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目的评价以发作性意识障碍为主要表现的脑缺血发作病理生理机制和治疗选择。方法回顾性分析12例以发作性意识障碍为主要表现的脑缺血发作病人临床和治疗随访资料。结果过度降压是常见的发作诱因,临床表现为短暂的不同程度意识障碍,持续数分钟至数小时。血管造影可分为颈内动脉系统严重狭窄(双侧多见),椎基底动脉系统严重狭窄和多血管病变。血管造影及脑灌注检查发现颈内动脉系统严重狭窄患者存在大脑半球低灌注。结论发作性意识障碍是脑大动脉狭窄的少见表现,低灌注可能是该类病人发病机制。病人存在脑卒中的高度风险,血运重建可能改善病人的症状和预后,远期疗效有待于观察。
Objective To evaluate the pathophysiological mechanisms and treatment options of cerebral ischemic attack with episodic disturbance of consciousness as the main manifestation. Methods The clinical and treatment follow-up data of 12 patients with cerebral ischemic attack, which mainly manifested as episodic disturbance of consciousness, were retrospectively analyzed. The results of over-decompression is a common cause of attack, the clinical manifestations of transient levels of disturbance of consciousness, lasting several minutes to several hours. Angiography can be divided into severe carotid artery stenosis (bilateral more common), vertebrobasilar system severe stenosis and multiple vascular lesions. Angiography and cerebral perfusion examination revealed severe hemispheric hypoperfusion in patients with severe stenosis of the internal carotid artery. Conclusions Paroxysmal disturbance of consciousness is a rare manifestation of cerebral stenosis. Low perfusion may be the pathogenesis of this kind of patients. Patients with a high risk of stroke, revascularization may improve the patient’s symptoms and prognosis, long-term efficacy remains to be seen.