脑出血cerabralhaemorrhage.ppt
Cerebral Haemorrahge,Introduction,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 leading cause of sudden death,1,Acute onset,severe illness,high mortality,Occurs on the basis of chronic artery disease,2,3,Most occur inside 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 diseaseCerebral hemorrhage post MI/anticoagulation,thrombolysis treatment,Pathophysiology,BPEtilogyVascular rupture hemorrhage,hemorrhage,Destructionlocal symptomsGlial scar,Occupation,edemaintracranial hypertension displacementcerebral hernia,Age,Genetic,HBP,Smoking,2.5,Drinking,Oral anticoagulants,8-11,Low cholesterol,risk factors,Risk factors,Clinical manifestation,primary artery of hemorrhage,direction of hematoma expansion,degree of parenchymal destruction,Broken into ventricles or not,amount of bleeding,related factors,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 hours,also develop into a coma in a few minutes,manifestation,Clinical 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 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,Putamen-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 high density lesions,capsula interna haemorrhage,thalamic hemorrhage,accounting for 20%-25%,with disturbance of eye movement,lower bleeding,inner bleedingtypical 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,emotional excitement or physical activity,Occur suddenly,headache,nausea,vomiting appear after the disease,half of the patients had conscious disorder or convulsion,urinary incontinence,Diagnosis,direct CT scan:hemorrhage,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,CTfirst 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 infarctionDisplay vascular malformation empty phenomenon,3.DSA,Cerebral aneurysmCerebral arteriovenous malformationMoyamoya diseasevasculitis,4.MRI test,No CT examination conditionsNo intracranial pressure increase performance,Brain pressure increaseCSF meat washing water,Pay attention to the risk of cerebral herniaNo LP when suspected of cerebellar hemorrhage,go to the ward,Emergent Treatment,timely clear oral and respiratory secretion,tracheotomyartificial ventilation when necessary,Rescue,Medical Treatment,Special treatment,deal with acute phase blood pressure,control cerebral edema,reduce intracranial pressure,application of hemostatic drugs,cerebral protective agent and cryogenic treatment,special treatment,Emergency operation related factors,Putaminal Hemorrhage30ml、thalamic hemorrhage 14ml、Cerebellar hemisphere bleeding15ml,bleeding amount,location,time between bleeding and operation,age and general condition of the patient,experience of the operator,Emergency 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,
