Cerebral infarction: Difference between revisions

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{{Infobox medical condition (new)
 
| name            = Ischemic Stroke
 
| image          = Cerebral infarction.jpg
A type of [[stroke]] caused when a [[blood vessel]] that supplies [[blood]] to the [[brain]] is blocked by a [[blood clot]] or plaque.
| caption        = Cerebral infarction as seen on brain imaging
| field          = [[Neurology]], [[Emergency medicine]]
| symptoms        = [[Sudden numbness]], [[confusion]], [[vision loss]], [[dizziness]], [[severe headache]]
| complications  = [[Brain damage]], [[seizures]], [[paralysis]], [[dementia]], [[death]]
| onset          = Sudden
| duration        = Variable, may be permanent
| types          = [[Thrombotic stroke]], [[Embolic stroke]], [[Transient ischemic attack]]
| causes          = [[Atherosclerosis]], [[blood clot]], [[cardioembolism]]
| risks          = [[Hypertension]], [[smoking]], [[diabetes mellitus]], [[hyperlipidemia]], [[atrial fibrillation]], [[obesity]]
| diagnosis      = [[CT scan]], [[MRI]], [[carotid ultrasound]], [[blood tests]]
| differential    = [[Hemorrhagic stroke]], [[migraine]], [[seizure]], [[brain tumor]]
| prevention      = [[Healthy lifestyle]], [[antiplatelet drugs]], [[blood pressure control]], [[cholesterol management]], [[HPV vaccine]]
| treatment      = [[Thrombolysis]], [[thrombectomy]], [[anticoagulation]], [[rehabilitation]]
| medication      = [[Tissue plasminogen activator]], [[aspirin]], [[clopidogrel]], [[warfarin]]
| prognosis      = Better with early treatment; worsens with time and extent of damage
| frequency      = Most common type of [[stroke]]
| deaths          = Major cause of [[disability]] and [[mortality]] worldwide
}}
An '''ischemic stroke''' is a type of [[stroke]] that occurs when the [[blood supply]] to a part of the [[brain]] is interrupted or reduced due to a [[blood clot]] or [[plaque]] obstructing a [[blood vessel]]. This deprives brain tissue of oxygen and nutrients, leading to cell death within minutes. Ischemic strokes account for approximately 85% of all strokes.


== Causes ==
== Causes ==
Ischemic strokes are usually caused by a piece of [[plaque]] or a [[blood clot]] that blocks blood flow to the brain.
== Plaque buildup ==
When a fatty substance called plaque builds up on the inner walls of the arteries, it can lead to a disease called atherosclerosis. Plaque hardens and narrows the arteries, which limits blood flow to tissues and organs.
Plaque can build up in any artery in the body, including arteries in the brain and neck. Carotid artery disease is when plaque builds up in the carotid arteries in the neck that supply blood to the brain. It is a common cause of ischemic stroke.
== Blood clots in the brain ==
[[File:Cerebral infarction.jpg|alt=Cerebral infarction|thumb|Cerebral infarction]]
Plaque in an artery can break open. Blood platelets stick to the site of the plaque injury and clump together to form blood clots. These clots can partly or fully block an artery.
A blood clot that forms in one part of the body can also break loose and travel to the brain. This type of ischemic stroke is called an embolic stroke. Certain heart and blood conditions, such as atrial fibrillation and sickle cell disease, can cause blood clots that lead to stroke.


== Inflammation ==
=== Atherosclerosis and Plaque Buildup ===
[[Atherosclerosis]] occurs when fatty deposits, known as [[plaque]], build up inside the [[arteries]]. This process can narrow the arteries, including those in the neck (such as the [[carotid arteries]]), reducing blood flow and increasing the risk of stroke. If a plaque ruptures, it can trigger the formation of a blood clot.


