Cerebral infarction

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A type of stroke caused when a blood vessel that supplies blood to the brain is blocked by a blood clot or plaque.

Causes

Ischemic strokes are usually caused by a piece of plaque or a blood clot that blocks blood flow to the brain.

Plaque buildup

When a fatty substance called plaque builds up on the inner walls of the arteries, it can lead to a disease called atherosclerosis. Plaque hardens and narrows the arteries, which limits blood flow to tissues and organs.

Plaque can build up in any artery in the body, including arteries in the brain and neck. Carotid artery disease is when plaque builds up in the carotid arteries in the neck that supply blood to the brain. It is a common cause of ischemic stroke.

Blood clots in the brain

Cerebral infarction

Plaque in an artery can break open. Blood platelets stick to the site of the plaque injury and clump together to form blood clots. These clots can partly or fully block an artery.

A blood clot that forms in one part of the body can also break loose and travel to the brain. This type of ischemic stroke is called an embolic stroke. Certain heart and blood conditions, such as atrial fibrillation and sickle cell disease, can cause blood clots that lead to stroke.

Inflammation

Chronic (long-term) inflammation contributes to ischemic stroke. Researchers are still trying to understand this fully. We know that inflammation can damage the blood vessels and contribute to atherosclerosis, however. In addition, ischemic stroke can lead to inflammation that further damages brain cells.

Transient ischemic attack

A transient ischemic attack (TIA) is caused by a blockage in the brain just like an ischemic stroke. But the blockage breaks up before there is any damage to your brain. It typically lasts less than an hour but can come and go. Eventually, it can progress to a full stroke. A TIA is also called a mini-stroke.

Risk factors

There are many risk factors for stroke. You can treat or control some of your risk factors, such as high blood pressure and smoking. But you cannot control others such as your age or sudden changes in your health—for example, if you have an aneurysm.

Blood clot

The major risk factors for stroke include:

• High blood pressure

• Diabetes

• heart and blood vessel diseases. Conditions that can cause blood clots or other blockages include coronary heart disease, atrial fibrillation, heart valve disease, and carotid artery disease.

• High LDL cholesterol levels

• Smoking

• Brain aneurysms or arteriovenous malformations (AVMs). AVMs are tangles of poorly formed arteries and veins that can break open in the brain.

• Infections or conditions that cause inflammation, such as lupus or rheumatoid arthritis

• Age. A stroke can happen at any age, but the risk is higher for babies under the age of 1 and for adults. In adults, the risk increases with age.

• Sex. At younger ages, men are more likely than women to have a stroke. But women tend to live longer, so their lifetime risk of having a stroke is higher. Women who take birth control pills or use hormone replacement therapy are at higher risk. Women are also at higher risk during pregnancy and in the weeks after giving birth. High blood pressure during pregnancy—such as from preeclampsia—raises the risk of stroke later in life.

• Race and ethnicity. In the United States, stroke occurs more often in African American, Alaska Native, American Indian, and Hispanic adults than in white adults.

• Family history and genetics. Your risk of having a stroke is higher if a parent or other family member has had a stroke, particularly at a younger age. Certain genes affect your stroke risk, including those that determine your blood type. People with blood type AB (which is not common) have a higher risk.

• Other risk factors for stroke—some of which you can control—include:

• Anxiety, depression, and high stress levels. Working long hours and not having much contact with friends, family, or others outside the home are also linked with higher risk of stroke.

• Living or working in areas with air pollution.

• Other medical conditions, such as certain bleeding disorders, sleep apnea, kidney disease, migraine headaches, and sickle cell disease.

• Blood-thinners or other medicines that can lead to bleeding.

• Other unhealthy lifestyle habits, including eating unhealthy foods, not getting regular physical activity, drinking alcohol, getting too much sleep (more than 9 hours), and using illegal drugs such as cocaine.

• Overweight and obesity or carrying extra weight around your waist and stomach.

The signs and symptoms of a stroke often develop quickly. However, they can develop over hours or even days, such as when a transient ischemic attack (TIA) turns into a stroke.

Symptoms

The type of symptoms depends on the type of stroke and the area of the brain that is affected.

This animation discusses symptoms of stroke, also described below. Medical Animation Copyright © 2020 Nucleus Medical Media, All rights reserved.external link

Signs and symptoms of a TIA or stroke may include:

• Sudden numbness or weakness, especially on one side of the body

• Sudden confusion or trouble speaking or understanding speech

• Sudden trouble seeing in one or both eyes

• Sudden trouble walking, dizziness, or loss of balance or coordination

• Sudden severe headache with no known cause

• The FAST test can help you remember what to do if you think someone may be having a stroke:

• F—Face: Ask the person to smile. Does one side of the face droop?

• A—Arms: Ask the person to raise both arms. Does one arm drift downward?

• S—Speech: Ask the person to repeat a simple phrase. Is their speech slurred or strange?

• T—Time: If you observe any of these signs, call 9-1-1 right away. Early treatment is essential.

Complications

A stroke can cause lasting brain damage, long-term disability, or even death. When you have a stroke, your doctor may rate how severe it is. A more severe stroke means more brain tissue was damaged. When there has been significant damage, your doctor may call it a massive stroke. This can mean more severe complications.

After having a stroke, you may develop complications such as:

• Dangerous blood clots. Being unable to move around for a long time can raise your risk of developing blood clots in the deep veins of the legs. In some cases, blood clots can break loose and travel to the lungs. Your stroke care team may try to prevent these complications with medicine or a device that puts pressure on your calves to keep your blood flowing.

