[临床医学]脑出血-10.pptVIP

* 脑出血 INTRACEREBRAL HEMORRHAGE 南京医科大学第一附属医院 神经病学教研室 牛 琦 DEFINITION 脑出血（intracerebral hemorrhage） 原发性脑实质出血，占全部脑卒中的10～30％ 重点要掌握内容 脑出血的定义 常见脑出血的好发部位 常见脑出血的临床表现 脑出血的诊断和治疗 病因（Etiology） 1、高血压Hypertension 2、凝血系统疾病Coagulopathies 3、脑淀粉样血管病Cerebral amyloid angiopathy 4、动脉瘤、动静脉畸形、烟雾病 aneurysm、AVM、 Moyamoya disease 6、瘤卒中Hemorrhage into Tumors 7、梗死后脑出血Hemorrhage into cerebral infarcts 8、抗凝或溶栓治疗后anticoagulation therapy 9、其它(others)：动脉炎、肿瘤性出血 发病机制 长期高血压使深穿支动脉血管壁发生动脉硬化或微小动脉瘤（chronic hypertension appears to promote structural changes in the walls of penetrating arteries） 脑动脉壁薄弱，缺乏外弹力层，受高压血流冲击易发生动脉硬化和微小动脉瘤 好发血管： 豆纹动脉和旁正中动脉 出血有稳定型 活动型 出血48小时水肿达高峰期 主要的神经功能缺损是由于出血和水肿引起脑组织受压而不是破坏，所以神经功能可有相当的恢复 病 理Pathology Arterial territory Anterior cerebral Middle cerebral Posterior cerebral Anterior choroidal 病理 Most hypertensive hemorrhages originate in certain area of predilection, corresponding to long, narrow,penerating arterial branches along which Charcot-Bouchard (粟粒状动脉瘤)aneurysms are found at autropsy.These include the caudate an dputaminal branches of the middle cerebral arteries(42%);branches of the basilar artery supplying the pons (16%); thalamic branches of the posterior cerebral arteries (15%); branches of the superior cerebellar arteries supplying the dentate nuclei and the deep white matter of the cerebellum(12%); and some white matter branches of the cerebral arteries(10%), especially in the parietooccipital and temporal lobes Basal ganglia vascular rupture can break into and fill the lateral ventricles (two patients shown) Coronal Horizontal Classic “lateral basal ganglia” hypertensive hemorrhage, forming an intraparenchymal hematoma. 临床表现（Clinical findings） Often occurs 50～70 years old patient Hypertensive hemorrhage ocurrs without warning, most commonly while the patient is awake. Headache is present in 50% of patients and may be severe; vomiting is common. Followin