Among the main etiological factors, atherosclerosis and arterial hypertension are considered, often a combination of these two conditions is detected. Other cardiovascular diseases, especially those accompanied by signs of chronic heart failure, cardiac arrhythmias (both permanent and paroxysmal forms of arrhythmia), often leading to a decrease in systemic hemodynamics, can lead to chronic ischemia of cerebral circulation. An anomaly of the vessels of the brain, neck, shoulder girdle, aorta (especially its arches), which cannot be manifested before the development of an atherosclerotic, hypertonic, or other acquired process in these vessels, is also significant.
Recently, a large role in the development of chronic cerebral ischemia has been assigned to venous pathology, not only intra- but also extracranial. A certain role in the formation of chronic cerebral ischemia is able to play vascular compression, both arterial and venous. Not only spondylogenic effect should be taken into account, but also compression by altered neighboring structures (muscles, tumors, aneurysms). Another cause of the development of chronic cerebral ischemia can be cerebral amyloidosis (in elderly patients).
Clinically detectable encephalopathy is usually of mixed etiology. In the presence of the main factors for the development of chronic cerebral ischemia, the rest of the variety of causes of this pathology can be interpreted as additional causes. Isolation of additional factors significantly aggravating the course of chronic cerebral ischemia is necessary for developing the correct concept of etiopathogenetic and symptomatic treatment.
The main causes of chronic cerebral ischemia: atherosclerosis and arterial hypertension. Additional causes of chronic cerebral ischemia: cardiovascular disease (with signs of CSU); heart rhythm disturbance, vascular abnormalities, hereditary angiopathies, venous pathology, vascular compression, arterial hypotension, cerebral amyloidosis, systemic vasculitis, diabetes mellitus, blood diseases.
In recent years, 2 main pathogenetic variants of chronic cerebral ischemia have been considered, based on the following morphological signs: the nature of the damage and primary localization. With bilateral diffuse lesion of white matter, a leukoencephalopathic (or subcortical Biswangerian) variant of discirculatory encephalopathy is isolated. The second is the lacunar variant with the presence of multiple lacunar foci. However, in practice, mixed options are very common.
The lacunar variant is often due to direct occlusion of small vessels. In the pathogenesis of diffuse lesion of white matter, the leading role is played by repeated episodes of a fall in systemic hemodynamics – arterial hypotension. The cause of the drop in blood pressure may be inadequate antihypertensive therapy, decreased cardiac output. In addition, persistent cough, surgical interventions, orthostatic hypotension (with vegetative-vascular dystonia) are of great importance.
In conditions of chronic hypoperfusion, the main pathogenetic link in chronic cerebral ischemia, depletion of compensation mechanisms occurs, and the energy supply to the brain decreases. First of all, functional disorders develop, and then irreversible morphological disorders: a slowdown in cerebral blood flow, a decrease in blood glucose and oxygen levels, oxidative stress, capillary stasis, a tendency to thrombosis, and depolarization of cell membranes.
- I stage. The above complaints are combined with diffuse micro-focal neurological symptoms in the form of anisoreflexia, coarse reflexes of oral automatism. There may be slight changes in gait (slow walking, small steps), decreased stability and uncertainty when performing coordinating tests. Often note emotional and personality disorders (irritability, emotional lability, anxious and depressive traits). Already at this stage there are mild cognitive impairments of the neurodynamic type: exhaustion, fluctuation of attention, slowdown and inertia of intellectual activity. Patients cope with neuropsychological tests and work, which does not require accounting for lead time. Vital activity of patients is not limited.
- II stage. It is characterized by an increase in neurological symptoms with the possible formation of a mild, but dominant syndrome. Separate extrapyramidal disorders, incomplete pseudobulbar syndrome, ataxia, central nervous system dysfunction (proso- and glossoparesis) are detected. Complaints become less pronounced and not so significant for the patient. Emotional disorders are exacerbated. Cognitive function increases to a moderate degree, neurodynamic disturbances are supplemented by dysregulatory (fronto-subcortical syndrome). The ability to plan and control their actions is deteriorating. Violation of tasks that are unlimited in time, but retains the ability to compensation (the ability to use hints). Perhaps the manifestation of signs of a decrease in social and professional adaptation.
- III stage. It features a vivid manifestation of several neurological syndromes. Disturbed walking and balance (frequent falls), urinary incontinence, parkinsonism syndrome. Due to the decrease in criticism of the state, the volume of complaints decreases. Behavioral and personality disorders are manifested in the form of explosiveness, disinhibition, apathetic-abulic syndrome and psychotic disorders. Along with neurodynamic and dysregulatory cognitive syndromes, operational disorders (disorders of speech, memory, thinking, praxis) appear that can develop into dementia. In such cases, patients are slowly maladaptive, which manifests itself in professional, social and even everyday activities. Quite often, disability is stated. Over time, the ability to self-service is lost.
The causes of the development of chronic cerebral ischemia are closely related to atherosclerotic stenosis, thrombosis, embolism. A certain role is played by post-traumatic separation of the vertebral arteries, extravasal (extra-vascular) compression in the pathology of the spine or neck muscles, deformation of arteries with permanent or periodic disturbances in their patency, hemorheological changes in the blood.
