acute cerebrovascular disease
Introduction
Introduction to acute cerebrovascular disease Acute cerebrovascular disease refers to a group of diseases of sudden onset of cerebral vascular circulatory disorders. It can be a sudden thrombosis of the cerebral blood vessels, ischemic cerebral infarction caused by cerebral embolism, or a cerebral hemorrhage caused by cerebral vascular rupture, often accompanied by Nervous system symptoms, limb hemiplegia, aphasia, mental symptoms, dizziness, ataxia, cough, severe coma and death, clinically known as cerebrovascular accident, stroke or stroke. Hypertension and atherosclerosis are the most common and common causes of cerebrovascular disease. There is data showing that 93% of patients with cerebral hemorrhage have a history of hypertension, 86% of patients with cerebral thrombosis have a history of hypertension, and 70% of patients with cerebrovascular disease have a history of atherosclerosis. Keep lying still and avoid unnecessary checks. Keep the respiratory tract unobstructed, and lay on the side to prevent the tongue from falling, sucking, and intermittently giving oxygen. Excessive secretions and paralysis of the throat should be done early as a tracheotomy. basic knowledge The proportion of illness: 0.3% Susceptible people: no special people Mode of infection: non-infectious Complications: cerebral palsy, elderly patients with brain and heart syndrome, renal failure
Cause
Cause of acute cerebrovascular disease
Causes:
Hypertension (35%):
Hypertension and atherosclerosis are the most common and common causes of cerebrovascular disease. There is data showing that 93% of patients with cerebral hemorrhage have a history of hypertension, 86% of patients with cerebral thrombosis have a history of hypertension, and 70% of patients with cerebrovascular disease have a history of atherosclerosis.
Heart disease (28%):
Heart disease is one of the main causes of cerebral embolism. Rheumatic, hypertensive, coronary atherosclerotic heart disease and subacute bacterial endocarditis may cause wall thrombus. When heart failure or atrial fibrillation occurs, the thrombus falls off and flows to the cerebral artery. An embolism has occurred. Since the embolus can be repeatedly detached, it is easy to relapse.
(3) Aneurysms and arteriovenous malformations caused by abnormal intracranial vascular development are common causes of subarachnoid hemorrhage and cerebral hemorrhage, and often rupture multiple times.
(4) Some inflammation can invade the meninges, cerebral blood vessels, or invade the cerebral blood vessels to cause cerebral arteritis, such as purulent, tuberculous, fungal inflammation and rheumatism, etc., can cause cerebrovascular disease.
(5) Hematological diseases such as thrombocytopenic purpura, polycythemia, and leukemia often cause hemorrhagic cerebrovascular disease. A small number of ischemic cerebrovascular diseases occur.
(6) Metabolic diseases such as diabetes and hyperlipidemia are closely related to cerebrovascular diseases. It is reported that 30% to 40% of patients with cerebrovascular disease have diabetes, and the incidence of arteriosclerosis in diabetic patients is five times higher than that of normal people. The time of arteriosclerosis is earlier than that of normal people, and the degree of arteriosclerosis is also higher. weight.
(7) All kinds of trauma, poisoning, brain tumors, brain tumors after radiotherapy, etc., can cause ischemic or hemorrhagic cerebrovascular disease.
Drug factors (21%):
Cerebrovascular disease can be caused by many factors. The most common ones include hypertension, heart disease, arteriosclerosis and climate abnormalities. At present, some drugs, such as antihypertensive drugs, sedatives, diuretics, etc., are also found to induce ischemic An important factor in cerebrovascular disease.
(1) The blood flow of the antihypertensive drug brain tissue is mainly maintained by blood pressure. If the antihypertensive drug with strong action or the amount of antihypertensive drug is used too much, the blood pressure suddenly drops sharply, which affects the blood supply to the brain. The blood flow in the brain is slow, which promotes cerebral thrombosis. Do not take large doses of antihypertensive drugs before going to bed. After the person falls asleep, most of the body is at rest, the metabolism is slowed down, and the blood pressure is relatively reduced. If you take a lot of antihypertensive drugs, it will definitely lower your blood pressure, and the blood supply to the vital organs such as heart, brain and kidney will decrease, and the blood flow will be slow. Increased blood viscosity, hoarding in the cerebral blood vessels to form a thrombus, and cerebrovascular disease.
(2) Sedatives Some sedatives with strong effects, such as chlorpromazine, chloral hydrate, magnesium sulfate, etc., can also cause blood pressure to drop sharply in a short period of time, causing ischemia and hypoxia of brain tissue, leading to cerebral thrombosis.
(3) Hemostatic drugs are generally accompanied by arteriosclerosis, high blood lipids, and increased blood viscosity. If you use large doses of hemostatic drugs, such as Anluo blood, hemostatic acid, etc., can increase the coagulation of blood, make the blood slow, and promote cerebral thrombosis.
