Causes and Treatment of Cerebral Infarction - Oren Zarif - Cerebral Infarction
The most common cause of cerebral infarction is an arterial-to-artery embolism, although watershed infarcts are also possible. Embolic infarcts that are associated with plaques usually affect the middle and posterior cerebral arteries. These tend to involve the cerebral cortex and look wedge-shaped on neuroimaging studies. A stroke caused by an embolic infarct is more rare.
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Watershed infarctions occur in areas that are supplied by two distal cerebral arteries. A generalized hypotension can also cause a watershed infarct. This pattern is also called bilateral watershed infarction, and affects both sides of the brain. In both types, hemorrhaging and edema cause expansion in the affected areas. Other types of cerebral infarction can occur in the same brain area.
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MRI scans can also detect the presence of cerebral infarction. An MR scan can reveal whether the infarcted area has increased water content. If the MRI scan shows a decrease in specific gravity, then the infarction is likely a branch of a major artery. Although it is difficult to distinguish between an acute and a hemorrhagic infarction, a contrast-enhanced image can be useful for determining the type of infarcted area.
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Massive cerebral infarcts cause a coma and death. Decompressive hemicraniectomy may be necessary to alleviate the symptoms. Surgical management for cerebral infarctions involves resection of infarcted tissue, hemicraniectomy, or duraplasty. A surgical approach can be life-saving in the early stages of cerebral infarction. This method is not without risk, but has been shown to be effective for some patients.
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The treatment of cerebral infarction depends on which part of the brain is affected. Some types of cerebral infarction affect the primary motor cortex. Others may be localized in the brainstem. Other symptoms include a loss of sensation in one side of the body, a lack of eye movement on the opposite side, abnormal pupil dilation, and a decreased response to light. Speech infarctions on the left side of the brain may result in slurred speech. Left-side brain infarctions can lead to aggravated reflexes.
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Neuroimaging findings in 28 patients with suspected cerebral infarction are shown in Table 3. Twenty-four of these patients had single-infarctions, while thirteen had multiple infarctions. A wedge-shaped area of parenchymal loss represents a distant hemorrhagic infarct. In addition, eight patients with TBM had space-occupying lesions, while two had parenchymal infiltrations or fibroproductive lesions.
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Atherosclerotic lesions on the cerebral arterial tree are not evenly distributed throughout the brain. The most affected areas are those near the common carotid artery bifurcation, the siphon, and the M1 segment of the middle cerebral artery. Other regions of the cerebral artery are also frequently affected, such as the basilar and vertebral arteries. The causes of these infarctions are not completely understood. However, plaques in the aortic arch are considered an independent risk factor for stroke.
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Symptoms of cerebral ischemia vary widely, but most strokes are sudden and progressive. The signs of ischemic stroke include progressively impaired consciousness, edema, and infarct extension. If detected in time, patients may recover within days or continue to improve for up to one year. Neuroimaging helps distinguish between acute ischemia and other conditions. The presence of brain glioma, a mass lesion, or an acute large vessel occlusion may be evident on CT.
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Earlier, mechanical thrombectomy was limited to patients with primary ischemic meningitis and those with middle cerebral artery occlusion. However, stroke centers may justify a delayed mechanical thrombectomy in patients with a high probability of substantial tissue at risk. MR and CT perfusion imaging can identify the infarcted area and the ischemic penumbra. When the infarct area is larger than the surrounding tissue, ventricular decompression can prevent further cerebral ischaemia.
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Patients with irregular blood cell shapes are at greater risk for cerebral ischemia. They may have lower blood pressure, congenital heart defects, and sickle cell anemia. They are also at a higher risk of developing cerebral ischemia than patients without these conditions. If untreated, cerebral ischemia may lead to heart failure and cardiorespiratory arrest. The underlying causes of cerebral ischemia vary from person to person.
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Patients with ischemic stroke should undergo a thorough medical history. Any medical conditions that contribute to cardiovascular disease should be ruled out before the patient undergoes intravenous thrombolytic therapy. This type of therapy is contraindicated in patients who are taking blood thinners. In addition, patients who are suffering from hypertension should be evaluated for diabetes or cardiovascular disease. In such a case, intravenous thrombolytic therapy should be a last resort.