It should be borne in mind that symptoms similar to those associated with chronic ischemia can be caused not only by vascular, but also by other factors – chronic infection, neurosis, allergic conditions, malignant tumors, and other reasons for which a differential diagnosis should be made .
vasculitis (vascular inflammation) of an allergic and infectious etiology,
abnormalities of the vascular bed of the brain and aneurysms,
kidney disease and other diseases.
The development of chronic cerebral ischemia contributes to a number of reasons, which are commonly called risk factors. Risk factors are divided into correctable and non-correctable. Non-correctable factors include old age, gender, hereditary predisposition. It is known, for example, that stroke or encephalopathy in parents increases the likelihood of vascular disease in children.
These factors cannot be influenced, but they help to pre-identify individuals with an increased risk of developing vascular pathology and help prevent the development of the disease. The main correctable factors for the development of chronic ischemia are atherosclerosis and hypertension. Diabetes mellitus, smoking, alcohol, obesity, lack of exercise, poor nutrition – the reasons leading to the progression of atherosclerosis and worsening of the patient’s condition.
In these cases, the coagulation and anticoagulation system of the blood is disrupted, the development of atherosclerotic plaques is accelerated. Due to this, the lumen of the artery is reduced or completely clogged. In this case, the crisis course of hypertension is of particular danger: it leads to an increase in the load on the vessels of the brain.
Chronic ischemia of GM is a progressive disease, which is accompanied by increasing disorders of the central, peripheral and autonomic nervous system. The first signs of the disease often go unnoticed, since they do not have any acute manifestations, but are expressed in general malaise, headaches, drowsiness, distraction, irritability.
Manifestations of chronic cerebral ischemia are divided into three stages: initial manifestations, subcompensation and decompensation.
In the 1st stage, subjective disorders dominate in the form of headaches and a feeling of heaviness in the head, general weakness, increased fatigue, emotional lability, dizziness, decreased memory and attention, and sleep disturbances. These phenomena are accompanied by albeit mild but persistent objective disorders in the form of anisoreflexia (the difference between symmetrical tendon reflexes), discoordination phenomena, oculomotor insufficiency, symptoms of oral automatism, memory loss and asthenia.
In complaints of patients with stage 2 chemotherapy, memory impairment, disability, dizziness, instability when walking are more common, manifestations of an asthenic symptom complex are less common. At the same time, focal symptoms become more distinct: revival of reflexes of oral automatism, central insufficiency of the facial and hyoid nerves, coordinator and oculomotor disorders, pyramidal insufficiency, amyostatic syndrome, increased mnestic-intellectual disorders.
At this stage, it is possible to isolate certain dominant neurological syndromes – discoordinate, pyramidal, amiostatic, disinnestic, etc., which can help with the appointment of symptomatic treatment. At this stage, the patient’s social and labor activity is already disrupted, in some cases, even the help of strangers is already required even in everyday affairs. It is impossible to reverse the changes that have occurred in the nervous system, but you can mitigate the symptoms and slow down the progression of the disease.
Painful manifestations will vary depending on the degree of the disease. At an early stage, the disease is quite easy to detect – fatigue is manifested during physical or mental activity. Later, to this seemingly easy symptom, other, more serious ones are added, meaning a worsening of the general background. They progress at high speed and after a short period of time increase the area of influence:
- Disorder of the nervous system.
- Partial memory loss.
- Mood swings.
- Frequent and prolonged headaches.
- Blood pressure jumps.
- Rapid breathing.
- Loss of consciousness.
- Emetic urges.
- Feeling of cold or numbness of limbs.
When acute coronary artery disease occurs, the symptoms of circulatory disorders are difficult to miss. Manifestations depend on the location of the lesion and may vary. Symptoms of transient attack and ischemic stroke are identical, but in the first case they are temporary, reversible, and with timely help they quickly regress, and in the second case, some of them are irreversible. We list the characteristic signs of acute forms:
- sharp pain in the head;
- slurred speech;
- complete or partial loss of vision;
- involuntary urination, defecation;
- loss of sensation in certain areas of the body;
- numbness of body parts;
- decrease in range of motion in the limbs on the one hand;
- violation of coordination of movements;
- deterioration of fine motor skills;
- nausea, vomiting;
- convulsive syndrome.
In the chronic form, three degrees of cerebral ischemia are distinguished:
- the first is the stage of initial manifestations;
- the second is subcompensation;
- the third is decompensation.
In the initial stage, cerebral ischemia of the brain can proceed almost imperceptibly for the patient and those around him, or the symptoms are ignored due to the lack of expression. The main manifestations include:
- general weakness;
- a feeling of heaviness in the head;
- noise in ears;
- frequent mood swings;
- depressive state;
- violation of coordination of movements;
- shuffling gait;
- forgetfulness, distraction.
When cerebral ischemia of the 2nd degree develops, the primary signs are aggravated, become more obvious. The most striking symptoms are:
- frequent headaches, dizziness;
- significant memory impairment;
- isolation, apathy;
- coordinating and oculomotor disorders;
- intellectual disorders.
In the third degree of pathology, most of the damage to the brain and the functions lost as a result of this are irreversible. Signs of coronary artery disease include:
- frequent syncope;
- violation of swallowing;
- urinary incontinence;
- inappropriate and uncontrolled behavior;
- inability to move;
- loss of memory;
- disorder of mental functions up to dementia.
