脑卒中患者GCS昏迷评分与临床肺部感染评分的相关性研究

目的探讨格拉斯哥昏迷评分（Glasgow Coma Scale,GCS）在急性脑卒中（Acute stroke）患者意识障碍中的应用,同时分析GCS与临床肺部感染评分（Clinical Pulmonary Infection Score,CPIS）的相关性。方法选取我院收治的急性脑卒中患者124例,应用GCS评价急性脑卒中患者意识障碍水平,同时分析临床肺部感染评分。结果 GCS评分越高,CPIS评分越低,GCS评分越低,CPIS评分越高,两者呈负相关性。结论 GCS和CPIS评分对于预测脑卒中预后有一定意义。     

Diagnosis of acute ischaemic stroke with fluid-attenuated inversion recovery and diffusion-weighted sequences

We evaluated the feasibility and use of diffusion-weighted and fluid-attenuated inversion-recovery pulse sequences performed as an emergency for patients with acute ischaemic stroke. A 5-min MRI session was designed as an emergency diagnostic procedure for patients admitted with suspected acute ischaemic stroke. We reviewed routine clinical implementation of the procedure, and its sensitivity and specificity for acute ischaemic stroke over the first 8 months. We imaged 91 patients (80 min to 48 h following the onset of stroke). Clinical deficit had resolved in less than 3 h in 15 patients, and the remaining 76 were classified as stroke (59) or stroke-like (17) after hospital discharge. Sensitivity of MRI for acute ischaemic stroke was 98 %, specificity 100 %. MRI provided an immediate and accurate picture of the number, site, size and age of ischaemic lesions in stroke and simplified diagnosis in stroke-like episodes. The feasibility and high diagnostic accuracy of emergency MRI in acute stroke strongly support its routine use in a stroke centre. Received: 20 May 1999 Accepted: 2 August 1999     

热射病事件后官兵急性应激反应与创伤后应激障碍症状调查

 目的 探讨训练导致重型热射病事件后官兵急性应激反应(acute stress response, ASR)发生的特征及继发创伤后应激障碍(post-traumatic stress disorder, PTSD)发生情况。方法 收集2020年7月(事件发生后1 d)和2020年8月(事件发生后1个月)对重型热射病事件涉及单位官兵整体采样。采用单样本前后对照方法,应用急性应激反应量表(acute stress response scale, ASRS)对直接经历事件的官兵(直接经历者)进行评分。比较在同一训练环境中直接经历事件的官兵(事件组)与未经历事件的官兵(对照组)在事件后1个月ASRS及PTSD检查表平民版(PTSD checklist-civilian version,PCL-C)的评分差异。结果 直接经历者ASRS量表总反应指数在事件发生后1个月比事件发生后1 d明显下降,差异有统计学意义(t=3.191,P=0.003)。在控制军龄变量后,事件组ASRS中行为维度评分均值高于对照组,呈边缘性显著差异;继续对ASRS中行为维度分析,两组在注重外形因子[F(1,60)=5.801,P=0.019, η²=0.088]、饮食因子[F(1,60)=3.859,P=0.05,η²=0.060]差异具有统计学意义;两组PCL-C量表评分差异无统计学意义。结论 虽然热射病事件未导致事件经历者ASR及PTSD发生,但事件经历者ASR的行为维度有一定改变,建议以认知行为疗法干预为主。     

急性应激大鼠脑组织NO、SOD含量变化及意义

目的 :观察急性应激大鼠脑组织一氧化氮 (NO)含量和超氧化物歧化酶 (SOD)活力变化 ,探讨其在急性应激障碍发病中的作用。方法 :通过建立急性应激模型 ,分别取脑边缘系统大脑额叶、海马、下丘脑及中脑 ,制成脑组织匀浆测定NO的含量和SOD的活力。结果 :急性应激组大鼠大脑额叶、海马、下丘脑及中脑组织SOD活力明显高于对照组 (P <0 .0 5) ,NO含量在海马、下丘脑升高明显 (P <0 .0 5)。结论 :结果提示 ,在应激反应过程中自由基对脑有损害作用 ,可能参与应激障碍的发病。     

Circulatory response to acute hypobaric hypoxia in conscious dogs.

