What Is an Intraventricular Hemorrhage?

Ventricular hemorrhage refers to blood breaking into the ventricular system. Common cerebral vascular hemorrhage diseases are mostly secondary to spontaneous cerebral hemorrhage, aneurysm or rupture of arteriovenous malformations. The incidence of secondary ventricular hemorrhage accounts for about 90.0 of the total incidence. %, And the case fatality rate is as high as 60.0% -90.0%.

Ventricular hemorrhage refers to blood breaking into the ventricular system. Common cerebral vascular hemorrhage diseases are mostly secondary to spontaneous cerebral hemorrhage, aneurysm or rupture of arteriovenous malformations. The incidence of secondary ventricular hemorrhage accounts for about 90.0 of the total incidence. %, And the case fatality rate is as high as 60.0% -90.0%.

Chinese name

Intraventricular hemorrhage

Foreign name

ventricular hemorrhage

Ventricular hemorrhage I. Causes and common diseases:

(1) Cause:

1. Vascular lesions cause bleeding such as moyamoya disease, cerebrovascular malformations, and carotid occlusive diseases.

2. Other causes of cerebral vascular rupture and bleeding, such as hypertensive cerebral hemorrhage, miliary aneurysm rupture and hemorrhage, brain trauma, intracranial tumor, leukemia, etc.

(B) common diseases:

Intracerebroventricular hemorrhage is a common clinical critical illness. The disease has rapid onset and rapid development. It is extremely prone to serious complications such as intracranial hypertension, cerebral vasospasm, or hydrocephalus. If patients fail to receive effective treatment in a timely manner, life safety can be seriously threatened.

Ventricular hemorrhage 2. Differential diagnosis:

(A) Hypertensive cerebral hemorrhage:

The patient has a significant history of hypertension and has a rapid onset, often reaching a peak in minutes or hours. Clinical manifestations are sudden severe headache, nausea, vomiting, and often accompanied by restlessness, lethargy or coma.

(B) Moyamoya ventricular hemorrhage:

It is more common in children and young people. It is mainly diagnosed by angiography. It is manifested by progressive stenosis and occlusion of bilateral internal carotid artery, middle cerebral artery and anterior cerebral artery. An abnormal smoky vascular network appears within.

(C) Rupture and bleeding of miliary aneurysms:

Before the onset, there were no special symptoms or paralysis of one eye muscle, migraine, etc. CT showed a slightly denser circular mass in the skull.

(D) Cerebrovascular malformations:

CT and MRI can show local irregular low-density areas, and cerebral angiography can see a bunch of irregular twisted blood vessel clusters.

Ventricular hemorrhage

(1) Physical examination:

1. Visual inspection for head trauma.

2. Blood pressure measurement Whether the blood pressure is significantly increased is necessary for the diagnosis of hypertensive cerebral hemorrhage.

(2) Laboratory inspection:

Laboratory tests such as blood routine and bone marrow tests can help diagnose leukemia.

(Three) imaging inspection:

1. Ultrasound and angiography can show vascular blood flow, blood flow resistance, blood flow velocity, etc .; Cerebral angiography can specifically understand the morphological changes of blood vessels, such as running, distribution, displacement, thickness and circulation time. Changes, such as the size, number, morphology, spasm, and bleeding of aneurysms, are important for diagnosing vascular lesions and intraventricular hemorrhage caused by aneurysms.

2. CT, MRI of the brain can find the location, scope, amount of bleeding, and edema of the brain tissue around the bleeding, showing whether there are tumors and vascular lesions in the skull.

Ventricular hemorrhage IV. Principles of treatment:

(1) Extraventricular drainage:

Drainage tubes need to be placed after puncture in this treatment method, but the effect of removing hematoma is not obvious, and the efficiency of removing hematoma is low. In addition, excessive hemorrhage will release chemicals, which can easily induce various kinds of brain tissue irritation and damage, which will affect the patient's postoperative recovery.

(B) Ventriculoscopy:

During surgery, it can effectively protect the ventricle wall and the posterior marginal veins of the foramen ventricle, and avoid damage to the ventricle of the ventricle due to the aspirator; when the surgeon enters the 3rd and 4th ventricles, the hypothalamus should be protected in a focused way; keep the flow out Tract, thereby avoiding artificially elevated intracranial pressure. After performing ventriculoscopy, the patient is placed with a drainage tube to improve the accuracy of the catheter placement and avoid or reduce the drainage tube obstruction; at the same time, remove most of the hematomas in the ventricle, reduce the drainage time, avoid or reduce intracranial infection and obstructive brain Water accumulation to improve the efficacy of surgery.

(3) Drainage from waist and large pond:

Early application of large waist drainage was safe and effective. It can effectively alleviate the lack of extraventricular drainage. It can quickly clear the blood of the third and fourth ventricles when combined with ventricular hemorrhage treatment. It can also reduce the damage of arachnoid granulosa cells by blood toxic products and reduce the incidence of traffic hydrocephalus. Incidence. The early application of the lumbar great pond not only can reduce the replacement of the extraventricular drainage tube, but also reduce the risk of patients undergoing cerebrospinal fluid bypass surgery in the future.