NEURO CRITICAL CARE MEDICINE- CASE OF THE MONTH
51 YR/ Male, Acromegaly patient, with Growth Hormone secreting pituitary Macro-adenoma, presented with history of difficulty in walking, and difficulty in turning in bed with Left Vocal Cord Palsy of 3 months’ duration underwent Craniotomy and decompression on 1st February 2013.
Other associated co morbid conditions: are Diabetes Mellitus, Hypothyroidism, Hypocortisolism.
Past history of Cervical and upper dorsal canal stenosis and nearly paraplegic due to D1-D2 IDEM for which he underwent Laminectomy and excision under GA on 18th September 2012.
Post operatively (after craniotomy) he developed pancreatitis: (Acute pancreatitis: confirmed by CT Abdomen on 07/02/13 and also Ranson criteria) improved with conservative management.
He went through Septicemia which required Vasopressor and Inotropic support with multiple courses of antibiotics.
Large Pneumothorax needed ICD drainage.
Developed BRADYCARDIA (etiology is obscure) managed with oral orciprenaline.
Totally he has an ICU stay of 77 days with prolonged ventilatory support with percutaneous tracheostomy.
With good nursing care in NICU he improved and did not develop any bed sores.
Presently he is ambulant with support, breathing on his own, maintaining stable vitals and discharged to Post Op Ward.
Kindly add the dscussion part which happended while managing this case. also why he had all these trend of events? investigations preop and post op, if it can be furnished... Pneumothorax was spontaneous or iatrogenic??
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