Cerebral Infarction

Question 1

What structures are affected by cerebral infarction?

Answer 1

1. all parts of the brain
2. arteries to the brain
3. large and small arteries within the brain

Question 2

Which arteries leading to the brain are affected?

Answer 2

Internal and external carotid arteries

Vertebral arteries

Question 3

What is the physiology behind cerebral infarction?

Answer 3

Supply of oxygen and nutrients to the brain

Removal of CO2 and waste products from the brain

Question 4

How can the arteries going to or within the brain be affected to cause cerebral infarction?

Answer 4

Disease of the wall of the arteries

e.g. atherosclerosis caused by cholesterol and inflammatory cells

Question 5

How can problems with the atria lead to cerebral infarction?

Answer 5

Dilated atria of the heart allow blood clots to form

Atria are delated in atrial fibrillation

Question 6

What are the physiological abnormalities of cerebral infarction?

Answer 6

1. ischaemia of brain tissue
2. necrosis of brain tissue
3. raised intercranial pressure

Question 7

What is the difference between ischaemia and necrosis?

Answer 7

Ischaemia is a reduced blood/oxygen supply leading to cells

Necrosis is death of cells

Question 8

How does raised intercranial pressure cause problems?

Answer 8

It is caused by brain swelling (oedema) and can further damage nerve cells

Question 9

What lifestyle choices increase the risk of cerebral infarction?

Answer 9

1. smoking
2. high blood pressure
3. high cholesterol
4. diabetes

Question 10

What cardiovascular condition increases risk of cerebral infarction?

Answer 10

Atrial fibrillation

Question 11

What event may have occurred prior to the cerebral infarction that acts as a warning sign?

Answer 11

Transient ischaemic attack (TIAs)

these are reversible “mini strokes” that do no obvious lasting damage

Question 12

What causes a TIA?

Answer 12

Very small blood clots that temporarily block an artery

Question 13

What are the main symptoms of cerebral infarction?

Answer 13

1. weakness of the arm and/or leg (usually on 1 side of the body)
2. dysarthria
3. drooping of corner of mouth
4. dysphagia
5. expressive dysphasia

Question 14

What is dysarthria?

Answer 14

Slurring of the speech

Question 15

What is dysphagia?

Answer 15

Difficulty swallowing

Question 16

What is expressive dysphasia?

Answer 16

Inability to find the right words to speak

Inability to understand the words of others

Question 17

A clinical sign of cerebral infarction is possible bruit - what is this?

Where is it found?

Answer 17

It is the noise of turbulent blood flow caused by atherosclerosis with narrowing

It is heard over a carotid artery in the neck

Question 18

What would be seen on a brain CT or MRI scan of a patient with cerebral infarction?

Answer 18

Changes of brain ischaemia (reduced blood flow)

Swelling and infarction (necrosis of brain cells)

Question 19

What type of ultrasound could be used and why?

Answer 19

Ultrasound of carotid artery

May show evidence of narrowing due to atherosclerotic plaques

Question 20

What may an echocardiogram show in a patient with cerebral infarction?

Answer 20

Evidence of a blood clot in the atrial appendage

Question 21

What may an ECG show in a cerebral infarction patient?

Answer 21

May be evidence of atrial fibrillation

Irregular heart beat with absent P waves

Question 22

How is cerebral infarction treated?

Answer 22

Thrombolytic drugs are given

They dissolve the blood clot from within the artery and restore blood flow

Question 23

What is the on-going treatment for patients with atrial fibrillation?

Answer 23

Warfarin - an anticoagulant

Question 24

What is the on-going treatment for patients with carotid atherosclerosis?

Answer 24

Antiplatelet drugs such as aspirin

Question 25

What is the on-going treatment with patients with hypertension?

Answer 25

Management of high blood pressure in an attempt to lower it