Foci of chronic cerebral ischemia what is it

Brain ischemia is a chronic severe illness. It is caused by a violation of the supply of oxygen to the body. All human systems suffer from this. But the brain reacts first.

The mechanism of the disease is very simple. Vessels that transport blood are susceptible to the accumulation of cholesterol accumulations. No wonder nutritionists so advocate the limited use of products containing it. Of course, normal blood flow through “clogged” vessels is completely impossible. There is chronic atherosclerosis. It is characterized by blockage of blood vessels.

The main function of the vessels – transport – has been lost. Through blood vessels clogged with cholesterol plaques, blood cannot enrich the body with oxygen in sufficient quantities. Such starvation is the most severe stress for all human tissues. It should be noted that it is the brain that is the largest consumer of oxygen. That is why this fasting is fatal for him. At the same time, the consequences that cerebral ischemia provokes can be fatal. After all, these cells are not restored.

What is cerebral ischemia and what consequences can this condition lead to?

The brain is the main human organ related to the central nervous system. In humans, a large brain represents:

  • 2 large hemispheres;
  • diencephalon;
  • midbrain;
  • cerebellum;
  • medulla.

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:

  1. Acute cerebral ischemia.
  2. 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:

  1. Arterial hypertension.
  2. Heart disease (often in combination with hypertension).
  3. Pathology of the great vessels (congenital or acquired).
  4. Atherosclerosis.
  5. Varicose veins.
  6. Vasculitis of various origins (rheumatic diseases, systemic syphilis).

Cerebral clinical symptoms of transient vascular pathologies:

  1. Headache.
  2. Dizziness, flies before the eyes.
  3. Nausea and vomiting that does not bring relief.
  4. A disorder of consciousness, a sharp change in the character or mood of the patient.

Focal clinical symptoms of transient vascular pathologies:

  1. Short-term violation of sensitivity in the zone of innervation of a single nerve.
  2. Disorder of the motor function of a muscle or limb.
  3. 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:

  1. The first mild degree is characterized by an attack length of not more than 5 minutes.
  2. The second degree, moderate – 10-15 minutes without registration of residual phenomena after the attack.
  3. 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:

  1. Until persistent disappearance of the clinic, compliance with strictly bed rest.
  2. Compliance with the ward regime for 14-21 days after the disappearance of clinical manifestations.
  3. Milk and vegetable diet.
  4. Fresh air and / or oxygen inhalation.
  5. Detoxification therapy (ascorbic acid).
  6. Vitamins of group B.
  7. 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:

  1. Observe the regime of work and rest, correctly alternate heavy and light labor.
  2. Eat right.
  3. 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:

  1. Closing the lumen of a vessel with a thrombus, embolus, foreign body (catheter), helminth, tumor, atherosclerotic plaque, etc.
  2. 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:

  1. Irritability and forgetfulness.
  2. Stray and impaired concentration.
  3. Impaired performance.

The second stage of encephalopathy is manifested:

  1. Speech articulation disorder.
  2. Difficulty walking without paresis.
  3. Decreased coordination and awkwardness in movements.
  4. Gradual amplification of reflexes, sometimes the definition of pathological reflexes.

The severe stage is manifested:

  1. Sphincter disorder.
  2. An objective manifestation of monoparesis (lack of movement in one limb or part of the body). And at first these are temporary, then permanent symptoms.
  3. Severe disorder of coordination of movements.
  4. Speech impairment, up to aphasia.

At the second stage of the disease, the patient needs disability registration, as his performance is severely impaired.

The treatment of cerebral ischemia in old age, as well as the symptoms of this pathology, is more symptomatic, since the initial cause of vascular pathology is not fully understood.

Medicines that are used for encephalopathy of a vascular nature:

  1. Vitamin preparations (B vitamins, ascorbic acid, glutamic acid, nicotinic acid).
  2. Vasodilators (Platifilin, Papaverine).
  3. ATP preparations (Riboxin).
  4. Biostimulants (aloe, eleutherococcus, tincture of lemongrass).
  5. Antisclerotic drugs (potassium iodide (2% solution, 25 ml 3 / d) and similar drugs).
  6. In case of mental disorders, you can use Seduxen, Elenium, Bromine, tincture of valerian.

