### Date : 2024-06-08 12:00 ### Topic : Cerebral Infarction #neurology #medicine ---- ### Cerebral Infarction: An Overview **Cerebral infarction**, also known as ischemic stroke, occurs when blood flow to a part of the brain is interrupted or reduced, preventing brain tissue from getting the oxygen and nutrients it needs. Brain cells begin to die within minutes of the infarction. #### Pathophysiology Cerebral infarction is primarily caused by either: 1. **Thrombosis:** A blood clot forms in one of the arteries supplying the brain. 2. **Embolism:** A blood clot or other debris forms away from the brain—commonly in the heart—and is swept through the bloodstream to lodge in narrower brain arteries. 3. **Systemic hypoperfusion:** Reduced blood flow due to severe cardiac failure. 4. **Venous thrombosis:** Rare, but involves a clot in a vein. #### Risk Factors - Hypertension - Diabetes mellitus - Hyperlipidemia - Smoking - Atrial fibrillation - Obesity - Sedentary lifestyle - Previous stroke or transient ischemic attack (TIA) #### Symptoms Symptoms of cerebral infarction can vary depending on which part of the brain is affected but commonly include: - Sudden numbness or weakness in the face, arm, or leg, especially on one side of the body - Sudden confusion, trouble speaking, or understanding speech - Sudden trouble seeing in one or both eyes - Sudden trouble walking, dizziness, loss of balance, or lack of coordination - Sudden severe headache with no known cause #### Diagnosis Diagnosis is typically made through: 1. **Clinical Evaluation:** Assessment of symptoms and medical history. 2. **Imaging:** CT scan or MRI to identify the location and extent of brain injury. 3. **Blood Tests:** To check for risk factors like hyperlipidemia or diabetes. 4. **Electrocardiogram (ECG):** To identify atrial fibrillation or other cardiac issues. 5. **Echocardiogram:** To identify sources of emboli in the heart. #### Treatment Immediate treatment is crucial and may include: 1. **Thrombolytics:** Medications like tissue plasminogen activator (tPA) to dissolve clots, ideally administered within 3-4.5 hours of symptom onset. 2. **Antiplatelet Agents:** Aspirin or clopidogrel to prevent further clotting. 3. **Anticoagulants:** For patients with atrial fibrillation. 4. **Surgery:** Mechanical thrombectomy to remove a large clot. 5. **Supportive Care:** Management of blood pressure, blood glucose levels, and other supportive measures in a hospital setting. #### Prevention - Control high blood pressure. - Maintain a healthy diet. - Exercise regularly. - Avoid smoking. - Manage diabetes and heart conditions effectively. - Take medications as prescribed to manage risk factors. ### Patient Example **Patient:** Jee Hoon Ju, 68-year-old male **Presentation:** John presents to the emergency department with sudden onset of right-sided weakness and slurred speech. His wife notes that he was fine an hour ago and suddenly developed these symptoms while watching TV. **History:** - Hypertension for 10 years, poorly controlled - Type 2 diabetes mellitus - Smoker for 40 years, recently quit - Previous TIA 2 years ago **Examination:** - Blood pressure: 180/110 mmHg - Pulse: 90 bpm, irregularly irregular - Neurological exam: Right-sided hemiplegia, aphasia, facial droop on the right side **Investigations:** - CT head: Evidence of left middle cerebral artery territory infarction - ECG: Atrial fibrillation - Blood glucose: 250 mg/dL **Management:** - Intravenous tPA administered within the 3-hour window - Admission to stroke unit for monitoring and supportive care - Started on anticoagulation therapy for atrial fibrillation - Blood pressure control with antihypertensives - Blood glucose management with insulin **Follow-Up:** - John underwent rehabilitation for physical and speech therapy - His medications were adjusted for optimal control of hypertension, diabetes, and atrial fibrillation - Lifestyle modifications and cessation of smoking were reinforced **Outcome:** John showed gradual improvement over several weeks with significant reduction in his stroke symptoms, although some residual weakness and speech difficulties remained.