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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 Sec
2、ond 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 arteriesIntroductionEtiologyEtiologyHigh blood pressure - the mo
3、st 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 treatmentPat
4、hophysiologyPathophysiology BPEtilogyVascular 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 factorsRisk factorsClin
5、ical manifestationprimary artery of hemorrhage direction of hematoma expansiondegree of parenchymal destructionBroken into ventricles or not amount of bleedingrelated factors prodromal stageGeneral: no foreboding, A few: dizziness, headache, etc Clinical symptomsrelevant to the bleeding site, speed,
6、 amount of bleeding. Acute onset, often peak in a few minutes or several 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（lachrymat
7、ion）, 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 appe
8、ared 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
9、 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 ven
10、tricle putamen-capsula interna brain stem epencephalon thalamus brain lobe locationlocation Clinical symptoms Putamen-capsula interna haemorrhage the opposite side of bleeding lesion often appears hemiplegia, hemidysesthesia and hemianopsia, etc Three partial syndromemost common, accounting for 60%l
11、eft putamen haemorrhage high density lesionscapsula interna haemorrhage thalamic hemorrhageaccounting for 20%-25%with disturbance of eye movementlower 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 ons
12、et, clinical manifestations include headache, vomiting or convulsionconsciousness disorder scarce and mildcerebellar hemorrhageaccounting for 10%, common in dentate nucleus of cerebellar hemisphere sudden attack of headache, dizziness, vomiting, ataxia of body or trunk and nystagmus, etccerebellar h
13、emorrhagePrimary brain stem hemorrhage More than 90% of primary brain stem hemorrhage caused by high blood pressure occurs in pons, a few happens in the midbrainventricular hemorrhage Primary intraventricular hemorrhage manily shows meningeal stimulation and increased intracranial pressure symptomsS
14、econdary ventricular hemorrhage shows nerve dysfunction caused by primary hemorrhage stove in addition to the above features ventricular hemorrhageDiagnosis1 1age50， high blood pressure arteriosclerosis history2 2emotional excitement or physical activity3 3Occur suddenly, headache, nausea , vomiting
15、 appear after the disease, half of the patients had conscious disorder or convulsion, urinary incontinenceDiagnosis4 4obvious localization signs and symptoms, such as hemiplegia, meningeal stimulation5 5the blood pressure increased obviously after the attack6 6 hemorrhage stoves are visible by CT sc
16、ans and MRI , cerebrospinal fluid can show hemorrhagicdirect CT scan: hemorrhageSudden onset, with severe headache, vomiting, obvious meningeal stimulation, rarely appears local nervous system symptoms, hemorrhagic cerebrospinal fluidlong course, enhanced cerebral CT and MRI is of diagnostic value d
17、ifferential diagnosiscerebral infarctionsubarachnoid hemorrhageIntracranial tumor bleedingassistant examinationcheckcheck MRILPCraniocerebral CT scanDSAdigital subtraction angiographylumbar puncture1. CT test n CTfirst choicen Round and oval evenly high density hematoma, clear boundary 2. MRI test D
18、istinguish cerebral hemorrhage with 4 5 w (CT cant recognize)Differentiate between chronic cerebral hemorrhage and cerebral infarctionDisplay vascular malformation empty phenomenon3. DSA n Cerebral aneurysmnCerebral arteriovenous malformationnMoyamoya diseasenvasculitis4. MRI test No CT examination
19、conditionsNo intracranial pressure increase performanceBrain pressure increaseCSF meat washing waterPay attention to the risk of cerebral herniaNo LP when suspected of cerebellar hemorrhagego to the ward Emergent TreatmentEmergent Treatment timely clear oral and respiratory secretion tracheotomyarti
20、ficial ventilation when necessaryRescueMedical TreatmentMaintain life indications1Hemostasis and prevent rehaemorrhagia2Reduce and control cerebral edema3Prevent and treat all complications4Special treatmentdeal with acute phase blood pressurecontrol cerebral edema, reduce intracranial pressure appl
21、ication of hemostatic drugscerebral protective agent and cryogenic treatmentspecial treatmentEmergency operation related factors Putaminal Hemorrhage30ml、thalamic hemorrhage 14ml、Cerebellar hemisphere bleeding15ml bleeding amount,location, time between bleeding and operation,age and general conditio
22、n of the patientexperience of the operatorEmergency operationmethodneuroendoscopyStereospecific suction technique catheter drainagecraniotomyneuroendoscopyMinimally invasive catheter drainagecraniotomy- evacuation of hematomacraniotomy- evacuation of hematomacraniotomy- evacuation of hematomacraniot
23、omy- 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
