![Semi-quantitative Assessment Using [18F]FDG Tracer in Patients with Severe Brain Injury](/_next/image?url=https%3A%2F%2Fcloudfront.jove.com%2FCDNSource%2Fteasers%2F58641.jpg&w=3840&q=50)
这个病人是不是中风了?
Larry B Goldstein1, David L Simel
1Department of Medicine, Duke Center for Cerebrovascular Disease, Durham, NC 27710, USA. golds004@mc.duke.edu
JAMA
|May 19, 2005
概括
精确的中风评估依赖于神经学检查结果. 专注于面部,手臂漂移和语音可以提高中风和过渡性缺血性攻击的诊断准确度.
科学领域:
- 神经学 神经学
- 诊断的准确性 诊断的准确性
- 临床检查 临床检查
背景情况:
- 准确评估疑似中风或暂时性缺血性发作 (TIA) 对于及时治疗和二次预防至关重要.
- 1994年之前的一项系统性审查强调了临床评估的重要性.
研究的目的:
- 系统地审查和更新关于临床症状的准确性和可靠性的证据,以及用于诊断中风和TIA的神经学检查结果的证据.
- 为管理疑似脑血管事件患者的临床医生提供最新的诊断准确性数据.
主要方法:
- 对1994年至2005年间发表的文章进行了全面的文献搜索.
- 选择的研究提供了关于中风诊断临床发现的准确性 (灵敏度,特异性,概率比) 和/或可靠性的初级数据 (kappa统计数据).
- 纳入研究的最终诊断通过神经成像和实验室测试得到证实.
主要成果:
- 急性面部,手臂漂移或言语异常的存在显著增加了中风的可能性 (LR + = 5.5).
- 缺少这三个发现会降低中风的可能性 (LR- = 0.39).
- 诸如突然的语言变化,视力丧失和虚弱等特定症状显示出高诊断一致性 (kappa = 0.60);像NIH中风量表这样的标准化量表可以提高可靠性.
结论:
- 临床病史和神经学检查仍然是评估疑似中风患者的基础.
- 对面部,手臂漂移和语音异常的专注评估可以提高中风评估的诊断准确性和可靠性.
相关概念视频
01:15Ischemic Stroke l: Introduction
Ischemic stroke is an acute cerebrovascular condition in which blood flow to a brain region is suddenly interrupted, leading to tissue infarction. Neurons depend on continuous oxygen and glucose supply, so even brief reductions in perfusion cause energy failure, ionic imbalance, and irreversible injury. Ischemic strokes are classified into thrombotic and embolic types based on their underlying mechanisms.Thrombotic MechanismsThrombotic stroke develops when a clot forms within a cerebral artery.
01:17Hemorrhagic Stroke l: Introduction
A hemorrhagic stroke is an acute neurological event that occurs when a weakened cerebral blood vessel ruptures, allowing blood to accumulate within or around the brain. The sudden release of blood forms a focal hematoma that increases intracranial pressure, displaces neural tissue, and can obstruct cerebrospinal fluid pathways. These effects may be compounded by intraventricular extension of the hemorrhage, cerebral edema, or compression of adjacent structures, all of which contribute to...
01:26Transient Ischemic Attack l: Introduction
A transient ischemic attack (TIA) is a brief episode of neurological dysfunction caused by a temporary, focal reduction in cerebral blood flow. Although symptoms resemble those of an ischemic stroke, the interruption in perfusion is short-lived and does not cause permanent infarction. TIAs are clinically important because they often serve as early warning events for future stroke.Mechanisms of Transient Cerebral IschemiaTransient cerebral ischemia may arise through several mechanisms. One...
01:28Traumatic Brain Injury l: Introduction
DefinitionTraumatic brain injury, or TBI, is a disturbance of normal brain function induced by an external mechanical force, such as a direct blow to the head or a penetrating injury. It can affect both brain structure and function, producing a wide range of clinical outcomes. TBI is a heterogeneous condition, meaning its effects may differ based on the type, location, and severity of the injury.Basis of ClassificationTBI is classified based on severity, injury mechanism, or pathophysiology. In...
01:22Dementia l: Introduction
Dementia is an acquired, progressive syndrome characterized by a decline in multiple cognitive domains severe enough to impair daily functioning and reduce independence. Although memory loss is a central feature, the diagnosis requires additional deficits involving language, executive function, visuospatial skills, judgment, calculation, or abstract reasoning. These cognitive impairments reflect underlying neurodegenerative or vascular processes that gradually disrupt neuronal networks...
01:29Hepatic Encephalopathy
DefinitionHepatic encephalopathy is a reversible neurologic syndrome that results from advanced liver dysfunction or portosystemic shunting. It leads to disturbances in cognition, behavior, and motor function due to the brain’s exposure to gut-derived toxins that the liver fails to detoxify.EtiologyThis condition develops either in the setting of acute fulminant hepatitis or progressively during chronic liver disease, such as cirrhosis and portal hypertension. Portosystemic shunting—including...