Hidrocefalus – prikaz slučaja
Sažetak
Hidrocefalus je patološko stanje sa mnogim varijacijama, koje se uvek karakteriše povećanjem cerebrospinalne tečnosti, koja jeste ili je bila pod povećanim pritiskom, a može se javiti u bilo kom uzrastu. Prezentuje se kao različita neurološka i psihijatrijska stanja. Najvažniji simptomi kod odraslih osoba su: vrtoglavica, kognitivni pad, demencija, apraksija hoda, problemi sa kontrolom bešike.
U ovom radu prikazan je slučaj starije osobe sa hidrocefalusom. Pacijent muškog pola, starosti 74 godine, javio se lekaru Doma zdravlja zbog vrtoglavica, nestabilnosti pri hodu i nesigurnosti pri penjanju uz stepenice. Prisutna je i zaboravnost, loša koncentracija, slabija kontrola mokrenja. Orijentacioni neurološki pregled pokazao je: hod na širokoj osnovi, sa pozitivnim Rombergovim znakom pri zatvorenim očima. Upućen je neurologu sa upitnom dijagnozom vertiginozni sindrom R42.0. Nakon neurološkog i radioloških pregleda potvrđena je dijagnoza komunikantnog, normotenzivnog hidrocefalusa i pacijent je operisan neurohirurškom intervencijom.
Terapijski pristup ovom stanju, u zavisnosti od uzrasta, kliničkog nalaza i komorbiditeta, određuje se individualno za svakog pacijenta. Hirurgija zauzima glavno mesto u terapiji, jer se ugradnjom šanta, postiže brza redukcija simptoma.
Uloga izabranog lekara je da, na osnovu anamnestičkih podataka, kliničkog pregleda shodno dijagnostičkom algoritmu, sprovede sve aspekte lečenja i nege, kako bi bio unapređen funkcionalni status i kvalitet života ovih pacijenata i njihovih porodica.
Reference
Kostić V. Neurologija za studente medicine. Beograd: Medicinski fakultet Univerziteta u Beogradu; 2020.
Stevović V, Dragovć M. Hirurgija za studente i lekare. Beograd: Savremena administracija; 2000.
Saratlić V, Ivanišević V. Causes, classification, diagnostics and treatment of hydrocephalus. Biomedicinska istraživanja 2019; 10(2): 202–8.
Bogaczyk V, Fleck S, Berneiser J, Opolka M, Vollmer M, Baldauf J, Gasch CM, Lemke EM, El Refaee E, Matthes M, Hirschfeld H, Lauffer H, Gaab M, Schroeder H, Marx S. Long-term quality of life after ETV or ETV with consecutive VP shunt placement in hydrocephalic pediatric patients. Childs Nerv Syst 2022; 38(10): 1885-94. Erratum in: Childs Nerv Syst. 2022; 38(10): 1895.
Naumović N, Slankamenac P, Filipović D, Ivetić V, Todorović ST, Bosković K. [Effects of calcium antagonists on brain ischemia]. Med Pregl 2011; 64(5-6): 257-61. Serbian.
Tullberg M, Toma AK, Yamada S, Laurell K, Miyajima M, Watkins LD, Wikkelsø C. Classification of Chronic Hydrocephalus in Adults: A Systematic Review and Analysis. World Neurosurg 2024; 83: 113-22.
Kalevski S, Peev N. Syndrome of hydrocephalus in young and middle-aged adults. Review of the literature and illustrative cases. Sanamed 2015; 10(1): 37–45.
Möhwald K, Wuehr M, Decker J, Asch EM, Schenkel F, Illigens B, Schniepp R. Quantification of pathological gait parameter thresholds of idiopathic normal pressure hydrocephalus patients in clinical gait analysis. Sci Rep 2022; 12(1): 18295.
Schniepp R, Möhwald K, Wuehr M. Key gait findings for diagnosing three syndromic categories of dynamic instability in patients with balance disorders. J Neurol 2020; 267(Suppl 1): 301-8.
Pauwels S, Casters L, Lemkens N, Lemmens W, Meijer K, Meyns P, van de Berg R, Spildooren J. Gait and Falls in Benign Paroxysmal Positional Vertigo: A Systematic Review and Meta-analysis. J Neurol Phys Ther 2023; 47(3): 127-38.
Thorlacius-Ussing G, Frederiksen KS, Holst AV, Juhler M, Hasselbalch SG. [Diagnosis and treatment of normal pressure hydrocephalus]. Ugeskr Laeger 2020; 182(19): V12190710. Danish.
Veen E, Nieboer D, Kompanje EJO, Citerio G, Stocchetti N, Gommers D, Menon DK, Ercole A, Maas AIR, Lingsma HF, van der Jagt M. Comparative Effectiveness of Mannitol Versus Hypertonic Saline in Patients with Traumatic Brain Injury: A CENTER-TBI Study. J Neurotrauma 2023; 40(13-14): 1352-65.
Fowler JB, De Jesus O, Mesfin FB. Ventriculoperitoneal Shunt. 2023 Aug 23. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 29083724.
Grasso G, Torregrossa F. The impact of cerebrospinal fluid shunting on quality of life in idiopathic normal pressure hydrocephalus: a long-term analysis. Neurosurg Focus 2023; 54(4): E7.
Pillai SV. Techniques and Nuances in Ventriculoperitoneal Shunt Surgery. Neurol India 2021; 69(Supplement): S471-S475.
Stojanović-Jovanović B, Tripković V, Zdravstvena nega odojčeta sa hidrocefalusom, Sestrinski žurnal 2016; 3(1): 17.
Yang YN, Zhang J, Gu Z, Song YL. The risk of intracranial infection in adults with hydrocephalus after ventriculoperitoneal shunt surgery: A retrospective study. Int Wound J 2020; 17(3): 722-8.
Nakajima M, Hara T, Miyajima M, Akiba C, Kawamura K, Sugano H, Tange Y, Shimoji K, Karagiozov K, Arai H. Shunt Malfunction and Calcification of Abdominal Fascia Tissue Resulting in Obstruction of Abdominal Catheter. World Neurosurg 2019; 126: 96-98.
Kankam SB, Karami S, Nejat A, Meybodi KT, Habibi Z, Nejat F. Odd presentation of shunt malfunction: a case series and review of literature. Childs Nerv Syst 2023; 39(9): 2479-85.
Walther LE, Blödow A. Aktuelle Aspekte zu Gleichgewichtsstörungen im fortgeschrittenen Lebensalter [Current aspects of vertigo and dizziness in advanced age]. HNO. 2020 Mar;68(3):191-198. German.
Osmanspahic A, Despotovic M, Hadzivuković N, Pavlovic J, Matovic S, Zivanovic S, Zlatanovic M, Despotovic M, Kucurski Lj. Quality of life of users of long-term health care. PONS Med J 2023; 20(2): 52-8.
Lima MG, Barros MB, César CL, Goldbaum M, Carandina L, Ciconelli RM. Health related quality of life among the elderly: a population-based study using SF-36 survey. Cad Saude Publica 2009; 25(10): 2159-67.
Canković S, Nikolić EA, Jovanović VM, Kvrgić S, Harhaji S, Radić I. Quality of life of elderly people living in a retirement home. Vojnosanit Pregl 2016; 73(1): 42-6.