The intake of any drug must begin with a clear weighing of the pros and cons. Such tactics will prevent the wrong combination of drugs and deterioration.

It is necessary to realize that such violations are very difficult to cure, in this regard, doctors set themselves the task of preventing the patient from worsening. Prevention of dangerous consequences (stroke or cerebral infarction) is necessary.

Types of Ischemia

Such pathological processes can occur in an acute or chronic form of the disease, while having its own characteristics, causes and signs.

  1. Acute ischemic brain disease develops as a result of a sharp cessation of the flow of blood and other nutrients to the structures of the brain. Although the attack lasts a short time, it can cause irreparable damage to human health. Depending on the location of the affected area of ​​the brain, the disease can manifest itself in different ways – for example, it can be severe dizziness, a sharp violation of visual acuity or vision of various degrees, manifests itself most vividly in comparison with another form of pathology.
  2. The chronic course of the disease is so called due to the fact that a lack of nutrients occurs for a rather long time. This form of ischemia has lubricated symptoms, which greatly complicates the diagnosis. Very often, the cause of this condition is atherosclerosis and other diseases of the circulatory system, due to which there is a narrowing of the lumen of the cerebral arteries.
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The absence of treatment and improper treatment of acute ischemia can transfer the disease to the category of chronic, with corresponding consequences.

Specialists also distinguish a focal and global form of ischemia, while the first is characterized by the limitedness of the affected area of ​​the brain and develops as a result of a clot in a blood clot of one of the blood vessels. But global ischemia occurs against the background of a general deterioration in cerebral circulation. Most often, such a development of the disease is observed with cardiac arrest or pathologically acute hypotension.

Treatment

The treatment of chronic cerebral ischemia is aimed at stopping the progression of the disease and conducting reliable prevention of exacerbations.

Be sure to treat arterial hypertension with both medications and the correction of nutrition and lifestyle.

Blood sugar levels are normalized. A low-carb diet is recommended; lipid-lowering drugs are used.

Individual somatic pathology is monitored by a specialist physician.

To improve and restore normal circulation, antiplatelet agents and angioprotectors are prescribed, goodbye to bad habits is practiced.

To minimize the effects of hypoxia on brain tissue and ischemic lesions, cerebroprotectors are used.

The main goal in the treatment of chronic cerebral ischemia is to stabilize the destructive process of cerebral ischemia in order to restore blood circulation in the vessels. Proper treatment will help slow down the progression of the disease by activating the sanogenetic mechanism of compensating functions. Also, therapy implies the prevention of this disease and its attendant.

Pathology is not an indication for urgent hospitalization of the patient. Inpatient treatment is necessary when the process of the disease is complicated by the development of a stroke condition or severe pathology. If a cognitive type of disorder is found, if the patient is deprived of his usual environment, the condition may worsen.

Treatment of chronic ischemia is usually carried out by a neurologist on an outpatient basis. In the case of the development of the disease before the 3rd stage, doctors appoint patronage.

The medical type of treatment for this pathology involves therapy in two directions.

  1. The first direction is designed to normalize brain perfusion by acting on different parts of the cardiovascular system.
  2. The second direction has an effect, first of all, on the platelet link of hemostasis.

These two directions are able to optimize cerebral blood flow by performing a neuroprotective function.

In the case of developing occlusive stenotic damage to the great arteries located in the brain, surgical treatment will be indicated. Reconstructive surgery is performed on the carotid artery by stenting or carotid endarterectomy.

Like any other brain disease caused by insufficient blood supply to this organ, the first manifestations of ischemia depend on the degree of hypoxia. In this case, the patient first of all feels the fast fatigability of the body, it becomes quite problematic for him to concentrate on one subject or an event from his life, and his intellectual abilities are further reduced.

The main symptoms of coronary heart disease:

  • frequent dizziness, fainting;
  • decreased perception of the surrounding world by the organs of touch;
  • sleep disturbance;
  • blood pressure instability;
  • the appearance of frequent headaches;
  • disorders of perception of information;
  • emotional instability.

It is noteworthy that coronary artery disease of the brain of the right or left hemisphere has corresponding symptoms, which manifest themselves to varying degrees and depend on the location of the affected area, therefore, treatment of the left hemisphere usually bears fruit faster in people of any age.

