脑出血cerabralhaemorrhage

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,*,*,*,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,*,Cerebral Haemorrahge,Introduction,I,t 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 leading cause of sudden death,1,Acute,onset,severe,illness,high,mortality,O,ccurs on the basis of,chronic artery disease,2,3,Most occur,in,side,cerebral hemisphere,4,Hypertension cerebral hemorrhage comes,directly from the,larger basilar arteries,Introduction,Etiology,High blood pressure,- the most common cause,Cerebral atherosclerosis brain arteritis,Blood,disease,(leukemia, aplastic anemia thrombocytopenic purpura hemophilia erythrocytosis disease sickle cell disease),Aneurysm, arteriovenous malformation, Moyamoya disease,C,erebral hemorrhage post MI,/,anticoagulation, thrombolysis treatment,Pathophysiology,BP,Etilogy,Vascular rupture hemorrhage,hemorrhage,Destruction,local symptoms,Glial scar,Occupation,edema,intracranial hypertension, displacementcerebral hernia,Age,G,enetic,HBP,Smoking, 2.5,Drinking,Oral anticoagulants, 8-11,Low c,holesterol,risk factors,Risk factors,Clinical manifestation,primary artery,of h,emorrhage,direction of,hematoma expansion,degree of,parenchymal,destruction,Broken into ventricles,or not,amount of bleeding,related factors,prodromal stage,General,:,no foreboding,A,few,:,dizziness, headache, etc,Clinical symptoms,relevant to the bleeding site, speed, amount of bleeding. Acute onset, often peak in a few minutes or several hours , also develop into a coma in a few minute,s,manifestation,Clinical manifestation,P,rodromal 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 suddenly 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, or 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 sign + 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,location,Clinical symptoms,P,utamen,-,capsula 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 h,igh density lesions,capsula interna haemorrhage,thalamic hemorrhage,accounting for 20,%,-25%,with,disturbance of eye movement,lower bleeding, inner bleeding,typical symptoms : eyes adduction, only see apex nasi,Lobar 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 mild,cerebellar hemorrhage,accounting for 10,%, common in dentate nucleus of cerebellar hemisphere,sudden attack of headache, dizziness, vomiting, ataxia of body or trunk and nystagmus, etc,cerebellar hemorrhage,Primary brain stem hemorrhage,More than 90% of primary brain stem hemorrhage caused by high blood pressure occurs in pons, a few happens in the midbrain,ventricular 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,ventricular hemorrhage,Diagnosis,1,age,50， high blood pressure arteriosclerosis history,2,emotional,excitement,or physical,activity,3,Occur suddenly, headache, nausea , vomiting appear after the disease, half of the patients had conscious disorder or convulsion, urinary incontinence,Diagnosis,4,obvious localization signs and symptoms, such as hemiplegia, meningeal stimulation,5,the blood pressure increased obviously,after the attack,6,hemorrhage stove,s,are visible by CT scans and MRI , cerebrospinal fluid can show hemorrhagic,direct,CT,scan:,hemorrhage,Sudden onset, with severe headache, vomiting, obvious meningeal stimulation, rarely appears local nervous system symptoms, hemorrhagic cerebrospinal fluid,long course, enhanced cerebral CT and MRI is of diagnostic value,differential diagnosis,cerebral,infarction,subarachnoid hemorrhage,Intracranial tumor bleeding,assistant examination,check,MRI,LP,Craniocerebral CT scan,DSA,digital subtraction angiography,lumbar puncture,1. CT,test,CT,first choice,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 infarction,Display vascular malformation empty phenomenon,3,.,DSA,Cerebral aneurysm,Cerebral arteriovenous malformation,Moyamoya disease,vasculitis,4,. MRI,test,No CT examination conditions,No intracranial pressure increase performance,Brain pressure increase,CSF meat washing water,Pay attention to the risk of cerebral hernia,No LP when suspected of cerebellar hemorrhage,go to the ward,Emergent Treatment,timely clear oral and respiratory secretion,tracheotomy,a,rtificial ventilation,when necessary,Rescue,Medical Treatment,Maintain life indications,1,H,emostasis,and prevent,rehaemorrhagia,2,Reduce and control cerebral edema,3,P,revent and treat all complications,4,Special treatment,deal with,acute phase blood pressure,c,ontrol cerebral edema,reduce intracranial pressure,application of h,emostatic drugs,c,erebral protective agent and,cryogenic treatment,special treatment,Emergency operation related factors,Putaminal Hemorrhage,30ml,、,thalamic hemorrhage,14ml,、,Cerebellar hemisphere bleeding,15ml,bleeding amount,location, time between bleeding and operation,age and general condition of the patient,experience of the operator,E,mergency operation,method,neuroendoscopy,Stereospecific suction technique,catheter drainage,craniotomy,neuroendoscopy,Minimally invasive catheter drainage,craniotomy,-,evacuation of hematoma,craniotomy,-,evacuation of hematoma,craniotomy,-,evacuation of hematoma,craniotomy,-,evacuation of hematoma,before surgery,after surgery,before surgery,after surgery,1 w after surgery,1 y after surgery,before surgery,after surgery,before surgery,1 w after surgery,1 y after surgery,thalamic hemorrhage,before,after,intraventricular hemorrhage,before,1 w after,Complications,GI Bleeding,pulmonary infection,UT,I,bedsore,renal failure,common,