ich自发性脑出血的诊断与治疗PPT.pptx

Intracranial Hemorrhage introduction Intracranial hemorrhage (ie, the pathological accumulation of blood within the cranial vault) may occur within brain parenchyma. Intracerebral hemorrhage accounts for 8-13% of all strokes. Intracerebral hemorrhage and accompanying edema may disrupt or compress adjacent brain tissue, leading to neurological dysfunction. INCIDENCE MORTALITY: Each year, approximately 37,000 to 52,400 people in the United States. The case-fatality rate 34.6% at 7 days. 50.3% at 30 days. 59.0% at 1 year. (Stroke. 2009;40:00-00) RISK FACTORS: Hypertension- 60-70 %. Cerebral Amyloid Angiopathy- 15 %. Heavy alcohol consumption. Hypercholesterolemia. Anemia. Smoking/anti-platelet agents merging evidence. LOCATIONS Subcortical/lobar: 20 % Putamen 40-50 % Thalamus 15 % Pons 8 % Cerebellum 8 % Herniation Syndromes Displacement of structures with resulting compression of tissue and blood flow 1. Uncal 2. Central 3. Cingulate 4. Transcalvarial 5. Upward 6. Tonsillar Smith, Julian; Joe J. Tjandra; Gordon J. A. Clunie; Kaye, Andrew H. (2006). Potential Secondary Brain Injury Intracranial Effects Secondary impact Edema Delayed ICH Hyperemia Vasospasm Seizures Systemic Effects Hypoxia Hypercarbia Hypotension Electrolyte imbalance Anemia/old blood Hyperthermia Laboratory Studies Complete blood count (CBC) with platelets Prothrombin time (PT)/activated partial thromboplastin time (aPTT): Identify a coagulopathy. Serum chemistries including electrolytes and osmolarity: Assess for metabolic derangements, such as hyponatremia, and monitor osmolarity for guidance of osmotic diuresis. Toxicology screen and serum alcohol level if illicit drug use or excessive alcohol intake is suspected Imaging Studies CT scan CT scan readily demonstrates acute hemorrhage as hyperdense signal intensity. Hematoma volume in cubic centimeters can be approximated by a modified ellipsoid equation: (A x B x C)/2, where A, B, and C represent the longest linear dimensions in centime