Lichy C, Hacke W
Neurologische Klinik, Klinikum Memmingen, Bismarckstrasse 23, 87700, Memmingen, Germany.
Internist (Berl). 2010 Aug;51(8):1003-11. doi: 10.1007/s00108-009-2540-6.
Acute stroke must be considered as an emergency with highest priority. The same is true for patients with transient ischemic attacks, given their high risk for following stroke events within the first 48 hours. Early brain imaging is essential for discrimination of either ischemic or hemorrhagic stroke. In acute ischemic stroke, rapid establishment of reperfusion is the major therapeutic goal. This is achieved by intravenous thrombolysis, in selected cases by an intraarterial approach with pharmaceutical and/or mechanical recanalization. The effect of successful reperfusion is highly dependent on time: the earlier, the better the odds for substantial clinical improvement. The recent extension of the time window for systemic thrombolysis to 4.5 hours must not result in any delays of diagnosis and treatment initiation! Stroke units with facilities for early etiological workup with according secondary prevention measures, for prevention and treatment of complications, and for early rehabilitation have been shown to yield the best outcome for all stroke victims.
急性中风必须被视为最优先处理的紧急情况。短暂性脑缺血发作患者也是如此，因为他们在最初48小时内发生后续中风事件的风险很高。早期脑部成像对于鉴别缺血性或出血性中风至关重要。在急性缺血性中风中，迅速建立再灌注是主要治疗目标。这可通过静脉溶栓来实现，在某些情况下可通过动脉内途径进行药物和/或机械再通。成功再灌注的效果高度依赖于时间：越早进行，临床显著改善的几率就越大。近期将全身溶栓的时间窗延长至4.5小时，绝不能导致诊断和治疗启动的任何延迟！配备有设施进行早期病因检查并采取相应二级预防措施、预防和治疗并发症以及早期康复的卒中单元，已被证明能为所有中风患者带来最佳治疗效果。
