Brain spasm

Introduction Cerebral vasospasm refers to the stimulation of the arterial wall of the supply brain for various reasons, causing vasospasm, reducing cerebral blood flow, and transient ischemic attack.

Cause

The causes of cerebral vasospasm are:

1. Arteriosclerotic plaque of the internal carotid artery or vertebral-basal artery system, which narrows the vascular lumen and presents eddy currents, stimulates the blood vessel wall to cause vasospasm, and causes insufficient blood supply to the vertebral-basal artery.

2, sustained high blood pressure, can cause cerebral vasospasm, or hypertensive encephalopathy;

3, when the subarachnoid hemorrhage can cause extensive and focal cerebral vasospasm.

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After the occurrence of cerebral vasospasm, the clinical increase of intracranial pressure (headache, vomiting, fundus edema or aggravation) often occurs, and the disturbance of consciousness is aggravated. The patient changes from awake to lethargy or coma; or from coma (early cerebral vasospasm recovers within 2 days) awake coma (re-cerebral vasospasm). This dynamic change in consciousness is a prominent feature of cerebral vasospasm. At the same time, there are often different degrees of focal signs appearing or aggravating, such as hemiplegia, partial sensory disturbance, and aphasia. The patient continued to have fever and the peripheral blood leukocytes continued to increase. The above symptoms are aggravated, and it is difficult to re-bleed (such as lumbar puncture failed to confirm re-bleeding) and intracranial hematoma and other interpretations, and angiography to find vasospasm, you can diagnose cerebral vasospasm.

Differential diagnosis

Cerebral vasospasm: Arteriosclerotic plaque of the internal carotid artery or vertebral-basal artery system narrows the vascular lumen and presents eddy currents. When the eddy current accelerates, the blood vessel wall is stimulated to cause vasospasm and a transient ischemic attack occurs, and the symptoms disappear when the vortex decelerates. However, some scholars believe that due to the special nature of the cerebral vascular structure, it is not easy to occur. However, most scholars believe that vasospasm can undoubtedly occur in the internal carotid artery and the cerebral artery ring, cerebral angiography can be seen in the aortic stenosis; subarachnoid hemorrhage can cause extensive and focal cerebral vasospasm; brain surgery on the brain When the aorta is operated, the diameter of the artery is significantly thinned. Therefore, cerebral arterial spasm can also be caused by persistent hypertension, local injury or microparticle stimulation, and cause transient ischemic attack.

Meningeal irritation: meningeal irritation is a series of symptoms caused by meningeal lesions, including cervical rigidity, Kernig sign, Brudzinski sign.

1 neck stiffness is an important objective sign of meningeal irritation, which is mainly manifested by varying degrees of muscle rigidity, especially extensor muscles. The head flexion is obviously restricted, that is, the passive flexion neck encounters resistance, and the head side bend is also subject to certain Restricted, the head rotation movement is limited to light, and the head back is not strong. Found in various types of meningitis, subarachnoid hemorrhage, increased intracranial pressure, cervical disease and so on.

The 2Kernig sign is also called the flexor and knee extension test. The patient's supine position bends the knee joint into a right angle, and then passively bends the flexed leg. When the knee joint cannot be straightened, resistance and pain occur and the knee joint forms an angle of less than 135°. When the K sign is positive. Kernig sign positive in addition to suggesting that there are signs of meningeal irritation, it is suggested that the posterior root is stimulating, lumbosacral radiculopathy, the pain is limited to the waist and the affected limb, while the meningeal stimulation sign Kernig sign is bilateral, and the same intensity, pain Located on the chest and back and not limited to the waist and affected limbs.

3Brudzinski patients with supine supine, bilateral flexion and knee flexion when flexing the neck; compression of the bilateral cheeks caused by double upper arm abduction and elbow flexion; slamming their pubic symphysis with double lower limb flexion and Adduction, said to be positive for Brudzinski.

After the occurrence of cerebral vasospasm, the clinical increase of intracranial pressure (headache, vomiting, fundus edema or aggravation) often occurs, and the disturbance of consciousness is aggravated. The patient changes from awake to lethargy or coma; or from coma (early cerebral vasospasm recovers within 2 days) awake coma (re-cerebral vasospasm). This dynamic change in consciousness is a prominent feature of cerebral vasospasm. At the same time, there are often different degrees of focal signs appearing or aggravating, such as hemiplegia, partial sensory disturbance, and aphasia. The patient continued to have fever and the peripheral blood leukocytes continued to increase. The above symptoms are aggravated, and it is difficult to re-bleed (such as lumbar puncture failed to confirm re-bleeding) and intracranial hematoma and other interpretations, and angiography to find vasospasm, you can diagnose cerebral vasospasm.

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