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神经眼科急症是指如果不能及时诊断和治疗，就会严重威胁患者视力甚至危及生命的神经眼科临床疾病谱，其中血管性原因所致的神经眼科急症（血管神经眼科急症）占绝大部分。由于交叉学科的特点，血管神经眼科急症患者多首诊于眼科或急诊，首诊医师往往对疾病认识不全面，易导致该类患者诊断滞后、误诊或漏诊；当患者转诊于神经科时，神经科医师如果对疾病的诊断不能及时确定，易导致治疗延迟。本文对血管神经眼科急症疾病谱主要疾病的临床表现、检查方法和治疗方法等方面进行综述，以期为该类疾病的快速诊断和精准治疗提供依据。 Abstract: Neuro-ophthalmic emergency refers to the spectrum of neuro-ophthalmic clinical diseases that can seriously threaten patients’ vision or even endanger their lives if they are not diagnosed and treated in time, among which the neuro-ophthalmic emergency caused by vascular causes (vascular neuro-ophthalmic emergency) accounts for the vast majority. Due to the characteristics of interdisciplinary, patients with vascular neuro-ophthalmic emergency are often first referred to the department of ophthalmology or emergency, and the first doctors often have incomplete understanding of the disease, which is easy to lead to delayed diagnosis, misdiagnosis or missed diagnosis of such patients. When patients are referred to the department of neurology, if the neurologist’s diagnosis of the disease cannot be determined in time, it is easy to delay treatment. In this paper, the clinical manifestations, the examination methods and the treatment methods of the major diseases in the spectrum of vascular neuro-ophthalmic emergency were reviewed in order to provide the basis for the rapid diagnosis and accurate treatment of these diseases.

目的 探讨动脉内溶栓（intra-arterial thrombolysis，IAT）治疗视网膜中央动脉阻塞（central retinal artery occlusion，CRAO）患者的临床特征及功能性视觉恢复情况。 方法 纳入2018年1月—2023年8月西北大学附属第一医院神经内科和神经眼科连续收治的非动脉炎性CRAO患者，根据入院后是否进行IAT治疗分为IAT组和非IAT组。功能性视觉定义为 视力≥20/100。比较分析两组患者的临床特征和不同时间段（入院、出院时和出院1个月时）功能性视觉恢复情况。 结果 共纳入131例（131只眼）非动脉炎性CRAO患者，男性93例（71.0%），平均年龄为（61.6±12.6）岁， 其中IAT组57例（43.5%），非IAT组74例（56.5%）。与非IAT组患者相比，IAT组患者年龄更低[（58.4±12.5）岁 vs.（64.1±12.2）岁，P=0.011]、合并卒中病史者比例更低[10（17.5%）vs. 25（33.8%）， P=0.037]、发病至就诊时间更短[10.0（6.0～24.0）h vs. 55.0（20.2～162.0）h，P＜0.001]、醒后发病者比例更高[26（45.6%）vs. 15（20.3%），P=0.002]和患侧颈内动脉血管状态更佳（无狭窄∶轻度狭窄∶中-重度狭窄∶闭塞=41∶7∶7∶2 vs. 32∶11∶21∶10，P=0.006）。IAT组患者出院1个月时功能性视觉比例较非IAT组患者更高[25（43.9%）vs. 18（24.3%），P=0.018]，而入院和出院时差异无统计学意义 （P＞0.05）。多因素logistic回归分析显示，IAT组患者出院1个月时的功能性视觉较非IAT组患者显著改善（OR 3.24，95%CI 1.08～9.69，P=0.036）。IAT组患者术中发生眼动脉痉挛2例（3.5%）、穿刺部位皮肤出血2例（3.5%）和新发脑栓塞（均为无症状性栓塞）事件4例（7.0%）。 结论 是否进行IAT治疗的CRAO患者部分临床特征存在差异，IAT治疗可显著提高CRAO患者出院1个月时的功能性视觉，且手术安全性较好。提示临床医师需重视CRAO患者的IAT治疗，以期改善患者的视觉功能。 Abstract: Objective To investigate the clinical characteristics and functional visual recovery of patients with central retinal artery occlusion (CRAO) treated with intra-arterial thrombolysis (IAT). Methods The non-arteriotic CRAO patients admitted to the Department of Neurology and Neuro-ophthalmology of the First Affiliated Hospital of Northwest University from January 2018 to August 2023 were included. They were divided into IAT group and non-IAT group according to whether IAT was performed after admission. Functional vision is defined as visual acuity≥20/100. The clinical features and functional visual recovery at different time periods (admission, discharge and 1 month after discharge) were compared and analyzed between the two groups. Results A total of 131 patients (131 eyes) with non-arteriotic CRAO were included, including 93 males (71.0%) with a mean age of (61.6±12.6) years. There were 57 patients (43.5%) in IAT group and 74 patients (56.5%) in non-IAT group. Compared with patients in non-IAT group, patients in IAT group had younger age [(58.4±12.5) years vs. (64.1±12.2) years, P=0.011], lower proportion of stroke history [10 (17.5%) vs. 25 (33.8%), P=0.037], shorter time from onset to visit [10.0 (6.0-24.0) h vs. 55.0 (20.2-162.0) h, P0.05). Multivariate logistic regression analysis showed that the functional vision of CRAO patients in the IAT group at 1 month after discharge was significantly improved compared with those in the non-IAT group (OR 3.24, 95%CI 1.08-9.69, P=0.036). In the IAT group, ophthalmic artery spasm occurred in 2 cases (3.5%), skin bleeding at the puncture site in 2 cases (3.5%), and new cerebral embolism (all asymptomatic embolism) occurred in 4 cases (7.0%). Conclusions Some clinical features of CRAO patients who were treated with or without IAT were different. IAT can significantly improve the functional vision of CRAO patients at 1 month after discharge, and the surgical safety is good. This suggests that clinicians should pay more attention to IAT in CRAO patients in order to improve their visual function.