The success of the treatment of cerebral ischemia depends on a large number of factors, including the accuracy of the diagnosis, the speed of medical assistance and the susceptibility of the body to the therapy received. Therefore, it is extremely important to prevent the occurrence of consequences such as ischemic stroke, which in most cases leads to negative consequences.

The treatment of cerebral ischemia is often complicated by the appearance of other concomitant diseases, therefore, in the treatment of the disease itself and its manifestations, a set of measures is usually used to improve cerebral circulation and eliminate the negative consequences.

The brain is reliably protected by the bones of the cranial box, and any surgical intervention in its structures can have an extremely negative effect on the overall health of the patient, therefore, in the treatment of chronic forms of ischemia, it is preferable to use conservative medical methods of treatment.

The decision on how to treat and what medications and procedures should be used is made by the patient’s doctor based on the cause of the disease that caused similar changes in brain structures.

So, if ischemia was caused by thrombophilia, then prophylactic drugs are used that prevent blood clotting and blood clots (anticoagulants), for example, Aspirin and other medicines made on its basis (Aspirin-cardio).

To dissolve an already formed thrombus, special medications are used – thrombolytics (Tenecteplaza, Retaplaza). However, their use is strictly limited due to the fact that such drugs have a large number of side effects, it is used only with a confirmed diagnosis. Due to the directed action of thrombolytics, their use allows to reduce the percentage of deaths among patients with acute course of the disease, while taking the drug should be performed no later than 3 hours after the first signs of ischemia.

Also used are vasodilator drugs, which over time restore blood flow to the affected brain structures, thereby improving intracellular metabolism (Nimodipine).

To improve brain activity and accelerate the restoration of damaged structures, special drugs are used – nootropics, which contribute to the speedy restoration of higher psychiatric functions of the brain (for example, “Piracetam”).

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

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.

Unfortunately, quite effective methods of combating the disease have not been found. If the patient is diagnosed with chronic cerebral ischemia, treatment should be carried out only by a competent neurologist.

As a rule, the fight against an ailment includes such measures:

  1. Normalization of blood pressure, preventive methods to avoid stroke, ischemic attacks. For these purposes, a variety of blood-thinning and vasodilating drugs are used. Pentoxifylline, Warfarin, etc. are referred to such medicines.
  2. Restore blood circulation in the vessels, improve metabolism. Omaron is considered quite effective. It includes piracetam. Namely, this substance has a beneficial effect on cells, restoring them and significantly improving oxygen saturation. Encephabol, which is widely used in the treatment of children with a similar ailment, has also proven itself well.
  3. Recovery of physiological and behavioral functions. For such purposes, massage, magneto-and electrophoresis, exercise therapy, restorative therapy are prescribed.

A drug that can improve brain activity, Cerebrolysin, is widely used. Medicines that are designed to maintain blood circulation – “Bilobil”, “Nimodipine.”

If the patient has revealed quite advanced cerebral ischemia of the brain, the treatment consists in surgical intervention. The main goal is the operative removal of sclerotic plaques. Brain surgery is the most complex type of surgery. They require the highest skill from the doctor. Moreover, quite often they are fraught with serious, sometimes completely unpredictable, grave consequences.

That is why surgery is a last resort. They resort to it only in cases where conservative treatment has not yielded positive results.

Folk remedies

It is important to understand that without proper medical methods, ischemia of the brain cannot be stabilized. Folk remedies can be used only as additional methods of treatment. The following are considered quite effective:

  • decoctions of oak bark;
  • freshly squeezed carrot juice;
  • decoctions of mint;
  • Adonis;
  • compresses from a variety of herbs.

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:

  1. 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.
  2. 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.

