Brown R D, Evans B A, Wiebers D O, Petty G W, Meissner I, Dale A J
Division of Cerebrovascular Diseases, Mayo Clinic Rochester, MN 55905.
Mayo Clin Proc. 1994 Nov;69(11):1027-39. doi: 10.1016/s0025-6196(12)61368-8.
To report a cost-effective and scientifically based algorithm for the clinical assessment and treatment of patients with transient ischemic attack (TIA) or minor ischemic stroke.
We comprehensively reviewed the literature on the epidemiologic features, assessment approaches, and treatment recommendations for ischemic cerebrovascular disease and developed an algorithm by using the available clinical and research data to support all decision-making steps.
For patients with TIA or minor ischemic stroke, the appropriate setting for investigation (inpatient or outpatient), suggested diagnostic tests, use of anticoagulants and antiplatelet agents, and indications for surgical treatment are reviewed.
Although stroke is a common cause of death and lost productivity in the United States, the clinical assessment of patients with TIA or minor ischemic stroke has lacked consistency. The simplified algorithm clarifies patients who may be candidates for hospitalization and possible anticoagulation therapy. Initial diagnostic studies should include computed tomography of the head without use of a contrast agent, which quickly distinguishes nonhemorrhagic from hemorrhagic cerebrovascular disease. Evolving noninvasive studies of the cerebral vasculature are providing increasingly sensitive means of detecting stenoses, yet cerebral angiography remains the "gold standard." Treatment options depend on the pathophysiologic findings on diagnostic evaluation.
The assessment of patients with ischemic cerebrovascular disease is complex. The simplified algorithmic approach reported herein necessitates entry of appropriate patients into the algorithm. Because of clinical heterogeneity, an algorithm may apply to a wide spectrum of patients but will not cover every situation; hence, evaluation must be guided by a patient's unique history and findings on examination and by the physician's clinical experience.
报告一种具有成本效益且基于科学的算法，用于短暂性脑缺血发作（TIA）或轻度缺血性卒中患者的临床评估和治疗。
我们全面回顾了关于缺血性脑血管疾病的流行病学特征、评估方法和治疗建议的文献，并利用现有的临床和研究数据开发了一种算法，以支持所有决策步骤。
对TIA或轻度缺血性卒中患者的适当检查环境（住院或门诊）、建议的诊断测试、抗凝剂和抗血小板药物的使用以及手术治疗指征进行了综述。
尽管卒中是美国常见的死亡原因和导致生产力丧失的原因，但TIA或轻度缺血性卒中患者的临床评估一直缺乏一致性。简化后的算法明确了可能需要住院治疗和接受抗凝治疗的患者。初始诊断研究应包括不使用造影剂的头部计算机断层扫描，这能快速区分非出血性和出血性脑血管疾病。不断发展的脑血管无创研究提供了越来越敏感的检测狭窄的方法，但脑血管造影仍然是“金标准”。治疗方案取决于诊断评估中的病理生理结果。
缺血性脑血管疾病患者的评估很复杂。本文报告的简化算法方法要求将合适的患者纳入该算法。由于临床异质性，一种算法可能适用于广泛的患者，但不能涵盖所有情况；因此，评估必须以患者独特的病史、检查结果以及医生的临床经验为指导。
