新时代的缺血性脑血管病治疗策略

王拥军国家神经系统疾病临床医学研究中心首都医科大学附属北京天坛医院마스터제목스타일편집22020/1/192마스터제목스타일편집32020/1/193마스터제목스타일편집42020/1/194마스터제목스타일편집52020/1/195HenryDuret:AForgottenNeurologistEurNeurol2014;72:193–202DOI:10.1159/000361046195thenasassociatememberin1907.AnactivememberoftheNeurologicalSocietyofParis,foundedin1899,hewasalsoinvolvedwiththeBiologicalSocietythroughouthislongcareer,presentinghisfirstworktomembersin1873.HewasacorrespondentoftheRoyalAcademyofBelgium,doctorhonoriscausaattheUniversitédeLouvainandCommanderoftheOrderofSaintGrégoireleGrand.Duretretiredin1911andcouldnotbecalledupforser-viceduringWorldWarI(1914–1918)becauseofhisage.Henonethelessdirectedtheauxiliarymilitaryhospitals4 and10,onthepremisesoftheCatholicMedicalSchoolofLilleandinanearbymiddleschool.Duret‘deployedgreatenergytograduallyslowthetakeoverofourauxiliaryhospitalsbyGermanauthoritiesandlimittheirhegemonytotheutmostpossible’.DuretwasmadeaKnightoftheLegionofHonouron23February1921forhismilitaryachievements.Hediedon7April1921afteraslow,painfulboutwithcancer[10,11].HenriClaude(1869–1945),whoheldtheChairofmentalillnessandbraindiseasesatSainte-AnneHospital,deliveredaeulogytotheNeurologicalSo-cietyon5May1921,inwhichherecalledtheformidablestudyundertakenduringthewarbythisrelentlessworker,entitled:Traumatismescranio-cérébraux.Formidable’isnotexcessiveinqualifyingsuchawork.Threeenormousvolumesof1,500pageshavealreadybeenpublished.Thefourthwascompletedin1922byhiscolleaguesinLille:Jules-AlfredVoituriez(1858–1938)andJosephDelépine(1877–1923).Claudewentontonote:Theprefaceofthefirstvolumeincludesabriefsummaryofthework,followedbythesemovinglines:‘Wethankheavenforbeingabletocompleteourprojectdespitethehorrorsandsufferingcausedbyalongwarandafour-yearoccupationmarkedbyper-secutionandcruelty’.Ashenotes,DuretpursuedthisworkduringtheGermanoccupation,andheexplainsthatitwasonlyaftermanyappealsthattheGermanauthorities,inashowof‘humanity’,decidedagainstdestroyingtheexistingbook![12].Inearly1921,afewofhiscolleaguesattheCatholicMedicalSchoolofLilleproposedDuretasacandidatefortheNobelPrizeinMedicineorPhysiology.Hisdeathputanendtotheirefforts.Whethercoincidentallyorconse-quently,theprizewasnotattributedthatyear[1,9](fig. 1).OntheSupplyArteriesoftheBrainThethesisofEtienneLancereaux(1829–1910),defend-edin1862,isoneofthefirstcompleteFrench-languagereportsofthepathophysiologyofcardiovascularacci-dents;itstitletranslatesas‘CerebralThrombosisandEm-bolismConsideredPrincipallywithRegardtoBrainSoft-ening’[13].InGermanyin1872,JuliusCohnheim(1839–1884),studentofRudolfVirchow(1821–1902),structuredandnamedthemodernconceptsofemboliccerebralin-farction,terminalarteries,andanastomoses(backupcir-culatoryroutes).However,noneoftheseauthorsassociatespecificsupplyarterieswithpreciselocations[14,15].ItwasDuretwho,on7December1872,presentedthefirststudyon‘thedistributionofthearteriessupplying themedullaoblongata’totheBiologicalSociety.Hewrote:Theprogressrecentlymadeinunderstandingmedullarypathol-ogycallsforamorecompletestudyofmedullarycirculationthanwhatcanbefoundinthetreatisesofdescriptiveanatomy.Wehaveembarkedonthisstudy,underCharcot’sdirection,tofillthisgap.AsDuretindicated,thesupplyarteriesofthemedulla,whichwewillcallmedianarteriesorarteriesofthenuclei,havenotbeendescribed[...].Thedistributionofarterialbloodinanorganasimportantastheme-dullahasnotbeenlefttochance;itisgovernedbylaws.Fig.1.HenryDuret(1849–1921).Openlicence().WithkindpermissionoftheBIUsantéParis.Downloadedby:78.236.141.68-9/11/20142:31:41PMHenryDuret:AForgottenNeurologistEurNeurol2014;72:193–202DOI:10.1159/000361046197scriptionwastheonlyvalidone[20–23].Despitethebe-ginningofacontroversythathascontinuedfromDuret’sdeathuntilnow,thesetwopublicationsearnedDuretthePrixErnestGodard(1826–1862),discernedbytheBio-logicalSocietyofParisin1874[15,24,25](fig. 3).Duret’sworkgaverisetothetheoryofcerebrovascularaccidents,wherebyeachcerebralinfarctresultsfromthrombosisinasingleartery.Thistheoryledtoamulti-tudeofstudies,publishedatthebeginningofthe20thcentury.Inthefollowingexamples,thevariousauthorsallbasetheirargumentsonDuret’sseminalpublication –agoodindicationofthepre-eminenceofhisinnovativeresearch.In1916,JohnSebastianBachStopford(1888–1961),aprofessorofanatomyinManchester,discussedandreviewedthestudyofbrainstemvascularizationbyfollowinginDuret’sfootstepsandprovidingcommen-tary[26].AsforAlexanderKolisko(1857–1918)workinginVienna,in1891hecontestedthecarotidoriginoftheanteriorchoroidalarteryasdescribedbyDuretin1874[27,28].CharlesEdwardBeevor(1854–1908),oftencred-itedwiththefamousaxiomofJohnHughling-Jackson(1835–1911):‘Thebraindoesnotknowmuscles,onlymovements’,spentsevenyearsinjectinghundredsofbrainsandtherebyestablishedthefirstarterialmapoftheencephalon.RefiningDuret’stechnique,whichconsistedofinjectingsolidmicroparticlesofcoloredgelatineofasingleshade,Beevorsimultaneouslyinjectedseveralarte-rialtrunks,ratherthanone,andusedasolublegelatinein severalshades.Thewords‘accordingtoDuret’appearseveraltimesoneachpageofh