Chronic (long-term) inflammation contributes to ischemic stroke. Researchers are still trying to understand this fully. We know that inflammation can damage the blood vessels and contribute to atherosclerosis, however. In addition, ischemic stroke can lead to inflammation that further damages brain cells.
=== Blood Clots and Emboli ===
Blood clots may form directly in cerebral vessels ('''thrombotic stroke''') or elsewhere in the body—such as the [[heart]]—and travel to the brain ('''embolic stroke'''). Conditions like [[atrial fibrillation]], [[myocardial infarction]], and [[valvular heart disease]] can increase the risk of emboli.


== Transient ischemic attack ==
=== Inflammation ===
Chronic [[inflammation]]—due to infections or autoimmune disorders such as [[lupus]] or [[rheumatoid arthritis]]—can damage vascular walls and promote clot formation, contributing to ischemic stroke risk.


A [[transient ischemic attack]] (TIA) is caused by a blockage in the brain just like an ischemic stroke. But the blockage breaks up before there is any damage to your brain. It typically lasts less than an hour but can come and go. Eventually, it can progress to a full stroke. A TIA is also called a mini-stroke.
== Transient Ischemic Attack (TIA) ==
<youtube>
A [[transient ischemic attack]] or "mini-stroke" is caused by a temporary blockage of blood flow to the brain. Symptoms usually resolve within minutes to hours and do not cause permanent damage, but TIAs are warning signs for future full-blown strokes.
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== Risk factors ==
There are many risk factors for stroke. You can treat or control some of your risk factors, such as high blood pressure and smoking. But you cannot control others such as your age or sudden changes in your health—for example, if you have an aneurysm.
[[File:Blood clot diagram.png|alt=Blood clot|thumb|Blood clot]]
The major [[risk factor]]s for stroke include:


* [[High blood pressure]]
== Risk Factors ==
 
Common risk factors for ischemic stroke include:
* [[Diabetes]]
 
* [[Heart disease|heart]] and [[blood vessel disease]]s. Conditions that can cause [[blood clot]]s or other blockages include [[coronary heart disease]], [[atrial fibrillation]], [[heart valve disease]], and [[carotid artery disease]].
 
* High LDL cholesterol levels


* [[Hypertension]]
* [[Diabetes mellitus]]
* [[Hyperlipidemia]]
* [[Smoking]]
* [[Smoking]]
* [[Atrial fibrillation]] and other [[cardiac arrhythmias]]
* [[Carotid artery disease]]
* Use of [[oral contraceptives]]
* [[Obesity]] and physical inactivity
* Excessive [[alcohol consumption]] and [[drug abuse]]
* [[Chronic kidney disease]]
* [[Sleep apnea]]
* [[Age]] (risk increases over 55)
* [[Sex]] (men at younger age; women higher lifetime risk)
* [[Race and ethnicity]] (higher in [[African Americans]], [[Native Americans]], [[Hispanics]])
* [[Genetics]] and [[family history]]
* [[Psychosocial stress]], [[depression]], [[social isolation]]
* Exposure to [[air pollution]]


* [[Brain aneurysm]]s or arteriovenous malformations (AVMs). AVMs are tangles of poorly formed arteries and veins that can break open in the brain.
[[File:Blood clot diagram.png|thumb|right|A blood clot can block blood flow to the brain, causing an ischemic stroke]]
 
* [[Infection]]s or conditions that cause inflammation, such as lupus or rheumatoid arthritis
 
* [[Age]]. A stroke can happen at any age, but the risk is higher for babies under the age of 1 and for adults. In adults, the risk increases with age.
 
* [[Sex]]. At younger ages, men are more likely than women to have a stroke. But women tend to live longer, so their lifetime risk of having a stroke is higher. Women who take birth control pills or use hormone replacement therapy are at higher risk. Women are also at higher risk during pregnancy and in the weeks after giving birth. High blood pressure during pregnancy—such as from preeclampsia—raises the risk of stroke later in life.
 
* [[Race]] and [[ethnicity]]. In the United States, stroke occurs more often in African American, Alaska Native, American Indian, and Hispanic adults than in white adults.
 
* [[Family history]] and [[genetics]]. Your risk of having a stroke is higher if a parent or other family member has had a stroke, particularly at a younger age. Certain genes affect your stroke risk, including those that determine your blood type. People with blood type AB (which is not common) have a higher risk.
 
