Cerebral Infarction

Cause

Cerebral infarction can occur when an artery in the brain gets clogged. This is called atherosclerosis. Fats accumulate on the inside of blood vessels. If a portion breaks off, it may block a blood vessel in the brain. Clogging of the artery takes time. There are progressively more and more deposits against the artery wall, which ultimately leads to the situation that no blood can pass through anymore. Then we speak of cerebral infarction.
It may also be that a blood clot goes through the heart to the brain and shuts off an artery there. Then the brain receives no more blood and oxygen. The clot can get stuck in the brain itself or in a vein that carries blood towards the brain. The main places where blood clots occur are the carotid arteries, the heart and the valves.

Symptoms

A cerebral infarction occurs rapidly and unexpectedly and can be identified by the following signs and symptoms:

• Paralysis in the face (e.g. crooked mouth).
• Confused speaking and thinking.
• Tinglings.
• Disturbance or loss of vision.
• Severe headache.
• Dizziness and balance disorders.
• Paralysis or numbness.

Diagnosis

The doctor can identify a cerebral infarction on the basis of physical examination and a description of what has happened. The doctor can usually determine on the basis of the neurological symptoms, which artery in the brain is blocked. The typical sound of blood swirls in the carotid artery (audible with a stethoscope) may indicate narrowing.
Making the exact diagnosis requires several examinations, including a CT or MRI scan of the brain, blood tests and possibly an ECG or an examination of the blood vessels in the neck.
First, a doctor must determine whether the patient has had a cerebral infarction or a cerebral hemorrhage. This is not visible from the outside. The symptoms are the same, but for treatment it is crucial to know.

Treatment

In case of a cerebral infarction, treatment must be started as quickly as possible. This treatment is called thrombolysis. The patient is given an infusion of clot-dissolving drugs. The sooner the patient receives thrombolysis, the less chance of permanent damage. Thrombolysis can reduce the damage, but it also has a major drawback: the risk of bleeding increases.
And with a cerebral hemorrhage, the bleeding should just be stopped. Therefore, thrombolysis may only worsen the situation in case of cerebral hemorrhage. Thrombolysis should start at least within 4.5 hours after the occurrence of the first failures. After 4.5 hours, the chance of recovery decreases rapidly. The risks of treatment (especially bleeding) do no longer outweight the benefits (proper recovery) then.
After cerebral infarction, the patient will also receive medication to lower blood pressure and cholesterol.

Prognosis

Approximately ten percent of the patients who have had cerebral infarction, recover almost completely and about twenty-five percent recovers largely. Approximately forty percent of the patients have moderate to severe disabilities, for which special care is needed and about ten percent should be cared for in a nursing home or other care facility. Some patients have both serious physical and mental impairment and cannot move, speak or eat normally anymore. Approximately fifteen percent of the patients with cerebral infarction dies in hospital. In the elderly, this percentage is higher.

Considerations

Once a person has had a cerebral infarction, he or she is at increased risk of getting it again. This risk can be reduced by taking the following measures:

• Quit smoking. Smoking is very bad for the arteries.
• Drink no more than one or two glasses of alcohol per day and preferably not every day.
• In case of overweight, try to lose weight or in any case try not to gain weight.
• Try to exercise at least half an hour per day. Every small exercise helps.
• In case of high blood pressure, take care for healthy living and take medications daily.
• In case of diabetes, ensure a proper control of the blood sugar.
• In case of high cholesterol, follow dietary advices and faithfully take medicines to lower the cholesterol.
• Eat healthy with lots of fresh vegetables and fruits.
• Stress increases the risk of cardiovascular problems. If thre’s a lot of stress, it's important to do something about it.

Facts

• The term ‘infarction’ is derived from the Latin word infarcere (putting in, filling up).
• The prevalence of cerebral infarction is 1%.
• Men are at higher risk of having cerebral infarction than women.
• The prevalence increases sharply with age. In people under 55 years, the disease is relatively rare.