Hemodynamics were studied in seven conscious dogs during acute hypobaric stress at 14,000 ft simulated altitude. Silastic catheters were chronically implanted in the pulmonary artery, left atrium, and aorta. Pulmonary and central aortic pressures, cardiac output, and pulmonary blood volume were determined under conditions of normoxia and acute hypoxia in a hypobaric chamber maintained at 446 mm Hg pressure (14,000 ft). Altitude resulted in significant increases in heart rate, cardiac output, pulmonary blood volume, and pulmonary artery pressure. Left atrial pressure and calculated systemic vascular resistance decreased during hypobaric hypoxia while stroke volume, stroke work index, arterial pressure and pulmonary vascular resistance remained unchanged. Arterial blood PO2 decreased markedly at altitude, and all animals hyperventilated with resultant systemic hypocarbic alkalosis. The combination of elevated pulmonary arterial pressure and increased pulmonary blood volume may by an etiologic factor in the development of high-altitude pulmonary edema.     

卒中单元联合高压氧治疗急性脑卒中的疗效观察

目的观察卒中单元联合高压氧治疗急性脑卒中的疗效。方法将研究对象分为对照组、卒中单元组、卒中单元+高压氧组,均采用常规的药物治疗,卒中单元组早期制定标准化操作程序,给予规范的综合康复治疗,卒中单元+高压氧组在卒中单元的基础上加上高压氧治疗。在治疗前后均采用欧洲卒中量表(ESS)和Barthel指数(BI)评分,并与对照组比较。结果治疗后卒中单元组、卒中单元+高压氧组ESS评分及BI评分显著高于对照组(P<0.01),卒中单元+高压氧组ESS评分及BI评分显著高于卒中单元组(P<0.05)。结论卒中单元联合高压氧治疗能明显改善急性脑卒中患者的运动功能及日常生活活动能力,改善生活质量。     

Imaging of acute stroke prior to treatment: current practice and evolving techniques

Standard imaging in acute stroke is undertaken with the aim of diagnosing the underlying cause and excluding stroke mimics. In the presence of ischaemic stroke, imaging is also needed to assess patient suitability for treatment with intravenous thrombolysis. Non-contrast CT is predominantly used, but MRI can also exclude any contraindications to thrombolysis treatment. Advanced stroke imaging such as CT and MR angiography and perfusion imaging are increasingly used in an acute setting. In this review, we discuss the evidence for the application of these advanced techniques in the imaging of acute stroke.     

Lesions masquerading as acute stroke

Rapid and accurate recognition of lesions masquerading as acute stroke is important. Any incorrect or delayed diagnosis of stroke mimics will not only increase the risk of being exposed to unnecessary and possibly dangerous interventional therapies, but will also delay proper treatment. In this article, written from a neuroradiologist's perspective, we classified these lesions masquerading as acute stroke into three groups: lesions that may have “normal imaging,” lesions that are “symptom mimics” but on imaging clearly not a stroke, and lesions that are “symptom and imaging mimics” with imaging findings similar to stroke. We focused the review on neuroimaging findings of the latter two groups ending with a suggestion for a diagnostic approach in the form of an algorithm. J. Magn. Reson. Imaging 2013;37:15–34. © 2012 Wiley Periodicals, Inc.     

Triggers of acute cardiovascular events and potential preventive strategies: prophylactic role of regular exercise

There is now considerable evidence to suggest that acute myocardial infarction, sudden cardiac death, and stroke can be triggered by physical, chemical, and psychological stressors, including heavy physical exertion and situations that create heightened emotional stress. The increased risk appears to be largely limited to a susceptible subset of the population, that is, individuals with known or occult cardiovascular (CV) disease. In this article, we summarize the evidence supporting the impact of selected triggers in the pathogenesis of acute CV events, as well as the potential role of various preventive strategies, especially regular exercise training and improvements in cardiorespiratory fitness to reduce the CV risk imposed by various triggers.     

