Caplan L R
New England Medical Center Hospitals, Boston, Massachusetts 02111.
Rev Neurol (Paris). 1991;147(4):265-73.
Technological methods for diagnosing brain embolism have improved. Both donor sources and recipient sites are now more readily documented. Embolism is a dynamic process. Thrombi develop and change in their cardiac or arterial 'nests', discharge into the vascular system, lodge in brain or systemic arteries, and often break up and move on. Traditionally, clinicians have sought to distinguish a cardiac from intraarterial source in order to prescribe warfarin for cardiac origin embolism. Most often surgery or aspirin is given for intraarterial embolism. Yet substances that embolize from either site are diverse. Might identification of the embolic material ("birds") be a more rational guide to treatment than simply the locations of the "nests"?
诊断脑栓塞的技术方法已经有所改进。目前，供体来源和受体部位都更容易记录。栓塞是一个动态过程。血栓在其心脏或动脉“巢穴”中形成并变化，排入血管系统，滞留在脑动脉或体循环动脉中，并且常常破碎并继续移动。传统上，临床医生试图区分心脏来源和动脉内来源，以便为心脏源性栓塞开华法林。对于动脉内栓塞，最常采用手术或给予阿司匹林治疗。然而，从这两个部位栓塞的物质多种多样。识别栓塞物质（“鸟”）是否比仅仅确定“巢穴”位置更能合理地指导治疗呢？
