急性缺血性脑血管病规范化治疗.ppt

急性缺血性脑血管病规范化治疗 中南大学湘雅医院神经内科 谷文萍 Wenping Gu,MD.PhD. Neurology Department, Xiangya Hospital, central south University 脑血管疾病Cerebrovascular Diseases， CVD 在脑血管病变基础上发生的局限性或弥漫性脑功能障碍 the cerebral diseases that are resulted from various cerebrovascular diseases 急性脑血管疾病分类classification of acute cerebrovascular diseases 短暂性脑缺血发作（transient ischemic attack TIA） 颈动脉系统(internal carotid artery system) TIA 椎－基底动脉系统(basilar-vertebral artery system)TIA 脑卒中（stroke, apoplexy, cerebrovascular accident） 蛛网膜下腔出血（subarachnoid hemorrhage） 脑出血（intracerebral hemorrhage, ICH） 脑梗死 (cerebral infarction) 动脉粥样硬化性血栓性脑梗死 (arterothrombotic cerebral infarction) 脑栓塞(cerebral embolism) 腔隙性脑梗死(lacunar infarction)等 危险因素risk factor 高血压hypertension 糖尿病diabetes 心脏病heart dieases 高脂血症hyperlipemia TIA 或脑卒中史historic stroke 吸烟smoking和酗酒heavy alcohol consumption等 不可干预的因素non-intervention ：年龄、性别、种族、遗传因素等 主要的症状和体征sings and symptoms 起病突然 全脑症状 局灶性症状和体征(focal sings and symptoms) 颈内动脉系统表现 (internal carotid artery) 椎-基底动脉系统表现 (basilar-vetebral artery) 脑膜刺激征 短暂性脑缺血发作 transient ischemic attack 短暂性脑缺血发作transient ischemic attack , TIA 脑动脉一过性供血不足 transient insufficiency of blood in cerebral arteries 短暂发作 transient attack 局灶性脑功能障碍 focal brain disorder 24小时内完全恢复 complete recovery in 24 hours 可反复发作 recurrent attacks 病因和发病机制etiopathogenisis and pathogenesy 微栓塞 microembolism 脑血管痉挛、狭窄或受压 cerebrovascular spasm 血流动力学改变 hemodynamics disorders 血压、血液成分改变blood compotents disorders 其他 others 临床表现clinical situation ＞50岁 patients older than 50, 常伴有动脉硬化、高血压、糖尿病、冠心病等 accomply with angiosclerosis, hypertension, diabetes, coronary artery disease 发病突然，迅速出现局限性神经功能障碍 acute onset of a neurologic deficit 持续时间短 ，＜24小时 neurologic deficit persists for less 24 hours 不留后遗症 no residual 可反复发作 recurrent attacks 颈内动脉系统TIA TIA of internal carotid artery 短暂性偏侧或单肢无力 transient hemiparesis 面部、单肢或偏身麻木 hemisensory disturbances 同向偏盲或单眼一过性失明 homonymous hemianopia or tr