Acute intracerebral hematoma

Introduction to acute intracerebral hematoma Acute intracerebral hematoma refers to hematoma in the brain parenchyma, which can occur in any part of the brain tissue, occurring in the front of the frontal and temporal lobes, accounting for 80% of the total, followed by the parietal and occipital lobes, accounting for about 10%. The rest are located in the deep brain, the basal ganglia, the brainstem and the cerebellum. The superficial intracerebral hematoma located in the frontal, anterior and at the base is often associated with brain contusion and subdural hematoma, and the clinical manifestations are rapid. Deep hematoma, more than the white matter of the brain, caused by deep deformation of the blood vessels due to deformation or shearing force of the brain, less bleeding, less hematoma, clinical manifestations are also slower. When the hematoma is large, the hematoma located in the basal ganglia of the brain, near the thalamus or the ventricle wall, can cause intraventricular hemorrhage to the ventricular rupture. The condition is often severe and the prognosis is poor. basic knowledge Proportion of the disease: the incidence rate of trauma or hypertension patients is about 0.2% - 0.3% Susceptible people: no special people Mode of infection: non-infectious Complications: swelling, brain edema, upper gastrointestinal bleeding, coma, malnutrition, hemorrhoids

Causes of acute intracerebral hematoma

(1) Causes of the disease

Acute intracerebral hematoma is formed within 3 days after the injury, and the clinical symptoms and signs are formed. The frontal and basal sides of the frontal and temporal lobes are the most common, and most of them coexist with brain contusion and subdural hematoma. The occipital force is caused by traumatic injury, severe brain contusion and laceration of the bungee and frontal lobe, and subcortical arteriovenous tear. The intracerebral hematoma caused by impact injury or concave fracture caused by direct impact at the point of impact Rarely, accounting for about 10%, can be seen in the frontal lobe, parietal lobe, temporal lobe, cerebellum, etc., due to brain deformation or shearing force caused by deep cerebral vascular tears caused by basal ganglia, brain stem and brain Deep hematoma is rare.

(two) pathogenesis

The initial stage of hematoma formation is only a blood clot. The upper part of the hematoma is often mixed with the brain tissue of the contusion. The deep part is also surrounded by compressed necrosis and edema. After about 4 to 5 days, the hematoma begins to liquefy. It is tan old blood, surrounded by glial cell hyperplasia. At this time, the surgically removed hematoma shows clear perimeter and almost no bleeding. After 2 to 3 weeks, the surface of the hematoma has a capsule formed, which stores yellow liquid and gradually becomes Cystic lesions, visible hemosiderin deposition in adjacent brain tissue, local brain back flattening, widening, softening, and fluctuating, but clinically no increased intracranial pressure.

Acute intracerebral hematoma prevention

There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.

Acute intracerebral hematoma complications Complications swelling cerebral edema upper gastrointestinal bleeding coma malnutrition acne

1. If surgical treatment is followed, the condition changes should be closely observed, and attention should be paid to the presence or absence of recurrent and delayed hematoma.

2. Secondary brain swelling and cerebral edema.

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

Symptoms of acute intracerebral hematoma Common symptoms Sensory disturbance Consciousness disorder Increased intracranial pressure Balance dysfunction Nausea and vomiting Ataxia hemianopia Pseudo-sensory edema

The clinical manifestations of acute traumatic intracerebral hematoma are related to the location of the hematoma and the degree of combined injury. The frontal lobe and temporal lobe hematoma are often associated with severe brain contusion or subdural hematoma, and more symptoms of increased intracranial pressure and disturbance of consciousness. Lack of localized symptoms and signs, cerebral hematoma and contusion involving the main functional area or basal ganglia hematoma can be hemiplegia, partial sensory disturbance, aphasia, etc., cerebellar hematoma manifested ipsilateral limbs and balance dysfunction, brain stem hematoma Patients with severe conscious disturbance and central sputum, occipital and posterior occipital concussive brain injury caused by intracranial hematoma, post-injury consciousness disorder is serious and progressive, some have intermediate consciousness improvement or waking period, the condition deteriorates Rapidly, it is easy to form cerebellar incision, cranial sag fracture and intracerebral hematoma caused by impact injury. Brain contusion is relatively limited, and the disturbance of consciousness is rare and light. In addition to the symptoms of local brain damage, there are often headaches and vomiting. Signs of increased intracranial pressure such as fundus edema, especially in elderly patients due to increased vascular fragility, are more likely to occur intracerebral hematoma.

Acute intracerebral hematoma is similar to subdural hematoma of brain contusion and laceration. After the brain injury, the patient will have a CT scan of the intracranial pressure and brain compression, so as to confirm the diagnosis. Hematoma is a complex hematoma, and often multiple, it is very important to analyze the location of the hematoma and imaging examination according to the mechanism of injury. Otherwise, it is easy to miss the hematoma during operation. It should be noted that the acute phase is more than 90%. Intracerebral hematoma can show high-density mass on CT scan, surrounded by low-density edema, but the hematoma becomes equal density at 2 to 4 weeks, which is easy to miss diagnosis. When it is more than 4 weeks, it is low-density. It can be seen that, in addition, delayed intracerebral hematoma is more common in patients with delayed hematoma. It should be vigilant and should be reviewed by CT if necessary.

Examination of acute intracerebral hematoma

CT scan

It is characterized by a round or irregular shape with a high-density mass. The CT value is 50-90Hu, surrounded by a low-density edema zone, accompanied by morphological changes in the ventricular pool, mid-line structural displacement, etc., often accompanied by brain contusion And the performance of subarachnoid hemorrhage (Figure 1).

2.MRI

Most of them are not used for the examination of acute intracerebral hematoma. Most of them are T1 and other signals, and T2 is low signal. It is easier to display lesions with T2 low signal.

Diagnosis and diagnosis of acute intracerebral hematoma

Acute traumatic intracerebral hematoma, before CT application, it is difficult to identify with brain contusion, localized cerebral edema swelling, subdural hematoma, injury mechanism, clinical manifestations after injury, etc., diagnostic puncture, surgical exploration It is a method of diagnosis and treatment. Since the advent of CT, timely CT scan can confirm the diagnosis.

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