Hello! We sympathize with you for your unfortunate brain hemorrhage. During your hospitalization, we will systematically evaluate your condition and develop the best treatment plan and post-discharge rehabilitation guidance according to your individual situation. We hope that you and your relatives will read it carefully to understand your condition and our treatment plan.
I. Introduction to cerebral hemorrhage Wang Lixin, Department of Brain Diseases, Guangdong Provincial Hospital of Traditional Chinese Medicine
Cerebral hemorrhage accounts for about one-third of cerebrovascular diseases, and middle-aged and elderly people are the main group of people who suffer from cerebral hemorrhage, with 40-70 years old being the most important age of onset. Vascular lesions are closely related to hyperlipidemia, diabetes, hypertension, aging of blood vessels, smoking, etc. The commonly referred to cerebral hemorrhage refers to spontaneous primary cerebral hemorrhage. Patients often have a sudden onset due to emotional agitation and effortful exertion, manifesting as aphasia, hemiparesis, or in severe cases, unconsciousness, and more than half of the patients are accompanied by headache and vomiting. A large amount of cerebral hemorrhage may affect the function of the mesencephalon and brainstem, and soon after the onset of the disease, the patient may become unconscious or even brain herniation and die.
II. Classification of cerebral hemorrhage and changes in condition.
Medically, cerebral hemorrhage is divided into hemorrhage in the basal ganglia (shell nucleus, thalamus, caudate nucleus), lobar hemorrhage, cerebral bridge hemorrhage, cerebellar hemorrhage, and ventricular hemorrhage according to the hemorrhage site. The clinical manifestations of each site of hemorrhage vary, and the severity of the disease has a greater relationship with the amount of hemorrhage, the site of hemorrhage, the underlying disease, and the individual’s physical condition. Within 6 hours after a brain hemorrhage, there is a risk that the hematoma will continue to expand, with a chance of about 30-46%, which is correlated with your blood pressure, coagulation function, bleeding pattern and site, and age, etc. Now that you have been examined for brain hemorrhage, continued bleeding is your greatest risk now. In addition, the peak of cerebral edema is reached 3-5 days after brain hemorrhage. Due to the compression of edema around the hematoma, your symptoms may worsen, and in severe cases, you may suffer from unconsciousness, coma or even brain herniation and death. Therefore, 1-2 weeks after the onset of the disease is a critical period for the progression of the disease to worsen.
Relevant tests and implications after cerebral hemorrhage
After you are admitted to the hospital, we will perform the following examinations in order to clarify the site and size of your brain hemorrhage, the risk factors such as hematoma enlargement and cerebral edema, and the causes of brain hemorrhage and its related complications, so as to provide a basis for the prognosis and treatment of your condition. We will conduct the following examinations: 1. Comprehensive physical examination, neurological examination and scoring, cerebrovascular examination: By asking medical history, present symptoms and signs, and auscultation and palpation of each blood vessel distribution area, we can generally understand the cause of your illness, the location of the lesion, and the severity of your condition. 2.Cranial CT: It is the first choice to clarify cerebral hemorrhage, you may have completed this examination when you were admitted to the hospital in an emergency, which is necessary; moreover, you need to review it at any time when your condition changes, in order to clarify the severity of hematoma enlargement and cerebral edema, and to provide strong evidence for deciding the treatment plan. 3.Cranial MRI examination: most cerebral hemorrhages in young patients are caused by arteriovenous malformations and aneurysms, and some brain aneurysms can also bleed. We will arrange cranial MRI examination for these patients as soon as possible, in order to distinguish the site and size of arteriovenous malformation or aneurysm and brain tumor bleeding. 4.Cerebral angiography (DSA): If the cranial MR examination suggests the possibility of arteriovenous malformation or aneurysm, we will suggest you to have this examination to decide whether you need arteriovenous malformation or aneurysm embolization or craniotomy. Other tests: Various blood and stool tests, liver and kidney functions, blood lipids, blood glucose, coagulation function, electrocardiogram, cardiac ultrasound and other tests are performed to determine whether you have any other diseases other than cerebral hemorrhage, how serious they are and whether they need treatment. On the other hand, it is necessary to assess the cause of your bleeding and the risk of rebleeding. At the same time, you can guide your doctor to use medication and try to avoid the side effects of medication for cerebral infarction.
IV. Treatment goals
At present, the treatment of cerebral hemorrhage is basically divided into two methods: internal conservative treatment and surgical removal of hematoma. If the amount of thalamic hemorrhage is more than 15ml, the amount of shell nucleus hemorrhage is more than 30ml, the amount of cerebellar hemorrhage is more than 10ml, the amount of lobar hemorrhage is more than 20ml, open cranial hematoma removal or cone cranial hematoma removal is feasible, if the ventricular hemorrhage is cast, ventricular puncture and drainage or lumbar puncture and drainage is feasible. Internal conservative treatment. Surgical treatment can reduce the mortality in the acute stage, but the long-term efficacy does not differ from that of conservative medical treatment. In addition, lobar hemorrhage in elderly patients is mostly due to vascular amyloidosis or vascular malformation, unless the hematoma is large and life-threatening, and surgical treatment is risky, and can be treated conservatively with internal medicine. After the acute phase is over and the condition is stabilized, the main purpose is to prevent rebleeding and promote neurological recovery.
V. Treatment plan
According to the international and domestic guidelines for prevention and treatment of cerebrovascular disease, combined with our many years of effective experience in Chinese medicine treatment of cerebral hemorrhage, our department has developed a clinical pathway for the treatment of acute cerebral hemorrhage in Chinese and Western medicine, which mainly includes anti-control of blood pressure, blood sugar and various stroke risk factors, prevention of hematoma enlargement and rebleeding, as well as the promotion of neurological recovery by means of Chinese acupuncture, proprietary Chinese medicine, tonics, acupuncture and rehabilitation. If the hematoma is indicated for surgery, hematoma removal or ventricular puncture and drainage or lumbar puncture and drainage can be performed, and if the hemorrhage is due to vascular malformation, interventional embolization treatment or surgical resection can be performed. Of course, the doctor will explain the risks and benefits of surgery to you in detail, and discuss with you whether to carry out surgical treatment.
VI. Post-discharge rehabilitation and recuperation
As mentioned above, there is no special medicine that can completely improve your symptoms. The risk of cerebral hemorrhage can be reduced.