Cerebral infarction
Introduction
Introduction to Cerebral Infarction Cerebral infarction (cerebral infarction, ischemic stroke) refers to ischemic necrosis or brain softening of localized brain tissue caused by blood supply disorders, ischemia, and hypoxia. The common clinical type of cerebral infarction is cerebral thrombosis. Formation, lacunar infarction and cerebral embolism, etc., cerebral infarction accounted for 80% of all strokes. Several diseases associated with it are: diabetes, obesity, hypertension, rheumatic heart disease, arrhythmia, dehydration of various causes, various arteritis, shock, excessive blood pressure drop and so on. basic knowledge The proportion of illness: 0.12% Susceptible people: good for the elderly Mode of infection: non-infectious Complications: Acne, Cerebral Infarction
Cause
Causes of cerebral infarction
Cardiogenic disease (50%):
60% to 75%, common diseases due to chronic atrial fibrillation, the main source of embolus is rheumatic valvular disease, endocarditis and thrombosis, and myocardial infarction, atrial myxoma, heart surgery, heart Catheter, mitral valve prolapse and calcification, congenital atrioventricular septal defect (venous abnormal embolus).
Non-cardiac disease (5%):
Such as atherosclerotic plaque detachment, pulmonary vein thrombosis or clot, fat plug and air embolism during fracture or surgery, blood clot or thrombus detachment during endovascular treatment, carotid fiber dysplasia (more common in women), lung infection , sepsis, hypercoagulable state of nephrotic syndrome, etc. can cause cerebral embolism.
Embolons of unknown origin (30%):
About 30% of brain embolism.
Prevention
Cerebral infarction prevention
Weight control. Obesity is a risk factor for cerebral infarction and should be controlled by controlling diet (especially high-energy foods) and physical exercise. Dietary nutrition should be balanced, eat more vegetables, fruits and cereals, reduce the intake of saturated fatty acids and cholesterol, salt intake is controlled below 6 grams per day. Insist on exercise can reduce the risk of recurrence by 20%, and perform at least 30 minutes of moderate physical activity every day, such as walking, jogging, Tai Chi, cycling, etc., 5-7 times a week. In addition, adjust your mentality, treat yourself and others correctly, and try to maintain a positive, open-minded, relaxed mood. For those who have a tendency to depression, antidepressant medication should be added.
Complication
Cerebral infarction complications Complications acne cerebral infarction
The following complications are prone to occur: myocardial infarction, pulmonary infection, urinary tract infection, renal insufficiency, hemorrhoids, joint contracture, stress ulcer, secondary epilepsy, psychiatric problems after cerebral infarction, dementia, etc.
1, myocardial infarction is a common complication of cerebral infarction, the current pathogenesis is unknown, some studies have shown that many patients with cerebral infarction, in the acute phase, often accompanied by myocardial ischemia, but this change in most patients in the acute After the period can be changed, some patients may develop into myocardial infarction. Therefore, for patients with cerebral infarction, we have to carry out routine electrocardiogram examination. If myocardial infarction is found, a simultaneous treatment plan should be adopted for cardiovascular and cerebrovascular diseases.
2. Pulmonary infection is the most common complication of patients with cerebral infarction. Many studies have shown that lung infections are the leading cause of death in cerebral infarction. Pulmonary infection in patients with cerebral infarction is generally related to the following factors: patients with long-term bed rest, resulting in sedimentary pneumonia, therefore, in the nursing work, advocate diligently turn over, diligent sucking. Improper care, causing dripping pneumonia caused by drinking water or eating cough. Improper use of antibiotics in patients causes dysbacteriosis, and the majority of patients are elderly, have poor resistance, and increase the risk factors.
3, urinary tract infection: seen in patients with indwelling catheter, or incontinence, patients who do not get good care, commonly used drugs for the treatment of bacterial urinary tract infections have a rapid onset of Western medicine antibiotics, and safe and reliable, prognosis Good Chinese medicine Yinhua Biyanling tablets and so on.
4, renal insufficiency: is also an important complication of patient death, mainly related to the following factors: cerebral infarction is a "stress" state, high adrenaline levels in the body, easily cause renal artery contraction, affecting renal blood flow . Many drugs such as mannitol and antibiotics also have different effects on kidney function.
5, hemorrhoids: patients stay in bed for a long time, if not often turned over, some of the patient's bone bulge will press the fixed tissue, causing long-term ischemia and necrosis of local tissue, forming a hemorrhoid. The best way to prevent hemorrhoids is to turn over and, if possible, use an air bed for the patient.
6, joint contracture: if the cerebral infarction patient does not get good rehabilitation training, the affected side of the muscle will be disuse atrophy, under the combined effect of muscle atrophy and increased tension, the joint can not be normal activities for a long time, will cause the patient's joint deformity Cursed. The joint activity of the affected area can become very painful.
7. Stress ulcers: Patients with hemorrhagic stroke and large-area cerebral infarction often have upper gastrointestinal bleeding, which is also a common clinical complication and common cause of death.
8, secondary epilepsy: whether it is hemorrhagic or ischemic stroke, after the excessive acute phase, the original brain lesions may leave "scar", if it becomes abnormal discharge, it may induce epilepsy, to large The episode is dominated. If the patient develops secondary epilepsy, regular anti-epileptic treatment is initiated.
