Cerebral subarachnoid hemorrhage
Introduction
Introduction to brain subarachnoid hemorrhage Brain subarachnoid hemorrhage is a clinical syndrome caused by rupture of blood vessels in the brain or brain surface and blood entering the subarachnoid space. It can occur in all ages and is more common in young adults. Most of them occur acutely in emotional or exertive situations, and some patients may have a history of recurrent headaches. Subarachnoid hemorrhage is one of the most common emergencies in neurology, and the incidence rate accounts for 6% to 10% of acute cerebrovascular diseases. basic knowledge The proportion of sickness: 0.5%-0.7% Susceptible people: more common in the elderly Mode of infection: non-infectious Complications: headache, nausea and vomiting, coma, hyponatremia
Cause
Causes of subarachnoid hemorrhage
Cerebral arteriovenous malformation (35%):
Cerebral arteriovenous malformation is a malformed vascular group formed by abnormal development of the embryonic stage. The weakened blood vessel wall is in a critical state of rupture, and the stimulating or inconspicuous cause may cause rupture. Arteritis or intracranial inflammation causes vascular wall lesions, and tumors or metastatic cancer directly erode blood vessels can cause bleeding.
Smoking and drinking (30%):
Smoking and drinking are closely related to subarachnoid hemorrhage. Foreign animal experiments have shown that there are three factors in the formation of aneurysms: Willis ring hypertension and increased vascular fragility, smoking can affect these three factors cause acute elevation of blood pressure, after 3 hours Gradually falling back, and the clinical findings of subarachnoid hemorrhage, the highest probability of occurrence within 3 hours after smoking, smoking can also activate lung macrophage activity, promote hydrolase release, can cause lung damage and cerebrovascular fragility, Increased to increase the risk of subarachnoid hemorrhage, heavy drinking may cause high blood pressure or other changes including hemagglutination mechanism and cerebral blood flow, can accelerate the promotion of subarachnoid hemorrhage, it has been reported that the excessive drunk subarachnoid The incidence of bleeding is twice as high as that of non-drinkers.
Prevention
Prevention of brain subarachnoid hemorrhage
Young and middle-aged people should improve their awareness of disease prevention, develop good habits such as quitting smoking, avoiding alcohol, eating a balanced diet, regular living, and smooth stools. Usually, they should work and rest, exercise moderately, maintain a peace of mind, and actively treat diseases such as high blood pressure. . For patients with suspected subarachnoid hemorrhage, those with conditions can choose CT scan of the brain. CT scan can not confirm the lumbar puncture and cerebrospinal fluid examination. Whole cerebral angiography is the gold standard for the diagnosis of subarachnoid hemorrhage caused by rupture of aneurysm. Early examination can confirm the bleeding of the patient and determine the prognosis. Therefore, in the event of discomfort, patients should try to avoid emotional or mental stress, and go to regular hospitals as soon as possible.
Complication
Brain subarachnoid hemorrhage complications Complications headache nausea and vomiting coma hyponatremia
1, rebleeding: after the condition is stable, sudden severe headache, vomiting, seizures, coma and even brain strong attack, neck strong, Kernig sign aggravated, review cerebrospinal fluid is bright red, acute period of arteriovenous malformation is less common.
2, cerebral vasospasm: an important cause of death and disability, transcranial Doppler or cerebral angiography and diagnosis.
3, extended to the brain parenchyma: anterior or middle cerebral artery aneurysm rupture, blood injection to the brain parenchyma caused by hemiparesis, aphasia, and sometimes cerebellum.
4, acute or subacute hydrocephalus: occurred on the day of the onset or a few weeks, progressive sleepiness, upper vision is limited, abductor nerve spasm, lower limb paralysis hyperreflexia.
5, 5% to 10% of patients with seizures, a small number of patients with hyponatremia.
Symptom
Cerebral subarachnoid hemorrhagic symptoms Common symptoms Amenoxia partial sensation disorder Arachnoid cysts Constipation Head dizzy light Arachnoid thickening Intestinal peristalsis Reduce nausea, dizziness, back pain
It is more common in young adults, and more often in emotional or exertive situations. Some patients may have a history of recurrent headaches.
1, headache and vomiting: sudden severe headache, vomiting, pale face, cold sweating, such as headache limitations somewhere has a sense of positioning, such as the former headache prompted the cerebellum and cerebral hemisphere (unilateral pain), the latter headache indicates the posterior cranial fossa Lesion.
