Cerebral infarction, also known as cerebral infarction and ischaemic stroke, is a common cerebrovascular disease, which refers to avascular necrosis or softening of localised brain tissue caused by blood circulation disorders, ischaemia, and hypoxia in the brain. Patients often have symptoms such as hemiplegia, sensory disturbances, nausea, and vomiting.
Clinical classification
- Classification based on clinical manifestations
Cerebral infarction can be divided into four types: total anterior circulation infarction, partial anterior circulation infarction, posterior circulation infarction, and lacunar infarction.
- Classified by etiology
It can be divided into five types, namely, large atherosclerosis, cardiogenic embolism, small artery occlusion, other types with clear causes and unknown causes.
epidemiology
contagious
Non infectious.
incidence rate
Cerebral infarction is the most common type of cerebrovascular disease, accounting for approximately 70% of all acute cerebrovascular diseases.
Easy to reach people
- More common in middle-aged and elderly patients.
- Obesity and overweight, diabetes and hypertension are at high risk.
cause of disease
executive summary
There are many reasons leading to cerebral infarction, among which the major three diseases are atherosclerosis, cardiogenic embolism and arteriolar occlusion.
underlying cause
- Atherosclerotic cerebral infarction
Atherosclerosis is a common cause of cerebral infarction, which is mainly caused by thrombosis, artery to artery embolism, carrier artery disease blocking the perforating artery and low perfusion.
(1) Thrombosis formation
Atherosclerosis can promote platelet adhesion, aggregation and release, and then lead to thrombosis. With the development of atherosclerosis and repeated thrombosis, eventually leading to lumen occlusion.
(2) Arterial to arterial embolism
It refers to the blockage of distal vessels by emboli falling off from atherosclerotic lesions. The detached emboli may be formed by the debris of atherosclerotic plaque, the partial or complete detachment of thrombus formed at the atherosclerotic site.
(3) Blockage of perforating artery due to carrier artery disease
Atherosclerotic plaque or thrombosis covers the opening of the perforating artery, resulting in occlusion of the perforating artery.
(4) Low perfusion
After atherosclerotic lesions lead to lumen stenosis, when there is hypotension or blood pressure fluctuation, the blood flow of the diseased vessels will be reduced, and the brain tissue at the distal end of the diseased vessels between the arterial blood supply areas will have hypoperfusion, which can lead to cerebral ischemia and hypoxic necrosis in serious cases.
(5) High risk factors
The risk factors of atherosclerosis include hypertension, diabetes, coronary heart disease and dyslipidemia.
- Cardioembolic cerebral infarction
Cerebral embolism refers to various emboli in the blood (such as mural thrombus in the heart, atherosclerotic plaque, fat, tumor cells, fibrocartilage or air, etc.) that enter the cerebral artery with blood flow to block the blood vessels, and then cause infarction. When the embolus originates from the heart, it is called cardioembolic cerebral embolism. Heart diseases that can cause cardioembolic stroke include atrial fibrillation, atrial flutter, valvular heart disease, artificial heart valves, infective endocarditis, myocardial infarction, cardiomyopathy, heart failure, and cardiac myxoma.
- Cerebral infarction with small artery occlusion
It mainly refers to small perforating arteries in the deep part of the cerebral hemisphere or brainstem. On the basis of various diseases such as hypertension, the vascular wall undergoes lesions, resulting in occlusion of the lumen and the formation of small infarction foci.
- Cerebral watershed infarction
On the basis of cerebral artery stenosis, hemodynamic abnormalities such as decreased blood volume and systemic hypotension occur, leading to vascular occlusion and infarction. Commonly seen in shock caused by various reasons, overdose of anesthetics, improper use of antihypertensive drugs, cardiac surgery combined with hypotension, and severe dehydration.
symptom
executive summary
Due to different causes and locations of lesions, the symptoms of cerebral infarction also vary. Generally, it manifests as symptoms and signs of focal neurological deficits, such as hemiplegia, hemiparesis, aphasia, ataxia, etc., and may also present with symptoms such as headache and vomiting. In the early stages, patients generally have clear consciousness, but in severe cases, coma or even death may occur.
Typical Symptoms
- Atherosclerotic cerebral infarction
The clinical manifestations depend on the size and location of the infarction, mainly including symptoms and signs of focal neurological deficits, such as hemiplegia, hemiparesis, aphasia, ataxia, etc. Some may have whole brain symptoms such as headache, vomiting, and coma. Patients are generally conscious, and when they die from basilar artery occlusion or extensive cerebral infarction, their condition becomes severe, leading to consciousness disorders and even brain herniation, ultimately resulting in death.
- Cardioembolic cerebral infarction
The onset is rapid, and most patients have short-term consciousness disorders. When the intracranial arteries or vertebral basilar arteries are occluded, cerebral edema leads to increased intracranial pressure, and patients may become comatose in a short period of time. Sometimes, epileptic seizures may also occur. The clinical manifestation is the same as that of atherosclerotic cerebral infarction, depending on the embolized blood vessel and the location of obstruction, and there is focal neurological deficit. In addition, patients may also have symptoms of heart disease, skin, mucosal embolism, or other organ embolism.
- Cerebral infarction with small artery occlusion
Most patients present with lacunar cerebral infarction, with the following four common manifestations:
(1) Pure motor hemiplegia
The most common type accounts for about 60%. Hemiplegia involves the same side of the face and limbs, with roughly equal degrees of paralysis, without sensory impairment, visual field changes, or language barriers.
(2) Dysarthria clumsy hand syndrome
About 20%, manifested as articulation disorders, swallowing difficulties, contralateral paralysis, mild hand weakness, and fine motor disorders.
(3) Pure sensory stroke
About 10%, manifested as hemiparesis, which may be accompanied by sensory abnormalities.
(4) Ataxia induced hemiparesis
Manifested as mild hemiplegia, accompanied by ataxia of the paralyzed limb, often with lower limbs being heavier than upper limbs.
- Cerebral watershed infarction
There may be central hemiplegia and hemiparesis, hemianopia, mental disorders, strong grip reflex, cortical sensory disorders, mild hemiplegia, etc. There are certain differences in clinical manifestations among different infarction sites.
complication
- Paralysis and muscle movement disorders
As the most common complication, it manifests as paralysis of one or both limbs, facial muscle paralysis, difficulty walking, speaking, or chewing, decreased self-care ability, and seriously affects the patient’s quality of life.
- Difficulty speaking and swallowing
If the lesion affects the central control of the pharyngeal muscles, it can cause language and swallowing dysfunction.
- Memory loss or emotional disorders
Patients may experience memory loss or difficulty controlling their emotions, leading to mental symptoms such as mania and depression.
- Cerebral hemorrhage
Patients with cerebral infarction due to cerebrovascular stenosis or blockage were admitted to the hospital, and cerebral vascular rupture and bleeding occurred in the later treatment process. The incidence rate is about 8.5%~30%, which can be prevented by stopping the drugs that can lead to bleeding.
- Pressure ulcer
Patients with cerebral infarction who are bedridden often have symptoms such as limb paralysis and sensory impairment, which can lead to abnormal phenomena such as blood circulation blockage, malnutrition, skin compression, edema, and sensory loss, thus easily causing pressure ulcers. Therefore, daily care of patients is very important, and caregivers should help patients frequently turn over and clean their bodies to prevent pressure ulcers.
- Nutritional disorders
Some patients may have difficulty swallowing and may experience nutritional disorders. If necessary, fluid replacement and nutritional support should be given. Promote enteral nutrition support.