出血性脑卒中1PPT课件.ppt

* 出血性脑卒中hemorrhagic apoplexy 中南大学湘雅医院神经内科 谷文萍 Wenping Gu,MD.PhD. Neurology Department, Xiangya Hospital, central south University 脑出血cerebral hemorrhage 脑出血cerebral hemorrhage 是指原发性非外伤性脑实质内出血 发病率高，占全部脑卒中20％—30％ 80%以上由高血压性脑内细小动脉病变引起,固又称高血压动脉硬化性脑出血 Hypertension is the most common underlying cause of nontraumatic intracerebral hemorrhage 病因与发病机制etiopathogenisis and pathogenesy 高血压性脑内细小动脉硬化 高血压性脑动脉硬化时可有脑内细小动脉透明变性、纤维素样坏死，病变管壁在血流冲击下形成微动脉瘤 hypertension appears to promote structural changes including lipohyalinosis, fibrinoid necrosis and microaneurysm formation in the walls of pinetrating arteries,predisposing them to intracerebral hemorrhage. 导致脑动脉管壁薄弱(cerebral arteries vessel wall weak )的其他疾病 血液系统疾病(hematological system disease ) 肿瘤卒中(tumor apoplexy) 原因不明(unknown aetiology ) 病理pathology 多为脑动脉深穿支破裂所致 豆纹动脉最为常见，次为丘脑穿通动脉 多发于大脑半球基底核区，次为脑叶、脑桥、小脑和脑室等 Most hypertensive hemorrhages originate in certain areas of predilection,corresponding to long,narrow,penetrating arterial branches.These include the caudate and putaminal branches of the middle cerebral arteies(42%);branches of the basilar artery supplying the pons(16%);thalamic branches of the posterior cerebral arteries(15%);branches of the superior cerebellar arteries supplying the dentate nuclei and the deep white matter of the cerbellum(12%);and some white matter branches of the cerebral arteries(10%). 出血可直接破坏脑组织(hemorrhage to destroy brain tissue ) 血肿挤压周围组织，引起脑组织水肿、颅内压增高，严重可引起脑疝(hematoma crushing surrounding tissue) 临床表现clinical manifestation 50岁 高血压患者(hypertensive patients) 突然发病,迅速达高峰(suddenly onset) 全脑症状(global symptom) 局灶症状(focal symptom) 辅助检查laboratory findings 头颅CT(CT scan) MIR 脑血管造影(cerebral arteriography) MRA、CTA 、 DSA 腰穿脑脊液检查(lumbar puncture) 血、尿常规、血糖、电解质等检查 诊断与鉴别诊断diagnosis and differential diagnosis 大于50岁，多有长期高血压病史(old patients with hypertension) 活动中或情绪激动时突然发病(suddenly onset) 头痛、呕吐、意识障碍等全身症状(headache,vomitting, impairment of consciousness) 偏瘫、偏身感觉障碍、失语等局灶神经体征(hemiparesis,hemisensory deficit,hemianop