Cerebral infarction
The content of the article:
- The reasons
- Classification
- Brain infarction symptoms
- Diagnostics
- Treatment
- Video
Cerebral infarction (I63 according to the ICD-10 classification) is a serious pathological condition characterized by necrosis (necrosis) of brain tissue. It occurs as a result of ischemic stroke - a violation of blood supply in the cerebral arteries, which leads to oxygen starvation of the brain, causes damage to the tissues of a certain part of the brain and disruption of their functions. For this reason, ischemic stroke itself is sometimes called cerebral infarction. This disease is one of the leading causes of death.
Why does cerebral infarction develop, what is it and how does it differ from a stroke?
Another name for cerebral infarction is ischemic stroke
The reasons
What causes a cerebral infarction? The immediate cause is acute ischemia, that is, insufficient blood supply to the brain. It can be caused by blockages, spasms, or compression of the arteries that supply blood to the brain. Emboli, blood clots, less often - air bubbles or drops of fat can clog the vessels. Sometimes a violation of the blood supply to the brain occurs due to cardiovascular failure, leading to ischemia and hypoxia of the brain. The most common cause of ischemic stroke is thrombosis due to cerebral atherosclerosis or as a result of cardiogenic embolism.
Regardless of what became the triggering mechanism of ischemia, the pathological process develops in the same way: a violation of blood flow leads to a violation of protein synthesis and the breakdown of glucose in nerve cells. The brain trophism is disturbed, oxygen starvation occurs. In the part of the brain where oxygen has ceased to flow, the process of cell death begins, i.e., necrosis develops. However, if the blood supply to the affected area is quickly restored, the nerve cells are restored. Otherwise, extensive cerebral infarction occurs.
Due to energy hunger, nerve cells cannot maintain the constancy of their metabolism and undergo necrosis. Swelling of the brain develops. As a result of edema, the brain inside the cranium is compressed, its structures are displaced, perhaps depression of the cerebellum, wedging of the medulla oblongata into the occipital foramen. This is often fatal.
The main risk factors contributing to the development of cerebral infarction:
- lipid metabolism disorders;
- atherosclerosis;
- hypertonic disease;
- coronary heart disease;
- atrial fibrillation;
- congenital heart defects;
- diabetes;
- prolonged stagnation of blood;
- increased blood clotting;
- autoimmune vascular disease.
In addition to these diseases, there are risk factors associated with lifestyle, individual characteristics and bad habits:
- abuse of alcoholic beverages;
- long-term smoking;
- excess weight;
- sedentary lifestyle;
- hereditary predisposition;
- elderly age;
- metabolic disorders;
- acute or chronic infections.
Classification
Depending on the pathogenetic characteristics, the following types of cerebral infarction are distinguished:
- thromboembolic - infarction caused by thrombosis of cerebral arteries, i.e., associated with occlusion of an intracranial vessel by a thrombotic mass or atherosclerotic formation;
- rheological - caused by changes in the blood coagulation system. Blockage of blood vessels with blood clots in this case is due to an increase in viscosity and an increase in blood coagulability due to polycythemia or erythrocytosis;
- lacunar - formed when small intracranial arteries are blocked, usually occurs as a result of arterial hypertension. The development of small foci of a heart attack is characteristic.
Thromboembolic infarction includes atherothrombotic and cardioembolic. In atherothrombotic infarction, thrombosis or embolism of an arterial vessel arise from foci of atherosclerosis of the intracerebral arteries. Cardioembolic cerebral infarction develops as a result of cardiocerebral embolism in heart disease. In this case, emboli formed in the cavities of the heart are brought into the arterial system of the brain with the blood flow.
The thromboembolic type also includes hemodynamic cerebral infarction, which occurs with a sharp drop in blood pressure against the background of gross stenosis of the vessels of the brain or neck.
Brain infarction symptoms
The symptoms of cerebral infarction depend on the localization of the lesion. The disease can have an acute or subacute course, usually of a progressive (less often wavy) nature. In most cases, everything happens within a few minutes, less often - hours or days.