(4) diuretics in the elderly use diuretics, such as furosemide, hydrochlorothiazide, etc., due to a large number of diuretic, excessive water loss, blood concentration, increased viscosity, also easy to form cerebral thrombosis; the same reason, fever Excessive use of aspirin, compound aminopyrine and other sweating antipyretics, or excessive use of traditional Chinese medicine ephedra, cassia twig and other antiperspirant can cause a lot of sweating, and even excessive water loss and cerebrovascular disease .
(5) Contraceptives It has been reported that some contraceptives can increase the coagulation of blood. The incidence of cerebrovascular disease in oral contraceptives is 5-8 times higher than that in the control group. The shortest time to take the disease is several days, and the elderly are 5 years. Therefore, blood pressure and blood should be taken frequently during the course of taking birth control pills. Rheology examination, found that abnormal cases should be discontinued, for those with a tendency to cerebral thrombosis, the contraceptive should be discontinued.
(6) Anti-arrhythmia drugs take too much or the intravenous drip rate is too fast, can lower blood pressure, conduction block, bradycardia, and promote cerebral thrombosis. It can be seen that the cerebrovascular disease caused by drugs can not be ignored, and the elderly should be more cautious when using the above drugs. Generally, starting from a small dose, gradually increase the dose, avoid sudden drop in blood pressure, strong sedation, massive diuresis, excessive sweating, and excessive use of hemostatic agents to prevent cerebrovascular disease caused by drugs.
Prevention
Acute cerebrovascular disease prevention
Good eating habits can reduce the risk of cerebrovascular disease
1. Control energy intake. Eat more complex sugars, such as starch, corn, eat less glucose, fructose and sucrose, these sugars are monosaccharides, easy to cause high blood lipids.
2. Limit fat intake. When cooking, use vegetable oil to eat more sea fish. Marine fish contain unsaturated fatty acids, which can oxidize cholesterol, thereby lowering plasma cholesterol, prolonging platelet aggregation, inhibiting thrombosis, preventing stroke, and containing more linoleic acid. It has a certain effect on increasing the elasticity of microvessels, preventing vascular rupture and preventing complications of hypertension.
3. Appropriate intake of protein. Eating fish protein 2-3 times a week can improve blood vessel elasticity and permeability, increase urine sodium excretion, and lower blood pressure. When hypertension is associated with renal insufficiency, protein intake should be limited.
4. Eat more foods rich in potassium and calcium and low in sodium. Such as potatoes, eggplant, kelp, lettuce. Foods high in calcium: milk, yogurt, and shrimp. Eat less broth, because the increase of nitrogenous extracts in the broth can promote the increase of uric acid in the body and increase the burden on the heart, liver and kidneys.
5. Limit salt intake. Daily intake of 6g or less, that is, the size of the ordinary beer cover. Properly reducing salt intake helps lower blood pressure.
6. Eat more fresh vegetables and fruits. Eat fresh vegetables no less than 8 two a day, fruit 2 to 4 two.
7. Appropriate increase in seafood intake. Such as kelp, seaweed, seafood and so on.
Complication
Acute cerebrovascular disease complications Complications, cerebral palsy, brain and heart syndrome, renal failure
(1) Cerebral palsy: Most patients with cerebrovascular disease die in the acute phase. Most of the causes are due to massive bleeding, brain line structure displacement or destruction, whole brain edema, cerebral palsy, and the brain stem is squeezed and displaced. , endangered by the life center.
Domestic reports, cerebral hemorrhage combined with cerebral palsy death accounted for 44.8% ~ 50.1%, so timely and effective reduction of intracranial pressure, reduce brain edema, prevent cerebral palsy formation, is a key measure for treatment success or failure. And when the patient has the following conditions: 1 headache is severe or extremely irritated; 2 frequent vomiting or convulsions; 3 breathing and heart rate slow, high blood pressure; 4 conscious disturbance gradually worse; 5 bilateral pupils are not equal, suggesting intracranial The pressure is obviously increased, there may be cerebral palsy, and it should be actively dehydrated or treated with surgery.
(2) Brain-heart syndrome: When cerebral hemorrhagic lesions affect the lower central thalamus of the autonomic nerve, causing neurohumoral disorders, it often causes cardiac or organic changes, called brain-heart syndrome.
The brain-heart syndrome often occurs in two forms: one is the brain-heart stroke, which begins with cerebral hemorrhage and then cardiovascular disease. The second is the brain-heart simultaneous stroke, that is, cerebral hemorrhage and cardiovascular disease occur simultaneously or nearly simultaneously. However, due to the mutual concealment of symptoms, it is often easy to cause misdiagnosis and affect treatment. Therefore, it is necessary to pay great attention to the rescue process, and should carefully ask about the medical history and carefully observe the patient's performance of cardiac insufficiency. If there is chest tightness, shortness of breath, cyanosis, etc., there are abnormalities such as wet rales, low heart bluntness and tachycardia at the bottom of the lungs, and ECG should be checked in time. Once a heart rhythm disorder and ECG changes occur, the treatment of cerebral hemorrhage should be treated as an organic heart disease.
