multi-infarct mental disorder
Introduction
Introduction to multiple cerebral infarction disorders Multiple cerebral infarctional mental disorders affect cerebral blood supply due to cerebral arteriosclerosis, especially dementia syndrome caused by recurrent cerebrovascular accidents. Microemboli or cerebral white matter in the cerebral white matter of the external cerebral artery (carotid or cone-like basilar artery) is caused by scattered small infarcts in the cerebral white matter center, and is therefore called multiple infarct dementia. Multiple cerebral infarction disorders are mostly in the onset of middle-aged and old age. The degree of cerebral arteriosclerosis can vary from site to site. The middle cerebral artery and basilar artery are more easily hardened, and the anterior small arteriolar wall of the cerebral infarction is thickened, and the elastic layer is more broken. Changes in capillary vitreous changes and fibrosis are also seen in the basal ganglia. The brain has diffuse and localized atrophy, and the ventricle is enlarged. Microscopic examination can be seen in the frontal lobe and white matter center. There are infarct small softening lesions of different sizes. There are glial cell hyperplasia around the softening lesion, forming small cysts or scars and sparse areas. . Neuronal degeneration and gliosis are most obvious around the blood vessels. Arteriosclerosis can also be seen in organs such as heart and kidney. Retinal arteriosclerosis is more common. basic knowledge The proportion of illness: 0.032% Susceptible people: no specific people Mode of infection: non-infectious Complications: myocardial infarction pneumonia
Cause
Multiple causes of cerebral infarction
The root cause of this disease is caused by cerebral arteriosclerosis caused by organic changes in brain tissue.
pathology
The degree of cerebral arteriosclerosis can vary from site to site. The middle cerebral artery and basilar artery are more easily hardened, the small arteries and the pre-capillary small arterial wall thicken, and the elastic layer is more broken. Changes in capillary vitreous changes and fibrosis are also seen in the basal ganglia. The brain has diffuse and localized atrophy, and the ventricle is enlarged. Microscopic examination can be seen in the frontal lobe and white matter center. There are infarct small softening lesions of different sizes. There are glial cell hyperplasia around the softening lesion, forming small cysts or scars and sparse areas. . Neuronal degeneration and gliosis are most obvious around the blood vessels. Arteriosclerosis can also be seen in organs such as heart and kidney. Retinal arteriosclerosis is more common.
Prevention
Multiple cerebral infarction prevention
Reducing the occurrence of cerebral infarction can be prevented to some extent:
1, the blood pressure is controlled at a reasonable level, because the blood pressure is too high, it is easy to cause microcirculation in the brain and atherosclerotic small artery rupture and bleeding; and low blood pressure, cerebral insufficiency, microcirculation stagnation, easy to form brain infarction.
2, pay attention to mental health, many strokes are related to emotional excitement.
3, weight loss, obesity is recognized as one of the risk factors for stroke.
4, scientific and reasonable diet, to low-fat low-calorie, low-salt diet-based diet, and must have enough high-quality protein, vitamins, cellulose and trace elements, eating too much is not conducive to healthy, moldy food, salted fish, Cold foods do not meet the requirements of food hygiene and should be fasted.
5, timely treatment of diabetes, coronary heart disease, liver and kidney dysfunction and other diseases.
6. Moderate physical activity is good for health.
7, pay attention to the harbinger of stroke, although the stroke is a sudden sudden lesion, but often can also find some signs, mainly have the following performance:
(1) One side of the face or upper and lower limbs suddenly feel numb, weak and weak, mouth licking, flowing water.
(2) Suddenly speaking difficulties or not understanding others' words.
(3) Suddenly felt dizzy and swayed.
(4) Short-term confusion or lethargy.
(5) An unbearable headache occurs, and the headache changes from intermittent to persistent or accompanied by nausea and vomiting.
Complication
Multiple complications of cerebral infarction Complications myocardial infarction pneumonia
The main complications of cerebral infarction are:
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 should carry out routine electrocardiogram examination. If myocardial infarction is found, we should take a simultaneous treatment plan for cardiovascular and cerebrovascular diseases. Aspirin, Tianxintai thrombus Xinning tablets, Shengxi Jiangzhining granules.
2, pulmonary infection is the most common complication of patients with cerebral infarction, many studies have shown that lung infection becomes the most important cause of death in cerebral infarction. The lung infection of patients with cerebral infarction is generally related to the following factors.
The patient has been bedridden for a long time, resulting in sedimentary pneumonia. Therefore, in the nursing work, it is recommended to turn over and diligently suck.
Improper care, causing dripping pneumonia caused by drinking water or eating cough.
The patient's use of antibiotics is inappropriate, resulting in dysbacteriosis, plus the majority of patients are old, poor resistance, and increased susceptibility factors.
