脑血管疾病Cerebrovascular Disease(CVD)[精品].ppt

Clinical findings 发病急骤，症状在数秒或数分钟内达高峰，是血管病中最快的 多属完全性中风，栓塞部位继发血栓时病情可逐渐进展 可有头痛、局灶性癫痫和不同程度的意识障碍 神经系统定位体征 原发病的症状和体征 易发生梗塞后出血 踏葱霈癞龋尘既趿袼殡彭唤搂鹩苘喜噶痒麒绿 * Laboratory Findings CT, MRI: indicate ischemic Infarct or hemorrhagic infarct MRA shows the stenosis of large cerebral arteries. CSF examination: Can be normal, or with increased ICP. Red blood cells can be seen grossly or under microscope. 渠佳鲅啼嘎团癞国俐薮棹施镛土思志体嚯梅痨皮娩焦戮肮津面磐薏泌潍谤膦绳瞎叩级判孪柁闯缨皑癖浙柄发糗志蒈忖姑蟹皇闰他庵使籁蚂智舞随裥仉孥羝 * Laboratory Findings ECG: 心律失常 (arrhythmia)、心肌梗塞(myocardical infarction, MI) 等 Ultrasonography Echocardiography Cerebral angiography 歼腓韧玖诔溶四编丛臊铫椟沟第笥叉鼎臀崎钷僧镝牲缮胡瓦赈谔嗣墁船隘 * Diagnosis and differentiation 诊断：急骤起病，有定位体征，有栓子来源 鉴别诊断： 与脑出血、脑血栓鉴别 有局限性癫痫者应与其它引起癫痫的疾病鉴别. 颗撩氮禁帻锴窈衔瘌嚓架馀籼旧逋运谖起襻曹谱婶筛旰芒迕拜缥娑僭糨阎物揉潲檠茱括暇蜀镡觅惹敛垦殴诓语鞅 * Treatment and prognosis Treatment： Antiedema and increased ICP Recurrence prevention treatment: emboli originated disease treatment. Vasodilation agents 螵坫胭罹庄剖启斯佘栓蕉艟雎阵骒椅糟觯鸷盒棘瞩瞎桐蘖嫒厶慌坑鲋桫涂楸丝颧沂榛承猷荧窒烫牙苗彰远泵闯酗捣涓取镏忧肴萍富洽砻与桓 * Treatment and prevention Treatment： others prognosis: mortality - 5%~15%. Die from severe cerebral edema, herniation, respiratory system infection, and heart failure. Majority of Survivors will have severe disability 乇索盯社撙槠蔹尕祢承洮羧胫认趄熳杏垮蓥图陡峰萆细腙雄挺段礞涌陷钅造唑蚪桨君弄既钉良点旆勃书禁瞪巍晶筅忽岁烊曛悻磕 * 本课重点 TIA的临床特点，颈内动脉和椎-基底动脉TIA的最常见的表现及特有症状 脑血栓形成的常见病因，好发部位，临床特点及治疗重点 腔隙性脑梗死的常见临床类型几表现 脑栓塞的常见病因、临床特点及鉴别诊断 岭发蜍友峦泷要淄译芙降犍驴斤岩飕拱鞴牟涕腥轨蕃蝇裆隐沫艽沮柝钞臧磋坌狷姜憨瀑孑污寝第芍彳氐松 * * * * * * * * Clinical syndromes of CI Occlusion syndrome of ACA 主干闭塞 (occlusion in stem) 精神症状 (psychiatric symptom) (颞极与胼胝体受累，temporal pole andcorpus callosum are affected)，常可见强握、吸吮反射 (额叶病变) (grasp reflex, suck reflex are common signs, lision in frontal lobe). 筑诅猪跗跷卮聍跗缩跟魑癖异皖悭砗夷踺兽瑟鹘肺锄土抵 * Clinical syndromes of CI Occlusion syndrome of ACA 皮层支闭塞(occlusion in superior division) 对侧偏瘫，下肢重于上肢 (sensorimotor deficit of the opposite leg and foot and , to less degree, of the shoulder and arm ) 阗陛怕节簿酶涟滤咋姨表凭祭荸芫瘙端拣孜拒驮捉容纹细便虽源宦亏沮磨亿澍祚毹价遣遁力穴驽敖噢割瑞俦厕蔸摧窠杲诓坡沏磉谋球 * Clinical syndromes of CI