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Serebrovasküler Hastalık Öyküsü Olan Bir Olgu: Tekrarlayan İnme mi Psödonörolojik Bir Tablo mu?
A Case with a History of Cerebrovascular Disease: Recurrent Stroke or a Pseudoneurological Dysorder?
Received Date : 18 Aug 2021
Accepted Date : 16 Oct 2021
Available Online : 01 Nov 2021
Doi: 10.31609/jpmrs.2021-84678 - Makale Dili: TR
J PMR Sci. 2022;25(1):127-32
ÖZET
İnme ile psödonörolojik tabloların ayırt edilmesi her zaman kolay değildir. Altmış beş yaşında kadın hastaya, Ankara Üniversitesi Tıp Fakültesi Fiziksel Tıp ve Rehabilitasyon Kliniği’nde osteoartrit tanısıyla fizik tedavi ve rehabilitasyon programı başlatıldı. Taburcu edilme zamanı söylendikten bir süre sonra aniden konuşamama ve vücudunun sol tarafında kuvvet kaybı gelişti. Öncelikle, özgeçmişinde hipertansiyon, diyabet, sağ orta serebral arter bifurkasyonunda anevrizma, sağ vertebral arterde oklüzyon ve sekel bırakmadan geçirilmiş bir şüpheli inme öyküsü nedeniyle inme tanısı düşünüldü. Nöroloji konsültasyonuyla tanısal süreç başlatıldı. Bu sırada öz geçmişi daha detaylı incelendiğinde, 7-8 yıldır tekrarlayıcı depresyon ve yaygın anksiyete bozukluğu tanılarıyla tedavi gördüğü öğrenildi. Ayrıca hastanın muayenesinde, psödonörolojik tablo lehine bazı ipuçları bulunması nedeniyle psikiyatri kliniğine de konsülte edildi. Hastaya mevcut bulgularıyla konversiyon bozukluğu, karışık anksiyete ve depresif bozukluk tanısı konuldu. İnmeden ayırt edilmesi güç olan bu tür konversif bozukluğun tedavisinde, multidisipliner yaklaşımla iş birliği içerisinde sürecin yönetilmesi gerekmektedir. Bu olgu sunumu, inmeyle psödonörolojik bir tablonun ayırıcı tanısında yaşanan güçlükleri ve multidisipliner yaklaşımın önemini tartışmak amacıyla hazırlanmıştır.
ABSTRACT
l picture. A physical therapy and rehabilitation program was initiated for 65-year-old female patient with the diagnosis of osteoarthritis in the Ankara University Faculty of Medicine Physical Medicine and Rehabilitation Clinic. Just after being told about the time of discharge, the patient was suddenly unable to speak and lost strength on her left side. First of all, stroke diagnosis was considered due to the history of hypertension, diabetes, cranial aneurysm, occlusion of the right vertebral artery and a previous stroke without sequelae. The diagnostic process was initiated with neurology consultation. In the meantime, when the history of the patient was asked in more detail, it was learned that she had received depression and anxiety disorder treatment for 7-8 years. In addition, she was consulted to the psychiatry clinic due to some clues in favor of the pseudoneurological picture during the examination of the patient. Based on her current findings, the patient was diagnosed with conversion disorder and depression with anxiety. In the treatment of this form of conversion disorder, which is difficult to distinguish from stroke, the process should be managed in cooperation with a multidisciplinary approach. This case report is prepared to discuss the difficulties in the differential diagnosis of stroke and a pseudoneurological picture and the importance of a multidisciplinary approach.
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