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1、INTRACEREBRALHEMORRHAGEDEFINITIONOFTERMSpontaneousbleedinginthebrain.Primaryintracerebralhemorrhage.Althoughmanycausesofintracranialhemorrhagehavebeenfound,hypertensive(spontaneous)intracerebralhemorrhageaccountsformostofthehemorrhages.ETIOLOGY1.Hypertensivearteriosclerosis:
2、Hyalinosis,fibrinoidnecrosisandformationofmicroaneurysmsofintracerebralarteriolesandsmallarteries.ETIOLOGY2.Congenitaldefectsofvascularwall:Saccularaneurysmorberryaneurysm,arteriovenousmalformation(AVM)ETIOLOGY3.Hemorrhagicdisorders:Leukemia,aplasticanemia,liverdisease,compl
3、icationofanticoagulantorthrombolytictherapy,ect.ETIOLOGY4.Others:Arteritis,vascularamylosis,MoyamoyadiseaseMoyamoyaETIOLOGY5.Undeterminedcause(normalbloodpressure,noaneurysmorAVMandnohemorrhagicandotherdisordersabove).PATHOGENESIS ANDPATHOLOGY1.Pathogenesis:HypertensionFibri
4、noidnecrosis--RuptureHyalinosis--Formationofmicroaneurysmsofarteriolesandsmallarteries--RupturePATHOGENESIS ANDPATHOLOGYPenetratingbranchesofmiddlecerebralartery:Laterallenticulostriatearteries,Heubnerarteryandmediallenticulostriatearteries.PATHOGENESIS ANDPATHOLOGY2.Patholo
5、gyMostcommonsitesofhypertensivehemorrhage(1):*Basalganglia(Putamen-externalcapsule,thalamus-internalcapsule,andmixed)*Variouspartsofthecentralwhitematter(frontal,temporalandotherlobes)PATHOGENESIS ANDPATHOLOGY2.PathologyMostcommonsitesofhypertensivehemorrhage(2):*Cerebellarh
6、emisphere*Pons*VentriclesPATHOGENESIS ANDPATHOLOGY2.PathologyHematomainthebrain--displaceandcompressadjacentbraintissue--Brainedemaandischemia--Intracranialhypertension--Herniaofbrain--Ischemiaandnecrosisofbrainstem---DeathPATHOGENESIS ANDPATHOLOGY2.PathologyHematomaisobsorb
7、edoveraperiodofweeksandmonths.CLINICALPICTURE1.Commonoccurrenceageis50-70years(yongerthaninthromboticinfarction)BloodpressureismuchhigherinmostcasesOnsetwhilethepatientisupandactive,onsetduringsleepisararityCLINICALPICTURE2.Symptomsofextensivebrainlesions:Headache,vomitingan
8、ddisturbanceofconsciousnessetc.CLINICALPICTURE3.LocalneurologicalsymptomsPu
