中国协和医科大学神经病学课件 脑梗死.pptVIP

Ischemic Stroke Peng Bin Department of Neurology,Peking Union Medical College Hospital What do we need to know…… Definition and classification Vascular anatomy Mechanism Clinical features Diagnosis and differentiate diagnosis Treatment Definition Stroke: World Health Organization (WHO) has defined stroke as “rapidly developing clinical signs of focal (at times global) disturbance of cerebral function, lasting more than 24 hours or leading to death with no apparent cause other than that of vascular origin.” Ischemic stroke: deprivation of blood flow to an area of the brain, generally as a result of thrombosis, embolism, or reduced blood pressure. ---Onset : Rapidly ---Symptom: Focal or global cerebral dysfunction ---Duration: More than 24 hours ---Vascular origin: Classification of Ischemic Stroke Atherothrombotic cerebral infarction Cerebral embolism Lacunar infarction Cerebral watershed infarction Vascular Anatomy The brain is perfused by the carotid and vertebral arteries ---Anterior circulation : carotid artery ,etc ---Posterior circulation: vertebrobasilar artery. How does it happen? Clinical manifestations Ischemic syndromes of specific vessels depend on ----- the site of the occlusion ----- the presence of previous brain damage ----- collateral circulation MCA ACA PCA Example Internal carotid artery occlusion(MCA+ACA) * Symptomatic --Contralateral hemiparesis --Hemianesthesia --Hemianopia *Asymptomatic MCA ACA Asymptomatic Diagnosis Onset Causes or risk factors Clinical features ---Stroke syndromes Tests ---Brain CT scan ---Brain MRI ---TCD,CTA or DSA Differentiate Diagnosis Intracerebral hemorrhage General Management Standard frequency of observations and monitored parameters Deep vein thrombosis (DVT) prophylaxis Treatment of increased blood sugar levels (BSL) Treatment of increased temperature Treatment of increased blood pressure (BP) Specific treatment Thrombolytic therapy --Intravenous thrombolytic thera