Department of Medicine and Neurology, Melbourne Brain Centre, Royal Melbourne Hospital and The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia.
Department of Neurology, University of Cincinnati, Cincinnati, OH, USA.
Lancet. 2020 Jul 11;396(10244):129-142. doi: 10.1016/S0140-6736(20)31179-X.
Stroke is a major cause of death and disability globally. Diagnosis depends on clinical features and brain imaging to differentiate between ischaemic stroke and intracerebral haemorrhage. Non-contrast CT can exclude haemorrhage, but the addition of CT perfusion imaging and angiography allows a positive diagnosis of ischaemic stroke versus mimics and can identify a large vessel occlusion target for endovascular thrombectomy. Management of ischaemic stroke has greatly advanced, with rapid reperfusion by use of intravenous thrombolysis and endovascular thrombectomy shown to reduce disability. These therapies can now be applied in selected patients who present late to medical care if there is imaging evidence of salvageable brain tissue. Both haemostatic agents and surgical interventions are investigational for intracerebral haemorrhage. Prevention of recurrent stroke requires an understanding of the mechanism of stroke to target interventions, such as carotid endarterectomy, anticoagulation for atrial fibrillation, and patent foramen ovale closure. However, interventions such as lowering blood pressure, smoking cessation, and lifestyle optimisation are common to all stroke subtypes.
中风是全球范围内主要的致死和致残原因。诊断取决于临床特征和脑部影像学，以区分缺血性中风和脑内出血。非对比 CT 可排除出血，但 CT 灌注成像和血管造影的加入可对缺血性中风与类似疾病做出阳性诊断，并可识别大血管闭塞以进行血管内血栓切除术的目标。缺血性中风的治疗已取得重大进展，静脉溶栓和血管内血栓切除术的快速再灌注已显示可降低残疾程度。如果有可挽救脑组织的影像学证据，现在可以对在医疗护理中出现较晚的选定患者应用这些治疗方法。止血剂和手术干预措施都在研究中，用于脑内出血。为了预防再次中风，需要了解中风的机制，以针对干预措施，如颈动脉内膜切除术、心房颤动的抗凝治疗和卵圆孔未闭的封堵。然而，降低血压、戒烟和生活方式优化等干预措施对所有中风亚型都适用。
