hemorrhagic stroke
Introduction
Introduction to hemorrhagic stroke Hemorrhagic stroke, also known as intracranial hemorrhage, is a common form of stroke. Although its incidence is lower than that of ischemic stroke, its prognosis is poor, and its mortality and morbidity rate are higher than that of ischemic stroke. Intracranial hemorrhage accounts for 10-15% of all strokes (30% in Asia). The most important cause is high blood pressure, especially systolic hypertension, and age, male, hypocholesterolemia, alcohol abuse, and the use of illegal drugs are also risk factors. Cerebral microaneurysm rupture, cerebrovascular amyloidosis is also the main cause of intracranial hemorrhage. Microscopic hemorrhage on magnetic resonance may be associated with amyloidosis of the brain arteries. The prognosis of intracranial hemorrhage is related to many factors. Older age, more bleeding, specific site bleeding such as intraventricular hemorrhage or brain stem hemorrhage, and low concise neurological scores, these are indicators of poor prognosis. Hematoma volume greater than 60 ml, accompanied by coma in patients with intracranial hemorrhage, mortality rate of up to 90%. The prognosis of intracranial hemorrhage is also related to treatment and other factors. The treatment of intracranial hemorrhage lies in the individualized comprehensive treatment. On the one hand, for the treatment of intracranial hemorrhage related to treatment, such as oral anticoagulant, the first oral anticoagulant should be discontinued. On the other hand, symptomatic treatment, such as controlling blood pressure, controlling intracranial pressure, controlling blood sugar, preventing rebleeding, and preventing complications. In theory, intracranial hematoma removal surgery can prevent brain tissue displacement, prevent rebleeding, reduce mortality and improve the quality of life of survivors. basic knowledge The proportion of illness: 0.023% Susceptible people: no specific people Mode of infection: non-infectious Complications: upper gastrointestinal bleeding acne
Cause
Cause of hemorrhagic stroke
Miliary microaneurysm rupture (85%)
The bleeding is caused by the rupture of the miliary microaneurysm, which is mostly located in the basal ganglia and can be extended inward to the inner capsule. As the amount of bleeding increases, the hematoma is formed, and the brain tissue is destroyed. The surrounding brain tissue edema oppresses adjacent tissues and even cerebral palsy occurs. Bleeding spreads along the nerve bundle, causing the physiological conduction of nerve fibers to be interrupted. This dysfunction may be restored after the early removal of the hematoma. Hemorrhage in the brain stem, bleeding into the ventricles, the condition is serious.
Prevention
Hemorrhagic stroke prevention
Control blood pressure and avoid predisposing factors.
Primary prevention
If a body has only one or more of the above risk factors and no aura or manifestation of cerebrovascular disease, we classify it as a primary prevention target, that is, actively treat the existing risk factors, and regularly monitor the occurrence of other risk factors and take Targeted measures.
Secondary prevention
Individuals already have risk factors and have a stroke precursor such as a transient ischemic attack, giving early diagnosis and early treatment to prevent serious cerebrovascular disease, which is secondary prevention.
Tertiary prevention
For patients with stroke, early or super early treatment, reduce the degree of disability, clear or treat risk factors to prevent multiple secondary prevention. The so-called early treatment refers to the treatment of the acute phase of the patient a few hours after the onset of the disease. The so-called ultra-early treatment refers to the treatment that is implemented within a few hours after the onset of the disease. For example, for ischemic stroke, the thrombolysis starts within 6 hours after the onset of the disease. Treatment, the earlier the intervention of targeted treatment measures, the better the treatment effect, the lower the degree of disability.
Complication
Hemorrhagic stroke complications 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
Hemorrhagic stroke symptoms common symptoms coma
There was a history of hypertension and arteriosclerosis, sudden disturbance of consciousness and hemiplegia.
1. Short-term headache, vomiting, partial weakness or/and numbness, skewed mouth, unclear speech, lethargy, irritability, and even unconsciousness, which is more serious in the symptoms of hemorrhagic stroke.
2, the symptoms of hemorrhagic stroke are also manifested in the early stage of the disease, more blood pressure, rapid heart rate, shortness of breath, varying degrees of disturbance of consciousness.
3, fundus examination can be seen retinal arteriosclerosis, retinal hemorrhage, occasionally papilledema.
4. Most patients with hemorrhagic stroke have positive meningeal irritation.
5, limb hemiplegia, partial sensory disturbance, same-direction hemianopia. Large amounts of bleeding or bleeding near the thalamus often have high fever, small pupils, coma and sputum returning.
6, cerebral hemorrhage: cross-sectional sputum, that is, hemorrhagic lateral nerve and abducens nerve paralysis, contralateral limb paralysis; cross-sensory disturbance, that is, the side of the source of sensory disturbance and sensory disturbance of the contralateral limb, both eyes gaze to the affected side; Severe cases of double pupil diminished, coma, tonic or quadriplegia, high fever, central dyspnea and so on.
7, cerebellar hemorrhage: more manifestations of dizziness, frequent vomiting, nystagmus, ataxia, intentional tremor, widening of the base of the walking. A person with a large amount of bleeding can present a sudden coma and a large hole in the occipital bone.
8, ventricular hemorrhage: severe cases of coma, double pupil diminished, central high fever.
In addition, the symptoms of hemorrhagic stroke are vomiting, sudden coma, incontinence, fever, etc., but coma is the main symptom of hemorrhagic stroke.
Examine
Hemorrhagic stroke examination
(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 hemorrhagic stroke
diagnosis
Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.
Differential diagnosis
In the past, there was a history of hypertension arteriosclerosis, sudden disturbance of consciousness and hemiplegia. Head CT examination should be performed in time to identify cerebral hemorrhage or cerebral infarction. CT is accurate in the location of acute cerebral hemorrhage, which is characterized by high-density shadow zone, and bleeding can break into the ventricles. Hemorrhagic stroke is divided into three levels: grade 1, mild, patient consciousness is still clear or shallow coma, hemiparesis; grade II, medium, complete coma, complete hemiplegia; two pupils are large or only slightly different; , heavy, deep coma, complete hemiplegic and deafness, double sputum, vital signs are obviously disordered.
