User:Cms1982/Cerebral infarction/Bibliography

Ischemic stroke usually presents as a problem with nerve, spinal cord, or brain function. Depending on where the stroke is located in the brain, symptoms may start within minutes, or they make take hours to present themselves. Most strokes occur without warning. Some common symptoms include one sided weakness, facial paralysis or numbness, vision problems, trouble speaking, problems with walking and keeping balanced. A person can show one or more of these symptoms during a stroke. If person has a decrease in consciousness, they may be suffering from a stroke in more than one part of the brain or in the brain stem.

Stroke Recognition by Medical Personnel
There are many tests that can be done to prescreen a patient who maybe showing stroke like symptoms. No one test is better than the other and they all have room for improvement. One of these tests that is used by prehospital personal is the Cincinatti Pre Hospital Stroke scale (CPSS). This test looks for facial droop, arm drift, and a change in the person's speech pattern. Another test that can be used and is a modification to the CPSS is the Face Arm Speech Test (FAST). This checks for facial weakness, arm weakness, and speech disturbances. The ROSIER (Recognition of Stroke in The ER), is a test used by an ER physician. Each variable is rated from a -2 to a +5. Loss of consciousness (-1), convulsive fit (-1), face weakness (+1), arm weakness (+1), leg weakness (+1), abnormal speech patterns (+1), and visual defect (+1).

treatment[edit]
In the 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 hours of the onset. The quicker rTPA is started, the better the outcome for the patient.

If cerebral infarction is caused by a thrombus occluding blood flow to an artery supplying the brain, definitive therapy is aimed at removing the blockage by breaking the clot down (thrombolysis), or by removing it mechanically (thrombectomy). The more rapidly blood flow is restored to the brain, the fewer brain cells die. In increasing numbers of primary stroke centers, pharmacologic thrombolysis with the drug tissue plasminogen activator (tPA), is used to dissolve the clot and unblock the artery. Giving rTPA lessens the chance of disability after 3 months by 30%. Another intervention for acute cerebral ischaemia is removal of the offending thrombus directly. This is accomplished by inserting a catheter into the femoral artery, directing it into the cerebral circulation, and deploying a corkscrew-like device to ensnare the clot, which is then withdrawn from the body. Mechanical embolectomy devices have been demonstrated effective at restoring blood flow in patients who were unable to receive thrombolytic drugs or for whom the drugs were ineffective, though no differences have been found between newer and older versions of the devices. The devices have only been tested on patients treated with mechanical clot embolectomy within eight hours of the onset of symptoms.

Angioplasty and stenting have begun to be looked at as possible viable options in treatment of acute cerebral ischaemia. In a systematic review of six uncontrolled, single-center trials, involving a total of 300 patients, of intra-cranial stenting in symptomatic intracranial arterial stenosis, the rate of technical success (reduction to stenosis of <50%) ranged from 90 to 98%, and the rate of major peri-procedural complications ranged from 4-10%. The rates of restenosis and/or stroke following the treatment were also favorable. This data suggests that a large, randomized controlled trial is needed to more completely evaluate the possible therapeutic advantage of this treatment.

If studies show carotid stenosis, and the patient has residual function in the affected side, carotid endarterectomy (surgical removal of the stenosis) may decrease the risk of recurrence if performed rapidly after cerebral infarction. Carotid endarterectomy is also indicated to decrease the risk of cerebral infarction for symptomatic carotid stenosis (>70 to 80% reduction in diameter).

In tissue losses that are not immediately fatal, the best course of action is to make every effort to restore impairments through physical therapy, cognitive therapy, occupational therapy, speech therapy and exercise.

Permissive hypertension - allowing for higher than normal blood pressures in the acute phase of cerebral infarction - can be used to encourage perfusion to the penumbra.

Computed tomography (CT) and MRI scanning will show damaged area in the brain. A CT scan will rule out a hemorrhagic stroke, is cheaper for the patient, and can be found in almost all hospitals unlike a MRI machine. Once the Doctor rules out a hemorrhagic stroke, TPA can be given. A MRI can help to diagnose an acute cerebral infarct as quickly as 6 hours from start of symptoms, It can also help time when the stroke happened. The biggest problem with a MRI is it can't be done on a patient with certain metallic implants or if the patient is claustrophobic. A head and neck CT angiogram can be preformed within 6 hours of onset of symptoms to see where the occlusion may be located which can help in determining the cause of the stroke. In people who die of cerebral infarction, an autopsy of stroke may give a clue about the duration from the infarction onset until the time of death. copied from

Risk factors
Major risk factors for cerebral infarction are generally the same as for atherosclerosis. These include high blood pressure, diabetes mellitus, tobacco smoking, obesity, and dyslipidemia. There are also risks that a person can control. These include age and women who are taking hormones. A person's risk of a stroke doubles each decade after the age of 55. The American Heart Association/American Stroke Association (AHA/ASA) recommends controlling these risk factors in order to prevent stroke. The AHA/ASA guidelines also provide information on how to prevent stroke if someone has more specific concerns, such as sickle-cell disease or pregnancy. It is also possible to calculate the risk of stroke in the next decade based on information gathered through the Framingham Heart Study.

Risk factors.

Major risk factors for cerebral infarction are generally the same as for atherosclerosis. These include high blood pressure, diabetes mellitus, tobacco smoking, obesity, and dyslipidemia. There are also risks that can't be changed. These include age and premenopausal women. A person risks double each decade after the age of 55. Women who are on hormones, such as menopausal women, also have a higher risk of having a stroke. The American Heart Association/American Stroke Association (AHA/ASA) recommends controlling these risk factors in order to prevent stroke. The AHA/ASA guidelines also provide information on how to prevent stroke if someone has more specific concerns, such as sickle-cell disease or pregnancy. It is also possible to calculate the risk of stroke in the next decade based on information gathered through the Framingham Heart Study.

Outline of proposed changes
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How I plan to improve this article to start is by improving the diagnosis section. I want to explain which imaging test is best in different situations and what one may show over the other. I also want to include why a CT may be chosen over an MRI or vise versa. I also want to change the risk factors section around to include nonmodifiable risks in a person. I also want to add a little bit more to the opening paragraph. My goal for these changes is to give the reader a little more information on how a cerebral infarct is diagnosed and what some factors in a person's genetics may make them more susceptible to an infarct. This is also just the beginning of my changes I want to add to this article. As I find more information, I may add more changes to improve the quality of the article.