Causes and Mechanisms of Cerebral Infarction - Oren Zarif - Cerebral Infarction
One study looked at the frequency of vascular risk factors in young adults who suffered a cerebral infarction. The results indicated that the vascular risk factors correlated with cerebral infarction. This study focused on a population with high rates of racial and ethnic diversity. Despite its low prevalence, cerebral infarction has become a major cause of death among young people. In this article, we discuss the various causes and mechanisms of this condition.
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The AHA classifies various types of cerebral infarctions. These disorders are classified by their size, location, and underlying pathophysiology. In dogs, the most common form is ischemic infarct. Other types include hemorrhagic infarct (a result of ruptured blood vessels), territorial infarct, and lacunar infarct, which occurs in smaller areas.
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Hemorrhagic infarction is characterized by an expanded wedge-shaped area in the parenchyma. It is probably the result of embolism to the middle cerebral artery branch. Remote hemorrhage causes a zone of parenchymal loss in the brain. Another type of cerebral infarction affects the cortex of the brainstem and results in brainstem syndromes. Some symptoms are listed below:
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Acute infarction results in an increased density of reactive cells in the area of the brain. The predominant reactive cell type is neutrophils. The density of macrophages decreases over the first few weeks. At the same time, reactive astrocytes begin to form in the area of the infarcted neurons. In a third of stroke cases, perineuronal vacuolation occurs. The resulting hemorrhagic infarction results in a lethal outcome.
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Massive cerebral infarcts may cause brain edema, impinging on vital structures. While surgery is not a cure for cerebral infarction, early treatment is critical to preventing neurologic deterioration and death. Surgical management of cerebral infarction includes decompressive hemicraniectomy, duraplasty, and resection of infarcted tissue. The treatment of cerebral infarction should not be delayed if ischemic penumbra is suspected.
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There are many causes of cerebral infarction, with the most common being arterial-to-artery embolism. However, watershed infarcts are less common due to hemodynamic compromise. Infarcts associated with plaques tend to involve the middle and posterior artery territories and are wedge-shaped on neuroimaging studies. In a stroke, the blood flow in the brain is severely disrupted. This results in the infarcted region being inaccessible.
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The initial workup of cerebral ischemia includes the use of basic laboratory tests, including complete blood count, coagulation factors, EKG, and cardiac enzymes. Neuroimaging of the brain parenchyma and blood is required to differentiate between these conditions. While it is difficult to distinguish between these two types of strokes, the symptom progression and possible causes may provide valuable clues for the diagnosis. Other tests, such as bedside glucose testing, should be conducted.
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Another type of treatment for acute cerebral ischaemia involves the use of thrombolytic drugs. These drugs dissolve clots in the bloodstream. This treatment is increasingly popular for patients who experience a stroke within 3 hours of onset. Although this treatment is controversial, it is effective in many cases. MRI scans can be helpful in assessing the underlying causes. It is also used in severe cases of cerebral infarction, such as a large occlusion of the middle cerebral artery.
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Acute cardioembolic infarction (ACE) is a condition that disrupts the normal heart rhythm and the pumping function of the atria. This reduced blood flow may lead to blood clots that lodge in the brain and cause a stroke. Symptoms of this condition depend on the area of the brain involved, the size of the ischemic area, and the time period between acute stroke and recurrent events.
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Various materials from the blood circulation may lodge in the narrow vessels of the brain, including atherosclerotic plaque fragments. The most common source of these emboli is the heart. These can be clots from open heart surgery, bacterial endocarditis, or valvular disorders. Emboli may also originate from long bones or a ruptured aorta. Another possible cause is thrombosis of the subclavian artery.
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A second type of brain infarction is a secondary infarction associated with infection. It shares many features with cryptococcal meningitis, with the exception of extracranial involvement. In addition, cerebral infarctions are often associated with neurological complications such as seizures or hydrocephalus. A primary goal of treatment is early diagnosis and treatment to maximize survival. During the acute stage, ventricular decompression should be performed immediately to reduce the risk of further cerebral ischaemia.
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Early management is crucial in preventing death from a stroke. If symptoms occur early, the American Heart Association recommends that patients undergo an emergency room visit. If symptoms continue or worsen, the patient should be referred to a medical professional for further assessment and treatment. It is important to note the time the symptoms started to aid in the diagnosis and the proper treatment. Often, the person suffering from a stroke can be unconscious and even in a coma.