Cerebral infarction is a disease caused by various causes of cerebral blood vessel blockage, which leads to localized brain nerve cell necrosis, causing neurological dysfunction in the brain and clinical hemiplegia, aphasia, and slanting of the mouth and eyes, among many other symptoms. How to treat this disease?
When treating cerebral infarction, doctors mainly consider different periods of onset and different causes, as well as the severity of the disease, that is, the size of the infarct area and the infarct site, and take different treatment methods. Cerebral infarction varies greatly in severity due to different infarct sizes, different infarct sites, and different onset times, so the treatment methods for the same cerebral infarction vary greatly. The cerebral infarction we are talking about now refers mainly to the cerebral infarction based on cerebral atherosclerosis caused by various reasons.
The infarct area is small, the infarct site is not an important nerve center of the human body, and there are no obvious symptoms if the condition is mild, such as lacunar cerebral infarction with an infarct area of about 1 cm, and the patient usually has mild symptoms of dizziness or numbness of the limbs, and gets well soon with some medication, so no attention is paid to it, and when the MRI of the brain is done, it is already a thing of the past. Therefore, if the cause of cerebral infarction is determined in the outpatient examination, it is enough to take causal treatment; however, because the pathogenesis of cerebral infarction tends to develop gradually, we often see some patients with mild symptoms at the beginning, but the condition gradually worsens after a few days, therefore, if the MRI of the brain indicates the formation of new cerebral infarction, although the condition is mild, we should not take it lightly and it is better to be hospitalized.
However, some infarcts with large areas or sites in the brainstem, cerebellum, and ganglion areas of the brain can be serious and can result in severe neurological dysfunction or even life-threatening in some cases. Even after timely resuscitation, serious sequelae may remain, so immediate hospitalization is required.
The treatment of this disease is divided into several phases: the first ultra-early phase, the second acute phase, the third recovery phase, and the fourth sequelae recovery phase. The treatment with medication is different in different periods. Another problem is that there are various causes of cerebral infarction.
Therefore, the treatment methods adopted are different for different causes.
1.Ultra-early stage
It means that within 3-4.5 hours, the brain nerve cells are not completely dead from ischemia, not more than 3-4.5 hours, (if the onset of the disease is at night, counted from his sleep time) you can use the method of thrombolysis. The effect is better. Clinical evidence-based medical research shows that the only effective treatment for cerebral infarction is ultra-early thrombolysis, and other methods have not seen reliable efficacy. Because patients have little knowledge of cerebral infarction, treatment is often delayed, with the result that most of them miss the best time for treatment. Or the patient has many contraindications to the use of thrombolytic therapy. An effective way to accurately diagnose is early thrombosis is by doing head CT and MRI) of the brain to determine it. Intravenous thrombolysis with r-TPA and antiplatelet aspirin, cerebral protection with tartans and management of stroke units, and decompression of large cerebral infarcts with debridement are the five most effective approaches for cerebral infarcts; other approaches have not proven effective. Even patients with mild cerebral infarcts and those whose symptoms have resolved still require intravenous thrombolysis within three hours. Evidence-based medical studies have shown that interventional procedures are not more effective than drug therapy for arterial vascular and carotid stenosis in the brain. Therefore, patients with cerebral infarction should try to apply pharmacological treatment.
The symptoms of cerebral infarction vary according to the size of the infarct area and the infarct site, and the severity of the symptoms varies. There is no big difference in the treatment plan of Western medicine for various infarcts most of the time, except for some individual treatments that are different in the acute stage. Chinese medicine is relatively based on different stages of the disease, and different degrees of severity, as well as different symptoms of dialectical medicine, so Chinese medicine is more targeted than Western medicine, and the effect of improving symptoms is better. Therefore, this disease is mostly treated with a combination of Chinese and Western medicines.
