Fat, blood clots, wall thrombi, gas emboli, and other substances from outside the brain enter the intracranial circulation through the bloodstream, causing cerebral embolism and corresponding dysfunction in the affected blood supply areas. The source of emboli is most commonly cardiac in origin.

bubble_chart Auxiliary Examination

A lumbar puncture can reveal increased intracranial pressure and elevated cerebrospinal fluid protein levels, possibly containing red blood cells. After 24 hours, a cranial CT scan may show low-density areas in the brain, with some high-density shadows (hemorrhagic infarction) within these low-density regions. Some electrocardiograms may detect abnormalities such as arrhythmia or myocardial infarction. A chest X-ray helps assess whether there are any cardiopulmonary abnormalities.

bubble_chart Diagnosis

1. Medical history and symptoms: Most have a history of heart disease or previous cerebral embolism. Sudden onset without warning, common symptoms include hemiplegia or monoplegia, epileptic seizures, sensory disturbances, and aphasia. Sometimes rapid unconsciousness and symptoms of acute increased intracranial pressure may occur. Medical history inquiry should focus on the acuity of onset, main symptoms, history of similar episodes, and history of other systemic diseases.
2. Physical examination findings: Often include aphasia, hemiplegia or monoplegia, sensory disturbances, unconsciousness, and other focal neurological signs. Depending on the embolized blood vessel, other focal neurological signs, vascular embolism in other parts of the body, and signs of the primary disease may appear.

bubble_chart Treatment Measures

Appropriate hemodilution therapy may be employed. To prevent and treat cerebral edema, diuretics such as furosemide, which have minimal impact on cardiac function, can be selected. After excluding hemorrhagic infarction and infectious embolism through cranial CT and lumbar puncture, anticoagulation therapy can be initiated with warfarin at an initial dose of 4-6 mg/day, followed by a maintenance dose of 2-4 mg/day, along with the platelet aggregation inhibitor dipyridamole at 50 mg three times daily.

2. Treatment of Primary Diseases:

① Correct heart failure and improve cardiac function; for cases caused by myocardial infarction, treat the myocardial infarction;

② For infectious embolism, administer potent antibiotics to control the infection.

bubble_chart Differentiation

Attention should be paid to differentiation from cerebral hemorrhage; for unconscious patients, other systemic or intracranial diseases that may cause unconsciousness must be ruled out; differentiation from symptomatic epilepsy caused by other reasons is also necessary.