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Ներգանգային արյունազեղում (ICH), հայտնի է նաև ուղեղային արյունահոսություն, ներգանգային արյունահոսության տեսակ է որը տեղի է ունենում ուղեղային հյուսվածքում կամ փորոքներում [1]; also known as cerebral bleed, is a type of intracranial bleed that occurs within the brain tissue or ventricles. [1]Ախտանիշները կարող են ներառել գլխացավ, միակողմանի թուլություն, փսխում, ցնցումներ, գիտակցության մթագնում, և պարանոցի կարկամություն [2]։ Symptoms can include headache, one-sided weakness, vomiting, seizures, decreased level of consciousness, and neck stiffness. [2] Հաճախ ախտանիշները ժամանակի հետ վատանում են [3];Often symptoms get worse over time. [3] Fever is also common. [3]Շատ հաճախ արյունահոսությունն առկա է լինում և ուղեղային հյուսվածքում և փորոքներում [3]; In many cases bleeding is present in both the brain tissue and the ventricles. [3]

Պատճառագիտություն և Ախտորոշում

Հիմնական պատճառներն են գլխուղեղի վնասվածք, անևրիզմաներ, զարկերակերակային մալֆորմացիաներ ևգլխուղեղի ուռուցքներ [3]; Causes include brain trauma, aneurysms, arteriovenous malformations, and brain tumors. [3]Սպոնտան արյունահոսությունների ամենամեծ ռիսկի գործոնն են հանդիսանում բարձր զարկերակային ճնշումն ու ամիլոիդոզը [2]; The largest risk factors for spontaneous bleeding are high blood pressure and amyloidosis. [2]Այլ ռիսկի գործոններ են հանդիսանում ալկոհոլիզմը,արյան մեջ ցածր խոլեստերինը, արյան մածուծիկությունն իջեցնող դեղերը և կոկաինի օգտագործումը [2]։Other risk factors include alcoholism, low cholesterol, blood thinners, and cocaine use. [2]Հիմնական ախտորոշիչ մեթոդը համակարգչային շերտագրումն է [3]։ Diagnosis is typically by CT scan. [3]Իշեմիկ կաթվածը այն վիճակներից է, որը դրսևորվում է նույն նշաններով [3]։ Other conditions that may present similarly include ischemic stroke. [3]

Կանխարգելում և բուժում

Բուժումը պետք է իրականացվի ինտենսիվ թերապիայի բաժանմունքում [3]։Treatment should typically be carried out in an intensive care unit. [3]Գայդլայները խորհուրդ են տալիս իջեցնել արյան սիստոլիկ ճնշումը 140մմս․ս․ [3] [4]; Guidelines recommended decreasing the blood pressure to a systolic of 140 mmHg. [3] [4]Հակամակարդիչների ընդունումը հնարավորության դեպքում պետք է դադարեցվի իսկ արյան մեջ գլյուկոզի մակարդակը պետք է պահպանվի նորմայի սահմաններում [3]; Blood thinners should be reversed if possible and blood sugar kept in the normal range. [3]Հիդրոցեֆալիայի բուժման համար կարելի է իրականացնել վիրահատական միջամտություն փորոքային դրենաժի տեղադրմամբ, բայց կորտիկոստերոիդներ բուժման սխեմայում չեն օգտագործվում [3]; Surgery to place a ventricular drain may be used to treat hydrocephalus but corticosteroids should not be used. [3]Որոշ դեպքերում օգտակար են վիրահատական ճանապարհով արյան հեռացումը [3]; Surgery to remov the blood is useful in certain cases. [3]

Համաճարակաբանություն

գլխուղեղային արյունահոսությամբ ամեն տարի տառապում են

Cerebral bleeding affects about 2.5 per 10,000 people each year. [2] It occurs more often in males and older people. [2] About 44% of those affected die within a month. [2] A good outcome occurs in about 20% of those affected. [2] Strokes were first divided into their two major types, bleeding and insufficient blood flow, in 1823. [5]

Signs and symptoms

People with intracerebral bleeding have symptoms that correspond to the functions controlled by the area of the brain that is damaged by the bleed. [6] Other symptoms include those that indicate a rise in intracranial pressure caused by a large mass putting pressure on the brain. [6] Intracerebral bleeds are often misdiagnosed as subarachnoid hemorrhages due to the similarity in symptoms and signs. A severe headache followed by vomiting is one of the more common symptoms of intracerebral hemorrhage. Another common symptom is a patient can collapse. Some people may experience continuous bleeding from the ear. Some patients may also go into a coma before the bleed is noticed.

