Keywords: prevention of cerebral infarction

        Usual to patients with hypertension, headaches, dizziness, insomnia, emotional instability, anxiety, memory loss, numbness of the limbs, transient aphasia, mistaken for high blood pressure or cervical spondylosis performance. As medical medical science and technology development, high-resolution CT and magnetic resonance imaging in clinical use, found that hypertensive patients appear above the performance of approximately 16% to 32% of patients with lacunar infarcts.

    The clinical is now confirmed that high blood pressure is one of the most dangerous factors of lacunar infarction. Patients if not treated in time, the general will lead to damage of the heart, brain and blood vessels, and aggravate the development of atherosclerosis better its pathogenesis is that: to the middle-aged, due to changes in the machine (such as red blood cells deformability, platelet aggregation force enhancements, increased blood viscosity, dyslipidemia change), the blood is hypercoagulable state, the blood flow slowed down, resulting in a decrease in cerebral blood flow. In cerebral atherosclerosis based on lacunar infarction associated with hypertension, occurs.

    Lacunar infarction, 15 to 20 mm in diameter, fresh or the old deep brain infarction. Damaged blood vessels of the middle cerebral artery and the basilar artery deep perforating branches, often occur in the basal ganglia, thalamus, internal capsule, pons, basal ganglia and white matter, and other parts, often confused with symptoms of high blood pressure, CT and MRI can be used to confirm the diagnosis.

    Middle age, disease, the majority of long-term history of hypertension, it is called hypertension lacunar attack caused by hypertension tiny artery lesions, but also seen in patients with normal blood pressure. Clinical manifestations: 1. Pure sensory stroke; pure motor stroke; Masonic hemiparesis change tonality; dysarthria – clumsy hand syndrome; 5. Lacunar state.

    Diagnosis: clinical diagnosis of lacunar infarction according to the following points: 1. Before the onset (usually before the onset within 48h) is almost always transient ischemic attack, and some even attack several times. After the onset of clinical neurological signs isolated nature. The illness often progressive, formed in a few hours or a few days. Almost all cases the headache and disturbance of consciousness, all patients with neurological symptoms and signs, almost all can be fully restored. Small artery lesions infringement, cerebral angiography without exception; CSF examination the isotope scan X-ray and computer off scan showed no abnormality. 6. Lacunar infarction diagnosed pathological examination can find cavities.

    Lacunar infarction patients, the short-term treatment is entirely possible rehabilitation. First, should actively prevent and control high blood pressure, people over the age of 40 should be regularly measured blood pressure, for early detection and early treatment. Found that high blood pressure should be checked regularly to the heart, blood vessels, retinal and lipids, and dynamically observe the changes of hemorheology. Daily life avoid emotional fatigue, to satiation Baoyin and constipation. In addition, it should be a quiet rest, and selection of rutin, vitamin C, nicotinic acid, dipyridamole, enteric-coated aspirin, venoruton, nimodipine, Brain Essentials piperazine, piracetam, West Billings and other drugs. The choice of Chinese medicine Salvia, Chuanxiong.

Keywords: cerebral infarction needs anti-relapse

        Patients Sex: Male patient’s age: 65

        ● Detailed conditions and consultation purposes: a good doctor, my father left in 2000 after cerebral infarction sequelae of hemiplegia, also uncovers gallstones. I would like to inquire about the need to take drugs to prevent stroke recurrence, long-term medication will have side effects. Previously been eating Naoxintong step. “Thank you, doctor

        ● The incidence and duration: 2000 stroke

        ● general: Other Fortunately, some constipation, get up in the morning there will be sputum; physical strength is not good. About blood pressure 70,110

        ● history: 1995, 2000 slight MI, stroke

        A: multifaceted comprehensive regulation.

        Focuses on the prevention of blood pressure fluctuations, and to pay more attention to some dietary factors that may cause atherosclerosis. Need to take aspirin and other preventive drugs, shall be subject to the checks after under the guidance of a doctor taking drugs. To pay attention to the problem of your father constipation, avoid excessive straining at stool and adverse consequences.

Keywords:

        Ten days of June to the sustained high temperatures, the cerebral infarction incidence and an upward trend. According to the neurological director of the Central Hospital Kyi less first professor said, there are more than 100 cases by hospital CT diagnosis of patients.

