Which department should I go to for cerebral hemorrhage

Cerebral hemorrhage is a neurological emergency that requires an immediate and clear diagnosis within a short period of time. Currently, auxiliary treatments are mainly divided into several types. With the gradual improvement of the current medical level, imaging examinations have gradually developed into various brain tests because of their advantages such as short time, non-invasive and accurate results. For example, head CT, cerebrospinal fluid examination, etc., which are all helpful to us.

Disease diagnosis

Testing

Cerebral hemorrhage is a neurological emergency that requires an immediate diagnosis within a short period of time. Currently, auxiliary examinations are mainly divided into laboratory examinations and imaging examinations. With the gradual improvement of current medical standards, imaging examinations have gradually become the preferred examination method because of their advantages such as short time, non-invasiveness, and accurate results.

(1) CT scan of the head: CT scan is the first choice for clinical suspected cerebral hemorrhage. It can show a round or oval uniform high-density hematoma. It can show a fresh hematoma with clear boundaries after the onset of the disease. It can also determine the location, size, shape of the hematoma, whether it has broken into the ventricle, the edema band around the hematoma, and the space-occupying effect. If there is a large amount of blood accumulation in the ventricle, a high-density cast can be seen, and the ventricle can be dilated. After 1 week, a ring-shaped enhancement can be seen around the hematoma. After the hematoma is absorbed, it becomes low-density or cystic. Dynamic CT observation can reveal the pathological evolution of cerebral hemorrhage and guide clinical treatment as soon as possible when the condition changes during the treatment of the disease. Currently, head CT has become a more widely used examination method.

(2) MRI examination: It can detect small amounts of brainstem or cerebellum hemorrhage that CT cannot identify, distinguish cerebral hemorrhage that CT cannot identify after 4 to 5 weeks of disease, distinguish old cerebral hemorrhage from cerebral infarction, show vascular malformation and voiding, and roughly determine the duration of bleeding and whether the bleeding is repeated. However, MRI examination requires the patient to lie still in the scanner for a long time (more than 10 minutes), which is difficult to do for patients with impaired consciousness. It is generally not as widely used as CT examination.

(3) DSA whole brain angiography: Cerebral angiography was once the main diagnostic method for cerebral hemorrhage. However, it cannot show the hematoma itself and can only infer the location and size of the hematoma based on the displacement of related blood vessels around the hematoma. In addition, DSA examination is an invasive examination and its first-line application has been significantly reduced. It is worth mentioning that DSA is still of great significance in identifying the causes of cerebral hemorrhage, because it can intuitively see the shape and morphology of cerebral blood vessels. Patients suspected of having cerebral vascular malformations or aneurysm rupture should undergo DSA examination to confirm the diagnosis.

(4) Cerebrospinal fluid examination: Patients with a clear diagnosis of cerebral hemorrhage are generally not subjected to cerebrospinal fluid examination to prevent brain herniation. However, when it is not possible to perform a brain CT scan or brain MRI examination, lumbar puncture still has certain diagnostic value. After cerebral hemorrhage, due to edema of brain tissue, intracranial pressure is generally high. 6 hours after onset, in 80% of patients, the cerebrospinal fluid is mostly bloody or yellow, and a few have clear cerebrospinal fluid, because blood can break through the brain parenchyma into the ventricles or subarachnoid space and present as bloody cerebrospinal fluid. Therefore, when the cerebrospinal fluid is clear during lumbar puncture, the possibility of cerebral hemorrhage cannot be completely ruled out. Dehydration agents should be given before surgery to reduce intracranial pressure. Lumbar puncture should be contraindicated when there is increased intracranial pressure or the possibility of brain herniation.