Ischemic stroke: Cerebral thrombosis, cerebral embolism and lacunar infarction
Ischemic cerebrovascular disease accounts for 60% to 70% of all strokes. (1) Cerebral thrombosis: also known as thrombotic cerebral infarction. The most common cause is arteriosclerosis, followed by hypertension. It usually occurs during rest or sleep at night. After the onset of the disease, a CT scan should be performed as soon as possible to rule out cerebral hemorrhage. MRI can detect large-area cerebral infarction in the early stage, with a lesion detection rate of 95%. (2) Cerebral embolism: The embolus enters the cerebral blood vessels with the blood flow and causes acute occlusion. It is characterized by a rapid onset, and headache and vomiting are common after the onset of the disease. Patients often have a history of rheumatic heart disease, myocardial infarction, and atrial fibrillation. (3) Lacunar infarction: caused by hypertension and its associated hyaline degeneration of small arteries. The diameter of the infarct does not exceed 20 mm, and small empty sacs remain due to the phagocytosis of softened necrotic tissue. The clinical symptoms are mild or even asymptomatic. CT can show lesions of 2 to 20 mm in the blood supply area of deep penetrating branches.
Table 7 Differentiation between Cerebral Infarction and Cerebral Hemorrhage | Differentiation Points | Cerebral Infarction | Cerebral Hemorrhage | | :--- | :--- | :--- | | Age of Onset | Mostly over 60 years old | Mostly under 60 years old | | Onset State | Quiet state or sleep | Dynamic onset (during activity or emotional excitement) | | Onset Speed | Peak in 10 hours or 1-2 days | Peak in 10 minutes to several hours | | Global Brain Symptoms | Mild or absent | Symptoms of increased intracranial pressure such as headache, vomiting, and drowsiness | | Altered Consciousness | Usually mild or absent | More common and severe | | Neurological Signs | Mostly asymmetrical hemiplegia | Mostly symmetrical hemiplegia | | Head CT | Low-density lesions in brain parenchyma | High-density lesions in brain parenchyma | | Cerebrospinal Fluid | Colorless and transparent | Bloody |
For ischemic stroke, ultra-early thrombolytic therapy should be pursued. Generally, within 6 hours is considered the effective treatment time. Conventional therapies include: ① Thrombolysis: commonly used urokinase and rt-PA. ② Anticoagulation: commonly used heparin and warfarin. ③ Fibrinolysis: fibrinolytic enzymes, batroxobin, and lumbrokinase. Adjunctive therapy uses aspirin to inhibit platelet aggregation. Neurotrophic drugs include ATP, coenzyme A, and cerebrolysin. Atherosclerosis is a chronic inflammatory proliferative lesion of the arterial intima. It is named for its yellowish, porridge-like appearance due to the accumulation of lipids in the intima. Excessive LDL-C accumulation in the vessel wall leads to endothelial damage. Oxidized LDL is cytotoxic. Macrophages take up large amounts of cholesterol, becoming foam cells and forming atherosclerotic plaques.
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