感染性動脈瘤導致腦出血之個案報告─應用「國際功能、失能和健康分類模式」分析

A Case Report of Cerebral Hemorrhage due to Mycotic Aneurysm-Application of International Classification of Functioning, Disability and Health (ICF) Model

李詩瑋(Shih-Wei Li) ； 吳彥霖(Yan- Lin Wu) ； 嚴筱晴(Hsiao-Ching Yen)

《物理治療》 37卷1期 (2012/03) Pp. 74-81

摘要

感染性動脈瘤是一種不常見的動脈瘤型態，這是種經由細菌感染動脈血管管壁造成局部且不可逆的血管擴張，其擴張幅度至少為原先血管管徑的1至1.5倍。因感染性動脈瘤而導致腦出血的個案在臨床上非常少見，其出院目標及預後的訂定是否類似於一般腦出血個案則較少被討論。本篇中的個案是位25歲男性，於2011年1月8日進行心臟超音波檢查，結果發現主動脈狹窄併有囊腫而接受二尖瓣置換手術。於同年1月20日，個案抱怨在枕葉處突然出現強烈頭痛並有右側偏癱的情形，腦部電腦斷層掃瞄顯示其左側額－顳－頂－枕葉發生顱內出血、蜘蛛腦膜下出血以及腦室出血情況，並立刻接受緊急左額顳頂葉開顱手術，2011年2月22日開始進行物理治療療程。本篇使用「個案處理模式與國際功能、失能和健康分類模式」分析後，發現其右側肢體肌力普遍不足，造成患側無法良好承重及維持平衡，影響行走與部分功能的執行。根據過去文獻研究報告指出，類似個案在動作部份的進步幅度較大，但出院後仍須在監督下才能執行日常生活功能的比例高，而研究也指出與個案相似且生活可獨立者，其認知能力仍會殘留缺失。因此，在評估個案功能及參考相關文獻研究後，為本個案訂立出院目標及其預後。

關鍵字

腦出血 ； 個案處理模式 ； 感染性動脈瘤 ； 預後

並列摘要

Mycotic aneurysm is a kind of uncommon aneurysm which is defined as a localized, irreversible dilatation of an artery to at least one and one-half times of its normal diameter due to destruction of the vessel wall by infection. Cerebral hemorrhage due to mycotic aneurysm is very rare in clinics. No literature has been reported as whether the goal at discharge or prognosis for this kind of patients is similar to patients with cerebral hemorrhage. Our reported case is a 25-year-old male who had Cardiac echo examination on 2011/1/8, and aortic valve thickening and perivalvular abscess were found. He then received surgical intervention at National Taiwan University Hospital. Severe headache localized at occipital area with right hemiplegia was complained on 2011/1/20. CT revealed large area of intracerebral hemorrhage, intraventricular hemorrhage and subarachnoid hemorrhage at left fronto-temporo-parietal-occipital area. Emergent left fronto-temporo-parietal craniectomy for hematoma evacuation was performed, and physical therapy was started on 2011/2/22. With client management model and ICF model analyses, we found that patient's body dysfunction was the key component related to his limited capacity. Due to weakness of right limbs, patient was not able to take weight and maintain balance with his affected side. Researcher reported greater motor progress in similar cases, although most of them still need supervision at discharge. Cases being categorized as independent still had cognitive impairment. Therefore, we would set our goal at discharge and predict patient's prognosis after evaluation and the literature report.

並列關鍵字

Cerebral hemorrhage ； Client management model ； Mycotic aneurysm ； Prognosis