Tatalaksana Cerebral Venous Sinus Thrombosis dengan Alkoholik dan Perdarahan Intraserebral

Abstract

Cerebral venous sinus thrombosis (CVST) adalah suatu sindrom seperti stroke, angka kejadiannya sangat jarang, sehingga dapat menjadi dilema bagi dokter di instalasi gawat darurat dalam menegakkan diagnosis. Seorang lelaki 25 tahun, 50 kg, tinggi badan 165 cm, mengeluh lemah anggota badan sebelah kanan sejak 12 jam sebelum masuk rumah sakit. Keluhan disertai dengan sukar berbicara. Satu hari sebelum masuk rumah sakit, pasien mabuk-mabukan dan mengalami muntah-muntah ± 3–5 x/hari. Riwayat kejang, konsumsi obat-obatan dan trauma sebelumnya disangkal. Tidak ada riwayat demam, hipertensi, diabetes mellitus dan penyakit penyerta lainnya. Dilakukan dekompresi evakuasi perdarahan sebagai tindakan penyelamatan jiwa setelah pasien terehidrasi, operasi dilakukan dalam anestesi umum. Lama operasi selama 2 jam dan lama pasien teranestesi 2 jam 15 menit. Pasien dirawat di ICU selama 2 hari, lalu dipindahkan ke ruang HCU. Pada hari ke-5 pascabedah mulai diberikan enoxaparin sodium 50 mg subcutan selama 6 hari. Lalu pasien dipindahkan ke ruang rawat inap dan pulang ke rumah pada hari ke-15 perawatan. Target pencapaian utama pada pasien CVST adalah untuk rekanalisasi penyumbatan, menjaga venous return, mengurangi risiko hipertensi vena, infark serebral dan emboli paru. Algoritma tatalaksana pasien CVST terkadang harus disesuaikan dengan kondisi klinis pasien saat tiba di rumah sakit. Pemberian low-weightmoleculer heparin (LWMH) tetap diberikan selama tidak terjadi peningkatan tekanan darah yang bermakna

Cerebral Venous Sinus Thrombosis Management with Alkoholic and Intracerebral Hemorrhage

Cerebral venous sinus thrombosis (CVST) is a syndrome similar a stroke, the incidence is very rare, so it can be a dilemma for doctors at emergency departments to make the diagnosis. A 25 year old male weighing 50 kg and height 165 cm. Patients complained of right limb wekness since 12 hours before admission. Complaints are accompanied by difficulty speaking. One day before entering the hospital, the patient got drunk and experienced vomiting ± 3–5 times a day. History of seizures, previous consumption of drugs and trauma was denied. No history of fever, hypertension, diabetes mellitus and other comorbidities. Decompression by hematoma evacuation was performed as a life-saving action after the patient was hydrated, surgery was performed under general anesthesia. Operation duration was 2 hours and anesthesia duration was 2 hours 15 minutes. The patient was admitted to the ICU for 2 days, then transferred to the HCU room. On the 5th day post-surgery patient got 50 mg subcutaneous enoxaparin for 6 days. Then the patient was transferred to the ward and returned home on the 15th day of treatment. The main achievement targets in CVST patients were for clotting recanalization, maintaining venous return, reducing the risk of venous hypertension, cerebral infarction and pulmonary embolism. The CVST patient management algorithm sometimes has to be adjusted to the patient's clinical condition upon arrival at the hospital. Provision of LWMH is still given as long as the blood pressure does not increase significantly.