The statement that a cavernous infarction is a cerebral infarction has frightened a large number of people who occasionally have a head CT or MRI that reveals a single or multiple cavernous infarcts, and so aspirin, statins, and so on are administered. Is it really necessary to deal with such foci of infarction that are only a few millimeters in size?

1. So far, doctors all over the world have different hypotheses about the pathogenesis of lacunar infarcts: aging of the arterial endings, clogging of the blood with "trash" (what do you mean by trash?), high blood viscosity, microarterial spasms, etc. There are many hypotheses about the pathogenesis of lacunar infarction, such as aging of arterial endings, clogging of blood "trash" (what do you mean by "trash"?), high blood viscosity, and spasm of small arteries. As an example, the internal carotid artery is the trunk of a tree, the leaves are the brain cell clusters, the cavity infarction is the stem (microvessel) connecting a leaf caused by the occlusion of the leaf died. In the analogy of this leaf growing in a place where people can see it (a functional brain cell cluster), then different functional areas will produce transient symptoms: dizziness, salivation, slurred speech, etc., but soon disappears. If the dead leaf is in a place where people can't see it, i.e. in a non-functional area, there are no symptoms at all, and of course you don't know about it.

2. It can be said with certainty that the proportion of cavernous infarcts is closely related to age, more than 50% of people over 60 years of age will find cavernous infarct foci (low-density shadows) when they undergo CT, more than 80% of people over 70 years of age will find them, and sometimes there is more than one, and the vast majority of people over 80 years of age have multiple cavernous infarcts. Therefore, if there is no cerebral thrombosis, cerebral infarction (small arterial plaque rupture thrombosis, infarction area is much larger than the cavernous infarction) can be visualized as a result of aging of cerebral arterial endings. In contrast, the young 30-50 year olds are now found to have a high percentage of cavernous infarcts, most of which are related to emotional, stress-induced spasms of the tiny cerebral arteries, which cause irreversible death of brain cells in as little as 4-6 minutes.

3. Cavitary infarction is directly proportional to age, so is there any relationship with the three highs? The answer is Ken Li has! Long-term hypertension peripheral small arteries at high pressure and blood vessels in the endothelial membrane elastic fibers, collagen fibers premature loss of elasticity, the middle layer of the ring smooth muscle proliferation and other factors make the downstream micro-arteries ischemia, aging faster, high blood glucose and high blood lipids will also aggravate the damage to the peripheral small arteries and recession. Of course, in the left atrium of the pathologically enlarged atrial fibrillation, the left auricle is sometimes dislodged by thrombus particles, which can also block the peripheral microarteries. Dozens of harmful substances absorbed into the bloodstream by smoking can also damage the tiny peripheral arteries. Cerebral infarction is God's way of taking care of you, if plaque rupture occurs in the middle and small arteries due to the end of the three highs and excessive smoking, it will lead to cerebral infarction of different sizes and that would be disastrous, and it would be difficult to tell the consequences of hemiplegia, aphasia, speech difficulties, swallowing disorders, inability to take care of oneself and other complications that may arise from not only the poor quality of life but also the sequelae of prolonged confinement to the bed.

Patients with caval infarction who have hypertension, hyperlipidemia, diabetes mellitus, and have had cardiovascular and cerebrovascular events, or have had PCI with stent implantation, have smoked for more than 400 years (number of cigarettes smoked per day X number of years), and have multiple plaques, especially soft plaques found by vascular ultrasound and CT scan, are in need of aspirin and statins to prevent plaque rupture to produce a new thrombus forming a cerebral infarction or a cardiac infarction, and to minimize the recurrence of caval infarction. Multiple occurrences. Even if there are three high, but usually good control, there is no need to prevent cavity infarction patients with the above conditions to take aspirin and statin drugs to prevent cavity infarction, it is more important to control diet, weight, appropriate exercise and control their emotions, otherwise, when excited and angry, the increase of adrenaline in the blood will cause arterial spasm, which occurs in the small arteries of a cavity infarction, the larger soft plaque arteries occurring cerebral infarction, and sometimes the emotions are more difficult to control, the heart knows that it is difficult to do so. Control, the heart to understand that it is difficult to do, then learn Q, the sky does not matter.

