602
KAZUISTIKA4321200011157120176236269319376408468532
/4878200011133
CASE4936200011155117168223
REPORT5184200011157113168230289344
Intracranial2819320097196491117157193220260304324363382
hypotension32183200974481128174201241286318337382427
in36623200971863
a374232009739
young37983200973781126171217
male403232009767106125166
patient42153200974685112131172217244
associated44763200973870102147184203242269309355
with48483200975979106151
shoulder50163200973176121166185231272299
injury5332320097196483128154195
|5584190011126
245565419001114293141
/23648040010732
Anest24418040010752100145178207
intenziv266880400107196794136184221240282
Med.29698040010770115165181
2024;35(4):245-2473169804001074487129169183227269291332354368413453494522560600641
/38558040010731
ANESTEZIOLOGIE39528040010753112155200245290342362425467527586607650
A46248040010753
INTENZIVNÍ4698804001071978123168227276296345405426
MEDICÍNA51458040010770114174195248268327381
www.aimjournal.cz4258040010765133201214257275349367415463490539579598614654693
https://doi.org/10.36290/aim.2024.042420843009543679513916918321423644414300984692114455543009514578112515447084300984383102148191234277321347386408476496542585627670690733778820
Intracranial4259100305792253204385616747919141062114312691350
hypotension182591003051412604055346317538961003108112071350
in3225910030575222
a34989100305120
young36699100305119245386532655
male43759100305201327407524
patient42511700305136259354433550692787
associated12631170030512022933746658266078688110031142
with245611700305180262357503
shoulder300911700305103248374515593730847962
injury40211170030575222293432550678
Kalina4251560014974137170202272335
M.1,2,3,78415600149102135910157008739559611615710681560014931
Černý11231560014972133179249309
V.1,2,4,51456156001497610015481570087395596117157177218
1Charles4251780071304531780012158113161193217267307
University,7811780012165120143191240273313336369419435
Faculty1238178001214893137192216249298
of1558178001215584
Medicine16631780012180131188212256279334385
in2069178001212379
Hradec2169178001216598146203253299
Králové,2489178001215488137160216263312332
Czech28421780012158103153198253
Republic31171780012153104161216273297320365
2Department4251910071304561910012167118175223256292375425481513
of991191001215584
Anaesthesiology,10961910012161116164215254288343394433456511535590647695711
Perioperative18281910012153102134158213270321354403435458506555
and24051910012148103160
Intensive2586191001212479112161217256278327376
Care29831910012158107139189
Medicine,31931910012180131188212256279335385405
J.3619191001213757
E.3697191001214971
Purkinje37901910012153107139187211267290340
University,41511910012165120143191241273314337370420436
Masaryk46081910012180129168217249300347
Hospital49771910012165120160216240273322345
in5343191001212479
Usti4682040012165103137160
nad6492040012156104160
Labem,830204001214897154205288309
Czech11602040012158103153199254
Republic14352040012154104161217274298321365
3Department4252170071304562170012167118175223256292375425481513
of991217001215584
Anaesthesiology,10962170012161116164215254288343394433456511535590647695711
Resuscitation18282170012154104144198237282305339387420443498554
and24032170012148103160
Intensive2584217001212479112161217256279327376
Care,29812170012158107139189209
Děčín32112170012167117163186241
Hospital,34732170012165121160217240273322346366
Czech38602170012158103153199254
Republic41352170012154104161217273298321365
4Department4252300071304562300012167118175223256292375426481514
of991230001215584
Anaesthesia,10962300012161116164215254288343394433456504525
Pain16422300012153101124179
Management18422300012180129184232288339422473528561
and24242300012148103160
Perioperative26052300012153102135158213270321354403435458507556
Medicine,31822300012180131188212256279335385405
Dalhousie36082300012167115138193248303343366416
University,40452300012165120143191240273313336369419435
Halifax,45012300012166114138161190239286309
Canada48312300012158106161209266314
5Department4252430071304552430012167118175223256292375425481513
of990243001215584
Anaesthesia10952430012161116164215254288343394433456504
and16202430012148104160
Intensive1801243001212480112161217256279327376
Care21982430012158107139189
Medicine,24082430012181132189212257280335385405
Charles28342430012158113161194217268307
