1 Massachusetts General Hospital, Stroke Research Center, Harvard Medical School, Boston, USA.
2 Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, USA.
Int J Stroke. 2018 Jan;13(1):6-10. doi: 10.1177/1747493017730907. Epub 2017 Sep 14.
Increasingly, our approach to cerebrovascular disease has become blurred by evidence published in literature often without careful consideration of what this evidence implies for specific patients at hand. In this essay, we analyze key contextual issues in cerebrovascular small vessel disease, in an attempt to highlight the symbolic gap that exists between research and clinical practice, a recurring theme in medicine. We highlight the importance of considering context when using data from epidemiologic, neuroimaging, and biomarker studies in determining relevance to the patient at hand. We argue, that while biomarkers and neuroimaging may eventually serve to help to identify individuals with specific cerebrovascular diseases, we must always continue to understand patients in a specific clinical context. These reflections are particularly relevant when considering cerebral microbleeds-a key marker of cerebrovascular small vessel disease whose detection often raises thorny clinical dilemmas.
我们对脑血管疾病的处理方法越来越受到文献证据的影响，但这些证据往往没有仔细考虑其对当前特定患者的含义。在本文中，我们分析了脑血管小血管疾病的关键背景问题，试图突出研究与临床实践之间存在的符号差距，这是医学中的一个反复出现的主题。我们强调在使用流行病学、神经影像学和生物标志物研究中的数据来确定与当前患者的相关性时，考虑背景的重要性。我们认为，尽管生物标志物和神经影像学最终可能有助于识别具有特定脑血管疾病的个体，但我们必须始终在特定的临床背景下了解患者。当考虑脑微出血时，这些思考特别重要，脑微出血是脑血管小血管疾病的一个关键标志物，其检测常常引发棘手的临床困境。
