Spontaneous brain hemorrhage.
Spontaneous brain hemorrhage.
复制标题
自发性脑出血。
作者：
R. Ojemann;R. Heros
自发性脑出血约占所有中风的10%，并且在约50%的病例中是致命的。与其他类型的中风相比，其发病率并未下降。高血压约占这些疾病的一半;其余的是由于肿瘤、动脉瘤和血管畸形、炎性和退行性血管病以及血液学和医源性凝血障碍。高血压性脑出血发生在大脑半球、小脑和脑桥的深灰色核团，根据部位不同，可导致特殊的临床症状。计算机断层扫描已经彻底改变了脑出血的诊断，并导致这些病变的医疗和手术管理的合理标准的发展。根据临床状况和持续监测ICP指导的强化药物治疗可能会改善结局。当病人经积极的药物治疗仍在恶化时，手术切除脑叶和壳核血肿是必要的。此外，大多数大的（大于3 cm）小脑血管，以及较小的小脑血管，导致显着的脑干压迫，应进行评估。强化药物治疗、择期晚期手术和立即手术在改善最终功能结局中的作用需要进一步研究。
Spontaneous brain hemorrhage accounts for about 10% of all strokes and is fatal in about 50% of the cases. Its incidence, in contrast to other types of strokes, has not declined. Hypertension accounts for about half of these hemorrhages; the rest are due to tumors, aneurysms and vascular malformations, inflammatory and degenerative vasculopathies and hematologic and iatrogenic disorders of coagulation. In some patients no cause is ever found. Hypertensive brain hemorrhage occurs in the deep gray nuclei of the hemispheres, the cerebellum, and the pons and results in specific clinical syndromes depending on the location. Computerized tomography has revolutionized the diagnosis of brain hemorrhage and is resulting in the development of rational criteria for medical and surgical management of these lesions. Intensive medical therapy guided by clinical status and continuous monitoring of ICP may improve outcome. Surgical removal of the hematoma is indicated in lobar and putaminal hemorrhages when the patient is deteriorating in spite of vigorous medical therapy. In addition most large (greater than 3 cm) cerebellar hemorrhages, as well as smaller cerebellar hemorrhages that result in significant brain stem compression should be evaluated. The roles of intensive medical therapy, elective late surgery and of immediate operation in improving eventual functional outcome need to be investigated further.