University31632430012164119142191240273313336369419
in3603243001212379
Prague,3703243001215385133189244294314
Third40382430012150106130162218
Faculty4277243001214993138193216249299
of4597243001215584
Medicine,47032430012180131188211256279334385405
Prague,5129243001215385133189244294314
Czech4682560012158103153198253
Republic7432560012153104161216273297320365
Intracranial425296001212480114147197242276325382406455479
hypotension9252960012155102160217251302358398422478535
is1481296001212363
a15652960012148
rare1634296001213282115166
condition1821296001214599156214238272296352409
with2250296001217499133189
a24602960012148
wide2529296001217398155207
range2756296001213383139196247
of3024296001215585
symptoms.3130296001213989174231266321405445468
Typically,3618296001215092151175221271295319368385
it4024296001212357
is4102296001212363
characterized41862960012145101150183233279315365399424467518577
by47832960012157105
postural49082960012157114154189245279328353
headaches,52812960012156107156214425310001214894150201242264
rarely711310001213382116166191240
by9733100012157104
coma.1099310001214599184233255
Severe13763100012150101150200234284
cases1682310001214595135186227
can1931310001214594151
be21033100012157109
life‑threatening.223431000121244878129163198254287338387421471528552608665687
In2943310001212480
most30453100012183140180215
cases,3282310001214494134186226248
intracranial3552310001212480113147196242275325381405454479
hypotension40523100012156102161218252302359399423479535
is4609310001212464
caused4695310001214594150190242300
by50173100012157104
repeated5143310001213383142194243276326385
lumbar425324001212378160217265298
punctures7423240012156111166211246301333383422
or1183324001215487
is1289324001212362
spontaneous.1370324001213995151206238287342392448503542564
Here,19523240012165115148198218
we21893240012172121
present2329324001215689139178229284316
a26643240012148
case2730324001214493132182
in2931324001212378
which30283240012172128151196251
intracranial3297324001212378111143192236269317372395443467
hypotension37823240012155101158214246296351390413468523
was43243240012172121160
associated4502324001214887126181227250297330379436
with4957324001217296129184
shoulder5160324001213994149204227284334367
injury425338001212380104160193245
and6933380012148104162
brachial878338001215791140186242266315340
plexus1241338001215782133181238278
injury.1542338001212480104160193245262
Key4253540012461113164
words:6103540012475133171232276302
brachial933355001215790138183238261309333
plexus1287355001215781131178234273
injury,1581355001212479102157189240256
coma,1858355001214599182230251
cerebrospinal2131355001214493126176233266321360416440495543567
fluid2719355001212955110133190
leakage,2930355001212474122169218274324344
overdrainage,32953550012155102152184241273322345400448504554574
intracranial3890355001212479111144192237270318373396444468
hypotension.43793550012156101159215247297352391414469525546
Intrakraniální4253790016643122172235300379443508588630697740818861
hypotenze13103790016677140218286338403479541605
u19393790016676
mladého203937900166110152219292355431498
muže256137900166110184246311
v28963790016665
souvislosti29853790016656125200264308365406473530582623
s36323790016656
poraněním37123790016675144205271350413490532645
ramene43813790016661127239302378440
Intrakraniální425400001212479111144192239273321376399447470525548
hypotenze9914000012156101159214247296352395445
je1454400001212474
relativně1546400001213382106154186209258314364
vzácná1928400001214893142187242290
jednotka2236400001212474132187242274321370
projevující2624400001215790144168218265321345368412435
se3077400001213990
širokou318540000121396294149196250305
škálou3508400001213986135158213268
příznaků.3794400001215790113156211259306361381
Typicky4193400001215091148172216263313
je4524400001212474
charakterizována46164000012145100148180229275311360393416459514561609664712
posturálními53464000012157112152425414001213388121169192248271354377
bolestmi8204140012157113137187227261344367
hlavy,1205414001215679127174224240
vzácně1463414001214893143188243294
též1775414001213382125
kómatem.19184140012147101185233265315398419
Těžké2355414001215098141188237
případy2610414001215790113170219275323
mohou29514140012183139194249305
být32744140012157103139
život3432414001214266114168201
