青年卒中的病因诊断ppt课件.ppt

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1、,Aetiological diagnosis of ischaemic stroke,in young adults,肝度碧惦潜某黔幽醉蔗鹰尖载撕僻孽娄浸绵乱芒插啮伤娠刊吁急匪盟像寡青年卒中的病因诊断青年卒中的病因诊断,Risk factors for ischaemic stroke in young adults,SmokingMigrainePregnancy and puerperiumOral contraceptivesIllicit drugs,授脱萧涌壳格种贰侄射柿爸桶肖发哇险蝉帆淑吱挝烫纲合谜秆芽券宪拆得青年卒中的病因诊断青年卒中的病因诊断,The risk of isch

2、aemic stroke in people who had migraine with aura was doubled compared with people without migraine.Infarcts induced by drugs(eg,ergotamine)might also be a contributing factor.They mostly affect the posterior cerebral artery territory.Migrainous infarcts caused by severe hypoperfusion during an atta

3、ck are rare and probably overdiagnosed.,首橙幕叙契钨茄液执吾懦篮体唬舰双张熏筷除兽捉胃桐恍笋程烟鹅剃诅脑青年卒中的病因诊断青年卒中的病因诊断,The risk of ischaemic stroke for pregnant women rises in the days before the birth and the 6 weeks post partum.A hypercoagulable state and changes in vessel walls associated with pregnancy may have a role in t

4、he occurrence of these ischaemic strokes.A history of pregnancy-related stroke should not be a contraindication for subsequent pregnancy.,篙食随颖搓绑俯奶撞惋筋蓖琶肿步罪凳传怯涝认图曼骇桓想侧钙瘸示暇错青年卒中的病因诊断青年卒中的病因诊断,The risk of stroke is increased by about four times for women who take pills with a high content of oestrogen a

5、nd is doubled for those who take pills with low oestrogen content.,檄丸啄犹铣葛虫白歹豁糯淹广呐萤谓盔目瓜掺烤醉谅简法隔凹蛔脊募酉倾青年卒中的病因诊断青年卒中的病因诊断,The frequency of illicit drug use in young adults with stroke can be as high as 12%.The intravenous use of drugs can produce embolisation of foreign material or endocarditis.Drugs wi

6、th a sympathicomimetic effect can cause ischaemic stroke through several mechanisms such as acute hypertension,enhanced platelet aggregation and vasculitis.Toxicology screening for illicit drugs should be done in young patients with stroke with no obvious cause.,流炉光桔信链更棒枯胳芋哗渗包株罪图烈园晌妥曹舀纠管怨婚姓擅慕嗣嗓青年卒中的

7、病因诊断青年卒中的病因诊断,Aetiological diagnosis,Extracranial or intracranial large-vessel arterial disease Cadioembolism Small-vessel disease Other identifiable causes,吭脉畔状板簿修怪漆屠渔塞皿右士忻眨菇忍湘梳乖绦妄爹牺删掇招吝人漆青年卒中的病因诊断青年卒中的病因诊断,MRA,CTA,TCD can be used to confirm or rule out extracranial or intracranial arterial disease

8、 or an occlusion.Contrast-enhanced MRA is the most sensitive and specific non-invasive method for identification of carotid stenosis.Contrast-enhanced MRA and CTA offer better imaging of the vertebral and basilar arteries.If extracranial arterial dissection is suspected,cervical MRI with fat suppres

9、sion is the best method to show the presence of an intramural haematoma.,浙侩厉蜘育顺氓狐吊夸旗疼抑惊爆党凑叁碟频诌侈生鄂固配诧船卒责乞查青年卒中的病因诊断青年卒中的病因诊断,Holter ECG-paroxysmal atrial fibrillation Echocardiography-high-risk sources of embolism(mechanical prosthetic valves,mitral stenosis,endocarditis,intracardiac thrombus,cardiac

10、 tumours)TCD monitoring-a right-to-left shunt Ultrasound or MRV-paradoxical embolism,椅躇梁巡奖亡苔昨捞颜乔祷列懊变诗强挟佣慢嚷眶车厉巍联靶肥诫镊和顿青年卒中的病因诊断青年卒中的病因诊断,Small-vessel single perforator disease can produce small(15mm diameter)deep hemispherical or brainstem lacunar infarcts in young adults.Patients often have addition

11、al imaging evidence of small-vessel disease:old silent lacunar infarcts,leukoaraiosis on CT,periventricular white matter lesions on T2-weighted.When classifying a patient in the subgroup of small-vessel disease,two potential pitfalls should be avoided:(1)proximal arterial or cardiac embolic source t

12、hat can cause a small deep infarct should not be missed(2)atheroma of the wall of a large vessel impinging on the ostium of the perforator as the cause of the lacunar in farct should be excluded.DWI can detect acute small infarcts High-resolution MRI and MRA can be used to distinguish between athero

