Coma followed by fever is common in

First the patient falls into a coma, then develops a fever, which is most likely because he suffers from cerebral hemorrhage. Cerebral hemorrhage is a relatively dangerous disease for patients. If not treated in time, it may even have a certain impact on the patient's life safety and cause the patient to enter a vegetative state. Below we will introduce the causes, clinical manifestations and treatments of cerebral hemorrhage.

1. Causes

Common causes are hypertension combined with arteriosclerosis, microaneurysms or microvascular aneurysms. Others include cerebral vascular malformations, meningeal arteriovenous malformations, amyloid angiopathy, cystic hemangiomas, intracranial venous thrombosis, specific arteritis, fungal arteritis, moyamoya disease and arterial anatomical variations, vasculitis, and tumor stroke.

In addition, blood factors include anticoagulation, antiplatelet or thrombolytic therapy, Haemophilus infection, leukemia, thrombotic thrombocytopenia, intracranial tumors, alcohol poisoning and sympathetic nerve stimulant drugs.

The triggering factors include overexertion, climate change, bad habits (smoking, alcoholism, excessive salt intake, being overweight), blood pressure fluctuations, emotional excitement, and excessive fatigue.

2. Clinical manifestations

1. Movement and language disorders

The most common movement disorder is hemiplegia; the most common speech disorder is aphasia and slurred speech.

2. Vomiting

About half of the patients experience vomiting, which may be related to increased intracranial pressure, vertigo, and irritation of the meninges by blood during cerebral hemorrhage.

3. Impairment of consciousness

It manifests as drowsiness or coma, the degree of which is related to the location, amount and speed of cerebral hemorrhage. Large amounts of bleeding in deep parts of the brain within a short period of time will most likely result in impaired consciousness.

4. Eye symptoms

Anisocoria often occurs in patients with increased intracranial pressure and brain herniation; hemianopsia and eye movement disorders may also occur. During the acute phase of cerebral hemorrhage, patients often stare at the bleeding side of the brain (gaze palsy).

5. Headache and dizziness

Headache is the first symptom of cerebral hemorrhage, often located on the side of the head with bleeding; when there is increased intracranial pressure, the pain can spread to the entire head. Dizziness often accompanies headache, especially when bleeding occurs in the cerebellum or brain stem.

Treatment

1. Generally, you should rest in bed for 2 to 4 weeks, keep quiet, and avoid emotional excitement and high blood pressure. Closely observe vital signs such as temperature, pulse, respiration and blood pressure, and pay attention to pupil changes and changes in consciousness.

2. Keep the airway open and clear respiratory secretions or inhaled materials. If necessary, perform tracheal intubation or endotracheal intubation in a timely manner; patients with impaired consciousness or gastrointestinal bleeding should fast for 24 to 48 hours, and the gastric contents should be emptied if necessary.

3. Water, electrolyte balance and nutrition. The daily fluid intake can be calculated as urine volume + 500 ml. If there is high fever, sweating, or vomiting, maintain the central venous pressure at 5-12 mmHg. Pay attention to prevent water and electrolyte disorders to avoid aggravating cerebral edema. Supplement sodium, potassium, carbohydrates and calories daily, and give fat emulsion injection (fat emulsion), human serum albumin, amino acids or energy mixtures when necessary.

4. Adjust blood sugar. If blood sugar is too high or too low, it should be corrected in time to maintain the blood sugar level between 6 and 9 mmol/L.

5. For those with obvious headaches and excessive irritability, sedatives and analgesics may be given as appropriate; for those with constipation, laxatives may be used.