脑梗塞1.1_培训课件.ppt

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * 发病年龄，起病状态，进展速度 完全性卒中 头痛、痫性发作和意识障碍 神经系统定位体征 原发病的表现 梗塞后出血 脑栓塞—临床表现 CT和MRI MRA 腰穿 心电图 超声心动 脑栓塞—辅助检查 诊断：症状及体征；心电、CT、MRI 鉴别诊断 脑出血、脑血栓形成鉴别 局限性癫痫者与引起癫痫的疾病鉴别 脑栓塞—诊断及鉴别诊断 脑栓塞—治疗及预后 治疗 预后 病因治疗 一般治疗及中医中药治疗 改善脑循环及抗凝治疗 * * * * * 很久以来，胆固醇与卒中的相关性一直存在争论。 从病理学机制上分析：胆固醇水平与动脉粥样硬化密切相关，而众所周知，颅内外动脉粥样硬化是缺血性卒中发生的独立危险因素，依此我们推断，卒中与胆固醇应该是存在相关性的。 * * (a) Nonenhanced CT scan obtained 5 hours after the onset of stroke in a 65-year-old woman with MCA occlusion demonstrates obscuration of the lentiform nucleus (long white arrow) and of the head of the caudate nucleus (arrowhead) as well as hypoattenuation of the insular ribbon (short white arrow) and effacement of the sulci of the temporoparietal MCA territory (black arrows). (b-d) Color maps of TTP (b), CBF (c), and CBV (d) demonstrate a ribbon-shaped area of nonperfusion (small white arrows) and markedly reduced perfusion in the residual MCA territory. The reduction of CBF and CBV appears to be more severe in the temporoparietal MCA territory (arrowhead) than in the frontal territory (large arrow). (e, f) Image and graphs illustrate TACs obtained within the superior sagittal sinus (1), normal brain parenchyma (2), the anterior part of the MCA territory (3), the temporoparietal MCA territory (4), and a nonperfused area (5) and compared with a TAC obtained within a branch of the MCA. Enhancement starts approximately 5 seconds later in the superior sagittal sinus than in the MCA. Although the maximum slopes of the TACs are nearly identical, maximum enhancement is much higher within the large superior sagittal sinus due to less partial volume effects. The reduction of the maximum slope in the anterior part of the MCA territory compared with the superior sagittal sinus and the normal brain parenchyma is compatible with moderately reduced blood flow. There is further reduction of the maximum slope and decreased maximum enhancement in the temporoparietal MCA territory compared with the norm