2.Acute stage
In the acute stage of treatment, there is no special medicine available, and the recovery of limb function is slow, mainly relying on its own nerve function. The main purpose of treatment in this period is to prevent further expansion and reoccurrence of thrombus, eliminate the conditions for thrombus growth, and promote the melting of thrombus. To maximize the protection of brain cells that have not died due to the damage of brain nerve cells caused by ischemia. We also use brain protection drugs to prevent the damage of free radicals and other chemicals that can poison brain cells after the blocked blood vessels are reopened due to ischemia. Then, we prevent complications such as heart, brain and kidney diseases. Basically, the medication is to reduce blood clotting, use anti-thrombotic and anti-platelet drugs, brain cell nutrients, and brain cell protection agents to remove substances that are toxic to brain cells. Patients who are severely bedridden should be turned regularly and their backs should be fastened to prevent bedsores, and adequate nutrition with low salt and high protein and vitamins should be given. Also, appropriate Chinese medicine to activate blood circulation and improve cerebral circulation should be used to reduce blood viscosity. In addition, according to the size of the infarct, some drugs for symptomatic treatment, such as dehydration drugs, drugs for the treatment of impaired consciousness, etc., should be used for specific cases.
In the acute stage, it is important not to lower the blood pressure too fast, because the increase of blood pressure is often due to the self-protective reaction after the brain nerve cells do not get sufficient blood supply. Therefore, as long as the blood pressure is not particularly high, it is not recommended to lower the blood pressure. If the blood pressure is not too high, but now the blood pressure has increased too much, it can be lowered by about 20mmHg, at most 15% of the original blood pressure.
High blood pressure can help maintain adequate blood supply to the brain, which is often seen clinically as a result of ischemia in the brain due to lower blood pressure, leading to the aggravation of cerebral infarction. In addition, we should treat the causes of cerebral infarction for the right reasons. Lowering blood pressure, lowering blood sugar and lowering blood lipids should always be used throughout the disease in the future, and long-term application can completely control the development of the disease and prevent recurrence. It should be noted that in this acute period, although the patient’s limb function has not recovered. However, it is also necessary to move the limbs passively and perform massage. It can prevent muscle atrophy leading to difficult recovery of limb function in the future.
3.Recovery period
After two to three weeks of treatment, the patient enters the recovery period. It is a relatively heavy cerebral infarction, hemiplegia, aphasia, limb tremors, or restlessness and other neurological functions also began to have some recovery, and with the continuation of time, the recovery of language, swallowing difficulties, choking on water, and limb functions gradually accelerated. During this period, the patient can do physical function rehabilitation training, not to walk more. Rather, it is necessary to start to set the posture, movement, strength training, mainly for the balance of standing and basic muscle strength recovery training. This will prevent the recovery of deformities of the limbs in the future. During this period, the blood pressure can be gradually lowered to 150/90mmHg, or to normal if tolerated. If you have hemiplegia, you can treat it with Chinese herbal medicine, acupuncture, and rehabilitation training.
Many patients, their families and even some doctors only pay attention to medication, thinking that hemiplegia can be cured with medication. Without rehabilitation training and limb function exercise, the hemiplegic limb will not return to function without the best medicine. In a sense, the hemiplegic limb can be restored to normal without medication and only exercise. Pay attention to the comprehensive investigation of the causes of cerebral infarction to prevent recurrence. This is because after the death of brain nerve cells, they cannot be regenerated, and even if there is regeneration, it is very difficult. The recovery of limb dysfunction such as hemiplegia caused by nerve cell necrosis relies on the normal nerve cells around the cerebral infarction that have not died to establish new nerve connections to replace the functions of the dead nerve cells. And this suggested new connection between nerve cells all depends on the exercise of limb function to stimulate the newborn nerve cell fibers, without the stimulation of exercise, the best medicine will not produce new nerve function.
Due to the different parts of the brain infarction, patients show different symptoms. Cerebellar infarction is dominated by dizziness, nausea and vomiting, while fever, memory loss, emotional abnormalities and other sensory disorders such as pain, chills, fever and other abnormal sensations occur in the thalamus. Infarction of the optic nucleus can cause visual impairment. Brainstem infarction is a coma, and after treatment and waking up, there is also a loss of balance in the body, which is manifested by strong limbs, but cannot stand and walk alone. Damage to the linguopharyngeal nucleus can lead to swallowing and dysarthria. Occipital lobe infarction can lead to visual impairment and many other different manifestations, and there is no fundamental difference in Western medicine treatment. Chinese medicine can be targeted to improve these symptoms with good results depending on the different conditions.
