What tests should be done if cerebral infarction is suspected

Cerebral infarction is a very risky disease. If the patient is not taken for diagnosis and treatment in time when symptoms of cerebral infarction appear, it is very likely that the patient will become coma, paralyzed or even die. Therefore, if you suspect you have symptoms of cerebral infarction, you must go to the hospital for examination in time. Specifically, four types of examinations are needed: CT examination, MRI examination, routine examination, and special examination.

1. CT examination

Brain CT scans show that the size and location of cerebral infarction lesions have an accuracy rate of 66.5% to 89.2%, and the accuracy rate of early cerebral hemorrhage is 100%. Therefore, early CT examination is helpful for differential diagnosis and can rule out cerebral hemorrhage. When cerebral infarction occurs within 24 hours, or the infarct focus is less than 8 mm, or the lesion is in the brainstem and cerebellum, brain CT examination often cannot provide a correct diagnosis. If necessary, follow-up examination should be performed within a short period of time to avoid delaying treatment.

CT shows that the infarct focus is low-density, which can clearly identify the location, shape and size of the lesion. Larger infarct focuses can compress the ventricles, deform them and shift the midline structure. However, within 4 to 6 hours after the onset of cerebral infarction, only some cases can show slightly low-density focuses with unclear boundaries, while most cases can only show low-density focuses with clearer boundaries and less than 5 mm in size after 24 hours. Infarction in the posterior cranial fossa is not easily visualized by CT, and infarction on the cortical surface is often not detected by CT. Enhanced scanning can improve the detection rate and qualitative diagnosis rate of lesions. The CT manifestation of hemorrhagic infarction is irregular patchy high-density areas within large low-density areas. The difference from cerebral hematoma is that the low-density areas are wider and the hemorrhagic foci are scattered in small pieces.

2. MRI

MRI is extremely sensitive in detecting cerebral infarction and is better than CT in detecting cerebral ischemic damage. It can detect earlier cerebral ischemic damage, which can be seen within 1 hour of ischemia. Large infarctions can almost always be demonstrated on MRI 6 hours after onset, showing low signals on T1-weighted imaging and high signals on T2-weighted imaging.

3. Routine inspection

Routine examinations include blood, urine, stool routine tests, liver function, kidney function, coagulation function, blood sugar, blood lipids, electrocardiogram, etc., and dynamic blood pressure monitoring can be performed if conditions permit. Chest X-ray should be routinely performed to exclude cancer thrombus and to determine whether aspiration pneumonia has occurred.

4. Special inspection

Transcranial Doppler ultrasound (TCD), carotid color B-ultrasound, magnetic resonance imaging, angiography (MRA), digital subtraction angiography (DSA), and carotid angiography can determine whether there is stenosis or occlusion of the intracranial and extracranial arteries.