2018.9.7

Patients with asymptomatic lacunar cerebral infarcts should be thankful that God has given you a kind warning.

A lacunar cerebral infarction is the mildest form of cerebral infarction

However, if there is a lacunar cerebral infarction, it means that the blood vessels in the patient's brain, or even in the body, have developed problems, and in this case, fortunately, only a small and unimportant blood vessel is blocked, and it has not been able to cause serious symptoms. However, the patient's blood vessel already has a big problem, and if no attention is paid to it, it may develop into a serious cerebral infarction in the future.

Therefore if a lacunar brain infarction is present then the following should be done immediately

1. Checking blood lipids, blood routine, liver and kidney functions and checking carotid ultrasound as well as measuring blood pressure and blood sugar

The blood lipid test is to see if there is hyperlipidemia, and if there is hyperlipidemia we should consider whether to take lipid-lowering drugs

A carotid ultrasound is performed to look for plaque and stenosis in the carotid arteries.

Measure your blood pressure to see if you have high blood pressure, which is a major cause of brain attacks.

Blood sugar is measured to rule out diabetes.

Liver and renal function is a way to see how the liver, kidneys, and blood clotting are functioning, as well as an assessment for future medications.

2. Consult your doctor to see if you need to start taking aspirin or lipid-lowering drugs. If you have high blood pressure, high blood sugar, or high blood cholesterol, then also consult your doctor about how to proceed with medication for related conditions.

3. Enhance exercise, lose weight, lose fat

4. eat less greasy food, eat less food with high sugar content, drink less milk tea ah cola these drinks, you can drink tea.

Conditional olive oil instead of lard, lots of vegetables and fresh fruits

5. Regular review at the hospital

Because the blood vessel is already abnormal, it is important to try to delay the next time a blockage occurs, because if the next time it comes back, there is a chance that it will be a really serious brain attack

Many elderly people will see the diagnosis of "cerebral infarction" on the report card after doing CT in the hospital. As soon as they see the word "cerebral infarction", they cannot help but be frightened and rush to ask the doctor: Have I had a stroke? Will I be paralyzed?

Difference between cerebral infarction and lacunar cerebral infarction

1. Cerebral infarction:The term "cerebral infarction" refers to the interruption of blood flow in large and medium-sized blood vessels supplying blood to the brain due to atherosclerosis or thrombus blockage, resulting in ischemia and necrosis of brain tissues in the corresponding area, and patients may suffer from paralysis or even more serious consequences.

2. Cavernous cerebral infarction:It is a condition in which the small arteries of the brain, on the basis of chronic hypertension, diabetes, and hyperlipidemia, develop lesions in the walls of the blood vessels as they age, leading to occlusion of the lumen and the formation of small foci of infarction.

Simply put: a cerebral infarction is the consequence of a blockage in a medium to large artery, whereas a lacunar cerebral infarction is the consequence of a blockage in a very small artery.

Symptoms of lacunar cerebral infarction

Because the blood vessel blocked by lacunar cerebral infarction is very small, very little brain tissue is damaged and its clinical manifestations are often very mild. Most patients can have no clinical symptoms, and only a small number of them will have symptoms such as dizziness, headache, numbness of limbs, vertigo, memory loss, slow reaction, dementia and so on. In terms of incidence, as age increases, almost all elderly people have lacunar cerebral infarction.

Does lacunar cerebral infarction require treatment?

Generally speaking, the prognosis of cavernous cerebral infarction is mostly good, with low disability rate, and patients can live and work normally. For some symptomatic patients, short-term infusion of some drugs that activate blood circulation and remove blood stasis can be considered to alleviate the symptoms; if there are no obvious symptoms, there is no need for special treatment for lacunar cerebral infarction per se, but targeted interventions should be carried out on the risk factors of the patients to reduce the risk of recurrence of lacunar cerebral infarction and massive cerebral infarction.

How can I prevent a reoccurrence or progression of a lacunar cerebral infarction to a cerebral infarction?

