[ ] (National Institute of Health Stroke Scale, NIHSS) 12 "Rapidly developing clinical signs of focal disturbance of cerebral function, l

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1 [] (National Institute of Health Stroke Scale, NIHSS) 12 "Rapidly developing clinical signs of focal disturbance of cerebral function, lasting more than 24 hours or leading to death with no apparent cause other than that of vascular origin [1]." Adams and Victor's Principles of Neurology "Sudden onset focal neurological syndrome due to cerebrovascular disease [2] " [3]

2 Taiwan J Fam Med Vol.22 No.1 24 (transient ischemic attack, TIA) 2009 [4] TIA TIA (diffusion weighted imaging, DWI) (perfusion weighted imaging, PWI) [4] TOAST classification (1) (large artery a t h e r o s c l e r o s i s ) ( 2 ) (cardioembolism) (3) (small vessel occlusion, lacune) (4) (other determined etiology)(5) (undetermined etiology. [5] 1 (1) 0.5mm TOAST Classification of Subtypes of Acute Ischemic Stroke Large artery atherosclerosis (embolus/thrombosis) Cardioembolism (high-risk/medium-risk) Small-vessel occlusion (lacune) Stroke of other determined etiology Stroke of undetermined etiology a.two or more causes identified b.negative evaluation c.incomplete evaluation TOAST: Trial of Org in Acute Stroke Treatment.

3 Chlamydia pneumoniae [2] (2) (emboli) 2 [5] (3) 15mm (lipohyalin degeneration) 2 TOAST Classification of High- and Medium- Risk Sources of Cardioembolism High risk sources Mechanical prosthetic valve Mitral stenosis with atrial fibrillation Atrial fibrillation (other than lone atrial fibrillation) Left atrial/atrial appendage thrombus Sick sinus syndrome Recent myocardial infarction (<4 weeks) Left ventricular thrombus Dilated cardiomyopathy Akinetic left ventricular segment Atrial myxoma Infective endocarditis Medium-risk sources Mitral valve prolapse Mitral annulus calcification Mitral stenosis without atrial fibrillation Left atrial turbulence (smoker) Atrial septal aneurysm Patent foramen ovale Atrial flutter Lone atrial fibrillation Bioprosthetic cardiac valve Nonbacterial thrombotic endocarditis Congestive heart failure Hypokinetic left ventricular segment Myocardial infarction (>4 weeks, <6 months)

4 Taiwan J Fam Med Vol.22 No [6] 80% (lacunar syndrome) 20% (4) [2] (5) (1) (2) (left middle cerebral artery infarction) (right putaminal hemorrhage) (3) Day 6 3 Etiology of Stroke of Other Determined Etiology Dissection Antiphospholipid syndrome Moyamoya disease Systemic lupus erythematosus Migraine-related stroke Mitochondrial disease Neurosyphilis Fibromuscular dysplasia Other vasculitis Intracranial operation Pregnancy Marfan syndrome Cancer (marantic endocarditis) Neurobehcet disease Radiation vasculopathy

5 CT MRI SAH MRI MRI T1 low T2 high DWI(diffusion weighted imaging) ADC(apparent diffusion coefficient) 4 [8] [8] 1. aspirin 2. (airway) (breath) (circulation) 1. (Cincinnati Prehospital Stroke Scale, CPSS) (1) (arm drift) 10 (2) (facial droop) 4 MRI Appearance of Intracranial Hemorrhage Time since hemorrhage T1-weighted T2-weighted Acute: first 6-24 hours (intracellular oxyhemoglobin) Gray Light gray Early subacute: 1-5 days (intracellular deoxyhemoglobulin) Gray Dark gray Middle subacute: 3-7 days (intracellular methemoglobin) White Dark gray Late subacute: 3-30 days (extrecellular methemoglobulin) White White Chronic >14 day (hemosiderin, mainly on outer rim) Gray Black

6 Taiwan J Fam Med Vol.22 No.1 (3) 72% 3 85% 2. ( L o s Angeles Prehospital Stroke Screen, LAPSS) (1)45 (2) (3)<24 (4) (5) mg/dl (6) (CPSS) 89% (LAPSS) 97%) [9] 1.ABC 2. 92% NIHSS (PT, PTT) [9] [9] [11]

