377.2 🩺 國考版

377.2.1 高頻考點

377.2.1.1 Stroke Statistics

  • 85% ischemic, 15% hemorrhagic
  • 2nd leading cause of death globally
  • Leading cause of disability

377.2.1.2 TOAST Classification

  • Large-artery
  • Cardioembolic (AF)
  • Small-vessel (lacunar)
  • Other (dissection, vasculitis, hypercoag)
  • Cryptogenic

377.2.1.3 MCA Stroke

  • Contralateral face + arm > leg
  • Hemisensory loss
  • Hemianopia
  • Aphasia (dominant) or neglect (non-dominant)
  • Gaze toward lesion

377.2.1.4 Wallenberg (Lateral Medullary)

  • PICA territory
  • Ipsilateral: face sensory loss, Horner, ataxia, dysphagia, hoarse
  • Contralateral: body sensory loss

377.2.1.5 Time Windows

Treatment Window
IV alteplase ≀ 4.5 hr
IV tenecteplase ≀ 4.5 hr (emerging)
Mechanical thrombectomy standard ≀ 6 hr
Mechanical thrombectomy extended 6-24 hr (DAWN, DEFUSE-3)

377.2.1.6 Alteplase Dose

  • 0.9 mg/kg IV (10% bolus, 90% over 60 min)

377.2.1.7 Tenecteplase Dose

  • 0.25 mg/kg single bolus

377.2.1.8 tPA Contraindications

  • Hemorrhage
  • Recent stroke/major surgery/major bleed
  • INR > 1.7
  • BP > 185/110 (treat first)
  • Glucose < 50 or > 400

377.2.1.9 LVO Criteria for Thrombectomy

  • ICA, M1, possibly M2
  • NIHSS ≥ 6
  • ASPECTS ≥ 6
  • Premorbid mRS 0-1

377.2.1.10 Extended Window Trials

  • DAWN: 6-24 hr, clinical-imaging mismatch
  • DEFUSE-3: 6-16 hr, perfusion-imaging mismatch
  • MR-CLEAN-LATE: 6-24 hr, less strict (2023)

377.2.1.11 Basilar Artery Trials

  • BAOCHE, ATTENTION (2022)
  • Thrombectomy beneficial extended window

377.2.1.12 Acute BP Management

  • Pre-tPA: < 185/110
  • Post-tPA: < 180/105 × 24 hr
  • No reperfusion: permissive unless > 220/120

377.2.1.13 CHANCE/POINT

  • ASA + clopidogrel × 21 days
  • For high-risk minor stroke/TIA
  • Reduces recurrence

377.2.1.14 THALES

  • ASA + ticagrelor × 30 days

377.2.1.15 Symptomatic Carotid Stenosis

  • 50-99% → CEA preferred (NASCET, ECST)
  • Within 2 weeks ideal
  • Number needed to treat improves with severity

377.2.1.16 PFO Closure

  • Cryptogenic stroke in young
  • High-risk PFO (RoPE score)
  • Plus antiplatelet
  • RESPECT, REDUCE, CLOSE

377.2.2 Specific Causes

377.2.2.1 Cervical Artery Dissection

  • Young, often after trauma (chiropractic, MVA, sports)
  • Carotid: headache, Horner, neck pain
  • Vertebral: occipital headache, vertigo
  • CTA/MRA
  • Antiplatelet or anticoagulation (CADISS no difference)

377.2.2.2 CADASIL

  • AD, NOTCH3 mutation
  • Recurrent strokes + migraine + cognitive + mood
  • White matter changes (anterior temporal characteristic)

377.2.2.3 Fabry Disease

  • X-linked, α-galactosidase A
  • Young stroke + neuropathy + skin + kidney + heart
  • Enzyme replacement (agalsidase)

377.2.2.4 Moyamoya

  • Internal carotid bilateral progressive stenosis
  • Collaterals “puff of smoke”
  • Ischemic or hemorrhagic strokes
  • Revascularization

377.2.2.5 RCVS

  • Thunderclap headache (recurrent)
  • Reversible vasoconstriction
  • Postpartum, vasoactive drugs (cocaine, SSRI)
  • Self-limited

377.2.2.6 Sneddon Syndrome

  • Livedo reticularis + recurrent strokes
  • APLS often

377.2.2.7 Sickle Cell Disease

  • Children especially
  • Transcranial Doppler screening
  • Exchange transfusion prevention