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    Curs 12 - AVC Hemoragic

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    Raluca Cernat
    The document discusses different types of cerebral hemorrhages, their causes and risk factors, symptoms, diagnosis, and treatment options. It covers intraparenchymal hemorrhage, subarachnoid hemorrhage, cerebral herniations, venous thrombosis, and provides details on diagnostic tests, complications, and medical and surgical treatment approaches for the different hemorrhage types.

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    Curs 12 - AVC Hemoragic

    Uploaded by

    Raluca Cernat
    46 views27 pages
    The document discusses different types of cerebral hemorrhages, their causes and risk factors, symptoms, diagnosis, and treatment options. It covers intraparenchymal hemorrhage, subarachnoid hemorrhage, cerebral herniations, venous thrombosis, and provides details on diagnostic tests, complications, and medical and surgical treatment approaches for the different hemorrhage types.

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    Curs 12- AVC hemoragic

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    The document discusses different types of cerebral hemorrhages, their causes and risk factors, symptoms, diagnosis, and treatment options. It covers intraparenchymal hemorrhage, subarachnoid hemorrhage, cerebral herniations, venous thrombosis, and provides details on diagnostic tests, complications, and medical and surgical treatment approaches for the different hemorrhage types.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    46 views27 pages

    Curs 12 - AVC Hemoragic

    Uploaded by

    Raluca Cernat
    The document discusses different types of cerebral hemorrhages, their causes and risk factors, symptoms, diagnosis, and treatment options. It covers intraparenchymal hemorrhage, subarachnoid hemorrhage, cerebral herniations, venous thrombosis, and provides details on diagnostic tests, complications, and medical and surgical treatment approaches for the different hemorrhage types.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 27

    Hemoragiile cerebrale

    • 15% din bolile vasculare cerebrale

    • Def: suferinta cerebrala datorata efractiei


    unui vas - extravazarea sangelui in:
    – parenchimul cerebral = hemoragie
    intraparenchimatoasa
    – extracerebral = hemoragie subarahnoidiana
    Hemoragia intraparenchimatoasa
    (hemoragia cerebrala, apoplexia)
    • > 10% din AVC; 12-15/100.000
    • rata decese ~ 50%

    • Factori de risc:
    • varsta peste 55 ani, sex M
    • consumul de alcool, droguri
    Factori de risc medicali
    • HTA
    • malformatii vasculare
    • amiloidoza cerebrala
    • iatrogen: antitrombotice, simpatomimetice
    • coagulopatii
    • leucoze
    • tumori
    Topografie
    • Profunda: HTA - • Lobara:
    stress hemodinamic
    amiloidoza
    – ganglioni bazali
    – talamus malformatii vasculare
    – punte toxice (alcool)
    – cerebel
    • Fara predilectie:
    coagulopatii
    tumori
    Diagnostic clinic
    • Debut brusc (in activitate), agravare progresiva
    (ore)
    • cefalee intensa +/- varsaturi
    • salt tensional (> AVC ischemic)
    • alterarea starii constienta - coma
    • deficit neurologic focal coresp topografiei:
    hemiplegie, paralizii nn cranieni, tulb
    sensibilitate, coordonare
    Diagnostic paraclinic
    • CT urgenta / IRM
    • dg etiologic
    Complicatii
    • Resangerare
    • efractie ventriculara - hidrocefalie acuta
    obstructiva
    • Efractie subarahnoidiana
    • edem cerebral

    • complicatii generale: infectii, tromboze


    venoase, tulburari cardiace
    Herniile cerebrale
    Transtentoriala
    Amigdaliana
    Tratament
    • Medical:
    – factor VIIa recombinat activat (NovoSeven) -
    abandonat
    – antiedematoase
    – TAS < 180 mmHg
    – trat etiologic (tulb coagulare)
    • Chirurgical (+/-):
    – evacuare: superficiale, risc letal (dimens, poz), tumori
    – drenaj ventricular
    – decompresie (si in AVC ischemice)
    Hemoragia subarahnoidiana
    Etiologie

    • Anevrisme intracraniene (75%)


    • traumatisme
    • disectii arteriale
    • coagulopatii
    • vasculite
    Diagnostic clinic
    • Debut brusc, agravare progresiva
    • salt tensional
    • Sindrom meningeal
    – cefalee, varsaturi, fotofobie
    – semne meningeale: redoare de ceafa, Kernig,
    Brudzinschi
    • alterarea starii de constienta
    • semne neurologice de focar
    Scala Hunt si Hess
    • 1. Asimptomatic / usoara rigiditate ceafa
    • 2. Paralizii nn cranieni, redoare ceafa
    • 3. Deficit focal minor, somnolenta/confuzie
    • 4. Deficit focal moderat/sever, stupor,
    rigiditate decerebrata incipienta
    • 5. Coma profunda, rigiditate decerebrata
    Diagnostic paraclinic

    • CT
    • punctie lombara
    • angiografie (I 72 h)
    Complicatii
    • Resangerare - max z 1, 14
    • Hidrocefalia normotensiva
    • vasospasm - z 3-10 => deficit focal (infarct)
    • hiponatremia - pierdere cerebrala de Na
    • tulburari vegetative (cardiace:tulb ritm,
    conducere)
    Tratament
    • Chirurgical: Z 1-3 sau > 14
    – Hunt si Hess 1-3
    • Medical:
    – Preventia vasospasm:
    • blocanti C Ca: nimodipina
    • Hiperhidratare (?) – nou: discutabil
    – supliment Na (corector)
    – controlul TA
    – antiedematoase, simptomatice (durere!)
    Sistemul venos
    Tromboza venoasa cerebrala
    Etiologie
    • Focar infectios de vecinatate
    • Traumatism
    • Coagulopatii
    • Iatrogen
    • Sarcina
    • Neoplazii
    Clinic
    • Cefalee
    • Sindrom meningeal
    • Crize epileptice
    • Semne neurologice de focar
    – Ocluzie venoasa
    – Infarct venos
    – Transformare hemoragica
    Paraclinic
    • Ct cerebral
    urgenta
    • MRI – angio timp
    venos
    • Angiografie

    • Profil coagulare
    • Focarul infectios
    Diagnostic diferential
    • Meningite, meningoencefalite
    • HSA
    • AVC ischemic / hemoragic

    • Tumori
    • Abcese
    Tratament

    • Anticoagulant:
    heparina fractionata ->
    standard
    • Corticoterapie + Ab
    • Simptomatic:
    antialgic, antiepileptic
    • Tromboliza,
    trombectomie,
    decompresie

    • Anticoagulant cronic:
    – Fara factori risc: 3-6
    l
    – Neprecizat: 6-12 l
    – Trombofilie:
    nedefinit
    Evolutie
    • Forme usoare: remisiune
    spontana
    • Forme medii: raspund la
    terapie, remisiune completa
    • Forme severe: sinusuri
    profunde, infarcte masive
    hemoragice – deces (10%)

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