1. Stabilize emotions and exercise reasonably:Don't be overly nervous after discovering lacunar cerebral infarction, you should maintain a positive and optimistic mindset, which is not only an important factor in the prevention of cardiovascular and cerebrovascular diseases, but also the key and secret of realizing longevity. At the same time, appropriate and moderate physical exercise and physical activities should be carried out according to the individual's physical condition, to the extent that he/she does not feel fatigue. It is not advisable to do strenuous exercise such as fast running and mountain climbing, but aerobic exercise such as jogging, walking and playing tai chi can be carried out.

2. Develop good eating habits:Patients with lacunar cerebral infarction should quit smoking and avoid alcohol, eat a light diet, and diversify their food with more fresh vegetables and fruits.

3. Remove risk factors:Hypertension, diabetes mellitus, hyperlipidemia, atherosclerosis, high blood viscosity, smoking, and alcohol consumption are all considered to be risk factors for cavernous infarction. Therefore, one should actively control blood pressure, blood glucose, blood lipids, quit smoking and avoid alcohol. It is necessary to take some anti-platelet drugs (e.g. aspirin) and plaque stabilizing drugs (e.g. atorvastatin calcium capsules).

4. Regular inspections:Regular checkups allow for early detection of problems and early intervention.

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Questions related to lacunar cerebral infarction is one of the most frequently asked questions in clinic. It can be said that with the advancement of examination equipments and the popularization of medical checkups, scanning a cranial CT has become a very common thing, and consequently more and more people find out that they have lacunar cerebral infarction. So, how should we face cavernous cerebral infarction?

In fact, strictly speaking, lacunar cerebral infarction is a small infarction foci formed when the small penetrating arteries in the deep part of the cerebral hemisphere or brain stem undergo occlusion of the lumen of the blood vessel under the involvement of various risk factors in the long term, especially under the effect of high blood pressure. To make an analogy, if the brain is a piece of white paper, lacunar cerebral infarction is a sesame seed sprinkled on the white paper, very small, but already exist.

As to whether cavernous cerebral infarction needs treatment, in many cases it should be said that it depends on the specific situation of the patient. If the patient has many risk factors, such as smoking and drinking, obesity, hypertension, diabetes mellitus, hyperlipidemia, and so on, then it is very likely that treatment is needed, such as giving aspirin and statin orally. However, if only lacunar cerebral infarction is detected and there are no other risk factors, it is also possible to improve lifestyle first, especially closely monitor blood pressure, blood lipids and blood sugar, and then give medication if necessary.

In short, the cavernous cerebral infarction to give which treatment, must depend on the patient's specific situation, not all people are the same, according to individual circumstances, case-by-case analysis.

What is a lacunar cerebral infarction?

Cavernous cerebral infarcts are ischemic microinfarcts occurring in the deep white matter of the cerebral hemispheres and the brainstem. The infarct foci are irregularly round, ovoid, or narrowly elongated, mostly several millimeters in diameter. In the past, this phenomenon was only detected during pathologic dissection of the human brain. As CT and magnetic resonance techniques have become more widespread and advanced, the probability of detecting lacunar cerebral infarcts has increased.

What are the causes of lacunar cerebral infarction?

The cause of lacunar cerebral infarction is not particularly clear, but the prevailing opinion is that it is related to the degeneration of small arteries and microarterioles caused by factors such as hypertension and diabetes mellitus, resulting in vascular occlusion.

Symptoms of lacunar cerebral infarction?

Symptoms of lacunar cerebral infarction are varied and may manifest as motor abnormalities, sensory abnormalities, ataxia, dysarthria, and so on, depending on the site of cerebral infarction. However, it is generally characterized by mild symptoms, single sign, good prognosis, no headache, intracranial hypertension, consciousness disorder and so on. If the infarction happens to occur in an unimportant area, it is very possible that the patient himself feels very mild and does not pay attention to it, or even does not feel it at all.

Does lacunar cerebral infarction require treatment?

Cavernous cerebral infarction is more common in middle-aged and elderly patients, and is more common in men than in women.

In some cases, it is discovered accidentally with no obvious symptoms, and it is very likely that the lesion is already old and the infarction has occurred for a long time. This kind of brain infarction itself is no longer necessary for treatment, but it puts out a strong warning signal to us that:

The cerebrovascular situation has most likely gotten very bad.

