Intraventricular hemorrhage

Introduction to intraventricular hemorrhage In the past, it was generally believed that traumatic intraventricular hemorrhage was caused by intracerebral hematoma in the adjacent ventricle breaking into the ventricle, or brain penetrating through the ventricular system. The blood of the wounded flowed into the ventricle, and it was rare, and bleeding from the ventricular wall was even rarer. . After CT scan was applied to clinical diagnosis, it changed the previous point of view and found that traumatic ventricular hemorrhage is not uncommon and often occurs in non-critical patients. basic knowledge Proportion of disease: 1.2% of severe head injury Susceptible people: no special people. Mode of infection: non-infectious Complications: cerebral edema, upper gastrointestinal bleeding, malnutrition, hemorrhoids

Intraventricular hemorrhage

(1) Causes of the disease

There are two cases of traumatic intraventricular hemorrhage: one is because the violence acts on the frontal or occipital part, and when the brain tissue moves violently in the anterior-posterior direction, the ventricular wall produces shear deformation and tears the ependymal blood vessels, which is called primary. Intraventricular hemorrhage; the second is a traumatic brain parenchymal hematoma, which is caused by breaking into the ventricle, which is called secondary intraventricular hemorrhage.

(two) pathogenesis

1. Traumatic intraventricular hemorrhage Traumatic intraventricular hemorrhage is mostly accompanied by extensive brain contusion and intracerebral hematoma. The hematoma adjacent to the ventricle penetrates the ventricular wall and enters the ventricle.

2. Some patients with simple intraventricular hemorrhage are simple intraventricular hemorrhage with mild brain contusion and laceration. This is due to the transient dilation of the ventricle during trauma, resulting in subventricular septal vein bleeding, and choroid plexus injury is extremely rare.

There is a small amount of blood in the ventricle, which can be diluted by the cerebrospinal fluid without causing obstruction of the ventricular system; a large number of patients can form a hematoma, block the interventricular space, the third ventricle, the aqueduct or the fourth ventricle, causing cerebral spinal fluid circulation obstruction.

Intraventricular hemorrhage prevention

There are no effective preventive measures for traumatic ventricular hemorrhage, and other causes should actively treat the primary disease.

Intraventricular hemorrhage complications Complications cerebral edema upper gastrointestinal bleeding malnutrition acne

1. After the operation, the condition changes should be closely observed, and recurrent and delayed hematoma should be found. It should be treated in time and the image should be reviewed.

2. Secondary brain swelling and cerebral edema should be properly controlled.

3. Severe patients are prone to upper gastrointestinal bleeding, and appropriate measures should be taken early to prevent them.

4. Long-term coma patients are prone to pulmonary infection, water and electrolyte balance disorder, hypothalamic dysfunction, malnutrition, hemorrhoids, etc., while strengthening nursing measures, should be dealt with in a timely manner.

Intraventricular hemorrhagic symptoms common symptoms, disturbance of consciousness, dizziness, nausea, venous and short circuit

Most patients have obvious incentives before the onset, such as emotional excitement, active activities, bathing, drinking, etc., mostly acute onset, a small number may be subacute or chronic onset.

1. General performance:

Depending on the location of bleeding and the amount of bleeding, light can be expressed as headache, dizziness, nausea, vomiting, elevated blood pressure, meningeal irritation, etc., severe manifestations of disturbance of consciousness, seizures, high fever, high muscle tone, bilateral Pathological reflexes, cerebral palsy in the late stage, denervation and respiratory and circulatory disorders and autonomic nervous system disorders, some patients may be associated with upper gastrointestinal bleeding, acute renal failure, pneumonia and other complications.

2. Primary intraventricular hemorrhage:

In addition to the general performance, compared with secondary intraventricular hemorrhage, there are the following characteristics:

1 The disturbance of consciousness is relatively light;

2 can be subacute or chronic onset;

3 positioning signs are not obvious;

More than 4 cognitive functions, disorientation and mental symptoms are common.

