Li Xinyi: Diagnosis of ischemic stroke based on CISS parting

With the change of people's understanding of ischemic stroke from a "disease" to a "clinical syndrome" concept, and the beginning of the treatment of different ischemic stroke patients based on the cause, the significance of ischemic stroke's cause credit type is even more important.
On March 22, 2019, at the "136" Xing Medical Engineering Leading Clinical Specialists Academic Series Event/The 4th Sanjin Thrombosis Forum and the Annual Meeting of shanxi Province Vascular Disease Specialist Alliance, Dr. Li Xinyi, from the Department of Neurology of Shanxi University Hospital, made a wonderful speech on the topic of diagnosis of ischemic stroke based on CISS subtype.
CISS ischemic stroke is not an independent disease, but a highly heterogeneic disease, and the causes of different types of ischemic stroke vary.
people's understanding of ischemic stroke from a "disease" to a "clinical syndrome" concept of change, and began to based on the cause of different ischemic stroke patients "to treat the cause."
, ischemic stroke pathogenic credits are the basis for clinical trials, epidemiological investigations, genetic studies, and treatment decision-making in clinical practice.
since the publication of the classic TOAST sub-type in 1993, people have been transforming it according to their own understanding in the process of use, and as far as possible in the process of evolution and development.
the ischemic stroke type (CISS) of China is divided into two stages: the first step is similar to the classic TOAST type, and the emoticons are divided into five types, namely atherosclerosis (LAA) ), heart-based stroke (CS), an arterial disease (PAD), other ethiopaths (OE) and eynology uncertainty (UE), wherein LAA also according to the site of the main atherosclerosis and intracranial, external atherosclerosis.
The second step is to type the pathogenesis of atherosclerosis intracranial and intracranial atherosclerosis into four types: carrier arteries (plaques or blood clots) blocking the permeation, artery-to-arterial embolism, low perfusion/embolism removal decline and mixing mechanisms (Figure 1).
CISS division has the greatest advantage of distinguishing the causes and pathogenesis of ischemic stroke caused by atherosclerosis, which is more in line with the pathophysiological process of disease development, and taking aortic archal atherosclerosis as a subtype of atherosclerosis rather than a cause of heart-based embolism is not only of great significance to the patient's secondary prevention, but also has important guiding significance for the classification screening of patients when the study is carried out.
Figure 1. CISS type diagnosis idea "four steps" 1, clinical manifestations of clinical performance is the direct cause and purpose of patient visits, but also the patient's most painful family members are most concerned about.
clinical manifestations of ischemic stroke are the manifestations/signs of impaired brain function, which belong to the performance level of the disease, and are intuitive, vivid, storyy, diverse, volatile and complex.
contains symptomological changes and positive signs of the nervous system.
depends on comprehensive, detailed and reliable consultation.
2. The occurrence of isomorgenic cerebrovascular disease in brain tissue originated from isoemia damage in brain tissue, which is the direct cause of clinical manifestations and the structural basis for changes in brain function.
detection of brain tissue damage (brain structure imagery) usually uses cranial CT (advantages are fast, sensitive to bleeding; the disadvantages are low resolution, insensitive to small infarction of the cortical layer) and skull MRI (including FLAR and DWI, etc.), with higher resolution.
3, cerebrovascular changes isoemia cerebrovascular disease encephalopathy is due to changes in the blood vessels that supply brain tissue, vascular changes are the cause of brain damage.
in our past work, we focused more on the damage to brain tissue and ignored the corresponding vascular changes.
In March 2003, the American Council of Specialists approved the establishment of a qualification examination for vascular neurology, the production of vascular neurology, a discipline that has pushed the clinical stage of cerebrovascular disease to a whole new stage, to pay attention to the change of blood vessels.
it's not enough to treat cerebral infarction if we're still just treating cerebral infarction based on clinical performance and a skull CT.
the evaluation means of cerebrovascular include: (1) cervical artery ultrasound can reflect structure, stenosis, plaque properties.
(2) TCD can detect intracranial blood vessels, but also to detect the direction of blood flow, MES plaque fragile reliable signs.
(3) MRA/CTA/DSA provides direct evidence of morphology, including stenosis, degree, atherosclerosis plaque properties, etc.
(4) HR-MRI is used to understand the tube wall structure, the direction of lesions expansion (inward/outward) and to determine the nature of lesions.
mra is safe and exaggerating; CTA is non-invasing and displays bone relations comparable to DSA; and DSA is the gold standard for invasing inspections.
4, the risk factors of vascular pathological changes (mainly atherosclerosis and small vascular glass-like degeneration) have their starting factors, divided into interventional factors and non-interventional factors.
the risk factors that can be interfered with are hypertension, diabetes, lipid metabolic disorders, atrial fibrillation and other heart diseases, hypercysteineemia, smoking, drinking alcohol, obesity, decreased exercise, etc., and non-interventional risk factors include age, sex, etc.
only by actively intervening and fully blocking the risk factors that cause pathological changes in blood vessels and their secondary pathological processes can we fundamentally reduce the re-occurrence of ischemic stroke, otherwise it will not help.
should also be carried out as early as possible.
ischemic stroke is not an independent disease, but a highly heterogeneic disease, and the causes of different types of ischemic stroke are different.
according to the cause credit type based on the cause of different ischemic stroke patients "to the cause of treatment" is of great significance.
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