心肌酶变化对急性脑卒中患者预后的影响

目的：观察急性脑卒中患者心肌酶变化特点及其对预后的影响。方法：观察56例急性卒中患者血清天冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）、肌酸激酶（CK）、乳酸脱氢酶（LDH）、α-羟丁酸脱氢酶（HBDH）的变化,比较不同GCS评分组心肌酶学检测结果以及死亡组与存活组心肌酶学检测结果。结果：GCS评分≤8分组心肌酶值增高,与其他2组比较差异有统计学意义（P〈0.05）;死亡组较存活组心肌酶值增高,差异有统计学意义（P〈0.05）;出血性卒中和缺血性卒中组心肌酶值比较差异无统计学意义（P〉0.05）。结论：血清心肌酶变化对急性脑卒中患者病情严重程度及预后有重要的预测价值。     

Past, present, and future perspectives on the endovascular treatment of acute ischemic stroke

Interventional neuroradiology plays a continuously expanding and exciting role in the treatment of acute stroke, as evidenced by the development of several important advances, including the advent of multiple new devices and therapies. Furthermore, guidelines regarding endovascular interventions in the setting of acute stroke have been developed and used. In addition to technological advances, the field of pharmacology in the setting of acute stroke is constantly evolving. In a rapidly expanding field, we aim to review significant recent advances related to the endovascular treatment of stroke as well as provide perspective for future directions.     

Intensive care of the acute stroke patient

Advances in the diagnosis, monitoring, and treatment of stroke have led to the development of specialized units capable of employing new technologies for acute stroke care. This new approach to treatment of the stroke patient has resulted in improved clinical outcomes and a better understanding of the factors that contribute to neurological recovery. Intensive monitoring after treatment, management of medical comorbidities, anticipation of known complications, and prompt treatment of a worsening condition each contribute toward this higher standard of care. While improved outcomes are associated with care in a dedicated stroke unit, many of the therapies employed have not been rigidly tested in randomized controlled trials. The stroke unit creates a unique environment for research and holds an academic responsibility to continue to validate its treatment and explore innovative therapies for treatment of acute stroke. The goal of this article is to discuss the current care of the acute stroke patient and to introduce novel therapies currently being investigated.     

Water diffusion and acute stroke

The occlusion of the middle cerebral artery was used as an experimental acute stroke model in 30 cats. The diffusion of water was followed by diffusion-sensitized MRI between 1 and 15 h after induction of stroke. It is demonstrated that images representing the trace of the diffusion tensor provide a much more accurate delineation of affected area than images representing the diffusion in one direction only. The reason is that the strong contrast caused by the anisotropy and orientation of myelin fibers is completely removed in the trace of the diffusion tensor. The trace images show a small contrast between white and gray matter. The diffusion coefficient of white matter is decreased in acute stroke to approximately the same extent as gray matter. It is further shown that the average lifetime of water in extra and intracellular space is shorter than 20 ms both for healthy and ischemic tissue indicating that myelin fibers are permeable to water. The anisotropy contrast did not change before or after induction of stroke, nor after sacrifice. Together, these observations are consistent with the view that the changes in water diffusion during acute stroke are directly related to cytotoxic oedema, i.e., to the change in relative volume of intra- and extracellular spaces. Changes in membrane permeability do not appear to contribute significantly to the changes in diffusion.     

Computed tomography perfusion imaging in acute stroke

The development of thrombolytic and neuroprotective agents for the treatment of acute stroke has created an imperative for improved imaging techniques in the assessment of acute stroke. Five cases are presented to illustrate the value of perfusion CT in the evaluation of suspected acute stroke. To obtain the perfusion data, a rapid series of images was acquired without table movement following a bolus of contrast medium. Cerebral blood flow, cerebral blood volume and mean transit time were determined by mathematically modelling the temporal changes in contrast enhancement in the brain and vascular system. Pixel-by-pixel analysis allowed generation of perfusion maps. In two cases, CT-perfusion imaging usefully excluded acute stroke, including one patient in whom a low-density area on conventional CT was subsequently proven to be tumour. Cerebral ischaemia was confirmed in three cases, one with an old and a new infarction, one with a large conventional CT abnormality but only a small perfusion defect, and one demonstrating infarct and penumbra. Perfusion CT offers the ability to positively identify patients with non-haemorrhagic stroke in the presence of a normal conventional CT, to select those cases where thrombolysis is appropriate, and to provide an indication for prognosis.     