It's like countless tiny branches of a big tree. When we notice that some of the branches start to die inexplicably, we have to be alert to the fact that the other branches are not doing so well either.

What should I do if I find a lacunar cerebral infarction unexpectedly?

1 Check to see if your blood pressure is normal. If you already have a history of high blood pressure, you should also reflect on whether your blood pressure is usually well controlled.

2 Check if your blood sugar is normal. If you are already diabetic, it is even more important to reflect on whether your blood sugar is usually being checked regularly.

3 Check your blood lipids for abnormalities.

4 Examine cardiac ultrasound, carotid arteries, and cerebrovascular ultrasound for blood clots or plaque in blood vessels.

5 Stop smoking and drinking, live a regular life, rest well, and don't stay up late.

6 Exercise consistently and keep your weight under control.

7 After a thorough physical examination and evaluation, take aspirin, statin and other medications under a doctor's supervision if necessary to prevent recurrence of cerebral infarction.

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Most patients with lacunar cerebral infarction are asymptomatic because of the small size of the infarcts and the fact that many of them occur in non-functional parts of the brain. Those who do have symptoms usually have mild symptoms, so the prognosis for the disease is usually good. However, whether felt or not, a lacunar infarction should be taken seriously.

In most cases, there is no specific treatment for lacunar infarcts per se, but the key issue is to understand the causes of the disease and to target interventions to the risk factors of the patient in order to reduce the risk of recurrent lacunar infarcts as well as massive infarcts.

Hypertension is the main cause of lacunar cerebral infarction. If you have high blood pressure, you must control it carefully to ensure that it is not higher than 140/90 mmHg.

At the same time, it is also necessary to adhere to a low-salt and low-fat diet, as in the case of preventing other cerebrovascular diseases, to exercise appropriately, to maintain a healthy lifestyle, to abstain from smoking and limiting alcohol consumption, to increase outdoor exercise, to control body weight, to maintain emotional stability, and to control blood glucose and blood lipids, so that the body can be adjusted to its optimal state. At the same time, the need for statin and aspirin therapy should also be decided on a case-by-case basis under the guidance of a doctor.

Last week the director of the blood transfusion department Hu did a nuclear magnetic, suggesting cavernous cerebral infarction, which can make him nervous, rushed to buy aspirin and statin, to formal treatment. I I just happened to run into Director Hu to get the medicine, I am I do not think it is necessary to take medication, you first go to the people in the God to see, although they all work in the hospital, but it does not mean that all the people in the hospital know clinical medicine.

Cavernous cerebral infarction, sounds like a cerebral infarction, many people aspirin, statin together, but cavernous cerebral infarction is after all cavernous cerebral infarction, and usually we say cerebral infarction is still different.

Cavernous cerebral infarction and age are closely related, even some experts say cavernous cerebral infarction, as long as there is no high-risk factors, just like our wrinkles, more than 50% of people over the age of 60 years old to do the examination may have cavernous cerebral infarction, more than 80% of people over the age of 70 years old may have cavernous cerebral infarction, and sometimes there is more than one, and the vast majority of people over the age of 80 years old are multiple cavernous infarcts. So if you find a cavernous infarction, do you have to put them on medication? Of course not. In fact, young people, too, can be found with lacunar infarctions, like our Director Hu, who is only 39 years old.

In fact, cavernous cerebral infarction is generally low risk and most of them do not have sequelae. Cavernous cerebral infarction refers to the occlusion of the small cerebral arteries, causing infarction of the brain tissue it supplies blood to, which may be related to thrombosis, plaque dislodgement, vasospasm, embolus dislodgement, etc. Of course, there is no definite conclusion as to why cavernous cerebral infarction occurs. Of course, there is no definite conclusion in the medical field as to why a lacunar cerebral infarction occurs. Why do most lacunar cerebral infarctions have no symptoms? Simple understanding, that is, small blood vessel blockage, will not affect the brain command, the command function is not affected, then naturally there will be no command failure, then there will be no symptoms. To make an analogy, our cerebral blood vessels are like a tree, when a big branch is broken, we can easily find out that it will have some effect on the tree, but if it is a small leaf fall, it is difficult for us to find out that it has no effect on the whole tree.

