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Dołączył: 29 Paź 2010
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 Wysłany: Pon 8:32, 13 Gru 2010 Temat postu: ugg jimmy choo Clinical analysis of 38 cases of br |
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Clinical analysis of 38 cases of brain stem hemorrhage
Abstract Objective: To investigate the causes of primary brain stem haemorrhage clinical manifestations and prognosis. Methods: 38 patients with complete data were fully analyzed the raw data. Results: The age 51 to 62 years, the most common risk factors for hypertension. The first symptom of dizziness, headache based. Mostly hemiplegia, quadriplegia followed. Various eye symptoms were complex, with bilateral miosis most. Conclusion: The blood loss> 5ml, breaking into the ventricle, delirium poor prognosis. Brainstem hemorrhage mortality, light brain stem hemorrhage prognosis, some patients can be cured. Materials and Methods General information: 60 cases in 23 males and 15 females; aged 37 to 85 years, mean 62.5 years; 31 patients with a history of hypertension, elevated blood pressure at onset of 35 cases. signs and symptoms: disturbance of consciousness on admission there were 26 cases,[link widoczny dla zalogowanych], including 20 cases of coma. Dizziness, headache in 25 cases, vomiting in 20 cases. Central high fever in 12 patients. Double miosis in 12 cases, 4 cases ranging from large, eyes fixed in 3 cases, monocular and binocular outreach can not stare at the side of the 3 cases, 2 cases of Horner's sign. Dysarthria in 14 cases. 25 cases of hemiplegia,[link widoczny dla zalogowanych], quadriplegia in 14 cases. Cross-paralysis in 4 cases. Sensory disturbance in 12 cases. 15 cases of meningeal irritation. Positive in 21 cases the pathological. Respiratory failure in 10 cases. 20 cases of pulmonary infection, urinary tract infection in 3 cases, 5 cases of renal dysfunction, upper gastrointestinal bleeding in 8 cases, 2 cases of obstructive hydrocephalus. imaging: are in the hospital the day by head CT, admitted within 1 week at least 1 line of head CT review, CT showed round, oval or irregular in shape, state more clearly the high-density film,[link widoczny dla zalogowanych], CT value 45 ~ 71Hu, average 59.6Hu. ① mainly in 8 cases of cerebral hemorrhage, hemorrhage diameter 0.5 ~ 2.8cm, blood loss was 0.7 ~ 8ml, an average of 3.12ml. Which only involved the brain stem hematoma in 3 cases of unilateral,[link widoczny dla zalogowanych], bilateral hematoma involving the brain stem in 4 cases. 1 case of hematoma ruptured into the ventricle. ② mainly pontine hemorrhage in 24 cases, bleeding lesions diameter 0.6 ~ 3.4cm, bleeding 0.5 ~ 10ml, an average of 3.46ml. Brain stem hematoma involving only one side of which 7 cases, hematoma in 14 cases involving bilateral brain stem. 8 cases hematoma ruptured into the ventricle. ③ the whole brain stem hemorrhage (most affected in the brain and pons) in 6 cases, bleeding lesions diameter 1.6 ~ 3.3cm, bleeding 3.2 ~ 11.5ml, an average of 5.37ml. Brain stem hematoma involving only one side of which 3 cases, hematoma in 3 patients with bilateral brain stem involvement. 2 cases of hematoma ruptured into the ventricle. the patients were given conservative treatment, control of blood pressure, dehydration and reduction of intracranial pressure, protect brain cells,[link widoczny dla zalogowanych], symptomatic treatment and medical treatment associated with the disease. Results 4 patients were cured, 17 cases improved, 3 patients deteriorated, 14 patients died. The group of 14 patients died, mortality 36.8.7%. 4 patients died of cerebral hemorrhage, pontine hemorrhage in 9 patients died, died of brain hemorrhage in 1 case combined pons. Special treatment for localized better prognosis, with regard to the amount of bleeding and prognosis, the majority of authors believe that hematoma volume <5ml higher survival rate, the prognosis is good. 14 cases of death in this group, 3 cases <5ml, survivors bleeding volume <5ml, death group blood loss 0.98 ~ 11.5ml, mean 4.96ml; survivors bleeding 0.5 ~ 4.02ml, mean 2.04ml. Bleeding death group was higher than the survival group, statistically significant difference test (P <0.05). discuss etiology and morbidity: hypertension cerebral arteriosclerosis is a major cause of brain stem hemorrhage, followed by aneurysms, vascular malformations [1 ]. clinical presentation: 28 patients in this group of patients in coma, 20 were fatal. That consciousness is a manifestation of poor prognosis and may be covered with the network structure of the Ministry of uplink system impairment. In addition, within the brain stem cranial nerve nuclei damage Ⅲ ~ Ⅳ, Ⅲ ~ Ⅳ reproducible cranial nerve palsy. The scope of many brain stem hemorrhage hematoma primary site pons or midbrain, cranial nerve damage occurs multiple performance mainly depends on its accurate positioning imaging diagnosis. prognosis: ① the size of hematoma: reported in the literature [1], when the hematoma diameter greater than 50% of stem diameter or diameter> 2cm, the patients with poor prognosis. ② bleeding: bleeding in this group> 5ml of 78% mortality, blood loss
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