ohrožující.36514140012155111143198240295319342386409430
Ve40994140012156102
většině4220414001214897130170193249299
případů4537414001215790113170219275330
je4885414001212475
intrakraniální4978414001212378111143192238273321376399447471526549
hypotenze4254280012156102160217250300357400451
způsobena9054280012143100156196252310361418466
opakovanými14004280012155113163210264312361417463548572
lumbálními2001428001212379163220270294349373457481
punkcemi25104280012158114170217262311396419
nebo29584280012156107165221
je3208428001212575
spontánní.3312428001214097154210243293349404428449
V37904280012156
této3875428001213383117172
kazuistice4076428001214797141196220260294317363412
popisujeme45174280012158114172196236291315366450501
případ,5047428001215891115172222279300
kdy53764280012147103151
intrakraniální425442001212379111143192239273321377400448471526549
hypotenze9954420012156101159215248297353396446
byla14624420012157103127175
spojena1659442001213996152175226281329
s20094420012140
traumatem2070442001213366114169252300333382466
ramene2557442001213381164215270321
s28994420012140
poraněním29604420012157113146194249300355378462
brachiálního3443442001215790138183238261309333388411468523
plexu.3987442001215781131179234255
Klíčová425458001246190118163221273326
slova:771458001244472131183236261
brachiální1053459001215790138183238261309333388411
plexus,1485459001215781131179234273294
kóma,18014590012146100184232253
intrakraniální2075459001212479111144192239273322377400448471526549
hypotenze,26464590012155101158214247296352395445465
únik31324590012155111134180
mozkomíšního33334590012184139181228282365388429485508565620
moku.39744590012184139186241262
Introduction4255060015340115166227293365436493547587653726
Intracranial42552400107196692119160200226267314332372390
hypotension831524001074886136184211253300333351398446
(IH)129352400107244297120
is1429524001071951
a14965240010741
rare155352400107266793135
condition1704524001074086134182201228247294342
characterized2062524001074087127153194234264305331350386428478
by2556524001074988
a26605240010740
spectrum2716524001073482126167425538001072855103177
of627538001074872
neurological725538001074893140167214233282332350391432451
symptoms,1202538001073475149199226273347380396
including1624538001071967107126174223242289339
postural1989538001074999132161209235277296
headaches2311538001074892132182223263311355389
or,272653800107487587
in2838538001071967
very425552001074184110153
rare59655200107266894137
cases,750552001074182115160193209
coma.977552001074086160201217
Severe1212552001074286126170196239
cases1468552001074182115159193
are1678552001074168111
potentially1806552001075099126169217244262303322340380
life‑threatening.220355200107203862105134162210237280320347389438456504553569
It2790552001071946
is2854552001071951
typically425566001072769118136176216234252291
associated731566001074073105152192210249275317366
with1112566001076482110157
the1284566001072774117
spontaneous1417566001073381129176202242289332380427459
leakage1891566001071962101138179227270
of2176566001074770
cerebrospinal2262566001073981106148196222268301349367414453471
fluid274956600107234591109156
(CSF)425580001072473116156181
or623580001074875
is715580001071851
a7835800010741
sequela840580001073478128176220239279
to1136580001072875
repeated1227580001072770119164204231274324
lumbar1568580001071966139189231257
punctures1842580001074998146186216264291334367
[1–3].222658000109266911115617924035800010716
Notably,24355800010758106134175224244284296
over2747580001074888132158
the425594001072774117
past558594001074889121149
decade,722594001074991131172220263276
only1014594001074794112151
two1181594001072793139
documented1335594001074996136182254297344370411460
cases1810594001073980112155187
have2013594001074787125167
reported2196594001072668116164190220261310
intracranial252159400107186591117157196222262309327366384
hypotension425608001074784133181207248295326344390437
resulting877608001072667100145163190208254302
from119460800107234995167
trauma137660800107275293138210249
with1640608001076482109156
no1810608001074895
connection1919608001074085132178221261290308354401
to2335608001072772
postoperative2422608001074996129156201250293319359385402442484
CSF425622001075194134
leakage576622001071963103141183232276
[4].869622001092669939616220010716
