Diagnosis and treatment of cerebral hemorrhage (diagnostic / practical summary one)

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Diagnosis and treatment of cerebral hemorrhage (diagnostic / practical summary one)

2021-11-25 14:46:54 21 ℃

(1) Primary cerebral hemorrhage: mainly refers to high blood pressure cerebral hemorrhage, a small number of cerebrovascular amyloid spots CAA and unknown cause cerebral hemorrhage. (CAA: Multi-system organ tissue of vascular amyloid samples, tissue biopsy, iodine, starch, cyanosis, amyloid vascular disease, bleeding has a high reconciliation incidence, feasible APOE gene detection screening)

(2) Secondary cerebral hemorrhage: Refers to the translational transformation of blood vessels and diamonds and cerebral infarction, prolonged dysfunction and thrombocytopenia, anti-coagulation or anti-platelet drug treatment, primary and transfer tumors and other causes.

Two: Clinical manifestations: more in activities (opposite to cerebral infarction), sudden headache, nausea, vomiting (intracranial high pressure); neurological defect symptoms: hemiplegia blind lighting sensory disorder (three bias) and influence (substrate) Section), dizziness and intensive disorders (cerebellum), pupils, unequal and breathing irregular (brainstem), different degrees of consciousness and epilepsy (cerebral cortex).

Three: Imaging:

CT flat sweeper, CT enhancement, CTA and MRA check

CT smoothness (can not distinguish between normal flow blood flow and other soft tissue): Early diagnosis of cerebral hemorrhage "gold standard", can quickly determine cerebral hemorrhage and substantially estimate of hemorrhage: hematoma = Maximum area long axis (cm) × Maximum area short Shaft (CM) × Level (Layer 1 Cm) X0.5.

Enhance CT and perfusion CT (relative to flatness, according to the different tissue of blood flow): "Demonstration" to find the "destination" suggestion of the contrast agent to expand the risk.

(Perfusion CT: Continuous scan for the selected local tissue or lesion, reflects the factor from entering tissue or lesion until most of the tissue or lesion, it reflects the perfusion law of the contrast agent in the tissue or lesion That is, that is, the blood microcirculation in these tissues or lesions. CT perfusion scan is very high in time resolution, and the time interval between each scan cannot be greater than 0.5 ~ 1.0 seconds, and the general CT equipment is difficult to complete).

Standard MRI: The body's external magnetic field is similar to the resonance of hydrogen in the body, so there is no radiation, but the body is taboo. It can be found that the early cerebral infarction of chronic hemorrhage can be found in the soft tissue. However, the high-density bone and the high gas content have not shown CT.

Cerebrovascular CTA and MRA (Non-invasive Check) (Enhanced CT scan) After the computer is processed, the non-blood content removal of only the blood vessels is retained only, and three-dimensional reconstruction makes the entire appearance of the blood vessels to show the disease vessels: aneurysm, vascular malformation, Vascular blockage): It can be used to screen the possible cerebrovascular deformity or aneurysms, but the negative result cannot completely exclude the existence of the lesion; "speckled" appeared on the CTA suggests that the risk of hematoma is high; MRA can be directly displayed Blood vessel.

Created Digital Reduction Vascular Machinery (DSA): Clearly show that cerebrovascular branches and aneurysms and malformed blood vessels provide reliable etiology and disease-related, which is the current vascular lesion inspection "gold standard" in vascular embolization treatment or surgical treatment. .

4: Laboratory examination: Help determine the cause of blood routine, liver and kidney function myocardial enzyme, and coagulation function. (Except for blood disease and platelet decreasing, abnormal coagulation, abnormal liver function abnormal). Suspected vascular starch samples can be detected by APOE gene.

Five: Diagnosis:

Diagnosis of cerebral hemorrhage: sudden headache and vomiting (intracranial hypertension), nerve impaired positioning signs, and timeline CT can confirm the impairment. Diagnosis: primary cerebral hemorrhage: 80% is hypertensive cerebral hemorrhage, and a small part is brain amorphous variability and unknown reasons. Secondary cerebral hemorrhage: Secondary from cerebrovascular malformation and brain aneurysms and brain tumors and cerebral infarction translation, secondary bloodlets, abnormal coagulation is abnormal (liver function abnormalities), anticoagulation and antiplatelet and Thromatherapy treatment. Diagnosis of complications: intracranial hyperpress, epilens, deep venous thrombosis (DVT) and pulmonary embolism.

Iron Camp Hospital Emergency (Li Xuefeng) 2021.11.24