Brain herniation

Introduction When there is a space-occupying lesion in a certain cavity in the cranial cavity, the pressure of the sub-chamber is higher than that of the adjacent sub-chamber, and the brain tissue is displaced from the high-pressure area to the low-pressure area, causing pressure on important structures such as brain tissue, blood vessels and nerves. And displacement, sometimes squeezed into the interdural space or pores, causing a series of serious clinical signs and symptoms, called cerebral palsy. Cerebral palsy is a late complication of high intracranial pressure. For a long time, it is most important to treat cerebral palsy with cerebral hypotension. The cerebral palsy should be actively rescued by large doses of dehydration, medicine and rapid supply of oxygen and rapid removal of the cause, but the condition Dangerous and poor prognosis.

Cause

When intracranial hematoma, severe cerebral edema, brain abscess and tumor occupying lesions occur, when the intracranial pressure increases to a certain extent, some brain tissue is forced to pass through the natural pores and shift to the lower pressure to form the brain. hernia. Any large volume of space-occupying lesions in the brain can cause cerebral palsy when the pressure distribution in the cranial cavity is uneven. The lesions on the screen cause the cerebellar incision, and the lesions in the lower part cause the occipital foramen. Common lesions that cause cerebral palsy are: 1 various intracranial hematoma caused by injury, such as acute epidural hematoma, subdural hematoma, intracerebral hematoma. 2 various intracranial tumors, especially tumors located in one side of the cerebral hemisphere and posterior fossa tumors. 3 intracranial abscess. 4 intracranial parasitic diseases and various other chronic granulomas. On the basis of the above-mentioned lesions, if some artificial factors are added, for example, excessive cerebrospinal fluid is released for lumbar puncture, so that the pressure difference between the cranial cavity and the spinal canal, the supratentorial cavity and the subdivision sub-cavity increases, which may promote Formation of cerebral palsy. This kind of cerebral palsy caused by iatrogenic factors should be avoided by clinicians.

an examination

Related inspection

Blood routine brain CT examination

Patients should undergo routine neurological examinations and corresponding laboratory tests.

Neurology routine examination:

(1) Whether the patient has used dilated or defamatory agents and whether there are diseases such as cataracts.

(2) Patients with cerebral palsy, such as the pupils on both sides, have been enlarged, not only to check the pupils, but also to check whether there is a difference in muscle tension between the two eyes. The side with reduced muscle tone often indicates the first involvement of the oculomotor nerve. Side, often the lesion side.

(3) The pupils of both sides of the cerebral palsy are dilated. If the pupil is changed to one side and the side is still enlarged after the dehydration treatment and the improvement of cerebral hypoxia, the scattered side is often the damaged side of the oculomotor nerve. Can be prompted for the lesion side.

(4) Patients with cerebral palsy, such as pupils are not equal, if the pupils of the pupils are more sensitive to light, the extraocular muscles are not paralyzed, and the smaller pupils of the pupils have lower diaphragmatic tension. This condition often indicates that the smaller side of the pupil is Sick side. This is due to changes in the parasympathetic nerve fibers of the diseased oculomotor nerve.

(5) Lumbar puncture is generally prohibited in patients with lumbar puncture cerebral palsy. Even if the intraspinal pressure measured by lumbar puncture is not high, it does not represent intracranial pressure. Because cerebellar tonsils can block cerebrospinal fluid circulation in the intracranial and spinal canal.

Laboratory inspection:

(1) When the CT cerebellum is inscribed, the basal pool (the upper saddle pool), the ring pool, and the quadruple pool are deformed or disappear. The midline is clearly asymmetrical and displaced when squatting.

(2) MRI: The deformation and disappearance of the cerebral cistern during cerebral palsy can be observed, and the structures in the brain such as hook back, hippocampus, diencephalon, brain stem and cerebellar tonsil are directly observed.

Differential diagnosis

There are two kinds of cerebral palsy, one of which is called the cerebral palpebral sputum, which is also called the scorpion scorpion, and the hippocampus. The other is called the occipital foramen, also known as the cerebellar tonsil.

(1) Cerebellar hiatus

The brain tissue of the temporal lobe of the lesion side is formed by being squeezed into the cleft hole of the cerebellum. Because the brain tissue that is squeezed in is the hippocampus of the temporal lobe, it is also called the temporal lobe (hippocampus). Because the brain tissue on the sky is squeezed below the canopy of the canopy, the middle cerebral oculomotor nerve and the posterior cerebral artery are compressed, and blood circulation is blocked. Patients often experience severe headaches, frequent vomiting, irritability, and even coma. The pupil on the side of the lesion first shrank, then gradually dilated, the pupils on both sides were not equal, the light reflection disappeared, and the contralateral central hemiplegia.

(2) large occipital condyle

It is due to posterior fossa lesion or intracranial hypertension, the cerebellar tonsil is squeezed into the occipital foramen and incarcerated. Because the brain tissue that is invaded is the cerebellar tonsil, it is also called the cerebellar tonsil. After the occurrence of large occipital condyle, the cerebral ventricle, cranial nerves and blood vessels are squeezed, the cerebral ventricles move down with the cerebellar tonsils, and the life centers such as respiration and heartbeat are damaged. Patients often have respiratory arrest, deep coma, quadriplegia, bilateral Dilated pupils, etc., if the rescue is not timely, will soon die.

Cerebral palsy is the most dangerous signal for cerebrovascular disease. More than half of the patients died of cerebral palsy. Therefore, in the acute phase should pay close attention to the patient's breathing, pulse, body temperature, blood pressure and pupillary changes, early detection of cerebral palsy, and active dehydration treatment, control intracranial hypertension, reduce mortality.

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