急性脑卒中救治规范与流程(英文).pptVIP

Neurocritical Care of Acute Stroke Wengui Yu, MD, PhD Division of Neurological Critical Care Departments of Neurological Surgery and Neurology The Primary Diagnoses In Neuro-ICU Advances in Stroke Management 1. Neuro-monitoring 1). Neuro Exam Simple and effective Neurologic changes that need immediate attention Mental status change Decreased levels of consciousness: lethargy, stupor, coma. Disorientation: name, place, time, and event. Speech difficulty: expressive or receptive aphasia Cranial nerve palsy: dilated and fixed pupil(s) New weakness/numbness 2). Neuroimagings b). CTA Contrast extravasation predicts hematoma expansion CT demonstrates a left putaminal hematoma (A). A small focus of enhancement is seen on CTA (B), consistent with extravasation on postcontrast CT (C). Unenhanced CT image 1 day after presentation reveals hematoma enlargement and IVH (D). - Wada et al. Stroke. 2007;38:1257 - Golstein et al. Neurology. 2007;20;68(12):889-94. Contrast extravasation predicts mortality in ICH A 69-yo man underwent imaging 2 hrs following onset of right-sided paralysis. Admission NCCT demonstrates a left thalamic hematoma with extension into the third Ventricle (A). CTA (B) and CECT (C), respectively, show 2 foci of active extravasation (arrows). Follow-up NCCT 12 hrs later shows marked hematoma growth with hemorrhage in both lateral ventricles and severe hydrocephalus (D). The patient had a fatal outcome. Becker et al. Stroke 1999;30:2025-2032 Kim et al. American Journal of Neuroradiology 2008; 29:520-525. The DWI map demonstrates a small area of diffusion restriction in the right MCA territory consistent with acute infarction. The MTT map demonstrates the infarct penumbra which is larger than the infarct, indicating the presence of salvageable tissue. 4). Transcranial Doppler (TCD) Non-invasive. Measure the velocity of flow in the intracranial circulation. The Doppler shift measured is inversely proportional to the diameter of the vessel. TCD Criteria