I was fine before going to bed, but had a cerebral infarction when I woke up. Why is that?

Author: Li Xiaogang, Chief Physician, Peking University Third Hospital

Deputy Director of Neurorehabilitation Group, Chinese Medical Association Neurology Branch

Reviewer: Li Jingjing, Chief Physician, Beijing Tiantan Hospital, Capital Medical University

Stroke, which is commonly called "stroke", is simply a problem with the brain blood vessels.

Stroke is divided into hemorrhagic stroke and ischemic stroke. The following article will mainly introduce ischemic stroke.

1. What causes ischemic stroke?

Ischemic stroke, also known as cerebral infarction, refers to the blockage or occlusion of the arteries supplying the brain, leading to neurological dysfunction.

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There are five main causes of ischemic stroke:

The first type is large-artery atherosclerosis, in which the large blood vessels in the brain have atherosclerotic plaques and vascular stenosis, leading to ischemic stroke.

The second type is cardiogenic embolism, which usually occurs when the patient has heart disease, such as atrial fibrillation, valvular heart disease, etc. The blood clot in the heart breaks off and blocks the cerebral artery, leading to ischemic stroke.

The third type is caused by small vessel disease, also known as branch artery disease in medicine. It is caused by blockage of very small arteries, which leads to lacunar cerebral infarction or small focal cerebral infarction in patients.

The fourth category is other causes, such as arterial dissection, arteritis, or arteriovenous malformation, where vascular diseases lead to ischemic stroke.

The fifth category is of unknown cause, that is, after the patient has suffered a cerebral infarction, all the tests have been done but the cause cannot be found, and finally it is classified as ischemic stroke of unknown cause.

In clinical practice, the incidence of ischemic stroke is very high, accounting for about 70%-80%, and hemorrhagic stroke accounts for about 20%-30%.

2. What are the risk factors for ischemic stroke?

There are many risk factors for ischemic stroke. Some risk factors cannot be changed or countered, such as age. The chance of cerebral infarction increases with age; family history. If a family member has a history of cerebral infarction, then he or she is more likely to suffer from cerebral infarction in the future; gender. Relatively speaking, there are more male patients with cerebral infarction than female patients.

However, there are also many risk factors that can be modified, such as high blood pressure, diabetes, hyperlipidemia, and bad lifestyle habits such as long-term smoking, alcoholism, and sitting for long periods of time, which are all risk factors for ischemic stroke.

Of course, there are other risk factors, such as homocystinemia, drug abuse, long-term use of contraceptives, etc., which are also prone to cause cerebrovascular disease. If these risk factors can be managed well, the occurrence of ischemic stroke can be reduced.

3. Why do some people feel fine before going to bed but suffer ischemic stroke after waking up?

During sleep, people will experience some pathological and physiological changes, such as sympathetic nerve inhibition, parasympathetic nerve excitement, and slow blood flow. If you already have atherosclerosis, poor vascular foundation, high blood sugar, and high blood lipids, your blood will be very viscous, and blood clots will easily form when blood flow is slow, so you may experience symptoms of ischemic stroke after waking up.

In addition, people with morning hypertension have particularly high blood pressure when they wake up in the morning. High blood pressure is the biggest risk factor for stroke, which can cause blood vessel blockage or thrombus detachment, making it easy to have a stroke after waking up.

People who suffer from obstructive sleep apnea, snore while sleeping, and have sleep apnea are also prone to stroke after waking up.

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4. Can ischemic stroke be detected early?

What symptoms indicate an ischemic stroke? Generally, they are as follows:

First, language dysfunction, suddenly not being able to understand what others are saying, or suddenly being unable to speak.

Second, the corners of the mouth are crooked. When talking and laughing, the corners of the mouth are asymmetrical and crooked.

Third, the limbs are weak. When both hands are raised horizontally, one hand will hang down, showing that there is obviously no strength.

There are also other symptoms, such as sudden dizziness, unsteady walking and other balance disorders, or sudden blacking out in front of the eyes, or sudden loss of vision in one eye.

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If the above symptoms occur, it may mean that an ischemic stroke is about to occur or has occurred. It is recommended that the patient or family members call the emergency number immediately and seek medical treatment as soon as possible.

Ischemic stroke and hemorrhagic stroke both cause neurological dysfunction, and their clinical manifestations are sometimes difficult to distinguish. The common feature is that they occur suddenly, and can manifest as hemiplegia and aphasia. In more serious cases, such as large amounts of bleeding or large vessel cerebral infarction, there can be disturbances of consciousness, which can only be differentiated through head CT or MRI examinations.

Finally, I would like to remind everyone, I hope everyone remembers, if you or your family or friends show some symptoms of stroke, do not take medicine casually. You must call the emergency number 120 or 999 as soon as possible and go to the hospital in time. The doctor will use CT or MRI to determine whether it is bleeding or ischemia, and then provide corresponding treatment.