41 岁男子急性脑梗死,溶栓后症状有好转
T:36.5℃,P 80 次/分,R 19 次/分,BP115/78 mmHg 体重 60 kg 神志清, 两瞳孔等大等圆,直径约 2.5 mm, 对光反射灵敏, 右侧眼角变小,
双侧额纹等对, 双侧鼻唇沟等对, 伸舌居中, 右侧软腭稍低于左侧, 颈软, 气管居中, 两肺呼吸音清,HR 80 次/分, 律齐, 腹平软, 肝脾肋下未及,
右侧肢体肌力正常,左侧肢体痛温觉消失,右侧面部痛温觉减退,触觉,位置觉、运动觉正常,Babinski 征(-)。
溶栓 48 h 后 CTA 发现动脉瘤
10 小时后头颅磁共振检查:右侧延髓背侧急性脑梗死。如下图
颅内动脉瘤全都不能溶栓吗?
rt –PA 静脉溶栓最为严重的并发症是症状性颅内出血 (sICH) ,可明显增加溶栓患者的死亡率和病残率[1]。
参考文献:
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