(3) bladder and rectal dysfunction: patients with mild cerebral hemorrhage often do not get used to lying defecation, and there is a temporary "postural urinary retention" and dry stool. In severe patients, when the lesions affect the hemisphere movement center, frequent urinary frequency and intravesical pressure increase. If the third ventricle is stimulated, there will often be an increase in rectal activity, resulting in a high degree of defecation, and the patient will have frequent intentions, but each time the amount of bowel movement is small. If the gray nodules are damaged, involuntary bowel movements may occur. If the whole brain is damaged, patients with deep coma often have incontinence or urinary retention.
(4) Renal failure and electrolyte imbalance: patients with cerebral hemorrhage can not respond to subjective feelings due to coma or aphasia, combined with complicated symptoms and more contradictory treatments; often due to frequent vomiting, fever, sweating, application of dehydrating agents and insufficient fluid replacement It causes loss of water, electrolyte imbalance and kidney failure. Oxygenosis is sometimes caused by hypoxia, hunger, abnormal breathing, or occasional alkalosis. However, in the case of coma or co-infection, the above-mentioned symptoms are often easily concealed and neglected, making the condition worse, so it should be observed. When it is found that the breathing is deepened, tachycardia, aggravation of consciousness, blood pressure drops, decreased urine output or no urine, limbs and facial edema or dehydration, it is necessary to carefully look for the cause, timely carbon dioxide binding, non-protein nitrogen, blood gas Analysis and electrolyte quantitative measurement, etc., when abnormalities are detected, timely treatment.
(5) Central thermoregulatory disorder: When cerebral hemorrhage reaches the lower part of the thalamus and the anterior part, the heat dissipation mechanism is destroyed, which can cause persistent high fever. The body temperature often reaches 40 °C or more, and may be accompanied by no sweat, cold limbs, and heartbeat. Overspeed, rapid breathing and other symptoms. However, white blood cells generally do not increase, compound aminopyrine, aspirin can not reduce it, sometimes with barbital plus ice pillow cooling is effective, if not treated in time, can die in a few hours.
(6) hemorrhoids: cerebrovascular patients often suffer from hemiplegia, long-term bedridden, plus some patients are fatter, not easy to turn over the care, the appendix, internal and external hemorrhoids, heel, hip and other bone protruding parts, often due to long-term compression, blood Cycling disorders lead to local malnutrition and acne.
In addition, the most common complications are upper gastrointestinal bleeding, lung infections and so on.
Symptom
Symptoms of acute cerebrovascular disease Common symptoms Ambiguous speech disorder Cerebrovascular cerebral artery palpebral heart and brain vascular accidental respiratory abnormality Limb twitching vascular murmur arrhythmia High blood pressure
Acute cerebrovascular disease can be divided into clinical manifestations and pathological changes:
(1) transient ischemic attack (TIA);
(2) cerebral infarction caused by cerebrovascular thrombosis or vascular embolism;
(3) cerebral hemorrhage, including intracerebral hemorrhage, subarachnoid hemorrhage, epidural hemorrhage, subdural hemorrhage;
(4) Hypertensive encephalopathy;
(5) cerebral arteritis;
(6) venous sinus and cerebral venous thrombosis;
(7) cerebrovascular disease caused by trauma;
(8) cerebrovascular diseases in newborns and children;
(9) Cerebrovascular disease of unknown cause.
Examine
Examination of acute cerebrovascular disease
Neurological examination
Pay attention to the state of consciousness, mental state, memory, computational power, orientation and speech function, pupil size, response to light, fundus lesions, co-operative examination of patients; attention to eye movement and position, presence or absence of asymmetry; observation center Sexual face, tongue, limb paralysis, sensory disturbance, pathological reflex and meningeal irritation, aphasia.
test
Blood, urine routine, platelets, hemorrhage, clotting time, prothrombin time, fibrinogen and other hemorheology items, and check for erythrocyte sedimentation rate, blood sugar, blood lipids, blood potassium, blood sodium, blood chlorine, liver function and Urea nitrogen.
Cerebrospinal fluid examination
Lumbar puncture can be performed when subarachnoid hemorrhage is suspected or when cerebral hemorrhage and cerebral ischemia are identified. Cerebrospinal fluid pressure is measured and sent to routine and biochemical measurements.
