Stroke Classification A Personal View
Stroke Classification A Personal View
复制标题
DOI：
10.1161/strokeaha.110.594630
复制
发表时间：
2011-01-01
期刊：
影响因子：
8.3
通讯作者：
Caplan, Louis R.
中科院分区：
文献类型：
--
作者：
Caplan, Louis R.
20世纪上半叶的临床病理学研究集中在中风后死亡患者的临床症状上。脑出血和脑梗死在尸检中被识别出来，但在生活中它们能被分开吗？1935年，阿林和梅里特在波士顿城市医院对245名中风患者进行了临床研究和尸检。他们报告了人口统计学、流行病学、历史和临床数据，以确定哪些特征可以区分血栓和出血。15%的患者发现出血（脑内或蛛网膜下腔），82%的患者有缺血性梗死，称为血栓性；然而，只有3%的人被认为是心源性栓塞性脑梗死。出血的主要特征是头痛、呕吐、意识受损、临床神经功能缺损的进展、脊髓液出血和脊髓液压力升高。该研究偏向于有大量致命性出血和梗死的患者。后来，斯堪的纳维亚的达尔斯加德-尼尔森编制了1000名中风患者的一系列数据，梅奥诊所的临床医生分析了1945年至1953年以及1955年至1969年期间的一系列患者。这些研究都是基于回顾性图表回顾，并且都是在CT之前进行的。梗死发生率是出血的4倍。只有当患者患有风湿性心脏病或近期心肌梗死时，梗死才被归类为栓塞性。根据这些标准，脑栓塞的发生率从3%到8%不等。非栓塞性脑梗死被认为是“血栓性”，与供血大动脉闭塞有关。颈部颈动脉和椎动脉疾病以及腔隙性梗死未被诊断在这些早期研究中。
Clinicopathological studies during the first half of the 20th century focused on clinical signs in patients who died after stroke. Brain hemorrhages and infarcts were recognized at necropsy, but could they be separated during life? In 1935, Aring and Merritt1 analyzed 245 stroke patients studied clinically and at necropsy at the Boston City Hospital. They reported demographic, epidemiological, historical, and clinical data to determine which features differentiated thrombosis from hemorrhage. Hemorrhages (intracerebral or subarachnoid) were found in 15% of patients and 82% had ischemic infarcts called “thrombotic;” however, only 3% were considered to have cardiogenic embolic brain infarcts. The main features favoring hemorrhage were headache, vomiting, impaired consciousness, progression of the clinical neurological deficit, bloody spinal fluid, and increased spinal fluid pressure. 1 This series was biased toward patients with large fatal hemorrhages and infarcts. Later, Dalsgaard-Nielsen2 in Scandinavia compiled a series of 1000 stroke patients, and clinicians at the Mayo Clinic analyzed series of patients seen during 1945 through 19543 and from 1955 through 1969. 4 These studies were based on retrospective chart reviews and all preceded CT. Infarcts were 4-times more common than hemorrhages. Infarcts were classified as embolic only if the patients had rheumatic heart disease or recent myocardial infarction. Rates of brain embolism using these criteria ranged from 3% to 8%. Nonembolic brain infarcts were assumed to be “thrombotic” and related to occlusion of brain supplying large arteries. Carotid and vertebral artery disease in the neck and lacunar infarction were not diagnoses included in any of these early studies.