Cerebral Infarction: Epidemiology, Classification, Mechanisms, Diagnosis, and Management

Cerebral infarction, the pathological basis of ischemic stroke, remains a leading cause of mortality and long-term disability worldwide. Its clinical heterogeneity reflects the complex interplay among vascular pathology, metabolic failure, immune responses, and genetic susceptibility, posing persistent challenges to effective risk stratification and individualized therapy. This review provides an integrative overview of cerebral infarction from a precision medicine perspective, synthesizing advances across epidemiology, pathophysiology, diagnostics, and therapeutics to bridge the gap between mechanistic insight and clinical outcomes. We first summarize global epidemiological trends, highlighting persistent disparities and the shift toward understanding modifiable and emerging risk factors. We then critically examine the evolution of stroke classification from traditional systems (e.g., Trial of Org 10172 in Acute Stroke Treatment [TOAST]) toward phenotype-driven and molecularly informed frameworks. The core of the review delves into key pathophysiological mechanisms-including neurovascular unit dysfunction, energy metabolism disturbance, and regulated cell death pathways such as ferroptosis-and their implications for targeted intervention. We further appraise contemporary diagnostic advances, encompassing multimodal imaging, circulating biomarkers, and artificial intelligence-assisted tools, alongside current treatment strategies like reperfusion therapy and emerging neuroprotective approaches. Finally, we discuss how multiomics technologies and data-driven models are redefining stroke subtyping and guiding individualized management. By employing a mechanism-phenotype-decision framework, this review offers a coherent synthesis of the field, providing a roadmap to support the transition from empirical care toward precision-oriented management in cerebral infarction.