Cerebral infarction, cerebral ischemia or ischemic stroke is the most common form of stroke. It results from ischemia – a sudden reduction in blood flow to the brain – which can cause nerve and brain cells to die.
What is a cerebral infarction?
The term cerebral infarction is used primarily when it refers to an ischemic stroke. In this case, decreased blood flow to the brain occurs, resulting in a decreased supply of glucose and oxygen to the organ. In medicine, such a loss of blood flow is called ischemia. Closures or constrictions of the arteries supplying the brain are responsible for the reduced 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. Medical science classifies cerebral infarction as an urgent emergency. In industrialized countries, ischemic stroke is one of the leading causes of death. People older than 70 are particularly affected. Men have a significantly higher incidence of cerebral stroke than women.
Causes
In most cases, a cerebral infarction is caused by arteriosclerosis, also called hardening of the arteries. This occurs in most people due to high blood pressure (hypertension), diabetes mellitus (diabetes) or the use of tobacco. The main reason for the occlusion of blood vessels is arteriosclerosis. Over time, plaques accumulate on the inner walls of the blood vessels. This refers to deposits of fat and cells. The larger the size of the plaques, the more the affected blood vessel narrows. People who suffer from diabetes, high cholesterol levels or high blood pressure are considered particularly susceptible to the formation of plaques. If an artery becomes increasingly narrowed by the plaques, not enough oxygen-rich blood can reach the tissue. There is also a risk of the plaques tearing. This tear can lead to the formation of a thrombus (blood clot). As a result, there is even a risk of complete occlusion of the vessel. 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 cerebral infarction is an embolism. The resulting embolus is free to move and able to follow the body’s bloodstream. In the worst case, it clogs a blood vessel of the brain and causes a stroke. Inflamed brain vessels, malformations of the heart or cardiac arrhythmias are usually responsible for an embolism. Risk factors for cerebral infarction include disorders of lipid metabolism, lack of exercise, alcoholism, and smoking, in addition to advanced age.
Symptoms, complaints, and signs
Typical of an ischemic stroke is the abrupt onset of various symptoms. In this case, the affected persons suffer from a clouding of consciousness. This can manifest as fatigue, loss of consciousness, and even a deep coma. Other possible symptoms include headaches, spinning dizziness, perception of double images, nausea, vomiting, swallowing and speech disorders, visual field defects, hemiplegia or paralyzed individual limbs, and memory loss. Neuropsychological deficits such as apraxia, attention deficits and cognitive dysphasia also occur. The actual symptoms depend on the affected vessel or brain area. Furthermore, different symptoms exist in men and women.
Diagnosis and disease course
If the patient shows early warning signs, such as temporary insensations, brief signs of paralysis, speech disorders or memory problems, it is important to consult a physician immediately. The physician first takes a detailed look at the patient’s medical history, which is followed by a neurological examination. Diagnostic imaging procedures such as computer tomography (CT) or magnetic resonance imaging (MRI) play an important role. Their use allows a rapid distinction to be made between a cerebral infarction and a cerebral hemorrhage, which is important for further treatment. Other possible examination methods include angiography, Doppler sonography, an EEG to check brain waves, an ECG to diagnose cardiac arrhythmias, and a lumbar puncture to check the cerebrospinal fluid (CSF).The course of a cerebral infarction depends on which brain region has been damaged and to what extent. Early therapy is extremely important for a favorable prognosis. While some patients suffer only mild effects, others require permanent care and are bedridden. It is not uncommon for chronic damage such as visual disturbances, speech disorders or paralysis to be present. In the worst case, the patient dies from the stroke.
Complications
Even with rapid and professional treatment of a cerebral infarction, there is a risk that complications will occur. These can further worsen the consequences of the stroke. Increased intracranial pressure is considered a feared complication. It is triggered by accumulations of water or hemorrhages in the brain. In addition, there is a risk of epileptic seizure or thrombosis (blood clot) due to the stroke. When complications occur, the location of the brain where the cerebral infarction occurs plays a major role. For example, a larger infarct in certain areas can sometimes cause only mild symptoms, while a smaller infarct in other regions of the brain can result in the most severe disabilities. In principle, however, serious consequences must be expected in the event of a cerebral infarction. The course of the disease in the first weeks after the stroke must also be taken into account. Typical sequelae of cerebral infarction include permanent paralysis, problems with swallowing associated with a risk of aspiration, and pneumonia. Aspiration is the flow of vomit, saliva or food into the airway, which in turn causes pneumonia. Numerous complications following a cerebral infarction result from subsequent bed rest. These include pressure ulcers (bedsores), which occur along with sensory disturbances. Due to the restricted activity of the urinary bladder and kidneys, there is a risk of urinary tract infections. Improper positioning of the patient can also cause joint stiffness.
When should you see a doctor?
