intracranial hemorrhage
Introduction
Introduction to intracranial hemorrhage Intracranial hemorrhage (intracranial hemorrhage) refers to the rupture of blood vessels in the brain, causing hemorrhage. Therefore, the brain cells that receive blood from the blood vessels are destroyed, and the blood vessels are forced to block the surrounding nerve tissue. Usually intracranial hemorrhage will occur in combination with hyperthermia. This symptom increases the oxygen consumption in the brain, which in turn causes insufficient oxygen supply to the brain. basic knowledge The proportion of sickness: 0.01% Susceptible people: no special people Mode of infection: non-infectious Complications: upper gastrointestinal bleeding acne
Cause
Cause of intracranial hemorrhage
High blood pressure (80%):
Such cerebral hemorrhage is one of the most serious and highest-level complications of hypertension. It can cause extremely serious symptoms in a short period of time, and even affects the basic physiological activities such as breathing and heartbeat in a short period of time, resulting in patients' death. On the basis of considering all other incentives, it must be emphasized that hypertension must be effectively controlled to effectively prevent the occurrence of hypertensive cerebral hemorrhage. On the basis of the long-term effects of hypertension, any factor that can induce short-term increase in blood pressure can lead to hypertensive cerebral hemorrhage.
Climate factors (5%):
It has been found clinically that cerebrovascular disease is particularly common in seasonal changes, such as the season of spring, summer, autumn and winter. Modern medicine believes that seasonal changes and changes in external temperature can affect the normal metabolism of human neuroendocrine and change blood viscosity. Consistency, plasma fibrin protein, adrenaline increased, capillaries contracted and fragility increased. In a short period of time, the intracranial blood vessels can not adapt to such obvious changes, that is, fluctuations in blood pressure, eventually leading to cerebral hemorrhage.
Emotional change (1%):
Emotional changes are another important cause of cerebral hemorrhage, including extreme grief, excitement, fear, etc. In clinical work, we have found that most patients with cerebral hemorrhage have a history of emotional excitement before onset, and even some people have done research to confirm clinical proximity. 30% of patients are cerebral hemorrhage due to anger and emotional agitation. The reason is mainly due to sympathetic excitation, rapid heartbeat, sudden increase in blood pressure, and rupture of the originally vulnerable blood vessels.
Bad living habits (3%):
The serious health effects of smoking on the human body are recognized by the World Health Organization. Long-term smoking can increase the fragility of blood vessels in the body, and the ability to withstand fluctuations in blood pressure is prone to cerebral vascular rupture. Long-term drinking can cause vasoconstriction and diastolic dysfunction, and damage to the vascular endothelium, deposition of intravascular lipids, resulting in poor vascular conditions, prone to cerebral hemorrhage. In addition, often overworked, lack of physical exercise, will also increase blood viscosity, destroy vascular conditions, leading to cerebral hemorrhage.
The above is just to list the clinically more common predisposing factors. Not all patients must have these incentives. Some patients may have cerebral hemorrhage in a quiet state due to the long-term effects of various basic diseases. The pathological mechanism of cerebral hemorrhage is relatively high. Patients with complications, especially those with the above incentives, need to be cautious to prevent serious complications.
Prevention
Intracranial hemorrhage prevention
(1) Control blood pressure: The most common cause of cerebral hemorrhage is hypertension. Controlling blood pressure is equivalent to preventing a large part of the possibility of cerebral hemorrhage. Under the guidance of a doctor, rationally apply and adjust blood pressure lowering drugs, regular blood pressure monitoring, blood pressure Can not be too high or too low, can avoid blood pressure fluctuations on the blood vessel wall, but also prevent cerebral hypoperfusion caused by low blood pressure. Dietary restrictions on salt intake, weight loss, lowering blood lipids, moderate exercise, biofeedback therapy, etc., can consolidate and promote the antihypertensive effect of drugs.
(2) Maintain a good mood: The environmental factors that cause high blood pressure include diet, social environment, life changes, and mental conflicts. In patients with hypertension, the vasoconstriction response is more persistent than normal, and mental stress, autonomic nerve activity, and conditional effects can cause hypertension. It is necessary to maintain a good mood.
(3) Pay attention to the law of life: develop good habits, such as working on time, ensure adequate sleep and rest time (especially those who have a nap habit), stylistic activities (especially playing mahjong, playing bridge, bowling, dancing) , climbing, walking, watching TV and surfing the Internet, etc.) Strive for moderation and moderation, keep the stool smooth and do not force heavy loads.
(4) Pay attention to food safety and change bad habits: The case of cerebral hemorrhage caused by drinking, eating or smoking excessively should be heard. It should avoid overeating, high-sugar and high-fat food, violent wine and alcohol, and smoking. At the same time, it is not advisable to eat too spicy and irritating foods and exaggerated beverages such as coffee and tea, but you should drink plenty of water in small quantities.
