patients Cerebral infarction

Causes and symptoms


What is a cerebral infarction or TIA?

A cerebral infarction occurs when a cerebral artery is blocked by a blood clot. A TIA is a temporary short-term blockage of an artery that causes the same symptoms as a cerebral infarction.

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What is a cerebral infarction or TIA?

A cerebral infarction occurs when a cerebral artery is blocked by a blood clot. Part of the brain no longer receives blood and in turn, no oxygen or nutrients. As a result, this part of the brain can no longer function properly. It cannot send or receive any information anymore. You will notice this because you experience loss of function, such as the inability to speak properly, paralysis or loss of sensation on one side of the body, or reduced field of vision. If this situation lasts longer, the brain tissue dies and there is a high risk of permanent loss of function.

TIA

A TIA (Transient Ischemic Attack) is a temporary short-term blockage of an artery that causes the same symptoms as a cerebral infarction. A TIA may be a precursor to a cerebral infarction. For this reason, people who have had a TIA are at increased risk of cerebral infarction.
 
Always call your general practitioner if you think you have or have had a TIA. If symptoms persist after 5-10 minutes, call the emergency line of the general practitioner immediately. During the evening/night, call the emergency line for the general practitioner after hours service or 112. If you no longer have any symptoms, call your general practitioner immediately on the normal line.

Causes of cerebral infarction or TIA at a young age

One of the main causes of early cerebral infarction or TIA is arterial dissection (a tear in the blood vessel wall).

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Causes of cerebral infarction or TIA at a young age

The chance that a person will experience a cerebral infarction or TIA at a young age (younger than 50 years of age) is relatively small. There are several causes. The cause of a cerebral infarction or TIA at a young age is unknown in over 30% of cases.

Arterial dissection

One of the main causes of early cerebral infarction or TIA is arterial dissection (a tear in the blood vessel wall). The wall of a blood vessel consists of several layers. During a dissection, a tear occurs in the inner lining of the blood vessel wall, causing the inside of the blood vessel wall to become detached from the outer part. This damage to the blood vessel wall can then cause blood clots. The blood clots may cause a blockage in the blood vessels of the brain.

A dissection can occur in the artery at the front of the neck (carotid), in the neck (vertebral), or in the arteries in the head. The prognosis of a cerebral infarction (with good recovery) due to a dissection is relatively favorable because the chance of recurrence over the long term is much smaller than with atherosclerosis (hardening of the arteries). Causes of dissection may be:
  • an accident
  • connective tissue disorder
  • fibromuscular dysplasia (FMD group)

Arteriosclerosis

The inner wall of blood vessels is normally smooth so that blood can flow undisturbed through the vessels. Known risk factors for cardiovascular disease such as high blood pressure, high cholesterol, diabetes, and smoking can damage this wall. This process is called atherosclerosis or arteriosclerosis. This can cause the artery to gradually clog and get partially occluded. This often occurs in the carotid arteries, but can also occur in the small cerebral vessels and cause problems there. This partial occlusion can destroy the carotid artery on the inside or cause abnormal blood flow. A blood clot is formed at this location, which is carried along the blood stream and can then cause a complete blockage in the cerebral blood vessels (arterial embolism).

Heart problems

This may include atrial fibrillation or Patent Foramen Ovale (PFO).

Other causes

However, other causes may also play a role in the development of a cerebral infarction or TIA at a young age:
  • antiphospholipid syndrome
  • familial hypercholesterolemia
  • fibromuscular dysplasia
  • drug use (in the past), including cocaine and MDMA

Symptoms acute phase

A cerebral infarction (usually) starts with sudden symptoms of loss of function. The most common symptoms are:

  • the mouth may droop due to one-sided facial paralysis
  • slurred or difficult speech
  • paralysis of one arm and/or leg
  • loss of strength or paralysis in a leg
  • sudden double vision
  • halved field of vision or sudden blindness
  • severe vertigo
  • coordination and balance disorders
  • very serious, sudden headache without cause

Admission to hospital

If you have recently had a TIA, cerebral infarction, or hemorrhage, you may need some extra attention during the initial period. You will then be admitted to the stroke unit in the Neurology nursing department.

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Admission to hospital

If you have recently had a TIA, cerebral infarction, or hemorrhage, you may need some extra attention during the initial period. You will then be admitted to the stroke unit in the Neurology nursing department. For about 24 hours, your vital signs (such as blood pressure and heart rate) will be monitored in this department. If you are stable, it will be determined in collaboration with other healthcare providers what place has the right care available for rehabilitation. This may be in your home, with or without assistance, in a rehabilitation center, or in the special rehabilitation department in a nursing home of your choice.