3, urinary tract infection
Seen in patients with indwelling catheters, or incontinence, patients who are not well cared for, commonly used drugs for the treatment of bacterial urinary tract infections have rapid onset of Western medicine antibiotics, and safe and reliable, good prognosis of Chinese medicine Yinhua Yan Ling tablets and so on.
4, renal insufficiency
It 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 lead to renal artery contraction, affecting renal blood flow.
Many drugs, such as mannitol, can also affect kidney function to varying degrees.
5, hemorrhoids
If the patient stays in bed for a long time, if the patient does not turn over frequently, some of the patient's bone protuberances will compress the fixed tissue, causing long-term ischemia and necrosis of the local tissue, forming a hemorrhoid. The best way to prevent hemorrhoids is to turn over. The condition should permit the use of an air bed for the patient.
6, joint contracture
If the patient with cerebral infarction does not get good rehabilitation training, the muscles on the affected side will be disused atrophy. Under the joint action of muscle atrophy and increased tension, the joints will not be able to move normally for a long time, which will cause the patient's joint deformity, contracture, and the affected area. Joint activity can become very painful.
7, stress ulcers
Hemorrhagic stroke patients and large areas of cerebral infarction patients often have upper gastrointestinal bleeding, which is also a common clinical complication and common cause of death, so we often use gastric mucosal protective agents or antacids when dealing with such patients.
8, secondary epilepsy
Whether it is hemorrhagic or ischemic stroke, after the excessive acute phase, the original brain lesions may leave a "scar". If it becomes an abnormal discharge, it may induce epilepsy. In secondary epilepsy, regular anti-epileptic treatment is required.
9. Psychiatric problems after cerebral infarction
This problem has received more and more attention. It is reported that after cerebral infarction, 70% of patients have different degrees of depression, anxiety and physical and mental disorders. Post-cerebral infarction depression has become an important cause of further rehabilitation of patients, due to physical activity disorder, At the beginning, I will actively cooperate with doctors to find "special effects, special effects" everywhere, in the hope of "completely getting better", but once the doctor tells the patient that there is no specific medicine for cerebral infarction, it is a life-long disease, and it will produce "negative disappointment," The drag on the child, he became a waste person..." The negative thoughts, while some patients fear of cerebral infarction again, and have produced extreme concern for their own body, a little discomfort is thought of the symptoms of cerebral infarction and obsessive-compulsive symptoms, after cerebral infarction Some patients have great emotional changes and temper. If these problems cannot be taken seriously, they are a heavy mental burden to the family and the patients themselves. Therefore, the family members should give care to the patients, and there must be no "disgust" performance. If you can, please ask a psychiatrist or psychiatrist for help.
10, dementia
At present, it has been reported that there is a certain relationship between lacunar ischemic lesions and vascular dementia. In some patients, extensive subcortical arteriosclerosis, infarction, and cognitive decline have occurred. We call it neurology. It is a brain disease for Binswanger.
Many studies have shown that the incidence of dementia in patients with cerebral infarction is significantly higher than that of the average person, but the connection between further pathogenesis of cerebral infarction and dementia is still unclear.
Symptom
Symptoms of multiple cerebral infarction disorders common symptoms atherosclerosis hypertension cerebral infarction consciousness fuzzy mental disorder dementia hardening
Most patients have a history of hypertension and hyperlipidemia, and some may have cerebrovascular accidents. Early patients complained of headache, dizziness, insomnia or lethargy, fatigue, decreased mental concentration, and the patient's original personality characteristics became more prominent, prone to excitement or mental allergy, gradually appearing near memory impairment, long-term memory equivalent For good, intelligent damage sometimes involves only certain specific and limited cognitive functions, such as calculation and naming. However, general reasoning and judgment can remain intact for a considerable period of time, and often can detect these obstacles and actively seek medical treatment or make efforts to make up for it. Therefore, it is called net-like dementia, and the patients mood is unstable and irritating. Increased, can cause crying or laughter because of negligible inducement, called emotional incontinence. Occasionally, depression, anxiety, suspicion, and delusions can occur. The loss of self-control ability in the late stage is not self-care for personal life, and sometimes it is difficult to distinguish it from Alzheimer's disease.
Acute onset patients often appear after cerebrovascular accidents, which can present a state of confusion, accompanied by behavioral disorders and hallucinations, and personality and intellectual disabilities appear after the attack. There are different neurological signs, such as hemiplegia, nystagmus, loss of recognition, blindness, ataxia, and positive pyramidal tract signs, depending on the location of the vascular infarction.
The course of the disease is characterized by a so-called ladder process in which the jump is intensified and incompletely relieved. It can last for years or even more than 10 years, and the cause of death is mostly heart and kidney failure.