    Lesions of cerebral infarction is a cerebral vascular accident, due to summer sweat more, more body water loss, increased blood viscosity, the continued expansion of blood vessels, vasodilation and contraction regulate function deterioration, coupled with sleep and activities of the elderly reduced, especially for the elderly love smoking and drinking, the incidence of cerebral infarction chance is much higher.

    In general, cerebral infarction, mostly unexpected, but a small number of older people will slow onset. If you feel dizzy, headache, the hemisensory obstacles, barriers to physical activity and aphasia, should raise the alarm. Most of the elderly onset unclear consciousness or drowsiness, mental So, if the above symptoms should promptly go to the hospital of neurology treatment, CT scan of the head can be diagnosed.

    Hot days, the elderly should pay special attention to the prevention of cerebral infarction. First of all, it should be done daily monitoring of blood pressure, hypertensive patients should be timely and regular use of antihypertensive drugs. Second, pay attention to rest, The housework and entertainment reasonable arrangements to prevent fatigue, tension and mood swings, to ensure that the sleep time. To adequate drinking water. Fourth, the use of low-salt, low-fat diet to prevent overeating. Taking low-dose aspirin and other preventive drugs. Finally, the habit of smoking, drinking elderly should pay attention to control.

Keyword: the limitations of cerebral infarction

        (A) CT in cerebral infarction onset within 4 to 6 hours, and some cases can be seen slightly ill-low-density lesions. But early CT examination to exclude cerebral hemorrhage, subdural hematoma, intracranial tumors, cerebral infarction-like disease. Most cases occur in the 24 hours after the border was clear low density lesions (Figure 24-3). About one week, there may be a strengthening of the infarct uneven. CT advantages for convenient, quick, applicable to critically ill patients, uncooperative patients. Can be found in the the infarct peripheral edema, brain mass effect and whether converted to hemorrhagic infarction. But less than 5mm infarction and posterior fossa infarct appeared difficult for CT. Cortical surface of the infarct is often not perceived by CT.

    (B) magnetic resonance imaging (MRI) MRI of the high magnetic field (1.5Tesla), in one hour of the onset may show cortical surface and infarction of the posterior fossa. Six hours after the onset of infarction can almost MRI showed performance for the T1-weighted low signal and T2-weighted high signal. The disadvantage of MRI is the high price of imaging a long time, does not apply to patients with critical illness, substandard authors and equipped metal dentures and ECG, pacemaker patients.

    (C) The non-invasive vascular screening duplex ultrasound (duplexsonography) can be used for assessment of extracranial carotid artery disease and the degree of stenosis. Transcranial Doppler (transcranial Doppler, TCD) can detect the base of the brain artery flow velocity, found the middle cerebral artery, the distal segment of the vertebral artery and the basilar artery stenosis or blocked, the assessment of collateral circulation. The TCD instrument of the recent development of bifocal probe, dual-channel or four-channel TCD instrument can be used for the detection cardiogenic of of asymptomatic emboli and vertebral measured emboli or arterial origin. Magnetic resonance angiography (MRI angiography) can be used to check for extracranial and intracranial the brain large artery lesions.

    (D) arteriography selective cerebral arteriography and several less angiography (DSA) applicable to ultrasound found severe stenosis of the internal carotid artery considered for carotid endarterectomy patients or clinical manifestations unusual suspect artery layered or arteritis those. This is an invasive examination, 2% to 12% of the subjects may be complicated the artery layered or embolic stroke.

    (E) blood tests should be routinely measured blood count, Classification, platelets, prothrombin time, partial thromboplastin time, blood glucose, electrolytes, creatinine. On the part of the patient based on the clinical situation, the selective determination of protein C, protein S, antithrombin III (AT III), fibrinogen, anticardiolipin antibodies, plasminogen activator inhibitor factor (PAI), syphilis serology test and so on. It should be measured after the acute phase of stroke onset to affect lipid levels.

    (VI) in cerebrospinal fluid in clinical suspicion of infectious diseases or by imaging and other tests can not determine the diagnosis before considering lumbar puncture.

    (Vii) Other ECG is essential. Also should be as routine chest X-ray to rule out tumor thrombus, can serve as a comparison of aspiration pneumonia occurred later.

Keywords: cerebral infarction laboratory tests

        Laboratory tests

    (1) electrocardiogram, echocardiogram, chest X-ray radiography and monitoring blood pressure, the primary signs of disease, such as hypertension and different types of heart disease.

