндоваскулярного лечения в региональном сосудистом центре города Новокузнецка //Журнал неврологии и психиатрии. Матер. 11-го Всерос. съезда неврологов. 2019. Т. 119. С. 572)
Serebrova EV, Usova NN. Sleep apnea syndrome in patients with acute stroke. Meditsinskie novosti. 2018; (3): 14-18. Russian (Сереброва Е.В., Усова Н.Н. Синдром апноэ сна у пациентов с острыми нарушениями мозгового кровообращения //Медицинские новости. 2018. № 3. С. 14-18)