intracranial tumor hemorrhage
Introduction
Introduction to intracranial hemorrhage Some intracranial tumors can cause intracranial hemorrhage, especially for patients with brain tumors with clinical bleeding as the first symptom. Because of the acute onset, it is necessary to get timely diagnosis and treatment, which should be paid attention by doctors. basic knowledge The proportion of illness: the incidence rate is about 0.005% - 0.007% Susceptible people: no special people Mode of infection: non-infectious Complications: cerebral edema, epilepsy, acute myocardial infarction, arrhythmia
Cause
The cause of intracranial hemorrhagic hemorrhage
Intratumoral bleeding (30%):
Intracerebral hemorrhage is the most common type of tumor hemorrhage, mostly intratumoral hemorrhage. Only 15% of hemorrhage is located around the tumor. In the hemorrhage of primary tumor, glioblastoma, malignant astrocytoma, less Glioblastoma and pituitary adenomas are the most common; in metastatic tumors, lung cancer, melanoma, choriomascem and gastric cancer are the most common, and about 2/3 of tumor hemorrhage is acute onset.
Subarachnoid hemorrhage (20%):
Subarachnoid hemorrhage is another type of hemorrhage after brain parenchyma. It is caused by tumors located on the surface of the brain, glioblastoma, meningioma, astrocytoma, pituitary adenoma and metastatic carcinoma. Subarachnoid hemorrhage caused by metastatic cancer is higher than that of primary tumor.
Intraventricular hemorrhage (20%):
The incidence of intraventricular hemorrhage caused by tumor is low, which can be caused by hemorrhage in the brain parenchyma or by tumor hemorrhage growing in the ventricle. Common tumors include choroid plexus papilloma, ependymoma and metastatic cancer.
Subdural hemorrhage (10%):
The incidence of tumor-induced subdural hemorrhage is low. The most common cause of metastatic cancer is that the main source of bleeding may be tumor hemorrhage to the subdural or rupture of the subdural bridge vein due to tumor invasion. There are also melanoma, malignant lymphoma, prostate cancer, lung cancer, liver cancer, etc. Meningioma sometimes causes subdural hematoma.
Epidural hemorrhage (10%):
Very rare, can be caused by meningiomas.
Pathogenesis
The bleeding mechanism is very complicated. The bleeding of different tumors may have different predisposing factors, which can be roughly divided into direct and indirect categories. The so-called direct factors refer to the bleeding caused by the tumor itself:
1. Tumor vascular defects include vascular varices, thin wall, vasospasm, etc., which are prone to rupture of blood vessels, which is more common in glioblastoma.
2. The nature of the tumor is multi-vascular, contains a large number of blood sinus, and is easy to damage bleeding.
3. Abnormal blood quality such as leukemia.
4. As the tumor enlarges, the blood supply increases, and the new arteries become aneurysmal varices and rupture due to the inability to resist the pressure of blood pressure.
5. Damage to the vessel wall by tumor cells.
6. Venous thrombosis or obstruction by tumor cells.
7. Radiation therapy, head trauma, surgical procedures, etc.
The so-called indirect factor refers to the bleeding directly caused by the non-tumor itself. When the intracranial pressure increases beyond the microcirculation perfusion pressure, the blood flow is stagnant, hypoxia, vascular endothelial cells are damaged, the wall of the vessel is ruptured, and focal hemorrhage around the blood vessels occurs. Known as microcirculation hemorrhage, when the intracranial pressure continues to rise to a very severe degree, the brain stem is displaced and distorted, and a large piece of bleeding occurs, which is called systemic circulation bleeding.
Prevention
Intracranial tumor hemorrhage prevention
1) Strengthen physical exercise
Enhance physical fitness, exercise more in the sun, sweat more can excrete acidic substances in the body with sweat to avoid the formation of acidic body.
2) Develop good habits, stop smoking and limit alcohol
Smoking, the World Health Organization predicts that if people no longer smoke, after five years, the world's cancer will be reduced by one third. Second, don't drink alcohol. Smoke and alcohol are extremely acidic and acidic substances. People who smoke and drink for a long time can easily lead to acidic body.