Disease complications

Chronic cerebral ischemia is a dangerous ailment. Circulatory disorders sometimes lead to complications:

  • Perhaps the development of ischemic stroke or heart attack. With such pathologies, some parts of the brain tissue soften, die. Nerve cells are not regenerated, which leads to a violation of certain brain functions. It is worth noting that such violations are most often recorded in elderly patients (over 60 years old).
  • Against the background of circulatory problems, encephalopathy sometimes develops. This is an organic lesion of parts of the brain that occurs without inflammation.
  • The disease can lead to the development of thrombophlebitis.
  • The destruction of nerve tissue in certain parts of the brain is sometimes accompanied by paralysis, dumbness, paresthesias, epileptic seizures.
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A large number of factors affect the severity of the consequences of cerebral ischemia: the degree of damage to the brain structures, the duration of the pathological process, as well as diseases that could develop due to a lack of blood circulation. Most often, the following complications result from ischemia:

  • in older people – ischemic stroke or softening of brain tissue;
  • vascular sclerosis and encephalopathy;
  • motor dysfunction;
  • paresthesia and other disorders of tactile sensations;
  • loss of speech ability;
  • epileptic seizures;
  • thrombosis with inflammation of the walls of blood vessels.

The most serious complication of ischemic disease is a brain stroke, in which the tissues located in the lesion are softened. This irreversible process leads to the destruction of neurons and their connections, due to which part of the brain dies. At the moment, there is really no correct treatment that prevented him and would contribute to the regeneration of lost structures.

As a result of brain encephalopathy, the systematic death of nerve cells and degeneration of their connections occurs. The consequences of this complication are extremely fatal for a person, as as a result of this ailment the individual loses control over his body and becomes incapable.

Hypoxic-ischemic brain damage in some cases is accompanied by various disorders of sensitivity. Like any other manifestation of dysfunction of the cerebral cortex, they are mirrored: for example, when the left hemisphere is damaged, a person loses the ability to clearly pronounce, but is fully aware of his position.

If the pathological process began to progress in a newborn or a child of the first year of life, then in most cases this leads to a lag not only in mental, but also in physical development. Therefore, in order to avoid such consequences, a pregnant woman should be sensitive to her state of health and follow all doctor’s prescriptions.

The main consequences of chronic cerebral ischemia will be oxygen starvation and metabolic disturbances in the tissues of this organ, while the disease will manifest stealthily and slowly.

Features of the disease

It is immediately worth saying that the foci of chronic ischemia in the brain do not appear on their own. This pathology develops against the background of another disease. The list of possible reasons is very impressive:

  • inflammation of the walls of blood vessels of an infectious or allergic origin;
  • persistent forms of hypertension;
  • atherosclerosis (the formation of plaques on the walls of blood vessels leads to a narrowing of their lumen and, consequently, an increase in blood pressure);
  • hypotension;
  • various injuries of the skull;
  • aneurysms, anatomical abnormalities of the vascular bed of the brain;
  • diseases of the endocrine glands and, accordingly, fluctuations in the hormonal background;
  • various disorders of the heart;
  • blood diseases;
  • pathology of the excretory system;
  • cerebral amyloidosis.

In addition, in modern medicine, it is customary to distinguish those risk factors, the presence of which contributes to the development of ischemia. The list of non-correctable factors (it is impossible to eliminate them) includes the hereditary predisposition and age of the patient. Correctable factors exist, and so are called, for example, smoking and other bad habits, obesity, atherosclerosis, hypertension.

Chronic cerebral ischemia is a complex disease provoked by problems with blood supply. The disorder affects all the systems of the human body, the brain is most sensitive.

A lot of cholesterol accumulates in the vessels. Normal blood flow is difficult, chronic atherosclerosis appears. The disease is characterized by blockage of blood vessels.

Their main transport function is lost.

Through vessels clogged with cholesterol plaques, blood cannot enrich organs with oxygen in the required amount. This condition provokes stress in the body. Chronic cerebral ischemia is detrimental to this organ, since it requires the most intensive supply of oxygen. The consequences of ischemia can be fatal.

One of the main causes of the development of chronic cerebral ischemia is a disease of the head vessels. Atherosclerosis is the cause of such disorders in 60% of cases.

When high pressure lasts for a long time, pathological changes in the muscle tissues of veins and arteries occur, their walls thicken and the lumen becomes smaller.

Spasm of the walls of blood vessels causes a deterioration in cerebral blood flow and lack of oxygen.

Other common causes of chronic cerebral ischemia: heart disease, kidney problems, tumors, decompression sickness, vasculitis or other systemic disorders, vascular problems, obesity, blood diseases, venous insufficiency, diabetes. The disease develops due to age-related changes in the body.

