脳出血の初期診療—先入観にとらわれず原因検索を

Initial Treatment of Cerebral Hemorrhage:Determining the Cause without Preconceived Notions

Point

・脳出血患者に対して，脳卒中以外の重篤な疾患と同様に，まずは気道，呼吸，循環の評価を行い，安定化を図る必要がある．

・脳出血の原因精査を行い，その原因に対して最適な治療を選択する必要がある．

・抗血栓療法に伴う脳出血では，その薬物にあった血液製剤・中和薬を投与し，血腫の増大を防ぐ必要がある．

　In Japan, cerebral hemorrhage accounts for 19.5% of stroke patients, and its prognosis is poorer than that of cerebral infarction, with a mortality rate of 14.6%. In the initial treatment of cerebral hemorrhage, the airway, respiration, and circulation should be stabilized, and the intracranial pressure and body temperature should be controlled. Hypertensive cerebral hemorrhage is the most common cause; however, the cause should be carefully examined, and the treatment method should be selected according to the degree of urgency. Cerebral hemorrhage patients undergoing antithrombotic therapy show poor outcomes owing to increased hematoma. Therefore, antithrombotic drugs should be discontinued immediately. Blood products and neutralizing drugs should be administered in response to the administration of antithrombotic drugs. In young individuals, cerebrovascular disorders may be caused by the abuse of sympathomimetic drugs, such as stimulants and cocaine. Whether individuals or their family members are using illegal drugs should be confirmed.