Violations of this process are diverse: spasms, atherosclerosis, strokes, aneurysms, stenoses, malformation. Cerebrovascular pathologies play a leading role in the disability of the population, a high percentage of deaths from stroke – the most common disease. Among the most common causes of hypertension, the presence of bad habits, diabetes, coronary artery disease.
Blood enters the brain through the paired carotid and vertebral arteries, the outflow is carried out through the two jugular veins. The carotid arteries begin in the chest, most of the blood is delivered through them. The vertebrates are located in the lateral bone canals of the vertebral column, in the brainstem they merge into a single basilar artery. At the base of the skull, all the great vessels join to form a Vallysian circle. Several large arteries depart from this formation, supplying the brain with oxygen and nutrients, then they branch into smaller vessels and capillaries.
Outflow of venous blood is carried out using internal and external veins, sinuses. Venous sinuses are peculiar collectors in the meninges, in which blood accumulates before entering the jugular veins. In addition, they play an important role in the absorption of cerebrospinal fluid from the subarachnoid space.
Classification of cerebrovascular diseases
Changes in the structure of these elements lead to disorders of the cerebral circulation of an acute, transient or chronic nature. According to ICD-10, most of the diseases are in the block labeled from I60 to I69. These include:
- hemorrhagic, ischemic, unspecified strokes;
- constriction of cerebral vessels, occlusion;
- sinus thrombosis;
- Moyamoy’s disease;
- atherosclerotic encephalopathy.
Under the codes G45 and G46, transient (transient) disturbances are encrypted – narrowing of cerebral vessels, ischemic attack, global amnesia. The classification adopted in Russia is somewhat different, since hypertensive cerebral crisis also applies to transient ones. And all chronic, slowly progressive disorders are combined under the concept of “dyscirculatory encephalopathy.” In addition to these, several other diseases with unstable symptoms are identified, but the most common ones will be discussed below.
This vascular pathology should be considered as the cause of most cerebrovascular diseases. At the moment, it is divided into a separate group on ICD, but it refers to systemic lesions of the middle and large arteries. The disease is a consequence of lipid metabolism disorders – the ratio of high and low density lipoproteins. With an excess of the latter, they accumulate in the vascular wall in the form of cholesterol plaques, causing the proliferation of fibrous tissue.
The process is accompanied by narrowing of the cerebral vessels, impaired hemodynamics, the formation of blood clots. The change in pressure in the bloodstream leads to various deformations of the arteries and veins, up to their overgrowing or rupture.
Atherosclerosis is more common in the elderly, being considered predominantly an age-related ailment. The formation of plaques is a natural and unavoidable process (even found in children), but it can be slowed down, eliminating a number of provoking factors. These include poor diet with an excess of unhealthy fats, smoking, drinking excessive amounts of alcohol, obesity, hypertension, diabetes.
Symptoms of atherosclerotic problems with cerebral vessels in the first, asymptomatic stage can be identified only by laboratory tests. When the lumen of the arteries narrows more than half, dizziness, sleep disturbances occur, memory, intelligence, attention worsen. Pronounced atherosclerosis is manifested by behavioral and mental disorders, the risk of acute cerebrovascular pathologies — strokes and thrombosis — increases many times over.
Treatment is comprehensive. First of all, the intake of low-density lipoproteins in the body is limited by dieting. It is also necessary to get rid of bad habits, move more. The second stage – drug therapy:
- Sequestrants of bile acids, the use of which helps to lower cholesterol levels in the blood.
- Nicotinic acid – increases the concentration of beneficial high-density lipoproteins with anti-atherogenic activity.
- Statins and fibrates slow down the synthesis of endogenous cholesterol produced by the body itself.
When the lumen of the artery overlaps completely, and the pills are ineffective, surgical intervention is indicated. During the operation, a stent is placed or a balloon dilation of the vessel is performed. Perhaps the treatment of atherosclerosis folk remedies at home: decoctions of herbal, garlic, honey, baths. Such methods require coordination with your doctor.
The term refers to the pathological dilatation of cerebral vessels, resulting from defects in the structure of the vascular wall in a particular area. It consists of three layers – intima, muscular, adventitia – and bulges outward with insufficient elasticity of one or several. Vascular tissue dystrophy is caused by congenital underdevelopment, damage or degenerative changes.
According to statistics, every twentieth inhabitant of the planet has an aneurysm, but in most cases it is asymptomatic. In the case of congenital underdevelopment, it first appears by the age of 20, the acquired forms of pathology manifest about 50. Of the specific symptoms, apoplexy manifestations are most often observed (rupture of cerebral vessels), less often – tumor-like. In the latter case, the clinical picture is fully consistent with the presence of a tumor in a certain lobe of the brain with its displacement. Most often diagnosed in the area of the junction of the optic nerve, when it leads to atrophy and loss of vision.