9. Psychiatric problems after cerebral infarction: This issue has received more and more attention.
10, dementia: At present, there are reports that there is a certain relationship between lacunar ischemic lesions and vascular dementia. In more patients, extensive subcortical arteriosclerosis, infarction, and decreased cognitive function have emerged.
Symptom
Cerebral infarction symptoms common symptoms brain stem infarction increased intracranial pressure vascular occlusion sensory disturbance brain occupying lesions ataxia
1, cerebral embolism can occur at any age, more common in young adults, more in the event of sudden onset, no prodromal symptoms, focal neurological signs peaked in seconds to minutes, more complete strokes, clear consciousness or Mildly confused, internal carotid artery or middle cerebral artery embolization leads to large area cerebral infarction, can cause severe brain edema, increased intracranial pressure, and even cerebral palsy and coma, common seizures, vertebral-basal artery system embolism often occurs In a coma, the focal signs of individual cases are stable or once improved, and then aggravation indicates re-emergence or subsequent blood.
2, about 4/5 of the cerebral embolism occurs in the anterior circulation, especially the middle cerebral artery, hemiplegia, partial sensory disturbance, aphasia or focal seizures, hemiplegia, heavier facial and upper limbs, vertebral basilar artery system involvement About 1/5, showing dizziness, diplopia, crossbow or quadriplegia, ataxia, drinking cough, dysphagia and dysarthria, etc., embolism into one or both sides of the posterior cerebral artery leads to isotropic hemianopia Or cortical blindness, primary embolization of the basilar artery leads to sudden coma, quadriplegia or basilar artery syndrome, most patients with rheumatic heart disease, coronary heart disease and severe arrhythmia, or cardiac surgery, long bone fracture, endovascular intervention, etc. Sub-source, as well as pulmonary embolism (air urgency, cyanosis, chest pain, hemoptysis and pleural friction, etc.), renal embolism (low back pain, hematuria, etc.), mesenteric embolism (abdominal pain, blood in the stool, etc.), skin embolism (bleeding point or ecchymosis) and other signs.
Examine
Examination of cerebral infarction
1, CT and MRI examination can show ischemic infarction or hemorrhagic infarction changes, combined with hemorrhagic infarction to support cerebral embolism, many patients continue to issue clinical symptoms of blood infarction and aggravation, 3-5 days after the onset of CT can be found early to stimulate infarction After bleeding, timely adjustment of treatment options, MRA can be found in the degree of carotid stenosis or occlusion.
2, lumbar puncture cerebral pressure normal, increased brain pressure suggesting a large area of cerebral infarction, hemorrhagic infarction cerebrospinal fluid can present bloody or microscopic red blood cells, the number of cells in the cerebrospinal fluid of infectious cerebral embolism increased (early granulocytes, late lymphocytes), fat The fat globule is seen in the cerebrospinal fluid.
3, ECG should be routinely examined to determine evidence of myocardial infarction, rheumatic heart disease, arrhythmia, etc., cerebral embolism can be used as the first symptom of myocardial infarction is not uncommon, carotid artery ultrasound can evaluate the degree of stenosis and atherosclerotic plaque, It is helpful to confirm the carotid-derived embolism.
Diagnosis
Diagnosis of cerebral infarction
diagnosis
1, the onset of rapid illness: most without prodromal symptoms, rapid onset, in seconds, often reached a peak in a few seconds after the onset.
2, most patients have signs of the nervous system: such as hemiplegia, partial sensation and hemianopia, in the main hemisphere there are motor aphasia or sensory aphasia. A small number of patients are dizziness, vomiting, nystagmus and ataxia. There may be a loss of transient consciousness, or limitation or generalized convulsions. Severe patients may have coma, gastrointestinal bleeding, cerebral palsy, or even death soon.
3, there are diseases that produce emboli origin: most patients have diseases that produce emboli origin such as heart disease, atrial fibrillation, cardiomyopathy, myocardial infarction, etc., especially the symptoms and signs of atrial fibrillation.
4, brain CT scan or MRI examination: 24 to 48 hours after the onset of brain CT scan showed that the embolization site has a low-density infarct, the boundary is not clear, and has a certain occupancy effect. However, brain CT scan negative within 24h can not rule out cerebral embolism. Brain MRI can detect infarcts and small embolization lesions earlier, and MRI examination of brain stem and cerebellar lesions is superior to brain CT scan.
Differential diagnosis
1, cerebral hemorrhage: sometimes the clinical manifestations of cerebral infarction and small amount of cerebral hemorrhage are quite similar, very confusing. The clinical symptoms of large-area cerebral infarction can be similar to cerebral hemorrhage. Among all the identification points, the onset and onset speed are the most clinically significant. Head CT/MRI can be diagnosed.
2, cerebral embolism: rapid onset, often have a history of heart disease, there are sources of emboli, such as rheumatic valvular heart disease, endocarditis, atrial fibrillation.
3, intracranial lesions: some subdural hematoma, intracranial tumors, brain abscess, etc. can also be a stroke-like incidence, hemiplegia and other symptoms of localized neurological deficits, sometimes increased intracranial pressure, especially the papillary Edema is not obvious and can be confused with cerebral infarction. CT/MRI is not difficult to identify.
