Young and middle-aged cerebral infarction
Introduction
Introduction to cerebral infarction The proportion of young and middle-aged cerebral infarction in stroke patients is not high. The stroke of middle-aged and young people generally refers to stroke patients under 40 years old. The incidence of cerebral infarction is much higher than that of cerebral hemorrhage. There is no significant difference between the two groups and the stroke of the elderly. TIA accounts for about one-third of the cases of young and middle-aged cerebrovascular diseases, which constitutes a special group. TIA is less likely to develop cerebral infarction. basic knowledge The proportion of illness: 0.0001%-0.0003% Susceptible people: no specific population Mode of infection: non-infectious Complications: atherosclerosis
Cause
The cause of cerebral infarction
Cerebral infarction mainly includes thrombosis and embolism.
(1) The causes of non-embolic cerebral infarction are:
1. Atherosclerosis forms a thrombus on the basis of atherosclerotic plaque in the arterial wall.
2. Arteritis Inflammatory changes in the cerebral arteries can cause changes in the vessel wall, and the lumen is narrowed to form a thrombus.
3. Hypertension can cause hyaline degeneration of the arterial wall, and the intima of the artery ruptures, making the platelets easy to adhere and accumulate to form a thrombus.
4. Hematological erythrocytosis and other prone to thrombosis.
5. Mechanical compression of the outside of the cerebral blood vessels is affected by factors such as nearby tumors, and changes in vascular occlusion may occur.
(B) the cause of embolic cerebral infarction
Often the blood flow brought into the cranial solid, liquid, or gas embolus to block a certain cerebral blood vessel, the cause of which is many, mainly cardiogenic and non-cardiac:
1. Cardiac acute or subacute endocarditis, which usually occurs on the basis of heart disease. The intima of the lesion is formed into a sputum by inflammation, and after detachment, cerebral embolism occurs along with the blood, such as rheumatic heart disease. Myocardial infarction, congenital heart disease, cardiac tumor, heart surgery, etc. are all likely to cause emboli to fall off, especially in these heart diseases. When atrial fibrillation occurs, it is easier to detach the embolus, which can cause cerebral embolism.
2. Non-cardiac gas embolism, fat embolism in long bone fracture, pulmonary vein embolization, cerebral venous embolism are the causes of non-cardiac cerebral embolism, and some sources of emboli can not be found as cerebral infarction of unknown origin.
Prevention
Prevention of cerebral infarction
For the prevention of the cause, maintain good living habits.
Complication
Young and middle cerebral infarction Complications atherosclerosis
Due to different causes, clinical manifestations of arterial lesions, cardiogenic diseases, and other diseases (such as AIDS, diabetes, and infection) can occur.
Symptom
Symptoms of cerebral infarction in young and middle-aged common symptoms, weakness, dysfunction, monocular blindness, microthrombus, sensory disturbance, dysphagia, ataxia, hemiplegic vertigo, nausea
It is characterized by cerebral thrombosis or cerebral embolism or migraine stroke.
1. The onset is slow, the cerebral embolism is the fastest, the cerebral thrombosis is often progressive, and the migraine stroke is accompanied by a typical migraine attack.
2. Arteritis patients may have multiple lesions, and those with blood diseases may be associated with venous thrombosis.
3. Significant symptoms and signs include "tripolarism", cortical aphasia, migraine, heart murmur or arrhythmia.
Examine
Examination of young and middle 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 followed by clinical symptoms of blood infarction and aggravated, the examination of CT within 3-5 days can be found early Post-infarction hemorrhage, timely adjustment of treatment options, MRA can be found in the degree of carotid stenosis or occlusion.
2. Lumbar puncture: normal brain pressure, increased brain pressure suggesting a large area of cerebral infarction, hemorrhagic infarction cerebrospinal fluid can present bloody or microscopic red blood cells; infectious cerebrospinal fluid cerebrospinal fluid cells increased (early granulocytes, late lymphocytes); Fat embolism can be seen in the cerebrospinal fluid.
3. Electrocardiogram: routine examination should be performed to determine evidence of myocardial infarction, rheumatic heart disease, arrhythmia, etc. It is not uncommon for cerebral embolism to be the first symptom of myocardial infarction. Carotid ultrasound can evaluate the degree of stenosis and atherosclerotic plaque. It is helpful for confirming carotid-derived embolism.
Diagnosis
Diagnosis and diagnosis of cerebral infarction
Differential diagnosis
The nature of cerebral hemorrhage and cerebral infarction is different, and the treatment methods are different. Therefore, it is necessary to make a clear diagnosis at an early stage. In the absence of conditional CT or MRI, the following points can be identified:
1. Patients with cerebral hemorrhage have a history of hypertension and cerebral arteriosclerosis, while patients with cerebral infarction have a history of transient ischemic attack or heart disease.
2. Cerebral hemorrhage often occurs in the case of emotional agitation or exertion, and cerebral infarction often occurs when resting quietly.
3. The onset of cerebral hemorrhage is rapid, and it progresses rapidly. It often reaches a peak within a few hours. There is no aura before the onset, and the cerebral infarction progresses slowly. It often worsens after 1-2 days. There is often a history of transient ischemic attack before the onset. .
4. Patients with cerebral hemorrhage often have headache, vomiting, neck stiffness and other symptoms of increased intracranial pressure, and high blood pressure, heavy disturbance of consciousness, blood pressure is more normal when the cerebral infarction occurs, conscious.
5. Patients with cerebral hemorrhage have high pressure on the lumbar cerebrospinal fluid, mostly bloody, while the cerebrospinal fluid pressure of patients with cerebral infarction is not high, clear and colorless.
6. Patients with cerebral hemorrhage are more common in central respiratory disorder, the pupil is often asymmetrical, or the pupil is narrowed, the eyeball is deflected in the same direction, floating, the central respiratory disorder is rare in patients with cerebral infarction, the pupil is bilaterally symmetrical, the eyeball is rarely skewed, floating .