The main clinical manifestations of chronic cerebral ischemia are polyformal motor disorders, memory impairment and learning abilities, disorders in the emotional sphere. Clinically, the features of chronic cerebral ischemia are a progressive course, staged, syndromic. It should be noted the inverse relationship between the presence of complaints, especially reflecting the ability to cognitive activity (attention, memory), and the severity of chronic cerebral ischemia: the more cognitive functions suffer, the less complaints. Thus, subjective manifestations in the form of complaints cannot reflect either the severity or the nature of the process.
The core of the clinical picture of discirculatory encephalopathy is currently recognized as cognitive impairment that is already detected in stage I and progressively increasing to stage III. In parallel, emotional disorders (inertia, emotional lability, loss of interest), a variety of motor disorders (from programming and control to execution as complex neokinetic, higher automated, and simple reflex movements) develop.
The main clinical signs of chronic cerebral ischemia are emotional disorders, memory impairment, learning and memory abilities, as well as motor disorders. There is a marked inverse relationship between cognitive impairment and the presence of complaints: the more cognitive activity suffers, the fewer complaints are made by patients. Therefore, it is impossible to assess the severity of the pathological process on the basis of subjective sensations and complaints of patients.
The main symptom of cerebral ischemia in a chronic course is cognitive impairment. At the same time, motor disorders and disorders of the emotional sphere arise and gradually progress.
Acute cerebral ischemia occurs suddenly, its manifestations:
- Strong headache ;
- nausea, sometimes even vomiting, and vomiting does not bring relief;
- general weakness;
- vegetovascular reactions (sweating, trembling, flushing);
- blurred vision;
- short-term impaired consciousness;
- focal neurological symptoms (determined by the location of the ischemic process).
With a transient disorder of cerebral circulation, impaired neurological functions are fully restored within 24 hours. If neurological symptoms disappear within a week, then they speak of a minor stroke. The persistence of a neurological deficit over 7 days indicates a completed ischemic stroke.
The first symptom of a chronic disease is fatigue, so coronary artery disease of the brain can be detected even at an early stage with timely contact to the doctor. If this is not done, then over time the disease progresses rapidly, expanding the range of influence. The range of symptoms that indicate a worsening situation:
- general weakness;
- speech impairment;
- decreased sensitivity;
- pressure drops;
- vomiting, nausea;
- focal headaches;
- memory impairment.
Along with the progression of neurological symptoms, as the pathological process in the neurons of the brain develops, an increase in cognitive disorders occurs. This applies not only to memory and intellect, which are disturbed in the 3rd stage to the level of dementia, but also to neuropsychological syndromes such as praxis (the ability to perform sequential complexes of conscious voluntary movements and perform targeted actions according to a plan developed by individual practice) and gnosis (recognition of objects ( objects, persons) with the preservation of elementary forms of sensitivity, vision, hearing.
Initial, essentially subclinical disorders of these functions are observed already in the 1st stage, then they intensify, change, become distinct. The 2nd and especially the 3rd stage of the disease are characterized by bright violations of higher brain functions, which dramatically reduces the quality of life and social adaptation of patients.
Regardless of the stage in which signs of chronic cerebral ischemia are detected, it is important to consult a doctor as soon as possible, since at the early stage of the disease, the changes are still reversible, and at later stages it is possible to stop the progression of the disease and improve the quality of life and social adaptation.
Cerebral ischemia in newborns
The main reason that cerebral ischemia occurs in a newborn is hypoxia during childbirth or in the mother’s womb. As in adults, cerebral ischemia in a newborn is divided into 3 degrees, depending on the duration of oxygen deficiency in the brain. It is quite difficult to identify the disease, if only because at this age the baby still does not know how to speak, which means that she will not be able to complain. Moreover, some of the symptoms do not yet appear in infants.
There are several syndromes on the basis of which it is possible to diagnose cerebral ischemia in a child:
- Convulsive. The body sometimes twitches involuntarily due to muscle contraction.
- Comatose. The baby is unconscious, the brain coordination function does not work.
- Hydrocephalic. The head increases in size, the pressure inside the skull rises.
- Hyperactivity. Frequent crying, anxious sleep, limbs sometimes tremble on their own.
- Oppression of the central nervous system. The sucking and swallowing reflexes inherent in every child from birth become weaker. In addition, facial asymmetry or strabismus may appear.
Due to differences in age, the severity of the course of the disease in infants and adults is somewhat different from each other:
- Cerebral ischemia of the 1st degree in a newborn. With the beginning of life, the child has a strong weakness of the body or, conversely, its increased activity.
- Grade 2 ischemia in newborns. Cramps occur. Inpatient treatment is required.
- Grade 3 ischemia in children. There is a likelihood of death, therefore urgent hospitalization is required. Ischemia affects the central nervous system. Because of this, loss of vision and damage to the hearing aid are possible.
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If you let the disease drift and do not go to the doctor in time, then serious consequences cannot be avoided.
It is worth remembering that cerebral ischemia often leads to deaths, the number of which is increasing from year to year. If you manage to survive, then serious health problems will not let you forget about yourself. All pathologies after this disease severely limit a person’s life. That is why it is so important to identify and properly treat the disease in time in both adults and infants.
The development of cerebral ischemia in newborns leads to fetal oxygen starvation during pregnancy or in the process of labor.
