Stroke

In this paper I propose a theoretical framework for the treatment of patients with self-care problems. This framework takes as its starting point the frequent countertransference “pulls” encountered with such patients toward what might be called concerned action—the impulse to intervene actively in a protective or directive way in the hope of fostering better self-care. I suggest that, rather than simply acting on these impulses, on one hand, or viewing them as projectively or intersubjectively induced impulses simply to be processed internally by the analyst for purposes of interpretation, on the other, we view such impulses as the opening of a paradoxical or dialectical potential space in the transference–countertransference relationship. I argue that self-care problems result from the breakdown of a central dialectic in the parent–child relationship between concerned action and empathic recognition and that it is this dialectic that must be reestablished and reworked in the treatment relationship.     

卒中

本栏目中卒中与成人卒中指南来自美国心脏学会2005年1月23～30日在堪萨斯州达拉斯举办的2005年心肺复苏及急诊心血管疾病治疗共识会议(Circulation,2005,112:Ⅲ-110-Ⅲ-114)。     

加拿大阿尔伯塔省卒中策略——卒中二级预防

<正> 缺血性卒中和短暂性脑缺血发作(transient ischemic attacks,TIA)患者再发卒中和其他血管事件的风险增加。TIA发生卒中的风险很高。TIA患者90d内发生卒中的风险为10%～20%。其中50%的患者是在2 d(48 h)内发生卒中。复发卒中比初发卒中更有可能致残和致死。20%～40%卒中患者病前有TIA或非致残卒中。卒中二级预防的重点在于阻止或推延高危人群的未来疾病事件,实现功能和临床症状的改善,促进健康和提高生活质量。幸运的是,有足够的证据显示:通过改变生活方式、管理血管危险因素和适当药物治疗来大大减少再发卒中的危险。     

Stroke：急性缺血性卒中血管内再通治疗工作流程新进展

<正>对于行血管内治疗的急性缺血性卒中患者,提供最佳的诊断过程和快速的血管内治疗需要急救医疗服务(emergencymedical service,EMS)人员、急诊科医师、卒中医师、神经介入医师和麻醉医师的密切合作。2019年Stroke杂志新发表的一项系统性回顾和荟萃分析探讨了对于急性缺血性卒中患者救治,特定的工作流程改进对快速行血管内治疗的效果。这些具体的工作流程改进内容如下:     

静止性卒中：附58例报告

报告５８例静止性卒中（无症状性卒中）经头颅ＣＴ检查均有梗塞灶，但无卒中史，神经系统检查正常。５８例中除１例外，其余均为腔隙性梗塞，其中病灶位于基底节有４０个，侧脑室旁６个，外囊３个，丘脑２个，顶叶６个，颞叶３个，枕叶１个，小脑１个，胼胝体膝部１个，本文讨论了静止性卒中与高血压，缺血性心脏病及ＴＩＡ发作持续时间的关系，提出将此类卒中称为静止性卒中更妥。     

Mixed Stroke

Purpose To summarize the chnical, autoptic and animal experimental dala of stroke, propose the concept of mixed stroke (MS) and demonstrate the enoiogy, pathogenesis, clinical mainfestations, prophylaxis and treatment of MS Background At present. stroke still is classified in the national and international academic fields as two main groups: hemorrhage and ischema In fact, thc cerebral vascular disease with hemorrhage forus and ischema focus at the same time is not rare moreover, this type of stroke has special etiology, pathogenesis and clinical manifestations. But it is always made a main dagnosis and neglected the other nature of coexistent focus on either clinical or pathological diagnosis according to traditional classification of stroke Data sources and methods Mort of pablished originsl articles about MS in our department and laboralory wcre reviewed. Resulta The clinical autoptic and animal experimental dats all prcved that hemorrhage and infarction could occur in the course of a stroke simultaneously or in suecession during a short time, which demonstrated the existence of MS It was found clinically that MS patients all had the hustory of hypcrtension and in the autoptic data the MS patients dying of stroke all had typical hypertensive changes in the heart and kidney. and had hypertensive arteriosclerosis in the cerebral arteriole and small artery. MS was cas lily thdueed in stroke-prone renovascular hypertensivc rats This kind of rats are free from genetic deficiency and arc not affected by senile factor, so their cerebral vascular foci are mainly induced by the single factor -hypertension. TThese indicate definitely that hypertensive cerebral vascular lesion is the basis inducing MS. The main lesions of hypertensive cerebral arteriole and small artery were hyalinosis and fibrinoid of the walls, and the formation of microaneurysms or hyperplasla of iniernal and external layers The math lcsions of hypertensive cerebral capillaries were increasing vascular permeability. mural damage. edema of brain tissuc surroumding the vessel. stenotie lumen and leakage of bloed cells These lcsions in varying degrees were observed at different part of thc same brain or at different length of the same vessel at the same time, on the basis of which both hemocrhagic stroke and ischemic stroke could occurr These indicate the brain of the same patient with hypertension has pathomocpliological base of hemorrhagic strokc and ischemic stroke at the same time After after acute cerebral vascular disease occurring, it can be complicated by the other opposite nature of focus during a short time owing to oppression. draw. vascular spasm, metabolic disotder. sharp fluctuation of systemic blood pressure and other factors. The MS patients often had alterations of consciousness and the sign5 of meningeal irritation. were easlily complicated by multiple system organ failure Few cascs had distinct mulufocal cerebral lesions climcally. but after a careful cxamination of the nervous system. bilateral pathologic reflexes were often found. CT or MRI is an important means to diagnose Mis and should be used in 1 -Sd after the onset The measures of treatment for MS should be more vigorous and reliable The factors aggravating pathological lesion should be paid special attention to prevent When MS suspected of occurring clinically, rational neutral measures of treatment are advisable With MS definitely diagnosed the doctors should treat the main foous positively. keep homeostasis, prevent the disorder of hypothafamic function. select proper drugs and treat mfection positively Preventing multiple system organ failure is a key to decrease the mortality of MS. Having spent many years exploring, we establish the anunal model of coexistent infarction and hemorrhage on the basis of stroke-prone renovascular hypertensive rats The incidence of MS up to 95% was found in the group. which were given an inIection of fiblinogen and resperpine. As this model can stimulate the clinical evolution of stroke very well and has very high incidence. it Is a good animal model of MS. conclusions It is essential to list MS as a type of stroke singly. Valuing and studying MS are im ponant for the whole fieid studying pathogenesis. prophylaxis and treatment of stoke.     

European Stroke Initiative Recommendations for Stroke Management-update 2003

This article represents the update of 'European Stroke Initiative Recommendations for Stroke Management', first published in this Journal in 2000. The recommendations are endorsed by the 3 European societies which are represented in the European Stroke Initiative: the European Stroke Council, the European Neurological Society and the European Federation of Neurological Societies.     

Pediatric Stroke

Pediatric stroke is relatively rare but may lead to significant morbidity and mortality. Along with the advance of brain imaging technology and clinical awareness, diagnosis of pediatric stroke is increasing wordwide. Pediatric stroke differs from adults in variable risk factor/etiologies, diverse and nonspecific clinical presentation depending on ages. This review will be discussed pediatric stroke focusing on their clinical presentations, diagnosis and etiologies/risk factors.