What Is a Cerebellar Hemorrhage?

Cerebellar hemorrhage

Cerebellar hemorrhage is directly related to hypertension and is caused by rupture of the cerebellar dentate nucleus artery. Cerebellar hemorrhage can occur from smoking, alcohol abuse, excessive salt, physical and mental exertion. Cerebellar hemorrhage mostly manifests as sudden onset of dizziness, frequent vomiting, headache at the pillow, and nystagmus.

Cerebellar hemorrhage disease name

Cerebellar hemorrhage

Cerebellar hemorrhage disease classification

Neurology

Overview of cerebellar hemorrhage diseases

Cerebellar hemorrhage refers to hemorrhage in the cerebellar parenchyma, which is directly related to hypertension.

(I) Susceptibility factors:

1, high blood pressure, especially with elevated systolic blood pressure;

2, irritable or emotional tension, often after angry, quarreling with others;

3. Smoking, drinking, excessive salt, and weight;

4. Excessive fatigue, excessive physical and mental labor, forced defecation and exercise.

(Two) clinical manifestations:

Cerebellar hemorrhage: Most show sudden onset of dizziness, frequent vomiting, occipital headache, ataxia of upper and lower limbs on one side without obvious paralysis, nystagmus, and peripheral facial paralysis on one side. A few are subacute and progressive, similar to cerebellar mass lesions. Severe massive hemorrhage showed a rapid and progressive increase in intracranial pressure, and soon entered a coma. The foramen magnum hernia usually died within 48 hours.

Cerebellar hemorrhage symptoms and signs

Sudden onset of symptoms, headache, dizziness, frequent vomiting, severe headache and balance disorders within minutes, but no limb paralysis. The consciousness of the disease is clear or slightly blurred. Mildness shows clumsy limbs, unstable movement, ataxia, and nystagmus. Massive bleeding can fall into coma and brainstem compression signs within 12-24 hours, such as peripheral facial nerve palsy, opposite side of gaze focus (compression of the pontine lateral vision center), pupil reduction and light reflection, limb paralysis and pathology Reflexes, etc .; late dilated pupils, central respiratory disorders, can die due to foramen magnum hernia. Outbreaks occur immediately in a coma, which is difficult to distinguish from pontine hemorrhage.

Causes of cerebellar hemorrhage disease

Cerebellar dentate nuclear artery rupture.

Cerebellar hemorrhage diagnostic test

Can be diagnosed by CT.

Cerebellar hemorrhage treatment plan

Active and reasonable treatment can save patients' lives, reduce the degree of neurological disability and reduce the recurrence rate.

1. Medical treatment

The patient was in bed and kept quiet. In severe cases, close observation of vital signs such as temperature, pulse, respiration, and blood pressure is required, and attention should be paid to changes in pupils and consciousness. Keep the respiratory tract usually, clean up the respiratory tract secretions in time, inhale oxygen during western medicine, and protect the arterial blood oxygen level above 90%. Intensify nursing and maintain limb function. People with impaired consciousness and gastrointestinal bleeding should fast for 24-48 hours before placing gastric tubes.

(1) Emergency treatment of blood pressure. The increase of blood pressure in acute cerebral hemorrhage is an automatic regulation mechanism of cerebral blood vessels that maintains normal cerebral blood flow under the condition of increased intracranial pressure. The use of antihypertensive drugs is still controversial. Antihypertensive can affect cerebral blood flow and cause hypoperfusion or cerebral infarction. Persistent hypertension can worsen cerebral edema. It is reasonable to reduce the diastolic blood pressure to about 100 mmHg, but care must be taken as the branched individuals are extremely sensitive to antihypertensive drugs. After the acute phase, conventional medication can be used to control blood pressure.

(2) Control of vasogenic cerebral edema: The edema reaches a peak 48 hours after cerebral hemorrhage, and it gradually subsides after maintaining for 3-5 days or more. Cerebral edema can increase intracranial pressure (ICP) and cause cerebral hernia, which is the main cause of cerebral hemorrhage. Corticosteroids are commonly used to reduce edema and reduce ICP after intracerebral hemorrhage, but there is insufficient evidence; dehydrating drugs have only a temporary effect. 20% mannitol, 10% compound glycerol, and diuretics such as furosemide are commonly used; or 10% plasma albumin is used.

(3) Rebleeding at the site of hypertensive cerebral hemorrhage is uncommon, and antifibrinolytic drugs are usually not required. If necessary, antifibrinolytic drugs such as 6-aminoacetic acid, tranexamic acid, etc. can be given early (<3 hours). . Li hemostatic is also recommended. Assessment of coagulation after cerebral hemorrhage is necessary to monitor hemostatic treatment.

