中国医科大学神经病学英文课件 Cerebral hemorrhage.pptVIP

Cerebral hemorrhage Etiology and pathogenesis Hypertension and arteriosclerosis Atherosclerosis, bleeding tendency (hemophilia, leukemia, aplastic anemia, thrombocytopenia), congenital angiomatous malformation, arteritis, tumor lenticulostriate arteries vertical to MCA Microaneurysms → rupture Pathology Site: basal ganglia (70%), brain lobe, brain stem, cerebellum Lateral hemorrhage: the bleeding is confined lateral to the internal capsule (lenticular nucleus, external capsule) Medial hemorrhage: thalamus hematoma →edema →herniation hematoma →stroke capsule Clinical feature Age: 50-70 Male female Occur at physical exertion or excitement Sudden onset of focal signs Usually accompanied by headache and vomiting May have consciousness disturbance Clinical feature 1. Putamen hemorrhage contralateral hemiplegia, hemianesthesia, and hemianopia Eyes are frequently deviated toward the side of the affected hemisphere Aphasia if dominant hemisphere is affected Clinical feature 2. Thalamus hemorrhage contralateral hemiplegia, hemianesthesia, and hemianopia Deep sensation disturbance Ocular signs Disturbance of consciousness Clinical feature 3. Pontine hemorrhage Mild: crossed paralysis Severe (5ml) coma pinpoint pupils hyperpyrexia tetraplegia die in 48 hours Clinical feature 4. Cerebellar hemorrhage Occipital headache, intense vertigo and repeated vomiting, ataxia, nystagmus Severe cerebellar hemorrhage : coma, compression of brain stem, tonsillar herniation Clinical feature 5. Lobar hemorrhage Seen in AVM, Moyamoya disease, Headache, vomiting, neck stiffness Seizure Focal signs Investigation 1. CT First choice High density blood Mass effect and edema High density → isodensity → low density Investigation 2. MRI Brain stem hemorrhage 24h, not distinguishable with thrombosis 3. DSA Young and with normal blood pressure 4. CSF Bloody Done only when the CT is not available and without increased ICP Diagnosis Age 50, with hypertension Sudden