The Willis lecture: transient ischemic attacks, scientific method, and new realities.
The Willis lecture: transient ischemic attacks, scientific method, and new realities.
复制标题
威利斯讲座：短暂性脑缺血发作、科学方法和新现实。
作者：
Toole,JF
短暂性脑缺血发作首先由托马斯威利斯于1679年描述，并于20世纪50年代定义，普遍认为是血管分布中的局灶性神经功能缺损发作，突然发作，在≤ 24小时内消退，无残留缺损。短暂性脑缺血发作的诊断依据是特征性病史和神经系统检查无残留物。在这些标准被接受后，20世纪70年代的局部脑血流和计算机头颅断层扫描，后来的正电子发射断层扫描，甚至最近的磁共振成像显示，即使在具有短暂性脑缺血发作所有定义特征的人中，也存在长期的病理生理和代谢紊乱。这些持续的异常需要重新检查短暂性脑缺血发作的概念的有效性。此外，我们小组怀疑短暂性脑缺血发作可能只是短暂性脑缺血发作后经常发生脑梗死的一个标志物，而不是其本身的危险因素。此外，使用神经成像技术揭示患者或医生未识别的脑梗塞的惊人频率产生了重新定义迄今用于诊断和评估短暂性脑缺血发作和脑梗塞的治疗和预后的类别的需要。
First described by Thomas Willis in 1679 and defined in the 1950s, transient ischemic attack is universally agreed to be an episode of focal neurologic deficit in a vascular distribution, sudden in onset and resolving without residual deficit in less than or equal to 24 hours. Transient ischemic attack is diagnosed by characteristic history and absence of residua on neurologic examination. After these criteria had been accepted, regional cerebral blood flow and computed cranial tomography in the 1970s, later positron emission tomography, and even more recently, magnetic resonance imaging reveal prolonged pathophysiologic and metabolic disturbances even in persons with all the definitional characteristics of transient ischemic attack. These persistent abnormalities necessitate reexamination of the validity of the concept of transient ischemic attack. Furthermore, our group suspects that transient ischemic attack is probably only a marker, and not itself the risk factor, for the cerebral infarction which frequently follows transient ischemic attack. Additionally, the surprising frequency with which cerebral infarction, unrecognized by patient or physician, is revealed using neuroimaging techniques has created a need to redefine the categories heretofore used for diagnosis and assessment of therapy and prognosis for transient ischemic attack and cerebral infarction.