(4) Maintaining nutrition and maintaining water-electrolyte balance: The daily fluid input is calculated based on urine volume + 500ml. Patients with high fever, sweating, vomiting or diarrhea need to increase fluid intake appropriately. Pay attention to prevent hyponatremia, so as not to aggravate cerebral edema.

(5) Prevention and treatment of complications:

Infection: Antibiotics are usually not used in the early stage or when the disease is mild. Elderly patients with dysconsciousness are prone to lung infections, and urinary retention or catheterization are likely to be complicated with urinary tract infections. They can be selected based on experience, sputum and urine culture, and drug sensitivity tests Antibiotics treatment; keep the airway unobstructed, strengthen oral and respiratory care, timely sputum should be tracheotomy, urinary retention can be indwelling and regular bladder irrigation;

Stress ulcers: can cause gastrointestinal bleeding, which can be prevented with H2 receptor blockers, such as cimetidine 0.2-0.4g / d, intravenous infusion; ranitidine 150mg orally, 1-2 times / d ; Losec 20mg / d; If upper gastrointestinal bleeding occurs, norepinephrine 4-8mg plus ice-cold 80-100ml orally, 4-6 times / d; Yunnan Baiyao 0.5g orally, 4 times / d ; When conservative treatment is ineffective, hemostasis can be stopped under gastroscopy. Pay attention to suffocation caused by vomiting, and maintain fluid volume with fluid or blood transfusion;

Dilute hyponatremia: 10% of patients with cerebral hemorrhage can occur, due to 9-12g of 1000ml liquid sodium supplement; it should be corrected slowly to avoid causing myelin lysis in the central pontine;

Brain salt wasting syndrome: excessive atrial natriuretic factor secretion leads to hyponatremia, treatment should be infused with sodium.

Seizures: Common generalized tonic-clonic seizures or focal seizures can be slowly injected intravenously with diazepam 10-20mg. In individual cases, seizures can be slowly injected intravenously with phenytoin sodium 15-20mg / kg. Long-term medication

Central hyperthermia: Physical cooling is recommended. If the effect is not good, dopamine receptor agonist dose can be used. If bromocriptine is 3.75mg / d, gradually increase the dose to 7.5-15.0mg / d and take it in divided doses. Or use nifedipine 0.8-2.0mg / kg, intramuscularly or intravenously, once per 6-12 hours, 100mg after remission, twice per day;

Deep venous thrombosis of the lower limbs: Progressive edema and stiffness of the affected limbs can be prevented, and paralyzed limbs can be prevented from turning over, passive movement, or raising the limbs. The venous blood flow of the limbs can be confirmed, and 100 mg intravenous infusion of heparin can be used once a day ; Or low molecular weight heparin 4000u subcutaneous injection, 2 times / d.

2. Surgical treatment

It can save the life of critically ill patients and promote the recovery of nerve function. The operation should be performed within 6-24 hours after the onset of disease. The prognosis is directly related to the level of preoperative consciousness. Patients with coma usually have poor surgical results.

(1) Indications for surgery:

Increased intracranial pressure in patients with intracerebral hemorrhage accompanied by signs of compression of the brainstem, such as bradycardia, increased blood pressure, slowed respiratory rhythm, and decreased consciousness;

Cerebellar hematoma hematoma volume 10ml or vermicular part> 6ml, hematoma broke into the fourth ventricle or the pressure of the cistern disappeared, symptoms of brain stem compression or signs of acute obstructive hydrocephalus;

Obstructive hydrocephalus caused by severe ventricular hemorrhage;

Cerebral lobe hemorrhage, especially those caused by AVM and with obvious space effect.

(2) Contraindications to surgery: brain stem hemorrhage, deep brain hemorrhage, and cerebral lobe hemorrhage caused by amyloid angiopathy should not be treated surgically. Most cases of deep brain hemorrhage can break into the ventricle and spontaneously decompress, and surgery will cause damage to normal brain tissue.

(3) The common surgical methods are:

Cerebellar decompression: It is the most important surgical treatment for hypertensive cerebellar hemorrhage, which can save lives and reverse neurological deficits. The surgical effect is good when the patient is awake at an early stage;

Craniotomy hematoma removal: surgical treatment may be effective when the midline structure is shifted and the initial brain hernia is caused by the space effect;

drilling to expand bone hematoma removal;

drilling minimally invasive intracranial hematoma removal;

ventricular hemorrhage and ventricular drainage.

3. Rehabilitation

Patients with cerebral hemorrhage should be rehabilitated as soon as possible after the condition is stable, which is beneficial to the recovery of nerve function and the improvement of quality of life. If the patient is depressed, medications (such as chloracetin) can be given in time and psychological support can be given.