SECTION1第一部分
A43-year-oldwomanpresentedwitha4-dayhistoryofrightlimbweakness.Whilebiking4daysearlier,shefeltaweaknessinherrighthandandleg.Shehadahistoryofhypertensionformorethan2years,andwastakingextended-releasenifedipinetablets(40mg)andperindopril(4mg)daily,butherbloodpressurewasdifficulttocontrol(fluctuationsof–/90–mmHg).Thepatientdidnotsmokeordrinkalcohol,andhadnofamilyhistoryofsimilardiseases.
患者为43岁女性，因“右侧肢体无力4天”就诊。患者于4天前骑自行车时感右手和右腿乏力。既往高血压病史2年以上，每日服用硝苯地平缓释片（40mg）和培哚普利（4mg），但血压仍控制不佳（波动在-/90-mmHg）；无吸烟或喝酒史；无类似疾病的家族史。
Clinicalexaminationrevealedabloodpressureof/98mmHg,facialacne,abdominalobesity,andecchymosisontheupperlimbs(figure,AandB).TheMedicalResearchCouncilpowerwas4/5ontheflexorandextensoroftherighthip,knee,andankle.Noothernervoussystemabnormalitieswereobserved.Therandombloodglucoselevelwas14.38mmol/L.BrainMRIrevealedacuteinfarctionsintheleftthalamusandrightoccipitallobe,subacuteinfarctionsintheleftcerebellum,andoldinfarctionsintheperiventricularandcentrumsemiovale(figure,CandD).
临床检查发现血压为/98mmHg、面部痤疮、腹部肥胖和上肢瘀斑（图A，B）。MRC分级法肌力检查提示右髋关节、膝关节及踝关节屈肌和伸肌肌力均为4/5级。其他神经系统检查未见明显异常体征。随机血糖水平为14.38mmol/L。头颅MRI显示左侧丘脑和右侧枕叶急性梗死、左侧小脑亚急性梗死以及脑室周围和半卵圆中心陈旧性梗死灶（图C，D）。
Questionsforconsideration:
1.Whichtypeofcerebralinfarctionshouldfirstbeconsideredastheetiology?
2.Whichexaminationsshouldbeperformednext?
问题思考：
1.该患者脑梗死的病因分类首先考虑什么？
2.接下来该进行哪些检查？
SECTION2第二部分Amiddle-agedwomanpresentedwithprimarysymptomsofrightlimbweakness.BrainMRIrevealedmultipleinfarctionsinvolvingbilateral,anterior,andposteriorcerebralcirculation,aswellasoldandnewlesions,suggestingrecurrentcerebralinfarction.Thoroughexaminationswereneededtodeterminethecauseofillness.
中年女性患者以右侧肢体肌力减退为主要表现。头颅MRI显示累及双侧半球、前后循环的多发梗死灶，并且新旧病灶同在，提示为复发性脑梗死。因此，该患者需要进行全面检查以确定病因。
AccordingtotheTrialofOrginAcuteStrokeTreatmentcriteria,acuteischemicstrokeisclassifiedintothefollowing5subtypes:(1)largearteryatherosclerosis,(2)cardioembolism,(3)small-arteryocclusion(lacune),(4)strokeofotherdeterminedetiology,and(5)strokeofundeterminedetiology.1Ischemicstrokecausedbyatherosclerosisorheartdisease北京哪家医院治疗白癜风好呢北京中科医院在哪里
