各论-01-1颅内压增高、脑疝.ppt

Place weight on case history, somatoscopy, especially NS examination. Diagnosis (1) Lumbar vertebrae puncture Accessory examination. Accessory examination. Diagnosis (2) The plain radiograph of the skull Accessory examination. Diagnosis (3) Cerebral Vascular Angiography digital subtraction Angiography , DSA 3D-DSA Accessory examination. Diagnosis (4) CT MRI Treatment 7.Treatments 7.1. General treatment Observe T, P, R, Bp, consciousness, pupil Prevent inhalation pneumonia Pay attention to fluid infusion, acid-base balance Pay attention to loosening the bowels Keep airway unobstructed Oxygen inhalation Treatment 7.Treatment 7.2. Etiological treatment Space-occupying focus: removal Hydrocephalus:by-pass operation of CSF eg. Ventriculoperitoneal shunt Acute brain hernia: emergency surgery Treatment 7.2. Etiological treatment: Operative treatment Treatment Sphenoidal meningioma Etiological treatment Treatment Space-occupying focus: removal Intraoperation Treatment Etiological treatment Sphenoidal meningioma Treatment Etiological treatment 238 Treatment Etiological treatment Hydrocephalus:by-pass operation of CSF eg. Ventriculoperitoneal shunt Etiological treatment Treatment Acute brain hernia: emergency surgery. eg.Epidural hematoma Epidural hematoma Thoroughly stop bleeding Subdural exploration 7.3. Ventriculocentesis Very effective emergency measures to severe increased ICP ! Treatment (Schematic diagram) Treatment Puncture trans anterior horn of lateral ventricle Ventriculocentesis Treatment 7.4. Dehydration therapy Mannitol 20% Glucosi 50% Furosemide (Lasix) Glycerin fructose Hydrochlorothiazide Dimox Treatment 7.5. Hormonotherapy Improve function of Blood brain Barrier, BBB ， lower permeability of capillary Desamethasone Methylprednisolone Hydrocortisone Prednisone 7.6. Subhypothermia therapy Lower cerebral metabolism, Reduce cerebral oxygen consumption Prev