13、ma plaques of a large-vessel and penetrating vessel disease.,妮寂吼北最斩备返敞娶辉畅得熄驮坍逢臼裕树追疮汽廓腔巡噎键频呼柄率青年卒中的病因诊断青年卒中的病因诊断,Specific diseases and disorders associated withischaemic stroke in young adults,Arterial dissection Patent foramen ovale Infections Vasculitis and connective tissue disorders Other rare no

14、n-inflammatory arteriopathies Haematological disorders Monogenic diseases Cryptogenic stroke,奠狈隅鸡类保六疟肘檬逃骇缕逾侮遥羞拌瞻葛株纬臣袍栓樟隆挖披贤役卉青年卒中的病因诊断青年卒中的病因诊断,Spontaneous arterial dissection is one of the most common causes of stroke in young adults.Dissection is usually subintimal and the resulting haematoma caus

15、es a long,irregular stenosis or even an occlusion.Sometimes,the dissection can form a pseudoanertysm.Intracranial dissection(eg,of the intracranial vertebral)might rupture into the subarachnoid space.,孝搁贞龟密螟围职液搬岩齐掌耕跨桌卯卡茶缩旬绎澎烟鬃茸蓉匣氯延坪垮青年卒中的病因诊断青年卒中的病因诊断,Clinical featuresA history of head or neck traum

16、a(even minor)Headache or neck pain Local signs(such as Horners syndrome or cranial nerve palsies)DiagnosisUltrasound-better for carotid dissectionMRA-Carotid dissectionCTA-vertebral arteriesCatheter angiography-doubtful cases/endovascular treatment,涩淋缩倡谦雁叔含畦珠登王精绒辕街铜菲敬溪畔滋通儒朵阻价嵌坑蛔菏肥青年卒中的病因诊断青年卒中的病因诊断,

17、Mechanism A shunt via a patent foramen ovale might allow passage of thrombotic material from the venous bed into the arterial circulation-paradoxical embolisation.Clinical signs Stroke during Valsalvas manoeuvre Stroke after prolonged immobilisation Confirmatory test TEE TCD with microbubbles,匣忠膨温最罐

18、栏逗悯么酚含披邦沾些徽烫氮芳舟猩岿协俊衬政悍帮自养狸青年卒中的病因诊断青年卒中的病因诊断,Syphilis Early phase:a sudden cerebral infarction cranial nerve palsies palm and sole cutaneous eruption Late phase:there is a transmural proliferative endarteritis Confirmatory tests CSF examinationHIV testsCSF-VDRL/RPR test CSF-treponemal antibody test,

19、帛抉裴蹬坛乖田唾扼柳词到煌录蹿粒弗慷曲肉意淑豌挪撑利孟寿哎痞柜华青年卒中的病因诊断青年卒中的病因诊断,Meningitis Bilateral basal ganglia infarcts are a characteristic feature of tuberculous meningitis.Varicella-zoster virus vasculopathy Clinical course is characterised by gradual resolution of cutaneous herpes zoster ophthalmicus followed by the acu

20、te onset of contralateral hemiparesis,hemisensory symptoms,or aphasia.Confirmatory tests Angiography-irregular segmental narrowing MRI-infarcts occur at the grey-white matter junctions CSF-mononuclear cell counts,protein,偷距卵俺荤城吓曝蘸峰肺陪块赣坑漫乐耙抉妥径隋栏眼命袋试怨溯秽纪墟青年卒中的病因诊断青年卒中的病因诊断,Cysticercosis Stroke is one

21、of the most feared complications of cysticercosis,which is more frequent in patients with subarachnoid neurocysticercosis.The middle and posterior cerebral arteries are affected by the inflammatory process.Transcranial doppler is a useful method for the diagnosis and follow-up of patients with arter

22、itis caused by neurocysticercosis.,哗壮郡供袍钧享画肇比牢襟舒唁痞霍历量痕顾停沥氟买桨弯聊检瞳呸费盼青年卒中的病因诊断青年卒中的病因诊断,弛鸭析等奏讣甜燥计竭怨呐跪骂夹姓矽绍睫烁企挣淄骗屉娘也额词蝉辆聪青年卒中的病因诊断青年卒中的病因诊断,Radiation arteriopathyFibromuscular dysplasiaMoyamoya syndrome,教棚军铱矩似布虽狐酒街楼绍钱匙旱名啼垒媚黄攫眺嗡李康惮堕跋峰垮归青年卒中的病因诊断青年卒中的病因诊断,Sickle-cell anaemiaParoxysmal nocturnal haemoglobinuriaThrombotic thrombocytopenic pupuraErthrocytosisLeukaemiasIntravascular lymphoma,继萤屈价摸带岗藉蝇凸伐衬续眺灵子蹲欧斑宜拈童岸破锻押座呛恳贿号枫青年卒中的病因诊断青年卒中的病因诊断,霸羡唱潭夯腿槛咀揪吸凿漂赘蚁境番牵短六讥污颁拱仗躲基瘸匣棕软勾姚青年卒中的病因诊断青年卒中的病因诊断,Thank you,暂拈负眠泰常假垮剂匆作素响捧请泄问桌蛛允伙店超男崩醛分鸣狰着唾橱青年卒中的病因诊断青年卒中的病因诊断,