7 [11] 60 [10] 2009 [12] [9] [11] 56 [9] (National Institute of Health Stroke Scale, NIHSS) [9] 6-25 NIHSS tissue plasminogen activator tpa 30% [13] %90% 60 tpa 24 [9] 220/120 mmhg % 140 mg/dl [9] [11] piracetamnootropil [14] 7 15] 7

8 Taiwan J Fam Med Vol.22 No ( ) 1. Actilyse NIHSS 4 NIHSS 25 NIHSS mmhg 110 mmhg heparin aptt warfarin sodiuminr ,000 / mm 3 50 mg/dl400 mg/dl>200 mg/dl 4. 1/

9 CHADS2 [16] dipyridamole Aggrenoxclopidogrel Plavix Aggrenox Plavix 7 relative risk mg/dl (5 drinks a day) heparin low molecular weight heparin Clexane PTT PTT warfarincoumadinpt INR2 3 [15] 70-99% 48% [15] [17] 80 [18] [11] 24 TIA

10 Taiwan J Fam Med Vol.22 No.1 1. World Health Organisation. Cerebrovascular Disorders (Offset Publications). Geneva, Ropper AH, Brown RH: Adams and Victor's Principles of Neurology. 8th ed. United States of America: McGraw-Hill Co., 2005: Rowland LP: Merritt's Neurology. 11th ed. Philadelphia: Lippincott Williams & Wilkins Co., 2005: Easton JD, Saver JL, Albers GW, et al: Definition and evaluation of transient ischemic attack: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular S u rg e r y a n d A n e s t h e s i a ; C o u n c i l o n Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on Peripheral Vascular Disease. Stroke 2009; 40: Adams HP Jr, Bendixen BH, Kappelle LJ, et al: Classification of subtype of acute ischemic stroke: definitions for use in a multicenter clinical trial. Stroke 1993; 24: Bogousslavsky J, Caplan LR: Stroke Syndromes. 2nd ed. Cambridge: Cambridge University Press, 2001: Lee TH, Hsu WC, Chen CJ, et al: Etiologic study of young ischemic stroke in Taiwan. Stroke 2002; 33: Atlas SW, Thulborn KR: Magnetic Resonance Imaging of the Brain and Spine. 3rd ed. Philadelphia: Lippincott Williams & Wilkins Co., 2002: : I n t e r n a t i o n a l C o n s e n s u s o n Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2005; 112: IV-111 IV Adams HP Jr, Del Zoppo G, Alberts MJ, et al: Guidelines for the early management of adults with ischemic stroke. Stroke 2007; 38: Del Zoppo GJ, Saver JL, Jauch EC, et al: Expansion of the time window for treatment of acute ischemic stroke with intravenous tissue plasminogen activator. A science advisory from the American Heart Association/American Stroke Association. Stroke 2009; 40: The National Institute of Neurological Disorders and Stroke rt-pa Stroke Study Group: Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1995; 333: Kessler J, Thiel A, Karbe A, et al: Piracetam improves activated blood flow and facilitates rehabilitation of post-stroke aphasic patients. Stroke 2000; 31: Straus SE, Majumdar SR, McAlister FA: New evidence for stroke prevention: scientific review. JAMA 2002; 288:

11 Fuster V, Ryden LE, Cannom DS, et al: ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines. Circulation 2006; 17. Mas JL, Chatellier G, Beyssen B, et al: Endarterectomy versus stenting in patients with symptomatic severe carotid stenosis. N Engl J Med 2006; 355: Yadav JS, Wholey MH, Kuntz RE, et al: Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med 2004; 351: : e257-e354.

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448 老年人晕厥樊瑾 [ 中图分类号 ] R 441 2 [ 文献标识码 ] A doi:10.3969 / j.issn.1003 9198.2016.06.002 樊瑾教授晕厥指因一过性全脑低灌注而突发短暂性意识丧失和姿势性张力丧失 [1] 发作特点为突发持续时间短能自行