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ID:40795536
大小:280.52 KB
页数:53页
时间:2019-08-07
《高血压小动脉纤维素样坏死fib》由会员上传分享,免费在线阅读,更多相关内容在教育资源-天天文库。
1、脑出血IntracerebralhemorrhageDepartmentofNeurology,The2ndaffiliatedhospital,HarbinMedicalUniversityConceptionItmeansprimaryandnontraumaticintracerebralhemorrhage.Countfor20%~30%instrokeHypertensionisthemostcommonunderlyingcauseofnontraumaticintracerebralhemorrhage.EtiologyHalfofthepatientssu
2、fferfromhypertensioncombinedwitharteriolaratherosclerosis,itisthemostcommoncauseofthedisease.Others:cerebralatherosclerosis,hematopathy,cerebralamyloidangiopathyCAA,aneurysm,AVMPathophysiology高血压——小动脉:纤维素样坏死fibrinoidnecrosis、脂质透明变性hyalinefattychange、microaneurysm小动脉瘤、微夹层动脉瘤——渗出exudation、破
3、裂rupture高血压——远端血管痉挛vasospasm——缺氧anoxia、坏死angio-necrosis、血栓形成thrombosis——斑点状出血、脑水肿brainedema——融合成片(子痫)Pathophysiology脑内动脉:壁薄、中层肌细胞及外膜结缔组织少、缺乏外弹力层——随年龄增长弯曲呈螺旋状——出血主要部位:深穿支penetratingarteries豆纹动脉lenticulostriateartery:大脑中动脉呈直角分出,易发生粟粒状动脉瘤,为脑出血最好发部位,其外侧支称为出血动脉bleedingarteryPathophysiology一次出血
4、常在30min内停止头CT动态观察:20%-40%患者24小时内血肿仍继续扩大,为活动性出血activehemorrhage或早期再出血earlyrebleeding多发性脑出血常继发于:hematopathy,cerebralamyloidangiopathy,neoplasm,vasculitisPathologyHypertensiveICH:基底节的内囊区intercapsule、壳核putamen占70%,脑叶lobe、脑干brainstem、小脑齿状核区各占10%LocationofICH:壳核(内囊、侧脑室),丘脑thalamus(第三脑室、内囊、侧脑室),
5、脑桥pons、小脑cerebellum、蛛网膜下腔subarachnoidspace、第四脑室forthventriclePathologyHypertensiveICH:cerebralpenetratingarterymiliaryaneurysmNonHypertensiveICH:occurinsubcorticalwhitematterwithoutarteriosclerosisPathologySwellingandcongestionofhemisphere出血灶:充满血液的空腔,周围是坏死脑组织及淤点状出血性软化带、脑水肿血块溶解——吞噬细胞清除含铁血黄
6、素和坏死脑组织——胶质增生(胶质瘢痕或中风囊)Clinicalfeaturesage:50~70yearsoldsex:moremalepatientsseason:winterorspringpasthistory:hypertensioninducement:activity、excitementonset:acuteonsetClinicalfeaturesHypertensivehemorrhageoccurswithoutwarning,mostcommonlywhilethepatientisawake.Headacheispresentin50%ofpati
7、entsandmaybesevere,vomitingiscommon.Bloodpressureiselevatedafterthehemorrhagehasoccurred.Thus,normalorlowbloodpressureinapatientwithstrokemakesthediagnosisofhypertensivehemorrhageunlikely,asdoesonsetbefore50yearsofage.ClinicalfeaturesbasalganglionhemorrhageThetwomo
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