Autumn and winter alternate, and it is the high incidence of cerebral hemorrhage. The emergency departments of the First Affiliated Hospital of Zhejiang University School of Medicine will receive patients with cerebral hemorrhage almost every day, and neurosurgery operations are non-stop, and cerebral vascular rupture and bleeding can kill people every second. Among them, the brainstem hemorrhage in the life center is the most dangerous, and some people describe "surgery must be paralyzed" and "either dead or disabled". It is precisely because of this that experts from the Department of Neurosurgery of the First Hospital of Zhejiang University traveled thousands of miles to Haixi Prefecture, Qinghai, to overcome the minimally invasive altitude sickness and remove the "ticking time bomb" in the brain of a 37-year-old female patient, bringing about the miracle of life.
"Thank you for your timely treatment, so that my lover out of danger of life, please accept our family's heartfelt thanks to you... Words cannot describe our gratitude! The husband of the patient Damei (pseudonym) said excitedly in the face of Chen Shuifang, president of Haixi Prefecture People's Hospital, deputy chief physician of Battle, and the team of cerebrovascular intervention experts in the department of neurosurgery of Zhejiang University First Hospital who came to see him after the operation.
The "culprit" of the sudden brainstem hemorrhage of a 37-year-old female patient in Haixi is a deformed blood vessel that explodes at any time in the brain
On National Day 2021, the temperature in Haixi Mongol and Tibetan Autonomous Prefecture in Qinghai Province has hovered around 0 °C. In Delingha, 2,200 kilometers away from Hangzhou, 37-year-old Damei couldn't help but have a headache and came to Haixi Prefecture People's Hospital for treatment accompanied by her husband. Previously, intermittent headaches have tormented her for more than ten years, whenever the temperature drops, headaches will always suddenly visit without warning, but she has always chosen to "carry", "where the pain is held down with your fingers, or go to sleep", but recently the frequency of headache attacks is getting higher and higher, the duration is getting longer and longer, and this time it is also accompanied by numbness and weakness in the left hand.
After the head CT examination, the deputy chief physician of Battle found that there was a very dangerous brainstem hemorrhage in Damei, for young patients without a history of hypertension, he immediately thought of the possibility of cerebrovascular disease, so he quickly carried out a skull MR examination, found that there was a suspicious abnormal cerebrovascular shadow around the brainstem hemorrhage, and initially determined the previous speculation.
However, there are many types of cerebrovascular diseases, diverse forms, skull MR still can not be further diagnosed, the "gold standard" for diagnosing cerebrovascular diseases is the whole cerebral angiography (DSA), Haixi Zhou People's Hospital has previously had the hardware facilities and staffing for this special examination. Deputy Chief Physician Battle mastered the whole cerebral angiography technique in the First Hospital of Zhejiang University 2 years ago. Therefore, he then led the local team of Haixi Prefecture People's Hospital to successfully carry out a whole cerebral angiography for Damei, and found that the cerebellar curtain area of Damei was close to the brainstem, and there was a cerebrovascular malformation with a diameter of about 1 cm and twisted like an earthworm.
Preoperative DSA imaging
Cerebrovascular malformations are a congenital cerebrovascular disease, and cerebral hemorrhage is the most common manifestation of cerebrovascular disease. Cerebrovascular malformations that have already had bleeding are at risk of rupture again at any time. The walnut-sized brainstem is the center of life, controlling the most basic functions of the human body such as breathing, heartbeat, and body temperature. Brainstem hemorrhage is one of the most dangerous types of intracerebral hemorrhage, usually, even 2 to 3 ml of brainstem hemorrhage can cause serious consequences, once the amount of bleeding exceeds 5 ml, the mortality rate is as high as 70%. Damei's life is in danger, but she can't transport long distances. Moreover, the treatment of cerebrovascular malformations around the brainstem is extremely complex and the risk is extremely high, and dr. Battle has no bottom in his heart on how to successfully "defuse" the bomb and save the lives of patients.
There is no minor operation in neurosurgery, and it can not stand the waiting, Zhejiang Aid Qing expert, president of Qinghai Haixizhou People's Hospital, chief physician of the Department of Respiratory Medicine of Zhejiang University First Hospital Chen Shuifang after learning about Damei's condition, the first time to get in touch with the Department of Neurosurgery of Zhejiang University First Hospital.
As early as one year ago, in September 2020, HaixiZhou People's Hospital has established a neurosurgery workstation of Haixi Zhou People's Hospital, Professor Zhan Renya of the First Hospital of Zhejiang University, focusing on building an academic exchange and talent training platform between the Department of Neurosurgery of zhejiang University First Hospital and the Emergency Department of Haixi Zhou People's Hospital, and comprehensively improving the trauma treatment capacity and diagnosis and treatment level of nervous system diseases in Haixi Prefecture.
Thousands of miles to help! Experts "one needle" to cure the cerebral vascular malformations
"Delhi has patients in need of treatment!" Dean Chen Shuifang's call for help thousands of miles away has been highly valued by Professor Zhan Renya, director of the Department of Neurosurgery of the First Hospital of Zhejiang University, and the whole department. After a detailed understanding of Damei's condition, Professor Zhan Renya believes that the patient's cerebrovascular malformation is large, the lesion is located in the large vein area of the brain, adjacent to the brainstem, the location of the deep craniotomy is not easy to expose, not suitable for craniotomy, and the cerebrovascular intervention with less trauma is the preferred treatment method. Professor Zhan Renya immediately assigned Pan Jianwei, chief physician of undergraduate neurointerventional experts, and Yan Min, attending physician, to delingha to treat patients.
