| Cerebral infarct | |
|---|---|
| Classification and external resources | |
 CT scan slice of the brain showing a right-hemispheric cerebral infarct (left side of image). |
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| ICD-10 | I 63 |
| ICD-9 | 434.01, 434.11, 434.91 |
| eMedicine | neuro/ |
| MeSH | D002544 |
A cerebral infarction is the ischemic kind of stroke due to a disturbance in the blood vessels supplying blood to the brain. It can be atherothrombotic or embolic.[1] From stroke caused by cerebral infarction two other kinds of stroke should be distinguished: cerebral hemorrhage and subarachnoid hemorrhage.
Contents |
Classification
There are various classification systems for a cerebral infarction.
- The Oxford Community Stroke Project classification (OCSP, also known as the Bamford or Oxford classification) relies primarily on the initial symptoms; based on the extent of the symptoms, the stroke episode is classified as total anterior circulation infarct (TACI), partial anterior circulation infarct (PACI), lacunar infarct (LACI) or posterior circulation infarct (POCI). These four entities predict the extent of the stroke, the area of the brain affected, the underlying cause, and the prognosis.[2][3]
- The TOAST (Trial of Org 10172 in Acute Stroke Treatment) classification is based on clinical symptoms as well as results of further investigations; on this basis, a stroke is classified as being due to (1) thrombosis or embolism due to atherosclerosis of a large artery, (2) embolism of cardiac origin, (3) occlusion of a small blood vessel, (4) other determined cause, (5) undetermined cause (two possible causes, no cause identified, or incomplete investigation).[4]
Symptoms
Symptoms of cerebral infarction are determined by topographical localisation of cerebral lesion. If it is located in primary motor cortex- contralateral hemiparesis occurs, for brainstem localisation typical are brainstem syndromes: Wallenberg's syndrome, Weber's syndrome, Millard-Gubler syndrome, Benedikt syndrome or others.
Treatment
In last decade, similar to myocardial infarction treatment, thrombolytic drugs were introduced in the therapy of cerebral infarction. The use of intravenous rtPA therapy can be advocated in patients who arrive to stroke unit and can be fully evaluated within 3 h of the onset.
References
- ^ Ropper, Allan H.; Adams, Raymond Delacy; Brown, Robert F.; Victor, Maurice (2005). Adams and Victor's principles of neurology. New York: McGraw-Hill Medical Pub. Division. pp. 686–704. ISBN 0-07-141620-X.
- ^ Bamford J, Sandercock P, Dennis M, Burn J, Warlow C (June 1991). "Classification and natural history of clinically identifiable subtypes of cerebral infarction". Lancet 337 (8756): 1521–6. doi:. PMID 1675378. http://linkinghub.elsevier.com/retrieve/pii/0140-6736(91)93206-O. Later publications distinguish between "syndrome" and "infarct", based on evidence from imaging. "Syndrome" may be replaced by "hemorrhage" if imaging demonstrates a bleed. See Internet Stroke Center. "Oxford Stroke Scale". http://www.strokecenter.org/trials/scales/oxford.html. Retrieved 2008-11-14.
- ^ Bamford JM (2000). "The role of the clinical examination in the subclassification of stroke". Cerebrovasc. Dis. 10 Suppl 4: 2–4. doi:. PMID 11070389.
- ^ Adams HP, Bendixen BH, Kappelle LJ, et al. (January 1993). "Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment" (PDF). Stroke 24 (1): 35–41. PMID 7678184. http://stroke.ahajournals.org/cgi/reprint/24/1/35.
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