Overview of Cerebral Infarction
Multiple cerebral infarction is defined as more than 2 foci of cerebral infarction. Cerebral infarction is an ischemic cerebrovascular disease, which mainly includes cerebral artery occlusive cerebral infarction, lacunar cerebral infarction and cerebral embolism.
Causes
The etiology of multiple cerebral infarction is mainly atherosclerosis, and hypertension is a promoter of atherosclerosis. Long-term persistent hypertension causes hemodynamic changes, endothelial damage, lipid deposition under the endothelium, promoting the formation of lipid plaques, narrowing the blood vessels, causing ischemic cerebrovascular disease. It is also partly caused by the entry of emboli from different sources into the intracranial arterial system leading to vascular occlusion.
Symptoms
The clinical manifestations vary depending on the location and size of the infarction. Focal localizing signs of cerebral infarction such as central facial paralysis, hemiparesis, hemiparesis, hemiparetic sensory deficits, increased dystonia, pyramidal fasciculations, pseudo medullary palsy, hyperalgesia, and urinary and fecal incontinence. The common symptoms are as follows:
1. Limb paralysis
There is a close relationship between the location of the infarct and limb paralysis. A large infarct does not produce obvious limb paralysis, while a small infarct in a motor area can cause severe limb weakness.
2. Aphasia
Aphasia may be present in some patients.
3. Mental retardation
Mental activity disorders are directly related to the location and volume of brain tissue damaged by vascular lesions. Cognitive dysfunction is characterized by loss of near-memory and computational ability, apathy, anxiety, dysphasia, and depression.
Examination
The examination mainly includes imaging examination and rehabilitation evaluation:
1. Imaging examination
(1) Cranial CT CT scan is a more convenient and cheaper examination for diagnosing cerebral infarction. It can clarify the location and size of necrosis of brain tissue (i.e. cerebral infarction), the degree of cerebral edema, etc. It is of guiding significance to the treatment, but foci can not be detected within 24 hours of the onset of the disease. However, CT is often unable to detect the lesions within 24 hours of the onset of the disease. In addition, the shortcomings of CT lie in the poor display of lesions in the brainstem and cerebellum.
(2) Cranial magnetic resonance scanning This examination can make up for the defects that CT cannot detect lesions within 24 hours and does not show lesions in certain parts of the brain, especially magnetic resonance angiography can show large occluded blood vessels. Its shortcoming is that it is more expensive, and some patients can not carry out this examination due to the metal objects that can not be removed from the body, such as cardiac pacemaker, metal teeth, fracture nails, etc., which limits its use.
(3) Cerebral angiography The examination can find the site of vascular stenosis and occlusion, and in the early stage (within 6 hours of the onset of the disease), thrombolytic drugs can be injected directly into the stenosis or occlusion to carry out thrombolysis, but the disadvantage is that there are certain injuries and complications.
2.Rehabilitation assessment
Muscle strength, muscle tone, balance function, daily life ability assessment, Brillouin staging, speech function assessment, psychological function assessment, etc.
Diagnosis
Diagnosis can be made on the basis of medical history, clinical manifestations and relevant examinations.
Treatment
1. Drug treatment
Principles of drug treatment in acute stage.
(1) Ultra-early treatment Firstly, the public should be made aware of the importance and necessity of ultra-early treatment of cerebral infarction in order to raise the public’s awareness of the emergency and first aid of cerebral infarction. Consult the doctor immediately after the onset of the disease, if there is no contraindication, strive to thrombolytic therapy within 3-4.5 hours of treatment time window, and reduce cerebral metabolism to control cerebral edema and protect cerebral cells, to save the ischemic hemidiaphragm;
(2) Individualized treatment Adopt the most appropriate treatment according to the patient’s age, degree of condition and underlying disease;
(3) Prevention and treatment of complications such as infection, cerebro-cardiac syndrome, hypothalamic injury, post-infarction anxiety or depression, abnormal secretion of antidiuretic hormone syndrome and multi-organ failure;
(4) Holistic treatment: supportive therapy, symptomatic treatment and early rehabilitation; timely preventive intervention against risk factors of the disease such as hypertension, diabetes and heart disease to reduce recurrence rate and disability rate.
2.Surgical treatment
In case of large cerebral infarction with serious cerebral edema and signs of cerebral hernia, craniotomy and decompression surgery are feasible; in case of cerebellar infarction, patients whose condition deteriorates due to brain stem pressure can be saved by suction of infarcted cerebellar tissues and decompression surgery of posterior cranial fossa.
3.Rehabilitation treatment
It should be carried out at an early stage and follow the principle of individualization to formulate short-term and long-term treatment plans, select treatment methods in stages and according to local conditions, and provide patients with targeted physical fitness and skill training to reduce the rate of disability, promote the recovery of neurological function, improve the quality of life and reintegrate into the society.