青年缺血性卒中_精品文档PPT资料.ppt
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青年缺血性卒中_精品文档PPT资料.ppt
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5.7%(within28days)4.8inNeuroNeurochirpol2000Nov-Dec;
wIncreasedwithage:
especiallyafter35y/owDramaticincreasedafter45inotherreportKristensen:
Stroke,Volume28(9).September1997.1702-1709EpidemiologywTable1.AverageAnnualAge-andSex-SpecificIncidenceRatesofFirstIschemicStrokeinYoungAdultsinNorthernSweden,1991to1994From:
Kristensen:
Stroke,Volume28(9).September1997.1702-1709EpidemiologywTable1.AgesofYoungMenandWomenWithIschemicStrokeArchNeurol.1995;
52:
491-495EtiologywAtherosclerosisisthemaincauseofstrokeinelderly,whileemboligenouscardiopathyistheoneofthemaincauseofyoungadultAnnaliItalianidiMedicinaInterna.11
(1):
33-8,1996Jan-MarwCardiacembolismwasthemostcommoncauseofstrokeinptyoungerthan40Stroke.30(11):
2320-5,1999Nov.20018350wAtherosclerosiswas38.2%andcardioembolismwas18.1%ActaNeurologicaScandinavica.101
(1):
19-24,Jan2000.EtiologywAtherosclerosis33.3%,Prothromboticstate15.5%,Cardiogenic9.5%OrvHetil2001Mar25;
607-10wAtherosclerosis29.8%,Cardioembolism19.5%,Hematologic5.8%ArchNeurol.1995;
491-495wSocardioembolismandatherosclerosisaretowmajorcauseofstrokeinyoungadultswCausearediverseEtiologyEtiologyEtiologywAtherosclerosis:
a.Largearteryb.SmallarterywEmbolism:
a.Cardiogenicb.Non-cardiogenicwNon-Atherosclerosisartriopathy:
a.Inflammatoryb.Non-inflammatorywHemologicaldisorder:
a.Viscosityb.CoagulopathywOthers:
EtiologywEmbolism:
a.Cardiogenic:
1.Valvular:
RH,prosthetic,endocarditis,MVP2.Arrhythmia:
Af,sicksinussyndrome3.AMI/LVaneurysm:
4.LVmyxoma:
5.Cardiomyopathy:
b.Non-cardiogenic:
1.PulmonaryAVM:
Osler-Weber-Rendusyndrome2.ASD/VSDorPOFwithshunt:
3.Pulmonaryembolism:
EtiologywNon-atherosclerosisarteriopathy:
a.Inflammatory:
1.Takayasusdisease:
=Granulomatousarteritis,mono,無脈症2.Hepersensitivearteritis:
Churg-straussdisease3.Infectious:
Syphiliticarteritis,TB,HIV-associated4.Drugrelated:
heroin,amphetamine5.Systemicdisease:
SLE,RA,polyarteritisnodosaEtiologywNon-atherosclerosisarteriopathy:
a.Non-inflammatory:
1.Moyamoyadisease:
2.Arterydissection:
3.Irradiationvasculopathy:
4.Fibromusculardysplasia:
5.Firinoidvasculopathy:
EtiologywHematologicaldisorder:
a.Viscosity:
1.MDS:
CML,polycythemiavera,essentialthrombocythemia2.Multiplemyeloma:
3.Leukemiab.Coagulopathy:
b.Coagulopathy:
1.Hemoglobindisorder2.ProteinC/Sdeficiency3.AntithrombinIIIdeficiency4.DIC5.Anti-phospholipidantibodyEtiologywOthers:
1.Migraine2.Pregnancy3.TraumaRiskFactorStroke,Volume28(9).September1997.1702-1709RiskfactorwAgreedbymostreportersare:
1.Cigarettesmoking2.Hypertension3.HyperlipidemiaOrvHetil2001Mar25;
607-10Postgraduatemedicine.81(5):
141-4,149-511987Apr.ActaNeurologicaScandinavica.101
(1):
19-24,Jan2000ClinicalPresentationwEmbolism:
1.Suddenonsetofcorticalimpairment2.Heartconditionpredisposingtoembolism3.Maybefluctuated,andmayrecoverordeterioratClinicalPresentationwLargearteryatherosclerosis:
1.Cerebralcorticalimpairment:
aphasia,apraxia,anopia,agnosia,restrictedmotorinvolvement2.Historyofintermittentclaudication,TIAClinicalPresentationwSmallarteryocclusion(lacunae)1.Traditionalclinicallacunarsyndromea.Puremotorhemiparesisb.Puresensorystrokec.Ataxiahemiparalysisd.Dysarthria-clumsyhande.Sensorymotorstroke2.HistoryofHTNandDMsupportsDxPrognosiswFirst28daysmortality:
4.8/5.7%wNeurologicaldeficit(Canadianneurologicalscale)andhandicapseverity(Rankinclassification,Barthelindex)areallmuchbetterthanelderly.1/3;
6mowAlthoughinfarctsizeusuallybigger(3cm)wRecurrenceriskislow:
1.1-1.2annuallywOverall,prognosisismuchbetter,soaggressivetreatmentinterventionisimportant.AdvisedClinicalStudywCT/MRI/angiographyw12leadEKGwEchocardiogram/TEEwDupplex(carotidandICdoppler)wBCS,rheumaticprofile,autoimmuneprofile,coagulationprofileConclusionwIschemiastrokeinyoungadultsmustbestudiedwithadifferentprotocolfromthatusedfortheelderly,duetothedifferenceoftheetiologyandtheprognosis.AnnaliItalianidiMedicinaInterna.11
(1):
33-8,1996Jan-Mar
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