Under the influence of various factors that impede normal blood flow, hypoxia forms, metabolism worsens, lipids are oxidized, free radicals are formed that negatively affect nerve cells. When neurons are damaged, they are destroyed, necrosis is formed. As a result, the brain begins to resemble a sponge.

In the course of the development of degenerative changes, the space around the blood vessels increases, gliosis develops. Gliosis is somewhat reminiscent of sclerosis in other organs, which is also accompanied by chronic hypoxia. Such transformations are often diffuse, they are localized in all departments of the central nervous system.

Periventricular ischemia is considered a condition that produces a chronic form of the disease. In this case, the nervous tissue surrounding the ventricles is irritated.

Ischemic disorders provoke a deterioration in blood flow and hypoxia. Neurons lack the necessary energy. This provokes intracellular biochemical changes in brain tissue.

The pathogenesis of the disorder is due to the sequential manifestation of the list of biochemical transformations under the influence of insufficiently oxidized oxygen, and with the appearance of oxidative stress based on a gradually progressive deterioration in blood supply to the formed elements of brain tissue. In this case, microlacunar regions of ischemia are formed.

Chronic cerebral ischemia of the 2nd degree becomes the cause of the transformation of the subcortex, the formation of demyelination with the defeat of oligo. Symptoms of the disease are objective and subjective.

Symptoms are characterized by the degree of disorder. The main signs of the disease: the head often hurts, a feeling of heaviness, dizziness, constant deterioration of attention and memory, sleep problems, psychological lability, poor coordination of movements.

As blood supply to nerve cells becomes difficult due to the development of stenosis and spasms of the cerebral arteries, the symptoms worsen, and places of the formation of a heart attack with accompanying focal signs appear, the intensity of which depends on the indicators of cerebrovascular disorders.

Each stage of the disease is characterized by its own symptoms. Consider 3 degrees of chronic cerebral ischemia:

  • Initial. With it, the main symptoms are present in the form of migraines, memory impairment, dizziness. Sleep problems are moderate. Emotional lability and general weakness appear without the presence of any neurological signs.
  • The stage of subcompensation, which is characterized by a gradual aggravation of symptoms and psychological transformations, leads to apathy, a depressed state, and a deterioration in the list of interests.
  • Decompensation with serious neurological disorders, provoked by the appearance of numerous lacunar and cortical heart attacks.

Cerebral ischemia in newborns is common. The problem arises due to brain hypoxia that appeared during childbirth. The disease continues in 3 stages, but difficulties are often associated with diagnosis, since far from all the symptoms can be identified. Therefore, doctors identified several syndromes:

  • Hydrocephalic. In babies with similar syndromes, the head becomes larger, the pressure inside the skull increases. The reason involves the accumulation of cerebrospinal fluid in the head.
  • Nervous excitability. The newborn’s muscle tone changes, tremors appear, sleep worsens, the child always cries.
  • Coma syndrome. A newborn is immersed in an unconscious state for a long time does not come out of it.
  • CNS depression syndrome. There are changes in muscle tone, weakening of reflexes, strabismus appears.
  • Convulsive syndrome. It is characterized by spasms of muscle tissue and twitching.

Consequences of the disease

Ischemia in the first stages of development can cause complications. Often there is hypoxia or metabolic problems that lead to the formation of other types of pathologies: heart attack, various forms of encephalopathy, problems with speech function, paralysis, epileptic seizures, paresthesia.

Fragments of brain tissue during a stroke die and cannot be restored. Modern medicine uses different treatment methods, but some experts question their effectiveness.

With encephmlopathy, the shaped elements of the brain are destroyed. Paralysis restricts mobility. Paresthesia causes a decrease in the sensitivity of nerve endings or a complete loss of speech function.

In children, this disease is the cause of mental retardation.

The development of chronic cerebral ischemia proceeds slowly, at the first stages no symptoms are detected. Signs of the disorder occur when it is already impossible to cure the patient. The success of therapeutic methods is due to the duration of hypoxia and its effect on other parts of the body.

