Silent Infarctions - Oren Zarif - Cerebral Infarction

While cerebrovascular disease is one of the most common causes of death, there are also numerous types of silent infarctions. These are characterized by similar risk factors, if not identical to those of symptomatic infarcts. These are particularly important to consider in the context of the natural history of cerebrovascular disease, as the presence of silent infarcts can provide important information regarding the nature of the condition.

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The symptoms of cerebral infarction depend on which part of the brain is affected. Primary motor cortex infarction usually results in weakness of the opposite side of the body, as does an infarction on the brainstem. Other symptoms may include abnormal pupil dilation, eye movement problems, and loss of sensation in the opposite side. If infarction occurs in the left side of the brain, speech may be slurred and reflexes aggravated.

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Internal cartoid artery anomalies are associated with cerebral infarct, whereas granulomatous angiitis is limited to intracranial arterioles. These conditions are both etiologically and pathologically heterogeneous, which makes diagnosis difficult. However, there is a meningeal biopsy for this condition in selected patients. If meningeal artery stenosis is associated with cerebral infarction, a cerebral biopsy may be indicated to determine the cause.

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Another study, which analyzed the etiology of young adult strokes, revealed a strong association between vascular risk factors and the likelihood of a subsequent cerebral infarction. The authors found that cardiac embolism and hematologic disorders were the most common causes of cerebral infarction in young adults. Approximately one-third of first strokes was not associated with a known cause. Despite the fact that many young adults are disproportionately affected by this disease, young adults should not be ignored in the primary prevention of stroke.

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A thrombotic stroke is preceded by a mini-stroke called a transient ischemic attack (TIA). These episodes can last for minutes or even 24 hours. TIAs are often warning signs of a thrombotic stroke and have similar symptoms. The other type of cerebral infarction is known as lacunar infarct, which occurs in the brain's small blood vessels. This type of cerebral infarction is associated with conditions such as diabetes and high blood pressure.

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Massive cerebral infarcts can impair vital structures, causing coma and death. Surgical decompression with a hemicraniectomy is often life-saving, but it's essential to act quickly as the symptoms and severity of this type of stroke can lead to further neurologic damage. Surgical management includes a series of procedures, including decompressive hemicraniectomy, duraplasty, and resection of infarcted tissue.

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Patients with mild symptoms can often be treated on an outpatient basis, and mild cases may require hospitalization. For those with more severe signs, treatment may require admission. Thrombolytic agents, which are commonly used in human medicine, can be prescribed. However, they must be used under the supervision of a physician. These treatments are not intended to treat underlying causes of the condition. Infarcts may also result in impaired mental status and altered physical functioning.

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CT perfusion is essential for choosing patients for reperfusion therapy. It increases the accuracy of ischemic stroke diagnosis fourfold. It reveals whether there's a filling defect or high-grade stenosis in the cerebral arteries. The CTA is highly accurate in identifying large-vessel stenosis, which accounts for a third of all ischemic stroke cases. MRI has a higher sensitivity, but is less commonly available.

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The presence of hemorrhage may make it difficult to differentiate cerebral infarction from a brain tumor. In general, though, the two conditions are easy to distinguish because of their characteristic imaging findings in the vascular distribution. However, if the clinical course is unusual or the patient's history is ambiguous, the diagnosis may be misinterpreted as a brain tumor. So, while there are other forms of cerebral infarction, the distinction between these disorders is crucial for the treatment of the patient.

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The cause of cerebral infarctions is complex, and early diagnosis is essential for maximizing the chances of a successful outcome. Many conditions may mimic the symptom of MI, including pulmonary embolism, pericarditis, aortic dissection, and acute cholecystitis. The symptoms of cerebral infarctions can vary from subclinical to severe. If the cause of the stroke is TBM, ventricular decompression should be performed as soon as possible to minimize further cerebral ischaemia.

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Another way to diagnose cerebral infarction is to undergo a carotid ultrasound. This is done through a small incision and guides a thin flexible tube into the carotid arteries, which are responsible for supplying blood to the brain. An echocardiogram is also useful in identifying possible sources of the blood clots, which may have travelled to the brain. In many cases, thrombolytic drugs are used to break up these clots and prevent the stroke from occurring or causing permanent damage to the brain.