Cerebral Infarction Flashcards
What structures are affected by cerebral infarction?
- all parts of the brain
- arteries to the brain
- large and small arteries within the brain
Which arteries leading to the brain are affected?
Internal and external carotid arteries
Vertebral arteries
What is the physiology behind cerebral infarction?
Supply of oxygen and nutrients to the brain
Removal of CO2 and waste products from the brain
How can the arteries going to or within the brain be affected to cause cerebral infarction?
Disease of the wall of the arteries
e.g. atherosclerosis caused by cholesterol and inflammatory cells
How can problems with the atria lead to cerebral infarction?
Dilated atria of the heart allow blood clots to form
Atria are delated in atrial fibrillation
What are the physiological abnormalities of cerebral infarction?
- ischaemia of brain tissue
- necrosis of brain tissue
- raised intercranial pressure
What is the difference between ischaemia and necrosis?
Ischaemia is a reduced blood/oxygen supply leading to cells
Necrosis is death of cells
How does raised intercranial pressure cause problems?
It is caused by brain swelling (oedema) and can further damage nerve cells
What lifestyle choices increase the risk of cerebral infarction?
- smoking
- high blood pressure
- high cholesterol
- diabetes
What cardiovascular condition increases risk of cerebral infarction?
Atrial fibrillation
What event may have occurred prior to the cerebral infarction that acts as a warning sign?
Transient ischaemic attack (TIAs)
these are reversible “mini strokes” that do no obvious lasting damage
What causes a TIA?
Very small blood clots that temporarily block an artery
What are the main symptoms of cerebral infarction?
- weakness of the arm and/or leg (usually on 1 side of the body)
- dysarthria
- drooping of corner of mouth
- dysphagia
- expressive dysphasia
What is dysarthria?
Slurring of the speech
What is dysphagia?
Difficulty swallowing
What is expressive dysphasia?
Inability to find the right words to speak
Inability to understand the words of others
A clinical sign of cerebral infarction is possible bruit - what is this?
Where is it found?
It is the noise of turbulent blood flow caused by atherosclerosis with narrowing
It is heard over a carotid artery in the neck
What would be seen on a brain CT or MRI scan of a patient with cerebral infarction?
Changes of brain ischaemia (reduced blood flow)
Swelling and infarction (necrosis of brain cells)
What type of ultrasound could be used and why?
Ultrasound of carotid artery
May show evidence of narrowing due to atherosclerotic plaques
What may an echocardiogram show in a patient with cerebral infarction?
Evidence of a blood clot in the atrial appendage
What may an ECG show in a cerebral infarction patient?
May be evidence of atrial fibrillation
Irregular heart beat with absent P waves
How is cerebral infarction treated?
Thrombolytic drugs are given
They dissolve the blood clot from within the artery and restore blood flow
What is the on-going treatment for patients with atrial fibrillation?
Warfarin - an anticoagulant
What is the on-going treatment for patients with carotid atherosclerosis?
Antiplatelet drugs such as aspirin
What is the on-going treatment with patients with hypertension?
Management of high blood pressure in an attempt to lower it
