血管性头痛与创伤性脑损伤

M. Aragão, L. Araújo, M. Valença
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引用次数: 0

摘要

在医疗紧急情况中,死亡风险最大的患者是脑血管事故患者和创伤性脑损伤患者。许多患者入院时伴有意识状态下降(昏迷)和局灶性神经功能缺损。在对这些患者的评估中,为了确定病变的类型和大脑的位置,神经影像学是必不可少的。就中风而言,我们可以将其细分为出血性和缺血性。在出血性出血中,我们可以提到(1)自发性脑内血肿和(2)颅内动脉瘤破裂引起的出血,以蛛网膜下腔出血为主。头部创伤的患者情况危急;即使是那些到达医院时神志清醒的人,也会因为颅内血肿、水肿或脑挫伤而在几个小时内降低意识水平。因此,使用计算机断层扫描和磁共振成像,甚至数字血管造影进行神经影像学评估,对于这类患者的持续监测至关重要。由于血管病变的发展速度和头部外伤,检查通常需要重复几次。这类患者的一个警告信号是头痛。在颅内动脉瘤破裂的情况下,我们通常会有雷击般的头痛,一种爆炸性的,突然的疼痛,这是一个人一生中遭受的最严重的疼痛。颅周和一些颅内结构对痛觉性刺激敏感,如硬脑膜、大动脉和静脉窦。大脑对痛苦的刺激相对不敏感。这篇叙述性综述的目的是告知在急诊科对卒中和创伤性脑损伤患者进行神经影像学评估的重要性。总之,对于患有脑血管疾病或遭受创伤性脑损伤的危重患者,除了进行神经学和体格检查外,神经影像学评估是至关重要的
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Vascular headache an traumatic brain injury
In a medical emergency, the most urgent patients at significant risk of death are those witha cerebrovascular accident and those with traumatic brain injury. Many are admitted withdiminished conscience status (coma) and focal neurological deficits. In the evaluation ofthese patients, neuroimaging is indispensable in order to identify the type of lesion andthe location of the brain where it is located.In the case of stroke, we can subdivide it into hemorrhagic and ischemic. Among hemorrhagic hemorrhages, we can mention (1) spontaneous intracerebral hematomasand (2) hemorrhages due to rupture of an intracranial aneurysm, with subarachnoidhemorrhage leading.Patients with head trauma are critical; even those who arrive at the hospital alert andoriented can decrease their level of consciousness in a few hours due to an intracranialhematoma, edema, or cerebral contusion.Thus, the availability of performing neuroimaging evaluations, using computed tomography and magnetic resonance imaging, or even digital angiography, is vital for continuoussupervision of this type of patient. The exams often require repetition several times due tothe rate of evolution of vascular lesions and after head trauma.A warning sign in these types of patients is headache. In the intracranial aneurysmal rupture, we classically have the thunderclap headache, an explosive, sudden pain mentionedas the worst pain the individual has suffered in his or her life. The pericranium and someintracranial structures are sensitive to nociceptive stimuli, such as the dura mater, largearteries, and venous sinuses. The brain is relatively insensitive to painful stimuli.This narrative review aims to inform the importance of neuroimaging assessment of patients with stroke and traumatic brain injury in an emergency department. In conclusion,a neuroimaging evaluation is paramount in addition to a neurological and physicalexamination of the critically ill patient with cerebrovascular disease or who has suffereda traumatic brain injury
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