17. Cerebral infarction and cerebral haemorrhage

Cerebral infarctions and cerebral haemorrhages are cerebrovascular disorders. They are a major cause of mortality and disability. Imaging is required to make the correct diagnosis. Cerebral infarctions are caused mainly by thromboembolisms, which can develop at the site of an atherosclerotic stenosis; there are also cardiac sources of embolism and other causes, though the latter are rare. A TIA is in fact an impending cerebral infarction and needs to be diagnosed quickly. The possibility of thrombolysis and mechanical thrombectomy during the acute phase means that a cerebral infarction is a medical emergency. Hypertension, amyloid angiopathy and vascular malformations can cause intracranial bleeding. Non-traumatic subarachnoid haemorrhages are usually caused by a ruptured aneurysm. Cerebral venous sinus thrombosis is a much rarer cause of cerebral infarction or haemorrhage than arterial cerebral infarction. The treatment of patients with cerebrovascular disorders at a stroke unit is multidisciplinary. If residual symptoms are present after a cerebral infarction or cerebral haemorrhage the success of rehabilitation is affected by cognition and mood. This chapter builds on our basic understanding of the cerebrovascular system, which is discussed in Chap. 11. A general introduction (sect. 17.1–17.3) is followed by a description of ischaemic accidents (sect. 17.4–17.5). We then look at haemorrhages: intracerebral (sect. 17.6) and subarachnoid (sect. 17.7). Subdural and epidural haematomas are dealt with in a different chapter (sect. 21.6). A few other specific areas are discussed at the end of this chapter (sect. 17.8–17.10). We return to neurovascular abnormalities in the chapters on movement disorders (Chap. 27), dementia (Chap. 18) and the final chapter on neurological complications (Chap. 30).