5 How serious is hemorrhagic stroke in Taiwan? About 73 per one hundred thousand occur each year22% in all stroke30 days mortality: 26-30%The first leading cause of serious long-term disability in adultsBefore my topic, let me show how serious is hemorrhagic stroke in Taiwan.Generally, there is 73 per patients in hemorrhagic stroke at Taiwan each year.Hemorrhagic type stroke accounts for 22% of all strokes a d is associated with higher mortality rate than cerebral infarctions.The 30 days morality rate is up to 30%.It is also the first leading cause of serious long-term disability in adults in Taiwan.Taiwan Guidelines for the Management of Stroke 2008
6 Taiwan Guidelines for the Management of Stroke 2008 The secondary leading cause of deathMale: 4.67/1000Female: 3.32/1000Taiwan Guidelines for the Management of Stroke 2008
9 致病因(Etiology) Hypertension Acutely increased CBF, especially to area previously rendered ischemicVascular anomaliesArteriopathiesCoagulation disorderInfectionVenous or dural sinus thrombosisDrug abusePost-traumaticeclampsia
11 Intracranial hemorrhage ICH in putamum and subcortical area 3cm, volume 20cc surgical decompressionICH in cerebellum 2cm, volume 10cc surgical considerationEVD or ICP monitor was considered in acute hemoventricle.
34 腦瘤B. Embryonal tumors： a. medulloepithelioma b. neuroblastoma c. ependymoblastoma d. retinoblastoma e. PNET (primitive neuroectodermal tumors)如Medulloblastoma (1.5%)C.腦脊髓神經腫瘤(6.6%) a. schwannoma (或neurilemoma, neuroma) b. neurofibroma
35 腦瘤D. Meningeal tumor a. meningioma (23.3%) b. 腦膜細胞以外由中胚層來者 I.良性：chondroma, lipoma, fibroma II.惡性：chondrosarcoma,rhabdomyosarcoma c.原發性黑色素細胞瘤 d.起源不明者：hemangioblastoma,hemangioericytomaE.造血組織 如malignant lymphoma、plasmacytoma
36 腦瘤F. Germ cell tumors 如germinoma, embryonal carcinoma, yolk sac tumor, choriocarcinoma,teratomaG. Cystic and tumor like lesions 如Rathke's cleft cyst, epidermoid cyst, Dermoid cyst,第三腦室colloidcystH. 腦下垂體腫瘤：如pituitary adenoma (20.6%) pituitary carcinomaI. Local extension from regional tumors a. craniopharyngioma (分adamantinomatous, squamous, papillary type) b. paraganglioma c. Chordoma d. chondromaJ. Metastatic tumors
58 Glasgow Coma Scale Eyes open （睜眼反應） 4 3 2 1 Spontaneous To speech To painNoneBestVerbal response（最佳語言反應）5AlertConfusedDrowsyGroansMotor respons（最佳語言反應）6ObeyLocalized painWithdrawalAbnormal flexionExtension