The choice of therapeutic technique and prognosis will depend on the correct and timely procedure for diagnosing the disease. The doctor must necessarily have a conversation with the patient, note all signs of ischemia, apply the following diagnostic methods:

  • MRI or CT can determine the localization of foci of inflammation in the head, expansion of the ventricles and atrophic transformations.
  • Ultrasound. With the help of this tool, studies of the vessels of the head, the degree of tortuosity, anomalies, problems with blood flow are carried out.

To eliminate signs of chronic ischemia, medical and surgical treatment methods are used. If we consider the methods of surgical intervention, stenting of the carotid arteries and endaretrectomy.

Medicines used to treat ischemia are classified as follows:

  • For antihypertensive therapy. It is necessary to maintain normal blood pressure. In this case, the patient should not have surges in pressure. The most suitable groups of drugs for such purposes are antagonists or inhibitors.
  • For antiplatelet therapy. Due to the activation of the vascular link of hemostasis, patients are prescribed antiplatelet drugs like Dipyridamole.
  • Lipid-lowering therapy. Tools such as Atrovastatin contribute to the normal functioning of the endothelium, thin the blood.
  • Medications of combined action. Sometimes doctors prescribe several drugs for complex treatment, for example Piracetam and Cinnarizine.

For drug therapy, doctors recommend such funds:

  • Antiplatelet agents. These are drugs that prevent the development of blood clots. These include aspirin, clopidogrel.
  • Nootropic medicines stimulate brain function.
  • Vasodilators improve blood circulation, increase lumen in veins and arteries. Medicines thin the blood, they have nicotinic acid, pentoxifylline, etc.
  • Satin-containing medicines: atorvastatin, rosuvastatin.
  • Means that increase the lack of vitamins.

These drugs are consumed twice a year for 2 months. At the initial stages, physiotherapeutic techniques are used: acupuncture, head and collar zone are massaged, sports, electrophoresis.

Operations are carried out at the last stages of the IHM. Sometimes the vessels of the brain are damaged, and therapy with the help of drugs has been ineffective, it is necessary to carry out surgical intervention. The technique using stem cells is practiced. Initially, the embryo shaped elements are taken, then cultivation to the desired size is ensured.

Stem cells are introduced into the body using a dropper. The procedure lasts approximately one hour. As a result, new stem cells become in place of the affected, complement the damaged tissue. Traditional medicine is risky to use without additional techniques.

Traditional medicine for ischemia in the head should be used only with the permission of a specialist. The most effective are the following methods:

  • Need to take 1 tbsp. lies. medical galega, pour boiling water, brew for 2-3 hours. You need to use tincture 100 ml 2-3 times before each meal. To replace this plant, sweet clover is perfect.
  • Hop cones, catnip, Nonea, chistets are combined in equal proportions, poured with boiling water. You need to insist at least 3 hours, consume 100 ml before meals.
  • Garlic recipes are quite popular. It is necessary to finely crush a few cloves, pour alcohol in equal proportions. Tincture is prepared for 2 weeks, then 5 drops are used, dissolved in a spoonful of milk.
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Preventive measures

The first stage

At the first stage, a combination of classical complaints with a diffuse type of neurological symptomatology is observed, which manifests itself as anisoreflexia and a non-coarse type of reflexes. It is also possible that the gait may change (walking can become slow, the patient often moves in small steps). The first stage is characterized by a decrease in coordination stability and uncertainty when performing movements.

Very often, doctors note emotional disturbances in the form of irritability and anxiety in patients, and depression is not rare. At this stage, slight cognitive abnormalities of the neurodynamic type arise, which implies the depletion of the nervous system, decreased attention, and inertia of the intellect.

It is characterized by aggravated neurological symptoms, which are characterized by the formation of an implicit syndrome, nevertheless one that subsequently dominates. In addition, various extrapyramidal disorders can be detected, as well as ataxia, pseudobulbar syndrome and even CN dysfunction. Interestingly, over time, complaints become less pronounced, they are no longer so acutely perceived by the patient himself.

In addition, at the second stage, the patient’s ability to control his own actions worsens, and there are also difficulties in planning cases that a person wants to take at the next time. Although there is a violation in the performance of actions, however, the ability to compensate remains for a long time. In addition, there are signs of reduced social adaptation.

