中枢脑血管病.pptVIP

中枢脑血管病

TheFiveMostCommonStrokeSymptomsSuddennumbnessorweaknessofface,armorleg,especiallyononesideofthebody.Suddenconfusion,troublespeakingorunderstanding.Suddentroubleseeinginoneorbotheyes.Suddentroublewalking,dizziness,lossofbalanceorcoordination.Suddensevereheadachewithnoknowncause.(Source:NationalStrokeAssociation)1/26/20262

OtherImportantbutLessCommonStrokeSymptomsSuddennausea,feverandvomitingdistinguishedfromaviralillnessbythespeedofonset(minutesorhoursvs.severaldays).Brieflossofconsciousnessorperiodofdecreasedconsciousness(fainting,confusion,convulsionsorcoma).Source:NationalStrokeAssociation1/26/20263

ClinicalFeaturesDependsonvascularterritoryinvolvedUsuallyabruptonsetMostprecise:levelsofconsciousness(LOC),grossmotorlevelLeastprecise:sensoryexam,history(includingTIA)Clinicalexamperformanceimproveswithtraining1/26/20264

脑血管疾病

（cerebrovasculardisease）脑梗死（cerebralinfarction）脑出血（intracranialhemorrhage）动静脉畸形（aterio-venousmalformation）蛛网膜下腔出血（subarachnoidhemorrhage）和颅内动脉瘤（intracranialaneurysm）1/26/20265

TheconsequencesofcerebralischemiadependonthedegreeanddurationofreducedCBF.Neuronscantolerateischemiafor30-60minutes.Perfusionmustbereestablishedbefore3-6hoursofischemiahaveelapsedorbeforetheCBFdropsto10.脑梗死cerebralinfarction1/26/20266

cerebralinfarctionPathologicchangeswithintheneuropilfollowthemetabolicabnormalities.OneofthefirsteffectsiscytotoxicedemathatresultsfromfailureoftheNa/Kionpump.Earlyon,thisstageisstillreversible.Prolongedischemialeadstocelldeathandcoagulationnecrosis.After3-6hoursofischemia,irreversibledamageoccurstothecapillaryendothelium.1/26/20267

CTandMRscansinpatientswithasymptomaticbruitsorTIAsareusuallynegative.Theearliestsignmaybeabnormalvasculardensity/signal.Thefirstparenchymalchangesobservedon