Acute subacute infarction
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Acute and Subacute Infarction: Insights from Recent Research
Frequency and Demographics of Acute and Subacute Cerebral Infarction
Incidence in Population-Based Studies
Acute and subacute cerebral infarctions (CI) are relatively rare but significant findings in older populations. A study involving 2095 participants aged 50 to 98 years found that the frequency of incidental acute or subacute CI was 0.28% among MRI scans and 0.43% among unique individuals. The incidence was higher in participants aged 70 years or older, with most infarcts being asymptomatic and predominantly occurring in men.
Metabolic Changes in Cerebral Infarction
Proton magnetic resonance (MR) spectroscopic imaging has been instrumental in identifying metabolic changes in acute and subacute cerebral infarctions. Key findings include significant reductions in N-acetyl aspartate (NAA), choline, and creatine levels, along with increased lactate levels in the early stages of infarction. These metabolic changes can be detected as early as one day after symptom onset and provide valuable insights into the progression of cerebral infarcts.
Diagnostic Challenges and Techniques
Spinal Cord Infarction
Diagnosing spinal cord infarction (SCI) can be particularly challenging due to its rarity and the similarity of its symptoms to other conditions like multiple sclerosis. Diffusion-weighted imaging (DWI) has proven useful in differentiating acute to subacute SCI from other conditions, aiding in timely and accurate diagnosis.
Coronary Angiography Timing in Myocardial Infarction
The timing of coronary angiography (CAG) in patients with non-ST-elevation myocardial infarction (NSTEMI) is crucial. Studies comparing acute versus subacute CAG have shown no significant difference in outcomes such as all-cause death, reinfarction, and readmission with congestive heart failure. However, acute CAG is associated with earlier revascularization and shorter hospital stays, suggesting potential benefits in specific clinical settings .
Biomarkers and Clinical Outcomes
Biomarkers in Cerebral Venous Thrombosis
In patients with cerebral venous thrombosis (CVT), the presence of venous infarction is associated with more severe clinical presentations. Biomarkers such as high-sensitivity C-reactive protein (hs-CRP) and claudin-5 have been identified as significant indicators of venous infarction and are correlated with clinical severity, providing potential targets for therapeutic intervention.
Mechanical Complications Post-Myocardial Infarction
Mechanical complications following acute myocardial infarction (AMI), such as ventricular septal rupture (VSR) and free wall rupture (FWR), are rare but life-threatening. Early diagnosis and surgical intervention are critical for survival. Echocardiography and clinical assessment play vital roles in identifying these complications, with specific criteria showing high sensitivity and specificity for diagnosis .
Conclusion
Acute and subacute infarctions, whether cerebral or myocardial, present significant diagnostic and therapeutic challenges. Advances in imaging techniques and the identification of specific biomarkers have improved the ability to diagnose and manage these conditions effectively. Continued research and clinical vigilance are essential for optimizing outcomes in affected patients.
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