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
- 头颅 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)
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
治疗流程
无脑静脉窦血栓形成
脑静脉窦血栓形成
撰稿人
作者
David Wang, DO, FAHA, FAAN
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.
Yi Dong, MD, PhD
Department of Neurology
Huashan Hospital
Fudan University
Shanghai
China
利益声明
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
利益声明
YW declares that he has no competing interests.
鸣谢
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
Julien Morier, MD
Neurology Registrar
Neurology Service
Centre Hospitalier Universitaire Vaudois (CHUV)
Lausanne
Switzerland
利益声明
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
利益声明
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
利益声明
TR declares that he has no competing interests.
鉴别诊断
- 脑出血
- 短暂性脑缺血发作
- 短暂性全面性遗忘症
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