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are divided into acute phase treatment, recovery phase treatment, surgical indications

(1) acute phase

three purposes: save the patient's life; reduce disability; prevent recurrence.

four principles:

(1) Keep quiet to prevent continued bleeding;

(2) Reduce cerebral edema and reduce intracranial pressure;

(3) Adjust blood pressure to prevent continued bleeding;

(4) Strengthen care to prevent and treat complications.

(2) Recovery period treatment

As long as the vital signs are stable, rehabilitation treatment should be carried out early

Within 3 months, sports exercises, language training and other rehabilitation treatments for paralyzed limbs should be carried out to promote functional recovery.

* Active treatment of hypertension is an effective means to prevent recurrence of cerebral hemorrhage (Level I recommendation, Level B evidence)

The recommended blood pressure control target is 140/90 mmHg (Level II recommendation, Level B evidence)

(3) Indications for surgery

1. Basal ganglia bleeding

For moderate amounts of bleeding (putamen bleeding ≥ 30 ml, thalamic bleeding ≥ 15 ml), minimally invasive puncture hematoma removal or small bone window hematoma removal can be selected at the appropriate time to remove the blood in a timely manner.

Patients with massive bleeding or cerebral herniation often need surgical craniectomy, decompression and hematoma removal to save their lives.

2, Cerebellar hemorrhage, easy to form cerebral herniation

The bleeding volume is ≥10ml, or the diameter is ≥3cm, or it is combined with hydrocephalus, and surgical treatment should be performed as soon as possible.

3. Lobar hemorrhage

Elderly patients often suffer from amyloid angiopathy bleeding. Unless the hematoma is life-threatening or is caused by vascular malformation and requires surgical treatment, most patients receive conservative medical treatment.

4, Intraventricular hemorrhage

Mild partial intraventricular hemorrhage can be treated conservatively by internal medicine;

Severe total intraventricular hemorrhage (ventricular cast) requires intraventricular puncture and drainage plus lumbar puncture fluid drainage.

The three important predictors of prognosis of cerebral hemorrhage are the size of the hematoma, the location of the bleeding, and the patient's state of consciousness at the time of admission (GCS score)

1) Those with large amounts of bleeding and poor general condition have a high mortality rate. Hematomas with a maximum diameter greater than 3cm have a higher mortality rate.

2) The case fatality rate of brainstem hemorrhage is 70%, cerebral hemisphere hemorrhage is about 20%, and the overall case fatality rate is 30-40%.

3) The disability rate of survivors reaches 70%

Reference:

1. Compiled by Wang Yongjun, 2010 "Caplan Stroke" Clinical Practice. 4th Edition

2. Dingxiangyuan website, Department of Neurology, Liuzhou Hospital of Traditional Chinese Medicine, An Hongwei, "Brain" Blood vessel positioning diagnosis and medical record analysis PPT"

3. Wu Jiang, " Neurology " People's Medical Publishing House, third edition

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