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Cerebral infarction
What is a cerebral infarction?
Brain infarction is also relatively common in clinical practice, mainly seen in elderly people, generally accompanied by underlying diseases such as hypertension, hyperlipidemia, and diabetes. Brain infarction is primarily caused by the blockage of cerebral blood vessels, leading to necrosis of brain tissue due to ischemia and hypoxia. After a brain infarction occurs, patients should seek medical attention in a timely manner and be admitted to the department of neurology or neurosurgery for systematic drug treatment. If the infarction area is large or a brain herniation has formed, surgical intervention should be considered, such as decompressive craniectomy and lowering intracranial pressure.
How is lacunar infarction treated?
Lacunar stroke is a type of cerebral stroke characterized by lesions smaller than 1.5 cm in diameter. Often, these can be discovered incidentally on a CT or MRI scan in asymptomatic patients. In such cases, it's important to evaluate whether the patient has risk factors such as hypertension or diabetes, and consider the patient's age, smoking, and drinking habits. Further assessments with cranial MRI angiography or other vascular imaging are recommended to clarify the state of the blood vessels and guide treatment. Additionally, some patients may experience an acute onset with symptoms like slurred speech or limb weakness. Although these symptoms might be mild, it is crucial to seek prompt medical attention to assess the blood vessels and guide further treatment based on the physician's physical examination of the patient.
Which department should I go to for a cerebral infarction?
Stroke is caused by blockage or narrowing of blood vessels within the skull, leading to ischemic necrosis of brain tissue and a range of symptoms. Typically, patients with strokes are seen in neurology departments. Of course, the location of the stroke varies, and each patient's clinical presentation is different. If a stroke occurs, a cranial CT scan can provide a clear diagnosis. Clinically, treatment primarily involves dehydration, lowering intracranial pressure, brain protection, and nutritional support. If the patient has a large area of cerebral infarction and high intracranial pressure, they can be seen in neurosurgery, where procedures such as craniotomy decompression may be used to reduce intracranial pressure.
What should be done if the area of cerebral infarction is large?
If a large cerebral infarction occurs, brain edema often peaks within two to three days, and the mortality rate is extremely high. If medical attention is sought within six hours of onset, thrombolytic therapy can be considered. If emergency thrombolysis is exceeded, then only conservative drug treatment is available. For example, mannitol dehydration to reduce intracranial pressure, nourish neurons, protect brain cells, provide nutritional support, etc. After a stroke, it is essential to monitor changes in the patient's consciousness and pupils, dynamically assess the patient’s Glasgow Coma Score, and be aware of various potential complications. Family members should be well-informed about the patient's condition, etc. (Specific medications should be administered under the guidance of a doctor.)
Do you need to take medication for a long time for cerebral infarction?
Brain infarction generally requires long-term medication, and the specific medications to be taken can vary from person to person. Moreover, the choice of medication should be determined by a doctor based on the patient's condition and past risk factors. Brain infarction is a disease caused by multiple factors, with common causes including hypertension. In the case of hypertension, the choice of antihypertensive medication and the duration of treatment should be based on the patient's blood pressure to maintain it within a normal range. There is also a possibility that the condition is due to diabetes, as some diabetic patients are also prone to brain infarction. Such patients may need to use long-term antidiabetic drugs or insulin to control blood sugar. Additionally, antiplatelet medications might be necessary for brain infarction, but whether to use them should also be determined by the doctor based on the patient's specific circumstances. Since medications can have side effects, a comprehensive decision must be made on what drugs to use. (Note: The use of medications should be carried out under the guidance of a professional doctor.)
Stroke rehabilitation exercise
In the early stages of a stroke, for bedridden patients, passive limb exercises can be conducted at the bedside. This includes joint loosening exercises and passive flexing of knee and elbow joints to prevent joint contractures. When not exercising, proper limb positioning is needed; sandbags can be placed on the inside of the upper limbs to avoid internal rotation, and the legs should be placed in stiff cloth shoes or T-bar shoes to prevent external rotation. Once the patient enters the recovery phase, they can gradually begin standing and walking exercises, while also receiving treatments such as medications, hyperbaric oxygen therapy, and acupuncture. (The use of medications should be under the guidance of a professional doctor.)
Imaging manifestations of cerebral infarction
For patients with cerebral infarction, in addition to collecting medical history and clarifying symptoms and signs, imaging examinations are also very important for the diagnosis and differential diagnosis of cerebral infarction. They are indispensable tools in clinical examinations. Cerebral infarction primarily requires cranial CT and MRI scans. On cranial CT, cerebral infarction lesions mainly appear as low-density areas and are easily distinguishable from cerebral hemorrhage. The lesions may cause swelling and have a certain mass effect. In cranial MRI, the appearance of cerebral infarction is primarily seen in diffusion-weighted imaging as a distinctly high signal, making it very easy to identify the responsible lesions. In T2-weighted images, the high signal is also clearly visible and easier to differentiate.
Can moxibustion be used for lacunar infarction (a type of stroke)?
Lacunar stroke is when small blood vessels in the deep parts of our brain's hemispheres or brainstem, under the long-term influence of high blood pressure, diabetes, or other risk factors, cause the supplying arteries to undergo ischemic necrosis. The affected areas typically have a diameter of less than 1.5 to 2 centimeters, leading to an acute syndrome of neurological function impairment. Treatment of this disease first depends on the patient's age and risk factors to decide whether to use medication. Also, the prognosis is generally good; there is no need for moxibustion, as moxibustion has neither benefits nor harms for lacunar stroke.
Is a brain embolism the same as a cerebral infarction?
Cerebral embolism is a type of cerebral infarction, but not completely identical to cerebral infarction. Cerebral embolism occurs when an embolus from another part of the body outside the brain detaches and blocks a cerebral blood vessel. Cerebral embolism generally has a sudden onset, with a rapid development of symptoms, reaching a peak in a very short time, potentially causing severe conditions such as coma and paralysis of limbs within a short period. Common sources of emboli include arterial plaques in the neck vessels, particularly soft arterial plaques that are prone to detachment, forming an embolus that can obstruct cerebral vessels. Another common source of emboli is the detachment of mural thrombi from the inner walls of the heart, typically seen in patients with atrial fibrillation, where thrombi tend to form on the heart's inner walls and can detach to block cerebral vessels. Treatment includes the use of antiplatelet or blood-activating and stasis-dissolving drugs, as well as medications to stabilize plaques. It is vital to actively treat the primary disease, such as using anti-arrhythmic drugs for patients with atrial fibrillation.
CT manifestations of cerebral infarction
Brain infarction has different manifestations on CT scans at different stages. Generally, within 24 hours, the CT scan may not show any imaging of the cerebral infarction lesion. However, some patients, especially those with thrombosis in the middle cerebral artery, might exhibit a high density sign in the middle cerebral artery. In cases of large-scale cerebral infarction, some sulci on the side affected by the infarction may appear shallower, indicating possible brain swelling. Generally, within 24 hours, a CT scan can reveal a low-density image, which appears relatively darker. This condition is typically considered a brain infarction, and as time progresses, this dark, or low-density image, tends to become even darker. In some patients during the acute phase, although the infarction may not be apparent, a CT scan is performed to rule out bleeding, as CT is very sensitive to bleeding.