* Other risk factors for stroke—some of which you can control—include:
 
* [[Anxiety]], [[depression]], and high [[stress]] levels. Working long hours and not having much contact with friends, family, or others outside the home are also linked with higher risk of stroke.
 
* Living or working in areas with [[air pollution]].
 
* Other medical conditions, such as certain [[bleeding disorders]], [[sleep apnea]], [[kidney diseas]]e, [[migraine]] headaches, and [[sickle cell disease]].
 
* Blood-thinners or other medicines that can lead to bleeding.
 
* Other unhealthy lifestyle habits, including eating unhealthy foods, not getting regular physical activity, drinking alcohol, getting too much sleep (more than 9 hours), and using illegal drugs such as cocaine.
 
* [[Overweight]] and [[obesity]] or carrying extra weight around your waist and stomach.


The signs and symptoms of a stroke often develop quickly. However, they can develop over hours or even days, such as when a transient ischemic attack (TIA) turns into a stroke.
== Signs and Symptoms ==
Symptoms develop suddenly and may include:


== Symptoms ==
* [[Numbness]] or [[weakness]] on one side of the body
The type of symptoms depends on the type of stroke and the area of the brain that is affected.
* Trouble [[speaking]] or understanding language
* Vision loss in one or both eyes
* [[Dizziness]] or [[loss of coordination]]
* [[Severe headache]] without known cause


This animation discusses symptoms of stroke, also described below. Medical Animation Copyright © 2020 Nucleus Medical Media, All rights reserved.external link
=== FAST Acronym ===
 
* '''F''' – Face drooping
Signs and symptoms of a TIA or stroke may include:
* '''A''' – Arm weakness
 
* '''S''' – Speech difficulty
* Sudden numbness or weakness, especially on one side of the body
* '''T''' – Time to call [[emergency medical services]]
 
* Sudden confusion or trouble speaking or understanding speech
 
* Sudden trouble seeing in one or both eyes
 
* Sudden trouble walking, dizziness, or loss of balance or coordination
 
* Sudden severe headache with no known cause
 
* The FAST test can help you remember what to do if you think someone may be having a stroke:
 
* F—Face: Ask the person to smile. Does one side of the face droop?
 
* A—Arms: Ask the person to raise both arms. Does one arm drift downward?
 
* S—Speech: Ask the person to repeat a simple phrase. Is their speech slurred or strange?
 
* T—Time: If you observe any of these signs, call 9-1-1 right away. Early treatment is essential.


== Complications ==
== Complications ==
Without rapid treatment, ischemic stroke can lead to:


A stroke can cause lasting brain damage, long-term disability, or even death. When you have a stroke, your doctor may rate how severe it is. A more severe stroke means more brain tissue was damaged. When there has been significant damage, your doctor may call it a massive stroke. This can mean more severe complications.
* [[Brain edema]] or swelling
 
* [[Paralysis]] or [[muscle weakness]]
After having a stroke, you may develop complications such as:
* [[Aphasia]] or language impairment
 
* [[Cognitive decline]] and [[dementia]]
* Dangerous blood clots. Being unable to move around for a long time can raise your risk of developing blood clots in the deep veins of the legs. In some cases, blood clots can break loose and travel to the lungs. Your stroke care team may try to prevent these complications with medicine or a device that puts pressure on your calves to keep your blood flowing.
* [[Seizures]]
 
* [[Pneumonia]] due to swallowing dysfunction
* Difficulty speaking. If a stroke affects the muscles you use to speak, you may have trouble communicating as easily as before.
* [[Urinary incontinence]]
 
* [[Depression]] and mood disorders
* Loss of bladder or bowel control. Some strokes affect the muscles used to urinate and have bowel movements. You may need a urinary catheter (a tube placed into the bladder) until you can urinate on your own. Use of these catheters can lead to urinary tract infections. You may also lose control of your bowels or be constipated.
* [[Deep vein thrombosis]] and [[pulmonary embolism]]
 
* Loss of bone density or strength. This usually happens on one side of the body. Physical activity as part of rehabilitation can help prevent this loss. Your care team may also evaluate you for osteoporosis.
 
