cerebral infarction Cerebral infarction, also known as ischemic stroke, is a cerebrovascular disorder characterized by localized ischemic necrosis or softening of brain tissue due to ischemia and hypoxia.

Localized ischemic necrosis or softening of cerebral tissue

Disruption of cerebral blood circulation and tissue ischemia/hypoxia

Mainly treated with thrombolysis and stroke unit care

Favorable prognosis for mild cases, life-threatening for severe cases

Cerebral infarction, also known as ischemic stroke, is a type of cerebrovascular disorder characterized by disruption of cerebral blood circulation leading to localized ischemic necrosis or softening of cerebral tissue.

Cerebral infarction is the most common type of cerebrovascular disease, accounting for about 70% of all acute cerebrovascular diseases. It is more common in middle-aged and elderly patients, with a female-to-male ratio of 1:1. The disease mainly occurs in the Han population, and is less common in ethnic minorities.

Cerebral infarction can be classified in various ways, with the following being the most common:

Classification based on etiology

Large artery atherosclerosis type, cardioembolic type, small artery occlusion type, other defined etiology type, and undetermined etiology type.

Classification based on location of infarction

Total anterior circulation infarction, partial anterior circulation infarction, posterior circulation infarction, and lacunar infarction.

In addition, perinatal stroke is a special type of cerebral infarction, mainly characterized by focal neurological damage in early brain development, including neonatal arterial ischemic stroke, cerebral sinovenous thrombosis, and neonatal hemorrhagic stroke.

Large artery atherosclerosis

The mechanism of cerebral infarction caused by large artery atherosclerosis mainly includes thrombosis, arterial embolism, occlusive disease of penetrating arteries, and low perfusion.

Cardioembolic

The main causes of cardioembolic infarction include atrial fibrillation, atrial flutter, valvular heart disease, prosthetic heart valves, infective endocarditis, myocardial infarction, cardiomyopathy, heart failure, and cardiac myxoma, among others.

Small artery occlusion

Mainly due to cerebral small vessel disease caused by hypertension, arteriolosclerosis, and fibrinoid necrosis, among others.

A small portion is caused by microvascular disease related to diabetes.

Small penetrating artery atherosclerosis, vasculitis, and genetic diseases can also lead to occlusion of small penetrating arteries.

Watershed infarction is mainly caused by ischemia of the border zone arteries, commonly seen in various causes of shock, excessive use of anesthetics, improper use of antihypertensive drugs, hypotension during cardiac surgery, and severe dehydration, among others.

What are the triggering factors for cerebral infarction?

Smoking is a high-risk factor for cerebral infarction.

Having certain underlying conditions such as hypertension, heart disease, diabetes, and lipid abnormalities is a high-risk factor for this disease.

Middle-aged and elderly individuals are more susceptible to the disease.

Cerebral infarction does not have specific early symptoms, as they vary depending on the location, area, and the cause of vascular occlusion. Prior to the onset of cerebral infarction, some patients may experience transient sensory and motor impairments, such as numbness, paralysis in different parts of the body, dizziness, and blurred vision.

Blood tests and electrocardiograms

Electrocardiograms, complete blood count, coagulation function, blood sugar, blood lipids, renal function, and electrolytes can help identify risk factors in a timely manner.

Neurological examination

The type of neurological examination varies depending on individual differences, age, and other factors. Neurologists may ask questions and conduct relatively simple tests in the clinic to assess muscle, motor, health conditions, and sensory function.

CT scan of the head

Patients should not wear metal earrings, ear studs, necklaces, and other accessories during CT scans. Head CT scans are the preferred imaging method for the early discrimination between cerebral infarction and cerebral hemorrhage.

MRI of the head

Several hours after the onset of cerebral infarction, the affected area may show low T1 signal and high T2 signal. It can reveal brainstem, cerebellar infarctions, and lacunar infarctions. However, the main drawback of MRI is that it is less sensitive in diagnosing acute cerebral hemorrhage compared to CT.

Ultrasound examination

Transcranial Doppler and carotid artery ultrasound can detect intracranial arterial stenosis, occlusion, assess collateral circulation, monitor microemboli, and evaluate cerebral blood circulation. It can show arterial atherosclerotic plaques, vascular stenosis, and occlusion.

Digital subtraction angiography

It can show stenosis, occlusion of major cerebral arteries, and other vascular lesions, such as vasculitis, fibromuscular dysplasia, carotid or vertebral artery dissection, and moyamoya disease.

For the treatment of the acute cause, thrombolytic therapy can be performed in patients with indications. In hospitals with suitable conditions, stroke patients should be admitted to a stroke unit for treatment.

Actively treat the primary disease, maintain airway patency and oxygenation, control blood pressure, blood sugar, reduce intracranial pressure, treat fever, infection, possible upper gastrointestinal bleeding, electrolyte disturbances, control seizures, prevent deep vein thrombosis and treat pulmonary embolism.

Due to large individual differences, there is no absolute best, fastest, or most effective medication. In addition to commonly used over-the-counter drugs, the most appropriate medication should be selected under the guidance of a doctor based on individual circumstances.

There is no specific drug for cerebral infarction, only symptomatic supportive treatment drugs are available; drugs are generally used for neuroprotection and improvement of cerebral vascular circulation.

Neuroprotective drugs

Traditional medications include edaravone, cytidine diphosphate choline, and others. In addition, ganglioside has unique therapeutic effects in the treatment of neurological deficits.

