What is dyscirculatory encephalopathy: clinical presentation and treatment of the disease

When a disease is detected at an early stage and medical prescriptions are followed, a person can live many more years of happy life.

Description

Apathy, headache, bad mood are usually attributed to fatigue, a hard working day, trouble or weather conditions. The same phenomena may also be symptoms of the most complicated pathology – dyscirculatory encephalopathy.

The disease is officially recognized, included in the ICD-10 under the code G93.4. It is believed that in Russia she is sick 6% of the population.

Causes and mechanism of development

The main cause of the disease is a violation of blood circulation. There is a violation of blood flow to the brain and its various departments, as well as its outflow from the cavity of the skull. Diseases such as arterial hypertension, atherosclerosis, vasculitis, thrombosis, thrombophlebitis, and diabetes mellitus lead to pathology.

Dyscirculatory encephalopathy may occur due to genetic pathology, as a result of birth trauma, prolonged hypoxia in the prenatal period. The factors worsening the course are craniocerebral injuries, osteochondrosis, alcoholism, obesity, hypodynamia. Mental and mental stress, lack of sleep, overwork also contribute to the development of the disease.

The deterioration of the blood supply to the brain, damage to small and large vessels leads to the death of neurons and auxiliary (glial) cells, as well as to the formation of soft areas with low density. The white substance is the first to suffer – it is the most vulnerable. Following is the defeat of the gray matter.

Permanent lack of oxygen leads to disruption and destruction of the connections between the subcortical elements and the cortex, and destruction of nerve cells. As a result, emotional, cognitive and motor disorders appear. In all likelihood, in the early stages of the disease, the disorders appear only functionally and can be compensated. The functions of dead cells can take on the next.

The progression of the disease leads to neurodegenerative processes, organic lesions that are not amenable to compensation.

Kinds

Dyscirculatory encephalopathy most often occurs as an acquired disease, but there may be cases of congenital abnormalities. To the latter lead adverse factors accompanying pregnancy and childbirth.

The rate of onset of symptoms suggests a slowly progressive, remitting and rapidly progressive pathology. The duration of the first is measured in years. It may take 15 years between the first symptoms and disability.

Remitting dyscirculatory encephalopathy leads to the deterioration of the patient’s condition faster. Its feature is the alternation of periods of exacerbation and normalization of the state. Usually persistent, non-flawed defects occur within 10 years.

Galloping (fast-developing) form can lead to disability or even death in 2-3 years.

Depending on the leading cause, the following types of dyscirculatory encephalopathy are distinguished:

  1. Atherosclerotic. Developed due to the appearance of protein and lipid compounds on the walls of blood vessels. They reduce the lumen of blood vessels, thereby reducing the volume of blood circulated. There is a defeat of the main highways, providing blood flow to the brain and regulating its volume.
  2. Venous. The main cause of the disease is a violation of the outflow of venous blood. There are stagnations that poison the brain with toxins and cause .
  3. Hypertensive. Associated with spasms, thickening and rupture of the walls of blood vessels. Characterized by the rapid progression of the disease. May develop in people of young age. The acute form of the disease occurs immediately following an increase in pressure and may be accompanied by seizures and agitation. In chronic course there is a gradual damage to the small vessels.
  4. Mixed In this form, there are signs of hypertensive and atherosclerotic forms. Decreased blood flow through the main vessels is accompanied by hypertensive crises.

In some cases, encephalopathy is combined. The disease develops when blood supply is disturbed, toxic, or injured.

Symptoms

Dyscirculatory encephalopathy in the early stages of the disease resembles a condition that occurs with normal fatigue and fatigue. Emotional, cognitive and motor impairments are clearly traced.

A bad mood gives way to excitement, excessive joy, then apathy, indifference to everything, excitement, aggressiveness. The main characteristic of the emotional state of the individual is and apathy. At first, these two features remind of themselves occasionally, but over time they appear more actively and fill more and more with a person’s life, leaving no room for positive emotions, enthusiasm, optimism.

Cerebrovascular disease is characterized by impaired intelligence. The patient begins to forget difficult words, names, gradually loses the ability to analyze a large amount of material obtained by reading, studying new, communicating. He ceases to understand himself, loses the ability to self-control and self-analysis. Can’t plan your day work. Over time, it ceases to recognize others, its street, house, does not understand time. At the core of many actions is the impulse, not the logical connection.

Indifference covers all areas of activity – work, hobby. Attention is attracted to minor matters that seem light, feasible, not requiring concentration of attention and work of memory.

