神经病学精品教学：part2 Cerebrovascular diseases 2013.pptVIP

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神经病学精品教学：part2 Cerebrovascular diseases 2013.ppt

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Carotid Stenosis Atherosclerotic carotid artery disease is responsible for 10% of ischemic stokes * for patients with recent symptomatic carotic stenosis of 70%, carotid endarterectomy can reduce the rate of subsequent strokes Stroke 1988;19:547-54 Conclusion: Stroke is an important socio-medical issue. It can be divided into ischemic and hemorrhagic types with varied clinical manifestations. The diagnosis of stroke depends on clinicals and neuroimagings. Time is brain. Acute stroke should be correctly and immediately managed. Risk factors should be found and modified. Managements of TIA Same as other types of infarcts ASA, heparin, or fibrinogenolytic agents can been used. Pay more attention to the potential causes Managements of hemorrhagic stroke Control blood pressure and brain edema No proven specific curative therapy so that systematic managements are very important Surgery is indicated for some patients (cerebellar hemorrhage,subcortical hemorrhage, etc) 手术疗效? Meta-分析 Peto OR (95%CI Fixed) 2.00[1.04,3.86] 0.46[0.20,1.04] 4.39[0.81,23.65] 0.55[0.06,4.93] 1.66[0.82,3.34] 0.53[0.13,2.21] 0.48[0.09,2.69] 1.20[0.83,1.74] Study McKissock(1961) Auer(1989) Juvela(1989) Batjer(1990) Chen(1992) Morgenstern(1998) Zuccarello(1999) Total (95%CI) Chi-square 13.61(df=6) Z=0.96 Expt n/N 71/89 28/50 25/26 6/8 40/64 8/15 4/9 182/261 Ctrl n/N 60/91 37/50 21/26 11/13 31/62 11/16 7/11 178/269 Weight % 32.2 20.6 4.9 2.9 28.0 6.8 4.6 100.0 Peto OR (95%CI Fixed) 2 5 10 1 Favours Treatment Favours Control Mannitol for Acute Stroke 结论: 没有足够的证据能确定甘露醇治疗具有益处或害处,常规的使用并没有证据支持.需要进一步研究来证实. Managements of SAH Bed rest avoiding activities that would increase intracranial pressure Strictly controlling BP Using Vasodilactive agents prevent vasospasm (nimodipine etc) DSA and surgery Prognosis of stroke Depending to the severities and locations of strokes. Depending on acute managements Depending on comorbid conditions High frequency of recurrence and disability In Ch