South Clin Ist Euras. 2009; 20(3): 146-150

Diyaliz ile örtüþen serebrovasküler hastalýklarda tedavi güçlükleri: Olgu sunumu

Fazilet Hýz, Meral Çýnar, Leman Erkutlu, Ülgen Kökeþ, Turgut Karagöl
Taksim Eðitim ve Araþtýrma Hastanesi, Nöroloji Kliniði, Ýstanbul

Hemodiyaliz uygulanan olgularda serebral iskemi, vaskülit, subaraknoid kanama, subdural ve intraserebral hematom gibi nörolojik tablolar görülebilir. Bu durumlarda tedavi güçlükleri geliþebilir. Serebral kanamalý olgularda, hemodiyaliz esnasýnda verilen heparin kanama riskini artýrabileceðinden heparinsiz hemodiyaliz yöntemleri önem kazanýr. Kronik böbrek yetmezliði olan, 59 yaþýnda erkek hasta, 2 yýl süreyle haftada 3 seans, her bir seansý 4 saat süren hemodiyaliz tedavisi görmekteydi. Putaminal hematom sonucu akut geliþen sað hemiparezi tablosu ile kliniðimize yatýrýldý. Kanama nedeni ile hemodiyalizi heparinsiz uygulandý. Ýki hafta sonra, serebral iskemiye baðlý þuur bulanýklýðý ve sol bacakta parezi geliþti. Olgu, hemodiyaliz sürecinde geliþen serebral
iskemi ve hematom birlikteliðinde tedavi protokolünde yaþanan zorluklar nedeni ile sunuldu.

Anahtar Kelimeler: Diyaliz, kronik böbrek yetmezliði, serebral hematom, serebral iskemi

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The difficulties of treatment that developed at cerebrovascular diseases related of dialysis: Case report

Fazilet Hýz, Meral Çýnar, Leman Erkutlu, Ülgen Kökeþ, Turgut Karagöl
Taksim Training and Research Hospital, Department of Neurology, Ýstanbul,Turkey

The neurolojical states as cerebral ischemia, vasculitis, subarachnoid hemorrhage, subdural and intracerebral hematoma can be seen in cases with hemodialysis. Difficulties of treatment can be developed in these states. Hemodialysis with heparin can be increased risk of bleeding in the cases with cerebral hematoma. The patient was 59-year-old man with chronic renal failure. He has been treated by hemodialysis three times per week since two years. Each of session of dialysis was four hours. He was hospitalized with developed acute right hemiparesis due to putaminal hematoma. The hemodialysis was continued without heparin due to hemorrahage. On second week of his hospitalization, the left leg paresia and confusion due to the cerebral ischemia was occured. This patient presented in order to emphasize the difficulties in treatment protocols due to the cerebral ischemia and hematoma can be developed in course of hemodialysis.

Keywords: Dialysis, chronic renal failure, cerebral hematoma, cerebral ischemia

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ATIF KOPYALA