What is Acute Infarct?

Acute infarct, also known as acute stroke, is a serious medical condition characterised by neurological disability due to blockage or haemorrhage in the cerebrovascular system.

Associated Anatomy

Brain and cerebrovascular system

Causes

• Ischemia: Blockage of the blood vessels in the brain due to clots or plaque in the brain leads to ischemia and a reduced supply of oxygen and nutrients, which further leads to cell damage or death.
• Haemorrhage: The damage to arteries or leakage of blood vessels leads to haemorrhage, which then exerts excessive pressure on brain cells and tissues leading to cerebral oedema and cellular damage.

Signs or Symptoms

Signs and symptoms of acute infarct include the following:

• Numbness in the face or extremities, specifically on one side
• Sudden change in behaviour
• Trouble in walking
• Dizziness
• Seizures
• Severe headache
• Trouble speaking
• Difficulty in understanding others or lack of responsiveness
• Nausea
• Vomiting
• Lack of coordination
• Disorientation
• Slurred speech
• Confusion
• Vision problems

Possible Treatments

• Medications: Medications include anti-clotting drugs to dissolve the clot and avoid further formation of clots. For haemorrhages, medications would aim to form the clot for the bleeding to stop. In addition, various antiplatelet drugs, statins, blood pressure-lowering drugs, tissue plasminogen activators, etc. could be given to prevent secondary infarcts.
• Stents: Stents are placed in the weakened arteries to provide support and avoid narrowing.
• Surgery: It is usually the last option when other treatments are not working and could involve removing the clot by opening the artery or through a catheter. For haemorrhages, the surgery aims to close the aneurysm by clamping to stop additional bleeding and correct the disorder.

Risk Factors

• Age: The risk of developing infarct increases with age.
• Gender: Men are at an increased risk of developing infarcts.
• Genetics: People with a family history of stroke or high blood pressure are at more risk.
• Race: Blacks and Whites are at an increased risk to develop acute infarcts compared to other races.
• Lack of activity: Lack of physical activity increases the risk of infarcts.
• Diet: People eating junk foods and high amounts of saturated fats are at an increased risk of developing infarcts.
• Chances of developing acute infarcts increase in people who use tobacco or alcohol.

Typical Test

The typical test starts with the diagnosis of the patient’s medical history, signs, symptoms, and physical examination. Blood tests such as platelet count, clotting time, glucose levels, and cholesterol levels are recommended to understand the aetiology. Imaging tests include Magnetic Resonance Imaging (MRI) and Computerised Tomography (CT) scan to analyse the brain tissue and damage. A cerebral angiogram could be recommended to monitor blood flow in brain vasculature. In addition, an electrocardiogram (ECG) and echocardiogram could be ordered to understand the cardiac activity and origin of clots.

Prevention

Primary Prevention

• Quit smoking: Smoking is an important risk factor and you should quit smoking to reduce the risk of developing acute infarcts.
• Limit alcohol use: You should avoid or limit the use of alcohol to help reduce the risk of developing acute infarcts.
• Maintain a healthy weight: You should maintain a healthy weight to stay away from obesity and associated risks and comorbidities.
• Exercise: Include exercise in your daily routine to reduce the risk of developing acute infarcts.
• Diet: Eating a well-balanced diet rich in nutrients, fibre, and proteins helps to reduce the risk of developing acute infarcts.

Secondary Prevention

Secondary prevention aims to reduce the risk of complications and recurrences. The following measure can be taken:

• Regular follow-ups: You should make regular follow-ups as per the schedule to assess the recovery, risk of recurrence, and overall quality of life.
• Symptom watch-out: Always look for signs of recurrence or complications and seek immediate medical care.
• Lifestyle: Exercise regularly and eat a well-balanced diet.
• Manage weight and diabetes: Managing diabetes, obesity, and weight will help to reduce the chances of complications or recurrences.
• Awareness: Being aware of the disease and having realistic expectations helps in better planning and management.

Alternate Name

Acute cerebral stroke

Differential Diagnosis

Symptoms of acute infarct could mimic that of various other diseases or disorders such as brain cancer, conversion disorder, convulsions, systemic infections, positional vertigo, etc. In a few cases, toxic metabolic disorders such as hypoglycemia or hyponatremia could also mimic symptoms of acute infarct; hence, a differential diagnosis is required to rule out other possibilities.

Epidemiology

• Acute infarcts are a leading cause of disability globally.
• Blacks are more prone to get acute infarcts compared to whites and the Hispanics have the lowest risk compared to blacks and whites.
• Men are at an increased risk to develop acute infarcts compared to women. The prevalence increases with age with older adults (> 65 years) being at the highest risk.

Expected Prognosis

Prognosis depends on the age, infarct location, severity of the stroke, comorbid conditions such as hypertension, diabetes, obesity, etc. The recovery is usually quick during the first 3-4 months, post-treatment and for some, the recovery could take 1-2 years.

Natural Progression

Acute infarct progresses with worsening of various neurological functions and could lead to permanent disability or fatal outcome if not addressed within the first few hours of onset.

Pathophysiology

An acute infarct occurs when the blood flow to the brain is blocked by occlusion or due to a haemorrhage in the brain. This leads to hypoxia (deficiency of oxygen) and depletion of adenosine triphosphate (ATP) in the cells. This further causes a sequence of actions leading to cellular damage and neurological disabilities.

Possible Complications

Various complications of acute infarct include cerebral oedema, an extension of infarct, re-bleeding, deep vein thrombosis, hypertension, hyperglycemia, fever, pulmonary embolism, aspiration pneumonia, cerebral herniation, urinary tract infection, depression, seizures, etc. In the case of large infarcts, oedema and herniation are the most common complications and could lead to death if not treated in time.

Our Medical Acute Infarct Experts

If you are facing any similar signs or symptoms please contact the Nanavati Max team to schedule an appointment at : +91 22 6836 0000

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