brain herniation
Introduction
Introduction to the brain When there is a space-occupying lesion in a certain cavity in the cranial cavity, the pressure of the sub-chamber is higher than that of the adjacent sub-chamber, and the brain tissue is displaced from the high-pressure area to the low-pressure area, thereby causing a series of clinical syndromes called cerebral palsy. . The brain tissue on the screen (the hippocampus of the temporal lobe, hook back) is squeezed under the curtain through the cerebellum, known as the cerebellum or the scorpion. Under the curtain, the cerebellar tonsils and the medulla oblongata are squeezed into the spinal canal, called the occipital foramen or cerebellar tonsil. The cingulate of one side of the cerebral hemisphere is pushed back into the contralateral cavity through the inferior sac, called the cerebral palsy or the cingulate palpebral. basic knowledge The proportion of illness: 0.005% - 0.008% Susceptible people: no special people. Mode of infection: non-infectious Complications: headache, nausea and vomiting
Cause
Cerebral palsy
Uneven pressure distribution in the cranial cavity (35%):
Any large volume of lesions in the cranium can cause cerebral palsy when the pressure distribution in the cranial cavity is uneven. The lesions on the screen cause cerebellar incision, and the lesions in the lower part cause the occipital foramen.
Intracranial foreign body (25%):
Various intracranial hematoma caused by injury, such as acute epidural hematoma, subdural hematoma, intracerebral hematoma, etc.; various intracranial tumors, especially tumors located in one side of the cerebral hemisphere and posterior fossa tumor; intracranial abscess.
Intracranial parasitic diseases and various other chronic granulomas (5%):
Intracranial parasitic diseases and various other chronic granulomas, on the basis of the above-mentioned lesions, such as additional artificial factors, such as lumbar puncture to release excessive cerebrospinal fluid, between the cranial cavity and the spinal canal, on-screen segmentation and The increase in pressure difference between the sub-chambers can promote the formation of cerebral palsy. This kind of cerebral palsy caused by iatrogenic factors should be avoided by clinicians.
Prevention
Cerebral Palsy Prevention
Cerebral palsy is the most dangerous signal of cerebrovascular disease. About half of the patients die from cerebral palsy. Therefore, in the acute phase, the patient's breathing, pulse, body temperature, blood pressure and pupillary changes should be closely monitored, and cerebral palsy should be detected early. Dehydration treatment, control intracranial hypertension, reduce mortality.
1. Observe the patient's consciousness and vital signs.
2, keep the airway open, if necessary, oxygen or artificial ventilation.
Complication
Cerebral palsy Complications, headache, nausea and vomiting
Cerebral palsy is a very serious disease, often caused by increased intracranial pressure, combined with severe headache and frequent vomiting, irritability, changes in consciousness and other symptoms, while causing muscle weakness in the limbs or intermittent head and neck recoil, limbs Straight, over-extension of the back, angulation, and other movement disorders, the disease continues to develop, leading to changes in vital signs such as breathing, pulse, blood pressure, body temperature, and serious death.
Symptom
Cerebral palsy symptoms common symptoms cerebral palsy crisis on light reaction irritability nervous vomiting drowsiness complexion flushing memory impaired coma
First, the cerebellum incision
1, the symptoms of increased intracranial pressure: manifested as severe headache and frequent vomiting, the degree is more intensive than before the cerebral palsy, and there is irritability.
2, change of consciousness: manifested as lethargy, shallow coma and even coma, slow or disappeared to the external stimulus.
3, pupil change: the pupils on both sides are not equal, the pupil on the side of the disease is slightly reduced at the beginning, the light reaction is slightly retarded, and the pupil on the disease side gradually becomes larger and slightly irregular, and the direct and indirect photoreaction disappears, but the contralateral pupil still remains. Can be normal, this is because the affected side of the oculomotor nerve is stressed and pulled, in addition, the affected side can also have dangerous drooping, eyeball external oblique, etc., such as cerebral palsy continue to develop, there may be bilateral pupil dilation, photoreaction Disappeared, this is the bowel movement of the oculomotor nucleus caused by dysfunction.
4, dyskinesia: most occur in the contralateral side of the pupil dilated side, manifested as the limb's voluntary activity decreased or disappeared, the continued development of cerebral palsy caused the symptoms to spread to both sides, causing muscle weakness in the limbs or intermittent head and neck recoil The limbs are straight and the back of the body is overstretched. The hornbone is inverted and is called the brain toughness. It is a characteristic manifestation of severe damage to the brain stem.
5, the disorder of vital signs: manifested as blood pressure, pulse, breathing, body temperature changes, blood pressure suddenly high and low, breathing suddenly and slowly, sometimes flushed, sweating, sometimes turned pale, sweat closed, body temperature It can be as high as 41 ° C or higher, or as low as 35 ° C or less, and finally the breathing stops, finally the blood pressure drops, and the heart stops and dies.
Second, the occipital bone hole:
Patients often have only severe headaches, repeated vomiting, vital signs and neck stiffness, pain, and changes in consciousness appear later, without changes in pupils and respiratory arrests occur earlier.
Third, the brain squats:
The brain tissue of the affected side of the cerebral hemisphere of the diseased side is softened and necrotic, and symptoms such as paralysis of the contralateral lower extremity and dysuria are observed.
Examine
Cerebral palsy examination
Regular neurological examinations and corresponding laboratory tests should be performed.
(1) Whether the patient has used dilated or defamatory agents and whether there are diseases such as cataracts.
(2) Patients with cerebral palsy, such as the pupils on both sides, have been enlarged, not only to check the pupils, but also to check whether there is a difference in muscle tension between the two eyes. The side with reduced muscle tone often indicates the first involvement of the oculomotor nerve. Side, often the lesion side.
(3) The pupils of both sides of the cerebral palsy are dilated. If the pupil is changed to one side and the side is still enlarged after the dehydration treatment and the improvement of cerebral hypoxia, the scattered side is often the damaged side of the oculomotor nerve. Can be prompted for the lesion side.
(4) Patients with cerebral palsy, such as pupils are not equal, if the pupils of the pupils are more sensitive to light, the extraocular muscles are not paralyzed, and the smaller pupils of the pupils have lower diaphragmatic tension. This condition often indicates that the smaller side of the pupil is Sick side. This is due to changes in the parasympathetic nerve fibers of the diseased oculomotor nerve.
(5) Lumbar puncture: Lumbar puncture is generally prohibited in patients with cerebral palsy. Even if the intraspinal pressure measured by lumbar puncture is not high, it does not represent intracranial pressure. Because cerebellar tonsils can block cerebrospinal fluid circulation in the intracranial and spinal canal.
(6) When the CT cerebellum is incision, the basal pool (the upper saddle pool), the ring pool, and the quadruple pool are deformed or disappear. The midline is clearly asymmetrical and displaced when squatting.
(7) MRI: The deformation and disappearance of the cerebral cistern during cerebral palsy can be observed, and the structures in the brain such as hook back, hippocampus, diencephalon, brain stem and cerebellar tonsil are directly observed.
Diagnosis
Cerebral palsy diagnosis
The disease can be caused by a variety of causes, and it needs to be differentiated from intracranial vascular tumors and cerebral hemorrhage, as well as other space-occupying lesions. It is reasonable to say that he is caused by a variety of intracranial hypertension caused by various intracranial factors. The brain tissue breaks into the hole in the skull. Therefore, it is necessary to carry out positive dehydration and reduce intracranial pressure in the clinic, and at the same time, the head ct examination is carried out to specify the specific reasons.
