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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 stress hemodinamic
ganglioni bazali talamus punte cerebel

Lobara: amiloidoza malformatii vasculare toxice (alcool) 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 edem cerebral efractie ventriculara - hidrocefalie acuta obstructiva complicatii generale: infectii, tromboze venoase, tulburari cardiace

Tratament
Medical:
factor VIIa recombinat activat (NovoSeven) antiedematoase TAS < 180 mmHg trat etiologic (tulb coagulare)

Chirurgical (+/-):
evacuare: superficiale, risc letal (dimens, poz), tumori drenaj ventricular decompresie (si in AVC ischemice)

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