The following signs suggest the presence of cerebral ischemia in a newborn:
- marbling of the skin;
- startles and causeless crying;
- sleep disorders;
- muscle atony;
- head volume is more than normal;
- bulging large fontanel;
- violations of sucking and swallowing;
- respiratory failure;
- convulsive seizures.
Deficiency of blood supply to the organs of the central uneven system at the stage of intrauterine development and during the first months of life is most dangerous. In this case, the main complications will be associated with abnormal formation of the nervous system, as well as with a lag in mental and physical development. A child can begin to speak much later, refuse to eat and react sluggishly to the outside world.
The causes of pathology in childhood are usually associated with intrauterine development. It can be a cardiovascular defect or hypoxia during pregnancy. The most dangerous formation of ischemia in the early stages of child development.
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Methods of diagnosis
With suspicions of chronic cerebral ischemia and any other disturbances in cerebral circulation, it is necessary to consult a neurologist. During the consultation at the Acimed neurology clinic, an experienced specialist will examine the patient’s complaints, clarify his personal and family history, conduct a physical examination and neurological tests.
The mandatory examinations that the doctor will prescribe are as follows:
laboratory blood tests
MRI of the brain
dopplerography of the vessels of the head and neck
radiography of the cervical spine
and other studies according to indications
The following components of the anamnesis are characteristic of chronic cerebral ischemia: myocardial infarction, coronary heart disease, angina pectoris, arterial hypertension (with damage to the kidneys, heart, retina, brain), atherosclerosis of the peripheral arteries of the extremities, and diabetes mellitus. A physical examination is performed to identify the pathology of the cardiovascular system and includes: determining the safety and symmetry of the pulsation in the vessels of the limbs and head, measuring blood pressure on all 4 limbs, auscultation of the heart and abdominal aorta in order to detect heart rhythm disturbances.
The purpose of laboratory research is to determine the causes of the development of chronic cerebral ischemia and its pathogenetic mechanisms. It is recommended that a general blood test, PTI, determination of blood sugar, lipid spectrum. To determine the degree of damage to the substance and blood vessels of the brain, as well as the detection of background diseases, the following instrumental studies are recommended: ECG, ophthalmoscopy, echocardiography, cervical spondylography, ultrasound of the main arteries of the head, duplex and triplex scanning of extra- and intracranial vessels. In rare cases, angiography of cerebral vessels is indicated (to detect vascular anomalies).
MRI of the brain. Signs of chronic ischemia: expansion of the central (red arrow) and peripheral (blue arrow) liquor spaces, a cyst in the region of the basal nuclei on the right (green arrow), periventricular gliosis (yellow arrow), expanded
The above complaints, characteristic of chronic cerebral ischemia, can also occur with various somatic diseases and oncological processes. In addition, such complaints are often included in the symptom complex of borderline mental disorders and endogenous mental processes.
Great difficulties are caused by the differential diagnosis of chronic cerebral ischemia with various neurodegenerative diseases, which, as a rule, are characterized by cognitive disorders and any focal neurological manifestations. Such diseases include progressive supranuclear palsy, corticobasal degeneration, multisystem atrophy, Parkinson’s disease, Alzheimer’s disease. In addition, it is often necessary to differentiate chronic cerebral ischemia from a brain tumor, normotensive hydrocephalus, idiopathic dysbasia and ataxia.
Neurological disorders involved neurologists and neurosurgeons. During the consultation, the doctor will take an interest in complaints, examine the medical history for risk factors and conduct a physical examination, including a reflex test.
Already at the stage of the initial examination, pronounced cognitive disorders indicating chronic ischemia can be detected. A stroke is diagnosed in specialized emergency departments.
The most informative methods of examination include angiography of cerebral vessels
- Angiography of cerebral vessels. The doctor introduces a contrast agent and imaging the vessels using x-ray or computed tomography. Important indicators include the presence of blockage and vascular fullness.
- Magnetic resonance imaging is a high resolution image of an organ. This method is useful for finding the cause of the disease and assessing the severity of ischemia.
- Electrocardiography – registration of cardiac activity. The resulting cardiogram may indicate primary pathologies of the heart that affect the blood supply to the brain.
- Echocardiography is a visualization of the heart. It is also conducted to search for the root cause of ischemia.
- A complete blood count to detect thrombocytosis, leukemia, polycythemia and other significant signs of pathology.
- Blood test for glucose and minerals.
- Study of coagulation function of blood.
- Analysis of cardiac biomarkers indicating myocardial infarction.
- Toxicological screening.
Comprehensive diagnostics help in time to find the cause of the disease. In the case of the chronic form, screening diagnostics aimed at identifying the asymptomatic stage of the disease is important.
Diagnosis of cerebral ischemia is sometimes difficult, as its symptoms are similar to those of a number of other diseases, in particular:
- cortico-basal degeneration;
- progressive supranuclear palsy;
- Parkinson’s disease ;
- multisystem atrophy;
- Alzheimer’s disease ;
- brain tumors;
- idiopathic dysbasia;
- normotensive hydrocephalus.