* [[Loss of vision]], hearing, or touch. Your ability to feel pain or temperature may be affected after a stroke, or you may have trouble seeing or hearing as well as before. Some of these changes could affect your ability to cook, read, change your clothes, or do other tasks.
 
* [[Muscle weakness]] or inability to move. A stroke can make your muscles become weak and stiff or cause them to spasm. This can be painful or make it hard to stand or walk around on your own. You may also have problems with balance or controlling your muscles. This puts you at risk of falling.
 
* Problems swallowing and pneumonia. If a stroke affects the muscles used for swallowing, you may have a hard time eating or drinking. You may also be at risk of inhaling food or drink into your lungs. If this happens, you may develop pneumonia.
 
* Problems with language, thinking, or memory. Stroke may affect your ability to focus on a task or make decisions quickly. It also raises the risk of dementia.
 
* [[Seizures]]. This is more common in the weeks after a stroke and is less likely as time goes on. If you have seizures, your stroke team may give you medicine.
 
* Swelling in the brain. After a stroke, fluid may build up between the brain and the skull or in the cavities of the brain, causing swelling. Doctors may drain fluid from the brain or cut away part of the skull to relieve the pressure on your brain.


== Diagnosis ==
== Diagnosis ==
Evaluation involves:


During the physical exam, your doctor will check you for:
=== Physical Examination ===
* Neurological exam to assess mental status, motor strength, coordination, and cranial nerve function


* Confusion
=== Imaging ===
* [[CT scan]] – often the first test to rule out [[hemorrhagic stroke]]
* [[MRI]] – better for detecting ischemic changes
* [[CT angiography]] or [[carotid ultrasound]] – evaluates vascular blockages


* Coordination and balance
=== Laboratory Tests ===
* [[Blood glucose]], [[CBC]], [[coagulation profile]], [[electrolytes]]


* Mental alertness
=== Cardiac Evaluation ===
 
* [[Electrocardiogram]] (ECG)
* Numbness or weakness in your face, arms, and legs
* [[Echocardiogram]] to check for [[cardiac emboli]]
 
* Trouble speaking or seeing clearly
 
The exam will help your doctor determine how severe your stroke was and plan your treatment.
 
== Diagnostic tests and procedures ==
 
An an imaging test to look at the blood vessels in your brain will help determine what type of stroke you have and where exactly it happened. The quicker these tests can be done, the better your doctor can treat you. Tests to diagnose stroke include the following:
 
[[Computed tomography]] (CT) uses X-rays to take clear, detailed pictures of your brain. It is often done right after a stroke is suspected. A brain CT scan can show if there is bleeding in the brain or damage to the brain cells from a stroke.
 
[[Magnetic resonance imaging]] (MRI) uses magnets and radio waves to create pictures of your brain. An MRI may be used instead of—or in addition to—a CT scan to diagnose a stroke. This test can detect changes in brain tissue and damage to brain cells.
 
Other imaging tests to look for narrowed blood vessels in the neck or an aneurysm or tangled blood vessels in the brain.
 
Your doctor may also order the following blood or heart tests.
 
Blood tests. Your doctor may test the blood and platelet count and glucose (sugar) levels in your blood to make sure they are stable and to see if a certain medicine can treat your stroke. Your doctor may also do blood tests to see how well your blood is clotting and to look for muscle damage.
 
[[Electrocardiogram]] (EKG). An EKG can help detect heart problems that may have led to a stroke. For example, this test can help diagnose atrial fibrillation or a previous heart attack.
 
[[Lumbar puncture]] (also called a spinal tap), if the imaging scan does not detect any bleeding in the brain but your doctor still thinks you may have had a hemorrhagic stroke. The doctor will use a needle to collect fluid from around your spine. The fluid will be tested for substances from broken-down blood cells.