She is distinguished by a vivid manifestation of neurological syndromes. In this case, a violation occurs when walking and the ability to keep balance (the patient can often fall). Urinary incontinence is observed, and Parkinson’s syndrome is also characteristic. Due to the absence or decrease in a sober understanding of what is happening with the patient, the volume of complaints decreases.

Personality disorders can manifest themselves as a retarded reaction, an explosive state, apathetic-abulic symptom and psychological abnormalities. In addition to neurodynamic (or dysregulatory) malfunctions in the cognitive sphere, the manifestation of operational disorders such as speech and memory impairment, decreased ability to think, and so on is possible.

All of these symptoms can later go into dementia. The latter leads to the inability to quickly adapt to the new situation, to a drop in performance in the personal, social and professional fields of life. Very often, doctors indicate a person’s disability. At some point, the patient ceases to serve himself.

Combined drugs

In addition to the main therapy described above, depending on the mechanism that caused the disease, individual treatment is prescribed, which is designed to normalize the rheological properties of the blood and establish venous blood flow, normalizing microcirculation. Typically, such drugs have neurotrophic and angioprotective properties. For example, a doctor may prescribe one of the following combinations:

  1. cinnarizine (not more than 75 mg) together with piracetam (1-1,2 g per day);
  2. piracetam (not more than 1,2 g) with vinpocetine (15 mg per day);
  3. nicergoline (not more than 30 mg per day) and pentoxifylline (approximately 300 mg per day).

Typically, such combinations of drugs are prescribed no more than twice a year, each course lasts about 2 months.

The third degree of pathology

At this stage, decompensation occurs. All the possibilities of the brain are exhausted, as a result of which the symptoms become brighter.

Serious motor impairment is observed. The patient’s gait becomes unstable, it is difficult for him to move, and during walking he often loses his balance and falls. Other, more serious and dangerous violations appear:

  • a person often loses consciousness, which is accompanied by complete relaxation of the muscles, lowering blood pressure, lack of reaction to light;
  • urinary incontinence develops;
  • swallowing processes are disturbed – it is very easy for a person to choke while eating;
  • the psycho-organic syndrome develops – the patient often falls into a stupor, becomes oblivious, loses the ability to control his behavior;
  • Parkinson’s syndrome manifests itself, characterized by muscle rigidity, tremor, epileptic seizures.

If untreated, pathology can lead to complete dementia.

Chronic cerebral ischemia of the 2nd degree

The stages are determined by clinical manifestations and neurological symptoms.

Clinical manifestations include movement disorders, memory lapses, learning disabilities, emotional leaps in behavior, sudden changes in mood and behavior.

I degree

Detect small focal neurological disorders. Cerebral ischemia of the 1st degree externally manifests itself in slowing down walking, a person begins to “mince” during gait.

In emotional terms, irritability, tearfulness, moodiness appear, a person has a tendency to depression, gloomy thoughts. The level of intelligence begins to decline. The quality of life at this stage practically does not suffer.

II degree

HIGM progresses, lesions spread further. Muscles begin to twitch regardless of a person’s desire. Facial muscles and tongue can be paralyzed.

Due to a decrease in intelligence, the patient loses interest in the environment, in all events, loses control over what is happening, cannot coordinate his actions. Complaints are almost absent, as a person is poorly aware of his condition.

There are signs of maladaptation, both social and professional. The patient can serve himself independently.

III degree

Grade 3 ischemia is manifested by severe changes in the body. Uncontrolled urination and bowel movements are present. The sense of balance when walking is disturbed to such an extent that the patient cannot move without the help of outsiders or is looking for support.

There is emotional degradation, obvious mental disorders, inadequate actions are characteristic. Memory is greatly reduced, the thinking process is deteriorating, and speech disorder becomes apparent. A person is not able to control his behavior, he can suddenly fall into a stupor or lose consciousness.

There is no social adaptation, self-service ability is dying away. Diagnostics

It is based on an analysis of the anamnesis, the presence of characteristic symptoms. Aggravating circumstances recognize the presence of coronary heart disease in a patient, heart failure, high blood pressure.

A general analysis of urine and blood is taken for research, biochemical studies are carried out to determine the level of glucose and the lipid spectrum.