A comprehensive examination begins with an examination of the patient, determining the neurological status, assessing the state of the cardiovascular and respiratory systems. In order to determine neurological status assess:
- clarity of consciousness;
- the coordination of movements of the eyeballs;
- pupil reaction to light;
- face symmetry;
- ability to make faces, facial expressions;
- tongue movements;
- coordination of movements;
- muscle tone and muscle strength;
- tendon reflexes;
If the doctor suspects that the patient is developing ischemic brain disease, a number of studies are prescribed to confirm the diagnosis, determine the degree of progression, and identify likely causes. During a physical examination, the state of the respiratory and cardiovascular systems is assessed, the neurological status is determined (clarity of consciousness, speech, memory, sensitivity, coordination of movements, the reaction of the pupils to light, and so on). Instrumental and laboratory studies are prescribed:
- computed or magnetic resonance imaging of the brain;
- Doppler ultrasound of large blood vessels;
- duplex scanning of blood vessels;
- angiography of cerebral vessels;
- brain electroencephalography;
- cardiac echocardiography;
- fundus ophthalmoscopy;
- radiography of the cervical spine;
- blood test for lipid fractions, glucose and cholesterol.
The patient examination scheme solves several problems at once: localization, type and volume of the lesion, the probable cause of the pathology and associated diseases. The doctor after interviewing the patient and identifying factors that could provoke the disease, sends him for diagnosis. Chronic cerebral ischemia is detected by MRI, in which the problem area is visualized, and a duplex scan showing the location of the affected vessels.
Treatment of cerebral ischemia
Depending on the stage of the disease, its causes and the condition of the patient, various treatment tactics may be chosen.
First of all, therapeutic measures will be aimed at eliminating the causes of ischemia. For these purposes, drugs are used (lowering blood pressure, lowering cholesterol and blood viscosity, reducing high blood glucose, neurometabolics, venotonics, improving cognitive functions and others.
In the treatment of cerebral ischemia of the 2nd and 3rd degree, the patient needs rehabilitation measures that will slow down the development of the disease, will help level out symptoms, social adaptation and improve the quality of life. An individual recovery program will be developed for the patient at the Aksimed rehabilitation center, taking into account the current condition of the patient, the degree of brain damage, and the forecasts of a neurologist.
The neurologists of the Aximed Clinic recall that with the timely start of treatment for chronic cerebral ischemia, the prognosis is positive, however, the disease is prone to progression and complications, so if you have this diagnosis, you must regularly undergo a medical examination and follow the doctor’s instructions regarding medications, diet and a healthy lifestyle .
Dysfunction of cerebral vessels contributes to the development of many ischemic diseases. The most severe of these is cerebrovascular insufficiency. Treatment of a pathological condition after diagnosis is prescribed individually. Often use drug therapy, correct lifestyle. In order to prevent the development of a stroke, sometimes the patient is prescribed surgical treatment.
The disease must be treated comprehensively. To reduce cholesterol, medications are prescribed – statins. Their main action is aimed at reducing the production of enzymes that produce cholesterol in the adrenal glands and liver cells. Statins do not have a mutagenic or carcinogenic effect, but have some side effects, so they are prescribed with caution to the elderly. Atorvastatin, Fenofib, Lovastatin are considered more effective drugs.
To combat high blood pressure that provokes ischemia, low doses of thiazide-like diuretics are prescribed. The drugs remove excess fluid from the body, while reducing the load on the heart muscle. They are used with monotherapy, and in combination with other drugs. A feature of statins is the ability not only to lower blood pressure, but also to correct the negative effects that chronic cerebral ischemia can provoke. Drugs in this group – Ramipril, Perindopril, Enalapril.
Therapy of such a pathology as chronic cerebral ischemia, without fail, needs to restore blood flow by expanding blood vessels and diluting blood. Drugs whose action is aimed at improving brain cell nutrition and normalizing blood circulation are an indispensable part of the comprehensive treatment of the disease. These include derivatives of nicotinic acid (Enduratin, Nikoshpan), calcium antagonists (Adalat, Foridon), vinca alkaloids (Cavinton, Vinpocetine).
Chronic starvation of brain neurons is a dangerous condition that can be improved with vasoactive drugs. They improve blood supply in the vessels by expanding the microvasculature. Vasoactive drugs include: phosphodiesterase blockers (Pentoxifylline, Tanakan), calcium blockers (Nimodipine, Cinnarizine), alpha-blockers (Niceroglyn).
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Neuroprotectors are able to reduce biochemical disturbances in nerve cells. Coronary heart disease destroys neural connections, and these drugs can protect and improve brain adaptation to negative influences. The appointment of neuroprotectors after a stroke is the most effective treatment.
Patients who are suspected of acute cerebral ischemia should receive treatment as soon as possible, which requires urgent hospitalization. First of all, measures are taken to restore blood circulation, which is achieved by conservative or surgical methods. Surgery is performed in especially severe cases with the aim of removing a blood clot or atherosclerotic plaque from a clogged cerebral artery, expanding the lumen of the vessel.
When brain ischemia is diagnosed, dieting is an important part in the treatment. Patients need to limit the consumption of animal fats, preservation, hot spices, muffins, sugar and salt. Useful foods rich in potassium (dried apricots, raisins, baked potatoes), iodine (seafood), dairy products, vegetables, fruits, cereals.
