Gürol BERBER, Muhammed Nabi KANTARCI, Mustafa BALKAY, Eyüp KANDEMİR

Adli tıp açısından malpraktise yaklaşım - arteryel anevrizma rüptürü olan bir olgu

Baş ağrısı günlük hayatta oldukça sık görülen ancak nonspesifik bir bulgudur. Baş ağrısına yol açan birçok hastalık olabildiği gibi herhangi bir organik neden olmadan da baş ağrısı olabilir. O güne kadar olan baş ağrılarından daha şiddetli ve farklı bir baş ağrısı tanımlayan hastalarda organik bir etken olup olmadığının araştırılması hayati öneme haiz olabilir. Çalışmamızda baş ağrısı ve mide bulantısı nedeni ile doktora başvuran 40 yaşında bir kadın olgu sunulmuştur. Kişi ayaktan tedavi edilip tıbbi önerilerle taburcu edildikten sonraki gün şuuru kapalı bir şekilde hastaneye getirilmiş ve beyin kanaması nedeniyle opere edilmiştir. 8 gün hastanede yoğun bakımda kaldıktan sonra öldüğü bildirilen ve tıbbi uygulama hatası iddiası nedeniyle adli otopsisi yapılan olgumuzda PCA (Posterior komünikan arter) anevrizma rüptürü tespit edilmiştir. Toplumun bilinçlenmesi ve doktorlar hakkında gittikçe artan şikayetler daha dikkatli ve özenli muayene ve tedaviyi gerektirmekte, hekimlerin de haklarını bilmelerini zorunlu kılmaktadır. Çalışmamızdaki gibi, atipik şiddetli bir baş ağrısı ile gelen hastada nadiren de olsa Willis poligonu anevrizması olması mümkündür. Bu nedenle, böyle vakaların daha dikkatli değerlendirilerek gerekli tetkiklerin ve muayenenin yapılması önem taşımaktadır.

Approach to malpractice in terms of forensic medicine a case with arterial aneurysm rupture

Headache is a fairly common but nonspecific finding in daily life. Although headache can occur due to numerous diseases, it can occur also without being related to any organic reason. In patients, describing a more severe and different kind of headache than they experienced before, it can be vital to investigate if there is an organic factor. In this study, a 40 year old female patient consulted to a physician because of headache and nausea is presented. The day after the patient s receiving an outpatient treatment for headache and nausea, and being discharged with medical advices, she was taken back to hospital unconscious and operated for a brain hemorrhage. After 8 days in intensive care unit, she was reported dead and PCA (Posterior Communicating Artery) aneurysm rupture was detected in the autopsy performed due to the claim of her family for medical malpractice. Society s becoming conscious and the increase in complaints about physicians require more careful and rigorous examination - treatment and oblige physicians to know their rights. Like in our study, it is possible that there is a Willis Polygon aneurysm in a patient with an atypical severe headache although it is rare. Thus, it s important to evaluate such cases more carefully and to perform required tests and examinations.

