脑血管疾病参考翻译part II.ppt

Common sites of aneurysms Clinical features 临床表现 Female preponderance 多数(F:M=1.6:1) Symptom onset: exercise, emotional stress 运动，情绪压力（？） Sudden severe headache, ~80% of patients “Worst headache in my life” 30~50% warning headache ~2wks before aneurysms rupture 动脉瘤破裂 Nausea and vomiting(~77%) Confusion, stupor, coma seizure Symptoms 症状 Meningeal irritation sign 脑膜刺激征: nuchal rigidity 颈项强直, Kernig sign and Brudzinski sign Not obvious in older patients Ophthalmoscope 眼底镜: vitreous membrane hemorrhage 透明膜出血, papilledema 视神经乳头水肿, retinal hemorrhage 视网膜出血 Focal neurological deficits 局灶性神经功能缺陷: 3rd nerve palsy 麻痹 Subhyaloid 透明膜下 hemorrhage Flame 火焰状 and dot 点状 hemorrhages Rebleeding 再出血 Vasospasm 血管痉挛 Hydrocephalus 脑积水 Others 其它: Seizures 癫痫 Osmolar disturbances 渗透障碍（？） Myocardial infarction 心肌梗死 and/or arrhythmias 心律失常 COMPLICATIONS 并发症 Rebleeding 再出血 associated with ~ 50% fatality rate 致死率 ~ 4% of re-bleeding occurs within the first 24 hours ~20-30% within the first month and ~ 3% per year thereafter 此后 Risk factors for re-bleeding: Higher initial blood pressure170 mmHg Worse neurological status 神经功能状况 on admission 入院时 (coma 昏迷) Headache and symptoms occur one more time or become worse, CT shows more bleeding Vasospasm 血管痉挛 20~30% of patients, is associated with delayed ischemia 迟发性缺血 and death Signs of ischemia appear 4~14days, most often at 7 days Potential mechanisms 潜在机制 RBC hemolysis 溶血 and subsequent 随后 release of oxygen, Hb, and other active oxygen 活性氧 species Secondary effects -Vessel wall changes 血管壁变化 Hydrocephalus 脑积水 15~20% patients May develops at any time. Acute, or over a few days or weeks Progressive 进行性 drowsiness 困倦, gait difficulties 步态艰难, abulia(意志力丧失) with incontinence 失禁 CT scanning shows enlarged ventricles 脑室扩大 Diagnostic approaches 诊断方法 CT Sensitivity 90~95% with in 24hrs intracerebral hemorrhage 颅内出血, mass effect, and hydrocephalus 脑积水 MRI 4 days ~2wks, detects deoxygenated hemoglobin 去氧血红蛋白 DSA 数字减影血管造影 Useful for aneurysm location and