小结
定义
病史和体格检查
关键诊断因素
- 面部、上肢或下肢单侧无力或瘫痪
- 感觉缺失（麻木）
- 言语障碍
- 构音障碍
- 视觉障碍
- 畏光
- 头痛
- 共济失调
- 危险因素
其他诊断因素
- 眩晕
- 恶心/呕吐
- 意识水平下降/昏迷
- 意识模糊
- 凝视麻痹
危险因素
- 高血压
- 老年
- 男性
- 亚裔、黑人和/或拉丁裔/西班牙裔
- 酗酒
- 滥用拟交感神经药物
- 脑出血家族史
- 血友病
- 脑血管淀粉样变性
- 镰状细胞病
- COL4A1 基因常染色体显性突变
- 遗传性出血性毛细血管扩张症
- KRIT1 基因、CCM2 基因或 PDCD10 基因发生常染色体显性突变
- 抗凝治疗
- 血管畸形
- 烟雾病
- 妊娠
- 吸烟
- 非甾体抗炎药 (non-steroidal anti-inflammatories, NSAIDs)
- 阻塞性睡眠呼吸暂停
- 糖尿病
- 拟交感神经药物
- 脑血管炎
- 血小板减少
- 白血病
诊断性检查
首要检查
- 头颅 CT 平扫
- 血清葡萄糖
- 血清电解质
- 血清尿素和肌酐
- 肝功能检测
- 全血细胞计数 (FBC）
- 凝血筛查
- 心电图（ECG）
需考虑的检查
- 血清毒理学筛查
- 头部 CT 血管造影（CTA）或磁共振血管成像（MRA）
- 头部 CT 血管造影或磁共振静脉成像
- 动脉内脑血管造影术
治疗流程
疑似脑出血
确诊的脑出血
撰稿人
专家顾问
Matthew Jones, MD, FRCP
Consultant Neurologist
Manchester Centre for Clinical Neurosciences
Northern Care Alliance
Honorary Senior Lecturer
University of Manchester
Manchester
UK
利益声明
MJ is the chair of the Association of British Neurologists Education Committee (unpaid position). MJ is a faculty member of an MRCP revision course.
Acknowledgements
BMJ Best Practice would like to gratefully acknowledge the previous expert contributors, whose work has been retained in parts of the content:
Fernando D. Goldenberg, MD
Clinical Associate of Neurology
Medical Director, Neuroscience ICU
Director, Neurocritical Care Education
Co-Director, Stroke Center
University of Chicago
Chicago
IL
Raisa C. Martinez, MD
Neurocritical Care Fellow
Department of Neurology
University of Chicago
Chicago
IL
利益声明
FDG and RCM declare that they have no competing interests.
同行评议者
David Werring, FRCP, PhD, FESO
Professor of Clinical Neurology
Head of Research Department, Brain Repair and Rehabilitation
UCL Institute of Neurology
Honorary Consultant Neurologist
National Hospital for Neurology and Neurosurgery
University College Hospitals NHS Foundation Trust
North Thames Clinical Research Specialty Lead for Stroke
NIHR Clinical Research Network
London
UK
利益声明
DW has received honoraria (speaking) from Bayer 2016, 2017, 2018 (talks or debates on intracerebral haemorrhage, atrial fibrillation, dementia) and honoraria (chairing) from Portola and Bayer 2019. DW has received consultancy fees from Bayer (2017; embolic stroke of undetermined source), JFB consulting (2018; PCSK9 inhibitors in stroke), Alnylam (2019; cerebral amyloid angiopathy), Portola (2019, 2020; andexanet alpha). JW was UCL Principle Investigator for NIHR clinical trials NAVIGATE-ESUS (Bayer, 2016-19), B2341002 (Pfizer 2014-2016), Action-2 (Biogen, 2016-19); Chief Investigator for OPTIMAS; steering committee and co-investigator for RESTART, TICH-2.
编辑
Helena Delgado-Cohen
Section Editor, BMJ Best Practice
利益声明
HDC declares that she has no competing interests.
Tannaz Aliabadi-Oglesby
Lead Section Editor, BMJ Best Practice
利益声明
TAO declares that she has no competing interests.
Julie Costello
Comorbidities Editor, BMJ Best Practice
利益声明
JC declares that she has no competing interests.
Adam Mitchell
Drug Editor, BMJ Best Practice
利益声明
AM declares that he has no competing interests.
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