Stroke at NYHQ 紐約皇后醫院 中風治療簡介 Edward Chai, MD 柴念斐醫生 New York Hospital Medical Center of Queens Clinical Assistant Professor of Neurology Weill Cornell Medical College 紐約皇后醫院神經內科主治醫師 康乃爾醫學院神經內科臨床副教授

What is a Stroke ? 什麽是中風？ Also called a Cerebral Vascular Accident or (CVA) but this term is outdated 中風也稱為腦血管意外或(CVA )，但是這個説法已經過時 A disruption in brain blood flow leading to loss of brain function as brain is deprived of oxygen 腦血流中斷造成腦内缺氧，而導致腦功能的損傷 Blockage阻塞: Ischemic缺血性 (about 大約佔80-90%) Bleed出血: Hemorrhagic出血性 (大約佔10-20%) NIH/NINDS Data

Stroke Epidemiology 中風的流行病學 750,000 strokes per year in US 美國每年有750，000個中風病例 4 million Americans living with neurologic deficits due to stroke 四百萬美國人身體有由於中風而造成神經系統缺陷 Third leading cause of death in US 美國死亡原因的第三位 leading cause of death worldwide 全球主要死亡原因 mortality from stab wound 5%, mortality from stroke 20% 外傷致死率為5% , 中風致死率為20% more women die from stroke (1/6) than breast CA (1/25) 女性因中風死亡比率 (1/6) 比因乳癌死亡比率 （1/25）要高 NIH/NINDS data

Stroke Epidemiology 中風的流行病學 Leading cause of long-term disability worldwide 是全球造成長期殘疾的主要原因 5% of ischemic stroke patients receive tPA 5%的缺血性中風病人接受tPA NIH/NINDS data

Ischemic Stroke 缺血性中風 Blockage of a blood vessel 血管堵塞 Blood clot 血塊 Plaque from artery intracranial or extracranial 動脈内外血片 Air 空氣 Fat 脂肪 Infection (endocarditis) 感染 （心内膜炎）

Hemorrhagic Stroke 出血性中風 Bursting of blood vessels due to 引起血管破裂原因 weak blood vessels 血管脆弱 Hypertension 高血壓 Aneurysm: weak spot in the artery 動脈瘤：血管中薄弱點 Arteriovenous malformation: vascular tumor動靜脈畸形：血管瘤 Risk factors are the same but the mechanism is different 風險因素是相同的，但其程序不同

Ischemic versus hemorrhagic 缺血性與出血性中風對比

Stroke Types 中風類型

Symptoms 症狀 Sudden numbness or weakness of face, arm or leg, especially on one side of the body 突然感到面部，手臂或腿麻木或無力，尤其是發生在身 體的一側 Sudden confusion, trouble speaking or understanding 突然有說話或理解困難

Symptoms (Cont’) 症狀 Sudden trouble seeing in one or both eyes 突然一眼或兩眼有視力障礙 Sudden trouble walking, dizziness, loss of balance or coordination 突然行走有困難，眩暈，失去平衡或協調 Sudden severe headache with no known cause 突然有原因不明的劇烈頭痛

Risk Factors 危險因素 Age 年齡 Heart Disease (Atrial Fibrillation, or Myocardial Infarction) 心臟疾病（心房顫動，或心肌梗死） High Cholesterol 高膽固醇 Diabetes 糖尿病 Obesity 肥胖 Cigarette Smoking 吸煙 Excessive drinking 酗酒 Stroke in the past or in family 本人或家庭成員有中風病史

MRI Diffusion Scan 磁場共振影像掃描

If you have a stroke…. 如果您發生中風 Go to the nearest emergency room 及時到最近的急診室就診 Time is brain….. 時間就是大腦 Even a few minutes can makes a huge difference in outcomes…. 即使是幾分鐘也能對癒後成效造成巨大的影響

Acute Treatment: TPA 緊急治療:TPA Ischemic Stroke occurred less than 4.5 hours ago with no risk for bleed then TPA or (Tissue Plasminogen Activator) 在内缺血性中風發生4.5小時內，並無再出血風險，可行 TPA治療或（組織型纖溶酶原激活劑治療） Clot Buster that clears the blood clot 溶解血塊以清除血 塊 4.5-6 hours: Mechanical clot retrieval or intra-arterial TPA 4.5-6小時：找出血塊或在動脈内使用TPA

Acute Treatment: TPA (Cont’) 緊急治療:TPA Fishing it out or squirting clot buster straight into the clot 引導出血塊或直接向血塊噴射溶解劑 Latter two treatments have unclear benefits but recent data shows benefits 後兩項治療方法的優點尚未確定，但最近的數據顯示確實 有好處

Tissue Plasminogen Activator 組織型纖溶酶原激活劑 Only proven treatment for acute stroke 是唯一證明有效治療急性中風的方法 Improves chances for better recovery (30 % better chance not to be disabled) 提供更好的癒後恢復（非致殘機率提高30 ％） NYHQ is a “Designated stroke center” 紐約皇后醫院是“指定的中風治療中心”

