The cause of cerebral hemorrhage is due to the rupture and bleeding of a cerebral blood vessel, which forms a hematoma that damages brain tissue and causes the corresponding symptoms. The most common cause is hypertension. Other causes include cerebrovascular malformation, aneurysm, blood disorders, vasculitis, smoker’s disease, and aneurysmal stroke. Other causes include cerebrovascular malformation, aneurysm, hematologic disease, vasculitis, smog, and aneurysmal stroke.
I. Clinical symptoms
1, headache dizziness headache is the first symptom of cerebral hemorrhage, mostly located on the bleeding side of the head; with increased intracranial pressure, the pain can develop to the whole head. Dizziness is often accompanied by headache, especially in cerebellar and brainstem hemorrhage.
2. Nausea and vomiting About half of the patients have nausea and vomiting at the onset, which is related to increased intracranial pressure, vertigo attacks, and blood irritation to the meninges during cerebral hemorrhage.
3. Impaired consciousness varies from drowsiness to coma depending on the site and amount of hemorrhage.
4. Changes in vital signs vary depending on the amount and site of bleeding, and may include increased blood pressure, increased heart rate, changes in respiratory rate, respiratory distress, and even respiratory arrest. High.
5, eye symptoms bleeding volume, the formation of brain herniation, there will be bleeding side pupil dilatation; there can also be partial blindness and eye movement disorders, such as cerebral hemorrhage patients in the acute stage often two eyes gazing at the bleeding side of the brain.
6, motor and sensory disorders motor disorders to hemiplegia is more common; speech disorders main wing present for aphasia and slurred speech.
7.Speech disorders are mainly aphasia and slurred speech.
Second, auxiliary examination
1.CT scan can clearly show the site of hemorrhage, the size of the hemorrhage, the morphology of the hematoma, whether it breaks into the ventricle, and whether there are low-density edema bands and occupational effects around the hematoma. The lesions are mostly round or ovoid uniform high-density areas with clear boundaries, and when there is a large amount of ventricular blood accumulation, they are mostly high-density casts with ventricular enlargement. 1 week later, there is circumferential enhancement around the hematoma, and the hematoma is hypodense or cystic after absorption. Dynamic CT examination can also evaluate the progression of hemorrhage.
2.MRI and MRA examinations are better than CT scan for detecting structural abnormalities, for detecting hemorrhagic foci in the brainstem and cerebellum and for monitoring the evolution of cerebral hemorrhage, and less than CT for diagnosing acute cerebral hemorrhage.
3. Other examinations include blood routine, blood biochemistry, coagulation function, electrocardiogram and chest X-ray examination. Peripheral leukocytes may be temporarily increased, blood glucose and urea nitrogen levels may also be temporarily elevated, and abnormal prothrombin time and partial thromboplastin time suggest coagulation dysfunction.
The diagnosis of cerebral hemorrhage should be considered in middle-aged and elderly patients with sudden onset during activity or emotional excitement, and rapid onset of focal neurological deficit symptoms as well as headache, vomiting and other symptoms of cranial hypertension, which can be rapidly and clearly diagnosed when combined with cranial CT examination.
Fourth, treatment of cerebral hemorrhage treatment principles are: lowering cranial pressure, adjusting blood pressure, removing hematoma, preventing and controlling continued bleeding, and enhancing care to prevent and control complications in order to save life, reduce mortality, disability and recurrence.
Combined with the site of bleeding and the amount of bleeding, choose conservative medical treatment or surgical treatment. Simple hypertensive brain out, bleeding volume below 30ml, a take conservative treatment, if greater than 30ml can be surgical removal of hematoma. Surgical methods are large bone flap craniotomy, small bone window craniotomy and minimally invasive puncture treatment.
1, generally should be bed rest for 2 to 4 weeks, keep quiet, avoid emotional excitement and blood pressure rise. Closely observe body temperature, pulse, respiration and blood pressure and other vital signs, and pay attention to pupil changes and changes in consciousness.
2. Keep the respiratory tract unobstructed and clear respiratory secretions or inhalants. If necessary, perform tracheal intubation or incision in a timely manner; those with impaired consciousness and gastrointestinal bleeding: straight fasting for 24 to 48 hours, and emptying of gastric contents if necessary.
3, water, electrolyte balance and nutrition, daily fluid intake can be calculated by urine volume + 500ml, if there is high fever, excessive sweating, vomiting, maintain central venous pressure 5 to 12mmHg or pulmonary wedge pressure at the level of 10 to 14mmHg. Pay attention to prevent water-electrolyte disorders, which may aggravate cerebral edema. Replenish sodium, potassium, sugar and calories daily.
4. Adjust blood pressure to control blood vessels within a relatively normal range.
5, obvious headache, excessive irritability, appropriate sedative analgesic can be given; constipation can be used to slow laxative.
6.Lower intracranial pressure, cerebral edema after cerebral hemorrhage reaches a peak in about 72 hours and gradually decreases after 3 to 7 days of maintenance, which can last 2 to 3 weeks or longer. Cerebral edema can increase the intracranial pressure and cause brain herniation, which is the main factor affecting the mortality and functional recovery of cerebral hemorrhage. Active control of cerebral edema and reduction of intracranial pressure is an important part of the acute treatment of cerebral hemorrhage.
7, surgical treatment, large bone flap craniotomy is to open a large bone window, remove the hematoma and remove the bone flap to achieve the decompression effect, which is suitable for patients with large bleeding volume; small bone window craniotomy is suitable for patients with small bleeding volume, postoperative edema is not large, and decompression without bone flap. If the bleeding volume is large, the condition is critical resulting in high intracranial pressure, and conservative medical treatment is not effective, surgical treatment should be performed in time. Minimally invasive intracranial hematoma removal is performed with a disposable soft or hard channel, puncture of the hematoma, intraoperative aspiration of the hematoma and dissolution of the clot with a hematolytic agent, and finally drainage is completed. This method minimizes the invasion of the body by the operation itself, is simple and fast, causes little damage to the brain, reduces complications, accelerates hematoma removal and shortens treatment time, and is especially suitable for patients who are old and frail or cannot tolerate traditional craniotomy, It can reduce the pressure on the surrounding brain tissues, reset the squeezed brain tissues in time, improve local blood circulation, reduce cerebral edema and cerebral hypoxia, and effectively protect the neurological function.
8, rehabilitation treatment, after cerebral hemorrhage, as long as the patient’s vital signs are stable and the condition no longer progresses, it is appropriate to carry out rehabilitation treatment as early as possible. Early phased comprehensive rehabilitation treatment is beneficial to restore the neurological function of patients and improve the quality of life.
9. Clarify the cause: After the condition is stabilized, especially for patients without a history of hypertension, it is recommended to perform cerebrovascular examination by CTA, MRA or DSA to clarify the cause of bleeding and actively deal with it to prevent re-bleeding.