附件病因分类
1.大动脉粥样硬化（Largearteryatherosclerosis）颅外（卒中很可能的病因）颅内（卒中很可能的病因）临床表现：应证实检查所见，包括梗死部位、大脑皮层受累（失语、忽视、运动部分受累）或脑干或小脑功能障碍。脑影像：与诊断一致，包括皮层或小脑病变，以及脑干或皮层下直径≥1.5cm的梗死。如果第一次头CT正常，应复查头CT或脑MRI检查。颈动脉影像：应识别显著的动脉粥样硬化性疾病，即颅外或颅内动脉≥50%的狭窄或闭塞。心脏影像：应排除明显的心源性栓子。血液检查和既往病史：应排除“其他病因”类别中定义的少见脑卒中原因。2.心源栓塞性脑卒中（Cardioembolicstroke）临床表现：应证实检查所见，包括梗死部位、大脑皮层受累（失语、忽视、运动部分受累）或脑干或小脑功能障碍。脑影像：与诊断一致，包括皮层或小脑病变，以及脑干或皮层下直径≥1.5cm的梗死。如果第一次头CT正常，应复查头CT或脑MRI检查。颈动脉影像：应排除显著的动脉粥样硬化疾病。心脏影像：应确认存在明显的心源性栓子。很可能的脑卒中病因仅用于发现了一个高危栓子来源。中危的栓子来源只能定为可能的脑卒中病因。血液检查和既往病史：应排除“其他病因”类别中定义的少见脑卒中原因。3.小血管闭塞（Smallvesselocclusion，SVO）（卒中很可能的病因）临床表现：患者应存在经典临床腔隙综合征之一（纯运动、纯感觉、纯感觉运动、纯偏侧颤搐、纯偏侧舞蹈、共济失调性轻偏瘫及构音障碍-手笨拙综合征）并且没有大脑皮层功能障碍的证据。脑影像：正常或显示脑干或皮层下相关病变，，直径＜1.5cm。颈动脉影像：应排除显著的动脉粥样硬化疾病。心脏影像：应排除明显的心源性栓子。血液检查和既往病史：应排除“其他病因”类别中定义的少见脑卒中原因。4.其他确定病因（Otherdeterminedaetiology）（可能的原因）非动脉粥样硬化性血管病，如脑血管炎血液病，如红细胞增多、血小板增多、镰状细胞病高凝状态，如抗磷脂抗体综合征，高胱氨酸尿症偏头痛性脑卒中其他临床表现：应证实为急性脑卒中，无论缺损症状如何。脑影像：应证实为急性缺血性脑卒中，无论梗死大小及部位。如果第一次头CT正常，应复查头CT或脑MRI检查。颈动脉影像：应排除显著的动脉粥样硬化疾病。心脏影像：应排除明显的心源性栓子。血液检查和既往病史：应提示一种卒中的少见原因或偏头痛性脑卒中。医院的血液检查结果参考范围。任何异常值将在卒中后3个月由单个实验室重复检测。这将排除由于实验室间参考范围的差异而导致的任何异常结果，以及由于急性脑卒中所指的急性期反应。如果这些初步的血液检查结果提示可能的诊断，应按照指示进行相关的进一步调查，以确认诊断。这一组的分类只会被归为脑卒中可能的病因。5.病因不明（Undeterminedaetiology）存在两个或两个以上的病因（多种很可能的或多种可能的病因）病因未查明对病因未查明的：临床表现：应证实为急性脑卒中，无论缺损症状如何。脑影像：应证实为急性缺血性脑卒中，无论梗死大小及部位。如果第一次头CT正常，应复查头CT或脑MRI检查。颈动脉影像：应排除显著的动脉粥样硬化疾病。心脏影像：应排除明显的心源性栓子。血液检查和既往病史：应排除“其他病因”类别中定义的少见脑卒中原因。如果存在一种可能的病因和一种很可能的病因，则以很可能的病因未卒中亚型。与经典TOAST分型相比，减少了TOAST分型中的不明原因型的比例，有一定的可取之处，但此分型也并不实质的改变，TOAST分型的缺点也依然存在。文献来源HajatC,CoshallC,RuddAG,etal.Theinter-andintraobserverreliabilitiesofanewclassificationsystemforischaemicstroke:theSouthLondonStrokeRegister.JNeurolSci.;(1-2):79‐85.AdamsHPJr,BendixenBH,KappelleLJ,etal.Classificationofsubtypeofacuteischemicstroke.Definitionsforuseinamulticenterclinicaltrial.TOAST.TrialofOrginAcuteStrokeTreatment.Stroke,;24(1):35-41.秦海强,王拥军,胡长梅.缺血性卒中病因学分型.慢性病学杂志,:15(8):-.AppendixA.AetiologicalclassificationA.1.LargearteryatherosclerosisExtracranial(probablecauseofstroke)Intracranial(probablecauseofstroke)Clinicalfindings:shouldcorroboratefindingsofinvestigations,includinglocationoftheinfarct,cerebralcorticalinvolvement(aphasia,neglect,restrictedmotorinvolve-ment).orbrainstemorcerebellardysfunction.Brainimaging:consistentwiththediagnosisincludecorticalorcerebellarlesionsandbrainstemorsubcorticalhemisphericinfarcts≥1.5cmdiameter.IfthefirstCTheadisnormal,afurtherCTheadorMRIheadshouldbeperformed.Carotidimaging:shouldidentifysignificantatheroscleroticdisease,i.e.≥50%stenosisorocclusionofanextracranialorintracranialartery.Cardiacimaging:shouldexcludethepresenceofanobvioussourceofcardiacembolus.Bloodtestsandpasthistory:shouldexcludetherarecausesofstrokeasdefinedinthecategory“otherdeterminedaetiology”.A.2.CardioembolicstrokeClinicalfindings:shouldcorroboratefindingsofinvestigations,includinglocationoftheinfarct,cerebralcorticalinvolvement(aphasia,neglect,restrictedmotorinvolve-ment).orbrainstemorcerebellardysfunction.Brainimaging:consistentwiththediagnosisincludecorticalorcerebellarlesionsandbrainstemorsubcorticalhemisphericinfarcts≥1.5cmdiameter.IfthefirstCTheadisnormal,afurtherCTheadorMRIheadshouldbeperformed.Carotidimaging:shouldexcludesignificantatheroscleroticdisease.Cardiacimaging:shouldconfirmthepresenceofanobvioussourceofcardiacembolus.Aprobablecauseofstrokewouldbeassignedtothefindingofahigh-risksourceofembolus.Amedium-risksourceofemboluswouldpointtoapossiblecauseofstrokeonly.Bloodtestsandpasthistory:shouldexcludetherarecausesofstrokeasdefinedinthecategory“otherdeterminedaetiology”.A.3.Smallvesselocclusion(probablecauseofstroke)Clinicalfindings:patientsshouldhaveoneofthetraditionalclinicallacunarsyndromes(puremotor,puresensory,puresensorimotor,purehemiballism,purehemichorea,ataxichemiparesisordysarthriaclumsyhandsyndrome)andnoevidenceofcerebralcorticaldysfunction.Brainimaging:shouldbenormalorshowarelevantbrainstemorsubcorticalhemisphericlesionwithadiameter＜1.5cm.Carotidimaging:shouldexcludesignificantatheroscleroticdisease.Cardiacimaging:shouldexcludethepresenceofanobvioussourceofcardiacembolus.Bloodtestsandpasthistory:shouldexcludetherarecausesofstrokeasdefinedinthecategory“otherdeterminedaetiology”.A.4.Otherdeterminedaetiology(possiblecauseofstroke)nonatheroscleroticvasculopathies,e.g.cerebralvasculitishaematological,e.g.polycythaemia,thrombocythaemia,Sicklecelldisease.hypercoaguablestate,e.g.antiphospholipidantibodysyndrome,homocystinuriamigrainousstrokeothersClinicalfindings:shouldconfirmanacutestrokeregardlessofdeficit.Brainimaging:shouldconfirmacuteischaemicstrokeregardlessofsizeorlocation.IfthefirstCTheadisnormal,asecondCTheadorMRIheadshouldbeperformed.Carotidimaging:shouldexcludesignificantatheroscleroticdisease.Cardiacimaging:shouldexcludethepresenceofanobvioussourceofcardiacembolus.Bloodtestsandpasthistory:shouldsuggestoneoftherarecausesofstrokeorthepresenceofmigrainousstroke.Referencerangesforbloodtestsforthetreatinghospitalwillbeused.Anyabnormalvalueswillberepeatedbyasinglelaboratoryat3monthsfollowingthestroke.Thiswillruleoutanyabnormalresultsduetodifferencesinreferencerangesbetweenlaboratories,aswellasaccountingfortheacutephasereaction,whichfollowsanacutestroke.Iftheseinitialbloodtestssuggestapossiblediagnosis,thisshouldbefollowedupbyrelevantfurtherinvestigation,asindicated,toconfirmthediagnosis.Categorieswithinthisgroupwouldbeattributedaspossiblecausesofstrokeonly.5.Undeterminedaetiologytwoormoreaetiologiesidentified(multipleprobableormultiplepossibleaetiologies)noaetiologyidentifiedFornoaetiologyidentified:Clinicalfindings:shouldconfirmanacutestrokeregardlessofdeficit.Brainimaging:shouldconfirmacuteischaemicstrokeregardlessofsizeorlocation.IfthefirstCTheadisnormal,asecondCTheadorMRIheadshouldbeperformed.Carotidimaging:shouldexcludesignificantatheroscleroticdisease.Cardiacimaging:shouldexcludethepresenceofanobvioussourceofcardiacembolus.Bloodtestsandpasthistory:shouldexcludetherarecausesofstrokeasdefinedinthecategory“otherdeterminedaetiology”.Ifapossiblecauseofstrokeisidentifiedalongwithaprobablecauseofstroke,thelatterwillsupersedeasthestrokesubtype.预览时标签不可点转载请注明：http://www.galanzweibolu.com/xjbzlyy/4932.html
