Things to know about cerebral infarction

Cerebral infarction is increasing due to the increase in cardiovascular and metabolic diseases. The disease reduces blood flow to the brain, cerebral vascular occlusion or low blood pressure.

The article was professionally consulted by Master, Doctor Nguyen Thi Huong - Neurologist - Department of General Internal Medicine, Vinmec Times City International General Hospital.

1. What is cerebral infarction?

Cerebral infarction is a pathological process that reduces blood flow to an area of ​​the brain due to narrowing or blockage of a blood vessel in the brain or low blood pressure. Cerebral ischemia is a condition in which a part of the brain is deprived of blood. If the lack of blood supply is not corrected or is prolonged, that part of the brain will die due to lack of oxygen and glucose. The area of ​​the brain that dies due to this lack of blood supply is called cerebral infarction .

Cerebral infarction accounts for about 80% of strokes, the remaining 20% ​​are cerebral hemorrhages and subarachnoid hemorrhages. The annual incidence of cerebral infarction is relatively high, about 130/100,000 people/year.

Cerebral infarction causes a high risk of stroke.

2. Causes of cerebral infarction

Common causes of cerebral infarction are:

1. Large vessel atherosclerosis accounts for 50%, of which extracranial large vessels account for 45% and intracranial large vessels account for 5%.
2. Causes from the heart that cause blood clots such as heart valve disease, atrial fibrillation , arrhythmia , heart failure . create blood clots that go to the brain, accounting for 20%.
3. Occlusion of small blood vessels in the brain, commonly found in patients with high blood pressure and diabetes, accounts for 25%.
4. Non-atherosclerotic arterial disease accounts for < 5%.
5. Blood diseases such as blood clotting disorders, blood cell diseases, congenital abnormalities of blood vessels. account for <5%.

3. Diagnosis of cerebral infarction

Symptoms of cerebral infarction occur suddenly, often while the patient is resting. Typical symptoms are hemiplegia, hemiplegia, difficulty speaking, and crooked mouth. There may be a disturbance of consciousness if the patient has extensive cerebral infarction, bilateral cerebral infarction, or brainstem infarction.

3.1 Paraclinical diagnosis

1. Brain CT scan: In the hyperacute phase 3-6 hours after the onset of the disease, changes in brain CT scan images are very subtle, mainly caused by cerebral edema in the ischemic area.

Early signs of cerebral infarction on brain computed tomography include loss of gray-white matter boundaries, blurring of cerebral sulci, narrowing of the Sylvian fissure, loss of the insular ribbon, narrowing of the ventricles and basal cisterns, and increased vascular density in the area of ​​the circle of Willis due to blood clots, especially in the middle cerebral artery.

Brain MRI to diagnose cerebral infarction.

Brain CT scan diagnoses cerebral infarction. In the stage after the cerebral infarction has formed, the brain CT scan image shows a hypodensity in the cerebral cortex, subcortical region or in the white matter; deep gray matter according to the area of ​​arterial blood supply.

1. Brain MRI : The advantage of brain MRI compared to CT scan in the acute phase of cerebral infarction is that MRI has specialized pulses such as DWI, ADC, FLAIR, MRA to accurately assess the acute nature of the lesion and the ability to intervene in the acute phase, and to make a preliminary assessment of the condition of large blood vessel occlusion in the brain without the need for injection. The disadvantage of MRI is that it takes longer to scan than CT scan, so it is not an ideal means for emergency stroke intervention.
2. Digital subtraction angiography: Digital subtraction angiography (DSA) is an invasive technique aimed at accurately diagnosing cerebral vascular occlusion and simultaneously providing emergency treatment to remove blood clots through the endovascular route: after detecting cerebral vascular occlusion through cerebral angiography and inserting instruments, the blood clot is aspirated (suction machine, catheter).

4. Signs of stroke

When seeing the patient showing signs of FAST (English abbreviation): F (face) crooked mouth, A (arm) weak limbs, S (speech) change in voice, T (time), take them to the hospital immediately.

Some other warning signs of stroke include dizziness, headache, numbness in limbs, crooked mouth, slurred speech, coma, convulsions, etc. When these signs are seen, the patient should be taken to the hospital early for treatment. The golden time for treatment window is the first 6 hours from the onset of symptoms, preferably within 4.5 hours, even the diamond window is the first hour from the onset of symptoms. If the treatment window is exceeded, the patient may not be treated promptly and may suffer severe disability.

5. Preventing stroke recurrence

Regular check-ups prevent the risk of stroke recurrence

1. Treatment of causes of cerebral infarction: hypertension, diabetes, cardiovascular disease, lipid disorders.
2. Reasonable diet: Follow a low-fat, low-salt (hypertension), low-starch, low-sugar (diabetes) diet, eat more green vegetables, exercise 30 minutes a day, stop smoking and drinking alcohol, and avoid obesity.
3. Regular check-ups and treatment as directed by your doctor
4. When there are signs of suspected cerebral infarction, the patient should be hospitalized immediately.

When there are symptoms suggesting a stroke such as hemiplegia, crooked mouth, difficulty speaking, etc., the patient needs to quickly go to the hospital, absolutely do not treat it at home. The patient should be diagnosed early and accurately so that the doctor can choose the most appropriate treatment method. The sooner you go to the hospital, the better, especially within the first 6 hours after the stroke, the higher the chance of recovery.

Currently, Magnetic Resonance Imaging - MRI/MRA is considered the 'gold' tool for screening for stroke . MRI is used to examine the condition of most organs in the body, especially valuable in detailed imaging of the brain or spinal nerves . Due to its good resolution and contrast, MRI images allow the detection of abnormalities hidden behind bone layers that are difficult to detect with other imaging methods. MRI can give more accurate results than X-ray techniques (except for DSA to evaluate blood vessels ) in diagnosing brain, cardiovascular, stroke diseases, etc. Moreover, the MRI imaging process does not cause side effects like X-ray or computed tomography (CT).