OVERVIEW
Overview of hemorrhagic cerebral infarction
Hemorrhagic cerebral infarction is defined as secondary hemorrhage within the infarcted area as a result of the reestablishment of blood perfusion to the vessels in the ischemic area.
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Department
Neurology
Synonyms: post-infarction cerebral hemorrhage
Post-infarction cerebral hemorrhage
Clinical symptoms
Impaired consciousness, aphasia, headache, vomiting, vertigo, hemianopsia, aggravation of hemiparesis of limbs, etc.
Hazards
Often combined with a variety of complications, severe patients may cause brain hernia, life-threatening.
Complications
Lung infection, decubitus ulcer, depression, etc.
Examination
Head CT.
Diagnosis
On the basis of ischemic cerebral infarction disease, the reappearance of the original disease aggravation or the appearance of new neurological symptoms and signs, combined with the imaging examination can be diagnosed.
Treatment principle
Lowering intracranial pressure, regulating blood pressure, preventing and controlling complications, treating the primary disease, and surgical treatment for those with large amount of bleeding.
Curability
Aggressive treatment can relieve symptoms.
Dietary recommendations
Low-salt, low-fat, high-protein, high-vitamin diet, avoid smoking, limit alcohol.
Etiology
Epidemiology
Incidence is higher in males than females.
Etiology
Often secondary to cardiogenic cerebral embolism and large atherosclerotic cerebral infarction, early application of anticoagulation, thrombolysis, volume expansion, vasodilator drugs and early surgical procedures and other contributing factors.
Symptoms and Diagnosis
Typical symptoms
According to the evolution of clinical symptoms, it can be divided into three types: mild, moderate and severe. Cerebral infarction mainly manifests as consciousness disorder, incomplete or complete aphasia, headache, dizziness, vomiting, hemianopsia, hemiparesis, hemiplegia, hemiplegia, motor ataxia, incontinence, etc. 1. Mild type occurs after 7-8 days of the original ischemic cerebral infarction, and there is no obvious manifestation in general, and the condition may even be improved gradually. 2. Medium type occurs in 4-7 days of the original ischemic cerebral infarction, and it manifests itself as original neurological manifestation. The symptoms are headache, dizziness, nausea, vomiting, aggravation of limb paralysis, and generally no consciousness disorder. 3. Heavy type occurs within 3 days of the original ischemic cerebral infarction, and is characterized by a sudden and obvious aggravation of the original neurological manifestations, persistent non-relief, consciousness disorder, pupil change, gastrointestinal hemorrhage, central hyperthermia, brain hernia, and so on.
Diagnostic basis
On the basis of ischemic cerebral infarction disease, there is a reappearance of consciousness disorder, aphasia, headache, vomiting, vertigo, hemianopsia, hemiparesis, etc. CT examination shows a high-density hemorrhagic foci, or magnetic resonance imaging reveals hemorrhagic signals in the background of infarct foci.
Treatment
Treatment guidelines
Lowering intracranial pressure, regulating blood pressure, preventing complications, treating primary diseases, and surgical treatment if bleeding is large.
Drug treatment
Immediately stop anticoagulation, volume expansion, thrombolysis, vasodilation and other drugs. Apply hemostatic drugs, such as aminoacetic acid, carbachol, phenolsulfonamide, tranexamic acid and so on. Dehydration, reduce intracranial pressure, commonly used drugs are mannitol, furosemide, dexamethasone, etc. 4. Apply anti-hypertensive drugs, such as lisdexamfetamine, etc. 5. Apply neuronal cell protector, such as cerebrolysin, cytarabine, etc.
Surgery
If the bleeding is large, hematoma drainage, hematoma removal or debridement should be performed as early as possible.
Other treatments
Head cooling, hibernation therapy, rehabilitation therapy, etc. can be supplemented as appropriate, while actively preventing and treating complications and primary diseases.
Prognosis
The prognosis of aged and seriously ill patients is poor, and the morbidity and mortality rate is high.
Nursing care
Daily care
Adopt good living habits, combine work and rest, take reasonable rest and ensure sufficient sleep. Keep a happy mood and avoid mental stimulation. Participate in appropriate physical exercise, promote blood circulation, and insist on rehabilitation training. Control blood pressure, regular outpatient follow-up, and consult the doctor in time if there is any discomfort.
Diet
Low-salt, low-fat, high-protein, high-vitamin, high-calorie diet, avoid smoking, limit alcohol.