急性缺血性中风是指血栓堵塞或者狭窄导致大脑动脉，从而减少或停止血液流动。这种血液供应的中断会使大脑组织缺乏必需的氧气和营养，导致脑细胞在几分钟内死亡。症状可能根据受影响的大脑部位而异，包括突然麻木或无力，尤其是身体的一侧，混乱，说话或理解言语困难，视觉问题，头晕或失去平衡。需要立即进行医疗干预，以帮助最小化大脑损伤并改善结果。

要鉴别诊断急性缺血性中风，需要进行全面评估，通常包括以下内容：
1. 病人信息和症状：收集症状的信息，如身体一侧突然无力或麻木、混乱、说话或理解语言困难、视觉问题、行走困难、头晕和突然的剧烈头痛。
2. 病史：关键包括以前的中风或短暂性脑缺血发作（TIA）、心脏病、糖尿病、高血压、高胆固醇、吸烟史以及家族中风或心血管疾病史。
3. 体格检查：进行详尽的神经系统检查，评估运动和感觉技能，检查面部和肢体的无力，评估反射和言语。检查还可能包括检测血压和听颈部颈动脉的异常声音（杂音），这可能表明有动脉硬化。
4. 诊断测试：
• 影像测试：最关键的是脑部影像测试，如CT扫描或MRI，用以确定中风的位置和范围，并鉴别缺血性中风与出血性中风。
• 颈动脉超声：检查颈动脉是否狭窄或阻塞。
• 心脏超声波：识别心脏中可能已移至大脑的血块。
• 血液测试：帮助排除其他症状原因，如低血糖或感染，并评估血液凝固因子。
5. 其他测试：根据患者的状况和初步测试结果，可能需要进行额外的测试，如心电图（检查可能导致中风的心脏病）、脑血管造影（查看大脑动脉中的血流）或心脏监测测试，检查是否有心房颤动或其他可能导致血块的心律。

在处理疑似急性缺血性中风的患者时，以下评估非常重要：
1. 病史采集:
• 症状发作时间: 确定症状开始的确切时间非常关键，因为它决定了患者是否适合接受溶栓等特定治疗。
• 风险因素: 收集有关高血压、糖尿病、吸烟、心房颤动以及以往中风或短暂性脑缺血发作（TIA）的历史。
• 症状描述: 记录特定的神经缺损，如虚弱、言语困难、面部下垂和视觉问题。

2. 体格检查:
• 神经系统评估: 进行重点的神经系统检查，包括评估精神状态、颅神经、肌力、感觉功能、反射、协调能力和步态。
• 生命体征: 监测血压、心率、氧饱和度和体温，以评估整体稳定性并识别其他潜在的并发症。

3. 诊断测试:
• 影像学检查: 立即进行大脑影像学检查，通常使用无对比剂CT扫描，以确认中风的存在并区分缺血性和出血性中风。MRI可能用于进一步评估。
• 颈动脉超声: 评估颈动脉是否存在动脉粥样硬化斑块或狭窄，这些可能是导致中风的因素。
• 心脏超声图: 检测心脏来源的栓子，如心房颤动或其他心脏异常。
• 血液检测: 包括完全血细胞计数、凝血研究和代谢组检查，用于检查感染、凝血障碍和电解质失衡。
• 心电图（ECG): 用于识别任何心律失常，特别是心房颤动，这是缺血性中风的一个重要风险因素。

这些评估有助于确认急性缺血性中风的诊断，确定原因，并指导适当的治疗策略。

病历记录（中文）

患者信息：
• 姓名：约翰·多伊
• 年龄：65岁
• 性别：男
症状：
• 左侧突然无力
• 说话困难
• 混乱
病史：
• 高血压
• 2型糖尿病
• 先前有短暂性脑缺血发作（TIA）
体检：
• 血压：170/95毫米汞柱
• 心率：88次/分钟
• 神经检查：左侧偏瘫，左侧面部下垂，言语不清
诊断测试：
• 头部CT扫描：未见出血，但右大脑半球显示缺血性梗塞迹象
• 心电图：正常窦性心律
• 血液检测：
• 胆固醇水平：高
• 血糖：升高
鉴别诊断：
• 急性缺血性中风
• 出血性中风（通过CT排除）
• 脑瘤（CT未显示肿块效应，可能性较小）

