post-stroke sequelae

Written by Shu Zhi Qiang
Neurosurgery
Updated on September 06, 2024
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Brain infarction is a very common type of ischemic cerebrovascular disease, which mainly includes the following types: the most common are lacunar infarction, cerebral thrombosis, and cerebral embolism. The neurological sequelae of lacunar infarction are not particularly typical, and patients may exhibit mild incomplete paralysis of limbs, decreased muscle strength, reduced sensation, or ataxia. Cerebral thrombosis and cerebral embolism often cause extensive brain infarction, where patients typically experience severe limb paralysis, loss of sensation, increased tendon reflexes, positive pathological reflexes, and an inability to care for themselves.

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Written by Gao Yi Shen
Neurosurgery
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What is a cerebral infarction?

Cerebral infarction is essentially a manifestation of ischemic necrosis of nerve cells. However, in clinical practice, there are many factors that can cause cerebral infarction. It is essential to treat the underlying causes to effectively prevent the further occurrence and progression of cerebral infarction. One characteristic of nerve cells is that once necrosis occurs, they cannot regenerate. Consequently, all patients who suffer from cerebral infarction may have some residual neurological deficits. Mild symptoms include headaches and dizziness, while severe cases may experience numbness and weakness in the limbs, speech impairments, and even more severe conditions such as a vegetative state or death. Therefore, in the case of cerebral infarction, it is crucial to focus on prevention early on to reduce the extent of necrosis. This can effectively ensure one's safety and reduce the occurrence of various complications and sequelae.

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Written by Gao Yi Shen
Neurosurgery
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Can a cerebral infarction be treated?

Stroke is treatable, but it must also be judged based on the situation. The meaning of "treatable" here is that various treatment plans can be used to reduce the further occurrence of cerebral infarction and the situation of recurrence. However, the nerve cells that have already suffered ischemic necrosis cannot be restored to exactly the same condition as before. This means that the best scenario is recovery to the point of being able to take care of oneself, but it is absolutely impossible to return to the state of freedom before the illness, such as running and jumping. Currently, there are many treatment methods, including medication and surgical treatment. Each of these is a mode of treatment, and each case's differences determine different treatment plans. Decisions must be made according to the situation.

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Written by Gao Yi Shen
Neurosurgery
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Can the blood vessels in a cerebral infarction be unblocked?

Whether the blood vessels in a cerebral infarction can be reopened is closely related to time. If it is within the hyperacute phase, which means within six hours from the onset of clinical symptoms to hospital admission, the majority of cases can undergo thrombolysis intravenously, or arterial thrombectomy to reopen the blood vessels. However, if the time exceeds this window, reopening is no longer feasible, and forced reopening at this stage can easily lead to the detachment of distal thrombi or cause reperfusion injury, which is more detrimental to the patient's condition. Therefore, it is impossible to reopen the blood vessels during the chronic phase or non-hyperacute phase. If treatment of this vascular occlusion is desired, vascular anastomosis can be considered, though the specific type of anastomosis surgery depends on the patient's specific condition at the time. Thus, the possibility of reopening a blood vessel in a cerebral infarction certainly depends on timing.

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Written by Gao Yi Shen
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Causes of cerebral infarction

There are many causes of cerebral infarction, but the most common in clinical practice is the narrowing or occlusion of the carotid artery. Since the brain is supplied by four blood vessels, any issues with any of these vessels can potentially lead to a cerebral infarction. Conditions commonly known as the "three highs"—high blood pressure, high blood sugar, and high cholesterol—can easily lead to narrowing or even blockage of the blood vessels. Thus, these factors are fundamentally the cause. Additionally, smoking and drinking can also lead to vascular narrowing and cause cerebral infarction. In some special cases, autoimmune diseases can cause inflammation inside the vessels, leading to narrowing. Other causes include arterial tears due to trauma, which can lead to ischemia and infarction, or abnormal blood supply due to arrhythmias causing cerebral infarction.

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Written by Gao Yi Shen
Neurosurgery
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Can cerebral infarction be cured completely?

Stroke is not a disease that can be completely cured. Instead, the goal of treatment is to prevent further occurrences and developments of stroke, and there is also the potential for some relative improvement later on. This is considered a very good treatment goal. In the case of stroke, it involves the ischemic necrosis of nerve cells. Additionally, nerve cells have a characteristic that once they die, they cannot regenerate. Therefore, in clinical practice, there are no treatments available that can promote the regeneration of nerves. Treatment can only compensate for the functions of the surrounding healthy nerves to take over the functions of the dead nerves. However, this compensatory process is very slow, often taking two to three months to show significant progress. Hence, it is necessary to continue active rehabilitation exercises later to promote the formation of this compensatory mechanism.