Cerebral infarction emergency, big coffee teaches you to see through CT films!

New Media Manager* is only for medical professionals to read for reference.
It can also be useful if there is only a CT scan at hand
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Mao Yiting, a teacher from the Department of Neurology, Huashan Hospital Affiliated to Fudan University, gave a detailed lecture on "Images of Cerebrovascular Diseases" in the fourth issue of Huashan College's "High-spirited Academic Season".
The content is now organized into a document for readers
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■ Briefly review cerebral infarction Cerebral infarction, also known as cerebral ischemic stroke, refers to the ischemic necrosis or softening of limited brain tissue caused by cerebral blood supply disorder, ischemia and hypoxia.

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The common clinical types of cerebral infarction are cerebral thrombosis, lacunar infarction and cerebral embolism, and cerebral infarction accounts for 80% of all strokes
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Diseases closely related to it include: diabetes, obesity, hypertension, rheumatic heart disease, arrhythmia, dehydration of various reasons, various arteritis, shock, and blood pressure drops too fast and too large
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Clinical manifestations are mainly characterized by sudden coma, unconsciousness, hemiplegia, speech impairment, and intellectual disability
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Cerebral infarction not only poses a great threat to human health and life, but also brings great pain and heavy burden to patients, families and society
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As a sudden brain disease, it can occur at any age.
The degree of necrosis varies with the location and size of the thrombus, and it is more common in middle-aged and elderly people aged 45 to 70
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And the onset is more acute, with no prodromal symptoms, focal neurological signs peaking in a few minutes to several hours, and most of them show complete stroke, clear consciousness or mild disturbance of consciousness, and major embolism of the internal carotid artery or middle cerebral artery.
Area of ​​cerebral infarction, severe cerebral edema, increased intracranial pressure, even brain herniation and coma, rare epileptic seizures; vertebrobasilar system embolism often occurs in coma, and in individual cases, the focal signs are stable or once improved and then worsened Prompt infarction recurrence or secondary bleeding
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1 What should I do if I have a cerebral infarction in the emergency room and only a CT scan is available at hand? CT scan can also be very useful! A better and early diagnosis plays a very important role in the prognosis of patients.
Plain CT scan (NCCT) is one of the most routine examinations, and the appropriate window width and window position are more conducive to the display of lesions (below)
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CT shows that the infarct is low-density, which can determine the location, shape and size of the lesion.
Larger infarcts can cause compression of the ventricle, deformation and displacement of the midline structure.
However, within 4 to 6 hours of the onset of cerebral infarction, only some cases Slightly low-density foci with ill-defined borders can be seen, and in most cases, clear-defined low-density foci and infarcts smaller than 5 mm can be displayed after 24 hours
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■ Early signs of cerebral ischemia in NCCT: lentiform blur sign, disappearance of insular ribbon sign, disappearance of sulcus sign, local low density sign
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● Lenticular blur sign↓● disappearance of insular ribbon sign↓● disappearance of cerebral sulcus sign↓● local low density sign↓2 CT scan can not only see, but also quantify ● Quantification of early cerebral ischemia signs on NCCT: Alberta stroke The early CT score of the project (ASPECTS score)↓①The lowest score: 0; the highest score: 14; the higher the score, the better the prognosis
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②The total score of the first 10 items is 10 points
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A score of 0 indicates diffuse ischemia involving the entire middle cerebral artery
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A score of > 7 indicates that the patient is very likely to live independently after 3 months, while ≤ 7 indicates that the patient is not able to live independently or is more likely to die
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If the ASPECTS score ≤7 after thrombolytic therapy, the risk of intracerebral hemorrhage is 14 times higher than that of patients with a score >7
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③ The sensitivity of ASPECTS score to the evaluation of functional outcome was 0.
78, and the specificity was 0.
96
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● Early signs of vascular lesions in NCCT: high density sign, point sign↓● Early ischemic signs, infarct core and penumbra in NCCT↓DWI can identify acute ischemic foci early and accurately predict the infarct core (sensitivity=91%-100% , specificity = 86%-100%), the apparent diffusion imaging sequence (ADC) must be combined in the work, and it should be used with caution
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Patients with negative DWI can also have acute cerebral infarction, the incidence rate = 6.
8%, the reasons: the size, time and location of the lesion; related factors: posterior circulation cerebral infarction
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Infarct core and penumbra: The original concept of the cerebral ischemic penumbra is the termination of the electrical activity of cells within ischemic tissue, but the preservation of transmembrane ionic potential
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The term was later used to describe a potentially reversible peri-infarct area that can develop into an infarct if blood flow is not restored within a time window or other measures are taken to prevent the process of cell death
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The latter concept is closer to clinical practice
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● Infarction core and penumbra, DWI combined with PWI can more accurately determine the prognosis of patients Blood flow can reach the ischemic area through other blood vessels (collateral or newly formed vascular anastomosis), so that the ischemic tissue can be compensated by different degrees of perfusion
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Cerebral collateral circulation is one of the structural reserves of brain reserve capacity.
The core of collateral circulation is the existence, occurrence, formation and recruitment of collateral blood vessels
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The path of the collateral circulation - is a fundamental factor in determining whether or when a stroke occurs
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Collateral circulation not only affects the clinical outcome of thrombolytic therapy, but is also a determinant of the efficacy of many interventions
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Collateral circulation is mainly divided into 3 grades: arterial collateral circulation can come from intradural, epidural or epidural vessels, and can be roughly divided into three grades according to the level of opening: • Primary collateral circulation: mainly from the vessels of the circle of Willis Composition; • Secondary collateral circulation: ophthalmic artery, pia mater, and other relatively small collaterals and collaterals anastomosis; • Tertiary collateral circulation: New blood supply vessels generated by angiogenesis and angiogenesis
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Collateral circulation greatly affects the prognosis of patients↓ With the development of imaging technology, more and more techniques are applied to the clinic, which also plays an important role in clinical treatment and prognosis evaluation
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This article is compiled from the fourth lecture of the [Huashan College] online video lecture, "Images of Cerebrovascular Diseases" by Professor Mao Yiting of the Department of Neurology, Huashan Hospital Affiliated to Fudan University
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Source of this article: Neurology Channel of the medical community This article is organized by: Huang Cong Speaker of this article: Mao Yiting, Department of Neurology, Huashan Hospital Affiliated to Fudan University Editor in charge: Mr.
Lu Li the timeliness, and the accuracy and completeness of the cited materials (if any), etc.
, and do not undertake any commitments and guarantees caused by the outdated contents, the possible inaccuracy or incompleteness of the cited materials, etc.
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Relevant parties are requested to check separately when adopting or using it as a basis for decision-making
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