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Hemorrhagic transforamtion is an very important clue to an embolic mechanism
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Contents
Brain Embolism? Recipient Artery Donor Source Pathophysiology Nature of Embolic Particles Treatment﹠Prevention Complications
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Brain Embolism Clinical Features
危险因素 -- 动脉粥样硬化较少 -- 心脏病因素较多（如AF、心肌病、心 瓣膜病、心衰等 -- 主动脉弓病变 -- 头颈部大血管病变 -- 静脉血栓形成条件 -- 其他部位栓塞证据
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临床提示栓塞的证据
TIA或小中风通常单次或发作频率较低，但单 次发作持续时间比较长 症状在一开始就达高峰，或阶梯式发展 有时在活动、咳嗽、打喷嚏时发作 梗塞灶可累及不同形态的多个血管区域 出血转化多见，也是较为特征性的影像学改变 可发现远端血管内栓子 梗塞灶常成楔形，位于皮质或皮质下 存在心脏、动脉或静脉栓子源的证据
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Donor Source
Heart Aorta Cervico-Cranial Arteries Veins (Paradoxical Embolism)
Dictionary
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Prevalent Concepts
Embolism =Cardiac-origin embolism The hit rate is very high Treatment is based on the sourceanticoagulants for cardiac-origin embolism and antiplatelets for arterial source embolism
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Contents
Brain Embolism? Donor Source Pathophysiology Nature of Embolic Particles Recipient Artery Treatment﹠Prevention Complications
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Definition of an embolus
Undissolved material carried by the blood current and impacted in some part of the vascular system such as thrombi, tissue fragments, clumps of bacteria, fat globules, or air bubbles
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常见的栓塞部位
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The recipient arteries are responsible for the clinical
presentation
What information is used to classify a stroke as embolic
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Recipient arteries Factors favoring an embolic stroke mechanism
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Recipient arteries(At necropsy and imaging）
Open-no blockage Distal blockage beyond the infarct Abrupt occlusion without narrowing Absence of underlying AS or other intrinsic disease No attachment of thrombus to artery
Recipient Artery Donor Source -- Heart -- Aorta -- Cervico-Cranial Arteries -- Veins (Paradoxical Embolism) Embolic matter ( the “stuff” )
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Clot in BA
缺血性脑血管病二级预防
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Disclosures
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Contents
Brain Embolism? Donor Source Pathophysiology of Embolic particles Recipient Artery Treatment﹠Prevention Complications
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Size of Infarcts Stroke Data Bank
Size of infracts on CT scan -- Cardiac-origin embolism- the median volume of infracts was 2.4x that found in patients with intraarterial embolism 早期意识障碍发生率 -- 心源性 29.8% -- 动脉源性 6.1%
Timing of symptoms--max at onset or one step within 24~48 hours Size of infarct Infarct location--cortical, cortical/subcortical Hemorrhagic transformation Appearance on vascular imaging of recepient artery--no important underlying AS, passage of blockage, shape of block, filling defect
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Contents
Brain Embolism? Recipient Artery Donor Source Pathophysiology Nature of Embolic Particles Treatment﹠Prevention Complications
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Brain Embolism Actors in the Drama