急性缺血性卒中伴大血管闭塞(acute ischemic stroke with large vessel occlusion,AIS-LVO)是鼻咽癌患者的少见并发症,且治疗难度较大。本文报道了2例鼻咽癌相关性AIS-LVO患者,其中1例为鼻咽癌放疗后出现颈内动脉假性动脉瘤合并出血患...
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急性缺血性卒中伴大血管闭塞(acute ischemic stroke with large vessel occlusion,AIS-LVO)是鼻咽癌患者的少见并发症,且治疗难度较大。本文报道了2例鼻咽癌相关性AIS-LVO患者,其中1例为鼻咽癌放疗后出现颈内动脉假性动脉瘤合并出血患者,覆膜支架置入术后出现急性支架内血栓闭塞,经血管内治疗后颈内动脉复通;另1例为鼻咽癌放疗后出现颈内动脉闭塞患者,经血管内治疗后颈内动脉复通。本文对这2例鼻咽癌相关性AI S-LVO患者的诊治过程进行分析和讨论,以期为临床治疗鼻咽癌合并脑动脉闭塞提供借鉴。
在缺血性卒中的多种风险原因中,高脂血症特别是高胆固醇血症始终占有着很关键的地位,通过降低血浆中胆固醇特别是低密度脂蛋白胆固醇的水平,可以很有效地减少缺血性卒中发生的风险,这一观点已是世界神经科专家的普遍共识。他汀类药物是缺血性卒中二级预防的基石,被广泛应用于临床,然而,他汀类药物也有其自身的局限性。首先,如果他汀类药物剂量增加一倍,其降脂效果仅增加6%,这使得许多患者仅靠他汀类药物很难达到LDL-C目标。其次,有些患者不能耐受他汀类药物,这一现象在接受大剂量他汀类药物治疗的中国患者中尤为明显。近几年新上市的新型降脂药物–前蛋白转化酶枯草溶菌素9 (proprotein convertase subtilisin/kexin type 9, PCSK9)抑制剂则为缺血性卒中的治疗提供了新的策略。Among the myriad risk factors for ischemic stroke, hyperlipidemia, particularly hypercholesterolemia, consistently holds a pivotal role. The reduction of plasma cholesterol levels, notably low-density lipoprotein cholesterol (LDL-C), has been recognized as an effective strategy to mitigate the risk of ischemic stroke. This perspective has garnered widespread acceptance among neurology experts globally. Statins, as the mainstay of secondary prevention for ischemic stroke, are extensively utilized in clinical settings. However, statins are not without their inherent limitations. Firstly, the lipid-lowering efficacy of statins plateaus with increased dosage;doubling the dose results in a mere 6% increase in cholesterol reduction, making it challenging for many patients to achieve their LDL-C targets with statin monotherapy. Secondly, statin intolerance is not uncommon, with a pronounced incidence observed among Chinese patients undergoing high-dose statin therapy. In this context, the advent of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, a novel class of lipid-lowering agents, offers a promising alternative for the management of ischemic stroke, presenting a new therapeutic horizon in the field.
卒中后抑郁是一种常见的卒中并发症,对患者的康复和生活质量有着显著影响。约三分一卒中患者伴有糖尿病,而糖尿病可加剧卒中后抑郁的风险,两者之间在病理生理学上存在相互促进的关系。本文将探讨糖尿病与卒中后抑郁之间的病理生理学联系,并从药物治疗的角度进行分析,旨在为合并糖尿病的卒中后抑郁患者提供预防和诊治参考。Post-stroke depression is a common complication of stroke, significantly affecting patients’ recovery and quality of life. Approximately one-third of stroke patients are diagnosed with diabetes, and diabetes can exacerbate the risk of post-stroke depression. There is a mutually reinforcing relationship between the two in terms of pathophysiology. This article will explore the pathophysiological connection between diabetes and post-stroke depression and analyze it from the perspective of drug therapy, aiming to provide prevention and treatment references for patients with post-stroke depression who also have diabetes.
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