Tissue Plasminogen Activator (Cont’) 組織型纖溶酶原激活劑 In the past six years we have septupled the amount of TPA we have given (13 times in 2008 to 45 in 2011, close to 90 in 2014) 在過去的六年裡，我們TPA治療數量增長了7倍（在2008年 有13例，2011年有45例 2014年有接近90 例） Risk of bleed only in persons with stroke 出血的危險僅限於中風病人

Our Successful Administration of tPA At NYHQ 紐約皇后醫院有成功的tPA治療 Our strengths are in our in house 24/7 Stroke Team with a physician assistant trained in stroke. This team improves the efficacy in providing stroke treatment. 我們的優勢是有一個24小時7天無間斷的治療團隊，其中包括一位 接受過中風治療訓練的助理醫師。這個團隊提高我們中風治療的 質量。 Neurology Division is a strong advocate of tPA, is always available and is very supportive. (we receive no financial support from Genetech the makers of tPA) 醫院的神經科非常支持tPA的使用。 （我們沒有從tPA的製造商 Genetech收到任何財政支援）

Our Successful Administration of tPA At NYHQ (Cont’) 紐約皇后醫院有成功的tPA治療 24/7 availability of a neurologist 您可以在任何時候聯係到神經科醫生，24小時7天無間斷 Engaged ER physicians-mock stroke team calls 與急診室中風團隊密切聯繫 A truly motivated team that share their case “success” stories with their colleagues. 我們是一個認真積極的團隊，與同事分享 “成功”的故事。

Core核部 Penumbra 邊緣部 Ischemic Penumbra 缺血性中風邊緣部分 Penumbra 邊緣部 Benign Oligemia良性血供減少區 Penumbra 邊緣部 Tissue at risk, still salvageable組織有危險，仍可修復 Target of acute stroke therapy急性中風標靶治療

After the Acute Phase 急性期過後 Work up to check for specific causes of stroke that need to be addressed to prevent future stroke 檢查中風的起因，以防止未來中風 Addressing complications secondary to acute stroke 解決急性中風的並發症 50 % of strokes do not result in a clear cause other than attributing it to general medical risk factors mentioned before 中風病例中50%是沒有明確的致病原因，只能歸咎於先前 提到的常見致病因素

Transient Ischemic Attack 短暫性腦缺血 An ischemic stroke that occurs but spontaneously resolves with no permanent damage 自動解除的缺血性中風不會引起永久損傷 Symptoms resolve usually after 24 hours 症狀在24小時後通常會消失 Symptoms may resolve completely but completed stroke may show up on MRI is not a TIA 症狀可以完全消失，但是在MRI上呈現的是完全性的中風 而不是短暫性腦缺血

Stroke risk at six, 12, and 24 hours following transient ischemic attack 短暫性腦缺血發作後6、12和24小時的中風機率 Time point, h 時間 Stroke risk (%) 中風機率（%） 95% CI 95%CI 6 1.2 0.2–2.2 12 2.1 0.8–3.2 24 5.1 3.1–7.1 Chandratheva A et al. Neurology 2009; 72:1941-1947.

Specific Conditions for Stroke 中風的特殊情況 Atrial Fibrillation 心房顫動 Carotid Disease or Extracranial Stenosis 頸動脈疾病或顱外動脈狹窄 Intracranial stenosis 顱內動脈狹窄

Atrial Fibrillation 心房顫動

Atrial Fibrillation 心房顫動 Irregular heart beat where the atrium does not beat normally and there is danger of blood clots forming there and causing ischemic stroke 當心房不正常搏動導致不規則的心臟跳動，血塊易於形成以致造成 缺血性中風 Risk is about 7-10% per year for a stroke 占每年中風病例中7-10% CHAD S2 score , C(HF) H(ypertension) A(ge)2 D(iabetes) S(stroke)2 V(ascular) S(ex) CHAD S2指數: 充血性心脏衰竭, 高血壓 ,年齡 ,糖尿病, 中風 ,血 管, 性別

Echocardiogram in stroke patients 中風患者的超聲波心動圖 An echocardiogram (TTE or TEE) study will identify important cardiac lesions in stroke patients even when clinical and routine lab data do not suggest a cardiac source of embolism. 即使臨床和實驗室檢查未能看出栓塞的源由， 超聲心動圖（TTE or TEE)研究可以找出在中風患者的重要心臟病 變。

Echocardiogram 超聲波心動圖

Carotid Disease 頸動脈疾病

Intracranial Stenosis 顱內動脈狹窄

Intracranial Stenosis 顱內動脈狹窄

Stroke rehabilitation 中風的復健

Stroke rehabilitation 中風的復健

Stroke rehabilitation 中風的復健

Thank You 謝謝！！