Stone S P, Allder S J, Gladman J R
Academic Department of Geriatric Medicine, Royal Free and University College Medical School, London, UK.
Br Med Bull. 2000;56(2):486-94. doi: 10.1258/0007142001903139.
The natural history of acute stroke is well defined. Predicting outcome in individuals, however, remains difficult, because prognostic studies examining associations between clinical signs or syndromes and outcome differ in patient selection, timing and choice of neurological assessments and outcome measures. Accuracy has been disappointing. Osler in 1892 stated that the 'course of the disease ... is dependent on the situation and extent of the lesion'. Until recently, it has not been possible to examine the stroke prognosis, using Osler's approach, with any great accuracy. The advent of diffusion weighted magnetic resonance imaging (DWI), which is highly sensitive to the pathophysiological changes underlying stroke, offers this possibility as it measures the site and extent of irreversible infarction. This review summarises the results of syndrome or sign-based predictive studies and shows how DWI may explain different outcomes in patients with identical neurological presentations, according to the 'situation and extent of the lesion'.
急性中风的自然病程已明确。然而，预测个体的预后仍然困难，因为检查临床体征或综合征与预后之间关联的预后研究在患者选择、时间安排、神经学评估及预后指标的选择上存在差异。其准确性一直不尽人意。1892年，奥斯勒指出“疾病的进程……取决于病变的部位和范围”。直到最近，采用奥斯勒的方法来精确检查中风预后才成为可能。弥散加权磁共振成像（DWI）对中风潜在的病理生理变化高度敏感，它能测量不可逆梗死的部位和范围，从而提供了这种可能性。本综述总结了基于综合征或体征的预测研究结果，并表明根据“病变的部位和范围”，DWI如何解释具有相同神经学表现的患者出现不同预后的原因。
