麻醉後發現的常壓性水腦症之病例報告

Normal Pressure Hydrocephalus Found after Anesthesia-- A Case Report

常壓性水腦症以臨床上逐漸發生的三個主要症狀：包括步態不穩，失智症，以及尿失禁為主要特徵。至於噁心，嘔吐，以及顱內高壓常見的症狀並不會發生。此七十一歲的男性病患是因為右膝退化性關節炎而預採全膝關節置換術，住院時的理學檢查除了輕微健忘外並未發現有任何神經學上的症狀。然而因為作業上的疏失，麻醉人員直到為這位病患上完全身麻醉後才被告知手術取消，不過病患在麻醉後甦醒良好。但是第二天早上患者卻呈現嗜睡及尿失禁，經一連串檢查後由電腦斷層診斷為常壓性水腦症。所以他再度被送入開刀房施行腦室腹膜分流術。術後病人神智恢復良好。由此病例，我們應該知道在每天處理的病患中，可能隱藏著常壓性水腦症的病人。醫護人員應警覺在病患出現步態不穩，失智，以及尿失禁的徵兆時能想到常壓性水腦症的可能性。

Normal pressure hydrocephalus (NPH) is characterized by insidious onset and gradual development of the triad of gait disturbance, dementia, and urinary incontinence. Nausea, vomiting, and signs of increased intracranial pressure do not occur. A 71-year-old male patient was scheduled for total knee replacement due to osteoarthritis of right knee joint. No neurological symptoms and signs except mild forgetfulness were detected during physical examination following admission. Due to operational mistakes, the anesthesiologist was informed that the surgery was cancelled just after completion of induction of general anesthesia. The patient was allowed to emerge from anesthesia. Unfortunately, his consciousness became drowsy the next morning. After a series of examinations, he was at last diagnosed as a case of NPH principally by the brain computed tomography scan. So he was scheduled again but this time for vetriculoperitoneal (V-P) shunt. The patient regained consciousness after V-P shunt. From this case, we learned that NPH may remain in concealment in the patients we contacted in our daily practice. A vigilant physician should keep in mind that the presentation of gait disturbance, dementia, and urinary incontinence in a patient may indicate the likelihood of NPH.