Cerebral infarction

Cerebral infarction, also known as ischemic stroke, occurs when the blood vessels that supply the brain are disturbed so that blood flow is interrupted. There are two common types of ischemic stroke: atherothrombotic, and embolic, as well as other less common causes. The cause of an ischemic stroke cannot be determined in approximately 40% of cases. Infarction is a medical term which describes the necrosis that occurs when blood supply to tissues is interrupted. Blood supply can be interrupted in a number of ways, such as blockage of a supplying artery, mechanical compression of an artery by a tumor or hernia, or rupture of an artery due to trauma. Brain infarction is often associated with atherosclerosis or high blood pressure. Cerebral infarction occurs when the blood supply to the brain is interrupted. Within minutes, a series of reactions known as the ischemic cascade begins, and can continue for several hours, and may even last for days. The brain is still vulnerable even when the blood supply is restored, due to the possibility of reperfusion injury.

During the ischemic cascade oxygen deprivation leads to the absence of ATP in the brains tissues. ATP proton pumps fail, allowing a massive influx of calcium ions into cells. This results in the generation of reactive oxygen species, free radicals, and other harmful chemicals. Eventually cells begin to die, some via necrosis, which triggers an inflammatory response which can itself cause further damage to brain tissue. The ischemic cascade can occur in any type of tissue, but the brain is considered most vulnerable due to its complete dependence on aerobic metabolism. Cerebral infarction can occur for several different reasons. The formation of a thrombosis, or blood clot, in an artery or blood vessel that feeds the brain can result in an interrupted blood supply. Embolism, in which a portion of thrombosis breaks off and causes a blockage, is another common cause infarction. Cerebral venous sinus thrombosis, in which blood vessels that drain the brain become blocked, may result in cerebral infarction as blood fails to recirculate in the body. Symptoms of cerebral infarction are fairly distinctive. Interruption of the blood supply to the brain can cause muscle weakness in the face and other parts of the body, tingling or numbness, inability to speak or understand speech, confusion, and memory disturbances. Diagnosis is usually made on the basis of symptom evaluation and neurological exams, as well as medical imaging tests such as CT or MRI. Treatment of ischemic stroke may involve breaking down or removing a thrombosis or embolus, and administering medication to prevent further clots. A large portion of braininfarction treatment is supportive in nature, as many people suffer brain tissue damage that requires rehabilitative therapy. Some people find they must relearn how to walk, talk, and carry out other everyday activities, while others may have to adjust to the permanent loss of such abilities.

Types

The different types of strokes are ischemic, hemorrhagic and a transient ischemic attacks. An ischemic stroke is the most common type of stroke and occurs due to a severely reduced blood flow caused by a blood clot or clogged artery. A hemorrhagic stroke is the result of a ruptured or leaking blood vessel in the brain. This type of stroke is caused by uncontrolled high blood pressure and aneurysms. A transient ischemic attack, also called a ministroke or TIA, is a temporary reduction in blood flow to the brain and lasts only a few minutes.

Risks

Risk factors of a stroke include being 55 years of age or older, high blood pressure, high levels of cholesterol or homocysteine, cigarette smoking, diabetes, obesity, cardiovascular disease, personal or family history of a stroke or TIA, use of birth control or other hormone therapy, heavy alcohol use and the use of illicit drugs. According to the Mayo Clinic, women die of strokes more often than men and African Americans are more likely than other races to have a stroke.

Signs and Symptoms

Signs and symptoms of a cerebral infarction include dizziness, loss of balance, loss of coordination, slurred speech, paralysis or numbness on one side of the body, blurred or double vision and a sudden, severe headache. Additional symptoms of a stroke include an unusual headache that can be accompanied by a stiff neck, pain between the eyes, facial pain, vomiting or unconsciousness. A TIA, which lasts for several minutes to 24 hours, is a potential sign of an impending stroke, but usually a stroke gives no warning.

Physical Examination

A diagnosis of a cerebral infarction is based on risk factors, a physical examination to test your mental and physical status, a blood pressure check and questions related to the presence and duration of symptoms. Your physician may perform blood tests to check the levels of a complete blood count, cholesterol and homocysteine.

Imaging Tests

Your physician may order imaging tests to diagnose a stroke. Imaging tests allow your physician to see your internal body structures. Imaging tests used to diagnose a stroke include a carotid ultrasound to show any narrowing in the carotid arteries, arteriography to produce X-ray images of the arteries, a computerized tomographic (CT) angiography, which provides a 3-D image of the blood vessels in the brain and neck, magnetic resonance imaging (MRI), which gives a 3-D view of the brain and an echocardiography, which produces images of your heart. Not all tests are indicated for every person. Your physician will determine the best test or a combination of tests for your situation.