1. 简述缺血性脑血管病急性期的治疗原则

（1）鉴别诊断疾病类型（短暂性缺血发作还是脑梗死；心源性还是动脉源性栓塞性……）（2）早期积极干预，紧急评估：降低颅内压，维持足够脑灌注预防脑疝卒中，减轻原发性脑损伤。

3）动脉源性栓塞性TIA稳定斑块，强化他汀治疗，积极降压，抗栓治疗。

心源性TIA抗凝治疗，血流动力型TIA扩容治疗，高纤维蛋白原血症TIA降纤酶治疗。

（4）对症治疗：外科治疗和血管介入治疗

（5）预防并发症的发生：脑水肿，颅内压增高，癫痫等

(1) Differential diagnosis of disease type (transient ischemic attack or cerebral infarction; cardiogenic or arterial embolic...)

(2) Early active intervention and emergency evaluation: reduce intracranial pressure, maintain sufficient cerebral perfusion, prevent cerebral hernia stroke and reduce primary brain injury.

(3) Arterial embolic TIA, stable plaque, intensive statin therapy, active hypotension and antithrombotic therapy.

Cardiogenic TIA anticoagulant therapy, hemodynamic TIA volume expansion therapy, high fibrinogen TIA defibrase therapy.

(4) Symptomatic treatment: surgical treatment and vascular interventional therapy

(5) Prevention of complications: brain edema, increased intracranial pressure, epilepsy, etc

2. 简述大脑中动脉梗死的临床表现

（1）主干闭塞：导致三偏症状，即病灶对侧偏瘫（包括中枢性面舌瘫和肢体瘫痪）、偏身感觉障碍及偏盲（三偏），伴双眼向病灶侧凝视，优势半球受累出现失语，非优势半球受累出现体象障碍，并可以出现意识障碍，大面积脑梗死继发严重脑水肿时，可导致脑疝，甚至死亡。

（2）皮质支闭塞：a.上部分支闭塞导致病灶对侧面部、上下肢瘫痪和感觉缺失，但下肢瘫痪较上肢轻，且足部不受累，双眼向病灶侧凝视程度轻，伴Broca失语（优势半球）和体象障碍（非优势半球），通常不伴意识障碍；b.下部分支闭塞较少单独出现，导致对侧同向性上四分之一视野缺损，伴Wernicke失语（优势半球），急性意识模糊状态（非优势半球），无偏瘫。

（3）深穿支闭塞：表现为对侧中枢性均等性轻偏瘫，对侧偏身感觉障碍，可伴有对侧同向性偏盲。优势半球病变出现皮质下失语，常为底节性失语，表现为自发性言语受限、音量小，语调低、持续时间短暂。

 

(1) Trunk occlusion: it leads to three partial symptoms, i.e. hemiplegia on the opposite side of the focus (including central facial and lingual paralysis and limb paralysis), hemiparesis and hemianopia (three partial), with eyes staring at the side of the focus, aphasia in the dominant hemisphere, body image disorder in the non dominant hemisphere, and disturbance of consciousness. When a large area of cerebral infarction is secondary to severe brain edema, it can lead to cerebral hernia, Even death.

(2) Cortical branch occlusion: A. upper branch occlusion leads to paralysis and sensory loss of the opposite side of the focus, upper and lower limbs, but the paralysis of the lower limbs is lighter than that of the upper limbs, and the feet are not involved. The degree of gaze from both eyes to the side of the focus is light, accompanied by Broca aphasia (dominant hemisphere) and body image disorder (non dominant hemisphere), usually without disturbance of consciousness; b. Lower branch occlusion rarely occurs alone, resulting in contralateral isotropic upper quarter visual field defect, accompanied by Wernicke aphasia (dominant hemisphere), acute blurred state of consciousness (non dominant hemisphere), and no hemiplegia.

(3) Deep perforator occlusion: manifested as contralateral central parity hemiplegia, contralateral hemiparesis, contralateral hemiparesis, and contralateral homonymous hemianopia. Subcortical aphasia occurs in dominant hemisphere lesions, often basal aphasia, which is characterized by spontaneous speech limitation, low volume, low intonation and short duration.