Subarachnoid hemorrhage
Subarachnoid means between the arachnoid membrane compartment and soft , which is fraught with constantly circulating cerebrospinal fluid , and larger vessels walk, while the soft membrane is also rich in blood vessels. When milli needlestick injuries in the soft film or subarachnoid blood vessels when it is subarachnoid hemorrhage, intracranial vascular accidental injury while acupuncture , blood into the subarachnoid space , is also attributable to this . Subarachnoid hemorrhage, the nervous system , one of the most common accidents acupuncture . Only from 1979 to 2002 statistics, our country has reported 40 cases of such accidents . Overseas also occur , although the vast majority of cases , are out of danger after the rescue , but the incidence is so high, is caused by acupuncture practitioners must attach great importance .
[ Injury ]
Due to needlestick injuries caused by subarachnoid hemorrhage was mainly due to operational reasons and points to the reason .
An acupoint reasons: easily lead to subarachnoid hemorrhage points: wind House , the wind pool , dumb door , shade out , sleep and other points . Especially the nape of the points , such as the occipital dumb door , the wind pool, wind House , etc., are located in the midline of the atlantoaxial joint or lateral , the deep rich in blood vessels , such as the vertebral artery , spinal artery, vertebral veins around central medullary vascular plexus and life . And the three points , it corresponds to the trailing edge of the foramen magnum atlantoaxial ( second cervical ) spine area between the occipital bone and vertebral ring ( first cervical vertebra ) the relatively large cavities between , mainly in connective tissue compartment , easily piercing . Needle too deep, dramatically improves the twist are easy to injure the deep blood vessels, causing traumatic subarachnoid hemorrhage , or even damage to the brain stem cause sudden death .
Wind House , if a male patient with dizziness, headache OK acupuncture therapy to acupuncture cents government points into the wind , twist the needle when the needle row , the patient suddenly felt “head a boom” and accompanied by severe headache, pain along the spine and then down , then immediately needle injection , headache continues to increase . After an injection of morphine , headache did not stop while bedridden , and nausea and vomiting that night . Next to our hospital , the outpatient lumbar puncture cerebrospinal fluid is bloody , with subarachnoid hemorrhage ( acupuncture due ) and hospitalized. Physical examination: Shen Qing , blood pressure 18.0/12.0kPa (134/90mmHg), neck tough Klinefelter ( + ) , I was no exception . Treatment: The bed rest , sedation pain, bleeding , time reducing intracranial pressure and other treatment, symptoms and signs gradually reduced and disappeared , hospital 12 days and discharged [ 1 ] .
Fengchi , such as a female patient with headache , acupuncture treatment in the clinic line to give acupuncture Fengchi , after the needle felt severe headache , accompanied by frequent vomiting . Admission examination: blood pressure 18.7/10.7kPa (140/80mmHg), body temperature 36.4 ℃, conscious, medical examination no abnormalities, fundus normal items strong, Klinefelter suspicious . Cerebrospinal fluid was bloody , pressure 210mmH2O. Diagnosis of subarachnoid hemorrhage. After sedation , bleeding and pain treatment , was discharged 19 days [ 2 ] .
Yamen , some statistics , in 200 cases of subarachnoid hemorrhage cases , about 19 cases are caused by needling the hole . If a 40 -year-old male patient suffering from complete bilateral deafness , I had acupuncture point injection therapy and vitamin B1 , 3 months no results. After the regiment continue to implement health team medic acupuncture treatment. At the 4th acupuncture Yamen , the patient immediately conscious acupuncture is not good, then a headache , but can endure , to help ease the production team even after closing Mai and blacksmith two days . The first three days work , headache intensified, accompanied by vomiting , pale, immediately to the health team clinic, giving general handling . Early the next morning came the emergency , sicker, considered as cerebrovascular accident, after she died [ 3 ] .
Sleep, shade out other acupuncture points located suboccipital , both in the horizontal axis spinous process on the edge of the deep as the atlanto-occipital and atlantoaxial joints, where there are vertebral artery through , rich in blood vessels , ligaments and joints are not sealed , constitute a greater the gap . Therefore, these acupuncture points accident-prone . If a male patient with insomnia , headaches for a long time , be acupuncture. With a 4 -inch-long needles sterilized by conventional deep hole piercing sleep , the patient suddenly felt numb body , electric shock-like sensation and pain in back of the head , followed by vomiting, headache worsened after severe neck pain . No previous history of similar attacks . After examination of subarachnoid hemorrhage. By bed rest , sedation, pain, bleeding and intracranial pressure such as processing, two weeks after recovery [ 4 ] .
Second, the reason for the action : The main acupuncture direction , depth, improper practices . According to the X-ray determination of the neck skin to the spinal canal after the trailing edge distance of about 5 ~ 5.5cm. When the neck straight ( head forward 10 ° ~ 20 ° angle ) vertical needle , and its direction along the ramp 10 ° ~ 20 ° angle , is pointing to the atlantoaxial joint space . Therefore, if the needle wind House , the wind pool , sleep and other points in this direction inappropriate deep puncture , or needle shade out cavity inclined 20 ° ~ 45 ° into the needle too deep , are likely to penetrate the spinal canal, injure blood vessels, causing bleeding. If then subjected to a significant reduction in lift and thrust , the damage is even more important .