视网膜动脉阻塞是临床上导致急性无痛性单眼视力丧失的主要疾病，由于发病机制和危险因素与缺血性卒中相似，被视为“视网膜卒中”。但作为一种特殊类型的卒中，“视网膜卒中”的临床管理仍存在较高的不确定性和争议。本文对“视网膜卒中”的定义演变、就诊科室、识别和评估、检查、治疗和二级预防等方面进行综述，以期为临床医师全面认识和系统规范诊治“视网膜卒中”提供依据。 Abstract: Retinal artery occlusion is the main cause of acute painless monocular vision loss, and its pathogenesis and risk factors are similar to ischemic stroke, so it is named as “retinal stroke”. However, as a special type of stroke, the clinical management of “retinal stroke” is still highly uncertain and controversial. This article reviewed the literatures on “retinal stroke”, and introduced the definition, department for medical treatment, recognition and evaluation, examination, treatment and secondary prevention of “retinal stroke”, in order to help clinicians better understand and standardize the diagnosis and treatment of retinal stroke.

Copyright of Chinese Journal of Stroke is the property of Chinese Journal of Stroke Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Chinese Journal of Stroke is the property of Chinese Journal of Stroke Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

【摘要】 目的 探讨西安地区伴心房颤动老年急性缺血性卒中（acute ischemic stroke，AIS）患者临床特征及1 年预后情况。 方法 通过西安卒中数据库平台，收集西安市4所三级甲等医院2015年1-12月连续入院的老年AIS （年龄≥65岁）患者的临床资料，比较分析伴心房颤动老年AIS患者的临床特征；登记随访1年的结局 事件（包括卒中复发、死亡和预后不良），通过多因素Logistic回归分析，探讨西安地区伴心房颤动老 年AIS患者1年不良预后的独立危险因素。 结果 研究最终纳入老年AIS患者1239例，其中伴心房颤动者133例（10.7%）。与不伴心房颤动组相比， 伴心房颤动老年AIS患者的年龄大[（77.7±6.3）岁 vs（74.0±6.1）岁，P=0.019]、出院mRS评分高（2.0 分 vs 1.0分，P0.05）。 结论 相比不伴心房颤动组，西安地区伴心房颤动老年AIS患者年龄更大、卒中所致残障及神经功 能缺损更重、合并肺炎和入院48 h不能行走的患者比例较高；伴心房颤动老年AIS患者1年死亡风险显 著升高。 【Abstract】 Objective To investigate the clinical characteristics and 1-year prognosis of elderly acute ischemic stroke (AIS) patients with atrial fibrillation (AF) in Xi'an area. Methods Clinical data of elderly patients with AIS (≥65 years) who were consecutively admitted to four tertiary-grade A class hospitals from January 2015 to December 2015 in Xi'an Stroke Data Bank were collected. The clinical characteristics of elderly AIS patients with and without AF were compared, and the outcome events of 1 year follow-up (including stroke recurrence, death and poor prognosis) were analyzed. Multivariate logistic regression analysis was used to find the independent risk factors for poor prognosis of 1 year in elderly AIS patients with AF in Xi'an area.Results Total 1239 elderly AIS patients were enrolled in this study, including 133 (10.7%) patients with AF. Comparing with the non-AF group, the elderly AIS patients in AF group showed older [(77.7±6.3) years vs (74.0±6.1) years, P=0.019], higher mRS score at discharge (median 2.0 vs 1.0, P0.05). Conclusions Comparing with the elderly AIS patients without AF, the elderly AIS patients with AF in Xi'an area were older, had more severe stroke, higher rate of pneumonia and higher rate of losing the ability to walk within 48h at admission, and higher risk of death at 1 year.

Copyright of Chinese Journal of Stroke is the property of Chinese Journal of Stroke Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)