== Treatment ==
== Treatment ==
A stroke requires emergency care. You will probably receive treatment in a specialized stroke unit of the hospital. A team of specialists will oversee your care. Treatment will depend on whether the stroke was ischemic or hemorrhagic, how much time has passed since symptoms began, and whether you have other medical conditions.
An ischemic stroke is a medical emergency that requires immediate care.


Treatment for an ischemic stroke or transient ischemic (TIA) may include medicines and medical procedures.
=== Medications ===


== Medicines ==
* '''tPA (Tissue Plasminogen Activator)''' – thrombolytic drug given within 3–4.5 hours of symptom onset
* '''Antiplatelets''' – such as [[aspirin]] or [[clopidogrel]]
* '''Anticoagulants''' – including [[warfarin]] or [[direct oral anticoagulants]] (DOACs) for cardioembolic strokes


The main treatment for an ischemic stroke is a medicine called tissue plasminogen activator (tPA). It breaks up the blood clots that block blood flow to your brain. A doctor will inject tPA into a vein in your arm. This type of medicine must be given within 3 hours after your symptoms start. In some cases, it is given up to 4.5 hours. The sooner treatment begins, the better your chances of recovery.
=== Surgical/Endovascular Procedures ===


If you cannot have tPA, your doctor may give an anticoagulant or blood thinning medicine, such as aspirin or clopidrogrel. This helps stop blood clots from forming or getting larger. The main side effect of these medicines is bleeding.
* '''[[Thrombectomy]]''' – mechanical removal of the clot
* '''[[Carotid endarterectomy]]''' – removes plaque from carotid arteries
* '''[[Angioplasty]] and [[stenting]]''' – opens narrowed vessels with balloons and stents


== Medical procedures ==
== Rehabilitation ==
Stroke rehabilitation includes:


You may need a procedure to open up blocked arteries and restore blood flow to the brain. This can be done several ways.
* [[Physical therapy]] – to regain strength and coordination
* [[Occupational therapy]] – to relearn daily tasks
* [[Speech therapy]] – for communication and swallowing difficulties
* [[Neuropsychology]] – for cognitive and emotional support


A [[thrombectomy]] removes the clot from the blood vessel. A surgeon will put a long, flexible tube called a catheter into your groin (upper thigh) and thread it to the blocked artery in your neck or brain. They will then use angioplasty and stenting or a device called a stent retriever to open up the blocked artery.
== Prevention ==
Preventive strategies include:


[[Angioplasty]] and [[stenting]] procedures use a thin tube to deliver a balloon or small mesh tube into the artery. Inflating the balloon or expanding the mesh tube clears space for blood to flow more easily to the brain.
* Managing [[blood pressure]], [[blood sugar]], and [[cholesterol]]
* Stopping [[smoking]]
* Healthy [[diet]] and regular [[exercise]]
* Use of [[statins]], [[antiplatelets]], and [[anticoagulants]] when indicated
* Treating [[atrial fibrillation]] and [[sleep apnea]]
* [[HPV vaccination]] and control of [[chronic infections]]


The stent retriever is a wire mesh inside the catheter that traps the clot. The stent retriever and the blood clot are then pulled out through the tube.
== Prognosis ==
Prognosis depends on the severity, timing of treatment, and location of brain damage. Early intervention improves survival and functional recovery. Some individuals may recover fully, while others face lifelong disability.


If carotid artery disease caused your stroke, your doctor may suggest carotid endarterectomy, a surgery to remove plaque from the carotid artery in your neck
== See Also ==
 
== Also see ==
* [[Stroke]]
* [[Stroke]]
* [[Hemorrhagic stroke]]
* [[Hemorrhagic stroke]]
* ICD 10 code for cerebral infarction: [[I63132]]
* [[Transient ischemic attack]]
{{stub}}
* [[Atherosclerosis]]
 
* [[Neurorehabilitation]]
{{Hemodynamics}}
* [[FAST (stroke)]]
{{Cerebrovascular diseases}}
* [[Cerebrovascular disease]]
 