Second, with the needle is too thick there is a certain relationship . If a male patient with paroxysmal left facial spasms , received acupuncture treatment in a clinic . Twice started acupuncture needles without discomfort , 3rd row back of the neck to switch to homemade wire Yamen Zhu needle acupuncture . Sick in the head forward seat , when the needle into the deep , the patient Tujue systemic shock -like numbness and weakness of the limbs , followed by headache , nausea, vomiting , limb flaccid paralysis , progressive increase of consciousness into lethargy by the sober . Confirmed by lumbar puncture cerebrospinal fluid was bright red , the diagnosis of subarachnoid hemorrhage [ 5 ] .
Third, the indirect causes : refers to non- acupuncture point area of the neck, after , that is not a direct needle puncture caused by intracranial vessels . May be associated with the former suffering from intracranial aneurysms , arteriovenous malformations , or have high blood pressure , atherosclerosis , etc. , and when acupuncture stimulation is too strong , leading to a sudden rupture of blood vessels , causing disease. Therefore, acupuncture is just one incentive.
Clinical manifestations
First, the symptoms: neck after acupuncture point in time , the patient suddenly felt a “shock -like” sensation or systemic shock splitting head appeared suddenly appeared like pain , located in the forehead , after the pillow or the entire head and can be extended to neck , shoulder, back and waist , and two legs. Appears dizziness , pale body cold sweats, nausea and vomiting, and vomiting can be presented jet , accompanied by varying degrees of consciousness, or delirium , disorientation , delusions and hallucinations. Light , God clear or showed transient blurred consciousness , suffering face , moaning more than all day, drowsiness, restlessness between ; severe can into a coma. Some patients may have localized or generalized seizures .
It should be noted that some cases of subarachnoid hemorrhage needle injury , often only occipital pain or neck stiffness, or just tell lower back pain, dizziness was misdiagnosed. If one case of 15 -year-old female patient , for the treatment of deaf , with a 3 -inch-long needle acupuncture Yamen , I strong stimulation techniques, acupuncture is extremely obvious. In the afternoon the patient expressed dizziness , headache, symptoms gradually worsened , nausea and vomiting to 3 days before going to the hospital for treatment. Conscious patients , in addition to neck with resistance, Kang Beng Achilles tendon reflex , abdominal reflex is more sensitive Klinefelter ( + ) , the various checks, such as temperature, pulse, blood pressure, 12 pairs of cranial nerves and muscle tension tests were normal . Pale red after lumbar puncture cerebrospinal fluid pressure 1.45kPa (148mmH2O), blood leukocytosis see before diagnosis of subarachnoid hemorrhage. 18 days after treatment, the symptoms disappeared , discharged [ 6 ] .
Second, the signs : the meningeal irritation based. Neck stiffness , may have Brandt Klinefelter syndrome and positive . Fundus examination can be found in front of the retina that is vitreous haemorrhage ; irregular breathing, slow pulse . Laboratory tests ; often has the appearance of bloody cerebrospinal fluid , microscopic examination shows a large number of red blood cells exist , initially often leukocytosis . Often high intracranial pressure may exceed 200mmH2O.
Caused due to acupuncture , there are the following clinical features:
( A ) , from acupuncture to headache, vomiting peak , tend to have a more severe course .
( Two ) , disturbance of consciousness began more obvious , and gradually serious bleeding may be increased gradually on . But there is not a long time in a coma .
( Three ) , headache, pain in the occipital -based, can be associated with neck pain , and often one of its earliest symptoms . This is rare in the general subarachnoid hemorrhage .
( Four ) , meningeal irritation may or may not occur , often without brain parenchyma or cranial nerve damage clinical manifestations.
[ Prevention ]
First, pay attention to the direction and depth of needling : wind House and other points can be found in the depth and direction of the cerebellum and medulla oblongata damage parts. Shade out , sleep and other points , not exceeding 5 cm is appropriate, and children reduce body lean . Within its angle to the vertical slant on safer to avoid direct piercing the spinal canal, but can not deep stab to the foramen magnum .
Second, pay attention to tactics Operation: acupuncture was gas, using a gentle twisting plus a small mention meddling law prohibited revisit thrusting . Deep needling process, such as the patient complained of systemic shock sensation or feeling shiny eyes , immediately needle injection , and closely observe whether there are other signs, symptoms appear . If the occipital pain , but subject to further examination, to avoid delaying the treatment time .
Third, in patients with hypertension and arteriosclerosis , caution too strong stimulation ; intracranial aneurysms or atherosclerosis patients avoid acupuncture .
[ Processing Method]
Subarachnoid hemorrhage, acupuncture is a more serious accident , to take early and effective measures .
Should generally be hospitalized for observation , the patient absolute bed rest for at least four weeks . Keep quiet, try not to move much , and do not get up urine . Applications, the Western drugs to stop bleeding, control of cerebral edema. Headache, irritability, given pain , sedative drugs, such as promethazine , codeine , diazepam , etc., vomiting , antiemetic drugs. If severe headache , frequent nausea and vomiting, slow pulse rate and breathing , and even coma, while the conservative method fails, surgical treatment should be considered .