Intracranial Hemorrhage 脑出血概要1.pptVIP

Intracranial Hemorrhage Marc Dorfman, MD, FACEP, MACPEM Residency Program Director Resurrection Medical CenterChicago, IL Case Presentation 57 year old female Sudden onset, severe headache Took ASA for relief Slurred speech Collapsed Physical Exam T 99.4 P52 BP 195/99 RR13 Pupils-2 mm reactive Neck-no JVD, bruits CV-bradycardia, no murmur Abd-bs+, soft , nt/nd Skin-warm and dry Neurological Exam Neurological exam: no gag reflex, withdraws to pain, +4 DTR GCS Eyes-1 Verbal-1 Motor-4 NIHSS Score Stroke scale 25 CT Scan Key Clinical Questions What are the most common etiologies and locations of ICH? What are the goals of BP management? What are the optimal strategies for managing ICP? What other treatment modalities are available to the ED physcian? Key Clinical Questions Which ICH patient require surgery? How does hemorrhage volume change over time? Does hemorrhage volume growth affect mortality? What are the new therapies being tested for this disease process? Intracranial Hemorrhage Epidemiology Etiology Diagnosis Treatment BP management Neurosurgical indications New treatment modalities ICH Epidemiology 30 day mortality: 35-52% 50% of these in first 48 hours One-fifth of survivors are independent at 6 months 7000 operations annually in USA to remove blood ICH Types Epidural Subdural Subarachnoid Intraparencymal Intraventricular Cerebellar Hypertensive ICH Hypertension Essential Eclampsia Sympathomimetics Cocaine Amphetamines Phenylpropanolamine Hypertensive ICH Basal ganglia (50%) Contralateral hemiparesis, sensory loss, conjugate gaze Lobar regions (20-50%) Contralateral hemiparesis or sensory loss, aphasia, neglect, or confusion Thalamus (10-15%) Contralateral hemiparesis, sensory loss, gaze paresis Pons (5-12%) Quadriparesis, facial weakness, decreased level consciousness Cerebellum (1-5%) Ataxia, miosis, gaze paresis Other ICH Etiologies Amyloid Trauma Vascular malformation-Avm, cavernoushemangiomas Aneurysm Tumor Coagulopathy Vasculitis ICH Pres