cerebral infarction

During a stroke, part of the brain no longer receives oxygen for a shorter or longer period of time. The lack of oxygen causes sudden failure symptoms. About 46,000 people in the Netherlands suffer a stroke every year.

What is a cerebral infarction?

A cerebral infarction occurs when a blood vessel in the brain is closed for a long time. The blood can then no longer pass through, so that too little blood flows to a part of the brain and a certain part of the brain gets a shortage of oxygen. The brain cells can only handle this for a short time and become damaged.

Causes of a cerebral infarction

An important cause of a closed blood vessel is arteriosclerosis (atherosclerosis). In the places where fat (cholesterol) and calcium are deposited in the blood vessels, a blood clot development, thrombosis. A thrombosis can spread and lead to a complete occlusion of the blood vessel. A blood clot can also break loose and close a small blood vessel further down: embolism.

A stroke can also be caused by the clogging of the small blood vessels in the brain, usually as a result of long-standing high blood pressure. Other rare causes include clotting disorders, vasculitis, or use of certain medications. Those rare causes are more common in stroke under age 50.

High age important risk factor

Aging of the body is often accompanied by changes in the blood vessels. This can lead to constrictions. Sometimes clots stick to the vessel wall or damage occurs to the vessel wall. These changes make you more likely to have a stroke. Age is therefore an important risk factor: strokes are relatively rare in people younger than 60 years. Men are more likely to have a stroke than women.

Factors that increase the risk of narrowing or blocking the blood vessels include:

• to smoke
• high bloodpressure
• high cholesterol
• diabetes mellitus
• rheumatoid arthritis
• stress
• overweight
• lack of exercise

Symptoms of a cerebral infarction

A stroke or cerebral infarction can sometimes be recognized by certain signs. These are the result of a temporary lack of oxygen in the brain, which later recovers: Transient Ischaemic Attack. Such a TIA always comes on suddenly, often lasts less than twenty minutes and usually disappears completely within a few hours.

A stroke occurs suddenly, develops rapidly and causes death of brain tissue within minutes to hours. Many different symptoms can occur, these can differ per person and depend on the brain region in which it originated. Each brain region has its own tasks. Common symptoms include:

• Paralysis in one half of the body or, for example, paralysis in an arm or leg.
• Vision problems: Loss of vision on one side.
• A crooked face or a crooked mouth.
• Speech problems or gibberish. Sometimes difficulties in chewing or swallowing.
• Severe vertigo or coordination problems.

Recognize the signals

The symptoms of a stroke are often easy to recognize and acting quickly is vital to prevent permanent damage. It is often not immediately clear whether you are dealing with a TIA, cerebral haemorrhage or infarction, so it is important to call 112 immediately. The sooner someone is hospitalized, the more options there are for treatment. Never drive yourself to the emergency department of a hospital, always have yourself taken.

Diagnose

On arrival at the hospital, the first thing to do is to diagnose and identify the cause. Many hospitals now have a ‘stroke unit’ that specializes in the care of stroke patients. A CT or MRI scan is often made, because the difference between an infarction and bleeding is of great importance. Blood thinners can be given in the event of an infarction, but not in the event of a bleeding.

In the days after a stroke, you often receive follow-up tests such as a blood pressure measurement, EKG (heart film), ultrasound examination or angiography (examination of the blood vessels). The plug that closes off a blood vessel in the brain sometimes comes from the heart (in case of cardiac arrhythmias or heart valve defects), but can also come loose from a narrowed carotid artery. The cardiologist and neurologist will therefore work together during the examination.

Treatment of cerebral infarction

For a cerebral infarction, time loss is brain loss, so treatment should start as soon as possible. The sooner the blockage in a cerebral vessel is resolved, the greater the chance of a good recovery.

Thrombolysis can take up to 4.5 hours after the onset of the first symptoms and is not possible for all patients. Treatment consists of an infusion of clot-dissolving drugs.

Another treatment option is relatively new and is used on a limited scale in the Netherlands. This involves removing or dissolving the clot in the blood vessel from the inside. This treatment lasts up to 6 hours after the first symptoms.

If there are severe narrowings of the carotid artery, the narrowings can sometimes also be reduced with surgery. Furthermore, the treatment mainly focuses on the prevention of another stroke. This includes lifestyle advice and medications.

Medications after a stroke

After a stroke you will be given one or more blood thinners. It is important to take these medicines, because they reduce the risk of another stroke. Often you will also be given medicines to lower blood pressure and cholesterol. Sometimes a medicine to protect the stomach is also prescribed. After a stroke, it is better not to use drugs with the female hormone oestrogen.

Revalidation

Most patients stay in the stroke unit for about 5 to 10 days after a stroke. The attending physician is initially the neurologist, sometimes other specialists are involved. Rehabilitation is started as soon as possible after admission: most recovery is possible in the first six months. A physiotherapist, occupational therapist and speech therapist will investigate the limitations.

You can often go home after admission to the stroke unit, after which the real rehabilitation phase starts. In the first months, this will mainly focus on recovery, after that the focus will be more on dealing with the limitations that have arisen. The treatment plan is highly dependent on the complaints; usually there is a combination of therapies performed by, among others, the physiotherapist, speech therapist and occupational therapist. Rehabilitation can be done as day treatment or in a rehabilitation center or nursing home with admission.

Consequences of an infarct

Many victims continue to suffer from the consequences of the infarction. The physical consequences are most visible, especially the (half-sided) paralysis. Difficulty keeping balance, epilepsy and fatigue are also common consequences. Annoying are also complaints such as incontinence and constipation.

However, a cerebral infarction can also lead to cognitive impairment. These complaints often only become clear when you are back home. For example, the ability to concentrate is reduced, or you are forgetful. The thinking speed of most stroke patients decreases. Other consequences include problems with language (aphasia), inability to perform complex actions in the correct order (apraxia), less attention to one side of the body (neglect), and inability to recognize objects or faces (agnosia). .

Personality can also change. After an infarction, sometimes the brake on emotions is gone, so that you are more likely to be emotional, irritated or aggressive. Many patients have difficulty with nuance, are less flexible and are more likely to be afraid, insecure or depressed. Especially these changes in emotions and behavior are often difficult for the partner and family. Contact with fellow sufferers can therefore provide support for both the patient and the environment.