卒中的神经影像学.ppt

脑卒中的神经影像学诊断 Types of stroke 脑卒中影像学诊断的重要性： 脑卒中是一种急性起病、由血管性原因致使局灶性或全脑神经功能缺损的临床综合征,临床症状通常持续超过24小时或死亡1,其中80%是缺血性卒中,15%为脑内出血,5%为蛛网膜下腔出血.正确诊断脑卒中是非常重要的,因为缺血性卒中的治疗方案2对于脑出血来说是禁忌证3.卒中的诊断需要可靠的脑部影像学检查4。 但选择何种影像检查,是CT还是磁共振成像(MRI)?在发病后多长时间内完成?是否有必要检查脑血流?哪一种方法具有最好的成本效益?所有这些都需要我们深入研究 1] Hatano S Experience from a multicentre stroke register:a preliminary report Bull World Helath Organization 1976/54/ P541-53 2] Chen ZM Sandercock P Pan HC Indications for early aspirin use in acute ischemic stroke:A combined analysis of 40000 randomized patients from the Chinese acute stroke trial and the international stroke trial.On behalf of the CAST and IST collaborative groups STROKE 2000/31/ P1240-9 3] Keir SL Wardlaw JM Sandercock PA Antithrombotic therapy in patients with any form of intracranial haemorrhage:a systematic review of the available controlled studies Cerebrovasc Dis 2002/14/ P197-206 4] Weir CJ Murray GD Adams FG Poor accuracy of stroke scoring systems for differential clinical diagnosis of intracranial haemorrhage and infarction LANCET 1994/344/ P999 In-hospital Diagnosis At the hospital, medical personnel will use one of more of the following diagnostic tests to determine the type of stroke and its location. Test that view the brain: CT (Computed Axial Tomography) MRI (Magnetic Resonance Imaging ) Test that view the blood vessels supplying the brain: Carotid Ultrasound Cerebral Angiography TCD (Transcranial Doppler) CTA (Computed Tomographic Angiography ) MRA (Magnetic Resonance Angiography ) DSA (Digital subtraction angiography) Computed Axial Tomography (CT scan, CAT scan): CT is a non-invasive, painless test that uses x-rays to produce a three-dimensional image of the interior of the patient’s head. An initial CT scan can quickly rule out hemorrhage or a brain tumor c