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Acidente vascular cerebral (AVC) isquêmico

最后审阅: 18 Aug 2025
最后更新: 05 Aug 2025

小结

定义

病史和体格检查

关键诊断因素

  • perda de visão ou deficit de campo visual
  • fraqueza
  • afasia
  • ataxia (coordenação prejudicada)
完整详情

其他诊断因素

  • história de ataque isquêmico transitório (AIT)
  • início súbito de sintomas
  • sintomas negativos (por exemplo, perda da capacidade funcional)
  • alterações sensitivas
  • cefaleia
  • diplopia
  • perda sensitiva
  • disartria
  • Síndromes "cruzadas"
  • paresia da mirada
  • arritmias, sopros ou edema pulmonar
  • vertigens/tonturas
  • náuseas e/ou vômitos
  • dor cervical ou facial
  • miose, ptose e anidrose facial (hemilateral)
  • nível alterado de consciência ou coma
  • confusão
完整详情

危险因素

  • hipertensão
  • idade avançada
  • doença falciforme
  • história familiar de AVC
  • história de ataque isquêmico transitório (AIT)
  • história de AVC isquêmico
  • microssangramentos cerebrais
  • tabagismo
  • diabetes mellitus
  • fibrilação atrial
  • comorbidades cardíacas
  • estenose da artéria carótida
  • aterosclerose intracraniana (AEIC)
  • dislipidemia
  • menor grau de escolaridade
  • etnia
  • nutrição e dieta deficientes
  • baixo peso ao nascer
  • sedentarismo
  • obesidade
  • abuso de álcool
  • uso de terapia oral contendo estrogênio
  • gestação
  • enxaqueca
  • apneia obstrutiva do sono grave
  • sono de duração longa ou má qualidade do sono
  • uso de substâncias ilícitas
  • hiper-homocisteinemia
  • lipoproteína(a) elevada
  • estados hipercoaguláveis
  • proteína C-reativa elevada
  • placas no arco aórtico
  • forame oval patente (FOP)
  • poluição do ar
  • cigarros eletrônicos
  • infecções
  • endometriose
完整详情

诊断性检查

首要检查

  • tomografia computadorizada (TC) do crânio
  • ressonância nuclear magnética (RNM) cranioencefálica
  • Angiotomografia ou angiografia por ressonância magnética
  • Perfusão por TC ou RNM
  • glicose sérica
  • eletrólitos séricos
  • ureia e creatinina séricas
  • enzimas cardíacas
  • eletrocardiograma (ECG)
  • Hemograma completo
  • rastreamento para coagulopatia
完整详情

需考虑的检查

  • análise toxicológica sérica
  • rastreamento de infecção
  • teste genético
  • radiografia torácica
  • venografia por TC ou ressonância magnética ou venografia digital por subtração
  • ultrassonografia de carótidas
  • ecocardiograma
  • ultrassonografia com Doppler transcraniano
  • angiografia convencional (invasiva)
完整详情

治疗流程

急症处理

ausência de trombose venosa cerebral

com trombose venosa cerebral

撰稿人

作者

David Wang, DO, FAHA, FAAN

Professor of Neurology

Co-Director

Petznick Stroke Center

Neurovascular Division

Barrow Neurological Institute

Phoenix

AZ

Disclosures

DW received honorarium from Boehringer Ingelheim for lectures on the use of thrombolytics for acute ischaemic stroke. He has also received honorarium from Amgen, Zhongmei Huadong, and ShiYao Pharmaceuticals for speaking. DW was Chair, Stroke Section of the American Academy of Neurology, 2017-2019. He was Chair, Quality and Safety Subcommittee of the American Academy of Neurology (term ended June 2018). DW is an author of references cited in this topic.

Yi Dong, MD, PhD

Department of Neurology

Huashan Hospital

Fudan University

Shanghai

China

Disclosures

YD declares that she has no competing interests.

Yilong Wang, MD, PhD

Professor of Neurology

Deputy Director, Department of Neurology

Beijing Tiantan Hospital, Capital Medical University

Beijing

China

Disclosures

YW declares that he has no competing interests.

Acknowledgements

Dr David Wang, Dr Yi Dong, and Dr Yilong Wang would like to gratefully acknowledge Dr George Ntaios and Dr Alireza Minagar, the previous contributors to this topic.

Disclosures

GN is on the advisory boards for, and has received honoraria, speaker fees, and research support from: Amgen, Bayer, Boehringer-Ingelheim, BMS/Pfizer, Elpen, Galenica, Medtronic, Sanofi, and Winmedica. AM declares that he has no competing interests.

Peer reviewers

Nishant K. Mishra, MD, PhD, FRCP, FAHA

Assistant Professor of Neurology

Yale University

New Haven

CT

Disclosures

NM declares that he has no competing interests.

Julien Morier, MD

Neurology Registrar

Neurology Service

Centre Hospitalier Universitaire Vaudois (CHUV)

Lausanne

Switzerland

Disclosures

JM declares that he has no competing interests.

Louis R. Caplan, MD

Lecturer in Neurology

Hospital Chief

Cerebrovascular/Stroke Division

Beth Israel Deaconess Medical Center

Division of Cerebrovascular/Stroke

Boston

MA

Disclosures

LRC declares that he has no competing interests.

Tony Rudd, MD

National Clinical Director

Stroke NHS England

Professor, Stroke Medicine

Kings College London

Chair, Intercollegiate Stroke Working Party

Royal College of Physicians

London

UK

Divulgaciones

TR declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referencias

Nuestros equipos internos de evidencia y editoriales colaboran con colaboradores expertos internacionales y revisores pares para garantizar que brindemos acceso a la información más clínicamente relevante posible.

Artículos principales

Kleindorfer DO, Towfighi A, Chaturvedi S, et al. 2021 guideline for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline from the American Heart Association/American Stroke Association. Stroke. 2021 Jul;52(7):e364-467.Texto completo  Resumen

Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2019 Dec;50(12):e344-418.Texto completo  Resumen

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
  • Acidente vascular cerebral (AVC) isquêmico images
  • Diferenciales

    • Hemorragia intracerebral
    • Ataque isquêmico transitório
    • Amnésia global transitória
    Más Diferenciales
  • Guías de práctica clínica

    • Diagnosis and management of cerebral venous thrombosis: a scientific statement from the American Heart Association
    • European Stroke Organisation (ESO) - European Society for Minimally Invasive Neurological Therapy (ESMINT) guidelines on mechanical thrombectomy in acute ischaemic stroke
    Más Guías de práctica clínica
  • Folletos para el paciente

    AVC causado por um coágulo sanguíneo: prevenção de um novo AVC

    Inserção de sonda de alimentação

    Más Folletos para el paciente
  • Calculadoras

    Escore de AVC do NIH

    Escore ABCD2 para prever o risco de AVC após um AIT

    Más Calculadoras
  • Videos

    Intubação traqueal - Vídeo de demonstração

    Ventilação com ressuscitador manual ("bolsa-válvula-máscara") - Vídeo de demonstração

    Más vídeos
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