Suffering and motor activity. At first it is fine motor skills – the patient cannot thread a needle, write something. Later, tremor of the arms and legs appears. There are obsessive movements. A person loses coordination, sometimes falls. Speech suffers – it becomes blurred, unclear.

The patient complains of a headache, a feeling of fullness, front sight, sounds in the ears. When walking, vomiting occurs. During the day, drowsiness haunts, and insomnia becomes a frequent night visitor. Vision falls, with one eye seeing normally, and before the second everything seems to be immersed in fog.

Stages

In the development of the disease, there are three degrees, characterized by the severity of symptoms, the peculiarities of their influence on the patient.

Dyscirculatory encephalopathy I degree

Damage to the brain tissue is of a minor nature, with correctly selected treatment, the pathology is corrected. Violations affect, first of all, the emotional sphere, and therefore are often taken for signs that characterize fatigue, meteo dependence, or the manifestation of depression. After rest, decrease in psychoemotional load, symptoms of DEP 1 disappear.

A person often experiences fatigue, becomes whiny, irritable, prone to depression, apathy, frequent mood changes, and sometimes to aggression. Against this background, there is a decrease in efficiency, difficulty with perception and understanding of new information, a decrease in intellectual abilities and ability to learn.

Distraction, forgetfulness appears. The patient can not concentrate, can not plan their time and responsibilities. Since most often the disease develops in old age, all these signs are attributed to natural processes.

Gradually, there are sleep disorders, there are periods of uncontrollable excitement, head spin, noise, hum in the ears. Possible instability gait.

Dyscirculatory encephalopathy II degree

Subcompensation is characterized by the manifestation of symptoms detected at the first stage of the disease. A person loses interest in everything. Shows causeless aggression. Speech becomes unclear, erased. There is a scarcity of facial expressions, gestures. A patient with circulatory encephalopathy of the 2nd degree loses the ability to work, spends time on meaningless or useless cases. Seizures join, fine motor skills are disturbed, movements become slow.

Often, a person suffering from DEP 2 is lost in time and in place, unable to care for himself. Pains in the head intensify, they cover mainly the parietal or frontal areas. Vomiting joins them. Malaise can last up to 2 days.

What is dyscirculatory encephalopathy: clinical presentation and treatment of the disease

Over time, the syndromes are clearly highlighted:

  1. Cephalgic. The main manifestations are a sharp, throbbing pain in the head, a feeling of fullness, discomfort from bright light, nausea, tinnitus, vomiting.
  2. Dissomnic. Characterized by sleep disorders. Drowsiness and insomnia appear. The patient has difficulty falling asleep, wakes up in the middle of the night.
  3. Vestibulo-atactic. Occurs due to impaired blood supply to the pyramidal structures of the brain, lesions of the vertebral and central arteries. Manifested in violation of gait – it begins to resemble the movement of a drunk person. The patient notes that his body ceases to obey. Coordination of movements worsens, loss of balance is observed, falls are possible. With the defeat of the cortical-nuclear pathways occur uncontrolled mouth movements. The voice timbre changes.
  4. Cognitive. It is characterized by a significant deterioration in thinking, memory, concentration. There are problems with understanding, speech. The patient finds the words with difficulty.

At this stage, there are signs of organic brain damage.

In most countries, they do not secrete 2nd degree dyscirculatory encephalopathy; they speak of a general group characterized by cognitive impairment caused by vascular diseases, as well as a stage of severe disease.

Dyscirculatory encephalopathy III degree

There is a decompensation of the brain – the changes are irreversible. Dementia is developing. The patient ceases to control himself, becomes oppressed, aggressive, goes to the conflict. The disease is characterized by a pronounced vestibulo-atactic syndrome. Deafness, sight weakens. Gait is very unstable.

In severe cases, there is paralysis, ataxia. A person loses the ability to care for himself, does not understand the meaning of the simplest actions. In most cases, with grade III, urinary incontinence, disinhibition.

Diagnostics

In order to establish the diagnosis of “dyscirculatory encephalopathy” and its stage, a specific algorithm has been developed. It includes several steps:

  1. At the initial admission, the patient’s condition is assessed, the pressure is measured. Complaints of the patient and his relatives are heard.
  2. Neuropsychological research is conducted to confirm the characteristics of the functioning of the brain.
  3. Symptoms that may characterize CSD and possible causes and factors of its development are identified.
  4. The cause-and-effect relationships between the objective data obtained using instrumental research methods and the identified disorders of the emotional, cognitive and motor sphere are determined.
  5. Other diseases are excluded.