Prehospital care of the acute stroke patient

Emergency medical services (EMS) is the first medical contact for most acute stroke patients, thereby playing a pivotal role in the identification and treatment of acute cerebrovascular brain injury. The benefit of thrombolysis and interventional therapies for acute ischemic stroke is highly time dependent, making rapid and effective EMS response of critical importance. In addition, the general public has suboptimal knowledge about stroke warning signs and the importance of activating the EMS system. In the past, the ability of EMS dispatchers to recognize stroke calls has been documented to be poor. Reliable stroke identification in the field enables appropriate treatment to be initiated in the field and potentially inappropriate treatment avoided; the receiving hospital to be prenotified of a stroke patient's imminent arrival, rapid transport to be initiated; and stroke patients to be diverted to stroke-capable receiving hospitals. In this article we discuss research studies and educational programs aimed at improving stroke recognition by EMS dispatchers, prehospital personnel, and emergency department (ED) physicians and how this has impacted stroke treatment. In addition public educational programs and importance of community awareness of stroke symptoms will be discussed. For example, general public's utilization of 911 system for stroke victims has been limited in the past. However, it has been repeatedly shown that utilization of the 911 system is associated with accelerated arrival times to the ED, crucial to timely treatment of stroke patients. Finally, improved stroke recognition in the field has led investigators to study in the field treatment of stroke patients with neuroprotective agents. The potential impact of this on future of stroke treatment will be discussed.     

Value of pre-intervention CT perfusion imaging in acute ischemic stroke prognosis

Noninvasive imaging plays an important role in acute stroke towards diagnosis and ongoing management of patients. Systemic thrombolysis and endovascular thrombectomy (EVT) are proven treatments currently used in standards of care in acute stroke settings. The role of computed tomography angiography (CTA) in selecting patients with large vessel occlusion for EVT is well established. However, the value of CT perfusion (CTP) imaging in predicting outcomes after stroke remains ambiguous. This article critically evaluates the value of multimodal CT imaging in early diagnosis and prognosis of acute ischemic stroke with a focus on the role of CTP in delineating tissue characteristics, patient selection, and outcomes after reperfusion therapy. Insights on various technical and clinical considerations relevant to CTP applications in acute ischemic stroke, recommendations for existing workflow, and future areas of research are discussed.

Neuroimaging is currently the mainstay of acute stroke workflow as it is used to rule out hemorrhage and select patients eligible for systemic thrombolysis and endovascular thrombectomy (EVT) (1). Advanced imaging has shown promise in acute stroke; however, the prognostic utility of computed tomography perfusion (CTP) imaging has drawn considerable debate. Given that stroke is associated with long-term morbidity and mortality, efforts to develop diagnostic imaging biomarkers have been pursued. However, the clinical translation of certain imaging modalities has been limited, especially CTP imaging. This could be attributed to the limited availability of CTP in under-resourced settings, variations in the diagnostic accuracy of CTP maps, and differences in the thresholds used in creating perfusion maps. In this paper, we will present a comprehensive overview of various imaging modalities in acute stroke with a particular focus on the clinically relevant utility of CTP and provide roadmap for future research.     

超选择性动脉溶栓联合血管内干预治疗急性缺血性脑卒中的临床探讨

目的探讨超选择性动脉溶栓联合血管内干预治疗急性缺血性脑卒中的疗效和安全性。方法回顾分析我院住院治疗的21例进行超选择性动脉溶栓的急性缺血性脑卒中患者的临床资料。结果21例患者中,颈内动脉系统病变16例．其中颈内动脉闭塞2例,大脑中动脉主干及分支闭塞6例,大脑前动脉闭塞1例,脑血管造影未见异常者7例。椎基底动脉闭塞5例,闭塞血管再通者,大脑中动脉4例,椎基底动脉2例。其中7例患者动脉溶栓的同时进行了血管内治疗,5例球囊成形术和2例支架植入术。临床症状完全恢复7例,明显好转或进步8例,无效3例,死亡3例;溶栓后脑出血2例．存活病例无1例并发脑出血及消化道出血。结论对选择的急性缺血性脑卒中患者进行超选择性动脉溶栓联合血管内干预治疗是安全有效的。     

