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

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.     

卒中健康管理师为主导的卒中管理模式对缺血性卒中预后及复发的影响研究

目的 探讨以患者需求为导向、卒中健康管理师为主导的卒中管理模式对轻中度缺血性卒中患者预后及卒中复发的影响.方法 连续纳入2019年1-6月诊治的轻中度缺血性卒中患者,随机分为对照组和试验组.对照组采用常规卒中管理模式,试验组采用以患者需求为导向、卒中健康管理师为主导的卒中管理模式.比较两组患者12个月随访时的血压、空腹...     

Stroke Mimics: Experience of a Moroccan Stroke Unit

Background: Stroke mimic is a medical condition presenting with acute neurological deficit and simulate real stroke. The objective of this study was to evaluate the frequency and the various etiologies of stroke mimics in our center. Methods: We retrospectively reviewed the Thrombolysis Alert registry and we studied the frequency and characteristics of patients with stroke mimic. Results: Among 673 patients who were admitted to the emergency department within 4.5 hours for sudden focal neurological deficit suggestive of acute stroke, 105 patients (15.6 %) had a stroke mimic. The mean age of patients with mimics and brain strokes were 66.3 and 64.8, respectively. The mean Onset-to-door time was 136.82 minutes and the mean door-to-imaging time was 32.63 minutes in stroke mimics. Seizure (28.5%) was the most common diagnosis of stroke mimics followed by conversion disorder (25.7%). Conclusions: Stroke mimic is frequent and heterogeneous entity that can be difficult to identify. Fortunately, most previous studies show no harmful effects when using thrombolysis in a stroke mimic.     

Secondary Stroke Prevention in Cryptogenic Stroke and Embolic Stroke of Undetermined Source (ESUS)

Purpose of the Review

The purpose of the study was to review the literature on cryptogenic stroke and embolic stroke of undetermined stroke (ESUS). Cryptogenic stroke according to TOAST criteria is a stroke which is not due to cardiogenic embolism, small vessel disease with lacunes or large vessel disease of brain supplying arteries. In the context of secondary stroke prevention studies, cryptogenic stroke is not operationally defined.

Recent Findings

The new concept of “embolic stroke of undetermined source” (ESUS) provides an operational definition. ESUS is diagnosed as a non-lacunar stroke on cerebral imaging and exclusion of large vessel atherosclerosis by CTA, MRA or ultrasound. Cardiogenic embolism is made less likely by ECG monitoring and echocardiography. At present, aspirin is used for secondary stroke prevention in patients with cryptogenic stroke.

Summary

Based on the construct that ESUS might be caused by undetected atrial fibrillation or other embolic mechanisms, ongoing randomised secondary stroke prevention trials are comparing non-vitamin K oral anticoagulants (NOACs) with aspirin.

     

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:     

Clinical Characteristics of Driving-related Stroke Occurring as a Recurrent Stroke

Background: Although the number of seemingly healthy subjects who suffer a minor stroke increases, there are no data on how frequently they sustain another stroke while driving. Methods: A single-center, retrospective study was conducted to clarify the clinical characteristics of driving-related stroke occurring as a recurrent stroke by analyzing data prospectively acquired between January 2009 and June 2019 on 3452 acute stroke patients. Results: One hundred-thirty five patients (85 ischemic stroke [IS] and 50 hemorrhagic stroke [HS]) had suffered a driving-related stroke. Of them, 22 (16%) had suffered a prior stroke (recurrent stroke group), while 113 had never suffered a stroke before (first-time stroke group). While the use of anti-thrombotics was significantly more common in the RS group, other variables including the frequency of road traffic accidents, did not differ significantly. The first stroke–recurrent stroke interval ranged from 0.2 to 18 years. The stroke type at the time of recurrence was IS in the majority of patients with prior IS. When compared to 432 patients with recurrent IS unrelated to driving, patients with recurrent IS related to driving (n = 16) had significantly higher frequency of lacunar strokes (56% vs 27%, P = .02) and lower frequency of cardioembolic strokes (6% vs 29%, P = .04). Conclusion: The current finding that 16% of patients who presented with driving-related stroke had previously suffered a stroke indicates that drivers with a prior stroke may be at increased risk for recurrent stroke while driving, and prolonged follow-up be necessary for minor stroke patients who resume driving.