Recognition and Treatment of Cerebral Infarction

A. What is Cerebral Infarction?

Cerebral infarction (CI), also known as ischemic stroke, refers to the softening and necrosis of localized brain tissue due to impaired blood circulation, resulting in ischemia and hypoxia.

B. What Causes Cerebral Infarction?

The primary causes of cerebral infarction include atherosclerosis (which narrows and obstructs cerebral blood vessels) and various forms of arteritis. Common comorbidities are hypertension, hyperglycemia, and hyperlipidemia. Thus, the “three highs” (high blood pressure, high blood sugar, and high blood lipids) are key factors that accelerate and worsen atherosclerosis, making them common causes.

C. What Symptoms Are Associated with Cerebral Infarction?

At-Risk Populations: Individuals aged 50-60 and older, those with atherosclerosis, hypertension, rheumatic heart disease, coronary heart disease, diabetes, smokers, drinkers, or a history of transient ischemic attacks.
Prodromal Symptoms: Headaches, dizziness, transient limb numbness, and weakness.

Onset: Gradual onset, often during rest or sleep.
Main Symptoms: Headache, dizziness, nausea, vomiting, slurred speech, and even coma.
Neurological Symptoms: Gaze fixation, facial droop, coughing when drinking, and difficulty swallowing.
Symptoms: Hemiplegia, reduced sensation on one side of the body, unsteady gait, limb weakness, and incontinence.

D. Complications of Cerebral Infarction

Pulmonary Infection: This is the leading cause of death among cerebral infarction patients, with contributing factors including:
Cerebral Edema: Cerebral infarction can lead to cerebral edema, which is an accumulation of excess fluid in brain tissue, causing increased intracranial pressure. Symptoms may include vomiting, nausea, and sudden blindness.

Coughing or choking while drinking, leading to aspiration pneumonia.
Older age and poor immunity make patients more susceptible.
Improper use of antibiotics causes dysbiosis.

Brain Herniation: Cerebral edema from infarction can cause diffuse brain swelling, increasing local or overall intracranial pressure, leading to displacement and compression of brain tissue, blood vessels, and cranial nerves, resulting in a series of critical clinical syndromes.
Anxiety and Depression.
Pressure Injuries

E. How to Identify Cerebral Infarction

F (Face): Observe for facial droop when the patient smiles.
A (Arm): Raise both arms and check for weakness or drooping.
S (Speech): Look for slurred or unclear speech.
T (Time): If any of the above symptoms are present, call emergency services immediately

F. Treatment for Cerebral Infarction

General Treatment in Acute Phase:
- Bed rest with personal care.
- For those with swallowing difficulties, consider placing a feeding tube for enteral nutrition.
- For incontinence, a catheter may be necessary; reposition every 2-3 hours and ensure skin care.
- Functional exercises for those with hemiplegia.

Lower Limb Functional exercises

Ultra-early Thrombolytic Treatment (Ideal Method):
- Time Window: Within 3 hours of onset.
- Medication: Alteplase.
- Blood Pressure Control: Systolic <180 mmHg, Diastolic <110 mmHg.
Acute Phase Treatments:
- Anticoagulation Therapy.
- Antiplatelet Therapy: Clopidogrel, Aspirin (monitor for bleeding risks).
Interventional Treatment:
- Using DSA, a catheter is navigated to the site of the brain lesion for examination, diagnosis, and treatment, including micro-dissolution and dilation.
Other Treatments:
- Controlled blood pressure: moderate and cautious.
- Use of vasodilators.
- Neuroprotective agents.
- Volume expanders as needed.

G. How to Care for Patients with Cerebral Infarction?

Patients with unsteady gait should have dedicated care to prevent accidents like falls.
Provide a light, easily digestible diet, strictly limit salt intake, and avoid fatty foods.
For hemiplegic patients, schedule regular turning and back tapping to prevent pressure sores and aspiration pneumonia.
Massage the paralyzed side to prevent muscle atrophy.
Elevate the lower limbs to promote venous return and avoid thrombosis.
For bedridden patients, encourage adequate fluid intake, frequent urination, and maintain perineal hygiene to prevent urinary tract infections.
Follow medical advice for medications; do not stop or reduce dosages independently.
Maintain oral hygiene: brush teeth twice daily and rinse after meals.
Encourage daily activities: include eating, hygiene, dressing, toileting, bathing, household chores, and walking.
Speech therapy for patients with language disorders: speak slowly and clearly, face the patient, and encourage verbalization of common items to aid memory recovery.
Maintain emotional stability: Encourage an optimistic outlook, enjoy life, manage negative emotions, and foster social interactions to promote recovery and reduce the risk of relapse.