EEG is often abnormal, cerebrospinal fluid examination can have a slight increase in protein, cerebral blood flow examination has reduced blood vessel elasticity, increased resistance, and slower blood flow. CT scans showed low-density areas and localized ventricular enlargement, and magnetic resonance imaging showed ventricular infarction.
Examine
Examination of multiple cerebral infarction disorders
(1) CT within 4 to 6 hours after the onset of cerebral infarction, some cases can be seen with a slightly low density of unclear borders, but early CT examination is to exclude cerebral hemorrhage, subdural hematoma, intracranial tumors and other similar cerebral infarction In most cases, the low-density lesions with clearer borders appear after 24 hours, and the infarcts may be intensified in about 1 week. The advantages of CT are convenient and rapid, suitable for critically ill patients, uncooperative patients, and infarcts can be found. Peripheral edema area, brain occupying effect and whether it turned into hemorrhagic infarction, but less than 5mm infarction and posterior cranial infarction are not easy to show CT, infarct on the cortical surface is often not detected by CT.
(2) Magnetic resonance (MRI) MRI of high magnetic field (1.5 Tesla) may show infarction of cortical surface and posterior cranial fossa within 1 hour of onset. Infarction after 6 hours of onset can be almost indicated by MRI. T1 weighted low signal and T2 weighted high signal, MRI has the disadvantage of high price and long imaging time, which is not suitable for critically ill patients, non-cooperators and patients with metal dentures and electrocardiographs.
(C) non-traumatic vascular examination duplex ultrasound (duplexsonography) can be used to assess the extent of extracranial carotid artery lesions and stenosis, transcranial Doppler (TCD) can detect the flow velocity of the brain's large artery, found the middle cerebral artery trunk The vertebral artery distal segment and basilar artery stenosis or blockage can be used to assess collateral circulation. The newly developed dual-focus probe TCD instrument, dual-channel or quad-channel TCD instrument can be used to detect the heart of asymptomatic emboli and intervertebral emboli Source or arterial origin, magnetic resonance angiography (MRI angiography) can be used to examine the extracranial and intracranial lesions of the brain aorta.
(4) Arterioscopic selective cerebral angiography and digital subtractive angiography (DSA) are suitable for patients with severely narrowed internal carotid artery after ultrasound examination. Patients with carotid endarterectomy or clinical manifestations are unusual and suspected arterial stratification Or arteritis, this is a traumatic examination, 2% to 12% of the subjects may have arterial stratification or embolic stroke.
(5) Blood tests should routinely measure blood cell counts, classification, platelets, prothrombin time, partial thromboplastin time, blood glucose, electrolytes, creatinine, and selective determination of protein C, protein S, anticoagulation for some patients according to clinical conditions. Blood enzyme III (ATIII), fibrinogen, anticardiolipin antibody, plasminogen activator inhibitor (PAI), syphilis serological test, etc., stroke episodes affect blood lipid levels, it should be measured after the acute phase.
(6) The cerebrospinal fluid is considered for lumbar puncture in cases where the clinically suspected infectious disease or imaging examination is still not possible.
(7) Other electrocardiogram examinations are essential, and chest X-rays should also be used as routine to exclude cancerous thrombi, and can be used as a ratio of aspiration pneumonia in the future.
Diagnosis
Diagnosis and differential diagnosis of multiple cerebral infarction
diagnosis
The diagnosis of this disease is mainly based on hypertension or cerebral arteriosclerosis accompanied by history of stroke or cerebral insufficiency, recent memory impairment and emotional instability, and personality remains relatively intact; the course of the disease is characterized by a step progression, and may be accompanied by Positive signs of focal nervous system.
The identification of this disease with Alzheimer's disease can be obtained by reference to the ischemic rating scale proposed by Hachinski:
Acute onset 2
Volatility course 2
Personality remains relatively complete 1
Body statement 1
Have high blood pressure or past history 1
Arteriosclerosis 1
Focal neurological signs 2
Focal neurological symptoms 2
Stepped deterioration 1
Night consciousness blur 1
Emotional depression 1
Incontinence 1
Stroke history 2
A total score of 7 or more can be diagnosed as atherosclerotic dementia, and a score of 4 or less can be diagnosed as Alzheimer's disease.
Differential diagnosis
1. Mental disorders caused by psychoactive substances and non-addictive substances.
2. Schizophrenia and other psychotic disorders.
3, mood disorder (affective mental disorder).
4, snoring, stress-related disorders, neurosis, somatoform disorders.
5. Physiological disorders related to psychological factors.
6, personality disorder, habit and impulsive control disorders, sexual psychological disorders.
7, mental retardation and psychological developmental disorders in the same year and adolescence.
8, childhood and adolescent hyperactivity disorder, conduct disorder, mood disorder.
9. Other mental disorders.
