Basal ganglia hematoma
Introduction
Introduction to basal ganglia hematoma The basal ganglia, also called the basal ganglia, is a gray mass buried deep in both sides of the cerebral hemisphere and is the main structure that constitutes the extrapyramidal system. It mainly includes caudate nucleus, lenticular nucleus (nuclear nucleus and globus pallidus), screen nucleus and almond complex. Traumatic basal ganglia hematoma is a special phenomenon that was discovered after extensive CT application. According to Macpherson (1986), the incidence rate is 3.1% of brain injury and is divided into two types: one is a simple base. Hematoma, the second is a complex basal ganglia hematoma. basic knowledge The proportion of sickness: 0.01% Susceptible people: no specific population Mode of infection: non-infectious Complications: cerebral hemo
Cause
Cause of basal ganglia hematoma
(1) Causes of the disease
There are many causes of cerebral hemorrhage. The most common cause is hypertension atherosclerosis, followed by congenital cerebral vascular malformation or aneurysm, blood disease, brain trauma, anticoagulation or thrombolytic therapy, amyloid vascular disease. Brain hemorrhage. According to the cause, the classification is as follows:
1. According to vascular pathology: common microaneurysm or microangioma, cerebral arteriovenous malformation (AVM), amyloid cerebral vascular disease, cystic hemangioma, intracranial venous thrombosis, meningeal arteriovenous malformation, specific arteritis, Fungal arteritis, moyamoya disease, and arterial anatomical variations.
2. According to hemodynamics: there are high blood pressure and migraine. Blood factors include anticoagulation, antiplatelet or thrombolytic therapy, Haemophilus infection, leukemia, thrombotic thrombocytopenia, and the like.
3. Others: intracranial tumors, alcoholism and sympathetic nerve stimulating drugs.
4. The cause is unknown: such as idiopathic cerebral hemorrhage.
In addition, some factors have a certain relationship with the occurrence of cerebrovascular disease, may be the cause of cerebrovascular disease: 1 blood pressure fluctuations: such as high blood pressure patients have not taken antihypertensive drugs recently, or angry, etc., causing blood pressure to increase, to contract The increase in pressure is especially important. 2 temper or emotional stress: common in angry, after quarreling with people. 3 bad habits: such as smoking, alcohol, excessive salt, overweight. 4 excessive fatigue: such as physical and mental labor, defecation, exercise.
(two) pathogenesis
Mechanism of cerebral hemorrhage
In terms of the mechanism of occurrence, in fact, each case of cerebral hemorrhage is not caused by a single factor, but may be caused by several comprehensive factors. There are many mechanisms for the formation of cerebral hemorrhage in hypertension, and it is generally recognized that the theory of microaneurysm is. It is generally believed that a simple increase in blood pressure is not sufficient to cause cerebral hemorrhage, and cerebral hemorrhage often occurs on the basis of combined cerebrovascular disease.
(1) rupture of microaneurysm: due to the long-term tension caused by hypertension in the small arterial wall of the brain, an aneurysm is formed in the weak part of the blood vessel wall, and its diameter is generally 500 m. In the hypertensive patients, many microaneurysms are formed in the penetrating artery of the brain, which are distributed in the striatum of the basal ganglia, the pons, the white matter of the brain and the cerebellum with an artery diameter of 100-300 m. This kind of aneurysm is formed into a saclike shape in a weak part of the blood vessel wall. When the blood pressure suddenly rises, the cystic blood vessel is easily broken to cause cerebral hemorrhage.
(2) Fat glass-like change or fiber necrosis: long-term hypertension has a damaging effect on the inner membrane of the arterial wall of the brain parenchyma with a diameter of 100-300 m. The lipid in the plasma enters the intima through the damaged endometrium. Wall thickening and plasma cell infiltration, the formation of fat glassy changes, and finally lead to tube wall necrosis. It is easy to rupture bleeding when blood pressure or blood flow changes drastically.
(3) cerebral atherosclerosis: In most patients with hypertension, the arterial intima has multiple lesions at the same time, including local fat and complex carbohydrate accumulation, hemorrhage or thrombosis, fibrous tissue growth and calcium deposition. Patients with cerebral atherosclerosis are prone to cerebral infarction, and the arteries in the ischemic soft zone of the large brain are easily ruptured and hemorrhagic necrotic lesions are formed.
(4) The outer membrane and middle layer of the cerebral artery are structurally weak: the middle cerebral artery is at right angles to the deep perforating-bean vein artery that occurs. This anatomical structure causes sudden increase in blood pressure due to factors such as exertion and agitation. The blood vessel is prone to rupture and bleeding.
Prevention
Basal section hematoma prevention
1. The disease is a traumatic disease, no preventive measures, pay attention to safety, and avoid trauma.
2. Once a traumatic brain injury occurs, the diagnosis should be confirmed as soon as possible and treated early.
3. Combined with other intracranial hematoma, and the prognosis is poor.
Complication
Basal ganglion hematoma complications Complications
The hematoma can be ruptured to cause basal ganglia hemorrhage, and there are tri-polar signs (contralateral hemiplegia, partial sensation of sensation and hemianopia).
1 shell nucleus hemorrhage: mainly the rupture of the lateral branch of the bean vein artery, usually caused by the study of motor function defects, persistent isotropic hemianopia, can appear to the opposite side of the lesion to the side of the gaze can not, the main hemisphere can have aphasia.
2 thalamic hemorrhage: caused by the rupture of the thalamic geniculate arteries and thalamic perforating arteries, resulting in more obvious sensory disturbances, transient isotropic hemianopia; hemorrhagic foci oppression cortex language center can produce aphasia, thalamic focal hemorrhage can appear independent The aphasia syndrome has a good prognosis; the characteristics of thalamic hemorrhage are: upper and lower limbs are equal, deep feeling cherishes high protrusion; massive hemorrhage causes the midbrain upper visual center to be damaged, the eyeball is downwardly deflected, such as staring at the tip of the nose; Heavier, hemorrhagic waves and the lower part of the thalamus or broken into the third ventricle, the coma deepens, the pupil shrinks, and the cortex is straightened; the nucleus of the thalamus or the striatum can be seen in the dance-throwing-like movement; The thalamus is involved, it is difficult to distinguish the origin of bleeding, called basal ganglia hemorrhage.
3 caudate head hemorrhage: less common, showing headache, vomiting and mild meningeal irritation, no obvious sputum, similar to subarachnoid hemorrhage, sometimes visible contralateral central facial lingual, clinical often easy to ignore, even Found because of headache during CT examination.
Symptom
Basal section hematoma symptoms common symptoms disturbance of consciousness
The clinical manifestations of this disease are characterized by complete hemiplegia in the early stage after head injury and relatively low consciousness disturbance.
Examine
Examination of basal ganglia hematoma
Early diagnosis depends on CT examination, and should be based on the size of the hematoma, the extent of the disease and whether the condition can be stabilized to determine the operation or not.
Diagnosis
Diagnosis and differentiation of basal ganglia hematoma
Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.
Different from the basal ganglia hemorrhage, the symptoms of basal ganglia hemorrhage are more critical than this disease, and most of them are sudden onset of active or emotional hyperactivity in middle-aged and elderly patients, and there are symptoms of focal neurological deficit such as hemiplegia and aphasia. As well as severe headache, vomiting and disturbance of consciousness, it is often highly suggestive of cerebral hemorrhage, and CT can be diagnosed without examination.
