cerebrovascular disease
Introduction
Introduction to cerebrovascular disease Cerebrovascular disease refers to a group of diseases caused by cerebral vascular rupture or thrombosis, which is caused by symptoms of hemorrhagic or ischemic injury of the brain. It is also called cerebrovascular accident or stroke, commonly known as stroke. The disease is common in acute episodes of people in middle-aged and older people. In severe cases, disturbance of consciousness and paralysis of the limbs can occur, which is the main cause of death and disability of human beings, and the main cause of death in patients with hypertension. basic knowledge The proportion of illness: 0.010% (high incidence of the elderly) Susceptible people: multiple middle-aged and elderly people Mode of infection: non-infectious Complications: cerebral palsy, elderly brain-heart syndrome, renal failure, electrolyte disorder, hemorrhoids
Cause
Causes of cerebrovascular disease
Disease factors (35%):
(1) 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.
(2) 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, leukemia, often cause hemorrhagic cerebrovascular disease. A small number of ischemic cerebrovascular diseases occur.
(6) Metabolic diseases: such as diabetes, hyperlipidemia, etc., are closely related to cerebrovascular disease. 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 induced (25%):
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) Antihypertensive drugs: The blood flow of brain tissue is mainly maintained by blood pressure. If a strong antihypertensive drug or a large amount of antihypertensive drug is used, the blood pressure suddenly drops drastically, thereby affecting the blood supply to the brain. The blood flow 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: Generally, middle-aged and elderly people are often 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: middle-aged and elderly people use diuretics, such as furosemide, hydrochlorothiazide, etc., due to a large amount of diuretic, excessive water loss, blood concentration, increased viscosity, and easy to form cerebral thrombosis; the same reason, when 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 is 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) Antiarrhythmic drugs: If the dosage is too large or the intravenous drip rate is too fast, blood pressure can be lowered, conduction block, bradycardia, and 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
Cerebrovascular disease prevention
Effective control of blood pressure can significantly reduce the incidence of cerebrovascular disease. In terms of diet, it is not limited to one-sided restriction of high-fat intake, nor can it be fat and sweet, and it is necessary to arrange diet scientifically and reasonably. Active treatment of various heart diseases is also an important measure to prevent and treat cerebrovascular diseases.
In addition, some incentives for cerebrovascular disease should be avoided, such as poor mood (angry, excitement), unhealthy diet (overeating, improper drinking), overwork, excessive exertion, excessive exercise, sudden sitting, etc. Postural changes, constipation, watching TV for too long, etc.
Complication
Cerebrovascular disease complications Complications cerebral palsy elderly brain-heart syndrome renal failure electrolyte disorder acne
The acute phase of cerebrovascular disease is dangerous and often has some serious complications. The most common ones are the following.
(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, endangering 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 and heart syndrome:
When cerebral hemorrhagic lesions affect the lower central thalamus of the autonomic nerve, leading to 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 have a temporary "postural urinary retention" and dry stool because they are not accustomed to lying defecation. 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 cannot respond to subjective feelings due to coma or aphasia. In addition, the symptoms are complicated and there are many contradictions in treatment. They are often caused by frequent vomiting, fever, sweating, dehydrating agent application and insufficient fluid replacement, resulting in water loss, electrolyte imbalance and renal function. Depletion. 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 disorders:
When cerebral hemorrhage reaches the lower part of the thalamus and the front 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 symptoms such as no sweat, cold limbs, tachycardia, and rapid breathing. 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:
Patients with cerebrovascular disease often suffer from hemiplegia, prolonged bedridden, and some patients are fatter, not easy to turn over, and the protruding parts of the tail, internal and external tendons, heels, hips, etc. are often caused by long-term compression and blood circulation disorders. Malnutrition, acne.
In addition, the most common complications are upper gastrointestinal bleeding, lung infections and so on.
Symptom
Symptoms of cerebrovascular disease Common symptoms Vascular blockage, nausea, unclear, salivation, dysfunction, slanting angle, inability to speak, difficulty in swallowing, loss of consciousness, vomiting, complexity, drunkenness
First, cerebral thrombosis:
Acute onset is the main feature, and it is one of the most urgent diseases. Most patients do not have any prodromal symptoms before the disease. Sudden onset during the activity, most of the symptoms develop to the highest peak in a few seconds or minutes, a small number of patients In a few days, there is a step or progressive deterioration, and about half of the patients have a disturbance of consciousness at the onset, but the duration is short.
Second, brain hemorrhage:
Usually in the activity and emotional onset, there is no warning before bleeding, 50% of patients have headache and very severe, common vomiting, blood pressure is significantly increased after bleeding, clinical symptoms often peak in minutes to hours, clinical symptoms and signs Due to the location of bleeding and the amount of bleeding, basal ganglia, thalamic and internal capsule bleeding caused by hemiparesis is a common early symptom; about 10% of cases have seizures, often focal; severe cases quickly turn into confusion Or coma...more.
