Many people who have cerebrovascular disease cannot tell which one it is, and often refer to cerebral thrombosis as cerebral infarction and cerebral hemorrhage as cerebral thrombosis. Although these are all cerebrovascular diseases, the pathogenesis and clinical manifestations are different, and the treatment also varies.
Cerebral hemorrhage is a clinical symptom caused by blood infiltration into the brain parenchyma after the rupture of cerebral blood vessels, and the condition is more acute and generally more serious than cerebral thrombosis and cerebral infarction. The common causes are hypertension and cerebral atherosclerosis, followed by cerebrovascular malformation and congenital aneurysm. Cerebral hemorrhage often develops during activity or emotional excitement, and generally has symptoms such as fall, coma, hemiparesis, vomiting, different degrees of impaired consciousness, and also facial muscle paralysis, mouth distortion and drooling. The site of bleeding varies.
Cerebral thrombosis is caused by atherosclerosis, endarteritis and high viscosity of blood, resulting in localized thrombosis of cerebral vessels and blockage of blood vessels. Cerebral thrombosis starts slowly and often develops during sleep or rest. In some patients, the symptoms are mild at first, but gradually worsen later, and even reach a peak 2-3 days after the disease. Patients with coma are less common and generally have mild symptoms. They may have hemiparesis and unilateral limb paralysis, and may also have aphasia, and some patients have symptoms such as numbness of the head or limbs.
Cerebral infarction is a symptom that occurs when emboli from other parts of blood vessels, such as the attached wall thrombus of heart disease, thrombus of aorta and carotid artery in the form of atherosclerotic plaque dislodged, pelvic and lower limb vein thrombus dislodged, and fat embolus running to the brain when fracture causes thrombosis, mostly occurring in patients with heart disease. The onset of the disease is rapid and often causes aphasia and hemiplegic sensory impairment mainly in the right upper limb, but coma rarely occurs.
Treatment of cerebral hemorrhage is often done with hemostatic agents. Patients with cerebral hemorrhage should avoid moving as much as possible and be kept quiet to prevent rebleeding. Currently, surgery is used to treat cerebral hemorrhage with certain effect. For cerebral thrombosis and cerebral infarction, vasodilator therapy is used. The application of extravascular drugs can change local ischemia and promote the rapid relief of symptoms, and the healing process is better.
Cerebral hemorrhage refers to bleeding caused by rupture of blood vessels in the brain parenchyma, and the most common causes are hypertension and cerebral atherosclerosis. After the onset, the patient quickly enters a coma; there are intracranial hypertension manifestations such as flooding and slow pulse, deep and slow breathing, facial flushing, and optic nerve papillary edema; most of them are accompanied by central hyperthermia.
Due to the different sites of hemorrhage, their neural localization manifestations are also different.
1. The internal capsule hemorrhage is the most common, and the main symptoms are “triple hemiparesis”: contralateral hemiparesis, hemianesthesia and hemianopsia. In the early stage of the paralyzed limb, the muscle tone is low and the reflexes disappear, but soon the muscle tone gradually increases, the tendon reflexes are enhanced and the pathological reflexes are positive. In the case of hemorrhage in the main hemisphere, there is aphasia.
2, Cerebral bridge hemorrhage with bilateral paralysis of the lateral muscles and limb muscles, enhanced tendon reflexes, positive pathological reflexes, and pinpoint size of bilateral pupils.
3.Ventricular hemorrhage manifests as severe headache, vomiting, and soon enters deep coma, and may have generalized tonic spasm attacks.
4. Cerebellar hemorrhage manifests as vertigo, headache, vomiting, ataxia, narrow pupils, and positive meningeal irritation signs.
The white blood cell count increases during hemorrhage, and cerebrospinal fluid examination is mostly bloody. CT examination within 1 week of onset can confirm the diagnosis of hematoma with a diameter greater than or equal to 1 cm.
The main prevention and treatment measures in the acute phase include.
1, to prevent continued bleeding patients should be absolutely static, try to avoid unnecessary moving, restlessness available diazepam (Valium) 5-10 mg intramuscular injection; appropriate hypotension, so that blood pressure control at (160-150)/(100-90) mm Hg or so is appropriate; optional hemostatic agents, but no significant hemostatic effect.
2, reduce intracranial pressure can be used 20% mannitol solution, dexamethasone injection, dosage and usage details see cerebral thrombosis.
3.Other measures to improve cerebral hypoxia, protect brain cells, continuous oxygen inhalation; exclude airway secretions, keep the airway unobstructed; head placement of ice pillow or ice cap to reduce the metabolic rate of brain tissue.
4.Strengthen observation and nursing care, observe pulse, respiration, blood pressure, pupil and mental changes; nasal feeding of liquid diet and intravenous fluid supplementation to maintain nutrition and water and electrolyte balance; actively prevent and treat pneumonia, decubitus ulcers and other complications; physical cooling should be used first when high fever is present, and antipyretic drugs should be used to strengthen the cooling effect if ineffective; diazepam (Valium) 5-10 mg should be used intramuscularly when convulsions are present.
5.Surgery If the patient is not suitable for conservative treatment, surgical treatment is required. Professor Chen Tiao Cheng (April 2000) of Huashan Hospital of Fudan University School of Medicine (formerly Shanghai Medical University) pushed acenaphthene craniotomy + recombinant streptokinase, the recent good rate and long-term good rate reached 67.7% and 66.7% respectively, which is much higher than other treatment methods.
Men between 40 and 60 years old are at high risk of cerebral hemorrhage, and the younger the age, the larger and more dangerous the area of cerebral hemorrhage is, and the prognosis is relatively worse. Blood pressure fluctuations can easily lead to cerebral hemorrhage, so middle-aged men should develop the habit of regularly measuring their blood pressure, and be careful not to overspend and avoid various risk factors for blood pressure fluctuations.
Cerebral hemorrhage occurs in the case of long-term hypertension on the basis of damaged blood vessels, and alcohol consumption, stress and emotional excitement are important triggers. Prof. Wang pointed out that the risk of cerebral hemorrhage is greatly increased by the high stress, busy work, lack of sleep and social activities of young and middle-aged people, especially the Chinese style of socializing, which is dominated by alcohol.
The occurrence of cerebral hemorrhage is also closely related to the structure and health of the blood vessels themselves. Intima-media lesions tend to be thickened and obstruct blood flow, while intima-media lesions tend to be ruptured and bleeding. However, while intimal thickening increases the risk of ischemia (increased risk of heart attack and cerebral infarction), it also has an objective protective effect on the blood vessels, reducing the risk of bleeding. The risk of hemorrhage or ischemia increases and decreases with age. In middle-aged people, when the degree of atherosclerosis is not yet severe and the intima is not yet thickened, the risk of ischemia is still small, but the risk of bleeding is larger.