The protrusions may take a spindle or kidney-shaped form. The frequent outcome of the disease is a rupture accompanied by an intense headache. Painful impulses initially have a localized character (in the area of aneurysm dislocation), then become diffuse. They are joined by vomiting, meningeal symptoms, loss of consciousness.
For the diagnosis and determination of the localization of the rupture of cerebral vessels, so-called focal symptoms are of great importance:
- visual function suffers if the aneurysm ruptures in the area of the carotid bifurcation;
- hemiparesis and speech disorders are observed in the defeat of the middle cerebral artery;
- mental disorders in combination with paresis of the lower limbs – the front;
- dysphagia, nystagmus, damage to the trigeminal nerve are observed with the localization of hemorrhage in the vertebro-basilar system.
With asymptomatic aneurysm usually detected by chance, during instrumental studies. If it is present, it is imperative that the neurologist be monitored, because with an increase in protrusion, surgical intervention is indicated. In the preoperative period, the level of cholesterol and blood pressure is corrected. During surgery, the aneurysm is clipped or endovascular occlusion is performed.
This pathology is congenital, it is the replacement of a portion of the capillary network with a vascular conglomerate of veins and arteries. Such problems with cerebral vessels have the following symptoms: epileptic syndrome, persistent headaches.
The reason for the development of anomalies is intrauterine malformations caused by the diseases or bad habits of the expectant mother, the use of medications with a teratogenic effect during pregnancy. The presence of malformations – tangles of vessels with a thinned wall – increases blood pressure, which often leads to hemorrhages of different localization.
The only treatment options are embolization or surgical removal of the defect.
In terms of morbidity, this pathology is 0.3%, and the death rate from it is a quarter of the total for the entire population of the Russian Federation. The percentage of disability is also high (about 80%), including persistent disability, self-care skills. Stroke as an acute lesion of cerebral vessels is divided into two main types: hemorrhagic and ischemic.
The first is a hemorrhage in the brain due to a rupture of the vessel. The second develops as a result of obstruction of the arteries and, accordingly, prolonged ischemia with the death of a tissue site (cerebral infarction). The symptomatology of both varieties is similar, but it differs in the dynamics of manifestation – with ischemic, it develops more slowly. Typical nausea, vomiting, headache, impaired consciousness. By the nature of the symptoms, as in the case of aneurysm, it is possible to judge the localization of the lesion.
Treatment is medication: drugs are used to combat edema, correct the respiratory function, and normalize pressure. In parallel, symptomatic therapy is carried out.
This is the name of the transient (or short-term) narrowing of the vessels of the brain. Cerebral angiospasm – a consequence of stenosis of the capillaries that feed the cells, and fraught with their death. Specific signs of pathology:
- Headaches in the morning of unclear localization. It can be triggered by sleep disorders, increased physical activity the day before, and stress.
- Decrease in memory, attention, general working capacity.
- Nausea, tinnitus, dizziness, hallucinations.
- In the head when bending, sneezing, coughing.
Causes of angiospasm are: congenital anomalies, head injury, systemic vasculitis, neurosis, osteochondrosis of the neck vertebrae, hypertension, IRR, tumors, infections. Treat pathology after identifying the cause. Therapy can include both medical (medication) and surgical methods.
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The clinical picture of vascular thrombosis corresponds to that in ischemic stroke. It usually begins during sleep or after it, the main cause is atherosclerosis (often in combination with hypertension). The separation of a blood clot causes narrowing of the cerebral vessels, up to its complete overlap – occlusion.
Symptoms are increasing, often over several days, manifesting themselves with paresis on the side of the opposite limbs, impaired motor activity of the mandible, and visual function.
This is the official name for inflammation of the blood vessels of the brain. The nature of the disease has not been studied enough, since in the inflammatory process, traditional agents — bacteria, fungi, viruses — play a minor role. Most often, the pathology is autoimmune, affecting mainly women over the age of 60 years.
Clinically, the disease is manifested by general weakness, slight fever, joint and muscle pain. A distinctive feature is the swelling of blood vessels under the scalp in combination with persistent pain. Often, partial blindness joins for one and a half months.
The main method of treatment is the use of glucocorticosteroids, which facilitate the patient’s condition already during the first days of therapy. NSAIDs, anticoagulants in this case are ineffective.
Other angiovascular disorders do not have significant differences from those described above, and for the information far from the medicine person they do not carry the load. Hypertensive cerebral crisis – a form of hypertensive, aggravating the existing symptoms. Moyamoy’s disease is a rare case of chronic narrowing. Encephalopathy is understood to be a disease of the small vessels of the brain (capillaries), leading to a gradual disruption of the cerebral circulation.
Elimination or minimization of provoking factors, such as unhealthy diet, bad habits, physical inactivity, can greatly reduce the risk of developing vascular pathologies. It is also important to timely seek medical help: the earlier the patient was hospitalized with a stroke or aneurysm, the greater the chances of recovery.