Cerebellar hemorrhage

Introduction Cerebellar hemorrhage refers to hemorrhage in the cerebellar parenchyma and 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.

Cause

The cranial dentate nucleus is broken. Within a few minutes, headache, dizziness, frequent vomiting, severe occipital headache and balance disorders, but no limb paralysis. The disease department has a clear consciousness or mild confusion, and mild manifestations of one side of the body are clumsy, unstable, ataxia and nystagmus. A large amount of bleeding can fall into a coma and signs of brain stem compression within 12-24 hours.

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Symptoms and signs

Sudden onset, headache, dizziness, frequent vomiting, severe occipital headache and balance disorder within a few minutes, but no limb paralysis. The disease department has a clear consciousness or mild confusion, and mild manifestations of one side of the body are clumsy, unstable, ataxia and nystagmus. A large amount of hemorrhage can fall into coma and brain stem compression signs within 12-24 hours, such as peripheral facial paralysis, contralateral side of the two eyes gaze lesions (the pons is centrally compressed), pupil diminution and light reflection, limb paralysis and pathology Reflex, etc.; late dilated pupils, central respiratory disorders, can die due to occipital macropores. The outbreak type of morbidity immediately appeared coma, and it was difficult to identify with pons bleeding.

Diagnostic examination

Can be diagnosed by CT.

Differential diagnosis

The diagnosis should be differentiated from the following symptoms:

1. Thalamic hemorrhage: The thalamus is the largest oval gray matter nucleus in the diencephalon, located on both sides of the third ventricle. The left and right thalamus are connected by gray matter masses (called intermediate blocks). The thalamus is closely related to the anatomy of the third ventricle and the lateral ventricle, and only the wall of the chamber is separated. Therefore, the thalamic hemorrhage often breaks into the ventricle, which can cause the lateral ventricle body to cast, or flow through the interventricular space to the third ventricle, returning to both sides. Lateral ventricle, resulting in bilateral bilateral ventricle triangle blood, and a large amount of bleeding, easy to flow into the third and fourth ventricles. Obstructive hydrocephalus is prone to occur when thalamic hemorrhage breaks 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.

2. Bridge cerebral hemorrhage: The pons is above the cerebral ventricle, which is the only way to transmit information between the central nervous system and the peripheral nerves. It regulates and controls human sleep. Bridge cerebral hemorrhage accounts for about 10% of cerebral hemorrhage, mostly caused by rupture of the pons of the basilar artery.

3. Deep hemorrhage of the brain parenchyma: Hypertensive cerebral hemorrhage occurs mostly in the deep arterioles of the brain. Hypertensive cerebral hemorrhage is one of the most serious complications of hypertension. The incidence rate of males is slightly higher, which is more common in elderly people aged 50-60 years, but it can also occur in young hypertensive patients.

4. Intracranial hemorrhage: refers to the rupture of blood vessels in the brain, causing hemorrhage. Therefore, the brain cells that receive blood from the blood vessels are destroyed, and the blood vessels are forced to block the surrounding nerve tissue. Usually intracranial hemorrhage will occur in combination with hyperthermia. This symptom increases the oxygen consumption in the brain, which in turn causes insufficient oxygen supply to the brain. Intracranial hemorrhage is a common serious disease in newborns and one of the leading causes of perinatal neonatal death. Under the sacral membrane, intraventricular hemorrhage is the longest.

5. Brain stem bleeding

(1) Brain stem hemorrhage is a severe acute nervous system with poor prognosis and high mortality.

(2) The amount of brainstem hemorrhage is below 15ml, and the mortality rate is about 17.1%. The amount of brain stem bleeding is above 15ml, and the mortality rate is about 81.8%. The mortality rate of brain stem hemorrhage more than 20ml is higher.

(3) The amount of brainstem bleeding is relatively small (about 6 ~ 9ml), generally in a large number of applications of albumin for 1 to 2 weeks, the consciousness disorder is mostly restored, the brain stem dysfunction is obviously improved, and the vital signs tend to be stable.

(4) In moderate amount of brain stem hemorrhage (about 10 ~ 14ml), the symptoms are severe, the large dose of continuous application of albumin is generally about 3 to 4 weeks, and some patients' life symptoms gradually become stable.

6. Intraventricular hemorrhage

The ventricle is a cavity in the brain, and there is a lateral ventricle in the cerebral hemisphere. The sagittal fissure between the thalamus and the hypothalamus is called the third ventricle. The fourth ventricle is between Yannao, Qiao and Cerebellum. There are small holes in each ventricle.

Ventricular hemorrhage refers to bleeding in these compartments. Divided into primary and secondary. The rupture of the choroidal artery on the ventricular wall is called primary ventricular hemorrhage, which is relatively rare. Hemorrhage in the brain parenchyma is broken into the ventricle and is called secondary ventricular hemorrhage. This type of bleeding is more common.

In clinical practice, in addition to the general manifestations of cerebral hemorrhage, ventricular hemorrhage often has some special manifestations, which are signs that the blood breaks into the ventricles.

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