How to treat cerebral ischemia, the doctor determines, based on diagnostic data. Drug therapy is the basis of complex treatment, while drugs can be injected or taken orally. We list the main groups of drugs prescribed for the treatment of this pathology:
- antiplatelet agents, anticoagulants – to prevent blood clotting and the formation of blood clots (acetylsalicylic acid, Aspirin cardio, Cardiomagnyl, Dipyridamole, Clopidogrel, Fraxiparin);
- antihypertensive drugs – to reduce blood pressure (Lisinopril, Enap, Ramipril, Amlodipine);
- neuroprotectors – protect neurons from negative factors (Actovegin, Citicoline, magnesium sulfate);
- anticholesterol drugs – to lower blood cholesterol (Atorvastatin, Rosuvastatin);
- thrombolytics – for the destruction of blood clots (Activase, Retaplase, Actilize);
- Nootropics – to improve brain activity (Piracetam, Cerebrolysin, Nootropil);
- antispasmodics and vasodilators – to relieve vascular spasms, expand the lumen of blood vessels (Papaverin, Eufillin, Bilobil, Vinpocetine).
It is important to understand that the prescribed treatment for chronic cerebral ischemia, as well as acute, cannot be replaced by any alternative methods, as this can be deadly. The possibility of using any alternative methods of treatment should be discussed with the doctor, and only with his permission can they be tested on oneself.
The goal of the treatment of chronic cerebral ischemia is the stabilization of the destructive process of cerebral ischemia, the suspension of progression, the activation of sanogenetic mechanisms for compensating functions, the prevention of ischemic stroke (both primary and secondary), as well as the treatment of concomitant somatic processes.
Chronic cerebral ischemia is not considered an absolute indication for hospitalization if its course was not complicated by the development of a stroke or severe somatic pathology. Moreover, in the presence of cognitive impairment, withdrawal of a patient from his usual environment can aggravate the course of the disease. The treatment of patients with chronic cerebral ischemia should be carried out by a neurologist in an outpatient setting. Upon reaching stage III cerebrovascular disease, patronage is recommended.
- Medication for chronic cerebral ischemia is carried out in two ways. The first is the normalization of brain perfusion by affecting different levels of the cardiovascular system. The second is the effect on the platelet link of hemostasis. Both directions contribute to the optimization of cerebral blood flow, while also performing a neuroprotective function.
- Antihypertensive therapy. Maintaining adequate blood pressure plays a large role in preventing and stabilizing chronic cerebral ischemia. When prescribing antihypertensive drugs, sharp fluctuations in blood pressure should be avoided, since with the development of chronic cerebral ischemia, the mechanisms of autoregulation of cerebral blood flow are disturbed. Among the antihypertensive drugs developed and introduced into clinical practice, two pharmacological groups should be distinguished – angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists. Both of them exert not only angiohypertensive, but also angioprotective effects, protecting target organs suffering from arterial hypertension (heart, kidneys, brain). The antihypertensive effectiveness of these groups of drugs increases when combined with other antihypertensive drugs (indapamide, hydrochlorothiazide).
- Lipid-lowering therapy. In patients with atherosclerotic vascular lesions of the brain and dyslipidemia, in addition to diet (limiting animal fats), it is advisable to prescribe lipid-lowering drugs (statins – simvastatin, atorvastatin). In addition to their main action, they contribute to the improvement of endothelial function, a decrease in blood viscosity, and have an antioxidant effect.
- Antiplatelet therapy. Chronic cerebral ischemia is accompanied by activation of platelet-vascular hemostasis, therefore, the appointment of antiplatelet drugs, for example, acetylsalicylic acid. If necessary, other antiplatelet agents (clopidogrel, dipyridamole) are added to the treatment.
- Combined action drugs. Given the variety of mechanisms underlying chronic cerebral ischemia, in addition to the basic therapy described above, patients are prescribed drugs that normalize the rheological properties of blood, venous outflow, microcirculation, which have angioprotective and neurotrophic properties. For example: vinpocetine (150-300 mg / day); ginkgo biloba leaf extract (120-180 mg / day); cinnarizine piracetam (75 mg and 1,2 g / day, respectively); piracetam vinpocetine (1,2 g and 15 mg / day, respectively); nicergoline (15-30 mg / day); pentoxifylline (300 mg / day). The listed drugs are prescribed twice a year in courses of 2-3 months.
- Surgery. In chronic cerebral ischemia, the development of an occlusive stenotic lesion of the main arteries of the head is considered an indication for surgical intervention. In such cases, reconstructive operations are performed on the internal carotid arteries – carotid endarterectomy, stenting of the carotid arteries.
The treatment of the disease is carried out by a neurologist in a hospital
Folk remedies for cerebral vessels
The disease is due to the fact that it progresses slowly, gradually increasing with a variety of symptoms. You can stop the development of chronic brain ischemia using folk recipes:
- Garlic-lemon mixture. Grind a few cloves of garlic (2-3) into gruel, pour unrefined vegetable oil (100 g), put in the cold for a day. Take 1 tsp. adding lemon juice (1 tsp) three times a day. Continue treatment for 1 to 3 months without interruption.
- Herbal infusion. Mix in the same amount of grass – mint, motherwort, thyme. Pour the mixture (3 tbsp.) With boiling water (450 ml). Insist until cool, strain, drink half a glass after meals 2 times / day. The course is at least 1 month.
