神经病学课件：Cerebrovascular Diseases(part II).pptVIP

Cerebrovascular Diseases(part II) OutlineIntroductionTransient Ischemic Attacks (TIA)Ischemic strokeIntracerebral HemorrhageSubarachnoid Hemorrhage Intracerebral hemorrhage(ICH)Spontaneous Intracerebral Hemorrhage(SICH)Accounts for 20~30% of all CVD30 day mortality: 35~50%Brain hemisphere 80%, brain stem and cerebellum 20% Etiology Primary ICH (78-88% cases)Hypertension (Essential, eclampsia, drug induced)Cerebral Amyloid Angiopathy (-50% individuals greater than 80 years old)Vascular malformationAneurysmAvmBleeding diathesis (体质）, coagulopathyTumorTraumaVasculitis CT examples Pathophysiology Primary-immediate effectsHemorrhage growthIncreased ICPSecondary effectsEdemaIschemiaHemorrhage is dynamic; process continues for several hours ICH Hemorrhage GrowthHematoma growth occurs in patients with normal coagulation profilesHematoma growth occurs within the first few hours (up to 40% in the first 3 hours) and is rare after 24 hoursIs associated with a worse outcome Hemorrhage Growth-PredictorsInitial Hematoma volumeIrregular shapeLiver diseaseHypertensionHyperglycemiaAlcohol useHypofibrinogenemia Edema ischemic penumbraUp to 75% increase in volume in the first 24 hoursPeaks around 5 to 6 days and lasts up to 14 daysEarly large edema relative to hematoma is a predictor of poor outcomeGlobal cerebral ischemiaVery elevated ICP and low cerebral perfusion pressure Clinical featuresFeatures of intracranial hypertensionHeadache, vomiting, decreased LOCCorrelated with hematoma size and prognosisProgressive over timeSeizures in lobar ICHFocal neurological deficits depending on the location of ICH Features of intracranial hypertensionHypertension (90%)Altered mental status (50%)Uncommon in patients with ischemic strokeHeadache (40%) : 17% with ischemic strokeVomiting (49%) 2% Ischemic stroke; 45% with SAHSeizures (6-7%)Trend toward worse outcome Focal neurological deficitsBasal ganglia (50%)Contralateral hemiparesis, sensory loss, hemianopiaLobar regions (20-50%)Contralatera