bubble_chart Overview

Hypertensive intracerebral hemorrhage refers to the rupture and bleeding of small cerebral arteries due to long-term hypertension and arteriosclerosis, leading to pathological changes. Among various non-traumatic causes of cerebral hemorrhage, hypertension accounts for about 60%, making it one of the most severe complications of hypertension. It predominantly affects patients aged 50 to 60, with a slightly higher incidence in males than females. Clinically, it manifests as sudden headache, vertigo, vomiting, limb paralysis, aphasia, and even impaired consciousness. Conservative treatment is the primary approach, but surgical hematoma evacuation may be necessary for massive bleeding. Given its high disability and mortality rates and its common occurrence, this condition warrants significant attention.

bubble_chart Clinical Manifestations

1. Sudden headache or dizziness accompanied by vomiting;
2. Often accompanied by varying degrees of impaired consciousness;
3. Appearance of varying degrees of hemiplegia, or even aphasia;
4. Major incontinence of urine;
5. In cases with significant bleeding or brainstem involvement, symptoms such as unequal pupil size, deep and slow breathing, and decerebrate rigidity may also occur;
6. Blood pressure at the onset is significantly higher than usual;
7. The above symptoms and signs reach their peak within a few hours.

bubble_chart Diagnosis

1. Middle-aged or older, with a history of hypertension, onset often occurs during activity (e.g., agitation or exertion).
2. Sudden headache and dizziness are common initial symptoms, followed by vomiting, paralysis, impaired consciousness, spasms, urinary incontinence, etc.
3. Neck stiffness, elevated blood pressure, slow pulse, deep and slow breathing with snoring sounds, and late-stage [third stage] may present symptoms of circulatory and respiratory failure.
4. Different bleeding sites may result in varying localized neurological signs.
5. Increased cerebrospinal fluid pressure, containing red blood cells, with elevated protein levels.
6. Cerebral angiography reveals signs of space-occupying lesions.
7. CT scan or MRI: shows the bleeding site, extent, volume of hemorrhage, surrounding cerebral edema, and ventricular displacement.

bubble_chart Treatment Measures

1. Rest quietly in bed, closely monitor changes in consciousness, pupils, and vital signs, and maintain airway patency;
2. Dehydration to reduce intracranial pressure;
3. Control blood pressure: maintain at 20.0～21.3/12.0～13.3 KPa (150～160/90～100 mmHg) as appropriate;
4. Maintain water-electrolyte and acid-base balance;
5. Prevent complications such as pneumonia, urinary tract infections, gastrointestinal bleeding, and bedsores;
6. Ventricular or hematoma puncture and drainage;
7. Craniotomy for hematoma removal;
8. Appropriate use of hemostatic agents;
9. Application of cerebral cell activators.

The mortality and disability rates of hypertensive intracerebral hemorrhage during the acute phase are very high, and the efficacy depends on the bleeding site, volume of hemorrhage, extent of damage, overall condition, and presence of complications. To reduce the incidence, efforts should focus on prevention and active control of hypertension. It is essential to adhere to prescribed medication, maintain a low-salt and light diet, follow a reasonable daily routine, balance work and rest, avoid prolonged excessive stress and intense emotional fluctuations, quit smoking, and limit alcohol consumption. If a hypertensive patient suddenly experiences headache, dizziness, vomiting, hemiplegia, or aphasia, the possibility of cerebral hemorrhage should be considered, and the patient should be promptly sent to the hospital for appropriate examination and treatment.

bubble_chart Cure Criteria

1. Cured: Symptoms are basically disappeared, muscle strength of the paralyzed limb reaches grade IV or above, language function is restored, and basic self-care in daily life is achieved.
2. Improved: Symptoms are alleviated, muscle strength of the paralyzed limb increases by grade I to II, and partial self-care in daily life is achieved.
3. Not Cured: Symptoms show slight improvement, muscle strength of the paralyzed limb improves by less than grade I, language function is not restored, and self-care in daily life is not possible.