Can a newborn's brain infarction be cured?

Patient's question:

Patient age: 2 days old, second day of birth, convulsions, difficulty breathing, crying

Doctor's answer:

Treatment Methods for Cerebral Infarction:
We often encounter patients with cerebral infarction sequelae or a history of cerebral infarction in the outpatient clinic who request intravenous infusion of a course (approximately two weeks) every six months, referred to as "thrombus dissolution therapy." Recently, the author received letters from some grassroots doctors who found that new infarctions occurred during the infusion process and were unsure how to explain this to their patients. Regarding these issues, a review of domestic and international literature has not yielded any theoretical basis for the claim that intravenous infusion every six months can prevent cerebral infarction. It is impossible to dissolve a thrombus six months later. The optimal time for thrombolysis, especially arterial thrombolysis, is within three hours of onset. Below is a detailed introduction to thrombolytic methods, indications, and side effects.
Prevention and Control of Hypertension in Cerebral Infarction:
When systolic blood pressure exceeds 160 mmHg or diastolic blood pressure exceeds 95 mmHg, the relative risk of stroke is 4. The choice of medication follows an individualized principle.
Prevention and Treatment of Heart Disease:
The main medications are aspirin and warfarin. Aspirin is primarily used for non-cardiogenic embolism-induced cerebral infarction, while warfarin is more commonly used for rheumatic heart disease with atrial fibrillation. The daily maintenance dose of warfarin is 2–4 mg. Prothrombin time and activity should be monitored. For the first 10 days, daily monitoring is required, followed by weekly monitoring three times a week. Once the prothrombin time stabilizes at the therapeutic target level, it should be measured every 7–10 days. Additionally, diabetes should be actively treated, and hyperlipidemia should be prevented. A reasonable lifestyle is essential: diet, exercise, maintaining a positive mindset, cautious use of contraceptives, smoking less or not at all, and avoiding excessive alcohol consumption.
Principles of Treatment for Acute Cerebral Infarction:
Treatment should be individualized, classified, and staged (Cerebral Infarction Treatment Methods I).
1. Thrombolytic Therapy:
- Performed within 3–6 hours of onset.
- Can be administered intravenously or via the artery (arterial thrombolysis is not widely used in clinical practice).
- Common drugs include urokinase and tissue plasminogen activator (t-PA).
- The main risk and side effect of thrombolytic therapy is intracranial hemorrhage, with a higher risk of hemorrhage in cases of cardiogenic embolism.
2. Anticoagulant Therapy:
- Common drugs include heparin and low-molecular-weight heparin, with coagulation tests required.
- The main side effect is bleeding, with low-molecular-weight heparin being safer than standard heparin.
3. Antiplatelet Drugs:
(1) Aspirin: An economical, practical, safe, and most conventional antiplatelet prophylactic medication. The minimum effective dose is 50 mg or 75 mg per day. In the acute phase, the dose can be increased to 300 mg per day. No hematological monitoring is required during treatment. Enteric-coated aspirin can significantly reduce side effects.
(2) Ticlopidine: Can be used for both treatment and prevention. The dose and administration are 125–250 mg per day, taken with meals. Blood counts, liver function, and coagulation should be monitored during treatment. Some patients may experience side effects such as leukopenia, jaundice, elevated transaminases, prolonged bleeding time, and should be cautious in cases of ulcer disease, thrombocytopenia, or bleeding disorders. This drug is more expensive than aspirin.
(3) Clopidogrel: Already in use in Europe and America. The efficacy of 75 mg of clopidogrel is equivalent to 250 mg of ticlopidine.
4. Fibrinolytic Therapy:
- Increases fibrinolytic system activity and inhibits thrombus formation.
- Common drugs include fibrinolytic enzymes, (DXKST), and (VST).
- Should be used within 24 hours of onset.
- Fibronectin levels should be monitored during treatment.
5. Blood Dilution Therapy:
- Aims to reduce blood viscosity, improve microcirculation, and supplement blood volume.
- Common drugs include low-molecular-weight dextran and 706 plasma.
6. Neuroprotective Agents:
(1) Calcium Channel Blockers: Prevent intracellular calcium overload, vasospasm, and increase blood flow.
- Common drugs include nimodipine, nicardipine, flunarizine, and cinnarizine.
(2) Citicoline: Stabilizes cell membranes.
(3) Glutamate Antagonists and GABA Enhancers.
(4) Others: Vitamin E, vitamin C, and mannitol also have antioxidant and free radical-scavenging effects.
7. Traditional Chinese Medicine (TCM):
- Medications include compound Danshen and chuanxionu.
- Adjunctive treatments include acupuncture and massage.
8. Rehabilitation Therapy:
- The primary method for treating cerebrovascular diseases abroad, typically started 3–7 days after onset, with systematic, standardized, and individualized rehabilitation.
9. General Treatment:
(1) Blood Pressure Adjustment: Antihypertensive drugs should be used cautiously during cerebral infarction. If blood pressure is 150–160/100, antihypertensive drugs are not necessary. Excessive lowering of blood pressure can worsen cerebral ischemia.
(2) Maintaining Airway Patency: Patients with breathing difficulties may receive oxygen, and tracheostomy may be necessary if needed.
(3) Reducing Intracranial Pressure and Cerebral Edema: Acute cerebral infarction, especially large-scale, can cause cerebral edema, which is a common cause of death within one week of onset. Mannitol should be used to reduce intracranial pressure. Patients with abnormal renal function may use glycerol fructose and furosemide.
(4) Preventing and Treating Respiratory and Urinary Tract Infections: Antibiotics should be used reasonably.
(5) Preventing Pulmonary Embolism and Deep Vein Thrombosis of the Lower Extremities: Low-molecular-weight heparin or heparin preparations can be subcutaneously injected.
(6) Early Mobilization to Prevent Pressure Ulcers: Turn and back-sweep the patient every two hours and perform passive exercises on paralyzed limbs to avoid pressure and pressure ulcers.
(7) Enhancing Nutrition: Depending on the patient's condition, nasogastric feeding or intravenous hyperalimentation can be provided to create opportunities for recovery.