• Wednesday May 27,2020

stroke

Cerebral infarction, cerebral ischemia or ischemic stroke is the most common form of stroke. It is the cause of ischaemia - a sudden under-circulation of the brain - which can lead to the death of nerve cells and brain cells.

What is a cerebral infarction?

If the patient has early warning signs such as temporary maladies, short paralyzes, speech problems or memory problems, it is important to see a doctor immediately.
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The term cerebral infarction is mainly used when it is an ischemic stroke. This results in a reduced blood flow to the brain, resulting in a reduced supply of the organ with glucose and oxygen.

In medicine, such a circulatory failure is called ischemia. Closures or narrowing of the arteries supplying the brain are responsible for the lower blood flow. If the ischemia is not reversible, this leads to the death of brain and nerve cells, which in turn triggers a cerebral infarction.

From the medicine the cerebral infarction is classified as an urgent emergency. In industrialized countries, ischemic stroke is one of the leading causes of death. Particularly affected are people who are older than 70 years. In men, a stroke is much more common than in women.

causes

Cerebral infarction is caused in most cases by atherosclerosis, also known as arteriosclerosis. In most people this is caused by high blood pressure (hypertension), diabetes mellitus (diabetes) or the consumption of tobacco. The main reason for occlusion of blood vessels is arteriosclerosis.

In the process, plaques accumulate on the inner walls of the blood vessels over time. This refers to deposits of fat and cells. The larger the size of the plaques, the more the affected blood vessel narrows. Particularly susceptible to the formation of plaques are people who suffer from diabetes, high cholesterol or high blood pressure.

If an artery is increasingly narrowed by the plaques, insufficient oxygen-rich blood can not reach the tissue. In addition, there is a risk of plaque rupture. This tear can lead to the formation of a thrombus (blood clot).

As a result, even a complete closure of the vessel threatens. This in turn leads to ischemia, in the course of which the supply of oxygen to the tissue is interrupted. The patient then suffers a stroke. Another possible cause of a cerebral infarction is embolism. The resulting embolus is free to move and able to follow the bloodstream of the body.

In the worst case, it clogs a blood vessel in the brain and causes a stroke. Inflammation of the cerebral vessels, malformations of the heart or cardiac arrhythmias are usually responsible for an embolism. In addition to a high age, the risk factors for a cerebral infarction include disorders of lipid metabolism, lack of exercise, alcoholism and smoking.

Symptoms, complaints & signs

Typical of an ischemic stroke is the abrupt appearance of different symptoms. The affected persons suffer from a clouding of consciousness. This can manifest itself through tiredness, unconsciousness or even a deep coma.

Other symptoms include headache, vertigo, double vision, nausea, vomiting, difficulty swallowing and speech, visual field defects, hemiplegia or paralyzed individual limbs, and memory loss.

In addition, neuropsychological deficits such as apraxia, attention deficit disorder and cognitive dysphasia occur. The symptoms that actually occur depend on the affected vessel or brain area. Furthermore, men and women have various complaints.

Diagnosis & disease course

If the patient has early warning signs such as temporary maladies, short paralyzes, speech problems or memory problems, it is important to see a doctor immediately. The doctor first deals in detail with the medical history of the patient, followed by a neurological examination.

An important role is played by diagnostic imaging techniques such as computed tomography (CT) or magnetic resonance imaging (MRI). Their use makes it possible to quickly differentiate between a cerebral infarction and a cerebral hemorrhage, which is important for further treatment.

Other possible screening methods include angiography, Doppler sonography, an EEG to check brain waves, an ECG to diagnose cardiac arrhythmias, and a lumbar puncture to check cerebrospinal fluid (cerebrospinal fluid). The course of a cerebral infarction depends on which brain region has been damaged and to what extent.

For a favorable prognosis, early treatment is extremely important. While some patients have minor effects, others require long-term care and are bedridden. Not infrequently, there are chronic damage such as visual disturbances, speech disorders or paralysis. In the worst case, the patient dies from the stroke.

complications

Even with rapid and professional treatment of brain infarction, there is a risk of complications. These can further aggravate the consequences of stroke. A feared complication is the increased intracranial pressure. It is triggered by accumulations of water or bleeding in the brain. In addition, there is a risk of epileptic seizure or thrombosis (blood clots) from the stroke.

When complications occur, it plays a big role at which point of the brain the cerebral infarction occurs. For example, a larger infarct may sometimes cause only mild discomfort in certain locations, while a smaller infarct in other brain areas causes severe disability. In principle, however, a cerebral infarct must be expected to have serious consequences.

The course of the disease in the first weeks after the stroke should also be considered. Typical sequelae of cerebral infarction include persistent paralysis, swallowing problems associated with aspiration risk, and pneumonia. Aspiration is the infusion of vomit, saliva, or food into the respiratory tract, which in turn causes pneumonia.

Numerous complications after a cerebral infarction are caused by the subsequent bed rest. This includes, among other things, a pressure ulcer (decubitus ulcer), which occurs together with sensory disturbances. Due to the limited activity of the bladder and kidneys, urinary tract infections threaten. Incorrect storage of the patient can also lead to joint stiffness.

When should you go to the doctor?

