Cerebral Embolism in the Elderly
Introduction
Introduction to cerebral embolism in the elderly Cerebral embolism refers to acute cerebrovascular disease caused by occlusion of cerebral arteries into the blood circulation, accounting for 15% to 20% of stroke. The age of onset is large, and the number of people with rheumatic heart disease is more than that of young and middle-aged people. The cause of coronary heart disease and aortic disease is more elderly. basic knowledge The proportion of illness: 0.003% Susceptible people: the elderly Mode of infection: non-infectious Complications: cerebral edema, coma, heart failure, cerebral palsy, elderly cerebral embolism, cerebral infarction
Cause
Causes of cerebral embolism in the elderly
Cardiogenic (25%):
(1) Atrial fibrillation: can be caused by coronary heart disease, rheumatic heart disease, hyperthyroidism and other diseases. Due to the widespread use of antibiotics, the incidence of rheumatic fever is greatly reduced, and 60.3% of elderly patients with non-rheumatic atrial fibrillation Cerebral ischemia symptoms occur, 2/3 of which are caused by cardiac embolism, and it is reported that elderly patients with hyperthyroidism have a worsening of atrial fibrillation due to sudden withdrawal of iodine, leading to cerebral embolism.
(2) Cardiac Surgery: Cardiac surgery can not only cause cardiac sputum or plaque to form emboli, but also make bubbles, fat particles in heart tissue also enter the blood circulation, causing cerebral embolism, 79% of these embolisms occur after surgery Within 24 hours, most of them showed multiple cerebral embolism, and the part was in the back of the brain. The cerebellum was more common.
(3) Infection: Inflammatory sputum formed on the heart valve of patients with acute or subacute bacterial endocarditis may cause cerebral embolism after detachment, and may also be complicated by meningitis, brain abscess and other infectious diseases. The incidence of embolic and metastatic infections in these elderly patients was 51%.
(4) Others: In myocardial infarction or cardiomyopathy, endocardial degeneration is easy to induce platelet adhesion and thrombosis, and embolus is formed after shedding; cardiac myxoma, mitral valve prolapse, congenital heart disease, atrioventricular septal defect will come from vein The embolus is pressed into the abnormal embolism produced by the left heart.
Non-cardiac (25%):
(1) Atherosclerosis: Aortic arch, carotid artery and other macrovascular atherosclerotic plaques and attachments fall off, which is also an important cause of cerebral embolism in the elderly. (2) Infection: sepsis, infectious pustule caused by lung infection. (3) Others: Fat emboli are mostly derived from long bone fractures or surgery. Gas embolism is common in chest and neck surgery, as well as tumor emboli, parasites and egg emboli and foreign body emboli.
Source unknown (10%):
Although a small number of cases have been examined, it is still impossible to determine the source of the embolus.
Pathogenesis
Cerebral embolism is more common in the internal carotid artery system, especially in the middle cerebral artery. The vertebrobasilar embolism only accounts for about 10% of the cerebral embolism. After the occlusion blocks the cerebral blood vessels, it not only causes acute ischemia in the blood supply area, but also often causes vasospasm. The blood area is enlarged; when the vasospasm is relieved, the embolus is moved to the distal end of the artery and the collateral circulation is established, the ischemic range is reduced, the symptoms are alleviated, and the pathological changes caused by cerebral embolism are basically the same as the cerebral thrombosis, but may be multiple, and bleeding Sexual infarction is more common, accounting for 30% to 50%. This is because the vascular wall of the embolization is damaged and necrotic. When the sputum is relieved, leakage of blood is likely to occur after the blood flow is restored. Inflammatory emboli can also cause localized arteritis. Or bacterial aneurysm, brain abscess, fat embolism, diffuse ecchymosis and cerebral edema in the white matter of the brain.
Prevention
Elderly patients with cerebral embolism prevention
Reasonable diet, proper exercise, prevention and treatment of various primary diseases such as coronary heart disease, high blood pressure, etc., long-term use of low-dose aspirin if necessary, and some use of transcranial Doppler monitoring in head and neck and cardiothoracic surgery.