Third, brain arteriosclerosis:
Frequent dizziness, headache, irritability, lack of concentration, memory loss, limb numbness, bleeding and other symptoms.
Fourth, transient ischemic attack:
Sudden black eyes appear suddenly in one eye, or loss of vision, or white flicker, or visual field defect, or diplopia, which can be restored in a few minutes. The contralateral limb is slightly hemiplegic or partial. Impaired dominance of the hemisphere appears transient aphasia or misuse or loss of reading or loss of writing, or at the same time the facial muscles, tongue muscle weakness. Sudden dysphagia, water and cough, unclear language or hoarseness.
Five, brain arachnoid hemorrhage:
Sudden headache, vomiting, pale face, cold sweats. Most patients have unconscious disorders, but they can be restless. Critically ill people may have embarrassment, varying degrees of confusion and coma, and a small number of seizures and psychiatric symptoms may occur. Meningeal irritation signs can be seen in young adults.
Examine
Examination of cerebrovascular disease
1, three routine, blood clotting examination.
2. Blood sedimentation, blood sugar, electrolytes and urea nitrogen test.
3. Liver function tests.
4, cerebrospinal fluid examination, central retinal pressure measurement, hemorheology examination, cervical double oblique X-ray film, Doppler ultrasound.
5, special examination: conditional first choice brain CT examination, if you want to understand the cause of stenosis or occlusion, subarachnoid hemorrhage, and prepare to enter the interventional or surgical treatment, feasible cerebral angiography or DSA (digital subtraction brain Angiography) can also be performed by MRI or MRA (magnetic resonance angiography). Local cerebral blood flow measurement can be performed if necessary.
Diagnosis
Diagnosis and diagnosis of cerebrovascular disease
By nature:
Cerebrovascular diseases are generally classified into two categories according to their nature: ischemic cerebrovascular disease and hemorrhagic cerebrovascular disease.
Ischemic cerebrovascular disease:
(1) Transient ischemic attack (TIA, also known as small stroke or transient ischemic attack), the cause of which is related to cerebral arteriosclerosis, which is caused by transient, ischemic and focal damage of brain tissue. Dysfunction.
(2) Cerebral thrombosis, which is caused by atherosclerosis, various arteritis, trauma and other physical factors, blood clots caused by blood vessels causing local cerebrovascular disease.
(3) Cerebral embolism, which can be induced by embolism of various diseases entering the blood and blocking the blood vessels in the brain. Clinically, heart disease is the most common cause; followed by fracture, or fat into the blood after trauma; egg or bacterial infection; air into the blood such as pneumothorax, embolism formed by phlebitis and other factors, embolized by the cerebral blood vessels.
Hemorrhagic cerebrovascular disease:
(1) cerebral hemorrhage refers to cerebral parenchymal vascular rupture and bleeding, excluding traumatic cerebral hemorrhage. Mostly caused by high blood pressure, cerebral arteriosclerosis, tumors, etc.
(2) Subarachnoid hemorrhage, due to rupture of blood vessels on the surface of the brain and the bottom of the brain, blood directly into the subarachnoid space. Common causes are aneurysm rupture, vascular malformation, hypertension, arteriosclerosis, and blood diseases.
According to foreign statistics, cerebrovascular disease is more common with ischemic, cerebral infarction accounts for 59.2% to 85%, and cerebral hemorrhage is generally less than 20% except for Japan. In 1984, a total of 280 complete strokes were found in rural areas in China. Subarachnoid hemorrhage accounted for 3.9%, cerebral hemorrhage accounted for 44.6%, cerebral thrombosis accounted for 46.4%, cerebral embolism accounted for 2.5%, and difficult to be classified accounted for 2.9%. It can be seen from the above information that China and foreign countries are different. Although the incidence of cerebral infarction is more common, the proportion of cerebral hemorrhage is 44.6%, which is obviously higher than that of foreign countries. The reason remains to be further explored.
In addition, since the 1970s, due to the widespread use of CT and MRI, some cerebrovascular diseases with hemorrhage and infarction have been found clinically, that is, mixed stroke. This disease has been reported to account for the number of hospitalized patients with various cerebrovascular diseases. 2.67%. The etiology and pathogenesis of this disease are still not fully understood. It is believed that hypertension and arteriosclerosis are important causes and are closely related to their severity.
By process
Cerebrovascular disease can be divided into acute cerebrovascular disease (stroke) and chronic cerebrovascular disease according to its progress: acute cerebrovascular disease including transient ischemic attack, cerebral thrombosis, cerebral embolism, hypertensive encephalopathy, cerebral hemorrhage And subarachnoid hemorrhage, etc.; chronic cerebrovascular diseases include cerebral arteriosclerosis, cerebrovascular disease dementia, cerebral arterial steal syndrome, Parkinson's disease and the like.
The so-called cerebrovascular disease generally refers to acute cerebrovascular disease, which is acute and often endangers human life. Therefore, it is also easy to attract people's attention. The chronic cerebrovascular disease has a long course and is easily overlooked.
