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,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,Cerebral hemorrhage,Cerebral hemorrhage,1,Etiology and pathogenesis,Hypertension and arteriosclerosis,Atherosclerosis,bleeding tendency(hemophilia,leukemia,aplastic anemia,thrombocytopenia),congenital angiomatous malformation,arteritis,tumor,lenticulostriate arteries,vertical to MCA,Microaneurysms rupture,Etiology and pathogenesis Hype,2,Pathology,Site:,basal ganglia,(70%),brain lobe,brain stem,cerebellum,Lateral hemorrhage:the bleeding is confined lateral to the internal capsule,(lenticular nucleus,external capsule),Medial hemorrhage:thalamus,hematoma edema herniation,hematoma stroke capsule,Pathology Site:basal ganglia,3,Clinical feature,Age:50-70,Male female,Occur at physical exertion or excitement,Sudden onset of focal signs,Usually accompanied by headache and vomiting,May have consciousness disturbance,Clinical featureAge:50-70,4,1.,Putamen hemorrhage,contralateral hemiplegia,hemianesthesia,and hemianopia,Eyes are frequently deviated toward the side of the affected hemisphere,Aphasia if dominant hemisphere is affected,Clinical feature,1.Putamen hemorrhageClinical,5,2.,Thalamus hemorrhage,contralateral hemiplegia,hemianesthesia,and hemianopia,Deep sensation disturbance,Ocular signs,Disturbance of consciousness,Clinical feature,2.Thalamus hemorrhageClinical,6,3.,Pontine hemorrhage,Mild:crossed paralysis,Severe(5ml),coma,pinpoint pupils,hyperpyrexia,tetraplegia,die in 48 hours,Clinical feature,3.Pontine hemorrhageClinical,7,4.,Cerebellar hemorrhage,Occipital headache,intense vertigo and repeated vomiting,ataxia,nystagmus,Severe cerebellar hemorrhage:coma,compression of brain stem,tonsillar herniation,Clinical feature,4.Cerebellar hemorrhageClinic,8,5.Lobar hemorrhage,Seen in AVM,Moyamoya disease,Headache,vomiting,neck stiffness,Seizure,Focal signs,Clinical feature,5.Lobar hemorrhageClinical fe,9,Investigation,1.CT,First choice,High density blood,Mass effect and edema,High density isodensity low density,Investigation 1.CT,10,2.,MRI,Brain stem hemorrhage,50,with hypertension,Sudden onset of headache,vomiting,focal sign,Occur at physical exertion or excitement,CT:high density blood,Diagnosis Age 50,with hypert,12,Differential diagnosis,Coma:poisoning,hypoglycemia,hepatic or diabetic coma,Focal signs:cerebral infarction,brain tumor,subdural hematoma,SAH,Differential diagnosisComa:po,13,Treatment,1.Keep rest,monitoring,air way,good nursing,2.Keep electrolytes and fluid balance.,3.,Reduce ICP:,20%Mannitol,125-250ml,3 to 4 times per day,Furosemide,albumin,dexamathasone,Treatment 1.Keep rest,monitor,14,4.,Control hypertension:180/105mmHg in acute stage,ACEI,beta-blocker,5.Prevent complications:,Infection:,antibiotics,gastric hemorrhage:Cimetidine,Losec,Venous thrombosis:heparin,Treatment,4.Control hypertension:40-50 ml,deteriorating,Cerebellum:15ml,diameter3cm,Thalamus:obstructive hydrocephalus ventricular drainage,7.,Rehabilitation,Treatment,6.Surgical therapy:Treatment,16,Subarachnoid hemorrhageSAH,Subarachnoid hemorrhageSAH,17,SAH,Cranial bone dura mater arachnoid pia mater brain lobe,Primary spontaneous SAH,Traumatic SAH,Secondary to cerebral hemorrhage,SAH Cranial bone dura mater,18,Etiology,1.Intracranial saccular aneurysm,2.AVM(arteriovenous malformation),3.Hypertension and atherosclerosis,4.Moyamoya disease,5.Mycotic aneurysm,tumor,polyarteritis nodasa,bleeding disease,Etiology 1.Intracranial saccu,19,Pathology,Anterior cerebral and anterior communicating,Internal carotid,Middle cerebral,Basilar,Pathology Anterior cerebral an,20,Clinical feature,1.Age of onset:,Saccular aneurysm:adult 30-60,AVM:juvenile,Hypertension:more than 60,2.Prodromal symptoms,Warning leaks:headache,vomiting,Cranial nerve paralysis:oculomotor,Clinical feature1.Age of onse,21,3.,Acute SAH,Sudden onset of severe headache,:“explode,burst,the worst of my life”,Vomiting,Associated with physical exertion,excitement,Transient loss of consciousness or coma,Pain of neck,back,leg,Mental symptoms:apathy,lethargy,delirium,Clinical feature,3.Acute SAHClinical feature,22,3.,Acute SAH,Signs of meningeal irritation:neck stiffness,positive Kernigs sign,Fundus examination:papilloedema,sub-hyaloid hemorrhage,Cranial nerve palsy,Clinical feature,3.Acute SAHClinical feature,23,4.,Delayed neurologic deficits,Rerupture,:in first 4 weeks,again has severe headache,vomiting,unconsciousness,with poor outcome.Due to fibrinolysis,Cerebrovascular spasm,:4-15 days after initial SAH,cerebral infarction disturbance of consciousness and focal signs,Hydrocephalus,:2-3 weeks after SAH,gait difficulty,incontinence,dementia,Clinical feature,4.Delayed neurologic deficits,24,Investigation,1.,CT,Subarachnoid clot in 75%of cases,Investigation1.CT,25,2.,CSF,Uniformly blood-stained,Xanthochromia:12 hours to 2-3 weeks,ICP,3.DSA:etiologic diagnosis,important to surgery,4.MRA,CTA,Investigation,2.CSFInvestigation,26,Diagnosis,Sudden onset of severe headache,vomiting,Neck stiffness,positive Kernigs sign,Uniformly blood stained CSF,CT sh
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