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„X¥ý¤Ñ©Ê¤§²§±`¦åºÞ©ó¸£¹ê½è¤º¡A¥i¯à¬OFL®É´Á´`Àôµo¨|²§±`¤Î«ùÁZµÛì©lªºAV shunt¦ÓµL¬y¸g·L¦åºÞ¡A°Ê¯ßÀ£¤O¨ÏÀR¯ß¦åºÞÂX±i¡A±`¦ñÀHÂX±iªºfeeding arteryºÞ¾À·Á¦Ó¯Ê¤Ö¥¿±`ªº¦Ù¦×¼h¤Îelastica¤º¼h¡A¦åºÞ¹ï©ó¦åÀ£©M¦å¬y§ïÅܨS¦³¥¿±`ªºautoregulation¡C
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1.¸£¤º¥X¦å¡ASAH©Î¸£«Ç¤º¥X¦å¡C(Hemorrhage¦û¤@¦ñ¡Apeak age¬°15-20y/o, mortality¬°10%¡Amorbidity¦û30-50%)¡AAVM¥X¦å¦û¥X¦å©Ê¤¤·ªº2.5-4.8%¡C
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4.§½³¡¯«¸g¯gª¬¡B¦pªÏÅé·Pı²§±`¡BµL¤O¡Bµø³¥¯Ê·lµ¥¡C
5.IICP
¤þ¡B ªvÀø
1.Y¸£¤º¦å¶ô¤Ó¤j¡A¤w³y¦¨uncal herniation¡A¶·§@ºò«æ¤â³N¡C
2.ª`·N¥Í©Rªí¼x¡BGCS¡BÀû¤Õ¡BªÏÅé¤O¶q¤§ÅܤơA¨C¤G¤p®É°O¿ý¤@¦¸¡A±±¨î¦åÀ£¡C
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1.Hypertension
2.Acutely increased CBF
3.Vascular anomalies
4.Arteriopathy
5.Brain tumor
6.Coagulation disorder
7.Infection
8.Drug abuse
9.Post-traumatic
¤A¡B Common sites of ICH
„XBasal ganglia (50%), thalamus (15%), pons (10-15%), Cerebellar (10%), Cerebral white matter(10-20%)
¤þ¡BManagement
1.initial:
a.reduction of hypertension (HTN)¡A¦ý¤£¯àover reatment°§CMAP¬°Admission MAP¤§80%
b.Anticonvulsant
c.Treat IICP: mannitol or Glycerol
d.Arrange angiography if atypical ICH: to R/O AVM, Aneurysm or tumor
2.Surgical indication
a.Symptomatic lesion
b.Lesions with marked mass effect, edema, midline shift
c.Persistent IICP
d.Favorable location: ¦plobar, cerebellar, extenal capsule, non-dominant hemisphere
e.¡Ø50y/o and tolerate surgery
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