Cortical branches: medial surface and floor of temporal lobe and occipital lobe

Central branch: thalamus, medial and lateral geniculate bodies, hypothalamus, and subthalamus

The first priority in the treatment of acute ischemic stroke is

➢ Hypertensive arteriosclerosis and vascular damage caused by atherosclerosis (most common)

➢ Arteritis caused by tuberculosis, syphilis, connective tissue diseases, leptospira, etc.

➢ Congenital vascular diseases (such as aneurysms, vascular malformations) and vascular injuries caused by various causes (trauma, brain surgery)

➢ Vascular damage caused by drugs, poisons, malignant tumors, etc.

➢ High blood pressure, low blood pressure, or sudden fluctuations in blood pressure

➢ Cardiac dysfunction, rheumatic or non-rheumatic valvular heart disease, cardiomyopathy

➢ Arrhythmia or conduction block, especially atrial fibrillation

➢ Increased blood coagulation or bleeding tendency caused by various reasons, such as dehydration, polycythemia, hyperfibrinogenemia and other hyperviscosity

➢ Abnormal coagulation mechanism, especially the use of anticoagulants, contraceptives, disseminated intravascular coagulation and various hematological diseases

➢ Emboli such as air, fat, cancer cells and parasites

➢ Cerebral blood vessel compression, trauma, spasm

Includes history, physical examination, and laboratory tests:

➢ Based on sudden onset and rapid onset of symptoms and signs of local or global brain damage

➢ Brain CT/MRI or MRA, DSA and CSF examinations found corresponding lesions or evidence of related diseases

➢ Common risk factors for stroke, such as high blood pressure, heart disease, diabetes, smoking and hyperlipidemia

General medical care and management of stroke comorbidities: saving lives, reducing disability

Carrying out ultra-early thrombolytic treatment for acute ischemic stroke is one of the current main medical tasks for acute stroke;

Prevent recurrence

improve the quality of life

Stroke Unit: The best approach to stroke treatment proven by evidence-based medicine

Proximal large artery stenosis hypotension

The clinical symptoms of this type of patients are stereotyped, with frequent attacks, and each attack lasts for a short time, usually no more than 10 minutes.

A-A Embolism Cardiogenic embolism

The clinical symptoms of this type of patients are variable, the frequency of attacks is usually sparse, and each attack lasts for a long time.

➢ Occurs more often in middle-aged and elderly people, more in men than women

➢ Often accompanied by vascular disease risk factors such as hypertension, atherosclerosis, diabetes or hyperlipidemia

➢ The onset is sudden and often recurring

➢ Nervous dysfunction lasts for a short period of time, the longest time is <24 hours, and clinical recovery is complete without residual symptoms.

➢ TIA caused by hemodynamic changes have similar or stereotyped clinical manifestations; TIA caused by microembolism has variable clinical manifestations

1. TIA in the middle cerebral artery territory

2. TIA in the anterior cerebral artery territory

3. TIA of main internal carotid artery

Most common clinical symptoms

Symptoms include dizziness, balance disorder, abnormal eye movement and diplopia. Facial and perioral numbness, alone or accompanied by contralateral limb paralysis and sensory impairment, presenting typical or atypical brainstem ischemic syndrome

1. Fall attack

2. Transient global amnesia (TGA)

3. Onset of visual impairment in both eyes

1. Routine blood tests, coagulation function, blood biochemistry and other blood tests

2. Electrocardiogram, transthoracic echocardiogram

3. Brain CT or MRI does not have an infarct corresponding to cerebral ischemia - the most important initial diagnostic examination

4. Non-invasive vascular disease examination (cervical vascular ultrasound, TCD, CTA or MRA)

1. Holter monitoring, transesophageal echocardiography

2. DSA check

3. Protein C, protein S, antithrombin III, antiphospholipid antibodies, etc.

Middle-aged and elderly patients suddenly develop symptoms of focal brain damage, consistent with ischemia of the internal carotid artery or vertebral-basilar artery system and its branches, and the symptoms completely recover within a short period of time (no more than 1 hour at most)

Those who are highly suspected of TIA, and neuroimaging examination does not find lesions corresponding to neurological deficits

Clinical Diagnosis of TIA Distinguishing Different Pathogenesis