Chief Physician Pan Jianwei and Attending Physician of Yan Min
In the face of the neurosurgery experts of the First Hospital of Zhejiang University who came from afar, the patients and their families cried with joy and expressed unconditional trust. On October 17, Chief Physician Pan Jianwei, Attending Physician Yan Min and Deputy Chief Physician Battle, who had overcome altitude sickness, successfully performed "complex cerebrovascular malformation embolization" for Damei at HaixiZhou People's Hospital. At this time, Damei not only has a brainstem hemorrhage, the vascular malformation mass of the brain is composed of a large number of small arteriovenous fistulas, arterial blood directly into the vein, and the tortuous and dilated vein is very easy to rupture and bleed again under the impact of the arterial blood flow, forming a hematoma in the brain that is life-threatening, and surgery is imminent.
The expert team penetrated the femoral artery at the root of the thigh of The big plum into the thick catheter of the refill, and then under the guidance of the X-ray of the cerebral angiography machine, the microcatheter with a thin hair of more than one meter long was carefully sent to the site of cerebrovascular malformation through the blood vessel, because the vascular malformation is located in the deep part of the brain, the blood supply artery is twisted and slender, the angle is sharp, and the operation is extremely difficult, but the expert team is careful and careful, perseverance, after more than 5 hours of intense surgery, the cerebrovascular malformation is finally completely embolized. After the operation, Damei's malformed clumps of brain disappeared and recovered well.
Chief Physician Pan Jianwei introduced that cerebrovascular intervention is one of the most advanced diagnostic and treatment methods for cerebrovascular diseases in the field of medicine, with small trauma and fast recovery, with the continuous advancement of equipment, materials and technology, more and more cerebrovascular diseases can be diagnosed and treated through cerebrovascular intervention. But at the same time, cerebrovascular intervention requires the surgeon's skills, mental strength, brain power and physical strength. After more than ten years of development, the neurosurgery intervention team of the First Hospital of Zhejiang University has become the leading and national first-class neurointerventional team in Zhejiang Province.
Under the leadership of Professor Zhan Renya, the neurosurgery team of the First Hospital of Zhejiang University is now one of the largest, most complete subspecialties and the highest medical technology in Zhejiang Province. Relying on advanced equipment, the department strengthens the concept of minimally invasive, improves the efficacy of surgery, reduces the disability rate and mortality rate of surgery, and improves the prognosis and function of patients.
The weather turned cold, and I was wary of cerebral hemorrhages coming to the door
Professor Zhan Renya especially reminded everyone that the weather turns cold, it is the peak of cerebrovascular accidents, once the cerebral hemorrhage occurs, there are many characteristics such as urgency and rapid progression, and patients often have limb hemiplegia, speech dysfunction, mental and cognitive impairment, etc., and may even endanger life.
People in the workplace stay up late all year round, irregular work and rest, work pressure, lack of exercise, unbalanced diet and other reasons, resulting in cerebral hemorrhage more and more preference for young people in the workplace. 50% of these patients will have some prodromal manifestations with more or less warning signs in the early stage of onset, so once the following abnormal signals appear, it is necessary to be vigilant:
Abnormal signals before cerebral hemorrhage: 1. Severe headache
Headache (head-exploding) is the first symptom of cerebral hemorrhage, often located on the head on the bleeding side. When there is increased intracranial pressure, the pain can progress throughout the head. Dizziness is often associated with headache, especially in the cerebellum and brainstem hemorrhage, and is accompanied by nausea, vomiting and other symptoms.
2 Speech is unclear
Stiff tongue roots, swollen tongue, slurred speech, and difficulty speaking are among the most common early signs of intracerebral hemorrhage, and you should seek medical attention as soon as they appear.
3 Body paralysis
Suddenly feel numb, weak, inconvenient movement on one side of the body, hand objects fall, mouth crooked, salivating, walking unsteadily. Patients with severe cerebral hemorrhage will also have symptoms of numbness throughout the body, and when the disease occurs, the body cannot move for a while, resulting in the patient being unable to complete the movement normally, and there is a certain relief after a short rest.
4 Blurred vision
Temporarily invisible, unclear, or ghostly in the eye, it can return to normal on its own, or blindness may occur. In addition, a very small number of patients with cerebral hemorrhage may also have eye swelling and other conditions.
5 Confusion
Some will show drowsiness, poor response, confusion, and impaired consciousness, while some of the more severe patients will experience confusion or even coma within minutes of the onset of illness.
For all patients with cerebral hemorrhage, "time is the brain" and "time is life", the longer the cerebral hemorrhage time, the greater the damage to brain function, and should be professionally diagnosed and treated in a regular hospital at the first time, especially cerebrovascular hemorrhage caused by cerebrovascular diseases, which requires rapid diagnosis and treatment by a professional team of cerebrovascular experts. If the patient has fainted or has limited mobility, the emergency call 120 should be called urgently, do not shake the patient's body, keep the patient breathing unobstructed is the first aid point.
Author: Liu Haibo Jiang Chen Yeke
Editor: Fu Xinxin