2, disturbance of consciousness and psychiatric symptoms: Most patients have unconscious disorders, but may have irritability, critically ill people may have convulsions, varying degrees of confusion and coma, a small number of seizures and mental symptoms may occur.
3, meningeal irritation: young and middle-aged patients are more common and obvious, accompanied by neck and back pain, elderly patients, early bleeding or deep coma can be no meningeal irritation.
4, other clinical symptoms: such as low fever, low back pain, etc., also can be seen hemiparesis, visual impairment, cranial nerve palsy of III, V, VI, VII, retinal flaky hemorrhage and papilledema, etc., in addition to concurrent Upper gastrointestinal bleeding and respiratory infections.
Examine
Examination of brain subarachnoid hemorrhage
1, laboratory inspection
(1) blood routine urine and blood glucose in patients with severe subarachnoid hemorrhage in the acute phase of blood routine examination showed increased white blood cell count, may have urine sugar and urine protein positive acute, high blood glucose is caused by stress response, blood sugar Elevation not only directly reflects the metabolic state of the body, but also reflects the severity of the disease, the higher the blood sugar, the higher the incidence of complications such as stress ulcer, metabolic acidosis, and azotemia, and the worse the prognosis.
(2) cerebrospinal fluid uniform bloody cerebrospinal fluid is the main indicator for the diagnosis of subarachnoid hemorrhage, pay attention to the waist immediately after the onset, because the blood has not entered the subarachnoid space, cerebrospinal fluid is often negative, wait until the patient has obvious meningeal irritation After that, or after a few hours, the positive rate of lumbar puncture will be significantly improved, and the cerebrospinal fluid will be uniform and bloody without clots. The vast majority of subarachnoid hemorrhage cerebrospinal fluid pressure increased, mostly 200 ~ 300mmH2O, individual patients with low cerebrospinal fluid pressure, may be blocked by the blood clot subarachnoid space.
The protein content in cerebrospinal fluid can be increased to 1.0g/dl. The protein increases most in 8-10 days after hemorrhage, and then gradually decreases. The content of sugar and chloride in cerebrospinal fluid is mostly within the normal range.
After the subarachnoid hemorrhage, the white blood cells in the cerebrospinal fluid have three characteristic evolution processes in different periods. The neutrophil-based blood cell reaction in the cerebrospinal fluid from 16 to 72 hours is significantly reduced after 72 hours, and gradually disappears after one week. Lymph-mononuclear phagocytic cells appeared in 23 to 7 days, the immune-activated cells were significantly increased, and red blood cell phagocytic cells appeared. The hemosiderin-phagocytic cells began to appear in the cerebrospinal fluid for 33 to 7 days, and gradually reached peaks in 14 to 28 days.
2, imaging examination
Brain CT scan or MRI examination, clinically suspected SAH preferred CT examination, safe, sensitive, and early diagnosis, high sensitivity on the day of bleeding, can detect more than 90% of SAH shows lateral cerebral cistern, anterior longitudinal fissure pool, saddle High-density hemorrhage signs in the cisternacle angle pool, ring pool and posterior longitudinal fissure pool of Shangchiqiao, and intracerebral hemorrhage or intraventricular hemorrhage can be determined. With hydrocephalus or cerebral infarction, the condition can be observed dynamically. CT enhancement can find most arteriovenous malformations and large aneurysms. MRI can detect small arteriovenous malformations of the brainstem, but it is necessary to pay attention to the acute MRI of SAH. Inducing rebleeding, CT may show that some patients have only a small amount of bleeding in the midbrain ring, which is called non-aneurysm.
Diagnosis
Diagnosis and diagnosis of subarachnoid hemorrhage
1, hypertensive cerebral hemorrhage: can also be seen slow response and blood cerebrospinal fluid, but there are obvious signs of the body such as hemiplegia, aphasia, etc., primary ventricular hemorrhage and severe SAH patients are difficult to identify clinically, cerebellar hemorrhage, caudate head hemorrhage, etc. CT and DSA examinations can be identified because no significant limb dysfunction is confused with SAH.
2, intracranial infection: may have headache, vomiting and meningeal irritation, but first fever, cerebrospinal fluid examination showed infection.
3, brain tumors: about 1.5% of patients with brain tumors can develop tumor stroke, the formation of intratumoral or paraneoplastic hematoma combined with SAH; cancer intracranial metastasis, meningeal cancer or central nervous system leukemia can also see bloody CSF, refusing detailed medical history, Cerebrospinal fluid detected cancer cells and head CT can be identified.
