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1、出血性腦卒中hemorrhagicapoplexy中南大學(xué)湘雅醫(yī)院神經(jīng)內(nèi)科谷文萍WenpingGu,MD.PhD.NeurologyDepartment,XiangyaHospital,centralsouthUniversity腦出血cerebralhemorrhage腦出血cerebralhemorrhage是指原發(fā)性非外傷性腦實(shí)質(zhì)內(nèi)出血發(fā)病率高，占全部腦卒中20％—30％80%以上由高血壓性腦內(nèi)細(xì)小動(dòng)脈病變引起,固又稱高血壓動(dòng)脈硬化性腦出血Hypertensionisthemostcommonunderlyingcauseofnontraumaticint
2、racerebralhemorrhage病因與發(fā)病機(jī)制etiopathogenisisandpathogenesy高血壓性腦內(nèi)細(xì)小動(dòng)脈硬化高血壓性腦動(dòng)脈硬化時(shí)可有腦內(nèi)細(xì)小動(dòng)脈透明變性、纖維素樣壞死，病變管壁在血流沖擊下形成微動(dòng)脈瘤hypertensionappearstopromotestructuralchangesincludinglipohyalinosis,fibrinoidnecrosisandmicroaneurysmformationinthewallsofpinetratingarteries,predisposingthemtointracer
3、ebralhemorrhage.導(dǎo)致腦動(dòng)脈管壁薄弱(cerebralarteriesvesselwallweak)的其他疾病血液系統(tǒng)疾病(hematologicalsystemdisease)腫瘤卒中(tumorapoplexy)原因不明(unknownaetiology)病理 pathology多為腦動(dòng)脈深穿支破裂所致豆紋動(dòng)脈最為常見(jiàn)，次為丘腦穿通動(dòng)脈多發(fā)于大腦半球基底核區(qū)，次為腦葉、腦橋、小腦和腦室等Mosthypertensivehemorrhagesoriginateincertainareasofpredilection,correspondingto
4、long,narrow,penetratingarterialbranches.Theseincludethecaudateandputaminalbranchesofthemiddlecerebralarteies(42%);branchesofthebasilararterysupplyingthepons(16%);thalamicbranchesoftheposteriorcerebralarteries(15%);branchesofthesuperiorcerebellararteriessupplyingthedentatenucleiandthe
5、deepwhitematterofthecerbellum(12%);andsomewhitematterbranchesofthecerebralarteries(10%).出血可直接破壞腦組織(hemorrhagetodestroybraintissue)血腫擠壓周圍組織，引起腦組織水腫、顱內(nèi)壓增高，嚴(yán)重可引起腦疝(hematomacrushingsurroundingtissue)臨床表現(xiàn)clinicalmanifestation>50歲高血壓患者(hypertensivepatients)突然發(fā)病,迅速達(dá)高峰(suddenlyonset)全腦癥狀(glo
6、balsymptom)局灶癥狀(focalsymptom)臨床表現(xiàn) clinicalmanifestation基底節(jié)區(qū)出血(basalgangliahemorrhage)：50%~60%殼核出血（putamenhemorrhage）內(nèi)囊外側(cè)型出血，為高血壓性腦出血最常見(jiàn)的類型Internalcapsulelateralbleedingisthemostcommontypeofhypertensivecerebralhemorrhage丘腦出血（thalamichemorrhage）尾狀核頭出血(headofcaudatenucleushemorrhage)腦葉出
7、血（lobehemorrhage）：5%~10%臨床表現(xiàn)clinicalmanifestation腦干出血（brainstemhemorrhage）中腦出血（midbrainhemorrhage）腦橋出血（pontinehemorrhage）：10%延髓出血（medullaoblongatahemorrhage）小腦出血（cerebellarhemorrhage）：10%腦室出血（cerebroventricularhaemorrhage）：3%~5%輔助檢查laboratoryfindings頭顱CT(CTscan)MIR腦血管造影(cerebralarter
8、iography)MRA