Consequences of cerebral ischemia
The severity and severity of the long-term effects of cerebral ischemia are determined by the form and stage of the disease. The most common complications are:
- ischemic stroke – is accompanied by softening and death of a portion of brain tissue;
- articulation disorders, up to dumbness;
- dysfunctions of the pelvic organs;
- persistent violations of swallowing and breathing;
The severity depends not only on the stage of the disease, but also on what other deficiencies have developed due to ischemia. The main negative factors are cerebral hypoxia and metabolic failure. The following pathologies may occur on ischemic soil:
- Ischemic stroke. Usually occurs in older people.
- Loss of ability to talk.
- Thrombophlebitis is an inflammation of the walls of the veins due to the formation of blood clots.
The severity of these consequences directly depends on how badly the vessel was clogged, how quickly it narrowed. Important is the duration of treatment and the general condition of the body. The sooner treatment begins, the easier the consequences.
Of course, it all depends on caring for the patient and providing him with the conditions necessary for maintaining life activity (with a chronic form of cerebral ischemia).
Nevertheless, with chronic cerebral ischemia, the patient can live from 5 to 10 years.
With proper treatment, there is every chance of a partial recovery: ischemic brain disease may recede a little.
Coronary artery disease of the brain can lead to dangerous consequences, including:
- paralysis of the respiratory center;
- swelling of the brain;
- pulmonary embolism;
- heart failure;
The brain is the main human organ related to the central nervous system. In humans, a large brain represents:
- 2 large hemispheres;
All structures of the skull have a unique histological structure and perform specific functions.
With the defeat of one of the parts of the organ of thinking, somatic disorders occur, which over time can be compensated by the transfer of function from one department to another.
For example, with a stroke in the cerebellum, the coordination of movements is disturbed, and the person stops moving. With well-chosen rehabilitation measures, the cortex (gray matter) takes control of the coordination of movements, and the person begins to move normally.
Coronary heart disease causes a common disease among older people – encephalopathy. The brain for its full existence needs a sufficient supply of oxygen and glucose.
With malnutrition, signs of insolvency begin.
To correctly understand the problem of circulatory failure in the brain in adults and newborns, you need to know how the nutrients reach the necessary cells of the body.
The main organ of the central nervous system receives nutrition through the branches of the internal carotid and basilar arteries. The common carotid artery, on which its own pulse is palpated, lies near the larynx. It is near the thyroid cartilage (where the Adam’s apple is located in men) that this vessel divides into the external and internal carotid arteries, the latter goes into the cavity of the skull.
In the blood supply to the hemispheres, the cortical branches play a large role, which feed almost all of their departments. Often, with the development of their pathology, cerebral ischemia occurs.
The vertebral artery has long been known among the population, since the diagnosis of “vertebral artery syndrome” is often made by neuropathologists.
This blood vessel from the 6th cervical vertebra through the holes in the transverse processes rises into the cavity of the skull and there diverges into 2 branches: the basilar and the anterior spinal cord. They, in turn, supply blood to the medulla oblongata, cerebellum, and partially the spinal cord.
In the pathology of the muscle corset of the neck, the vertebral artery is partially constricted, which causes oxygen starvation of the parts of the brain for which it is responsible for nutrition. So there is a vertebral artery syndrome.
A special role in the blood supply to the brain is played by the arterial circle of the cerebrum or the so-called Willis circle.
This education helps to compensate for the blood supply to the brain in case of failure of one of the arteries and save a person’s life.
It is precisely this feature of the blood supply to the brain that doctors are guided by when they develop tactics for treating cerebral ischemia, taking into account the symptoms that arise in old age.
The outflow of venous blood occurs through the large cerebral vein. In case of a malfunction of this structure, an increase in intracranial pressure occurs, which can be a life-threatening condition.
Vascular brain disorder is classified into:
- Acute cerebral ischemia.
- Chronic cerebral ischemia.
Chronic disease worsens the quality of life and can lead to a decrease in its duration. But the cause of sudden death does not become, in contrast to an acute condition.
This diagnosis characterizes a pathological condition that lasts at least a day. Pathogenetically, the condition is associated with a sharp violation of vascular patency, which is very quickly restored.
Often a diagnosis of TIA is made, which stands for transient ischemic attack.
The causes of such conditions are often:
- Arterial hypertension.
- Heart disease (often in combination with hypertension).
- Pathology of the great vessels (congenital or acquired).
- Varicose veins.
- Vasculitis of various origins (rheumatic diseases, systemic syphilis).
Cerebral clinical symptoms of transient vascular pathologies:
- Dizziness, flies before the eyes.
- Nausea and vomiting that does not bring relief.
- A disorder of consciousness, a sharp change in the character or mood of the patient.
Focal clinical symptoms of transient vascular pathologies:
- Short-term violation of sensitivity in the zone of innervation of a single nerve.
- Disorder of the motor function of a muscle or limb.
- Often patients complain of numbness of the limb on the one hand, a curved smile, loss of visual fields.
The main difference between this category of diseases is the reversibility of clinical symptoms.
E.V. Schmidt distinguishes 3 degrees of severity of TIA:
- The first mild degree is characterized by an attack length of not more than 5 minutes.
- The second degree, moderate – 10-15 minutes without registration of residual phenomena after the attack.
- The third degree, severe – the attack lasts for hours or days and can be characterized by microsymptoms of organic pathology. At the same time, there are no clinically noticeable cerebrovascular disturbances.
The danger of TIA (transient ischemic attacks) is due to the fact that most often they are repeated in the same place, affecting the same vessel and part of the nerve cells that supply them with blood.