{{Stroke}}
{{Cardiovascular diseases}}
{{Neuroscience}}
[[Category:Stroke]]
[[Category:Stroke]]
</translate>
[[Category:Cerebrovascular diseases]]
[[Category:Emergency medicine]]
[[Category:Neurology]]
[[Category:Brain disorders]]

Revision as of 18:10, 26 March 2025

Ischemic Stroke
Synonyms N/A
Pronounce N/A
Field Neurology, Emergency medicine
Symptoms Sudden numbness, confusion, vision loss, dizziness, severe headache
Complications Brain damage, seizures, paralysis, dementia, death
Onset Sudden
Duration Variable, may be permanent
Types Thrombotic stroke, Embolic stroke, Transient ischemic attack
Causes Atherosclerosis, blood clot, cardioembolism
Risks Hypertension, smoking, diabetes mellitus, hyperlipidemia, atrial fibrillation, obesity
Diagnosis CT scan, MRI, carotid ultrasound, blood tests
Differential diagnosis Hemorrhagic stroke, migraine, seizure, brain tumor
Prevention Healthy lifestyle, antiplatelet drugs, blood pressure control, cholesterol management, HPV vaccine
Treatment Thrombolysis, thrombectomy, anticoagulation, rehabilitation
Medication Tissue plasminogen activator, aspirin, clopidogrel, warfarin
Prognosis Better with early treatment; worsens with time and extent of damage
Frequency Most common type of stroke
Deaths Major cause of disability and mortality worldwide


An ischemic stroke is a type of stroke that occurs when the blood supply to a part of the brain is interrupted or reduced due to a blood clot or plaque obstructing a blood vessel. This deprives brain tissue of oxygen and nutrients, leading to cell death within minutes. Ischemic strokes account for approximately 85% of all strokes.

Causes

Atherosclerosis and Plaque Buildup

Atherosclerosis occurs when fatty deposits, known as plaque, build up inside the arteries. This process can narrow the arteries, including those in the neck (such as the carotid arteries), reducing blood flow and increasing the risk of stroke. If a plaque ruptures, it can trigger the formation of a blood clot.

Blood Clots and Emboli

Blood clots may form directly in cerebral vessels (thrombotic stroke) or elsewhere in the body—such as the heart—and travel to the brain (embolic stroke). Conditions like atrial fibrillation, myocardial infarction, and valvular heart disease can increase the risk of emboli.

Inflammation

Chronic inflammation—due to infections or autoimmune disorders such as lupus or rheumatoid arthritis—can damage vascular walls and promote clot formation, contributing to ischemic stroke risk.

Transient Ischemic Attack (TIA)

A transient ischemic attack or "mini-stroke" is caused by a temporary blockage of blood flow to the brain. Symptoms usually resolve within minutes to hours and do not cause permanent damage, but TIAs are warning signs for future full-blown strokes.

Risk Factors

Common risk factors for ischemic stroke include:

A blood clot can block blood flow to the brain, causing an ischemic stroke

Signs and Symptoms

Symptoms develop suddenly and may include:

FAST Acronym

Complications

Without rapid treatment, ischemic stroke can lead to:

Diagnosis

Evaluation involves:

Physical Examination

  • Neurological exam to assess mental status, motor strength, coordination, and cranial nerve function

Imaging

Laboratory Tests

Cardiac Evaluation

Treatment

An ischemic stroke is a medical emergency that requires immediate care.

Medications

Surgical/Endovascular Procedures

Rehabilitation

Stroke rehabilitation includes:

Prevention

Preventive strategies include:

Prognosis

Prognosis depends on the severity, timing of treatment, and location of brain damage. Early intervention improves survival and functional recovery. Some individuals may recover fully, while others face lifelong disability.

See Also



Stroke and related topics
Types
Risk factors
Diagnosis
Treatment
Prevention
This Stroke related articles is a stub.




Cardiovascular diseases
General
Diseases
Diagnostic tests
Treatments
Related topics
This cardiovascular disease related article is a stub.



Neuroscience
Basic
science
Clinical
neuroscience
Cognitive
neuroscience
Interdisciplinary
fields
Concepts
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