CEREBRAL INFARCTION

What is cerebral infarction? What are its clinical treatments and home remedies?

Overview:

Infarction is the obstruction of the blood flow to an organ or tissues. The infarction is commonly caused by the formation of thrombus, a blood clot forms and adhere in the vein. It may also be caused by an embolus, a blood clot, or any other object that flows in blood vessels. It leads to the local death of tissue or organ. Cerebral infarction refers to an area of necrotic tissue in the brain developing from a blockage or narrowing in the arteries supplying oxygen and blood nutrients to the brain. The inadequate oxygen to the brain tissues due to restricted supplies can lead to Ischemic stroke results in an infarction if the blood flow is not restored in a short period of time. The blockage may be due to atheromatous stenosis, swelling in the artery wall, which may be cause narrowing of the lumen.

Seek medical awareness if you think that you or someone around you might be having an infarction or stroke. The more shortly you receive therapy the better will be the prognosis. If cerebral infarction remains untreated for a longer duration, it may cause permanent damage to the brain cells. The Brain cells proceed to die in a few minutes. 1

Causes:

The two main causes of the stroke include ischemic stroke, a blocked artery and hemorrhagic stroke, leaking of blood vessels.

Ischemic stroke:

Ischemic stroke is the most general type of stroke. It happens when the blood vessels become narrow or clogged. This clot prevents blood flow to the brain. This can also occur due to atherosclerosis, deposition of fats in the lumen of the artery. About 80% of all strokes are ischemic.

Hemorrhagic stroke:

It occurs when the blood vessels in the brain are ruptured, which leads seeping of blood in the brain tissues. It causes damage to brain cells. The most commonly hemorrhagic stroke is caused by high blood pressure. 2

Classification:

There are various classifications of cerebral infarction based on multiple evidence. Most of them are considered lethal. Some of the classes are discussed below.

The Oxford Community Stroke Project classification (OCSP) depends on the initial symptoms. These four entities signify the degree of stroke, the region of the brain affected, the prognosis, and the underlying cause of infarct. Based on the duration of the symptoms, the stroke attack is classified as.

• Total anterior circulation infarct.
• Partial anterior circulation infarct.
• Lacunar infarct.
• Posterior circulation infarct.

The Trial of Org 10172 in Acute Stroke Treatment (TOAST) relay on the clinical symptoms and requires further investigation.

• Thromboembolism due to atherosclerosis of the artery
• Blockage of small blood vessels.
• Embolism of cardiovascular lineage.3

Symptoms:

The specified symptoms for cerebral infarction or stroke depend on the area of the brain affected.

• Weakness or paralysis of limbs on one or both sides depending on the region of the artery affected.

• On physical examination, the area of the head will show abnormal pupil dilation, lack of eye movement on the opposite side, and light reaction.
• If the left side of the brain is affected by infarction, speech will be slurred.
• Loss of coordination and drooping of the face on one side
• Sudden, severe headache with an unknown cause. 2

Prevention:

The stroke can be prevented, and about 50% of the strokes are preventable. There are many standards you can take to help prevent stroke. Here are a few precautionary measures to reduce evidence of stroke.

• Maintain normal blood pressure.
• Control your sugar levels.
• Limit cholesterol and saturated fat intake.
• Eat healthily and do more exercise.
• Checking BMI and maintain a healthy weight.4

Treatment:

Stroke management and treatment depend on one of the following measures. Or it can be used together. Some supplements may cause negative outcomes when used with other medications that may double or deny the action of the medication. Check your doctor or other health care provider before taking any additional nutrients or supplements.

1. Complementary and Alternative treatment for stroke
2. Clinical treatment for stroke.

Complementary and Alternative Medicine:

Complementary and Alternative medicine (CAM) can support stroke recovery and prevention. CAM includes dietary supplements, massage, and acupuncture. Adding CAM to your health care habit may help to boost your healing process. It involves:

Massage:

Massage promotes blood flow to an affected area, particularly for stroke-related muscle problems. It helps to improve movement, and muscle tone after stroke, reduce pain and improve health. External counterpulsation (ECP) therapy might facilitate healing in people having an ischemic stroke. It helps to enhance the cardiovascular system by improving blood circulation.

Herbal Supplements, Vitamins, and nutrients:

Vitamins promote recovery and reduce secondary risk factors. Vitamin supplements should be used by the permission of your health care provider.

• Vitamin B complex could help to lower the levels of homocysteine, an amino acid that increase the chance of stroke.
• Vitamin C may help in the healing and repair of damaged blood vessels. Vitamin E supplements aid with memory impairment.

Nutrients such as Omega-3 fatty acids improve cholesterol levels and prevent cell damage. Magnesium may lower blood pressure and improve circulation.

Herbal supplements can improve blood circulation in the brain and support to prevent another stroke. Ashwagandha or, Indian ginseng that has been proven to treat or prevent stroke. Turmeric can help in lowering cholesterol levels, and Garlic prevents blood clotting and eradicate plaque.

Acupuncture:

It involves the insertion of micro-needles into the specific point of the body by the practitioners. It is helpful to relieve pain and manage different muscles problem characterized by stroke. 5

Clinical treatment for stroke:

The clinical treatment for this condition is based on Preventive Medications. There are two categories of the medication used to prevent a secondary stroke.

1. Anti-Platelet drugs.
2. Anticoagulants.

Anti-Platelet Drugs:

Anti-platelet drugs are also known as platelet aggression inhibitors. Platelets are the type of cells present in the blood that aggregate and forms clots. Anti-Platelet drugs make these cells less adhesive and less liable to clot. The most commonly used medication to prevent stroke is Aspirin. Consult your doctor before initiating medication therapy. Many other drugs are also available in this class, including:

• Clopidogrel (plavix)
• Prasugrel (effient)
• Ticagrelor (brilinta)

Anticoagulant:

These are the drugs that show their effect by a reduction in blood clotting. Heparin is fast-acting and is more frequently used in hospitals for emergencies. Warfarin can be used for the longer-term. The various precautionary measures should be made into consideration when using warfarin, including INR, international normalized ratio. Several new anticoagulants are also available for the prevention of stroke in high risked patients. These medications include:

• Rivaroxaban (Xarelto)
• Dabigatran (Pradaxa)
• Edoxaban (Savaysa) 6

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Reference:

1.        Harrison, M. J. G., Kendall, B. E., Pollock, S. & Marshall, J. Effect of haematocrit on carotid stenosis and cerebral infarction. Lancet 318, 114–115 (1981).

2.        Markus, H. Stroke: causes and clinical features. Medicine (Baltimore). 36, 586–591 (2008).

3.        Kim, B. J. & Kim, J. S. Ischemic stroke subtype classification: an Asian viewpoint. J. stroke 16, 8 (2014).

4.        Investigators, S. P. in A. F. Stroke prevention in atrial fibrillation study: final results. Circulation 84, 527–539 (1991).

5.        Durai Pandian, J. et al. Complementary and alternative medicine treatments among stroke patients in India. Top. Stroke Rehabil. 19, 384–394 (2012).

6.        Mas, J.-L. et al. Patent foramen ovale closure or anticoagulation vs. antiplatelets after stroke. N. Engl. J. Med. 377, 1011–1021 (2017).