最后审阅: 16 四月 2021
最后更新: 03 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
  • 肌无力
  • 语言功能受损(失语症
  • 共济失调
  • 危险因素

其他诊断因素

  • 阴性症状(即功能丧失
  • 感觉缺失
  • 头痛
  • 复视
  • 构音障碍
  • 凝视麻痹
  • 心律失常、心脏杂音或肺水肿
  • 眩晕
  • 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
  • 意识水平改变或昏迷

危险因素

  • 老年
  • 卒中家族史
  • 缺血性卒中病史
  • 高血压
  • 吸烟
  • 糖尿病
  • 心房颤动
  • 伴发心脏病
  • 颈动脉狭窄
  • 镰状细胞病
  • 血脂异常
  • 教育水平较低
  • 非洲裔美国人或者西班牙裔
  • 饮食不良与营养
  • 缺乏体力活动
  • 肥胖
  • 酗酒
  • 雌激素治疗
  • 非法用药
  • 偏头痛
  • 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

诊断性检查

首要检查

  • 头颅 CT 平扫
  • 血清葡萄糖
  • 血清电解质
  • 血清尿素和肌酐
  • 心肌酶
  • 全血细胞计数 (FBC
  • 心电图(ECG
  • 凝血酶原时间和 PTT(含 INR

需考虑的检查

  • 血清毒理学筛查
  • 头颅弥散加权 MRI
  • CT 血管造影术或 MR 血管成像 ± 增强
  • CT 或 MRI 灌注加权成像
  • 颈动脉超声

治疗流程

撰稿人

Consultant Neurologist

Greater Manchester Neurosciences Centre

Salford Royal Foundation Trust

Honorary Senior Lecturer

University of Manchester

Manchester

UK

利益声明

MJ declares that he has no competing interests.

Neurology Registrar

Manchester Centre for Clinical Neurosciences

Manchester

UK

利益声明

RP has been sponsored by Novartis to attend the International Headache Conference.

BMJ Best Practice would like to gratefully acknowledge the previous expert contributor for this topic, whose work has been retained in parts of the content:

George Ntaios, MD, MSc (ESO Stroke Medicine), PhD, FESO

Assistant Professor of Internal Medicine

Medical School

University of Thessaly

Greece

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.

同行评议者展开全部内容

Consultant in Stroke Medicine

Addenbrooke’s Hospital

Associate Lecturer

School of Clinical Medicine

University of Cambridge

Cambridge

UK

利益声明

KK has received travel grants for conferences/speaker honoraria from Bayer, Boehringer, Daiichi-Sankyo, Pfizer, and Shire.

Section Editor, BMJ Best Practice

利益声明

HDC declares that she has no competing interests.

Lead Section Editor, BMJ Best Practice

利益声明

TAO declares that she has no competing interests.

Comorbidities Editor, BMJ Best Practice

利益声明

JC declares that she has no competing interests.

Drug Editor, BMJ Best Practice

利益声明

AM declares that he has no competing interests.

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