3. Secondary intraventricular hemorrhage:

In addition to its general performance, its clinical manifestations vary depending on the original blood site:

1 The hematoma located in the forelimb of the internal capsule is easily broken into the ventricle, and the clinical manifestation is relatively light;

2 2/3 hematoma in the posterior limb of the internal capsule, because it is relatively far from the ventricle, when the hematoma penetrates the ventricle, the brain parenchyma is severely damaged, the clinical manifestation is sudden coma, hemiplegia, aphasia in the main hemisphere, pathological reflex positive , the double eyeball gaze to the side of the lesion;

3 The hematoma located in the lower third of the internal capsule has many sensory disturbances and visual field changes;

4 hemorrhage of the thalamus, manifested as disturbance of consciousness, hemiplegia, numbness of one limb, difficulty in upper eye, high fever, diabetes insipidus, positive pathological reflex, etc.;

5 cerebellar hemorrhage manifested as headache, dizziness, nausea, vomiting, neck stiffness, ataxia, etc., severe cases of disturbance of consciousness, respiratory failure, etc., 6 brain stem hemorrhage, light manifestations of severe headache, vertigo, vomiting, the latter group Cranial nerve injury, neck stiffness, etc., severe coma, cross sputum, bilateral pupil dilation, respiratory failure and so on.

Examination of intraventricular hemorrhage

1. CT examination: CT can accurately confirm the location, extent, and size of the ventricle, and can be repeatedly checked to facilitate the dynamic observation and follow-up of bleeding, so it is the preferred method of examination.

2. Lumbar puncture and ventriculography: There is a certain risk, or aggravating the condition. At present, no routine examination is performed. Unless there is no CT condition or certain special needs, the examination should be carried out cautiously under the strict conditions of indications.

3. Cerebral angiography: cerebral angiography can show the cause of spontaneous intraventricular hemorrhage (such as aneurysm, cerebrovascular malformation, moyamoya disease and intracranial tumors) and some blood vessels after hematoma breaks the human ventricle. The characteristic performance of the bit.

Intraventricular hemorrhage with different etiology still has its own characteristics. Most patients with hypertensive intraventricular hemorrhage have a history of hypertension. Sudden onset of middle-aged and above, no cerebral angiography without intracranial vascular abnormalities: aneurysm, arteriovenous malformation and smoke The onset of intracranial hemorrhage is small, and cerebral angiography can confirm the diagnosis. The clinical manifestations of intracranial tumor intracranial hemorrhage before the onset of intracranial lesions, CT can be clearly diagnosed.

Diagnosis and diagnosis of intraventricular hemorrhage

Before the application of CT, the diagnosis of intraventricular hemorrhage is more difficult. In the exploration of the cranium and/or craniotomy, the diagnosis of the ventricle is performed after the ventricle is punctured. The appearance of CT not only makes the disease diagnosed, but also understands the source of the hemorrhage. Distribution in the ventricles and the occurrence of brain contusion and intracranial hematoma in other parts of the brain.

It needs to be differentiated from brain stem injury and subthalamic injury. Primary brain stem injury is often accompanied by brain contusion or intracranial hemorrhage, and the clinical symptoms are mutually wrong. It is difficult to distinguish between phlegm and blood stasis, and which is the main one. Especially for patients who are late in treatment, it is more difficult to distinguish the primary. Sexual injury or secondary damage. The difference between primary brain stem injury and secondary brain stem injury is the presence of symptoms and signs. Symptoms and signs of secondary brain stem injury are gradually produced after injury. Continuous monitoring of intracranial pressure can also be identified: primary intracranial pressure is not high, while secondary is significantly elevated. At the same time, CT and MRI are also effective means of differential diagnosis. MRI is significantly better than CT in showing small hemorrhagic foci or contusion in the brain parenchyma, especially for the slight damage to the corpus callosum and brainstem. Brainstem auditory evoked potentials can more accurately reflect the plane and extent of brain stem injury. Normally, the waves below the lesions of the auditory pathway are normal, and the level of the lesion and the waves above it show abnormalities or disappearances. Continuous intracranial pressure monitoring also has the effect of identifying primary or secondary brain stem injury. Although the clinical manifestations of the two are the same, the primary intracranial pressure is normal, while the secondary is significantly elevated.

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