oa Central African Journal of Medicine - Prevention, treatment and prognosis of completed ischemic stroke (cerebral infarction)

Volume 35, Issue 7
  • ISSN : 0008-9176



Prevention of cerebral infarction consists of identifying and treating or stopping the risk factors. Once cerebral infarction has occured, most treatment regimes include therapies with hemo dilution, steroids, barbiturates, opiate antagonists and perhaps prostacyclin. Anti-platelet aggregation agents, have been advocated but have not been shown conclusively to be effective. Most evidence shows them to be ineffective in reducing neurological deficit or mortality. However, calcium channel blockers may improve neurological outcome or reduce mortality in acute cerebral infarction. Aspirin in small doses, similarly reduces recurrence of cerebral infarction and mortality from stroke or myocardial infarction. Anticipation and treatment of complications of acute stroke such as aspiration pneumonia is essential. Bedsores due to immobilization should be avoided as far as possible but may be necessary in incontinent females. Condoms for male patients are preferable to catheterization. Physical therapy to aid mobility and attainment of independence in activities of daily living (all activities necessary for self care) must be begun early and continued even after the patient has been discharged from hospital. Case fatality at 30 days following cerebral infarction is about 15 percent. The life span of the survivors is shorter than that of the general population. The cumulative survival rate at the end of tbe first 5 years is about 50 percent for men and 60 percent for women. Late death is usually due to the coexisting coronary artery disease and not necessarily to the stroke recurrence rate of 10 percent per year. Although about 80 percent of patients recover from cerebral infarction and gain independence in mobility, only 30 percent ever recover well enough to resume their occupation. About 90 percent are left with residual diability and between 10-20 percent need institutional care. This information is based on Western communities, but it may be helpful in the management of cerebral infarction in other groups while awaiting documentation of the local experience.

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