出血性卒中

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Part two
Case analysis
Intracerebral hemorrhage(ICH)
Synonyms alternative names
Brain hemorrhage Cerebral hemorrhage Cerebral parenchymal hemorrhage Intracranial hemorrhage Intracerebral hemorrhage(ICH)
History of Present Illness-2
She had poor appetite and fatigue since she was sick. Only liquid diet was taken after illness. There was no dysipsia . Bowel movement and urination were normal.
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Neuro-imaging
• CT shows: hemorrhage from left putaminal involves internal capsule, rupture into ventricle and sulcus lateralis.(左壳核出血累及内囊，破入脑室和外侧裂) MRI suggests: hemorrhage from left basal ganglia involves lateral cleft. DSA reveals: Moyamoya disease.
Localizition-L.putamen
Right limbs paralysis+pathologic reflexes suggests lesion involved L. corticospinal tract; Right central facial+tongue paralysis revealed L corticonuclear tract; Deficit sensation at R. face and R. limbs means lesions also damage L. thalamic radiation pathway; CT,MRI support the clinical analysis Based on above information, localizition of hemorrhage is clearly comfirmed .
History of Present Illness-1
Mrs. Zhou had right-limb weakness abruptly on her way home 13 days prior. Then she was unable to stand up and hold something by right hand, with disturbance of speech at same moment. Moreover, she still felt mild dizziness concurrently. She denied headache, nausea nor vomiting. Limb convulsive seizure and loss of consciousness were not found during the course. There was no urinary or fecal incontinence as well. She was sent to Han Dan Hospital by her mates immediately. The CT scan showed intracerebral hemorrhage and her blood pressure at that time rose to 165/90 mmHg.
Mental state: Alert, oriented; intact intelligence. Speech: alalia. Cranial nerves:
– Ⅱ(optic nerve)----Pupils are equal and react to light normally. – Ⅲ, Ⅳ, Ⅵ(oculogyric nerve)----No strabismus. EOM(extraocular movement) normal. No nystagmus. – Ⅴ(trigeminal nerve)----Pinprick of right-side absent.
N.S physical exam-3
Motor:
– R: 0 muscle power, elevated tone, hyperactive reflex. Hoffmann’s positive. Babinski’s sign positive. – L: Normal.
Sensory:
Medical record
Mrs. Zhou, married, female, age 37, nurse, was admitted on April 13, 2001 with a chief complaint of sudden right-limb weakness and slurred speech for 13 days.
History of Present Illness-3
On physical examination, she was alert but aphasia; the muscle power of right-limb was 0 and Babinski’s sign on both sides was positive. There was also numbness(hemihypoesthesia) on rightside. Then she was put on dehydrating agent, hemostatic, multiple vitamins and so on. The patient was on state of over-drowsy for three days until she revived. Then the disturbance of speech had somewhat improved but still slurred. And furthermore, paralysis of right-limb didn’t improve apparently. She was transferred to our hospital on April 13, 2001 to receive further diagnosis and treatment.
N.S physical exam-2
Ⅶ(facial nerve)----Facial paralysis on right-side. Ⅷ(auditory nerve)----Hearing normal. Ⅸ, Ⅹ(glossopharygeal and pneumogastric nerve)-Uvula elevates symmetrically. Ⅺ(accessory nerve)----Trapezius, sternomastoid normal. Ⅻ(ligual nerve)----Tongue protrudes right. No atrophy nor tremor.
– R: Disturbance sensation.(including pinprick, touch and vibration) – L: Normal.
N.S physical exam-4
Cerebellar: Gait, finger-nose, heel-knee and Romberg incompatible due to paralysis. Menigeal irritation: negative. Palm-chin reflex and positive on right-side. sucking refles:
Hemorrhagic Stroke
Case Discuss May 9,2001
Part Part Part Part
1---case report 2---case analysis 3---related info 4---anatomy review
Part one
Case report
Some helpful words
CVD;cerebrovascular disease CVA;cerebrovascular accident Brain attack=stroke SAH:subarachnoid hemorrhage ICH:intracerebral hemorrhage AVM:arteriovenous malformation CT:computed tomography MRI;magnetic resonance imaging MRA:magnetic resonance angiography DSA:digital subtraction angiography
Lab test
CBC: WBC↑, neutrophils↑, Hemoglobin ↓ Urine and stool analysis（-） ESR: ↑ Lipid profile shows: TG↑,LDL↑,HDL↓ Etiological examination: Leptospira-Ab（钩端 螺旋体） and toxoplasmatic Ab（弓形体）（-） Immunologic test: Nothing special. Ultrasound : Nothing special.
Past medical history
Occasionally hypertension after exertion, usually 135/90-95 mmHg. Her blood pressure rose to 165/90 mmHg for several times after sick. Deny the history of cardiopathy, diabetes mellitus or stroke. Suffered from miliary tuberculosis of lung at the age of 15. Allergic history for drugs include cephalexia, ciproflexin and aglumin ethamsylate.
Personal history/ Family history
Deny smoking and drinking. Mild charater. Married with a child.
Has a family history of stroke(mother and father).
N.S physical exam-1
Diagnosis—ICH (intracerebral hemorrhage)
Abruptly onset, symptoms progress over minutes,deteriorated rapidly; Focal NS deficit, with progressive decrease in level of consciousness BP elevated after attack; CT,MRI showed high density signal at the site of putamen, involved internal capsule and subarachnoid space, ventricular system ICH is confirmed based on above info.