Drugs for improving cerebral vascular circulation

Currently, human urinary kallikrein and other drugs are commonly considered in clinical practice, and medication should be based on the doctor's assessment.

Cerebral infarction cannot be cured. As its cause is related to chronic diseases such as atherosclerosis, hyperlipidemia, and diabetes, which are incurable, and since the cause cannot be removed, cerebral infarction may recur.

Cerebral infarction is one of the leading causes of death in our country. In addition to its high mortality rate, it also has a high disability rate, leading to paralysis, aphasia, blindness, and causing heavy psychological and economic burdens on patients, families, and society.

The infarcted brain tissue cannot regenerate. After cerebral infarction, some patients may partially recover motor and sensory functions, while others may be left with permanent disabilities.

Limb paralysis and motor dysfunction: These are the most common complications, manifesting as paralysis on one or both sides of the body and facial muscle paralysis, leading to difficulties in walking, speaking, and eating.

Speech and swallowing difficulties: If the lesion affects the central control of the throat muscles, it can lead to language and swallowing difficulties.

Memory decline and cognitive difficulties: Patients may experience impairments in understanding, memory, and other cognitive functions.

Emotional disturbances: Patients often have difficulty controlling emotions and are more prone to depression, mania, and other mental symptoms.

Headaches: Patients with lacunar infarction are less likely to experience this symptom.

Decreased self-care ability and changes in social behavior.

Family members of cerebral infarction patients should have a basic understanding of the disease, provide psychological support to patients, offer appropriate comfort and encouragement, assist patients in taking medication on time, encourage regular exercise, and ensure regular check-ups.

For bedridden patients, family members should provide proper care, including timely turning and washing to prevent aspiration pneumonia and pressure ulcers. Daily family meals should focus on balanced nutrition, emphasizing the combination of meat and vegetables, and supplementing protein and vitamins.

Psychological care

Due to the slow recovery of motor and language functions, which require long-term care, patients may develop anxiety, depression, and other psychological issues, which can affect the recovery and quality of life. Patients should be cared for, respected, encouraged to express their feelings, and shielded from stressful stimuli and behaviors.

Medication care

Family members should be familiar with the precautions for the patient's medications and follow the doctor’s instructions for proper use.

Dietary care

Positioning: Choose a safe and conducive position for eating. Patients who can sit up should eat in a seated position with their head slightly bent forward. For patients who cannot sit up, the bed should be raised at a 30° angle, with a pillow under the head to facilitate forward bending. This position makes it difficult for food to leak out of the mouth and aids in the transport of food to the back of the tongue, reducing the risk of reflux into the nasal cavity and aspiration.

Swallowing methods: For patients who can swallow, alternate between dry swallowing and swallowing food. For those who cannot swallow, nasal feeding should be considered, and family members should be familiar with the nasal feeding method and precautions.

Lateral swallowing: When swallowing, tilt the head toward the healthy shoulder, especially suitable for patients with hemiplegia.

Nodding swallowing: When swallowing, coordinate with a forward bend of the head and inward movement of the jaw, resembling a nodding motion, to enhance airway protection and facilitate food entry into the esophagus.

Drinking water methods: Since drinking water with a straw requires considerable oral muscle function, it is best to avoid using a straw or drinking tea. When drinking water from a cup, keep the water level at least half full to prevent the risk of aspiration when the patient lowers their head.

Diet

Consume a high-protein, high-vitamin, low-salt, low-fat, and low-calorie diet. Choose nutritious, easily digestible foods that the patient enjoys and pay attention to the color, aroma, taste, and temperature of the food to prevent aspiration and aid in oral transport and swallowing.

Recommended diet

Food can be mashed or thickened during cooking to facilitate swallowing.

Consume plenty of fresh vegetables, fruits, grains, fish, and legumes to maintain energy balance.

Dietary taboos

Cerebral infarction patients must quit smoking and limit alcohol consumption.

Lifestyle

Quit smoking and drinking, actively control blood pressure.

Maintain a regular schedule and good living habits, engage in appropriate exercise.

For cerebral infarction, timely treatment is crucial to determining the patient's prognosis. Thus, if symptoms such as asymmetry in facial features, numbness and weakness in the arms, and difficulty expressing oneself are observed, seeking medical attention promptly is essential.

After standardized treatment, patients may be left with some sequelae. It is advisable to follow the doctor's advice and engage in rehabilitation exercises at an appropriate time, which can aid in recovery and improve the patient's quality of life.

Patients may also experience excessive anxiety, tension, and other psychological issues. When necessary, seeking help from relevant professionals for timely intervention is important.

After discharge, patients should strictly adhere to medication instructions and avoid stopping medication or using antibiotics and folk remedies without authorization.

Additionally, within their capabilities, patients should engage in moderate exercise, such as walking, after being discharged.

Routine prevention

Control blood pressure: This is the most important measure for preventing cerebral infarction. Patients should exercise more, reduce sodium and alcohol intake in their daily lives.

Balanced diet: Consume more fruits and vegetables, and reduce lipid intake; the diet should be low in salt and oil, and high-cholesterol foods should be avoided.

Quitting smoking: Studies have shown that smoking increases the incidence of various types of stroke.

Control blood sugar.

Maintain a healthy weight.

Engage in appropriate exercise and maintain a relaxed mood.

Maintain a regular schedule and ensure adequate sleep.

Medication prevention

Under the guidance of a doctor, use appropriate medications to prevent thrombosis.

Antiplatelet drugs: Aspirin and others are commonly used.

Anticoagulant drugs: Such as heparin, warfarin, and others.