The cerebral infarction is a medical emergency. The affected person loses control of various functional systems of the organism without warning, and is often unresponsive. In the case of loss of consciousness, intensive care treatment must be performed as soon as possible. Since a sudden death of the person threatened, must be reacted immediately. Every minute until a medical treatment decides on the life of the person concerned and possible consequential damage.

It therefore requires an ambulance service and until its arrival, first aid measures are to be taken. Already at the first unexpected abnormalities an emergency doctor should be contacted. If the person reports a sudden feeling of discomfort, weakness or double vision, there is cause for concern. Nausea, vomiting, dizziness or speech problems require a doctor. If there are concentration, orientation or attention disorders, an emergency medical care must be provided. For motor problems or paralysis, the person concerned needs immediate help.

Memory loss, acute fatigue, gait insecurity or discomfort in one half of the body require a visit to the doctor. If the person falls into a comatose state, call an emergency doctor. If there is evidence of confusion, dysphagia or visual field defects, medical attention will be needed as soon as possible. Observers of the event must ensure the respiration of the person concerned.

Treatment & Therapy

In case of a cerebral infarction, immediate treatment is required. This should take place in the hospital in a so-called stroke unit. There, the sufferer receives optimal diagnosis and therapy. He is also monitored intensively. The body temperature, heart rate, blood pressure, respiration and blood sugar are checked.

Furthermore, several medical disciplines such as neurology, neurosurgery, radiology and internal medicine work closely together. A possible treatment option for a cerebral infarction is the lysis therapy, which should lead to a dissolution of the blood clot.

At an early stage of ischemic stroke, blood-thinning medication can also be administered. These include primarily acetylsalicylic acid (ASA). However, this must not be taken with a lysis therapy. Also important are sufficient saturation of the blood with oxygen and thrombosis prophylaxis.

Outlook & Forecast

The timing of primary medical care, as well as the location and size of the cerebral infarction are critical to a prognosis. The later the person concerned receives intensive care and treatment, the worse the chances of recovery are in most cases. At the same time, the place of damage in the human brain is relevant for a good prognosis. With a very fast care and a good subsequent rehabilitation, there are good prospects for a recovery. Currently, however, every second patient of a cerebral infarction remains disabled for life, severely disabled or in need of care.

The extent of damage to the brain must be individually assessed and classified. If areas of the brain tissue are affected, which regulate important functions of the organism, such as locomotion, thinking or speaking, is to be expected with impairments that have lifelong effects on the state of health. Improvement of symptoms is possible, but recovery is unlikely.

In addition to the physical changes occur in a cerebral infarction often sequelae. Due to the mental stress caused by the changed living conditions, mental illnesses can be expected. These usually worsen the healing process, lead to delays or can almost completely prevent a recovery. With good mental strength and motivation of the patient many physical improvements can be achieved. However, if it comes to paralysis, these are permanent and irreparable.

prevention

To prevent cerebral infarction from occurring, the risk factors for arteriosclerosis should be reduced. These include regular monitoring of blood pressure and blood sugar as well as a lifestyle that includes a low-fat and low-sugar diet as well as enough exercise. In addition, the consumption of tobacco products should be avoided, because the risk of cerebral infarction increases considerably.

aftercare

A cerebral infarction often has the consequence that speech and perception disorders or even paralysis remain. When it comes to aftercare it is therefore important to start rehabilitation as early as possible. Especially the recognition and treatment of dysphagia should happen as early as possible. This way, long-term damage can be minimized. Studies indicate that the first three months after a cerebral infarction are crucial for brain regeneration.

Unfortunately, it belongs to the clinical picture that sufferers can suffer further strokes after the acute care of the brain infarct. Therefore, experts are advised to aim for inpatient rehab. The reduction in brain function is difficult to diagnose in an outpatient rehab. These may be various symptoms, such as the disturbance of perception, memory or short-term memory.

A general statement about the right aftercare for a cerebral infarction is difficult. It requires an exact cause research in order to connect the optimal aftercare. But just the control and reduction of risk factors should be considered in the aftercare.

Smoking, obesity and a generally unhealthy lifestyle increase the risk of another cerebral infarction. Adequate exercise, healthy nutrition and low alcohol and tobacco products can ensure that even in advanced age that another cerebral infarction is not repeated.

You can do that yourself

Cerebral infarction is also referred to as a stroke in which every minute counts to be recognized as such. If this is treated as quickly as possible, follow-up care will be inevitable. The longer the diagnosis has been delayed, the more damage can be caused to the patient. In the case of consequential damage caused by the disease, such as one-sided paralysis or language difficulties, the person concerned must take expert rehabilitation measures. These should be done by a specialist in his practice. It requires a lot of patience and empathy to achieve an effective recovery. With timely recognition and treatment as well as the necessary therapy it is possible in many cases that the patient is completely cured again.

In order to avoid a subsequent cerebral infarction, the patient will have to change his lifestyle, stop smoking and over-consumption of alcohol and may need to change the diet to a healthy diet. If there is another incident, it is important to take action immediately. These are to be immediately taken to the hospital or to call the emergency service, which is already described on the phone, that has already preceded by a cerebral infarction. The signs are one-sided obstruction of the movement, speech difficulties, visual impairments, which can be recognized.


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