Complication
Intracranial hemorrhagic complications Complications cerebral edema epilepsy acute myocardial infarction arrhythmia
1 postoperative bleeding: further aggravation of neurological deficits, can cause coma, life-threatening at any time.
2 postoperative cerebral edema: generally 3-5 days of cerebral edema peaks, lasting for two weeks or even longer, at any time the intracranial hypertension is sharply increased, resulting in cerebral palsy, neurological deficits are more serious, and even life-threatening.
3 stress ulcers, gastrointestinal bleeding, gastrointestinal disorders, and even gastrointestinal paralysis, intestinal obstruction, intestinal infections. Multiple organ dysfunction can also occur, life-threatening.
4 Infection: There may be infections in the lungs, urinary tract, skin, intestines, etc. The infection may be uncontrollable, septic shock, sepsis, etc., life-threatening, infection may prolong and prolong the course of the disease.
5 secondary epilepsy: at any time due to abnormal discharge of nerve cells after cerebral hemorrhage, brain dysfunction, seizures, seizures can cause airway spasm, phlegm, suffocation and other risks.
6 electrolyte and acid-base balance disorder, cerebral hemorrhage can cause dysregulated secretion of antidiuretic hormone, central hyponatremia or hypernatremia, brain salt consumption syndrome, severe cerebral palsy central myelinolysis.
7 central hyperthermia: cerebral hemorrhage can cause central nervous system damage, central hyperthermia, postoperative hematoma absorption, infection and other factors can also cause fever.
8 cerebral hemorrhage can occur after brain-heart syndrome, cardiac decompensation, heart failure, or complicated by acute myocardial infarction, sudden death, arrhythmia, etc., serious life-threatening.
Symptom
Intracranial hemorrhagic symptoms common symptoms intracranial hemorrhage bridge cerebral hemorrhage intracranial pressure increased intracranial headache
Usually, the clinical manifestations of neoplastic intracranial hemorrhage are different from those of other causes. For a patient with a known brain tumor, the condition suddenly worsens. When a new neurological dysfunction occurs, the possibility of acute hemorrhage is extremely high, but for only In patients with brain tumors with bleeding as the first symptom, at this time, the primary tumor is often neglected. Therefore, for cases with abnormal site bleeding and no other risk factors or causes of bleeding, tumor bleeding should be suspected. CT scans and MRIs have been reported. About 24% of patients with intracranial tumor hemorrhage have bleeding as the first symptom.
Examine
Examination of intracranial tumor hemorrhage
In the acute phase of hemorrhage, the high-density shadow appears on the CT film, and the surrounding low-density or iso-density area is accompanied by the occupancy effect. After the enhancement, there are different degrees of irregular density shadows. In the chronic phase, the liquefaction, absorption, and bleeding of the hematoma are high. Density foci turn to equal density or low density, but CT is not sensitive to lesions located in the skull base or posterior cranial fossa. Sometimes it is not possible to distinguish multiple small calcifications from small hemorrhages in the tumor. Magnetic resonance is the currently effective image. Diagnostic means, not only for the type of bleeding, but also for the diagnosis of hematoma, can accurately diagnose the lesions that can not be diagnosed by CT, especially for the differential diagnosis of cerebral vascular malformations, significantly better than CT, in addition, for blood images Brain tumor angiography should be further carried out.
Diagnosis
Diagnosis and diagnosis of intracranial tumor hemorrhage
Before the application of CT and magnetic resonance imaging, the diagnosis of neoplastic hemorrhage relies on surgery or biopsy. With the wide application of CT and magnetic resonance, it is not difficult to diagnose intracranial tumor hemorrhage. The vast majority of neoplastic hemorrhage is enhanced by CT. Can be diagnosed later. For patients with brain tumors with bleeding as the first symptom, attention should be paid to the differentiation of cerebral hemorrhagic diseases such as cerebral arteriovenous malformation, aneurysm, hypertension and moyamoya disease. If the tumor is found, the diagnosis can be confirmed.
