avc hemoragic + cvt

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    Herniile cerebrale

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    Transtentoriala

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    Amigdaliana

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    Hemoragiile cerebrale

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    • 15% din bolile vasculare cerebrale

    • Def: suferinta cerebrala datorata efractiei

    unui vas - extravazarea sangelui in:

     – parenchimul cerebral hemoragie

    intraparenchimatoasa

     – extracerebral hemoragie subarahnoidiana

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    Hemoragia intraparenchimatoasa

    !hemoragia cerebrala" apoplexia#• $ 1% din A&'( 1)-15*1+

    • rata decese , 5%

    • actori de risc:

    • varsta peste 55 ani" sex .

    • consumul de alcool" droguri

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    actori de risc medicali

    • HTA

    • malformatii vasculare

    • amiloidoza cerebrala• iatrogen: antitrombotice" simpatomimetice

    • coagulopatii

    leucoze• tumori

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    Topografie

    • /rofunda: HTA - stresshemodinamic

     – ganglioni bazali

     – talamus

     –  punte

     – cerebel

    • 0obara:

    amiloidoza

    malformatii vasculare

    toxice !alcool#

    • ara predilectie:

    coagulopatiitumori

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    Diagnostic clinic

    • Debut brusc !in activitate#" agravare

     progresiva !ore#

    • cefalee intensa *- varsaturi

    • salt tensional !$ A&' ischemic#

    • alterarea starii constienta - coma

    • deficit neurologic focal coresp topografiei:

    hemiplegie" paralizii nn cranieni" tulb

    sensibilitate" coordonare

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    Diagnostic paraclinic

    • 'T urgenta * 23.

    • dg etiologic

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    'omplicatii

    • 3esangerare

    • edem cerebral

    • efractie ventriculara - hidrocefalie acutaobstructiva

    • 4fractie subarahnoidiana

    • complicatii generale: infectii" trombozevenoase" tulburari cardiace

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    Tratament

    •.edical: – factor &22a recombinat activat !ovo6even# -

    abandonat

     – antiedematoase

     – TA6 7 18 mmHg – trat etiologic !tulb coagulare#

    • 'hirurgical !*-#:

     – evacuare: superficiale" risc letal !dimens" poz#" tumori

     – drena9 ventricular 

     – decompresie !si in A&' ischemice#

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    Hemoragia subarahnoidiana

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    4tiologie

    • Anevrisme intracraniene !5%#

    • traumatisme

    •disectii arteriale

    • coagulopatii

    • vasculite

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    Diagnostic clinic

    • Debut brusc" agravare progresiva

    • salt tensional

    • 6indrom meningeal

     – cefalee" varsaturi" fotofobie

     – semne meningeale: redoare de ceafa" ;ernig"

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    6cala Hunt si Hess

    • 1+ Asimptomatic * usoara rigiditate ceafa

    • )+ /aralizii nn cranieni" redoare ceafa

    • =+ Deficit focal minor" somnolenta*confuzie

    • >+ Deficit focal moderat*sever" stupor"

    rigiditate decerebrata incipienta

    • 5+ 'oma profunda" rigiditate decerebrata

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    Diagnostic paraclinic

    • 'T

    •  punctie lombara

    • angiografie !2 ) h#

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    'omplicatii

    • 3esangerare - max z 1" 1>

    • Hidrocefalia normotensiva

    • vasospasm - z =-1( deficit focal !infarct#

    • hiponatremia - pierdere cerebrala de a

    • tulburari vegetative !cardiace:tulb ritm"

    conducere#

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    Tratament

    • 'hirurgical: ? 1-= sau $ 1>

     – Hunt si Hess 1-=

    • .edical: – blocanti ' 'a: nimodipina

     – Hiperhidratare !@# nou: discutabil

     – supliment a !corector# – controlul TA

     – antiedematoase" simptomatice !durereB#

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    6istemul venos

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    Tromboza venoasa cerebrala

    4tiologie

    • ocar infectios de vecinatate

    • Traumatism

    • 'oagulopatii

    • 2atrogen

    • 6arcina

    •  eoplazii

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    'linic

    • 'efalee

    • 6indrom meningeal

    • 'rize epileptice

    • 6emne neurologice de focar 

     – Ccluzie venoasa

     – 2nfarct venos

     – Transformare hemoragica

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    /araclinic

    • 't cerebralurgenta

    • .32 angio timpvenos

    • Angiografie

    • /rofil coagulare

    • ocarul infectios

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    Diagnostic diferential

    • .eningite" meningoencefalite

    • H6A

    • A&' ischemic * hemoragic

    • Tumori

    • Abcese

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    Tratament • Anticoagulant: heparina fractionata * standard• 'orticoterapie Ab• 6imptomatic: antialgic" antiepileptic• Tromboliza" trombectomie" decompresie

    • Anticoagulant cronic: – ara factori risc: =- l –  eprecizat: -1) l – Trombofilie: nedefinit

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    4volutie

    • orme usoare: remisiune

    spontana

    • orme medii: raspund laterapie" remisiune completa

    • orme severe: sinusuri

     profunde" infarcte masivehemoragice deces !1%#