To993622001074285
our1094622001074896123
best1233622001075095128157
knowledge,1407622001073888136201220264314363407422
other1845622001074875124168194
reported2056622001072669119168195225268318
cases2391622001074081114158192
involved2600622001071866105153172213256306
head425636001074893133183
or635636001074875
vertebrae736636001074185111143186235263305349
injury.111163600107196786134161204216
We13536360010775117
would14966360010765114162181231
like175363600107193876119
to1899636001072875
present2000636001075077120154199247274
a23016360010741
unique2368636001074897116165213257
case2652636001074082115160
in2838636001071967
which4256500010765114132172220
intracranial66765000107196794121162203229271319338378397
hypotension1086650001074887137186214256304337356404452
was15606500010765107140
associated1722650001074174107156197216256283325376
with2120650001076484112160
a23026500010741
shoulder2365650001073381130178197246290316
injury270365000107196786133159202
and425664001074189138
presented583664001075077120153198246272315365
solely968664001073382101145165205
as1192664001074175
a12866640010741
coma.1347664001074087161201218
Case4256880015377141195256
report7046880015359120190256316372
A4257060010753
24-year‑old497706001074483111151193232258281331349398
male9137060010773113131174
was11057060010765106138
admitted1261706001074189162180207237278327
to1606706001072874
a16987060010741
trauma175770600107275394141213253
centre2028706001074082129155181223
after226970600107406394135161
a24487060010741
motorcycle25077060010773121147193219257299337355399
accident425720001074180118136184227274300
involving740720001071865104150169209227274322
a10777200010741
collision1133720001074085104122139171188235283
with1430720001076583111158
a16037200010740
traffic165872000107285494117143162201
sign,187472000107345199146160
resulting2049720001072769101147165192210257305
in2369720001071966
a24497200010741
right250572000107274593140166
shoulder26857200010734811281751933047510001074992117
injury.317951000107196683129155197208
Initial340151000107196684111129168186
evaluation3602510001074383123141188227253271318366
by3982510001075088
emergency40855100010744116159185232275322361403
services4502510001073477102145164203244277
showed4794510001073380127191233282
a50915100010741
paralysis5147510001074990115156174213245263294
of5456510001074871
the3047524001072875118
right318152400107264493140166
arm3362524001074166140
only,3517524001074795113152163
and3695524001074188137
the3847524001072875118
patient3980524001075091117135178225251
was42465240010765105138
fully439952400107237189107146
conscious.4560524001074086134166206223271318350366
Upon49415240010756104153200
admission,5156524001074190162180212244262309357371
a30475380010740
whole‑body31025380010764111158176219246294341388426
computed3541538001074084155202248274314361
tomography3915538001072771143189236260299346393429
scan4356538001073372111156
(CT)4525538001072370113138
was46765380010764103134
performed,4822538001075092116141186210282324371385
revealing5219538001072667105146184200216262309
a30475520010740
single309955200107334994140156197
fracture330855200107244987125152197221261
of3581552001074769
the3661552001072873114
right378755200107264389134158
collarbone,3957552001074083100116154178225271317358370
with4339552001076480106151
no4502552001074793
signs460755200107334894139170
of4789552001074768
head4869552001074789126172
or5053552001074772
spine513755200107337995140181
injury.533055200107196480124148188197
Two31875660010742101149
hours3356566001074997145172206
later,358256600107196087130156168
the3770566001072876120
patient3911566001075091118137181229256
fell418756600107246787105
into431356600107186693140
a44735660010741
coma,4534566001074187161202218
necessitating4772566001074993134176210243262290331358377425474
intubation,526756600107196693141191232304758000107274592140155
sedation,3217580001073376125165191209256304318
and3551580001074087135
transfer370258000107275394141173197239265
to3983580001072773
the4071580001072875118
intensive420458000107196692133180212230270312
care4531580001074080106148
unit4694580001074894112139
(ICU).484958000107244192146169181
A50465800010752
subsequent5113580001073379128160203252298341388414
brain3047594001075077118137185
CT3253594001075196
scan3370594001073475116164
showed3555594001073481130195238288
