How is a cerebral infarction treated?

Written by Hao Li Bin
Neurosurgery
Updated on October 20, 2024
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The treatment principles for cerebral infarction include thrombolysis, anticoagulation, volume expansion, lowering blood pressure, and brain protection. The main goal is to improve the blood circulation in the ischemic area of the brain as soon as possible and promote the recovery of neurological functions. During the acute phase, patients should rest in bed as much as possible, enhance care for skin, oral cavity, respiratory tract, and excretion, and maintain electrolyte balance. If a patient still cannot eat 48 to 72 hours after onset, nasogastric feeding with liquid nutrition should be provided to ensure nutritional supply. The priority should be given to the patient's daily care, diet, and the management of other comorbidities. Since some patients with cerebral infarction cannot take care of themselves during the acute phase and may even have difficulty swallowing, without adequate nutrition, metabolic issues can arise quickly. In such cases, even the best medications can fail to achieve positive outcomes. Since cerebral thrombosis is the most common type of cerebral infarction characterized by high incidence, high mortality, high recurrence rate, and high disability rate, patients may experience mild hemiplegia or severe scenarios leading to loss of life. Therefore, lifelong medication is necessary to prevent recurrence, achieve secondary prevention, and ultimately reduce the recurrence of cerebral infarction.

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Written by Gao Yi Shen
Neurosurgery
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Can the blood vessels in a cerebral infarction be unblocked?

Whether the blood vessels in a cerebral infarction can be reopened is closely related to time. If it is within the hyperacute phase, which means within six hours from the onset of clinical symptoms to hospital admission, the majority of cases can undergo thrombolysis intravenously, or arterial thrombectomy to reopen the blood vessels. However, if the time exceeds this window, reopening is no longer feasible, and forced reopening at this stage can easily lead to the detachment of distal thrombi or cause reperfusion injury, which is more detrimental to the patient's condition. Therefore, it is impossible to reopen the blood vessels during the chronic phase or non-hyperacute phase. If treatment of this vascular occlusion is desired, vascular anastomosis can be considered, though the specific type of anastomosis surgery depends on the patient's specific condition at the time. Thus, the possibility of reopening a blood vessel in a cerebral infarction certainly depends on timing.

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Written by Gao Yi Shen
Neurosurgery
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Is a cerebral infarction serious?

Stroke is a very serious disease; its essence lies in the ischemic necrosis of nerve cells. A characteristic of nerve cells is that once they undergo ischemic necrosis, they cannot regenerate. Along with cardiac muscle cells, they are the only cells in the human body that cannot regenerate once they have died. Therefore, for the part of the tissue where nerve cells have already died, such as in cases of cerebral thrombosis or stroke where the tissue has already been affected, it is impossible to completely restore it. If the affected area is relatively small, some compensation might be possible. However, if the affected area is relatively large, this will lead to a significant amount of ischemic necrosis in the neural tissue, which can cause total dysfunction of various tissue structures in the body, and in more severe cases, can lead to coma and eventually the death of the patient. Therefore, it is imperative to take this seriously in clinical practice.

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Written by Chen Yu Fei
Neurosurgery
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Stroke treatment methods

For patients who suffer a stroke, it is crucial to immediately transport them to the nearest local hospital. At the emergency room of the local hospital, a cranial CT scan or MRI should be conducted to confirm the presence of a stroke, as well as to determine its exact range and severity. If there is an acute indication for surgery, thrombolytic therapy is recommended. If the optimal time window for thrombolysis has passed, it is advisable to use medications that invigorate the brain, improve blood flow to remove stasis, nourish the nerves, and enhance microcirculation in the brain tissue. This can effectively help improve the conditions of ischemia and hypoxia in the brain nerves. Furthermore, further treatment should be adjusted based on the patient’s condition. During treatment, attention should be paid to the prevention and treatment of various complications or comorbidities, such as pulmonary infections, urinary tract infections, hypoproteinemia, deep vein thrombosis, etc.

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Written by Gao Yi Shen
Neurosurgery
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Premonitory symptoms of cerebral infarction recurrence

The symptoms preceding the recurrence of a cerebral infarction mainly involve observing the symptoms presented during the initial incidence of the stroke. In many cases, the recurrent symptoms are very similar to those initially experienced. For example, if dizziness was a symptom during the previous episode, then dizziness could also be a precursor symptom in a recurrence, with similar nature and intensity of dizziness as before. Additionally, if previous symptoms included limb numbness, weakness, or speech impairment, similar signs might precede a recurrence. Clinically, it is imperative to address these issues before an actual recurrence occurs, such as actively pursuing antiplatelet aggregation therapy, lipid-lowering, and stabilizing plaques, and resorting to surgical treatment if necessary, to better reduce the chances of stroke recurrence.

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Written by Chen Yu Fei
Neurosurgery
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What tests are done for a cerebral infarction?

For patients with cerebral infarction, it is recommended to take the patient to a local hospital for timely treatment during the acute phase. A cranial CT scan or MRI should be performed to help assess the current situation. Cranial MRI plays an important auxiliary diagnostic role in identifying the specific location, extent, and severity of the cerebral infarction. It is advised to perform a cranial MRI during the acute phase for a clear diagnosis, and then decide the next step of the treatment plan based on the situation. Within the surgical window, thrombolytic therapy can be applied to achieve dissolution of the clot. If the optimal timing for thrombolysis has been missed, it is recommended that the patient be hospitalized to receive treatment, including intravenous drips, brain-nourishing drugs, nerve nutrition, and medications that invigorate blood circulation and remove blood stasis, to help improve the state of ischemia and hypoxia in the brain tissue.