In addition to a close relationship with age, cavernous cerebral infarction is actually related to atherosclerotic sclerosis. This is why it is said that the treatment is different for different lacunar cerebral infarctions.

First, there are no symptoms, and there are no high-risk factors, then you can not take drugs, healthy lifestyle on the line, pay attention to observe the three high, quit smoking and drinking, healthy diet, weight control, adhere to aerobic exercise and so on. Because these lacunar cerebral infarction is generally a natural phenomenon, that is, age-induced, do not have to take drugs, because drugs have side effects.

Secondly, if you have symptoms, you need to be treated according to the cerebral infarction, and this time you need to take aspirin + statin and other drugs. Because to improve the symptoms, to prevent another cerebral infarction, or more serious cerebral infarction.

Third, there are no symptoms, but there are high-risk factors, although some people have no symptoms of lacunar cerebral infarction, but if the combination of hypertension, diabetes mellitus, high blood cholesterol, then first of all, we need to control the three highs, and at the same time, according to the specific situation needs to be added to the use of aspirin and statin, and even more need to adhere to a healthy lifestyle.

In conclusion, for people with healthy lifestyles, especially middle-aged and elderly people, the detection of a lacunar cerebral infarction without symptoms is nothing to worry about; it is merely a change of age.

However, for young people with symptoms, especially those with unhealthy lifestyles, it is important to change bad habits, adhere to a healthy lifestyle, control the three highs, and even need to be treated according to cerebral infarction.

[Copyright Dr. Cardiovascular Wang]

Cavernous cerebral infarction is a kind of cerebral infarction with the mildest symptoms. Cerebral infarction refers to the limited ischemic softening or necrosis of brain tissues caused by blood circulation obstruction in the brain and ischemia and hypoxia. Vascular wall lesions, blood composition and hemodynamic changes are the main causes of cerebral infarction. lacunar cerebral infarcts are mostly small lacunar foci caused by lesions of the basal ganglia or small penetrating branches of the cerebral bridges, and most of the foci are small in extent, not more than 15 mm. small arterial sclerosis, occlusion, atherosclerosis, and cardiac embolism are the most important high-risk factors for cerebral infarction.

It is common in middle-aged and elderly patients with hypertension, often accompanied by a history of chronic diseases such as hypertension, diabetes mellitus and hyperlipidemia. Some cases of lacunar cerebral infarction may be preceded by transient ischemic attack, which may start acutely or subacutely during quiet time. Although the symptoms of lacunar cerebral infarction are mild and can be relieved on their own, but there are hypertension, hyperlipidemia, diabetes mellitus and other diseases with dyslipidemia, which tend to make the disease progress, thrombosis and large infarcts. Therefore, even if some people have lacunar cerebral infarction but they don't feel anything like this, early intervention is necessary.

Aggressive etiologic interventions are required to control primary blood glucose and lipids, and blood pressure is required to be controlled below 130/80 mm Hg, or 140-150/90 mm Hg in elderly patients. Glycated hemoglobin was required to be <6.5%, non-fasting blood glucose was controlled between 8.0 and 10 mmol/L, and fasting blood glucose was controlled below 7.0 mmol/L. Require concurrent antiplatelet therapy with low-dose aspirin enteric-coated tablets. Improve living habits, low-salt, low-fat and light diet, regular exercise, quit smoking, limit alcohol, and do fundus examination regularly. Traditional Chinese medicines such as Panax ginseng, Salvia miltiorrhiza and Ginkgo biloba can also be used to assist in the treatment. The prognosis of lacunar cerebral infarction is generally good, and most of them can be recovered or close to the level of recovery. Although the mortality rate and disability rate are low, we should pay attention to it and actively control the blood pressure, blood lipid, and blood glucose in the target range in order to prevent recurrence.

The authoritative interpretation of Pharmaceutical Affairs, unauthorized reproduction, plagiarism will be punished.

Some people have lacunar brain infarcts but don't feel anything on their own, don't they need to be treated?

In fact, most people usually do not feel when a small cavernous infarction occurs, only when they go to the hospital for medical checkup or headache do they realize that they have cavernous brain infarction, and they will be very scared when they first learn about it, but they are relieved only after the doctor's explanation.

