林秋涌出血性中风-cgmhorgtw.ppt

Nontraumatic intracranial hemorrhage Diagnosis of Intracerebral Hemorrhage CT is enough for the diagnosis of all the intracerebral hemorrhages MRI is supplemental In subacute stage, MRI is helpful Indicating of angiography : Unusual location of ICH Young stroke, without bleeding tendency Diagnostic tools DSA CTA MRA 電腦斷層 (Computed Tomography; CT) Still the imaging method of choice for evaluation of acute head injury, ICH, acute infarction May have pitfalls in detecting hemorrhage resulting from tumor and vascular lesion, and in subtle lesion esp. in the posterior cranial fossa. 磁振造影術 (Magnetic resonance Imaging; MRI):not used frequently in the acutely intracranial hemorrhage patient because Hyperacute hemorrhages are not as conspicuous. Fractures cannot be easily identified. Examination times are longer in a potentially seriously injured individual. Its use is for subsequent evaluation of diffuse axonal injuries, tumor or vascular hemorrhage and contusions involving posterior fossa and brainstem. MR is more sensitive for detecting subacute and chronic hemorrhage. Sudden onset left limb weakness: Hypertensive Acute ICH 「高血壓」的腦溢血 HICH (hypertensive intracerebral hemorrhage)- the most common nontraumatic cause of intracranial hemorrhages in adults 「高血壓」的腦溢血 「高血壓」的腦溢血有其好發位置，大部分的基底核出血，小腦出血，腦幹出血都是典型的「高血壓」的腦溢血，這樣的病人如果年紀大、有高血壓，我們根本就沒有去找原因，就直接歸於「找不到原因」的出血，也不會再進一步檢查 Putaminal hemorrhage 是最常見的腦中風出血。 大的 Putaminal hemorrhage 通常成前後的橢圓形，然後從尾核的前方，破到腦室裡面，造成腦室內血塊。通常 putaminal hemorrhage 如果大於 30 cc 而且有 midline shift，就要考慮開刀去除血塊。 第二常見的就是視丘出血了。大部分的視丘出血都會破到腦室裡面 rupture into ventricle。這點比 putamen 常見。 「高血壓」的腦溢血 LocationPutamen/external capsule 60~65%Thalamus 15~25%Pons 5~10%Cerebellum 2~5%Subcortical white matter 1~2% (except amyloid hemorrhages) Basal ganglion: 2/3 of HICH patients Locations of HypertensiveIntracerebral Hemorrhages: Basal ganglion: putamen caudate nucleus Thalamus Brainstem Subcortical white matter of cerebrum and c