Dystrophic metamorphosis of brain cells
Introduction
Introduction Psychonosema caused by hypertension is the most common type of mental disorder associated with vascular disease. It refers to the mental disorder accompanied by the occurrence of essential hypertension. The mental disorder associated with essential hypertension is mainly manifested as neurosis-like syndrome, depression syndrome, hallucinations, delusional state, etc. When the blood pressure rises sharply and there is a hypertensive crisis, it often shows a disturbance of consciousness. The cause of hypertension is still unclear, and emotional instability, mental stress and other factors often make patients' blood pressure continue to rise. This sensitivity of hypertensive patients to mental factors, clinically believed that it is likely to be the cause of mental disorders in patients with hypertension. Primary hypertension (mild) refers to adult systolic blood pressure sustained 18.7 ~ 21.1kPa (140 ~ 159mmHg), diastolic blood pressure 12.0 ~ 13.2kPa (90 ~ 99mmHg). The patient had only systemic and small arteriolar spasms, and some patients developed brain weakness syndrome. It is characterized by head discomfort, emotional irritability, autonomic symptoms such as rapid heartbeat or pre-cardiac discomfort, and sleep disorders. Patients are prone to fatigue, weakness, inattention, poor memory, and reduced work capacity. Secondary hypertension (moderate): refers to systolic blood pressure continued to be 21.3 ~ 23.8kPa (160 ~ 179mmHg), diastolic blood pressure is more than 13.3 ~ 14.5kPa (100 ~ 109mmHg). The patient has small arteriospasm and hardening in the brain, which causes dystrophic changes in brain cells. Clinically, episodes of anxiety and depression can occur, accompanied by excitement. A small number of patients may have hallucinations and delusions, but their emotions are coordinated and well contacted. Tertiary hypertension (severe): refers to systolic blood pressure continuously 24.0kPa (180mmHg), diastolic blood pressure 14.7kPa (110mmHg). Patients may present with hypertensive encephalopathy or crisis, with obvious cerebral edema, varying degrees of disturbance of consciousness, accompanied by headache, vomiting, optic disc edema, temporary hemiplegia aphasia, pseudo-cerebral tumor-like syndrome, and heart and kidney Symptoms and signs of insufficiency.
Cause
Cause
(1) Causes of the disease
The current cause of essential hypertension is still unknown. May be related to age, psychosocial factors, genetic factors, high calorie diet. Most occur in 40 to 50 years old. No gender differences. On the basis of cerebrovascular wall lesions and blood components, hemodynamic changes, coupled with long-term emotional instability, persistent mental stress and other factors, can cause blood pressure to continue to rise, causing small arteriospasm and small arteriosclerosis, and thus The brain tissue is insufficiently supplied or even ischemic, so that the nerve cells are dystrophic, causing a transient cerebrovascular crisis or causing mental disorders. The general incidence is acute, the progress is slow, the course of disease is erratic, and the clinical manifestations are diverse, but eventually develop into dementia.
(two) pathogenesis
On the basis of vascular wall disease of hypertension, plus sleep disorders, dehydration, shock, heart failure, arrhythmia, erythrocytosis and other factors, can cause blood pressure drop, slow blood flow, increased blood viscosity or abnormal blood coagulation And other factors, often cerebral infarction, leading to brain dysfunction. The data show that the degree of cerebral blood flow reduction is positively correlated with the severity of dementia. The number of infarcts in multiple infarction plays an important role in the occurrence of dementia. Dementia is classified according to the extent of intracranial vascular lesions:
1. Dementia caused by diffuse lesions: multiple infarctions in the basal ganglia of the brain are more common. Pathological anatomy of multiple lacunar infarctions with different stages of disease, extensive atherosclerosis in the blood vessels.
2. Dementia caused by localized lesions: related to the size and location of the lesion. The main pathology is seen as cerebral arteriosclerosis. In addition to brain parenchyma and cerebrovascular disease, it can also involve organs such as the retina and heart and kidney. With the severe development of cerebral arteriosclerosis, diffuse brain atrophy can occur.
Examine
an examination
Related inspection
Brain CT examination brain MRI examination EEG examination brain nerve examination
The course and prognosis of the disease often depend on the severity of the hypertension itself, and the appearance of mental symptoms can exacerbate hypertension. Consciousness disorder has multiple episodes, and if the disturbance of consciousness persists, the prognosis is not good.
Mental disorders are often manifested in the following:
1. Early symptoms: The early symptoms of mental disorders are mainly brain weakness syndrome. Deformed head discomfort, emotional instability, sleep disorders, inattention, poor memory, decreased ability to work, autonomic dysfunction, etc.
2. Localized symptoms and signs of the nervous system: Localized symptoms of neurological symptoms are more common with pseudobulbaric palsy, dysarthria, difficulty in swallowing, central facial paralysis, degree of hemiplegia, aphasia, misuse or loss of recognition, epilepsy Attack, urinary incontinence, etc. Different localities have different localized symptoms of cerebral hemorrhage or cerebral infarction. For example, when there is an obstacle in the blood supply area of the posterior cerebral artery, there may be ipsilateral hemianopia, spatial ignorance and lack of self-knowledge.
3. Intelligent damage (dementia): The early stage is limited, that is, the cognitive function damage is uneven. Despite the memory impairment and intelligent damage, the self-knowledge and judgment remain better. Anxiety and depression only show excessive attention to their own diseases, and later they will have fear, anxiety, depression and concept of doubt. Often onset, it is progressively degraded. In the future process, some patients have perceptual disorders and thinking disorders, resulting in various hallucinations, delusional states, such as relationships, murder, suspected illness, jealousy, stolen thoughts and so on. Often the performance of mid-stage hypertension. But there is no barrier of consciousness. Some patients gradually developed from emotional vulnerability to emotional retardation, mandatory crying, and a few emotional outbursts. As the disease progresses, if physical complications, trauma, and acute environmental changes occur, especially in the case of an acute cerebrovascular accident, the symptoms of dementia will increase in a stepwise manner, and in the advanced stage, it becomes a comprehensive dementia.
