Brain stem hemorrhage

Introduction Brain stem hemorrhage is an acute and severe neurological disease with a very high mortality rate. The amount of bleeding is below 3 ml, and the mortality rate is about 70%. The amount of brain stem bleeding is above 5, and the mortality rate is about 90%. The mortality rate of brain stem hemorrhage exceeding 10 ml is 100%. Patients with brain stem hemorrhage developed coma early and heavy. 38 of 39 patients were comatose within 24 hours of onset: blood pressure was relatively high, 31 of 39 patients (the highest systolic blood pressure was above 200 mmHg, while the brainless hemorrhage group was only 46.1). %(6/13), P<0.05. The eye position changes more, accounting for 53.85%, which is characterized by separation of Christe, squint squint, eyeball floating, central fixation, etc., only 10% of the brainless hemorrhage group. Short survival period. 29 of the 39 patients (74.4%) died within 48 hours, and only 30.8% (4/13) of the brainless hemorrhage group, indicating that brain stem hemorrhage is one of the causes of death from cerebral hemorrhage.

Cause

Hypertensive arteriosclerosis is the main cause of brain stem hemorrhage. Brain stem hemorrhage is caused by high blood pressure leading to rupture of the central branch of basilar artery. It often causes coma within a few seconds to a few minutes, and can immediately stun, quadriplegia, pinpoint-like pupils, and die within hours. Horizontal eye movement is affected and vertical eye movement is good. In some cases, eyeballs can jump up and down. The contralateral eyeball has a 5-second interval of swimming. The disease often has quadriplegia and goes to the brain. Central hyperthermia and respiratory abnormalities can sometimes occur. Bleeding can break into the fourth ventricle, and the hematoma spreads to the ventral side, leading to a fixed pupil in the center. Small basal hemorrhage can cause "locking syndrome." Small hemorrhage that does not involve the ascending reticular activation system often has no severe neurological deficits, mild symptoms, and a good prognosis.

an examination

Related inspection

Brain CT examination brain MRI examination EEG examination brain nerve examination

Head movements sometimes have headaches, dizziness, sweating, and often coma for long periods of time in severe cases.

Most of the brain stem bleeding occurs in the pons. CT appears as a mass, round or elliptical high density shadow. CT value is 40 ~ 80HU, single or multiple (mostly single), the lesion edge is clear. If the amount of bleeding is large, the brain stem can be thickened, the density is increased, and the bridge pool and the ring pool are narrowed or disappeared. It can also break into the fourth ventricle and back up, causing the third ventricle and the midbrain aqueduct to change into a ventricle. , volume expansion, forward breakthrough, there may be blood in the bridge pool, ring pool, saddle upper pool. When a small amount of bleeding, attention should be paid to the identification of the volumetric effect of the posterior cranial fossa.

If the bleeding is spot-like, small piece-like, the bleeding site of the lesion is limited, the age is light, and the dehydration and decompression treatment is timely, and the recovery is better, and the hematoma is completely absorbed. However, the improvement of clinical symptoms and signs is often later than CT manifestations. Brain stem hemorrhage is acute, massive bleeding, involving important nerve nuclei, severe disease, high mortality, which may be one of the rare reasons for CT scan of medullary hemorrhage.

MR has no bone artifacts, can clearly show the anatomy of the brainstem and adjacent structures, can be directly sagittal and coronal imaging, and has good three-dimensional spatial positioning ability. For the old brainstem hemorrhage, the CT scan was greatly affected by the posterior cranial fossa because of its reduced bleeding density, and the lesions were not clear. However, the hemoglobin degeneration after hemorrhage can cause characteristic signal changes on MRI, so MR can distinguish the old brain stem hemorrhage and lacunar infarction according to the signal characteristics of the lesion area. Therefore, MR is very valuable for judging the size, quantity and distribution of old bleeding. In addition, vascular malformations and hemangioma leading to bleeding, because of the airflow effect, without angiography, MRI can also be directly displayed.

Differential diagnosis

Cerebral hemorrhage: refers to the rupture of blood vessels in the brain parenchyma causing bleeding. Hypertension and arteriosclerosis are the main factors of cerebral hemorrhage, and can also be caused by congenital cerebral aneurysms, cerebrovascular malformations, brain tumors, blood diseases, infections, drugs, trauma and poisoning. Awareness of consciousness. The headache is weighted on the side of the lesion. Vomiting is more common, mostly jetting, vomit is the contents of the stomach, mostly brown, and hiccups are quite common. Go to cerebral rigidity and convulsions. The patient generally breathes faster, and the severely ill person breathes deep and slow. When the condition deteriorates, it turns fast and irregular, or it is tidal breathing, sigh-like breathing, double inhalation, and the like. High blood pressure is not stable. High fever after bleeding. Meningeal irritation.

Thalamic hemorrhage: Obstructive hydrocephalus is prone to occur after breaking into the ventricles. Thalamic hemorrhage caused obstructive hydrocephalus, the patient was comatose at the time of onset, relieved after conservative treatment of internal medicine, obstruction was relieved, and consciousness was restored. Coma at the time of onset leads to death. The amount of thalamic hemorrhage broke into the ventricles, and there were 23 cases with more than 15ml, indicating that the greater the amount of bleeding, the greater the possibility of breaking into the ventricles.

Bridge cerebral hemorrhage: about 10% of cerebral hemorrhage, mostly caused by rupture of the pons of the basilar artery. Clinical manifestations include sudden headache, vomiting, dizziness, diplopia, different axes of the eye, side palsy, cross sputum or hemiplegia, quadriplegia. When the amount of bleeding is small, the patient's consciousness can be expressed as some typical syndromes, such as foville syndrome, millard-gubler syndrome, atresia syndrome, etc., may be accompanied by high fever, sweating, stress ulcers, acute pulmonary edema, Acute myocardial ischemia and even myocardial infarction. When a large amount of hemorrhage occurs, the hematoma spreads to both sides of the pons and the covered part of the pons. The patient quickly enters a coma. The bilateral pupils are needle-like, side-viewing paralysis, quadriplegia, difficulty breathing, and have a brain-strength attack. They can also vomit brown stomach contents. There are midline symptoms such as central hyperthermia, often dying within 48 hours.

Cerebellar hemorrhage: refers to bleeding in the parenchyma of the cerebellum, which is directly related to hypertension. Most of the sudden onset of symptoms of dizziness, frequent vomiting, occipital headache, one side of the upper and lower limbs ataxia without obvious paralysis, may have nystagmus, one side of the facial paralysis. A small number of subacute progressive, similar to cerebellar space-occupying lesions. Severe massive hemorrhage showed rapid progressive intracranial pressure and soon entered a coma. More than 48 hours, the pillow was smashed and died.

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