急性脑卒中救治规范与流程(英文）.ppt

Wengui Yu, MD, PhD
Division of Neurological Critical Care
Departments of Neurological Surgery and Neurology
Neurocritical Care of Acute Stroke
The Primary Diagnoses In Neuro-ICU
Intracerebral hemorrhage (ICH)
Subarachnoid hemorrhage (SAH)
Ischemic stroke/TIAs
Status post craniotomy for tumor resection
Traumatic brain injury (SDH, EDH)
Status post coil embolization, angioplasty, or stenting.
Thrombolysis for Ischemic Stroke
Intravenous t-PA
Intraarterial t-PA
Endovascular therapy
Angioplasty/Stenting
MERCI Retrieval
Penumbra Clot Retrieval
Coil embolization of aneurysm
Surgical treatment
Hemicraniectomy for MCA stroke
Advances in Stroke Management
S/p IA tPA
1. Neuro-monitoring
1). Neuro Exam
Simple and effective
Neurologic changes that need immediate attention
Mental status change
Decreased levels of consciousness: lethargy, stupor, coma.
Disorientation: name, place, time, and event.
Speech difficulty: expressive or receptive aphasia
Cranial nerve palsy: dilated and fixed pupil(s)
New weakness/numbness
2). Neuroimagings
a). CT
To follow hematoma expansion, cerebral edema, mass effect, herniation, or hydrocephalus.
Indicated in
First few days after stroke,
Deterioration on neuro exam,
Sedated and paralyzed patient.
b). CTA Contrast extravasation predicts hematoma expansion
CT demonstrates a left putaminal hematoma (A). A small focus of enhancement is
seen on CTA (B), consistent with extravasation on postcontrast CT (C). Unenhanced
CT image 1 day after presentation reveals hematoma enlargement and IVH (D).
- Wada et al. Stroke. 2007;38:1257
- Golstein et al. Neurology. 2007;20;68(12):889-94.
Contrast extravasation predicts mortality in ICH
A 69-yo man underwent imaging 2 hrs following onset of right-sided paralysis.
Admission NCCT demonstrates a left thalamic hematoma with extension into the third
Ventricle (A). CTA (B) and CECT (C), respectively, show 2 foci of active extravasation
(arrows). Follow-up NCCT 12 hrs later shows marked hematoma g