Diagnosis of cerebral infarction consists in conducting instrumental and laboratory examination
The first signs that are observed in acute disturbance of cerebral circulation of any localization:
- headache;
- confusion of consciousness;
- dizziness, which increases when the head is thrown back;
- double vision, blurred vision;
- pain in the eyeballs;
- dry mouth;
- lack of coordination, unsteady gait;
- slurred speech.
The following symptoms occur on one side of the body, opposite to the side of the affected hemisphere, that is, if the lesion is located in the right hemisphere, then the symptoms will appear on the left side of the body:
- complete paralysis, paresis (hemiparesis) or significant decrease in strength (hemiplegia) of the limbs on one side;
- a sharp decrease in sensitivity in one half of the body and face;
- asymmetry of the face: one corner of the mouth goes down, the nasolabial fold is smoothed out.
Sometimes, according to the manifestations of a heart attack, it is possible to determine which particular cerebral artery was affected. When the anterior cerebral artery is damaged, involuntary grasping reflexes, leg paresis, eye movement disorders, and motor aphasia are observed. In case of impaired blood flow in the middle cerebral artery - paresis and sensory disorder of the upper extremities and lower half of the face, sensory and motor aphasia, head tilting. With impaired blood circulation in the posterior cerebral artery, visual disturbances, problems with speech understanding and memory occur. In case of violations in the vertebro-basilar basin, the patient's eyesight deteriorates, there are problems with swallowing food, the pronunciation of individual letters. Speech becomes quiet and hoarse, paresis or paralysis is observed, impaired sensitivity of the limbs.
Diagnostics
The diagnosis should be made as soon as possible. Instrumental diagnostics is used. Computed tomography is an accurate and effective method, since it makes it possible to distinguish hemorrhage from a heart attack in most cases. Magnetic resonance imaging is also used, but the difference in methods is that MRI is not used for emergency diagnosis. Duplex scanning and Doppler ultrasonography are used to study the state of the vessels.
From laboratory diagnostic methods, an important role is assigned to the study of cerebrospinal fluid taken with the help of a lumbar puncture. In most patients with intracerebral hemorrhage, blood is found in the cerebrospinal fluid.
Treatment
Treatment of a heart attack should be started as early as possible, it is highly desirable that this happens no later than three hours after the manifestation. Timely first aid provided significantly reduces the risk of complications and subsequent development of the disease, allows you to minimize the consequences of cerebral infarction.
First pre-medical aid:
- turn the patient over to the right side and raise his head above body level by 30 degrees;
- unbutton tight clothing;
- measure pressure;
- use a drug that normalizes blood pressure that the patient usually uses;
- put a tray under the lower jaw if you have vomiting.
However, the very first step should be to call an ambulance.
In the hospital, medicines are used to reduce blood clotting, prevent or reduce cerebral edema. Therapeutic measures are aimed at stabilizing blood pressure, respiration, heart rate, restoration and maintenance of vital functions.
In the future, surgical intervention can be used to treat a heart attack. With the help of the operation, it is possible to eliminate the factors that led to the blockage of blood vessels, which reduces the risk of a second heart attack by 70%. Also, surgical treatment can be used to increase blood perfusion, decrease intracranial pressure, and maintain cerebral blood flow.
Medical attention must be provided within three hours of the onset of the attack
The rehabilitation of the patient is of great importance - the restoration of speech skills, physical activity, the return of muscle tone. Psychological rehabilitation and adaptation of the patient is also important.
Why is a cerebral infarction dangerous? The consequences of a cerebral infarction in the absence of timely medical care can be very serious, including death. This disease ranks second in the structure of mortality after myocardial infarction and belongs to the category of diseases requiring long-term rehabilitation measures.
Video
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Anna Kozlova Medical journalist About the author
Education: Rostov State Medical University, specialty "General Medicine".
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