出血性中风

定义

Stroke is a brain injury caused by an interruption in blood flow. It needs to be treated right away. Brain tissue that does not get oxygen and nutrients from blood can die within minutes. The damage to the brain can cause a sudden loss in 身体机能. The changes will depend on the part of the brain that is damaged.

Two blood flow problems can cause a 中风:

• A hemorrhagic 中风 is caused by a ruptured blood vessel. 可能是:
  • Intracerebral 出血—出血 in the brain
  • 蛛网膜下腔 出血—出血 in the tissue around the brain
• An ischemic 中风 is caused by a blocked blood vessel.

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原因

A hemorrhagic 中风 happens because of a weakened blood vessel in the brain. Blood vessels may be weakened by:

• Problems with the structure of a blood vessel
• Arterio-venous (AV) malformation—an abnormal knot of blood vessels
• 动脉瘤—a weakened spot in a blood vessel 墙
• Other illness or medical problems like 高血压
• Damage from trauma like a blow to the head or car accident

风险因素

Things that may raise the risk of 中风 包括:

• Men are more likely to have a 中风 than women
• Being 55 years of age or more
• Family history of 中风

Things that can raise a person's risk of hemorrhagic 中风 包括:

• 高血压
• 吸烟
• 睡眠呼吸暂停
• 可卡因的使用
• 酒精使用障碍
• Blood disorders or medicine that can make it harder for the blood to clot.

症状

症状 will depend on the part of the brain that is affected. Getting medical help right away is key to reducing the amount of brain damage. 呼吁 emergency medical services right away if someone suddenly has:

• Weakness or numbness of face, arm, or leg, especially on one side of the body
• 混乱
• Trouble speaking or understanding
• Trouble seeing in one or both eyes
• Lightheadedness, trouble walking, loss of balance, or clumsiness
• Severe headache with no known cause
• 失去知觉

Other symptoms a person may have are:

• 脖子僵硬
• 恶心或呕吐
• 对光的敏感度

诊断

A physical exam will be done. The doctor will look for muscle weakness, vision and speech problems. If possible, the doctor will ask about symptoms 过去的健康状况. A CT扫描 可能是为了 确认诊断.

Images of blood vessels will help find the cause of the 出血. 图像测试可能包括:

• MR血管造影
• CT血管造影
• 多普勒超声

Blood tests will also be done. Tests will show how well the blood 可以凝. The doctor may also check the fluid that surrounds the brain and spine.

治疗

Brain tissue without blood flow dies quickly. 快速治疗是 needed to stop the 出血 and get blood flowing to the brain again. 鲜血四溅 the brain is also trapped in the 头骨. It can put pressure on the brain. 这种压力 可能需要缓解.

医学

医学 can be given to help the blood clot. 这也可能 包括维生素K. 药物也有帮助:

• Ease pressure in the brain
• 预防癫痫发作
• 降低血压

手术

手术 可能是为了 help stop the 出血. Some may be done through blood vessels. A tube is placed into blood vessels of the groin and passed to the vessels in the brain. Next steps will depend on the cause and site of the 出血:

• For a burst aneurysm—A clip may be placed just before the damaged vessel. It should stop the 出血.
• For a leaking aneurysm that has not burst—A special coil or clip may be placed in 薄弱环节. The coil will help a clot form over the area. 它会防止 出血.
• For an abnormal tangle of blood vessels—手术 可能是为了 repair the blood vessels. It may be able to remove the tangles or reroute the blood around the area.

The 中风 and damaged tissue can cause swelling in the brain. 手术 may be needed to ease the pressure. One common way is to remove part of the 头骨. 这叫做 颅骨切开术.

康复

Recovery will depend on the amount of brain damage. 康复 may 包括:

• Physical therapy—to regain as much movement as possible
• Occupational therapy—to help with daily tasks and self care
• Speech therapy—to help with s墙owing and speech issues
• 心理治疗改善心情 减少抑郁

预防

Manage and watch medical issues. This includes aneurysms and high 血压. Other habits that may reduce the risk of 中风 包括:

• 有规律的锻炼.
• A balanced diet with plenty of fruits, vegetables, and whole grains.
• 戒烟.
• Keeping a healthy weight.
• 限制酒精. This means no more than 2 drinks per day for men and 1 drink per 妇女日.
• Not using recreational drugs, such as cocaine.

参考文献

• Intracerebral 出血. EBSCO DynaMed网站. 可用 在:http://www.力学.com/condition/intracerebral-出血.
• Stroke (acute management). EBSCO DynaMed网站. 可用 在:http://www.力学.com/management/中风-acute-management-1.
• 蛛网膜下腔出血. EBSCO DynaMed网站. 可用 在:http://www.力学.com/condition/subarachnoid-出血.
• 治疗方案. American Stroke Association website. 可以在: http://www.中风.org/en/help-and-support/resource-library/treatment-options.