    (2) skull X-ray radiography and sometimes can be found in the internal carotid artery siphon calcification; the infarct broader incidence 2-3 future shift midline waves, for about two weeks.

    (3) Cerebral angiography can be found in the arterial occlusion or stenosis of the site, cerebral edema caused by vascular compression, displacement and collateral circulation.

    (4) The brain CT and MRI can show cerebral infarction location, size, and its surrounding brain edema and signs of the presence or absence of bleeding, is the most reliable non-invasive diagnostic tool.

Keywords: cerebral hemorrhage

    Cerebral hemorrhage (cerebral haemorrhage) refers to bleeding in the brain parenchyma, due to the bleeding site can be divided into internal capsule, pons, cerebellum, and intraventricular hemorrhage. Often induced by exertion, mental stress and other factors, about half of the patients died of cerebral hernia within one week after the illness.

    [Cause]

    (1) hypertension, cerebral arteriosclerosis as the most common cause.

    (2) cerebral vascular malformations, brain aneurysm rupture.

    (3) intracranial tumor hemorrhage, such as the primary tumor (glioblastoma multiforme), or secondary tumors (human chorionic epithelioma).

    (4) cerebral paragonimiasis.

    Clinical manifestations

    (1) internal capsule bleeding (capsula interna haemorrhage)

    Acute onset, rapid emergence of severe headache, dizziness, vomiting, coma, the contralateral limb completely flaccid paralysis, often accompanied by bleeding lesions of head and eyes turned to the side, was “gaze lesions-like symptoms and three partial, ie hemiplegia hemisensory obstacles and hemianopia, called the internal capsule damage three partial syndrome, another disease side dilated pupils.

    (2) pontine hemorrhage

    Acute onset of consciousness quickly loss was a deep coma, vomiting, fever, lesions side muscle of peripheral paralysis, contralateral limb was central paralysis, head toward the lesion side, bilateral pathological reflex positive bilateral pupil is extremely narrow, was “needle-like".

    (3) cerebellar hemorrhage (cerebellum haemorrhage)

    Acute onset, the patient suddenly appeared occipital pain, often accompanied by dizziness, frequent vomiting and ataxia, and positive signs of meningeal irritation and soon went into a coma.

    (4) intraventricular hemorrhage (ventricular hemorrhage)

    Often restless, coma gradually deepened, uneven breathing, body temperature high and low, flexion both upper limbs, lower limbs straight, the trunk can be presented opisthotonus, sometimes limb twitching and miosis.

    [Diagnosis]

    (1) is more common in the elderly, the general incidence in the non-rest position.

    (2) disease often have high blood pressure, a history of cerebral arteriosclerosis.

    (3) before the onset of headache, limb tingling and other symptoms of a pioneer.

    (4) the incidence of acute internal capsule, pons, cerebellum or intraventricular hemorrhage various manifestations and signs.

    (5) fundus examination there are retina arteriosclerosis signs.

    (6) high blood pressure or normal.

    (7) often stiff neck and Kernig’s sign positive signs.

    (8) cerebrospinal fluid examination may have increased cerebrospinal fluid pressure, mostly bloody.

    (9) CT brain scan can show the image of the high-density lesion.

    (10) cerebral angiography to determine aneurysm or arteriovenous malformation lesions.

    Differential diagnosis

    (1) subarachnoid hemorrhage

    Rapid onset, more common in young people, often unconscious, stiff neck, and positive signs of Klinefelter can oculomotor nerve paralysis, cerebrospinal fluid pressure, was bloody, and cerebral angiography aneurysm, can help diagnosis.

    (2) cerebral embolism

    Rapid onset, more common in patients with rheumatic heart disease, sudden loss of consciousness, but recovered rapidly and cerebrospinal fluid examination was normal CT brain scan showed low density, the data can be identified.

    (3) cerebral thrombosis

    Slower onset, more common in the elderly, often atherosclerotic history, generally occurs at rest or during sleep, often unconscious barriers onset beginning, cerebrospinal fluid pressure is not high, transparent, CT brain scan showed low density, can help identification.

    (4) brain tumor

    Slow onset, often have headaches, vomiting and progressive increase symptoms, physical examination papilledema and focal neurological signs can help identify.

    (5) other causes of coma, such as drug intoxication, hypoglycemia, and Japanese encephalitis have their case characteristics to generally distinguish between coma and brain hemorrhage.

    [Family emergency treatment]

    (1) the patient supine, to keep quiet, to minimize moving to prevent re-bleeding.

