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النزف الدماغي CEREBRAL HEMORRHAGE


النزف الدماغي CEREBRAL HEMORRHAGE

المعلومة

If a focal neurologic deficit with altered mental status occurs within 24 hours of thrombolytic therapy, the event should be presumed to be an ICH until proven otherwise .

إذا حدثت أذية عصبية بؤرية مع تبدل الحالة الذهنية خلال 24 ساعة من المعالجة الحالة للخثار ؛ يجب الاشتباه بحدوث النزف الدماغي حتى يثبت العكس .

المرجع

Lippincott - Textbook of Cardiovascular Medicine, 2nd Edition (March 2002 )
dr.msh's picture
by
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وتأكيد التشخيص؟Eye-wink

dr.tabban's picture
dr.tabban


اول خطوة الCT

qusei


with or without contrast>>

dr.tabban's picture
dr.tabban


with

qusei


SAH النزف تحت العنكبوت
لعلاجها نتبع خطة ال 3H

مين الشاطر اللي حيقلنا شو هنن هال 3H?????

moonberg's picture
moonberg
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Quote:
with

بالعادة لتشخيص النزف مناخذ CT بدون حقن، لأن الدم مادة ظليلة بحد ذاته؟

DAM's picture
DAM

Dam you are right ,,absolutely with out contrast
SAH the golden 3H role is:
Hypertension ,,,you should keep BP above 160 mm\Hg and hypotension should be avoided . cuz it reduces ICP leading to further damage ,,

Hemodilution: it is a method to preclude vasospasm as much as possible,,,give pt Fluids,,plasma ,,albumin ,,dextran every thing that dilutes the blood is acceptable

the third H refers to hypervolemia which improves perfusion pressure and reduce blood viscosity
to acheive it , ht should be less than 45% by following the previous way: hypervolemic hemodilution(load pt with sufficient amount of fluids)

دمعة's picture
دمعة


you do CT scan WITHOUT contrast.

dr.tabban's picture
dr.tabban

Quote:
SAH the golden 3H role is:
Hypertension ,,,you should keep BP above 160 mm\Hg and hypotension should be avoided . cuz it reduces ICP leading to further damage ,,

Hemodilution: it is a method to preclude vasospasm as much as possible,,,give pt Fluids,,plasma ,,albumin ,,dextran every thing that dilutes the blood is acceptable

the third H refers to hypervolemia which improves perfusion pressure and reduce blood viscosity
to acheive it , ht should be less than 45% by following the previous way: hypervolemic hemodilution(load pt with sufficient amount of fluids)

great

ok u've said that we give the patient palsma fluids,to prevent vasospasm

ok we know that vasospasm the second common complication of SAH
so what the most common complication and when every complicatiom occur after the hemorrhage

moonberg's picture
moonberg
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Ok the first and the most important concern is rebleeding which occurs during next 2-3 weeks but its peak is after 48 hours so most physicians consider emergent intervention after performing angiography such as clipping of anurysm or coiling to prevent this devastating complication.
communicating hydrocephalus is another concern , it is due to decrease absorption of CSF ,it doesn`t warrant any surgical intervention except if it is severe and progressing ,then it will be indication for shunt ,,it occurs several weeks after SAH
vasospasm is very critical issue as long as it is accompanied with decreased perfusion and infarction,thus further damage to brain ensues .it occurs withen 4-10 days but the peak of its incidience is after 7 days. Virtually nemodipine is the drug of choice,it reduces vasospasm remarkably

دمعة's picture
دمعة


u r master dear Dam3a

moonberg's picture
moonberg
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Quote:
you do CT scan WITHOUT contrast

Embarrased Embarrased

qusei
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