最新:Etiologie des troubles neurologiques à incidence …神经系统疾病的病因学与发病# 224;……-文档资料.ppt
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1、Pathologie vasculaire,Les ACV : Ischmiques Athrome Embolies lacunes Hmorragiques Les tats vasculaires chroniques tats lacunaires Dmences vasculaires,Infarctus : zone de pnombre,Lacunes crbrales : 3 mcanismes,Occlusion artriolaire,Micro- hmorragie,Dilatation des espaces pri- vasculaires,Pathologie ca
2、rdiognique,Primary Hemorrhagic Stroke Intracerebral,Bleeding into the brain tissue Commonly results from hypertension Rapid onset of symptoms Causes irritation and increased ICP leading to loss of function and neuronal death,Primary Hemorrhagic Stroke Subarachnoid,Bleeding into the subarachnoid spac
3、e Commonly results from aneurysmal rupture Rapid onset of symptoms Results in severe sudden headache due to marked increase in pressure around the brain Risk of rebleeding, vasospasm and hydrocephalous,Pathogenesis Ischemic Cascade,Blockage of a cerebral blood vessel reduces CBF Ischemic-hypoxic bra
4、in damage Disturbance in glucose utilization Depletion of ATP Depletion of neurotransmitter substances Membrane depolarization Influx of sodium and water and calcium Release of glutamate Cell death,Effects of Reduced CBF,Normal ml/100g/min,50 55 25 20 15 8,Ischemia,Edema Loss of Na/K+ pump lactate e
5、lectrical failure; ATP activity,Penumbra,Infarction,Cell Death,Cerebral Infarction,Intravenous Thrombolysis Tissue Plasminogen Activator (tPA),Inclusion Criteria Age 18 Ischemic stoke by clinical presentation Persistent deficits beyond an isolated sensory deficit or ataxia CT scan negative for hemor
6、rhage Treatment initiated within 3 hours of symptom onset,Exclusion Criteria More than 3 hours since symptom began Rapidly improving deficits CT scan shows substantial edema, mass effect or shift PT 15 seconds; INR 1.7 or prolonged PTT Platelet count 185 or DBP 110 Prior stoke or serious head trauma
7、 within 3 months Prior ICH History of GI/GU bleeding Seizures at onset of stroke Symptoms suggest SAH,Administration of t-PA,Treatment should begin immediately Dosing: 0.9 mg/kg IV over one hour 10% IV bolus over 1 minute Maximum dose is 90 mg Aspirin recommended 160 325 mg/day for those unable to r
8、eceive t-PA,Complications of t-PA,Intracranial hemorrhage Systemic bleeding Reocclusion New stroke Death,Surgical Treatment,Craniotomy Craniectomy,Aneurysm Clipping,Aneurysm Coiling,Endovascular Procedures,Emerging Therapies,Intra-arterial t-PA Other antithrombotic agents IV heparin Abciximab: plate
9、let glycoprotein antagonist Argatroban: direct thrombin inhibitor Neuroprotective agents Glutamate antagonists - Calcium antagonists Opiate antagonists - GABA-A agonists Calpain inhibitors - Kinase inhibitors Antioxidants - Neuroperfusion Mild hypothermia - Blood substitutes Oxygenated fluorocarbon
10、nutrient emulsion (OFNE),Artre crbrale moyenne (sylvienne),Artres crbrales antrieure et postrieure,Territoires : artre crbrale antrieure,Territoires : artre crbrale postrieure,Territoires : artre crbrale moyenne,Territoires : synthse,aphasie de Broca,aphasie de Wernicke,aphasie de conduction,Aphasie
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