    (2) agitation may be given a sedative drugs, such as intramuscular or feeding 10mg stability and other drugs.

    Placed in the head, neck, armpits, groin and popliteal, etc. (3) high fever, an ice pack or cold water wet compress physical cooling methods to reduce the cerebral metabolic rate and oxygen consumption, increased cerebral hypoxia tolerance reduce intracranial pressure.

    (4) high blood pressure, generally in no hurry to take the first high-pin low diastolic blood pressure higher than 13.3KPa (100mmHg), (the head end of the foot of the bed elevated 30 degrees) with blood pressure lowering drugs; diastolic blood pressure below 13.3KPa when , take Trendelenburg (foot end of the foot of the bed elevated 30 degrees).

    (5) to maintain airway patency, vomiting patient taken supine and fasting.

    (6) If there is a shock, heart failure and cardiac arrest, should that emergency treatment, taken to hospital for emergency treatment.

    (7) due to the critical condition, and a higher mortality after the onset should sent to hospital.

Keywords: cerebral thrombosis cerebral hemorrhage

    Cerebral thrombosis (ischemic stroke) and cerebral hemorrhage (hemorrhagic stroke) are cerebrovascular disease, there are many similarities in performance between the two, as mostly seen in people over the age of 50, as well as varying degrees of hemiplegia, paralysis side shallow nasolabial fold, drooping mouth, feeling paralyzed side bust diminish or disappear, may appear the discourse unclear or aphasia. However, there are many differences both in the treatment. Therefore, in the early onset of such can make a preliminary identification, is very useful for the treatment of the patient.

    Cerebral thrombosis is usually secondary to cerebral atherosclerosis, vascular thrombosis, blood flow is blocked, resulting in brain tissue ischemia, necrosis. Cerebral hemorrhage is usually on the basis of long-term hypertension and vascular lesions, caused due to a sudden increase in blood pressure and the incidence of cerebrovascular rupture.

    Cerebral thrombosis in the elderly threat, this is not only that it is a high incidence of symptoms and longer duration, recovery slow and good recurrence in people, and often to rest, at rest or sleep onset unwittingly. This brought some difficulties to the prevention and timely detection.

    However, as long as careful observation of the patient prior to the onset of the performance, it was able to seize some clues, summarized clinical data at home and abroad, the following seven categories of abnormal performance as the the cerebral thrombosis important signal.

        ① recent numbness or weakness, whose hand things suddenly landing;
        The ② sudden temporary blindness or blurred vision;
        ③ sudden aphasia, or spit Yu unclear or difficult to speak, but “knew" clear consciousness, and will soon return to normal, without leaving any traces;
        ④ often dizziness, sometimes suddenly collapsed to the ground, but can quickly wake up;
        ⑤ recent memory impairment, especially in recent memory was significantly impaired, and even completely forgotten;
        ⑥ unexplained mental deterioration, concentration, thinking feel effortless, reducing efficiency;
        ⑦ by check eyes to check out cerebral arteriosclerosis or high blood pressure, or lipids, blood viscosity, Rheoencephalogram insufficiency change is more likely to occur cerebral thrombosis.

    The emergence of these phenomena should not be negligent, should be carefully treated, but do not panic. Shall immediately request the physician diagnosis and treatment immediately rest stops working, keep quiet living environment, the prescribed medication cerebral thrombosis multi incidence in a quiet state, often symptoms when you woke up, the slow progress of the disease, of hemiplegia symptoms in a few hours to within a few days more and more obvious, the consciousness often keep clear. Brain hemorrhage due to emotional and mental strain, straining to defecate, hard lifting heavy objects, prompting a sudden jump in blood pressure and sudden onset, the patient felt a sudden headache accompanied by nausea, vomiting, and development conditions are often in a few minutes to tens of minutes to climax occur immediately hemiplegia and confusion or coma, coma patient breathing deep with snoring. Some patients with clinical manifestations in between, relying on clinical manifestations is difficult to identify needed to be done, the vertebral biopsy, if necessary, can be checked by computer X-ray tomography (CT). In addition, the occurrence of cerebral thrombosis, the patient needs to be applied to the cerebral vasodilators. Thrombolytic agent and anticoagulant therapy. Cerebral hemorrhage patients need to be quiet, to minimize moving, the best place for medical treatment to prevent bleeding heavier available hemostatic agents, discretionary use of antihypertensive drugs.