This leads to the gradual development of organic pathology, which can include a critical decrease in the ability to remember, a change in intellectual activity, and severe asthenic syndrome with increased emotional exhaustion.
- A more serious sudden pathology is an acute stroke, which can be hemorrhagic or ischemic in nature.
First of all, patients with this diagnosis should be in a state of emotional rest. It is necessary to observe the rules of inpatient treatment:
- Until persistent disappearance of the clinic, compliance with strictly bed rest.
- Compliance with the ward regime for 14-21 days after the disappearance of clinical manifestations.
- Milk and vegetable diet.
- Fresh air and / or oxygen inhalation.
- Detoxification therapy (ascorbic acid).
- Vitamins of group B.
- The prescription of drug treatment is not regulated, because it must correspond to the concomitant diagnoses (diabetes mellitus, erysipelas, varicose veins, rheumatoid arthritis, etc.) and the prevention of their complications.
The constant intake of a rational regimen for the treatment of arterial hypertension, atherosclerosis, diabetes mellitus and other chronic diseases leads to a minimum percentage of transient brain disorders.
For non-drug prevention of this pathology, it is necessary:
- Observe the regime of work and rest, correctly alternate heavy and light labor.
- Eat right.
- To refuse from bad habits. Smoking is especially harmful, since tobacco smoke contributes to the uneven narrowing of blood vessels.
The most complex and debatable problem in the diagnosis is chronic cerebral ischemia, a chronic progressive vascular pathology called discirculatory encephalopathy. The ICD-10 has a code of I 60-I 69.
Most often, this condition manifests itself in old age and develops against the background of severe atherosclerotic lesion of the bloodstream, uncontrolled blood pressure with coronary heart disease (CHD) and the presence of rheumatism. Less commonly, the cause for such a serious illness is diabetes mellitus, sexually transmitted diseases (syphilis), and other pathological conditions that affect the vessels of the brain.
Encephalitis of the brain: causes, diagnosis and treatment methods
The pathogenetic cause of the disease is a change in the blood vessel. In this case, it may be noted:
- Closing the lumen of a vessel with a thrombus, embolus, foreign body (catheter), helminth, tumor, atherosclerotic plaque, etc.
- Narrowing the lumen due to a tumor-like process from the outside, edema, etc.
Most often, encephalopathy passes without vivid clinical symptoms, but with constant and prolonged monitoring of the patient, you can see how his personality changes.
The initial period of discirculatory encephalopathy is manifested by the following complaints of the patient:
- Irritability and forgetfulness.
- Stray and impaired concentration.
- Impaired performance.
Consequences and forecasts
With timely diagnosis and adequate therapy, the progression of chronic cerebral ischemia significantly slows down. The prognosis worsens in the presence of severe concomitant pathology (hypertension, arrhythmia, diabetes mellitus).
Complications of cerebral ischemia usually develop in the case of late seeking medical help or severe acute cerebrovascular insufficiency, which occurs with intracranial hypertension, damage to stem structures and massive death of neurons.
Timely diagnosis and the appointment of adequate treatment can stop the progression of chronic cerebral ischemia. In the case of a severe course of the disease, aggravated by concomitant pathologies (hypertension, diabetes mellitus, etc.), a decrease in the patient’s ability to work (up to disability) is noted.
Preventive measures to prevent the occurrence of chronic cerebral ischemia should be carried out from an early age. Risk factors: obesity, lack of exercise, alcohol abuse, smoking, stressful situations, etc. The treatment of diseases such as hypertension, diabetes mellitus, atherosclerosis should be carried out exclusively under the supervision of a specialist doctor. At the first manifestations of chronic cerebral ischemia, it is necessary to limit the consumption of alcohol and tobacco, reduce the amount of physical exertion, and avoid prolonged exposure to the sun.
The main methods of treatment:
- Intravenous administration of anticoagulant drugs. It is used both in resuscitation conditions for emergency clot removal, and in the future for prevention.
- Restoring the rhythm of heart activity.
- The appointment of antiplatelet agents.
- Surgical removal of a blood clot.
- Elimination of the cause of ischemia.
- Prescribing statins, anti-arrhythmic drugs and other drugs to prevent repeated attacks.
The prognosis depends on the degree of brain damage. The sooner the patient is taken to the hospital, the higher the likelihood of a favorable outcome. In the chronic form, the most favorable prognosis is possible with effective treatment of the disease in the early stages.
Possible complications of the disease include:
- Lose the functions of different parts of the brain. This may be blindness, hearing loss and psychomotor disorders.
- Loss of sensation in different parts of the body.
- Deterioration in cognitive function.
Preventive measures should be aimed at the possible root causes of the disease. These are, first of all, a healthy diet, moderate physical activity, control of the rhythm of contractions, a decrease in blood pressure and constant examinations. Early treatment of cardiovascular disease helps prevent neurological complications.
Prevention of Coronary Disease
With minimal likelihood, coronary disease of the brain develops in people who do not have bad habits, go in for sports, adhere to healthy eating standards and live in environmentally friendly regions. With this in mind, for the prevention of pathology today it should already be:
- Spend more time outdoors.
- Refuse alcohol and smoking.
- Eat right, balanced.
- To live an active lifestyle.
- Avoid stressful situations.
- Timely treat developing diseases.
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