Cavernous cerebral infarcts are small infarct foci caused by occlusion of the lumen of small perforating arteries deep in the cerebral hemispheres and the brainstem due to lesions in the vessel wall caused by various reasons.

Because these small deep arteries are terminal branches of the cerebral arteries and have a limited blood supply, the extent of ischemia-induced necrosis is also limited, usually to no more than a small 15-mm lesion. So most of them will not have any symptoms, only the necrotic area is absorbed, can be left with a small cystic cavity.

But we can't just ignore it because of that.

The first thing to check is if you have high blood pressure, high blood sugar, and high blood lipids. All of these underlying diseases can lead to the development of cavity infarcts, and don't be careless when you find yourself with some small cavity infarcts, which are actually early warning signals from the body to us!

If you rule out the 'three highs' and those problems, you need to pay attention to your habits and diet.

General age between 40 and 50 years old, the body is already in the downhill. You can not indulge yourself, control the mouth, those fried, barbecue, big fish and meat, smoking and drinking, these mouth and stomach desire should also have moderation. These are the triggers that lead to a high incidence of cardiovascular disease, you must learn to withstand temptation.

Although the body is on a downward spiral, most of this time of life is still a climb, right? The upward spiral of a career, the pressures on all fronts, the desperate efforts to stay up late and work overtime, and the exhaustive scheming. I'm sorry, but these are also causes of infarction.

I know for the sake of the family there is no way, then you have to participate in more outdoor sports, every day at work can take time to get up and move the muscles, let the mind rest for a few minutes, so that you can also improve work efficiency. It's best to stick to half an hour of aerobic exercise every day, whether jogging or brisk walking.

Can not stay up all night, do not stay up all night, this is really heartfelt words. Especially stay up late to work overtime, this is simply in the body to press a bomb, do not know when it will blow up.

The last is the emotional problems, emotions do not get excited, long-term stress leads to vascular spasm is easy to cause vascular infarction. So every day after work can be more and family, friends chat, some things to say, spit out will feel much easier.

Of course, it is best to see a doctor for a cavity infarction, have it checked out, and take preventive medication if needed. Dizziness, headache, accompanied by nausea and vomiting, or the appearance of one side of the mouth and eyes skewed, salivation, one or both lower limbs, weakness, short-lived confusion, etc. need to be sent to the hospital at the first time to save treatment.

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It is true that some people have lacunar cerebral infarction, but they do not feel sick at all, nor do they remember having symptoms of cerebral infarction, and it is usually because of other reasons that a CT or MR is done, and then a lacunar cerebral infarction is found in the brain. In this case, there is a term called "asymptomatic cerebral infarction" in our department of neurology. This means that the infarcts that are detected on imaging but not clinically symptomatic are usually small in size or are not in areas that affect function. This phenomenon is not uncommon in the elderly.

There is no way to make this incidentally detected lacunar cerebral infarction go away, therefore, from this point of view, this lacunar cerebral infarction does not need to be treated.

However, "asymptomatic infarction" does not mean that it has no clinical significance. The causes of lacunar infarction are usually similar to those of symptomatic infarction. They also include: hypertension, diabetes mellitus, hyperlipidemia, smoking, heavy alcohol consumption, obesity, heart disease, vascular disease and other risk factors. Therefore, the unintentional discovery of asymptomatic cerebral infarction is actually a wake-up call to start serious cerebrovascular prevention!

Therefore, although this asymptomatic lacunar infarction that has occurred is not to be treated, it is important to start preventing possible symptomatic cerebral infarcts, for example, by controlling blood pressure, glucose, and lipids; stopping smoking and drinking, exercising daily, controlling weight, treating heart disease, and other problems, and, if indicated, by taking oral aspirin and statin medications.

It is also important to note that having one or two asymptomatic lacunar cerebral infarcts may have little impact on health at this time. However, if the lacunar cerebral infarcts are multiple, they can cause cognitive impairment such as memory loss and slower reaction time, even if there are no typical symptoms such as hemiparesis or aphasia. Therefore, when asymptomatic lacunar cerebral infarction is detected, one should carefully search for one's risk factors and strictly control them to avoid more serious consequences.