(5) Pay attention to the symptoms around you: Although the incidence of cerebral hemorrhage is more abrupt, some patients will still have some aura and asymmetry symptoms that are easily ignored by people within hours or days before the onset of illness. Therefore, it is recommended that middle-aged and elderly people with hypertension have a sudden increase in headache or change from intermittent to persistent; sudden dizziness or dizziness is markedly aggravated; sudden-side limb or head, temporary tingling of the tongue Weakness or lack of activity; or sudden leaks of water in the mouth, hard tongue, inaccurate vocabulary, unclear vocabulary; or sudden rise in blood pressure, such as sudden rise in blood pressure, should seek medical advice and take corrective measures as soon as possible. To ensure safety.
Complication
Intracranial hemorrhage Complications upper gastrointestinal bleeding hemorrhoids
There are many complications of cerebral hemorrhage. The human brain is the general headquarters of life. The occurrence of cerebral hemorrhage will affect the normal operation of brain function. The complications of cerebral hemorrhage are often multiple, and all organs of the body can become complications. The organs that occur, so in the treatment of cerebral hemorrhage should pay attention to the treatment of complications, the main complications are the following:
(1) Pulmonary infection: Pulmonary infection is the most common complication of patients with cerebral hemorrhage. Patients with cerebral hemorrhage are often accompanied by activity disorder, and long-term bed rest becomes the most common cause of complications of pulmonary infection. The main complications of cerebral hemorrhage One of the main causes of death is pulmonary infection. Within 3 to 5 days after cerebral hemorrhage, comatose patients often have pulmonary infection, which is characterized by multiple paralysis and respiratory damage. It needs attention and needs tracheotomy if necessary. surgery.
(2) Upper gastrointestinal bleeding: also known as stress ulcer, is one of the serious complications of cerebrovascular disease. The cerebral hemorrhage combined with upper gastrointestinal hemorrhage is mostly mixed type and medial capsule internal hemorrhage, accounting for 45% and 40% respectively. %. After cerebral hemorrhage, systemic vasoconstriction, gastrointestinal function decline, gastrointestinal barrier to bacterial barrier, local blood supply is insufficient, extensive bleeding of the digestive tract can occur, and even fatal blood loss leads to shock, which is a serious complication.
(3) Hemorrhoids: Patients with cerebral hemorrhage stay in bed for a long time and cannot change their position. It is a series of manifestations that the body does not change its position for a long time, causing ischemia and necrosis of local skin and tissues due to excessive compression time. Patients with cerebrovascular disease, due to more elderly patients, limb paralysis, prolonged bed rest, inconvenient activities, easy to press on the bone bulge and other parts, so that local tissue ischemia and hypoxia, local ulceration, hemorrhoids formation, and long-term unhealed, is A major problem in the care of patients with cerebral hemo
In addition, cerebral hemorrhage is also common with complications such as renal failure and multiple organ failure (MOF). During the treatment, the function of each organ should be closely observed, and certain measures should be taken when necessary.
Symptom
Symptoms of intracranial hemorrhage Common symptoms Respiratory abnormal breathing Dyspnea shortness of breath stun blood pressure drop heart sound and pulse disappearance of ulnar artery or radial artery... Heart rate slow
Coma, heartbeat, blood pressure, and unstable breathing. The difference in bleeding points may affect nausea, vomiting, diarrhea and other symptoms, among which vomiting is the most serious. If the bleeding point is not large, observe for 48 hours first, and do a ct review in time, or do a lumbar puncture to check whether there is red blood cells in the cerebrospinal fluid to confirm the bleeding absorption.
Examine
Examination of intracranial hemorrhage
Auxiliary inspection
Cerebral hemorrhage belongs to the emergency department of neurology. It needs to be diagnosed immediately in a short time. At present, the auxiliary examination is mainly divided into laboratory examination and imaging examination. With the current improvement of medical level, the imaging examination has a short time. Non-invasive, accurate results, etc., has gradually become the preferred method of inspection.
(1) CT scan of the head: CT examination is the first choice for clinical suspected cerebral hemorrhage, which can show a round or oval uniform high-density hematoma. After the onset, a fresh hematoma with clear boundary can be displayed, and the location, size and shape of the hematoma can be determined. And whether it breaks into the ventricles, edema around the hematoma and the effect of occupying space; for example, a large amount of blood in the ventricle can be seen as a high-density cast, and the ventricle is dilated. After 1 week, a ring-shaped enhancement is seen around the hematoma, and the hematoma becomes low-density or cystic after absorption. Changes, CT dynamic observation can be found in the pathological evolution of cerebral hemorrhage, and the first time to guide clinical treatment in the course of disease changes during the course of disease treatment. At present, head CT has become a more extensive method of examination.
