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1、WenguiYu,MD,PhDDivisionofNeurologicalCriticalCareDepartmentsofNeurologicalSurgeryandNeurologyNeurocriticalCareofAcuteStrokeThePrimaryDiagnosesInNeuro-ICUIntracerebralhemorrhage(ICH)Subarachnoidhemorrhage(SAH)Ischemicstroke/TIAsStatuspostcraniotomyfortumorresecti
2、onTraumaticbraininjury(SDH,EDH)Statuspostcoilembolization,angioplasty,orstenting.ThrombolysisforIschemicStrokeIntravenoust-PAIntraarterialt-PAEndovasculartherapyAngioplasty/StentingMERCIRetrievalPenumbraClotRetrievalCoilembolizationofaneurysmSurgicaltreatmentHem
3、icraniectomyforMCAstrokeAdvancesinStrokeManagementS/pIAtPA1.Neuro-monitoring1).NeuroExamSimpleandeffectiveNeurologicchangesthatneedimmediateattentionMentalstatuschangeDecreasedlevelsofconsciousness:lethargy,stupor,coma.Disorientation:name,place,time,andevent.Spe
4、echdifficulty:expressiveorreceptiveaphasiaCranialnervepalsy:dilatedandfixedpupil(s)Newweakness/numbness2).Neuroimagingsa).CTTofollowhematomaexpansion,cerebraledema,masseffect,herniation,orhydrocephalus.IndicatedinFirstfewdaysafterstroke,Deteriorationonneuroexam,
5、Sedatedandparalyzedpatient.b).CTAContrastextravasationpredictshematomaexpansionCTdemonstratesaleftputaminalhematoma(A).AsmallfocusofenhancementisseenonCTA(B),consistentwithextravasationonpostcontrastCT(C).UnenhancedCTimage1dayafterpresentationrevealshematomaenla
6、rgementandIVH(D).-Wadaetal.Stroke.2007;38:1257-Golsteinetal.Neurology.2007;20;68(12):889-94.ContrastextravasationpredictsmortalityinICHA69-yomanunderwentimaging2hrsfollowingonsetofright-sidedparalysis.AdmissionNCCTdemonstratesaleftthalamichematomawithextensionin
7、tothethirdVentricle(A).CTA(B)andCECT(C),respectively,show2fociofactiveextravasation(arrows).Follow-upNCCT12hrslatershowsmarkedhematomagrowthwithhemorrhageinbothlateralventriclesandseverehydrocephalus(D).Thepatienthadafataloutcome.Beckeretal.Stroke1999;30:2025-20
8、32Kimetal.AmericanJournalofNeuroradiology2008;29:520-525.TheDWImapdemonstratesasmallareaofdiffusionrestrictionintherightMCAterritoryconsistentwithacuteinfarction.TheM
