出血性脑卒中课件

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1、出血性脑卒中hemorrhagicapoplexy中南大学湘雅医院神经内科谷文萍WenpingGu,MD.PhD.NeurologyDepartment,XiangyaHospital,centralsouthUniversity脑出血cerebralhemorrhage脑出血cerebralhemorrhage是指原发性非外伤性脑实质内出血80%以上由高血压性脑内细小动脉病变引起,固又称高血压动脉硬化性脑出血发病率高，占全部脑卒中20％—30％Hypertensionisthemostcommonunderlyingcauseofnont

2、raumaticintracerebralhemorrhage病因与发病机制etiopathogenisisandpathogenesy高血压性脑内细小动脉硬化高血压性脑动脉硬化时可有脑内细小动脉透明变性、纤维素样坏死，病变管壁在血流冲击下形成微动脉瘤hypertensionappearstopromotestructuralchangesincludinglipohyalinosis,fibrinoidnecrosisandmicroaneurysmformationinthewallsofpinetratingarteries,pred

3、isposingthemtointracerebralhemorrhage.导致脑动脉管壁薄弱的其他疾病血液系统疾病肿瘤卒中原因不明病理pathology多为脑动脉深穿支破裂所致豆纹动脉最为常见，次为丘脑穿通动脉、基底动脉旁中央支多发于大脑半球基底核区，次为脑叶、脑干和小脑Mosthypertensivehemorrhagesoriginateincertainareasofpredilection,correspondingtolong,narrow,penetratingarterialbranches.Theseincludethec

4、audateandputaminalbranchesofthemiddlecerebralarteies(42%);branchesofthebasilararterysupplyingthepons(16%);thalamicbranchesoftheposteriorcerebralarteries(15%);branchesofthesuperiorcerebellararteriessupplyingthedentatenucleiandthedeepwhitematterofthecerbellum(12%);andsomewhi

5、tematterbranchesofthecerebralarteries(10%).出血可直接破坏脑组织血肿挤压周围组织，引起脑组织水肿、颅内压增高，严重可引起脑疝临床表现clinicalmanifestation>50岁高血压患者(hypertensivepatients)突然发病,迅速达高峰(suddenlyonset)全脑症状(globalsymptom)局灶症状(focalsymptom)临床表现clinicalmanifestation壳核出血（putamenhemorrhage）内囊外侧型出血，为高血压性脑出血最常见的类型丘脑

6、出血（thalamichemorrhage）脑叶出血（lobehemorrhage）脑干出血（brainstemhemorrhage）中脑出血（midbrainhemorrhage）脑桥出血（pontinehemorrhage）延髓出血（medullaoblongatahemorrhage）小脑出血（cerebellarhemorrhage）脑室出血（cerebroventricularhaemorrhage）辅助检查laboratoryfindings头颅CT(CTscan)头颅MIR脑血管造影(cerebralarteriography

7、)DSA、MRA、CTA腰穿脑脊液检查(lumbarpuncture)血、尿常规、血糖、电解质检查诊断与鉴别诊断diagnosisanddifferentialdiagnosis大于50岁，多有长期高血压病史(oldpatientswithhypertension)活动中或情绪激动时突然发病(suddenlyonset)头痛、呕吐、意识障碍等全身症状(headache,vomitting,impairmentofconsciousness)偏瘫、偏身感觉障碍、失语等局灶神经体征(hemiparesis,hemisensorydeficit,

8、hemianopia,aphasia)CT见脑内出血病灶(CTfindhematomas)与其他类型脑卒中、脑外伤后硬膜下出血、内科疾病鉴别治疗treatment控制脑水肿、颅高