急性缺血性中风发生时，血栓阻塞或缩窄通往大脑的动脉，导致血流减少。缺血性中风约占所有中风病例的87%。

病例示例: 一位68岁的男性，有高血压和糖尿病病史，因突发左侧无力和说话困难被送到急诊室，症状始于1小时前。他的妻子注意到他的言语不清和左侧面部下垂，立即呼叫急救服务。检查时发现患者的血压升高至180/100毫米汞柱，血糖水平略高。头部CT扫描显示无出血，但头部MRI弥散加权成像证实右半球发生缺血性中风，影响了控制运动和语言的区域。

管理措施包括立即给予静脉溶栓治疗，前提是没有禁忌症，以帮助溶解血栓。抗血小板治疗和高血压及糖尿病等风险因素的管理也是防止进一步中风的关键。康复服务应尽早启动，以帮助恢复运动和语言功能。

在鉴别诊断急性缺血性中风时，应考虑几种可能模拟中风症状的疾病。这些包括：
1. 出血性中风 - 区分缺血性和出血性中风至关重要，因为治疗方法有很大差异。
2. 短暂性脑缺血发作 (TIA) - 通常称为小中风，TIA的症状与中风相似，但这些症状是暂时的，大脑的血流很快得到恢复。
3. 脑瘤 - 脑瘤可根据其位置和大小模仿中风症状。
4. 癫痫 - 癫痫后的瘫痪或虚弱（托德瘫痪）可以模仿中风症状。
5. 偏头痛伴有先兆 - 一些偏头痛可以引起类似中风的神经系统症状，如视觉障碍和单侧虚弱。
6. 全身性感染 - 如败血症或脑膜炎等条件可能有类似中风的神经系统表现。
7. 代谢性疾病 - 低血糖或高血糖可以产生与中风相似的神经系统症状。
8. 脱髓鞘疾病 - 多发性硬化症或其他损害神经细胞髓鞘的疾病可以出现与中风相似的症状。

在区分这些条件并提供适当治疗时，使用临床判断、影像测试和其他诊断程序至关重要。

Acute ischemic stroke occurs when a blood clot blocks or narrows an artery leading to the brain, resulting in a reduction or cessation of blood flow. This disruption in blood supply deprives the brain tissue of necessary oxygen and nutrients, leading to the death of brain cells within minutes. The symptoms can vary depending on the part of the brain affected, and may include sudden numbness or weakness, especially on one side of the body, confusion, difficulty speaking or understanding speech, vision problems, dizziness, or loss of balance. Immediate medical intervention is crucial to help minimize brain damage and improve outcomes.

To differentially diagnose acute ischemic stroke, a comprehensive evaluation is necessary that typically includes the following:
1. Patient Information and Symptoms: This involves collecting information about the onset of symptoms such as sudden weakness or numbness on one side of the body, confusion, trouble speaking or understanding speech, vision problems, difficulty walking, dizziness, and sudden severe headache.
2. Medical History: Key aspects include previous strokes or transient ischemic attacks (TIAs), heart disease, diabetes, hypertension, high cholesterol, smoking history, and family history of stroke or cardiovascular disease.
3. Physical Examination: A thorough neurological examination is performed to evaluate motor and sensory skills, check for facial and limb weakness, and assess reflexes and speech. The examination may also include checking the blood pressure and listening to the carotid arteries in the neck for any abnormal sounds (bruits) that indicate atherosclerosis.
4. Diagnostic Tests:
• Imaging Tests: Most critical are brain imaging tests like a CT scan or MRI to identify the location and extent of the stroke and to differentiate ischemic stroke from hemorrhagic stroke.
• Carotid Ultrasound: To check for narrowed or blocked carotid arteries.
• Echocardiogram: To identify sources of clots in the heart that may have traveled to the brain.
• Blood Tests: These can help rule out other causes of symptoms like low blood sugar or infections and evaluate blood clotting factors.
5. Additional Tests: Depending on the patient's condition and initial test results, additional tests like an ECG (to check for heart disease that can lead to strokes), a cerebral angiogram (to view blood flow in the brain arteries), or heart-monitoring tests to check for atrial fibrillation or other heart rhythms that could cause clots.

