中風 Strokes

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Stroke, also known as cerebrovascular accident (CVA), cerebrovascular insult (CVI), or brain attack, is when poor blood flow to the brain results in cell death. There are two main types of stroke: ischemic, due to lack of blood flow, and hemorrhagic, due to bleeding. They result in part of the brain not functioning properly.[1] Signs and symptoms of a stroke may include aninability to move or feel on one side of the body, problems understanding or speaking, feeling like the world is spinning, or loss of vision to one side among others.[2][3] Signs and symptoms often appear soon after the stroke has occurred. If symptoms last less than one or two hours it is known as atransient ischemic attack (TIA).[3] Hemorrhagic strokes may also be associated with a severe headache.[3] The symptoms of a stroke can be permanent.[1] Long term complications may include pneumonia or loss of bladder control.[3]

<!-- 定義與症狀 -->

’’’中風’’’({{lang|en|stroke}}),是指腦部缺血造成的腦細胞死亡。中风分为两种类型:一种是由血管阻塞所造成的缺血性脑中風;一种是由出血所造成的出血性脑中風。不論是缺血性或是出血性腦中風都會造成腦功能異常[1]。常見的中風症狀包括無法移動單側的肢體或者是一邊的身體沒有感覺、無法理解別人的話、不能說話、感覺天旋地轉、其中一邊的視野看不到等等[2][3]。中風的症狀通常在發生後很快就會出現,如果症狀在一兩小時內消失,我們有時會稱它為「暫時性腦缺血」[3]。出血性中風的患者可能會伴隨著突發而嚴重的頭痛[3]。中風的症狀有可能會成為永久性的後遺症[1],中風的患者也可能會有[[肺炎]]、[[尿失禁]]等長期後遺症[3]。[[世界卫生组织]]在20世纪70年代给出中风的传统定义[中3]是:「24小时以上[[脑神经功能缺损]],或在24小时内死亡」。中風定義中的「24小时」是用以区别暫時性腦缺血(定義為在24小时内症狀完全消失)。中風患者如果能儘快接受治療,可以减少留下永久損傷的機會。

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The main risk factor for stroke is high blood pressure.[4] Other risk factors include tobacco smoking, obesity, high blood cholesterol, diabetes mellitus, previous TIA, and atrial fibrillation among others.[2][4] An ischemic stroke is typically caused by blockage of a blood vessel.[5] A hemorrhagic stroke is caused by bleeding either directly into the brain or into the space surrounding the brain.[5][6] Bleeding may occur due to a brain aneurysm.[5]Diagnosis is typically with medical imaging such as a CT scan or MRI scanalong with a physical exam. Other tests such as an electrocardiogram(ECG) and blood tests are done to determine risk factors and rule out other possible causes. Low blood sugar may cause similar symptoms.[7]

<!-- 病因、診斷與病理生理學 -->

[[高血压]]是中风最主要的{{le|危险因子|risk_factor}}[中1][4]。其他的危险因子包括[[高龄]]、[[高血压]]、曾有中風病史或[[短暂性脑缺血发作]](TIA)、[[糖尿病]]、[[肥胖症|肥胖]]、[[膽固醇]]過高、[[抽烟]]、[[心房顫動]][2][4]。缺血性中風通常是由血管阻塞所引起[5],出血性中風則是因為腦內出血或是[[大腦週邊腔室出血]][5][6]。出血有時也可能是由於{{le|腦內的動脈瘤|Intracranial aneurysm}}造成[5]。一般而言中風的診斷需要配合[[醫學影像]]檢查,例如[[斷層掃描]]或是[[核磁共振攝影]],並配合[[理學檢查]]。其他檢驗-例如[[心電圖]]和血液檢查-則有助於發現導致中風的危險因子並排除其他可能的原因。[[低血糖]]可能造成類似中風的症狀[7]。

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Prevention includes decreasing risk factors as well as possibly aspirin, statins statins,surgery to open up the arteries to the brain in those with problematicnarrowing, and warfarin in those with atrial fibrillation.[2] A stroke often requires emergency care.[1] An ischemic stroke, if detected within three to four and half hours, may be treatable with a medication that can break down the clot. Aspirin should be used. Some hemorrhagic strokes benefit from surgery. Treatment to try recover lost function is called stroke rehabilitation and ideally takes place in a stroke unit; however, these are not available in much of the world.[2]

<!-- 預防與治療 -->

預防方式包括減少危險因子,也可以透過[[阿司匹林]]、降血脂藥物([[羟甲基戊二酸单酰辅酶A还原酶抑制剂]])、對於可能有{{le|颈动脉狭窄|Carotid artery stenosis}}的人進行{{le|颈动脉内膜切除术|Carotid endarterectomy}},以及對[[心房顫動]]的人給予抗凝血劑([[wafarin]])[2]。中風一般需要緊急照護[1]。缺血性中风通常會以[[阿司匹林]]治療,若在症狀出現後三小时內,也可能適用{{le|溶血栓|Thrombolysis}}的药物治疗[中4]。對於出血性中风而言,有時手術會有幫助。針對中風受損機能的治療與訓練稱為[[中風復健]],理想上會在中風中心(stroke unit)進行,不過許多國家都沒有這類的醫療機構[2]。

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In 2010 approximately 17 million people had a stroke and 33 million people had previously had a stroke and were still alive. Between 1990 and 2010 the number of strokes which occurred each year decreased by approximately 10% in the developed world and increased by 10% in the developing world.[8] In 2013, stroke was the second most frequent cause of death after coronary artery disease, accounting for 6.4 million deaths (12% of the total).[9] About 3.3 million deaths resulted from ischemic stroke while 3.2 million deaths resulted from hemorrhagic stroke.[9] About half of people who have had a stroke live less than one year.[2] Overall, two thirds of strokes occurred in those over 65 years old.[8]

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在2010年,大約有17,000,000的人中風,並且有33,000,000的人曾有中風病史且仍存活。1990至2010年間,已開發國家的中風年發生率下降了大約10%,而在開發中國家則是增加了10%。在2013年,中風是第二常見的死因,僅次於冠狀動脈疾病(Coronary Artery Disease),約佔了總數的12%(總共6,400,000例)。其中,約有3,300,000的人是因為缺血性中風死亡,3,200,000的人是因為出血性中風。大概有一半中風過的人,平均餘命不超過一年。總體來說,2/3的中風發生於65歲以上的人。

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