脑出血疾病专题知识专家讲座.pptVIP

ConceptionItmeansprimaryandnontraumaticintracerebralhemorrhage.Countfor20%~30%instrokeHypertensionisthemostcommonunderlyingcauseofnontraumaticintracerebralhemorrhage.脑出血疾病专题知识专家讲座第1页

EtiologyHalfofthepatientssufferfromhypertensioncombinedwitharteriolaratherosclerosis,itisthemostcommoncauseofthedisease.Others:cerebralatherosclerosis,hematopathy,cerebralamyloidangiopathyCAA,aneurysm,AVM脑出血疾病专题知识专家讲座第2页

Pathophysiology高血压——小动脉:纤维素样坏死fibrinoidnecrosis、脂质透明变性hyalinefattychange、microaneurysm小动脉瘤、微夹层动脉瘤——渗出exudation、破裂rupture高血压——远端血管痉挛vasospasm——缺氧anoxia、坏死angio-necrosis、血栓形成thrombosis——斑点状出血、脑水肿brainedema——融合成片(子痫)脑出血疾病专题知识专家讲座第3页

Pathophysiology脑内动脉:壁薄、中层肌细胞及外膜结缔组织少、缺乏外弹力层——随年纪增加弯曲呈螺旋状——出血主要部位:深穿支penetratingarteries豆纹动脉lenticulostriateartery:大脑中动脉呈直角分出，易发生粟粒状动脉瘤，为脑出血最好发部位，其外侧支称为出血动脉bleedingartery脑出血疾病专题知识专家讲座第4页

Pathophysiology一次出血常在30min内停顿头CT动态观察:20%-40%患者二十四小时内血肿仍继续扩大，为活动性出血activehemorrhage或早期再出血earlyrebleeding多发性脑出血常继发于:hematopathy,cerebralamyloidangiopathy,neoplasm,vasculitis脑出血疾病专题知识专家讲座第5页

PathologyHypertensiveICH:基底节内囊区intercapsule、壳核putamen占70%，脑叶lobe、脑干brainstem、小脑齿状核区各占10%LocationofICH:壳核（内囊、侧脑室），丘脑thalamus（第三脑室、内囊、侧脑室），脑桥pons、小脑cerebellum、蛛网膜下腔subarachnoidspace、第四脑室forthventricle脑出血疾病专题知识专家讲座第6页

PathologyHypertensiveICH:cerebralpenetratingarterymiliaryaneurysmNonHypertensiveICH:occurinsubcorticalwhitematterwithoutarteriosclerosis脑出血疾病专题知识专家讲座第7页

PathologySwellingandcongestionofhemisphere出血灶:充满血液空腔，周围是坏死脑组织及淤点状出血性软化带、脑水肿血块溶解——吞噬细胞去除含铁血黄素和坏死脑组织——胶质增生（胶质瘢痕或中风囊）脑出血疾病专题知识专家讲座第8页

Clinicalfeaturesage:50~70yearsoldsex:moremalepatientsseason:winterorspringpasthistory:hypertensioninducement:activity、excitementonset:acuteonset脑出血疾病专题知识专家讲座第9页

ClinicalfeaturesHypertensivehemorrhageoccurswithoutwarning,mostcommonlywhilethepatientisawake.Headacheispresentin50%ofpatientsandmaybesevere,vomitingiscommon.Bloodpressureiselevatedaft