Treatments


Medication, surgery, and lifestyle

There are different ways to treat a cerebral infarction. Risk factors and lifestyle also play an important role.

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Medication, surgery, and lifestyle

Medication

Immediately after a cerebral infarction or TIA there is an increased risk of a new cerebral infarction or TIA (stroke). To reduce the risk of a new stroke, you will be given medication that affects blood clotting. These are antiplatelets such as Clopidogrel (Grepid). These medications prevent platelets from clumping.
 
In some patients the blood clots are caused by an irregular heart rhythm (atrial fibrillation). In this case, blood clotting can be treated with other medications that affect the clotting. This can be done with medication provided by the anticoagulation clinic (such as sintrom mitis) or with new anticoagulants, also called "NOAC" or "DOAC". The advantage of this latter group of new medicines is that you don't have to go to the anticoagulation clinic anymore. In that case, it is not necessary to check the degree of blood thinning.
 
“Lifelong” medication after TIA or cerebral infarction at a young age
After a TIA or cerebral infarction at a young age, you are often prescribed medication. This medication is aimed at preventing new TIAs or cerebral infarctions and is often prescribed for life. This treatment is based on research done on all persons who have had a TIA or a cerebral infarction, i.e. both younger and older persons.
 
In recent years there has been more research into people who have had a TIA or cerebral infarction at a young age. It shows that lifelong medication is not necessary for everyone. This does not mean you can simply stop your medication now. The question of whether you can stop your medication depends on your personal situation and on the cause of your TIA or cerebral infarction. Check this with your treating neurologist. Never stop your medication without consulting your neurologist.
 

Risk factors

Increased blood pressure and cholesterol are important risk factors for the development of diseased blood vessels and the formation of blood clots. This is why almost every cerebral infarction patient is prescribed medication that lowers cholesterol and blood pressure. Your lifestyle is also important in preventing cerebral infarctions and TIAs. Examples include not smoking, a healthy diet, and sufficient exercise. We pay a lot of attention to this during the treatment and aftercare.
 

Surgery

In some patients, a clogged carotid artery is the cause of a TIA or cerebral infarction. This important cerebral blood vessel is then narrowed. Surgery can resolve this narrowing. If surgery is necessary, the doctor who performs the operation will discuss this in detail with you.

 


Rehabilitation aimed at improving complaints and limitations

Brain damage can cause many different complaints, such as loss of strength, memory problems, difficulty speaking, or spasticity. Rehabilitation is aimed at reducing the symptoms and problems in order to be able to function as well as possible again.

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Rehabilitation aimed at improving complaints and limitations

Brain damage can cause many different complaints, such as loss of strength, memory problems, difficulty speaking, or spasticity. Rehabilitation is aimed at reducing the symptoms and problems in order to be able to function as well as possible again. Depending on the complaints and how they limit a person's daily activities, different therapies are used. For example, physiotherapy for problems with walking and occupational therapy when self-care is difficult.
 
This can sometimes be with a primary care practitioner, i.e. a therapist in the neighborhood. If there are problems in more areas, treatment by a rehabilitation team led by a rehabilitation doctor is usually necessary. You can then be admitted to a rehabilitation center or follow a day treatment program from home in a rehabilitation center.
 
The rehabilitation doctor may treat spasticity with medication or injections. Speech and language problems are treated by a speech therapist. Cognitive and mood problems are examined and treated by a neuropsychologist. The rehabilitation team often pays attention to resuming work after a stroke at a young age. 

Rehabilitation at a later stage

Sometimes problems caused by the brain injury only become apparent after a long period of time. In this case as well, the general practitioner, neurologist, neurosurgeon, or nurse specialist can refer you for treatment by a therapist in the neighborhood, the treatment program Hersenz, or a rehabilitation doctor. Problems that only become apparent after a longer period of time often consist of behavioral changes and cognitive issues, such as difficulty with memory, planning, or dual-tasking and slow thought. This often requires specialized rehabilitation.

Aftercare

At the aftercare clinic you will have an interview with a nurse specialist or a specialized nurse. You can ask questions or discuss problems that have arisen after your cerebral infarction, brain hemorrhage, or TIA.

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Aftercare

At the aftercare clinic you will have an interview with a nurse specialist or a specialized nurse. You can ask questions or discuss problems that have arisen after your cerebral infarction, brain hemorrhage, or TIA. For example, problems with memory, attention, concentration and fatigue, side effects of medication, or new complaints. They can then give you advice or tips, or refer you to the right place that can support you in this.
 
They also pay attention to the risk factors of cerebral infarction, brain hemorrhage, or TIA, such as high cholesterol levels, high blood pressure, smoking, diabetes, and obesity. They will give you advice or refer you to a general practitioner or a medical professional.