ANALYSIS OF THE CLINICAL CASE OF SEVERE STROKE IN A PATIENT WITH ADVERSE PROGNOSTIC FACTOR

• Main Authors: Марина Анатольевна Пеганова, Елена Алексеевна Полукарова, Сергей Николаевич Филимонов, Светлана Станиславовна Зиборова, Александра Константиновна Волкова, Василий Николаевич Узун
• Format: Article
• Language: Russian
• Published: The Publishing House Medicine and Enlightenment 2021-06-01
• Series: Medicina v Kuzbasse
• Subjects: ишемический инсульт; факторы риска; неблагоприятный прогноз; фибрилляция предсердий; синдром апноэ во сне
• Online Access: https://mednauki.ru/index.php/MK/article/view/588

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.