最近审阅: 24 十月 2020
最近更新: 10 七月 2020

小结

定义

病史和体格检查

关键诊断因素

  • 视力丧失或视野缺损
  • 无力
  • 失语症
  • 共济失调(协调能力受损)

其他诊断因素

  • 短暂性脑缺血发作 (TIA) 病史
  • 突然发作的症状
  • 阴性症状(即功能丧失)
  • 感觉改变
  • 头痛
  • 复视
  • 感觉缺失
  • 构音障碍
  • 凝视麻痹
  • 心律失常、心脏杂音或肺水肿
  • 眩晕/头晕
  • 恶心和/或呕吐
  • 颈部或面部疼痛
  • 瞳孔缩小、眼睑下垂、面部无汗(单侧)
  • 意识水平改变/昏迷
  • 意识模糊

危险因素

  • 高血压
  • 老年
  • 镰状细胞病
  • 卒中家族史
  • 短暂性脑缺血发作 (TIA) 病史
  • 缺血性卒中病史
  • 脑微出血
  • 吸烟
  • 糖尿病
  • 心房颤动
  • 伴发心脏病
  • 颈动脉狭窄
  • 颅内动脉粥样硬化(ICAS)
  • 血脂异常
  • 教育水平较低
  • 种族
  • 饮食不良与营养
  • 低出生体重
  • 缺乏体力活动
  • 肥胖
  • 酒精滥用
  • 雌激素治疗
  • 偏头痛
  • 非法用药
  • 高同型半胱氨酸血症
  • 脂蛋白 (a) 水平升高
  • (血液)高凝状态
  • C 反应蛋白水平升高
  • 主动脉弓斑块
  • 卵圆孔未闭

诊断性检查

首要检查

  • 脑部 CT
  • 颅脑 MRI 扫描
  • CT 或磁共振血管成像 (MRA)
  • CT 或 MRI 灌注
  • 血清葡萄糖
  • 血清电解质
  • 血清尿素和肌酐
  • 心肌酶
  • 心电图(ECG)
  • 全血细胞计数(FBC)
  • 凝血酶原时间和 PTT(含 INR)
更多 首要检查

需考虑的检查

  • 血清毒理学筛查
  • 胸部 X 线检查(CXR)
  • CT、磁共振或数字减影静脉造影术
  • 颈动脉超声
  • 经颅多普勒超声
  • 传统的(侵入性)血管造影术
更多 需考虑的检查

治疗流程

撰稿人

Professor of Neurology

Co-Director, Neurovascular Division & Stroke Program

Neurology Department

Barrow Neurological Institute

Phoenix

AZ

利益声明

DW is 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.

Department of Neurology

Huashan Hospital

Fudan University

Shanghai

China

利益声明

YD declares that she has no competing interests.

Professor of Neurology

Deputy Director, Department of Neurology

Beijing Tiantan Hospital, Capital Medical University

Beijing

China

利益声明

YW declares that he has no competing interests.

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.

利益声明

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.

同行评议者展开全部内容

Neurology Registrar

Neurology Service

Centre Hospitalier Universitaire Vaudois (CHUV)

Lausanne

Switzerland

利益声明

JM declares that he has no competing interests.

Lecturer in Neurology

Hospital Chief

Cerebrovascular/Stroke Division

Beth Israel Deaconess Medical Center

Division of Cerebrovascular/Stroke

Boston

MA

利益声明

LRC declares that he has no competing interests.

National Clinical Director

Stroke NHS England

Professor, Stroke Medicine

Kings College London

Chair, Intercollegiate Stroke Working Party

Royal College of Physicians

London

UK

利益声明

TR declares that he has no competing interests.

内容使用需遵循免责声明