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hemorragia_cerebral_espontanea [2020/03/21 17:08] (actual) – creado - editor externo 127.0.0.1
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 +====== Hemorragia cerebral espontánea ======
  
 +===== Definición =====
 +La [[hemorragia cerebral]] espontánea es una colección hemática dentro del [[parénquima cerebral|]] en ausencia de [[traumatismo]] o [[intervención quirúrgica]] previa.
 +
 +===== Epidemiología =====
 +
 +Representa el 10-15% de todos los [[ictus]], y según su localización puede ser intra[[parenquima]]tosa o [[intraventricular]].
 +
 +Es la 3ª causa de muerte y se estima la duplicación de su [[incidencia]] en el año 2050.
 +
 +Se presenta con doble de frecuencia que la [[hemorragia subaracnoidea|hemorragia subaracnoidea]] y tiene peor pronóstico que esta.
 +
 +A partir de los 55 años de edad, la frecuencia es doble por cada década que pasa.
 +
 +Se produce con mayor frecuencia en personas de raza negra y japoneses.
 +
 +En cuanto al sexo, no se observan diferencias significativas entre ellos.
 +
 +Más frecuente por la mañana y en invierno.
 +===== Clasificación =====
 +
 +ver [[Clasificación de la hemorragia cerebral espontánea]].
 +
 +===== Etiología =====
 +
 +ver [[Etiología de la hemorragia cerebral espontánea]].
 +
 +
 +===== Clínica =====
 +
 +La clínica va a depender de la localización , del tamaño,  del edema acompañante y la presencia de hidrocefalia entre otros.
 +
 +Característicamente se produce un intenso dolor de cabeza, vómitos y alteración en el nivel de conciencia.
 +
 +Puede presentarse como una parálisis de la mitad del cuerpo, disminución de la apertura y desviación de los ojos hacia el lado del cerebro donde se produjo la hemorragia y dificultad para hablar. También puede manifestarse con una alteración para mover los ojos y disminución en la sensibilidad.
 +
 +Uno de cada 4 pacientes va a presentar un deterioro clínico en las próximas 24 horas sobre todo en alcoholismo, hematoma irregular,nivel de conciencia bajo y niveles bajos de fibrinógeno.Antecedentes de isquemia cerebral,enfermedad hepática,niveles altos de glucosa,y tensión arterial por encima de 200 mm Hg.
 +
 +===== Diagnóstico =====
 +
 +ver [[Diagnóstico de la hemorragia cerebral]].
 +
 +
 +
 +
 +===== Tratamiento =====
 +
 +[[Tratamiento de la hemorragia intracerebral espontánea]].
 +
 +
 +====Pronóstico====
 +
 +La fiebre y el crecimiento del hematoma son predictores independientes de mal pronóstico.
 +
 +Se necesitan investigaciones futuras para estudiar los mecanismos de este fenómeno y analizar si los protocolos iniciales de modulación de la temperatura se asocia con mejores resultados (Rincon y col., 2012).
 +
 +Solo un 20 % podrán realizar una vida independiente 6 meses después.
 +
 +El 50 % fallecen en el primer mes.
 +
 +Los volúmenes de >60 cm3 tienen una mortalidad del 90 %
 +
 +===Escalas pronósticas===
 +
 +El pronóstico final de los pacientes, no depende de una variable aislada, sino de la conjunción de varias; por ello se han intentado crear escalas pronósticas que las agrupen. 
 +
 +En la actualidad han surgido escalas breves, simples y con alta sensibilidad como la “ICH score” creada por Hemphill.
 +
 +Enlace http://www.mdcalc.com/intracerebral-hemorrhage-ich-score/
 +
 +====Conclusiones====
 +
 +No esta clara la estrategia a seguir.
 +
 +Estudios mal diseñados.
 +
 +Deben de agruparse en Localización, tamaño, GCS.
 +
 +No agrupar sistemáticamente todos los tipos de intervención quirúrgica.
 +
 +Hasta el momento, ninguna intervención en particular es claramente superior.
 +
 +Una revisión de los estudios aleatorios disponibles, sin embargo indica que las opciones menos invasivas puedan mostrar resultados mejores.
 +
 +Esto puede ser en particular verdadero en pacientes jóvenes con signos de deterioro neurológico reciente.
 +
 +Reducir el volumen de hematoma permanece como pilar básico.
 +
 +Las futuras investigaciones e intervenciones van indudablemente en esta dirección.
 +
 +Este interés en identificar mecanismos bioquímicos refleja el aumento reciente de publicaciones de investigación de mecanismos celulares y moleculares
 +
 +Mientras tanto, la responsabilidad permanece sobre el clínico para hacer el juicio terapéutico lo mejor posible.
 +
 +====Bibliografía====
 +Rincon, Fred, Patrick Lyden, and Stephan A Mayer. 2012. “Relationship Between Temperature, Hematoma Growth, and Functional Outcome After Intracerebral Hemorrhage.” Neurocritical Care (September 22). doi:10.1007/s12028-012-9779-9. http://www.ncbi.nlm.nih.gov/pubmed/23001769.
 +
 +
 +
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 +
 +
 +La [[hemorragia cerebral]] espontánea, es el sangrado no traumático en el [[parénquima cerebral]].
 +
 +====Epidemiología====
 +Es el segundo subtipo más común de [[accidente cerebrovascular]], con 5,3 millones de casos y más de 3 millones de muertes en todo el mundo en 2010.
 +
 +En el 2001, la incidencia anual era de 20-30 por 1.000.000 personas
 +
 +
 +====Clasificación====
 +Según su localización puede ser intraparenquimatosa o intraventricular (HV).
 +
 +====Etiología====
 +Hipertensión arterial 
 +
 +[[Hemorragia cerebral por malformación arteriovenosa cerebral]].
 +
 +Aneurismas (saculares. micóticos) 
 +
 +MAV. 
 +
 +Fístula arteriovenosa 
 +
 +Angioma venoso 
 +
 +Cavernoma 
 +
 +Telangiectasia 
 +
 +Enfermedades hematológicas 
 +
 +Afibrinogenemia 
 +
 +Déficit de factor de von Willebrand 
 +
 +Púrpura trombótica trombocitopénica idiopática 
 +
 +Leucemia 
 +
 +Síndrome de hiperviscosidad 
 +
 +Mieloma múltiple 
 +
 +Coagulación intravascular diseminada 
 +
 +Trombopenias primarias o secundarias a fármacos 
 +
 +Angiopatía cerebral amiloidea 
 +
 +Vasculitis multisistémica aislada del sistema nervioso central 
 +
 +Síndrome de Moyamoya 
 +
 +Trombosis venosa central 
 +
 +Tumores: primarios y metastásicos 
 +
 +Enfermedades infecciosas 
 +
 +Tuberculosis 
 +
 +Brucelosis 
 +
 +Leptospirosis 
 +
 +Micosis 
 +
 +Simpaticomiméticos 
 +
 +Anfetaminas (anfetamina. metanfetamina) 
 +
 +Cocaína 
 +
 +Crack 
 +
 +Norefedrina. efedrina. fenciclidina Fibrinolíticos
 +
 +===== Recomendaciones =====
 +
 +ver [[Recomendaciones en hemorragia cerebral espontánea]]
  • hemorragia_cerebral_espontanea.txt
  • Última modificación: 2020/03/21 17:08
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