Lobar hemorrhage

Introduction Cerebral hemorrhage refers to bleeding caused by rupture of blood vessels in the brain parenchyma. 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. Headache is the focus of the lesion side, vomiting is more common, mostly jetting, vomit is the stomach content, mostly brown, hiccup is also 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.

Cause

Headache, vomiting, aphasia, abnormal vision and meningeal irritation, seizures are common, and coma is rare. Topal lobe hemorrhage is the most common, with deep sensory disturbance and spatial conformational disorder; hemiplegia in frontal lobe, Broca aphasia, groping, etc. Wernicke aphasia and mental symptoms can be seen in the temporal lobe, and contralateral hemianopia appears in the occipital lobe. Often caused by cerebral arteriovenous malformations, Moyamoya disease, vascular amyloidosis and tumors.

an examination

Related inspection

Determination of plasma coagulation factor IX activity in craniocerebral MRI by cranial brain examination

Middle-aged and elderly patients with sudden onset of activity or emotional agitation, rapid occurrence of hemiplegia, aphasia and other symptoms of focal neurological deficits, as well as severe headache, vomiting and disturbance of consciousness, often highly suggestive of cerebral hemorrhage, CT can be diagnosed without examination .

MRI examination

It can be found that CT can not determine the small amount of brainstem or cerebellar hemorrhage, can distinguish the cerebral hemorrhage that can not be recognized by CT after 4-5 weeks, distinguishing old cerebral hemorrhage and cerebral infarction, showing vascular malformation. The bleeding time can be judged according to the dynamic change of the hematoma signal (affected by the change of red blood protein in the hematoma).

Differential diagnosis

(1) Hypertensive nucleus, thalamus and cerebral lobe bleeding must be differentiated from cerebral infarction, especially after cerebral embolism. CT examination can clearly identify the lesion. Cerebellar hemorrhage can be similar to brain stem or cerebellar infarction, and MRI can be diagnosed.

(2) Traumatic cerebral hemorrhage is caused by closed head trauma, which occurs under the affected skull or in the heel area. The history of trauma can provide diagnostic clues, which are common in the frontal and bungee, and CT can show hematoma.

(3) cerebral aneurysms, cerebral arteriovenous malformations, primary or metastatic brain tumors can cause cerebral hemorrhage, and stroke often shows a sudden increase in chronic course. Hematological diseases such as hemophilia (deficiency factor VIII), idiopathic thrombocytopenic purpura and acute myeloid leukemia, as well as anticoagulation and sputum treatment have a corresponding history or treatment history; CT, MRI, MRA and DSA can confirm the diagnosis. Cerebral amyloid angiopathy is a rare cause of cerebral hemorrhage, common in the elderly (average 70 years old), blood pressure can be normal, typically multifocal cerebral hemorrhage, may have familial cases.

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