急性脑血管病是内科常见危重病,临床表现典型者诊断并不难,但有些不典型者鉴别诊断却有一定困难.我们近年来在临床实践中,体会到脑出血与脑血栓的鉴别要点是:脑出血患者以50～60岁多见,几乎都有高血压病史,一般无小卒中史,多在活动时急性起病,有意识障碍,常有颅内压升高症状如头痛、恶心呕吐,瞳孔和呼吸改变较明显,体温常有升高,白细胞多为中度以上升高.发病早期(24小时)头颅超声波探查多有中线偏移,高血压眼底改变多见,脑脊液压力升高,多为血性.脑电图多呈弥漫性异常.脱水等综合治疗效果满意.脑血栓则反之,该病以60岁以上者多见,多有动脉硬化、糖尿病、高血压病史和小卒中发作史,常于休息睡眠时发病,意识障碍轻而局灶症状相对较重,可有颅内压升高.几乎没有呕吐,常无体温改变,白细胞不高或仅轻度升高,发病后24小时内头颅超声波探查,中线无明显偏移,眼底多为动脉 Acute cerebrovascular disease is a common critically ill medical disease, the clinical manifestations of the typical diagnosis is not difficult, but some atypical differential diagnosis there are some difficulties in recent years in our clinical practice, experience cerebral hemorrhage and cerebral thrombosis identification points : Patients with ICH more common in 50 to 60 years, almost all have a history of hypertension, the general history of no history of stroke, acute onset of activity and more, have disturbance of consciousness, often elevated intracranial pressure symptoms such as headache, nausea and vomiting, Pupillary and respiratory changes were more obvious, the body temperature often increased, more than moderate to moderate leukocyte increased.Early onset (24 hours) of the skull ultrasound and more midline shift, hypertensive fundus changes more common, elevated cerebrospinal fluid pressure, and more For the bloody EEG mostly diffuse abnormal dehydration and other comprehensive treatment of satisfactory cerebral thrombosis, on the contrary, the disease is more common in patients over the age of 60, and more with atherosclerosis, diabetes, hypertension history and history of minor stroke, Often at rest, sleep onset, consciousness disturbance and focal symptoms of relatively heavier, may have increased intracranial pressure. Vomiting almost no change in body temperature, leukopenia is not high or only mildly elevated within 24 hours after onset Head ultrasound exploration, in No offset, mostly retinal artery