It should be noted that one of the most difficult problems in clinical treatment of patients with severe cerebral infarction is lung infection. It can occur no matter in the acute phase or in the post-acute phase, and it is recurrent, manifested as fever, sputum and cough, which seriously affects the patient’s rehabilitation treatment. For these cases, the main thing is to turn and buckle the back regularly, and to make the patient sit up into the recovery period. If the patient cannot sit on his own, make a brace to give assistance to keep the patient seated. One should not lie flat in bed for a long time. For such chronic lung infection, the effect of Chinese medicine is better than the effect of western medicine.
4. Sequelae recovery period.
Rehabilitation of the sequelae period and secondary prevention of recurrence. The relatively light limb dysfunction can basically return to normal after a few months of treatment. Those that cannot return to normal enter the sequelae period after six months. The recovery of limb function is relatively slow. Some of them may have seizure convulsions caused by cerebrovascular disease. Some of them may have sequelae such as mania or psychotic symptoms due to cerebrovascular disease, and mental disorders, which can be treated with traditional Chinese medicine.
The medication in this period is mainly cause-specific treatment, a comprehensive analysis of what causes cerebral infarction? -The treatment should be carried out accordingly. The common causes of cerebral infarction are to control the thrombosis caused by the detachment of atherosclerotic plates, to treat hypertension, diabetes, hyperlipidemia and homocysteinemia, and to prevent the further development of atherosclerosis; and to eliminate the causes of relatively low incidence, such as thrombosis caused by rheumatic heart disease, atrial fibrillation, etc., thrombosis caused by the veins of the lower limbs and a few blood diseases, to prevent recurrence. If the triggering causes of cerebrovascular disease are not well controlled, this disease will recur and become more serious one time.
In some patients, angiography of the brain can reveal severe localized cerebral artery stenosis, and surgical stenting can be considered to expand the narrowed cerebral vessels. However, even if a stent is placed for severe hemiplegia, it will not immediately improve the hemiplegia. After the stent is placed, it is still necessary to continue to take medication to treat the hemiplegia and to continue to treat the cause of the hemiplegia with Chinese and Western medicine for the cause of cerebral arteriosclerosis, otherwise there is a possibility of restenosis after a few years.
The recovery of hemiplegia, unfavorable language, and other neurological dysfunctions are acquired later in life, so the recovery of functions is mainly obtained through the stimulation of limb function rehabilitation training to promote the reconstruction of brain nerve cell structure and function. This kind of recovery cannot be replaced by drugs, but only by the patient’s physical exercise. Just like a person who does not know how to ride a bicycle can only learn how to ride a bicycle by practicing on his own, you cannot pump substances from the blood of a bicyclist into a person who does not know how to ride a bicycle and imagine that you can learn without learning by using certain drugs. As long as you go to a rehabilitation hospital and under the guidance of a rehabilitation physician, you will be able to recover the function of your limbs through systematic and regular rehabilitation training. Therefore, we should have confidence that most of the hemiplegic patients can recover their limb functions without serious sequelae as long as the correct rehabilitation training is carried out. The human nervous system has a strong ability to repair itself.
It should be especially noted that acupuncture and Chinese medicine are very effective in the treatment of cerebral infarction. Especially for hemiplegia, dysphonia, dysphagia, choking and coughing, emotional abnormalities, even convulsions, tremors, as well as lung infections that do not heal for a long time, phlegm and fever have a very good effect. The symptoms are targeted to improve the effect. Early acupuncture, tonics, with the right patient will greatly shorten the course of the disease, can significantly improve the patient after the cerebral infarction a variety of uncomfortable symptoms, improve the quality of recovery. Combined with Chinese medicine can promote the recovery of limb function.
The cause of recurrence of cerebral infarction is the further development of atherosclerosis, which is caused by more than 200 factors. And nowadays, thirty percent of patients still have recurrence under standard treatment with Western medicine, so it is difficult to completely prevent infarction recurrence with Western medicine alone. At the same time, traditional Chinese medicine can improve cerebral blood supply and reduce atherosclerosis. Long-term application can reduce the degree of atherosclerosis and control the factors that lead to the recurrence of cerebrovascular disease, which can effectively reduce the recurrence rate of cerebrovascular disease. Moreover, Chinese medicine has less toxic side effects, and some of them are almost no side effects, which is especially suitable for long-term medication of cerebrovascular patients. Therefore, in the treatment of cerebrovascular disease, most patients choose Chinese medicine, both proprietary Chinese medicine and tonics.