In the management of a patient suspected of having an acute ischemic stroke, the following evaluations are crucial:
1. Medical History Taking:
• Symptom Onset: Identifying the exact time symptoms started is critical as it determines eligibility for certain treatments like thrombolysis.
• Risk Factors: Gathering information about history of hypertension, diabetes, smoking, atrial fibrillation, and previous strokes or transient ischemic attacks (TIAs).
• Symptom Description: Noting the specific neurological deficits such as weakness, speech difficulties, facial drooping, and vision problems.
2. Physical Examination:
• Neurological Assessment: Conducting a focused neurological exam including evaluation of mental status, cranial nerves, motor strength, sensory function, reflexes, coordination, and gait.
• Vital Signs: Monitoring blood pressure, heart rate, oxygen saturation, and temperature to assess overall stability and identify other potential complicating factors.
3. Diagnostic Tests:
• Imaging Studies: Immediate brain imaging, typically with a non-contrast CT scan, to confirm the presence of a stroke and differentiate between ischemic and hemorrhagic stroke. MRI may be used for further evaluation.
• Carotid Ultrasound: To assess the carotid arteries for any atherosclerotic plaques or stenosis that could be contributing to the stroke.
• Echocardiogram: To detect cardiac sources of emboli, such as atrial fibrillation or other heart abnormalities.
• Blood Tests: Including complete blood count, coagulation studies, and metabolic panel to check for infection, blood clotting disorders, and electrolyte imbalances.
• Electrocardiogram (ECG): To identify any cardiac arrhythmias, particularly atrial fibrillation, which is a significant risk factor for ischemic strokes.

These assessments help in confirming the diagnosis of acute ischemic stroke, determining the cause, and guiding appropriate treatment strategies.

Here's an example medical record containing the necessary information for a differential diagnosis of a patient suspected of an acute ischemic stroke:

Medical Record (English)

Patient Information:
• Name: John Doe
• Age: 65 years
• Sex: Male
Symptoms:
• Sudden onset of left-sided weakness
• Difficulty speaking
• Confusion
Medical History:
• Hypertension
• Type 2 Diabetes
• Previous transient ischemic attack (TIA)
Physical Examination:
• Blood Pressure: 170/95 mmHg
• Heart Rate: 88 bpm
• Neurological Examination: Left-sided hemiparesis, facial droop on the left side, slurred speech
Diagnostic Tests:
• CT Scan of the head: No hemorrhage, but signs suggestive of an ischemic infarct in the right cerebral hemisphere
• ECG: Normal sinus rhythm
• Blood Tests:
• Cholesterol levels: High
• Blood glucose: Elevated
Differential Diagnosis:
• Acute ischemic stroke
• Hemorrhagic stroke (ruled out by CT)
• Brain tumor (less likely without evidence of mass effect on CT)

Acute ischemic stroke occurs when a blood clot blocks or narrows an artery leading to the brain, causing a reduction in blood flow. Ischemic strokes account for about 87% of all stroke cases.

Sample Patient Case: A 68-year-old male with a history of hypertension and diabetes presents to the emergency department with sudden onset of left-sided weakness and difficulty speaking, which began 1 hour ago. His wife noticed his slurred speech and facial drooping on the left side and immediately called emergency services. On examination, the patient's blood pressure is elevated at 180/100 mmHg, and his blood glucose level is slightly high. A CT scan of the head shows no hemorrhage, but an MRI with diffusion-weighted imaging confirms an ischemic stroke in the right hemisphere, affecting the regions responsible for motor control and speech.

Management includes immediate administration of intravenous thrombolytics, provided there are no contraindications, to help dissolve the clot. Antiplatelet therapy and management of risk factors like hypertension and diabetes are also crucial to prevent further strokes. Rehabilitation services are initiated early to aid recovery of motor and speech functions.

In the differential diagnosis of acute ischemic stroke, several conditions should be considered that can mimic the symptoms of stroke. These include:
1. Hemorrhagic Stroke - It is crucial to differentiate between ischemic and hemorrhagic strokes, as the treatment differs significantly.
2. Transient Ischemic Attack (TIA) - Often called a mini-stroke, a TIA presents similar symptoms to a stroke but they are temporary and the blood flow to the brain is quickly restored.
3. Brain Tumors - A brain tumor can mimic stroke symptoms depending on its location and size.
4. Seizure Disorders - Post-seizure paralysis or weakness (Todd’s paralysis) can mimic stroke symptoms.
5. Migraine with Aura - Some migraines can cause neurological symptoms similar to strokes, such as visual disturbances and unilateral weakness.
6. Systemic Infections - Conditions like sepsis or meningitis can have neurological manifestations that resemble a stroke.
7. Metabolic Disorders - Hypoglycemia or hyperglycemia can produce neurological symptoms similar to those of a stroke.
8. Demyelinating Diseases - Multiple sclerosis or other diseases that damage the myelin sheath of nerve cells can present with symptoms similar to those of a stroke.

It is critical to use clinical judgment, imaging tests, and other diagnostic procedures to differentiate these conditions and provide the appropriate treatment.