Special inspection
Or conditional should be preferred brain CT examination, in order to timely confirm the diagnosis of cerebral hemorrhage or cerebral infarction; the location and extent of hematoma or infarction; if to understand the condition of vascular stenosis or occlusion, the cause of subarachnoid hemorrhage, and preparation for interventional therapy Or surgical treatment, can be used for cerebral angiography or digital subtraction angiography (DSA), but also for MRI or MRA. Local cerebral blood flow (rCBF) measurements are possible if necessary.
Diagnosis
Diagnosis and identification of acute cerebrovascular disease
Diagnostic points
, transient ischemic attack
1. For short-term, reversible, local cerebral blood circulation disorders, recurrent attacks, less than one or two times, up to dozens of times. More associated with atherosclerosis, can also be a prodromal symptom of cerebral infarction.
2. Can be expressed as symptoms and signs of the internal carotid artery system and / or vertebral basilar artery system.
3. The duration of each episode usually lasts from a few minutes to about 1 hour, and the symptoms and signs should disappear completely within 24 hours.
Second, stroke
(a) subarachnoid hemorrhage
Mainly refers to aneurysm, cerebral vascular malformation or intracranial abnormal vascular network disease and other bleeding.
1. Rapid onset.
2. Often accompanied by severe headache, vomiting.
3. General awareness or conscious disorder, may be associated with mental symptoms.
4. There are many aponeurosis stimuli, a few may be associated with focal signs such as cranial nerves and hemiparesis.
5. Lumbar puncture cerebrospinal fluid is bloody.
6. CT should be the preferred check.
7. Whole cerebral angiography can help identify the cause.
(two) cerebral hemo
The predilection sites are the putamen, thalamus, caudate nucleus head, midbrain, pons, cerebellum, subcortical white matter, cerebral lobe, ventricle and others. Mainly hypertensive cerebral hemorrhage, including non-traumatic intracerebral hemorrhage of other causes. The diagnosis points of hypertensive intracerebral hemorrhage are as follows.
1. It is often caused by physical activity or emotional agitation.
2. Frequent vomiting, headache and elevated blood pressure during seizures.
3. The disease progresses rapidly, and there are often disturbances of consciousness, hemiplegia and other neurological focal symptoms.
4. More history of hypertension.
5. CT should be the preferred check.
6. Lumbar puncture and sputum sputum fluid contains more blood and increased pressure (about 20% of which can contain no blood).
(three) cerebral infarction
1. Atherosclerotic thrombotic cerebral infarction.
(1) often develops in a quiet state.
(2) Most of the onset did not have obvious headache and vomiting.
(3) The incidence is slow, and more progress or staged, mostly related to cerebral atherosclerosis, also seen in arteritis, blood diseases.
(4) Clear consciousness or mild disorder within 1 to 2 days after general onset.
(5) Symptoms and signs of the internal carotid artery system and/or vertebral basilar artery system.
(6) CT or MRI should be performed.
(7) Lumbar puncture and cerebrospinal fluid should not contain blood.
2. Cerebral embolism
(1) Most of them are sudden onset.
(2) Most have no prodromal symptoms.
(3) General awareness or transient sexual disturbances.
(4) Symptoms and signs of the carotid system and/or vertebral basilar artery system.
(5) Lumbar puncture cerebrospinal fluid generally does not contain blood, if there are red blood cells can consider hemorrhagic cerebral infarction.
(6) The source of the embolus may be cardiogenic or non-cardiac, or may be accompanied by embolism symptoms such as other organs, skin, and mucous membranes.
Lacunar infarction
(1) The onset is caused by hypertensive arteriosclerosis, which is acute or subacute.
(2) Many unconscious obstacles.
(3) CT or MRI should be performed to confirm the diagnosis.
(4) The clinical manifestations are not serious. The more common ones are pure sensory stroke, pure motor hemiparesis, ataxia hemiparesis, dysplasia-hand clumsy syndrome or sensorimotor stroke.
(5) There is no red blood cell in the lumbar cerebrospinal fluid.
4. Asymptomatic infarction is a vascular disease without any brain and retinal symptoms. It is only confirmed by imaging studies and can be used as a clinical diagnosis depending on the specific situation.
Third, cerebrovascular dementia
1. Meet the diagnostic criteria for dementia in the 4th edition of the Diagnostic and Statistical Manual of Psychiatry.
2. Neurological symptoms and signs of acute or subacute onset.
3. History of recent and recent strokes.
4. The course of the disease fluctuates and progresses in a step.
5. Often combined with hypertension, diabetes, heart disease, hyperlipidemia and so on.
6. Hachinski ischemic scale score 7 points.
7. CT and MRI confirmed multifocal cortical or subcortical ischemic changes in the brain.
Fourth, hypertensive encephalopathy
Have a history of hypertension, often have obvious elevated blood pressure, especially diastolic blood pressure, often accompanied by headaches, vomiting, disturbance of consciousness, convulsions, papilledema and other symptoms and signs.