In the case of hypertensive crisis and encephalopathy, the patient may have a disturbance of consciousness, which may be accompanied by a horror hallucination or piece of delusion, excitement, impulsivity, verbal inconsistency or a pseudo-cerebral tumor-like syndrome (increased intracranial pressure). Some patients still have similar mania or depression after a recovery.
4. Mental disorders associated with cerebrovascular disease: mental disorders associated with cerebrovascular disease may have memory, intelligence disorders and localized neurological symptoms. In most patients, the course of the disease is stepwise and fluctuating, and some patients are worsened by stroke. Only a few patients can be relieved. The short course of disease is about 2 months, and the elders are more than 20 years old, with an average of 5 years. Half of the patients were accompanied by hypertension, and some were associated with coronary heart disease, diabetes, and hyperlipidemia. Symptoms such as high blood pressure, carotid murmur, mood swing with transient depression, crying or bursting laughter, transient turbidity or convulsions are often exacerbated by further infarction. Personality is relatively intact, but there may also be obvious personality changes, such as apathy, lack of self-control, or the original personality characteristics are more prominent, such as self-centered, paranoid or irritating. Most patients die from repeated episodes of acute cerebrovascular disease or coronary heart disease or secondary infection.
5. Somatic symptoms: often have headache, vomiting, dizziness, elevated blood pressure, transient stenosis or hardening of the fundus artery, changes in the heart of the X-ray, and changes in renal function in laboratory tests.
an examination
1. According to the recommendations of the World Health Organization (WHO), the blood pressure standard is: normal adult systolic blood pressure should be less than or equal to 140mmHg (18.6kPa), diastolic blood pressure is less than or equal to 90mmHg (12kPa). If the adult systolic blood pressure is greater than or equal to 160 mmHg (21.3 kPa), the diastolic blood pressure is greater than or equal to 95 mmHg (12.6 kPa) for hypertension; the blood pressure value is between the above two, that is, the systolic blood pressure is 141 to 159 mmHg (18.9 to 21.2 kPa). Between the diastolic blood pressures between 91 and 94 mmHg (12.1 to 12.5 kPa) is the critical hypertension. When diagnosing high blood pressure, blood pressure must be measured multiple times. At least two consecutive diastolic blood pressures with an average of 90 mmHg (12.0 kPa) or more can be diagnosed as hypertension. Only one time of elevated blood pressure can not be diagnosed, but need to be followed up. WHO's new standard: ideal blood pressure:
2. Before the onset of mental symptoms, there is a clear history of hypertension. That is, on the basis of suffering from essential hypertension, the patient develops a brain-debilitating syndrome, or has symptoms such as anxiety, depression, hallucinations, delusional state, and disturbance of consciousness, and the mental symptoms fluctuate with blood pressure and physical symptoms, that is, the fluctuation of symptoms. It is closely related to fluctuations in blood pressure.
3. In the early stage, it is mainly caused by brain weakness syndrome, and there are often disturbances of consciousness in the late stage.
4. When the patient has unconsciousness, the emotion is clear, the contact is good, but the judgment is lacking.
Diagnosis
Differential diagnosis
Dehydration of brain cells: Increased osmotic pressure of extracellular fluid can cause a series of symptoms of central nervous system dysfunction, including lethargy, muscle twitching, coma, and even death. It belongs to hypertonic dehydration. When the brain volume is significantly reduced due to dehydration, the vascular tension between the skull and the cerebral cortex increases, which can lead to rupture of the vein and local intracerebral hemorrhage and subarachnoid hemorrhage.
Cytochrome C oxidase deficiency is a type of Fanconi syndrome, and Fanconi syndrome is a hereditary or acquired disease. Often associated with cystine disease, characterized by abnormal proximal tubular function, causing glucoseuria, phosphate urine, amino acid urine and bicarbonate urine. More symptoms than adulthood, renal glucosuria, multiple amino aciduria, hypercalciuria, renal loss of sodium, hypophosphatemia, proximal renal tubular acidosis, hypouricemia, renal tubular proteinuria, low Potassium (myasthenia, soft palate, periodic paralysis, etc.), hypocalcemia (hand, foot and sputum).
There is uric acid crystal in leukocytes in joint fluid: hyperuricemia, also known as gout, is a group of diseases caused by dysfunction of sputum. Its clinical features are hyperuricemia and gout caused by it. Repeated episodes of acute arthritis, tophis deposited tophitic chronic arthritis and joint deformities, often involving the kidney caused by chronic interstitial nephritis and uric acid kidney stones. The disease can be divided into two major types of primary and secondary primary causes, except for a small number of enzyme defects, most of which are not elucidated, often accompanied by hyperlipidemia, diabetes, hypertension, arteriosclerosis and coronary heart disease. Is a hereditary disease. Secondary people can be caused by a variety of causes such as kidney disease blood diseases and drugs. There is uric acid crystals in leukocytes in joint fluid, which is one of the diagnostic criteria for gout.
Lymphocyte homing phenomenon of phytohemagglutinin: Protein loss of gastrointestinal syndrome refers to a syndrome caused by loss of plasma proteins, especially albumin, from the gastrointestinal mucosa due to various reasons. Clinically, it mainly manifests as systemic edema and low plasma proteinemia. Small intestinal lymphatic dilatation often has immunoglobulin loss and abnormal cellular immunity, and the lymphocyte ancestral phenomenon of phytohemagglutinin is also weakened, so it is prone to pulmonary infection.