PDF

___

1. Rasmussen BA. Epidemiology of headache. Cephalalgia 2001; 21:774-777.
2. Pryse-Phillips W, Findlay H, Tugwell P, Edmeads J. A Canadian population survey on the clinical, epidemiological and societal impact of migraine and tension type headache. Can J Neurol Sci 1992; 19:333-339.
3. Stewart WF, Lipton RB, Simon D. Work-related disability: results from the American Migraine Study. Cephalalgia 1996; 16:231-238.
4. Pesa J, Lage MJ. The medical costs of migraine and comorbid anxiety and depression. Headache 2004; 44:562-570.
5. Jensen R, Stovner LJ. Epidemiology and comorbidity of headache. Lancet Neurol 2008;7:354-61.
6. Stovner LJ, Hagen K, Jensen R, Katsarava Z, Lipton R, Scher A, et al. The global burden of headache: a documentation of headache prevalence and disability worldwide. Cephalalgia 2007;27:193-210.
7. Lipton RB, Bigal ME. The epidemiology of migraine. Am J Med 2005;118[suppl 1]:3-10S.
8-Olesen J, Steiner TJ. The international classification of headache disorders. 2nd ed [ICDH-II]. J Neurol Neurosurg Psychiatry 2004;75:808-11.
9. Abu-Arefe I, Russell G. Prevalence of headache and migraine in school children. Br Med J 1994; 309:765-769.
10. Ozge A, Bugdayci R, Sasmaz T, Kaliagası H, Kurt O, Karakelle H, et al. The sensitivity and specifity of the case definition criteria in diagnosis of headache: a school based epidemiological study of 5562 children in Mersin. Cephalalgia 2002; 22:791-798.
11. Lance JW. Mechanism and Management of Headache. Oxford, BH, 1998;158- 175.
12. Olsen J, Tfelt-Hansen P, Welch KMA. The Headaches. New York, Raven Press, 1993; 437-543.
13. Kurth T, Gaziano JM, Cook NR, Logroscino G, Diener HC, Buring JE. Migraine and risk of cardiovascular disease in women. JAMA 2006;296:283-91.
14. Bigal ME, Kurth T, Santanello N, Buse D, Golden W, Robbins M, et al. Migraine and cardiovascular disease: a population-based study. Neurology 2010;74:628-35.
15. Gudmundsson LS, Scher AI, Aspelund T, Eliasson JH, Johannsson M, Thorgeirsson G, et al. Migraine with aura and risk of cardiovascular and all cause mortality in men and women: prospective cohort study. BMJ 2010;341:3966.
16. Kruit MC, Launer LJ, Ferrari MD, van Buchem MA. Infarcts in the posterior circulation territory in migraine. The population- based MRI CAMERA study. Brain 2005;128:2068-77.
17. Scher AI, Gudmundsson LS, Sigurdsson S, Ghambaryan A, Aspelund T, Eiriksdottir G, et al. Migraine headache in middle age and late-life brain infarcts. JAMA 2009;301:2563-70.
18. Dufouil C, de Kersaint-Gilly A, Besancon V, Levy C, Auffray E, Brunnereau L, et al. Longitudinal study of blood pressure and white matter hyperintensities: the EVA MRI cohort. Neurology 2001;56:921-6.
19. Silberstein SD, Lipton RB, Goadsby PJ, Headache in clinical practice. 2nd ed. London, England:Martin Dunitz Ltd, 2002.
20. Ricardo E. Jorge, Jorge E. Leston, Stephan Arndt, Robert G. Robinson. Cluster headaches: Association with anxiety disorders and memory deficits. Neurology August 1, 1999; vol. 53; 3- 543
21. Çetinkaya Y, Tireli H. Bingöl ilinde Nöroloji Polikliniğine Başvuran Hastalarda Baş Ağrısı Sıklığı NöroPsikiyatri Arşivi 2005;42[1-4]:9-11
22. Lipton LB, Silberstein SD. The role of headache related disability in migraine management:implications for headache treatment guidelines. Neurology. 2001; 56 [1]: 35-42.
23. Rasmussen BK. Tension type headache, clusterheadache and miscellaneous headaches, epidemiology. J Olsen, P Tfelt-Hansen, KMA Welch [eds.], The Headaches, New York, Raven Press,1993;439.
24. Cooney BS, Grossman RI, Farber RE, Goin JE, Galetta SL. Frequency of magnetic resonance imaging abnormalities in patients with migraine. Headache 1996;36:616-21.
25. Swartz RH, Kern RZ. Migraine is associated with magnetic resonance imaging white matter abnormalities: a metaanalysis. Arch Neurol 2004;61:1366-8.
26. Igarashi H, Sakai F, Kan S, Okada J, Tazaki Y. Magnetic resonance imaging of the brain in patients with migraine. Cephalalgia 1991;11:69-74.
27. De Benedittis G, Lorenzetti A, Sina C, Bernasconi V. Magnetic resonance imaging in migraine and tension-type headache. Headache 1995;35:264-8.