Causes

Axial CT scan showing hemorrhage in the posterior fossa [7]

Intracerebral bleeds are the second most common cause of stroke, accounting for 10% of hospital admissions for stroke. [8] High blood pressure raises the risks of spontaneous intracerebral hemorrhage by two to six times. [7] More common in adults than in children, intraparenchymal bleeds are usually due to penetrating head trauma, but can also be due to depressed skull fractures. Acceleration-deceleration trauma, [9] [10] [11] rupture of an aneurysm or arteriovenous malformation (AVM), and bleeding within a tumor are additional causes. Amyloid angiopathy is a not uncommon cause of intracerebral hemorrhage in patients over the age of 55. A very small proportion is due to cerebral venous sinus thrombosis.

ներգանգային արյունազեղման ռիսկի գործոններն են [12]; Risk factors for ICH include: [12]

Traumautic intracerebral hematomas are divided into acute and delayed. Acute intracerebral hematomas occur at the time of the injury while delayed intracerebral hematomas have been reported from as early as 6 hours post injury to as long as several weeks.

Diagnosis

Spontaneous ICH with hydrocephalus on CT scan [7]

Both computed tomography angiography (CTA) and magnetic resonance angiography (MRA) have been proved to be effective in diagnosing intracranial vascular malformations after ICH. [13] So frequently, a CT angiogram will be performed in order to exclude a secondary cause of hemorrhage [14] or to detect a "spot sign".

Intraparenchymal hemorrhage can be recognized on CT scans because blood appears brighter than other tissue and is separated from the inner table of the skull by brain tissue. The tissue surrounding a bleed is often less dense than the rest of the brain because of edema, and therefore shows up darker on the CT scan. [14]

Location

When due to high blood pressure, intracerebral hemorrhages typically occur in the putamen (50%) or thalamus (15%), cerebrum (10-20%), cerebellum (10-13%), pons (7-15%), or elsewhere in the brainstem (1-6%). [15] [16]

Treatment

Treatment depends substantially on the type of ICH. Rapid CT scan and other diagnostic measures are used to determine proper treatment, which may include both medication and surgery.

Medication

Surgery

Surgery is required if the hematoma is greater than 3 cm (1 in), if there is a structural vascular lesion or lobar hemorrhage in a young patient. [17]

Prognosis

The risk of death from an intraparenchymal bleed in traumatic brain injury is especially high when the injury occurs in the brain stem. [27] Intraparenchymal bleeds within the medulla oblongata are almost always fatal, because they cause damage to cranial nerve X, the vagus nerve, which plays an important role in blood circulation and breathing. [9] This kind of hemorrhage can also occur in the cortex or subcortical areas, usually in the frontal or temporal lobes when due to head injury, and sometimes in the cerebellum. [9] [28]

For spontaneous ICH seen on CT scan, the death rate ( mortality) is 34–50% by 30 days after the insult, [7] and half of the deaths occur in the first 2 days. [29] Even though the majority of deaths occurs in the first days after ICH, survivors have a long term excess mortality of 27% compared to the general population. [30]

Epidemiology

It accounts for 20% of all cases of cerebrovascular disease in the United States, behind cerebral thrombosis (40%) and cerebral embolism (30%). [31]

Research

The inflammatory response triggered by stroke has been viewed as harmful in the early stage, focusing on blood-borne leukocytes, neutrophils and macrophages, and resident microglia and astrocytes. [32] A human postmortem study shows that inflammation occurs early and persists for several days after ICH. [33] Modulating microglial activation and polarization might mitigate intracerebral hemorrhage-induced brain injury and improve brain repair. [34] A new area of interest is the role of mast cells in ICH. [35]

References

  1. ^ a b Naidich, Thomas P.; Castillo, Mauricio; Cha, Soonmee; Smirniotopoulos, James G. (2012). Imaging of the Brain, Expert Radiology Series,1: Imaging of the Brain. Elsevier Health Sciences. p. 387. ISBN  978-1416050094. Archived from the original on 2016-10-02.
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  3. ^ a b c d e f g h i j k l m n o p q r s t u v Hemphill JC, 3rd; Greenberg, SM; Anderson, CS; Becker, K; Bendok, BR; Cushman, M; Fung, GL; Goldstein, JN; Macdonald, RL; Mitchell, PH; Scott, PA; Selim, MH; Woo, D; American Heart Association Stroke, Council; Council on Cardiovascular and Stroke, Nursing; Council on Clinical, Cardiology (July 2015). "Guidelines for the Management of Spontaneous Intracerebral Hemorrhage: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association". Stroke: A Journal of Cerebral Circulation. 46 (7): 2032–60. doi: 10.1161/str.0000000000000069. PMC  4462131. PMID  26022637.{{ cite journal}}: CS1 maint: numeric names: authors list ( link)
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Further reading

External links

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