小结
定义
病史和体格检查
关键诊断因素
- 面部、上肢或下肢单侧无力或瘫痪
- 构音障碍
- 共济失调
- 视觉障碍
- 危险因素
其他诊断因素
- 感觉缺失（麻木）
- 构音障碍
- 头痛
- 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）
- 意识水平下降或昏迷
危险因素
- 老年
- 卒中家族史
- 缺血性卒中或 TIA 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
- 阻塞性睡眠呼吸暂停
- 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
- 超声心动图
治疗流程
疑似缺血性卒中
确诊的缺血性卒中
撰稿人
专家顾问
Matthew Jones, MD, FRCP
Consultant Neurologist
Greater Manchester Neurosciences Centre
Salford Royal Foundation Trust
Honorary Senior Lecturer
University of Manchester
Manchester
UK
利益声明
MJ is the chair of the Association of British Neurologists Education Committee (unpaid position). MJ is a faculty member of an MRCP revision course.
Rachael Power
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.
Acknowledgements
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
Kayvan Khadjooi, MD, FRCP, PGCertMedEd
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.
编辑
Helena Delgado-Cohen
Section Editor, BMJ Best Practice
利益声明
HDC declares that she has no competing interests.
Tannaz Aliabadi-Oglesby
Lead Section Editor, BMJ Best Practice
利益声明
TAO declares that she has no competing interests.
Julie Costello
Comorbidities Editor, BMJ Best Practice
利益声明
JC declares that she has no competing interests.
Adam Mitchell
Drug Editor, BMJ Best Practice
利益声明
AM declares that he has no competing interests.
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