Cerebral infarction is a medical emergency. The affected person loses control of various functional systems of the organism without a warning and is often unresponsive. In the event of a loss of consciousness, intensive medical treatment must be provided as quickly as possible. Since sudden demise of the affected person is imminent, immediate response is required. Every minute until medical care is provided decides on the life of the affected person as well as possible consequential damage. Therefore, an ambulance service is needed and until its arrival, first aid measures are to be taken. An emergency physician should be contacted at the first unexpected signs. If the affected person reports a sudden feeling of malaise, weakness or seeing double images, there is cause for concern. If nausea, vomiting, dizziness or speech disturbances occur, a physician is needed. If concentration, orientation, or attention problems occur, emergency medical care must be provided. If there are motor problems or signs of paralysis, the affected person needs immediate help. If there is a loss of memory, acute fatigue, unsteadiness of gait, or discomfort in one half of the body, a doctor’s visit is necessary. If the affected person falls into a comatose state, an emergency physician should be called. If there are signs of confusion, difficulty swallowing or failure of the visual field, medical attention is needed as soon as possible. Observers of what is happening must ensure the victim is ventilated.
Treatment and therapy
Immediate treatment is required for a cerebral infarction. This should take place in the hospital in a so-called stroke unit. There, the sufferer receives optimal diagnostics and therapy. In addition, he is monitored intensively. Body temperature, pulse, blood pressure, respiration and blood sugar are monitored. Furthermore, several medical disciplines such as neurology, neurosurgery, radiology and internal medicine work closely together. One possible treatment option for a cerebral infarction is lysis therapy, which is designed to dissolve the blood clot. In an early stage of ischemic stroke, blood-thinning drugs can also be administered. These primarily include acetylsalicylic acid (ASA). However, this must not be taken during lysis therapy.Adequate saturation of the blood with oxygen and thrombosis prophylaxis are also important.
Outlook and prognosis
The timing of initial medical care and the location and size of the cerebral infarction are critical to establishing a prognosis. In most cases, the later the affected person receives intensive medical care and treatment, the worse the chances of recovery. At the same time, the location of the damage in the human brain is relevant for a good prognosis. With very rapid care as well as good subsequent rehabilitation, there is a good chance of recovery. At present, however, every second patient of a cerebral infarction remains disabled, severely disabled or in need of care for the rest of his life. The extent of damage to the brain must be assessed and classified on an individual basis. If areas of the brain tissue are affected that regulate important functions of the organism, such as locomotion, thinking or speaking, impairments are to be expected that have lifelong effects on the state of health. Improvements in symptoms are possible, but recovery is unlikely. In addition to the physical changes, secondary symptoms often occur with a cerebral infarction. For example, psychological sequelae are to be expected due to the mental stress caused by the changed living conditions. These usually worsen the healing process, lead to delays or can almost completely prevent recovery. If the patient has good mental strength and motivation, many physical improvements can be achieved. However, if paralysis occurs, it is permanent and irreparable.
Prevention
To prevent cerebral infarction from occurring in the first place, risk factors for arteriosclerosis should be reduced. These include regular control of blood pressure and blood sugar, and a lifestyle that includes a diet low in fat and sugar and sufficient exercise. In addition, tobacco use should be avoided because it significantly increases the risk of cerebral infarction.
Follow-up
A cerebral infarction often results in speech and perception disorders or even paralysis remaining. In follow-up care, it is therefore important to start rehabilitation measures as early as possible. Especially the recognition and treatment of swallowing difficulties should be done as early as possible. In this way, long-term damage can be minimized. Studies show that the first three months after a cerebral infarction are crucial for brain regeneration. Unfortunately, it is part of the clinical picture that those affected can suffer further strokes after the acute treatment of the cerebral infarction. Therefore, experts advise seeking inpatient rehab. Reduced brain performance is difficult to diagnose in outpatient rehab. It may involve various symptoms, such as the disturbance of perception, memory or short-term memory. It is difficult to make a general statement about the correct aftercare for a cerebral infarction. It requires an exact investigation of the causes in order to follow up with the optimal aftercare. However, it is precisely the control and reduction of risk factors that should be taken into account in follow-up care. Smoking, obesity and a generally unhealthy lifestyle massively increase the risk of another cerebral infarction. Sufficient exercise, a healthy diet, and low levels of alcohol and tobacco products can ensure that another cerebral infarction does not recur, even at an advanced age.
Here’s what you can do yourself
Cerebral infarction is also called a stroke, in which every minute counts in order to be recognized as such. If this is successfully treated as soon as possible, follow-up care will be unavoidable. The longer the diagnosis has been postponed, the more damage can be caused to the sufferer. In the case of consequential damage caused by the disease, such as paralysis on one side or speech difficulties, the affected person must take expert rehabilitation measures. These should be done by a specialist in his or her 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 for the patient to make a complete recovery. To avoid a subsequent cerebral infarction, the patient will need to make lifestyle changes, stop smoking and excessive alcohol consumption, and may need to change their diet to a healthy one.If another incident does occur, it is important to take immediate action. These are to be brought immediately to the hospital or to call the emergency service, to which already on the phone is described that a cerebral infarction has already preceded. The signs are unilateral disability of movement, difficulty in speaking, impaired vision, which can be recognized.
