Prevention and treatment of lacunar cerebral infarction

  Lacunar cerebral infarction (referred to as lacunar infarction), which is very common clinically, is actually a kind of cerebral infarction, named because of its small infarct area (generally less than 2-5 mm in diameter), and a few cases with a diameter of 10-20 mm are called large lacunar infarcts. It is believed to be a small cavity (hole) formed by the sclerosis and blockage of small terminal arteries in the brain due to hypertension, or arterial embolism caused by atherosclerotic soft plaques in the carotid artery, causing punctate ischemia, necrosis and liquefaction of deep brain tissue, i.e. some small lesions seen on CT or MRI films.  The lesions are usually multiple and occur in middle-aged and elderly people over 40 years of age, with a higher incidence of hypertension, diabetes mellitus, hyperlipidemia, hyperviscosity, hyperhomogeneous hemoglobinemia, hyperuricemia, obesity, smoking, alcoholism and salty food.  Because the brain tissue damaged by cerebral cavernous infarction is small or very small, the clinical symptoms are often mild, usually manifesting as mild limb weakness or numbness, dizziness, headache, unstable walking, memory loss, and in severe cases, symptoms such as inability to bite words, difficulty in swallowing or seeing things in pairs, or no symptoms at all, which are not easily alerted by patients and doctors. Many patients are only discovered during CT or MRI examinations of the head for other reasons.  Patients should overcome two misconceptions about cavernous infarction: one is the extreme fear and nervousness about cavernous infarction, thinking that they are suffering from a very serious disease and are under great pressure and tension. In fact, cerebral cavernous infarction is less dangerous than cerebral hemorrhage and larger cerebral infarction, and the prognosis is generally good, and most of them can be improved or cured within one to several weeks after treatment, and even resume normal work, study and life.  Secondly, because the symptoms are mild or even asymptomatic, they are easily taken lightly, indifferent, paralyzed and do not go for treatment. After the fusion of cerebral cavity infarcts and multiple small lesions occur many times in such patients, they may develop into multiple and larger cerebral cavity infarcts, resulting in gradual aggravation or development of severe cerebral infarction, causing clinical symptoms such as persistent limb numbness or paralysis, swallowing or speech disorders, and even intellectual decline and Vascular dementia and other serious consequences. Repeated small infarcts can be a big problem and a big problem.  Patients should actively and regularly undergo brain CT or MRI review to understand the development of cerebral cavernous infarction and facilitate timely adjustment of the prevention and treatment plan; at the same time, blood pressure, blood lipids, blood glucose, homocysteine, uric acid, blood rheology and platelet count should also be tested regularly for the above-mentioned pathogenic risk factors to improve the prevention effect.  The treatment principle is the same as other ischemic cerebrovascular diseases, mainly taking measures to lower blood pressure, blood lipids, homocysteine, uric acid, blood viscosity and platelet aggregation drugs for etiological treatment, continuously improving blood circulation in ischemic brain tissues and promoting neurological function recovery. Anticoagulation and thrombolytic drugs should not be used (especially in elderly people with hypertension) because of the risk of focal hemorrhage in the cerebral cavity.  In life, we should maintain a good mental balance and a healthy lifestyle, pay attention to the combination of work and rest, avoid smoking, alcohol and obesity, and adhere to a low-salt and low-fat diet, which are all important measures to actively prevent and control the development of the disease.