脑中风(STROKE)-课件.ppt

腦 中 風 (STROKE) 哈鐵木爾 Tomor Harnod MD (DR. Tumor Hard to Know) Neurosurgical Department, Tzuchi General Hospital, Hualien What is the “Stroke” (Cerebro-vascular Accident, CVA)? 腦中風, 或稱腦血管意外為急性之腦血管疾病, 由許多因素造成, 突發性之腦血管阻塞或破裂, 導致腦部組織缺氧或出血, 使病人意識或神經功能喪失. (神經醫學講義) The symptom /sign of the stroke sudden onset of conscious change or fainting numbness smell or taste change visual change dizziness, vertigo, imbalance fits, seizures, convulsions vomiting, headache, papilledema (triad) weakness, gait or speech disturbance difficulty with bladder or bowel control 意識障礙一定是腦部病因?The causes of conscious change or shock neurogenic cardiogenic hypovolemic septic metabolic or endogenous The stroke types--I 暫時性腦缺血 (Transient Ischemic Attacks, TIA)-- 突發局部功能喪失於24小時內完全恢復, 不遺留任何症狀. 阻塞性腦中風 (Occlusive Cerebral Vascular Disease)-- Lacunar infarct (2-20mm) Extracranial carotid artery disease Intracranial artery infarct (ICA, ACA, MCA, PCA, anterior choroidal artery) Cerebral emboli of cardiac origin CVA, VGH, Taipei, 1989 incidence for people aged 36-- 1,642/ 100,000 infarction-- 67.1% cerebral hemorrhage-- 14.0% SAH-- 4.2% unclassified-- 14.7% prognosis-- 67.1% independent in daily activity, 75.5% with independent ambulation CVA, VGH, Taipei, 1994 male/ female-- 1.5/ 1 infarction/ hemorrhage-- 1.5/ 1 prognosis-- in patients with infarct, 8.4% death 54.8% with poor outcome 36.8% with good or fair outcome The stroke types--II 出血性腦中風 (Cerebral Hemorrhage) putamen, thalamus, pons, cerebellum, lobar hemorrhage (AVM or Amyloid angiopathy?) 蜘蛛網膜下腔出血 (Subarachnoid Hemorrhage, SAH) Spontaneous ICH in Taiwan, NTUH, 1993 male/ female-- 1.1/ 1 prognosis-- 23-30% death (24.3% in patients with medical Tx., 18.7% in