Complication
Elderly patients with cerebral embolism complications Complications cerebral edema coma heart failure cerebral palsy elderly cerebral embolism cerebral infarction
Can be complicated by cerebral edema, increased intracranial pressure, leading to coma convulsions, lung infections, heart failure, and eventually cerebral palsy.
Symptom
Cerebral embolism symptoms in the elderly Common symptoms Dyspnea, sensory disturbance, consciousness disorder, chest tightness, angina pectoris, hemiplegic hypertension, spleen embolism, hemoptysis
History
Elderly patients often have heart disease, high blood pressure, history of arteriosclerosis or surgery, and fracture history.
2. Onset
It usually starts from static to dynamic, and the onset is rapid. The symptoms reach a peak within a few seconds or minutes.
3. Symptoms and signs
Patients often have transient disturbances of consciousness, which may be associated with symptomatic seizures, and are more common in arterial cerebral embolism. Men are more likely than women. The former has a higher rate of EEG, often with hemiplegia, aphasia, and partiality. Symptoms, hemianopia, etc., the symptoms depend on the nerve function of the blood supply area of the embolized blood vessels, but some tiny embolisms may have no clinical symptoms. In addition, they are often accompanied by symptoms and signs of underlying diseases such as chest tightness, hemoptysis, angina pectoris, and difficulty breathing. Wait.
Examine
Examination of cerebral embolism in the elderly
Cerebrospinal fluid
Cerebrospinal fluid can be normal, but also increased pressure, red blood cells can be seen in hemorrhagic infarction; infectious embolization white blood cell count can be increased; fat embolism can find fat globules.
2. Other
Blood can be elevated and erythrocyte sedimentation rate can be accelerated.
3. Head CT: The location and extent of the infarction can be determined. Generally, the low-density infarct area can be seen after 24 to 48 hours. For example, a high-density shadow in the low-density area is a hemorrhagic infarction.
4. Electrocardiogram: Arrhythmia and myocardial infarction can often be found.
5. Transesophageal echocardiography (TEE): Atrial wall thrombus and aortic plaque can be found, which is a useful technique for diagnosing cardiogenic cerebral embolism and predicting re-embolization.
6. Cerebral angiography (DSA): can confirm the embolization site and find aortic lesions, but the negative can not rule out cerebral embolism, especially after 2 to 3 weeks of onset, embolization, fragmentation, angiography can be normal.
7. Transcranial Doppler (TCD): can track microemboli in the cerebral blood vessels, and can also find asymptomatic cerebral embolism. It is reported in foreign countries that TCD can be used to monitor blood clots during head and neck surgery. It is simple. , timely, non-invasive advantages.
8. Single photon emission tomography (SPECT): The damage of brain tissue after embolization and the function of remaining intact brain tissue were evaluated by measuring asymmetric perfusion of intracranial blood.
Diagnosis
Diagnosis and diagnosis of cerebral embolism in the elderly
Diagnostic criteria
1. Elderly patients.
2. There are many cases of heart disease, arteriosclerosis, sources of emboli, evidence of embolism in other parts of the body such as retina, kidney, spleen embolism or medical history.
3. The onset of the disease, the disease peaks in a few seconds or minutes.
4. Often have a sexual dysfunction, may be associated with symptomatic epilepsy or other parts of embolism, with hemiplegia, aphasia and other neurological signs.
5. Auxiliary inspection
Differential diagnosis
1 cerebrospinal fluid is more normal.
After 224 to 48 hours, the head CT showed a low-density infarct zone, which may be associated with a hemorrhagic foci.
3 ECG, echocardiography found abnormalities in the heart and so on.
Brain hemorrhage
More active, emotional onset, often accompanied by headache and vomiting and varying degrees of disturbance of consciousness, blood pressure increased significantly, emergency head CT showed intracranial high-density hemorrhage.
2. Atherosclerotic cerebral infarction
More often in a quiet state, the onset is slightly slower, more than a few hours to several days to reach the peak, more than a history of transient ischemic attack (TIA), usually without consciousness disorder, vital signs are more stable, onset 24 After 48 hours, the head CT showed an intracranial low-density infarct.
