脑出血cerabral-haemorrhag

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1、Cerebral HaemorrahgeIntroduction It refers to hemorrhage in brain parenchyma or ventricle caused by cerebral artery,vein or capillary fracture,artery rupture hemorrhage is the most common.Primary parenchymal hemorrhage Accounting for 20%30%of all strokes HBP is the most common reason for ICH Second

2、leading cause of sudden death1Acute onset,severe illness,high mortality Occurs on the basis of chronic artery disease23Most occur inside cerebral hemisphere4Hypertension cerebral hemorrhage comes directly from the larger basilar arteriesIntroductionEtiologyHigh blood pressure-the most common cause C

3、erebral atherosclerosis brain arteritis Blood disease(leukemia,aplastic anemia thrombocytopenic purpura hemophilia erythrocytosis disease sickle cell disease)Aneurysm,arteriovenous malformation,Moyamoya diseaseCerebral hemorrhage post MI/anticoagulation,thrombolysis treatmentPathophysiology BPEtilog

4、yVascular rupture hemorrhage hemorrhageDestructionlocal symptomsGlial scarOccupation,edemaintracranial hypertension displacementcerebral hernia Age,Genetic HBP Smoking,2.5 Drinking Oral anticoagulants,8-11 Low cholesterol risk factors Risk factorsClinical manifestationprimary artery of hemorrhage di

5、rection of hematoma expansiondegree of parenchymal destructionBroken into ventricles or not amount of bleeding prodromal stageGeneral:no foreboding,A few:dizziness,headache,etc Clinical symptomsrelevant to the bleeding site,speed,amount of bleeding.Acute onset,often peak in a few minutes or several

6、hours,also develop into a coma in a few minutesmanifestationClinical manifestation Prodromal stage(1)Sudden numbness,weakness,activity inconvenience on one side of body,unable to hold things,mouth wide,drooling（lachrymation）,walking instability（claudication）(2)During a conversation,the patient sudde

7、nly cannot speak a word,or make unclear enunciation,or dont understand what other people say.(3)Temporary blurred visual,return to normal soon,or appear blindness(4)Sudden dizziness,the surrounding scene appeared rotation,astasia or faint on the ground.These performance can appear briefly for once,o

8、r appear again and again or aggravate gradually.Clinical symptoms(1)Onset at the age of 55-65(2)Occur after drinking,excitement or heavy physical activity(3)Acute onset,quick development,peak within a few hours,often with BP(4)The whole brain symptoms(massive haemorrhage):intracranial hypertention s

9、ign+consciousness disorder(5)Local symptoms:vary according to location(6)Complications:gastrointestinal bleeding,ventilatory disorder,pulmonary infection,urinary tract infection ventricle putamen-capsula interna brain stem epencephalon thalamus brain lobe locationlocation Clinical symptoms Putamen-c

10、apsula interna haemorrhage the opposite side of bleeding lesion often appears hemiplegia,hemidysesthesia and hemianopsia,etc Three partial syndrome most common,accounting for 60%left putamen haemorrhage high density lesionscapsula interna haemorrhage thalamic hemorrhage accounting for 20%-25%with di

11、sturbance of eye movement lower bleeding,inner bleedingtypical symptoms:eyes adduction,only see apex nasiLobar hemorrhage 意识障碍少而轻 accounting for 13%-18%the majority get acute onset,clinical manifestations include headache,vomiting or convulsion consciousness disorder scarce and mildcerebellar hemorr

12、hage accounting for 10%,common in dentate nucleus of cerebellar hemisphere sudden attack of headache,dizziness,vomiting,ataxia of body or trunk and nystagmus,etccerebellar hemorrhagePrimary brain stem hemorrhage More than 90%of primary brain stem hemorrhage caused by high blood pressure occurs in po

13、ns,a few happens in the midbrainventricular hemorrhage Primary intraventricular hemorrhage manily shows meningeal stimulation and increased intracranial pressure symptoms Secondary ventricular hemorrhage shows nerve dysfunction caused by primary hemorrhage stove in addition to the above features ven

14、tricular hemorrhageDiagnosisage50，high blood pressure arteriosclerosis historyemotional excitement or physical activityOccur suddenly,headache,nausea,vomiting appear after the disease,half of the patients had conscious disorder or convulsion,urinary incontinenceDiagnosisobvious localization signs an

15、d symptoms,such as hemiplegia,meningeal stimulationthe blood pressure increased obviously after the attack hemorrhage stoves are visible by CT scans and MRI,cerebrospinal fluid can show hemorrhagicdirect CT scan:hemorrhageSudden onset,with severe headache,vomiting,obvious meningeal stimulation,rarel

16、y appears local nervous system symptoms,hemorrhagic cerebrospinal fluidlong course,enhanced cerebral CT and MRI is of diagnostic value differential diagnosiscerebral infarctionsubarachnoid hemorrhageIntracranial tumor bleedingassistant examinationcheckcheck MRILPCraniocerebral CT scanDSAdigital subt

17、raction angiographylumbar puncture1.CT test n CTfirst choicen Round and oval evenly high density hematoma,clear boundary 2.MRI test Distinguish cerebral hemorrhage with 4 5 w(CT cant recognize)Differentiate between chronic cerebral hemorrhage and cerebral infarctionDisplay vascular malformation empt

18、y phenomenon3.DSA n Cerebral aneurysmnCerebral arteriovenous malformationnMoyamoya diseasenvasculitis4.MRI test No CT examination conditionsNo intracranial pressure increase performanceBrain pressure increaseCSF meat washing waterPay attention to the risk of cerebral herniaNo LP when suspected of ce

19、rebellar hemorrhagego to the wardtimely clear oral and respiratory secretion tracheotomyartificial ventilation when necessaryMedical TreatmentMaintain life indications1Hemostasis and prevent rehaemorrhagia2Reduce and control cerebral edema3Prevent and treat all complications4Special treatmentdeal wi

20、th acute phase blood pressurecontrol cerebral edema,reduce intracranial pressure application of hemostatic drugscerebral protective agent and cryogenic treatmentspecial treatmentEmergency operation related factors Putaminal Hemorrhage30ml、thalamic hemorrhage 14ml、Cerebellar hemisphere bleeding15ml b

21、leeding amount,location,time between bleeding and operation,age and general condition of the patientexperience of the operatorEmergency operationmethodneuroendoscopyStereospecific suction technique catheter drainagecraniotomyneuroendoscopyMinimally invasive catheter drainagecraniotomy-evacuation of

22、hematomacraniotomy-evacuation of hematomacraniotomy-evacuation of hematomacraniotomy-evacuation of hematomabefore surgeryafter surgerybefore surgeryafter surgery1 w after surgery1 y after surgerybefore surgeryafter surgerybefore surgery1 w after surgery1 y after surgerythalamic hemorrhage before afterintraventricular hemorrhage before1 w afterComplicationsGI Bleeding pulmonary infectionUT Ibedsorerenal failure commoncommon