Cerebrovascular infarction
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Cerebrovascular Infarction: Risk Factors, Pathophysiology, and Prognosis
Introduction to Cerebrovascular Infarction
Cerebrovascular infarction, commonly known as a stroke, occurs when blood flow to a part of the brain is interrupted, leading to tissue damage. This condition can result from various underlying mechanisms and is influenced by multiple risk factors. Understanding these factors and the pathophysiology of cerebrovascular infarction is crucial for effective prevention and management.
Risk Factors for Cerebrovascular Infarction
Age and Hypertension
Age is a significant risk factor for cerebrovascular events. Older individuals are more susceptible to strokes, with studies showing a higher incidence in patients aged 65 and above 14. Hypertension is another critical risk factor, particularly for subcortical infarcts. Elevated systolic and diastolic blood pressure levels are strongly associated with both prevalent and incident subcortical infarcts 610.
Cardiac Conditions
Cardiac conditions, especially those leading to embolic events, are major contributors to cerebrovascular infarctions. Embolic infarctions of cardiac origin are prevalent among younger adults suffering from cerebral infarction 2. Additionally, the coexistence of myocardial infarction and cerebrovascular accidents is not uncommon, particularly in elderly patients with degenerative arterial diseases 7.
Carotid Artery Stenosis
Carotid artery stenosis can lead to acute cerebrovascular syndromes. The presence of vulnerable plaques in the carotid arteries is associated with cortical infarctions, while reduced cerebral perfusion due to impaired cerebrovascular reactivity (CVR) can result in border-zone infarctions 35.
Diabetes and Other Metabolic Conditions
Diabetes is a notable risk factor for cerebrovascular infarctions, particularly for subcortical infarcts. Elevated fasting glucose and hemoglobin A1c levels are associated with an increased risk of silent cerebral infarctions (SCI) 610.
Pathophysiology of Cerebrovascular Infarction
Hemodynamic Factors
The pathophysiology of cerebrovascular infarction involves complex hemodynamic changes. In cases of carotid artery stenosis, the type and location of infarcts are influenced by cerebral blood flow (CBF) and CVR. For instance, cortical infarctions are often linked to normal CBF but impaired CVR, while mixed-pattern infarctions are associated with both impaired CBF and CVR 3.
Thromboembolic Events
Thromboembolic events play a crucial role in the development of cerebral infarctions. Thrombi or emboli in relevant arteries are found in a significant number of large recent infarcts. These events can lead to occlusions that cause ischemic damage to brain tissues 48.
Silent Cerebral Infarctions
Silent cerebral infarctions (SCI) are asymptomatic but can be detected through imaging studies. They are prevalent in apparently normal adults and are associated with risk factors such as old age, hypertension, and a history of coronary artery disease. SCIs often occur in the basal ganglia and periventricular white matter 10.
Prognosis and Outcomes
Mortality and Morbidity
The prognosis of patients who experience cerebrovascular events varies. The mortality rate is significantly higher in patients who suffer a cerebrovascular event compared to those who do not. For instance, the mortality rate in patients with cerebrovascular events post-myocardial infarction is notably higher 1. Additionally, the presence of multiple lacunar infarctions is associated with a poorer prognosis due to the cumulative impact on cerebral function 5.
Recovery and Long-term Effects
Recovery from cerebrovascular infarction can vary widely. In younger adults, a significant proportion of patients recover completely or show improvement over time 2. However, the presence of multiple risk factors and the severity of the infarction can influence long-term outcomes.
Conclusion
Cerebrovascular infarction is a multifaceted condition influenced by various risk factors, including age, hypertension, cardiac conditions, and metabolic disorders. Understanding the pathophysiological mechanisms and identifying high-risk individuals are essential for effective prevention and management strategies. Early detection and targeted interventions can significantly improve outcomes for patients at risk of or suffering from cerebrovascular infarctions.
Sources and full results
Most relevant research papers on this topic
Cerebrovascular events after myocardial infarction: analysis of the GISSI trial. Gruppo Italiano per lo Studio della Streptochinasi nell'Infarto Miocardico (GISSI).
Cerebrovascular events after myocardial infarction are low but increase morbidity and mortality, with age and poor haemodynamic state being significant risk factors.
RCT
Large Human Trial
Highly CitedPathophysiology of acute cerebrovascular syndrome in patients with carotid artery stenosis: a magnetic resonance imaging/single-photon emission computed tomography study.
Acute cerebrovascular syndrome in carotid artery stenosis is caused by vulnerable plaque and reduced cerebral perfusion, with both factors implicated in mixed-pattern infarctions.
Observational Study
Rigorous JournalIschaemic cerebrovascular diseases in an autopsy series. 2. Prevalence, location, pathogenesis, and clinical course of cerebral infarcts.
Ischemic cerebrovascular disease is prevalent, with thrombotic and embolic infarcts evenly distributed in the brain, and patients with embolism have a shorter survival time.
Observational StudyHighly CitedImpaired cerebrovascular reactivity as a risk marker for first-ever lacunar infarction: A case-control study.
Impaired cerebrovascular reactivity is a risk marker for first-ever lacunar infarction, with male sex, age, and presence of lacunar infarction on imaging as significant factors.
Observational StudyHighly CitedCerebrovascular Risk-Factors of Prevalent and Incident Brain Infarcts in the General Population: The AGES-Reykjavik Study
The risk for subcortical infarcts increases with small vessel disease risk-factors like hypertension and diabetes, while the risk for cortical infarcts increases with atrial fibrillation.
Observational StudyUNSUSPECTED CARDIAC INFARCTION WITH CEREBROVASCULAR ACCIDENTS
Unsuspected cardiac infarction is occasionally associated with cerebrovascular accidents in elderly patients, highlighting the importance of recognizing the coexistence of both cardiac and cerebral conditions.
Cerebral Apoplexy (Stroke): Pathogenesis, Pathophysiology and Therapy as Illustrated by Regional Blood Flow Measurements in the Brain
Cerebral apoplexy (stroke) is a complex, occlusive disease with a variety of treatment options, including anticoagulants and surgical reconstruction of arteries.
Highly CitedFatal cerebral infarction simulating an acute expanding lesion.
Cerebrovascular infarctions can mimic brain tumors, but these cases often die within a few days, highlighting the need for clinical differentiation between these two types of infarction.
Case ReportPrevalence and risk factors of silent cerebral infarction in apparently normal adults.
Silent cerebral infarction (SCI) is prevalent in 5.1% of symptom-free adults, with old age, hypertension, and mild alcohol consumption as risk factors, and mild alcohol consumption as a protective factor.
Observational StudyHighly Cited