Hello! We sympathize with you for your unfortunate brain infarction. During your hospitalization, your doctor will systematically evaluate your condition and develop the best treatment plan and post-discharge rehabilitation guidance according to your individual situation. We hope you and your relatives will read it carefully to understand your condition and our treatment plan.
I. Introduction to cerebral infarction Wang Lixin, Department of Brain Diseases, Guangdong Provincial Hospital of Traditional Chinese Medicine
Cerebral infarction accounts for about two-thirds of cerebrovascular diseases. It is caused by the sudden reduction or cessation of blood flow in the local blood supply artery of brain tissue, resulting in ischemia and hypoxia of brain tissue in the blood supply area of the vessel, leading to necrosis and softening of brain tissue, and thus the corresponding clinical symptoms and signs, such as hemiparesis, hemianesthesia, aphasia and other symptoms. Cerebral infarction is usually found in people aged 50 to 60 years or older, who often have atherosclerosis, hypertension, wind heart disease, coronary heart disease or diabetes, as well as bad habits such as smoking and alcohol consumption. The onset of the disease is generally slow, and patients tend to start in quietness and sleep, and most patients’ symptoms reach their peak after a few hours or even 1 to 3 days. Most patients are conscious after the onset of cerebral infarction, and a few may have varying degrees of impaired consciousness, with no significant changes in general vital signs. However, if the cerebral hemispheres have large infarcts, ischemia and edema, the function of the mesencephalon and brainstem can be affected, and soon after the onset of the disease, there will be impaired consciousness or even brain herniation and death.
II. Changes in the condition of cerebral infarction.
Medically, cerebral infarction is divided into acute phase (within 2 weeks of onset), recovery phase (2 weeks-6 months), and sequelae phase (more than 6 months) according to the duration of symptoms. You are now in the acute phase of cerebral infarction, and the following three conditions may occur in your condition. 1. Symptoms continue to worsen, which is medically referred to as progressive cerebral infarction, accounting for about 26% to 43% of all cerebral infarctions in the acute phase. This is the result of the natural development of the disease. 2. Stable disease: the symptoms do not change significantly after admission to the hospital despite the treatment. 3. Improvement: one third of the patients with acute cerebral infarction improve quickly after treatment during admission. These three changes are related to each person’s cerebrovascular stenosis and collateral circulation compensation, underlying disease and physical condition, and we hope your symptoms will improve as soon as possible.
III. Need for cerebrovascular evaluation
After your admission, we will perform the following examinations in order to clarify the site and size of your cerebral infarction, the degree of cerebrovascular stenosis, the compensation of side branches, the risk factors of cerebral infarction, other causes of cerebrovascular stenosis, and the condition of its related complications, so as to provide a basis for the prognosis and treatment of your condition. We will conduct the following examinations: 1. Comprehensive physical examination, neurological examination and score, cerebrovascular examination: By asking medical history, present symptoms and signs, and auscultation and palpation of each vascular distribution area, we can generally understand the cause of your disease, the location of the lesion, and the severity of your condition. 2.Cranial CT: It can distinguish cerebral infarction from cerebral hemorrhage, the treatment of these two diseases is completely different, you may have completed this examination at the time of admission, which is necessary; 3.Cranial MRI examination: For patients with cerebral infarction within 6-12 hours of onset, cranial CT may not find the infarction foci, nor can it see the blood vessels in the brain. 4.Transcranial ultrasound Doppler (TCD), carotid artery and vertebral artery ultrasound: TCD can show the blood flow velocity, vascular elasticity, and blood flow direction of intracranial vessels, and indirectly reflect intracranial vascular stenosis and blood flow compensation; carotid artery and vertebral artery ultrasound can clearly see the extracranial vessels (bilateral The carotid artery and vertebral artery ultrasound can clearly see whether there are atherosclerotic plaques and stenosis in the extracranial vessels (bilateral vertebral artery and internal carotid artery). This combined with the cranial MRA results will give us a general assessment of your cerebrovascular condition.5. Cerebral angiography (DSA): This is the most accurate and internationally recognized test to assess cerebrovascular stenosis and compensation. Other tests: various blood and stool tests, liver and kidney functions, blood lipids, blood glucose, coagulation function, electrocardiogram, cardiac ultrasound, etc. On the one hand, to clarify whether you have other diseases other than neurological system, how serious they are and whether they need treatment. On the other hand, to fully evaluate the cause of your cerebral infarction and the risk of another stroke. At the same time, it can guide the doctor to use medication and try to avoid the side effects of medication for cerebral infarction.
IV. Treatment goals
Brain tissue is different from other tissues in human body, it cannot be regenerated after necrosis. Therefore, within 4.5 hours of your initial onset, the treatment goal is to open the blood vessels through arterial and intravenous thrombolysis as soon as possible, and the blocked blood vessels may be reopened in about 40-80% of patients, and the symptoms will improve quickly or even recover completely. If the 4.5 hour golden time is exceeded, the existing treatment goal is to improve your symptoms and prevent the progression of the disease and the recurrence of the stroke, and there is no specific medicine that can completely restore your symptoms to normal. However, you should be aware that active neurorehabilitation within 3 months of the onset of the stroke will maximize the recovery of your neurological deficits, and that any treatment beyond 6 months will have very limited effect.
V. Treatment plan
According to the international and domestic guidelines for the prevention and treatment of cerebrovascular diseases, our department has developed a clinical pathway for the treatment of acute cerebral infarction with Chinese and Western medicine, which mainly includes anti-vascular platelet aggregation, lipid lowering and plaque stabilization, control of blood pressure, blood sugar and various stroke risk factors, together with Chinese medicine acupuncture, proprietary Chinese medicine, tonics, acupuncture and rehabilitation, and if necessary, you can undergo intracranial and extracranial stenosis surgery at an optional stage. If necessary, we can provide comprehensive treatment and rehabilitation through stenting surgery.
Post-discharge rehabilitation and recuperation
As mentioned above, there is no special medicine that can completely improve your symptoms, and active rehabilitation within 3 months is the most important treatment for neurological function recovery. The risk of cerebral infarction can be reduced.