• Difficulty speaking. If a stroke affects the muscles you use to speak, you may have trouble communicating as easily as before.

• Loss of bladder or bowel control. Some strokes affect the muscles used to urinate and have bowel movements. You may need a urinary catheter (a tube placed into the bladder) until you can urinate on your own. Use of these catheters can lead to urinary tract infections. You may also lose control of your bowels or be constipated.

• Loss of bone density or strength. This usually happens on one side of the body. Physical activity as part of rehabilitation can help prevent this loss. Your care team may also evaluate you for osteoporosis.

• Loss of vision, hearing, or touch. Your ability to feel pain or temperature may be affected after a stroke, or you may have trouble seeing or hearing as well as before. Some of these changes could affect your ability to cook, read, change your clothes, or do other tasks.

• Muscle weakness or inability to move. A stroke can make your muscles become weak and stiff or cause them to spasm. This can be painful or make it hard to stand or walk around on your own. You may also have problems with balance or controlling your muscles. This puts you at risk of falling.

• Problems swallowing and pneumonia. If a stroke affects the muscles used for swallowing, you may have a hard time eating or drinking. You may also be at risk of inhaling food or drink into your lungs. If this happens, you may develop pneumonia.

• Problems with language, thinking, or memory. Stroke may affect your ability to focus on a task or make decisions quickly. It also raises the risk of dementia.

• Seizures. This is more common in the weeks after a stroke and is less likely as time goes on. If you have seizures, your stroke team may give you medicine.

• Swelling in the brain. After a stroke, fluid may build up between the brain and the skull or in the cavities of the brain, causing swelling. Doctors may drain fluid from the brain or cut away part of the skull to relieve the pressure on your brain.

Diagnosis

During the physical exam, your doctor will check you for:

• Confusion

• Coordination and balance

• Mental alertness

• Numbness or weakness in your face, arms, and legs

• Trouble speaking or seeing clearly

The exam will help your doctor determine how severe your stroke was and plan your treatment.

Diagnostic tests and procedures

An an imaging test to look at the blood vessels in your brain will help determine what type of stroke you have and where exactly it happened. The quicker these tests can be done, the better your doctor can treat you. Tests to diagnose stroke include the following:

Computed tomography (CT) uses X-rays to take clear, detailed pictures of your brain. It is often done right after a stroke is suspected. A brain CT scan can show if there is bleeding in the brain or damage to the brain cells from a stroke.

Magnetic resonance imaging (MRI) uses magnets and radio waves to create pictures of your brain. An MRI may be used instead of—or in addition to—a CT scan to diagnose a stroke. This test can detect changes in brain tissue and damage to brain cells.

Other imaging tests to look for narrowed blood vessels in the neck or an aneurysm or tangled blood vessels in the brain.

Your doctor may also order the following blood or heart tests.

Blood tests. Your doctor may test the blood and platelet count and glucose (sugar) levels in your blood to make sure they are stable and to see if a certain medicine can treat your stroke. Your doctor may also do blood tests to see how well your blood is clotting and to look for muscle damage.

Electrocardiogram (EKG). An EKG can help detect heart problems that may have led to a stroke. For example, this test can help diagnose atrial fibrillation or a previous heart attack.

Lumbar puncture (also called a spinal tap), if the imaging scan does not detect any bleeding in the brain but your doctor still thinks you may have had a hemorrhagic stroke. The doctor will use a needle to collect fluid from around your spine. The fluid will be tested for substances from broken-down blood cells.

Treatment

A stroke requires emergency care. You will probably receive treatment in a specialized stroke unit of the hospital. A team of specialists will oversee your care. Treatment will depend on whether the stroke was ischemic or hemorrhagic, how much time has passed since symptoms began, and whether you have other medical conditions.

Treatment for an ischemic stroke or transient ischemic (TIA) may include medicines and medical procedures.

Medicines

The main treatment for an ischemic stroke is a medicine called tissue plasminogen activator (tPA). It breaks up the blood clots that block blood flow to your brain. A doctor will inject tPA into a vein in your arm. This type of medicine must be given within 3 hours after your symptoms start. In some cases, it is given up to 4.5 hours. The sooner treatment begins, the better your chances of recovery.

If you cannot have tPA, your doctor may give an anticoagulant or blood thinning medicine, such as aspirin or clopidrogrel. This helps stop blood clots from forming or getting larger. The main side effect of these medicines is bleeding.

Medical procedures

You may need a procedure to open up blocked arteries and restore blood flow to the brain. This can be done several ways.

A thrombectomy removes the clot from the blood vessel. A surgeon will put a long, flexible tube called a catheter into your groin (upper thigh) and thread it to the blocked artery in your neck or brain. They will then use angioplasty and stenting or a device called a stent retriever to open up the blocked artery.

Angioplasty and stenting procedures use a thin tube to deliver a balloon or small mesh tube into the artery. Inflating the balloon or expanding the mesh tube clears space for blood to flow more easily to the brain.

The stent retriever is a wire mesh inside the catheter that traps the clot. The stent retriever and the blood clot are then pulled out through the tube.

If carotid artery disease caused your stroke, your doctor may suggest carotid endarterectomy, a surgery to remove plaque from the carotid artery in your neck

Also see

• Stroke
• Hemorrhagic stroke
• ICD 10 code for cerebral infarction: I63132

Cerebral infarction Resources
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