Combined stent placement and thrombolysis in acute vertebrobasilar ischemic stroke

BACKGROUND AND PURPOSE: Acute vertebrobasilar ischemic stroke is often associated with high morbidity and mortality with limited therapeutic options. Endovascular treatment with thrombolysis has offered some hope for affected patients; however, overall outcomes have been less than satisfactory. In this report, we present the results of our approach in six consecutive cases of acute vertebrobasilar ischemic stroke by combined proximal vessel stent placement and thrombolysis. METHODS: Six consecutive cases were retrospectively reviewed for the clinical outcome of patients presenting to our institution with acute posterior circulation stroke who underwent cerebral revascularization including proximal arterial stent placement by using balloon-expandable coronary stents and intraarterial thrombolysis. All of these patients were initially evaluated by stroke team neurologists and imaged with MR, including diffusion-weighted imaging documenting acute posterior circulation stroke. MR angiography of the circle of Willis was also obtained. Short-term follow-up was conducted to assess National Institutes of Health stroke scores (NIHSS) and modified Rankin scores. RESULTS: In these six cases, a combined approach of proximal arterial stent placement (five cases of vertebral artery origin and one case of carotid and subclavian stent placement plus vertebral artery revascularization) and thrombolysis was performed at variable times after stroke onset (range, 30 hours to 5 days). Four of the six patients had good basilar artery recanalization (Thrombolysis in Myocardial Infarction [TIMI] grade 0-1 before tissue plasminogen activator thrombolysis and TIMI grade 2 after procedure). Four of six patients had excellent immediate recovery and were discharged to an acute rehabilitation unit or their homes with improved neurologic symptoms and functional status. Two patients died: one patient presented with coma at outset with an NIHSS of 38, and the other patient probably had reocclusion of the basilar artery within 24 hours despite initial postprocedural improvement. CONCLUSION: We demonstrate that, in the setting of acute stroke, stent placement in combination with revascularization and thrombolysis is practical and allows quick access to a clot and simultaneously increases perfusion through collaterals during the thrombolytic process. In particular, basilar thrombolysis may be facilitated by proximal vertebral stent placement as concomitant atheromatous vertebrobasilar stenosis is common.     

脑出血并发低钠血症42例临床分析

目的研究急性出血性脑卒中患者低钠血症的发生情况。方法回顾性分析42例急性出血性脑卒中患者并发低钠血症的临床特点、实验室检查、诊断及治疗情况。结果急性出血性脑卒中患者其血钠水平明显降低,包括抗利尿激素分泌不当综合征（SIADH）和脑性盐耗综合征（CSWS）,有明显的临床意义。结论早期分析和治疗低钠血症对急性出血性脑卒中治疗至关重要。     

Brain perfusion-CT in acute stroke patients

The role of neuro-imaging in the evaluation of acute stroke has changed dramatically in the past decade. Previously, neuro-imaging was used in this setting to provide anatomic imaging that indicated the presence or absence of acute cerebral ischemia and excluded lesions that produce symptoms or signs mimicking those of stroke, such as hemorrhage and neoplasms. More recently, the introduction of thrombolysis has changed the goals of neuro-imaging from providing solely anatomic information to providing physiologic information that could help to determine which patients might benefit from therapy. In particular, significant emphasis has been placed on the delineation of the ischemic penumbra, also called tissue at risk. Modern CT survey, consisting of three indissociable elements: noncontrast CT (NCT) of course, perfusion-CT (PCT) and CT-angiography (CTA), fulfill all the requirements for hyperacute stroke imaging. CTA can define the occlusion site, depict arterial dissection, grade collateral blood flow, and characterize atherosclerotic disease, whereas PCT accurately delineates the infarct core and the ischemic penumbra. CT offers a number of practical advantages over other cerebral perfusion imaging methods, including its wide availability. Using PCT and CTA to define new individualized strategies for acute reperfusion will allow more acute stroke patients to benefit from thrombolytic therapy.