(2) MRI examination: can find a small amount of brain stem or cerebellar hemorrhage that can not be determined by CT, can distinguish the cerebral hemorrhage that CT can not recognize after 4 to 5 weeks of disease, distinguish old cerebral hemorrhage and cerebral infarction, and show the phenomenon of vascular malformation Can also roughly determine the bleeding time, whether repeated bleeding, etc., but the MR examination requires the patient to stay in the scanner for a long time (more than 10 minutes), which is difficult for patients with existing disturbances, generally less than CT examinations are widely used.
(3) DSA whole cerebral angiography: cerebral angiography used to be the main diagnostic tool for cerebral hemorrhage, because it can not show the hematoma itself, only the location and size of the hematoma can be estimated according to the displacement of the relevant blood vessels around the hematoma, and DSA The inspection was an invasive examination and the current first-line application has been significantly reduced. It is worth mentioning that DSA is still significant in the identification of the causes of cerebral hemorrhage, because it can visually see the shape and shape of cerebral vessels. Patients suspected of having cerebral vascular malformations or aneurysm rupture should need DSA examination. Clear diagnosis.
(4) cerebrospinal fluid examination: cerebral hemorrhage diagnosis is generally not done cerebrospinal fluid examination to prevent cerebral palsy, but in the unconditional brain CT scan or brain MRI examination, lumbar puncture still has a certain diagnostic value. After cerebral hemorrhage, due to brain tissue edema, intracranial pressure is generally high. 80% of patients have bloody cerebrospinal fluid after 6 hours of onset, because the blood can break from the brain parenchyma into the ventricle or subarachnoid space, so the cerebrospinal fluid is mostly bloody or yellow. A small number of cerebrospinal fluids are clear. Therefore, when the lumbar puncture cerebrospinal fluid is clear, the possibility of cerebral hemorrhage cannot be completely ruled out. The dehydrating agent should be used to reduce intracranial pressure before surgery. If there is an increase in intracranial pressure or cerebral palsy, it should be contraindicated.
Diagnosis
Diagnosis and diagnosis of intracranial hemorrhage
diagnosis
Symptoms of cerebral hemorrhage are related to the location of bleeding, the amount of bleeding, the rate of bleeding, the size of the hematoma, and the general condition of the patient. They usually present with varying degrees of sudden headache, nausea and vomiting, slurred speech, urinary incontinence, physical activity disorders, and Disorder of consciousness. A small amount of bleeding in a non-functional area can only manifest as headache and mild neurological dysfunction, and massive bleeding and deep brain hemorrhage, thalamic hemorrhage or brain stem hemorrhage can cause rapid coma, even death within hours and days. . Typical basal ganglia hemorrhage can appear sudden weakness and numbness of the limbs, unclear language or aphasia, disturbance of consciousness, gaze to the bleeding side of both eyes, can have severe pain, accompanied by nausea and vomiting, urinary incontinence symptoms; thalamic hemorrhage often breaks Into the ventricle, the patient has unilateral facial and limb sensory disturbances, apathy and unresponsiveness; while cerebral bridge hemorrhage can have a hemorrhagic side of the facial paralysis and contralateral limb paralysis, and a large number of rapid emergence of disturbance of consciousness, quadriplegia, The eyeball is fixed and life-threatening; cerebellar hemorrhage is manifested as cerebellar signs such as headache, dizziness, vomiting, and dysarthria. Generally, there is no typical symptoms of limb paralysis. When the hematoma is large, it can invade the brain stem and cause rapid coma and death.
Differential diagnosis
The incidence of cerebral hemorrhage is more critical. Some symptoms are very similar to cerebral infarction. Before CT popularization, the rate of misdiagnosis of cerebral infarction and cerebral hemorrhage is higher. With the improvement of current diagnosis and treatment level, CT diagnosis can basically confirm the diagnosis, but still need Careful and careful differential diagnosis.
(1) Different from other cerebrovascular diseases such as cerebral infarction and subarachnoid hemorrhage, diagnosed according to the onset process, symptoms, signs and imaging examination. The cause of cerebral infarction is caused by brain tissue ischemia. The common cause is cerebral atherosclerosis. The onset is generally slow, mild disturbance of consciousness occurs, blood pressure is slightly elevated, and CT shows low-density lesions in the brain.
(2) intracranial space-occupying lesions, craniocerebral trauma, meningitis and other diseases: according to the severity of the disease, history of trauma, fever and other clinical manifestations as well as CT, MRI, cerebrospinal fluid and other tests to make a diagnosis. Primary tumors in the brain may have similar symptoms of cerebral hemorrhage, such as headache, vomiting, and physical symptoms. Enhanced imaging may be helpful in diagnosis.
(3) Other causes: comatose patients should be differentiated from disturbances of consciousness caused by carbon monoxide poisoning, hepatic coma, uremia, and hypoglycemia. Mainly detailed inquiries about medical history, signs and CT, cerebrospinal fluid and other tests. Inflammatory diseases such as leukemia, thrombocytopenic purpura, aplastic anemia, etc., can occur intracranial hemorrhage, when suspected of these reasons need to be carefully examined to rule out similar symptoms caused by other causes.