An ECG and an ultrasound of the heart are required to detect a blood clot or cholesterol plaque.

An ultrasound of the brain, duplex scanning is performed, which helps to identify abnormalities in the structure and functionality of blood vessels.

To determine how affected the walls of the blood vessels, to determine the speed of blood flow, ultrasound dopplerography is performed.

There are three stages. Each of them is characterized, as already mentioned, by additional symptoms. Accordingly, the necessary treatment also varies. It is extremely important not to start the disease. At the first symptoms, you should consult a doctor so as not to miss the moment of development of a serious ailment.

  1. Brain ischemia of the 1st degree. In general, the patient is quite normal. Sometimes there is a slight malaise, chills, dizziness. After physical work, pain in the hands appears. In some cases, a change in gait is noticed. A person, as it were, “pokes fun”, takes smaller steps. People around you may notice a change in temperament and the nature of the patient. As a rule, cerebral ischemia of the 1st degree causes the patient an inexplicable feeling of anxiety, constant irritability, sometimes even depression. If you observe a person more carefully, you can reveal distraction. It is very difficult for the patient to concentrate, concentrate. Slow thinking is also characteristic.
  2. Cerebral ischemia of the 2nd degree. This stage is characterized by an increase in symptoms. A person feels the progression of headaches, nausea. Behavioral disorders are more pronounced and are already quite noticeable. There is a loss of worldly and professional skills. The ability to plan action is increasingly difficult. At the same time, critical self-esteem of behavior is reduced.
  3. Cerebral ischemia of the 3rd degree. Absolute inaction regarding treatment leads to this stage. An acute lesion of almost all neurological functions is detected. The patient manifests Parkinson’s syndrome, impaired motor functions of all limbs, urinary incontinence. Decreased ability to control legs and loss of balance make walking difficult. In some cases, movement is completely impossible. Such a patient loses orientation in space. Sometimes he cannot adequately understand whether he is standing, lying or sitting. Speech is severely disturbed, memory is lost, and thinking is absent. Mental disorders reach their climax, sometimes you can observe the complete disintegration of the personality.

Each stage of the development of such a pathology is accompanied by a set of specific symptoms. Chronic cerebral ischemia of the 1st degree is characterized by a blurred clinical picture. At first only a slight malaise appears. Patients become weak and drowsy. Chills appear. Despite constant fatigue, it is not easy for a person to fall asleep.

Perhaps the appearance of migraines, tinnitus, dizziness. A gradual change in gait is observed – a person either legs too hard or shuffles while walking.

Chronic cerebral ischemia of the 1st degree is accompanied by emotional lability and cognitive impairment. It is difficult for the patient to concentrate, mental processes slow down, constant distraction appears. Personality disorders are also possible – excessive aggression, irritability or, on the contrary, apathy and depression appear.

This phase of the disease is a stage of subcompensation. Chronic cerebral ischemia of the 2nd degree is accompanied by more obvious disorders. Fatigue, weakness, headaches, emotional disturbances – all these symptoms become more pronounced. Other signs join them:

  • Ataxia appears with very noticeable impaired coordination.
  • Against the background of chronic cerebral ischemia, intellectual disorders gradually develop that inevitably lead to degradation of the individual.
  • The patient becomes apathetic, indifferent, loses interest in the world around him.
  • Man’s ability to control his actions, to plan, is deteriorating.
  • Against the background of chronic cerebral ischemia of the 2nd degree, the ability to professional and social adaptation is significantly reduced.

Chronic cerebral ischemia: ICD-10 code and general pathology information

Many people are interested in additional information about such a disease. In modern medical practice, such a pathology as chronic cerebral ischemia is quite common. ICD refers this condition to the group “Other cerebrovascular diseases” under the code I67.

This ailment develops against a background of prolonged cerebrovascular accident. As you know, nerve tissue is extremely sensitive to the level of oxygen, glucose and other nutrients. That is why their constant deficiency leads to damage to certain sections of the central nervous system. Foci of chronic cerebral ischemia, as a rule, are diffuse. In any case, pathology leads to a violation of the functions of a particular section of the central nervous system, which, of course, affects the patient’s condition.

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Svetlana Borszavich

General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.

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