Clinical differentiation of large-scale cerebral infarction from cerebral hemorrhage
Large-scale cerebral infarction refers to the ischemic infarction of most of the brain tissue in the cerebral hemisphere caused by complete occlusion of the internal carotid artery or the main trunk of the middle cerebral artery, which is clinically manifested as a sudden coma with severe neurological localized signs, which should be distinguished from cerebral hemorrhage.
Severe impairment of consciousness, which occurs immediately from a large-scale cerebral infarction, is initially neither caused by increased intracranial pressure nor necessarily entirely the result of irreversible impairment of brain function, but is mostly due to a transient disorder of brain function caused by extraordinary stimulation. Therefore, if properly handled, or the side branch circulation is open, consciousness and vital signs may stabilize or have a certain degree of relief in a short period of time.
However, if there is a large amount of intraparenchymal hemorrhage, its coma and instability of vital signs (such as breathing, arrhythmia, etc.) are caused by acute increased intracranial pressure, and most of them are initially accompanied by a significant increase in blood pressure (if there is a tendency to decrease blood pressure, it is a manifestation of extremely severe disease).
This reflex increase in blood pressure is caused by a sudden increase in intracranial pressure, because the pressure in the chest cavity suddenly increases significantly, the original blood pressure is not enough to maintain normal brain perfusion, so the blood pressure center of the brainstem reflexly raises blood pressure, which can increase the intrahythalmic pressure to maintain sufficient cerebral blood flow, which belongs to a pathophysiological mechanism. At this time, if a mannitol is given immediately to lower blood pressure, blood pressure will drop, and without the need for blood pressure lowering drugs, vital signs will tend to be stable. But if it is a large-scale cerebral infarction, it will not be
There is this effect, and even more serious disease. Acute intracranial pressure increase due to massive intraparenchymal hemorrhage is accompanied by vomiting at the onset of the disease, while large-scale cerebral infarction does not necessarily have vomiting, especially in the early stages. Bleeding from one side of the cerebral hemisphere, hippocampus rapidly develops, and the pupils are dilated. This does not occur in the early stage of large-scale cerebral infarction, often in large pieces of brain tissue ischemia, softening leads to severe cerebral edema when the mass effect leads to hippocampal hernia, so large-scale cerebral infarction often has a slower process than the mass effect of cerebral hemorrhage. #大有学问 #
