경부청소술 마취 후 발생한 뇌경색: 증례보고
Postanesthetic Cerebral Infarction Following Neck Dissection
박창주, 이종호, 김명진, 김현정, 염광원,
소속 상세정보
박창주 ( Park Chang-Joo ) - 서울대학교 치과대학 치과마취과학교실
이종호 ( Lee Jong-Ho ) - 서울대학교 치과대학 구강악안면외과학교실
김명진 ( Kim Myung-Jin ) - 서울대학교 치과대학 구강악안면외과학교실
김현정 ( Kim Hyun-Jeong ) - 서울대학교 치과대학 치과마취과학교실
염광원 ( Yeom Kwang-Won ) - 서울대학교 치과대학 치과마취과학교실
KMID : 0980220030030010034
Abstract
Postoperative stroke is uncommon even in elderly patients, who have a higher incidence of all types of postoperative complications. The mechanism of postoperative stroke is not certain, but can be explained by intravascular clottings originated from thrombus or embolus or by intracranial hemorrhage.
In a 66-year-old male patient with current hypertension medication, who underwent both neck dissection for malignancy metastasis under general anesthesia, the left hemiparesis and delayed emergency were found postoperatively. After transferred to intensive care unit, he got the thrombolytic therapy and then the therapies to decrease the swelling of the brain on the diagnosis of cerebral infarction in the vascular distribution of the middle cerebral artery. A brain MRI definitely showed the midline deviation to the left of the right brain hemisphere due to the progressing edematous changes. As he got worse, the emergency neurosurgical operation was proposed but rejected by his family. He died at postoperative 3 days.
In the hypertensive patient. perioperative stroke could be originated from the surgical stimuli on major vessels, which were inevitable in neck dissection during the operation. We report this case of the postoperative stroke, which could be highly possible to be associated with extensive head and neck surgery.
키워드
Brain; Cerebral infarction; Neck dissection; Postoperative complications
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