Department of Neurology, Comprehensive Stroke Center, Comprehensive Stroke Center, Philadelphia, PA 19104, USA.
Neurotherapeutics. 2011 Jul;8(3):425-33. doi: 10.1007/s13311-011-0041-5.
The initial therapeutic approach to acute ischemic stroke consists of thrombolytic therapy and early initiation of supportive care, usually commenced prior to the determination of the underlying stroke etiology. Varying stroke mechanisms may call for specific, etiology-based treatment. The majority of strokes result from cardioembolism, large-vessel atherothromboembolism, and small-vessel occlusive disease. There are scant data to support the use of acute anticoagulation therapy over anti-platelet therapy in cardioembolic stroke and large-vessel atherosclerosis, although it may be reasonable in a certain subset of patients. However, augmentation of blood flow with early surgery, stenting, or induced hypertension, may play a role in patients with large artery stenosis. The less commonly identified stroke mechanisms may warrant special consideration in treatment. Controversy remains regarding the optimal anti-thrombotic treatment of arterial dissection. Reversible cerebral vasoconstriction syndrome may benefit from therapy with calcium channel blockers, high-dose steroids, or magnesium, although spontaneous recovery may occur. Inflammatory vasculopathies, such as isolated angiitis of the central nervous system and temporal arteritis, require prompt diagnosis as the mainstay of therapy is immunosuppression. Cerebral venous thrombosis is a rare cause of stroke, but one that needs early identification and treatment with anticoagulation. Rapid determination of stroke mechanism is essential for making these critical early treatment decisions.
急性缺血性脑卒中的初始治疗方法包括溶栓治疗和早期开始支持性治疗，通常在确定潜在脑卒中病因之前开始。不同的脑卒中机制可能需要特定的、基于病因的治疗。大多数脑卒中是由心源性栓塞、大血管动脉粥样硬化血栓形成和小血管闭塞性疾病引起的。虽然在某些特定患者中可能合理，但在心源性栓塞性脑卒中及大血管粥样硬化中，急性抗凝治疗相对于抗血小板治疗的数据甚少，支持其应用。然而，早期手术、支架置入或诱导高血压增加血流可能在大动脉狭窄患者中发挥作用。较少识别的脑卒中机制在治疗中可能需要特殊考虑。动脉夹层的最佳抗血栓治疗仍存在争议。可逆性脑血管收缩综合征可能受益于钙通道阻滞剂、大剂量类固醇或镁治疗，尽管可能会自发恢复。炎症性血管病，如中枢神经系统孤立性血管炎和颞动脉炎，需要及时诊断，因为治疗的主要方法是免疫抑制。脑静脉血栓形成是一种罕见的脑卒中病因，但需要早期识别和抗凝治疗。快速确定脑卒中机制对于做出这些关键的早期治疗决策至关重要。
