Patient Male, 38 years old, 5 days ago, no obvious incentive to language disorder, such as expression, writing errors and can not read. Outside the hospital CT to show the left frontal temporal junction at low density lesions, qualitative diagnosis of cerebral infarction, located in the left frontal temporal lobe, the underlying lesions that perforating arterial disease is likely.Because patients have "physical health", no cardiovascular disease and metabolic disease history, therefore, in patients admitted to hospital, neurologists did not first consider the heart of cerebral embolism, that cerebral atherosclerosis is likely.
Electrocardiogram after admission prompted the old anterior myocardial infarction, echocardiography and suggestive left ventricular anterior wall, apical dysplasia, indicating that patients with blood stasis, thrombosis based on a large number of patients with smoking, drinking history and laboratory tests Confirmed type 2 diabetes and lipid metabolism abnormalities, further cardiac MRI and coronary angiography after the final determination of patients with cardiogenic cerebral embolism.
This patient's treatment strategy and other types of basic principles of cerebral infarction the same, while the need to pay attention to the treatment of primary heart disease, to prevent the recurrence of thrombolysis.
As the heart-derived cerebral embolism and cerebral hemorrhage is closely related, heart-derived cerebral embolism 90% with cerebral embolism after bleeding, and post-infarction vascular injury and blood flow reperfusion is an important cause of hemorrhagic cerebral infarction, therefore, Thrombolytic or anticoagulant therapy in patients with cerebral embolism is also controversial.
2010 China Cerebrovascular Disease Prevention Guidelines recommend that within 3 to 6 hours after the onset of cerebral infarction, no thrombolytic contraindications may be urokinase or recombinant tissue plasminogen activator (rtPA) thrombolysis.Cardiac thrombolysis in patients with cardiac embolism is still a lack of reliable clinical evidence. Cardiogenic cerebral embolism in the acute phase prone to hemorrhagic cerebral infarction, should adhere to the principle of individualized cautious anticoagulant therapy.