diffuse386459400107496892119168201245
brain4130594001075077119137185
oedema4336594001074893143187261302
(see4659594001072355100144
Fig.4824594001074260110126
1).497159400107446174
Other5066594001076190138183209
conditions5296594001074087136185204304760800107284795143176
that3240608001072876117144
can3401608001074082130
lead3548608001071963103152
to3717608001072875
a38086080010741
coma,3866608001074087161202218
such4101608001073380121169
as4287608001074174
hypoglycaemia,4378608001074886137186236255295335376420494513553569
hyponatraemia,4964608001074886137186235276303329371415489507548563
seizures,304762200107347896133181208251284300
hypercapnia,3367622001074887137182209248289339387406446462
or3849622001074875
hypoxia,3943622001074987138187225244284300
were42636220010765108135178
ruled446162200107267593137188
out.4668622001074896124141
An31876360010753100
intracranial330863600107196692118159198224265312329369387
probe3716636001075076122171215
for395363600107237096
multimodal40706360010774121139166184256304353393411
monitoring45026360010774121169187214260286304351399
was49236360010765105138
inserted508263600107196698141167197238288
and5391636001074188136
intracranial304765000107196692118159199224265313330370388
pressure3460650001075076118151183230255298
(ICP)378265000107244293136158
was39646500010765106139
measured41276500010774118157190236261304353
at4505650001074167
-54596650001072770
mm46796500010774147
Hg48516500010756105
in4981650001071966
the5072650001072775118
drainage5215650001074975116133181221269313
position3047664001074996128144170188233280
with3341664001076481108154
the3508664001072874116
upper3638664001074794142185210
body3861664001074996144183
elevated4057664001074361103141181206247295
to4365664001072872
30°.4451664001074385111122
Brain4586664001074570109126172
oximetry4772664001074783101171214240265306
and5091664001074187134
pressure5239664001074974115146178223247288
reactivity3047678001072668107147176193233252279320
index3382678001071865113156195
were35916780010765107133175
monitored.37806780010774121168186213258284326375390
The4184678001074291134
position4332678001075098130147174192239286
of4633678001074770
the4718678001072875118
probe4850678001075076122170214
was50796780010765105137
checked5231678001074086129170206248297
using304769200107488097144193
a32586920010741
CT3318692001075196
brain3432692001075076117135182
scan.3632692001073474114161177
The3828692001074190134
patient3980692001075091117135178225251
remained4250692001072668141181199246289338
sedated4607692001073377126166192234283
and4909692001074088136
ventilated5064692001074183130156174192231258299348
for543169200107247097
483047706001074489
hours,3159706001074895143168202217
sustaining3399706001073380112140180198245262309358
stable3780706001073462102151170213
low4016706001071966130
ICP4169706001071970114
levels4306706001071962102144163194
between4523706001075094121188230274321
-5-486770600107276996
and4986706001074188137
2-5146706001074468
mm52377060010774147
Hg.54077060010757105120
Upon30477200010756104152200
cessation3261720001074081114146187213231277325
of3601720001074770
sedation,3686720001073376125165191209255303317
the4018720001072875118
patient4151720001074989115133176223249
showed4414720001073480128191233282
a47117200010741
gradual4766720001074974115163209249267
improvement5047720001071991140165211250292365408455481
KORESPONDENČNÍ48575700974397142182222265321375429469522569622642
ADRESA1144757009749102146187227276
AUTORA:143775700974999140194239290307
1761757009518
Článek331475700984768110156198240
přijat35717570098467697119160189
redakcí:377675700982971119160201237258277
18.40707570095397489
8.417775700953954
2024;424875700953978115151164
Článek443075700984768110156198240
přijat46877570098467697119160189
k4892757009841
tisku:49497570098284983125172191
7.515675700953946
11.52197570095397081
2024531775700953978115151
MUDr.485769009562112164189200
Michal70376900956279115158195212
Kalina,9337690095397895111154191205
Michal.kalina@kzcr.eu115676900956279116159195212227262300317334376413471506542578601613652695712
Cit.39607690098476897118
zkr:409476900983678108128
Anest424076900954790130160186
intenziv44447690095165983122165198215252
Med.4714769009562102147161
2024;35(4):245-247489376900953977115151164203241260298317330370406443468503539575