All studies are prescribed by a neurologist. At the reception, he checks tendon reflexes, signs of violation of the vestibular apparatus, tremor, muscle stiffness. The doctor monitors possible problems with speech, disorders of the cognitive and emotional sphere. Assigns blood tests to see the general formula, the level of sugar, cholesterol, lipoproteins, especially the process of clotting.

To diagnose diseases of cerebral vessels can be using rheoencephalography. The survey will provide information about their elasticity, tone, blood supply, resistance.

Doppler ultrasound examination allows to determine the speed and direction of blood flow, to assess the integrity of blood vessels, to detect blood clots.

Electroencephalography provides an opportunity to assess the electrical activity of the brain in response to stimuli.

MRI provides three-dimensional images of brain structures with a clear pattern of vascular tissue, possible neoplasms, hemorrhages. The study provides information on blood flow and vascular condition.

Computed tomography allows you to see atrophic processes, the state of the arteries, veins, features of blood circulation. When conducting CT with a contrast agent, the structure of tissues, some parts of the brain, neoplasms, signs of inflammatory processes are analyzed.

Diagnosis includes a neuropsychological examination. Clarifies the patient’s ability to produce a series of movements, to carry out operations associated with logical thinking, processing information obtained using hearing, vision, sensations.

The presence of signs of hypertension is an indication for an ultrasound of the adrenal glands and kidneys.

If dyscirculatory encephalopathy is suspected, a consultation with an oculist and a cardiologist is indicated. The oculist will check the fundus of the eye, determine the breadth of vision. A cardiologist will prescribe an examination of the heart, clarify the presence of cardiovascular pathologies and their nature.

The use of various diagnostic methods will determine the degree and stage of brain damage, as well as prescribe therapy.

Treatment

Dyscirculatory encephalopathy requires serious, multifaceted treatment. Its objectives are to get rid of the underlying disease, prevent the risk of hemorrhage, restore blood supply and brain function. Includes non-drug, medicinal, surgical methods. Often used traditional medicine.

Drug therapy

Drug treatment of cerebral dyscirculatory encephalopathy depends on the reasons for it. To normalize the pressure used drugs in the following groups:

  1. Sartans. Drugs in this group block the interaction of neuroreceptors with hormones that cause vasoconstriction and increased pressure. The Sartans include , Hypotel, Walz.
  2. Diuretics. Their action is aimed at excreting fluid from the body and reducing edema, including vascular walls. Diuretics: Hypothiazide, Indapamide, Veroshpiron, Furosemide, Torasemide.
  3. Beta and alpha blockers. Drugs inhibit adenoreceptors, leading to vasodilation and reduction of heart muscle contraction. Preparations of this group: Konkosram, Methanoprolol, Gedralazin, Doksazozin.
  4. ACE inhibitors. Affect the enzyme that converts angiotensin I to angiotensin II. Drugs of this group: , Captopril.
  5. Calcium antagonists. Medications inhibit the penetration of calcium into the cells of the muscular tissue of the heart and blood vessels, reduce arrhythmia, and improve blood circulation. This group includes Diltiazem and Lacidipine.

Treat atherosclerosis is necessary drugs that improve lipid metabolism, accelerate fat metabolism, absorb cholesterol from the intestine, inhibit its production. Assign Sermion, Vinpocetine, Piracetam. Some of the drugs lead to a decrease in pressure, so they must be taken carefully with antihypertensive drugs in the treatment of diseases of mixed origin.

In any form of dyscirculatory encephalopathy, neuroprotectors are prescribed. Preparations of this group improves the metabolic processes in the brain. Often used Actovegin, Gliatilin. For intramuscular injections use Cerebrolysin.

Aspirin, Tenekteplaza will help prevent the formation of blood clots.

Non-drug therapy

For the treatment of first-degree dyscirculatory encephalopathy, therapeutic massage and physical culture are prescribed. Radon and oxygen baths are shown to improve blood circulation and vasodilation.

The electromotive therapy improves metabolism in the brain, stimulates the establishment of new connections between neurons.

When galvanotherapy is the impact of weak currents on the neck area. This improves blood circulation, improves metabolism.

Much attention is paid to a healthy lifestyle.

Surgical intervention

A severe form of the disease with a pronounced narrowing of the blood vessels is an indication for surgery. Stenting, endarterectomy, shunting.

Stenting involves the installation of a stent at the site of a narrowed artery. It performs the function of the vascular wall, expands and supports the vessel.

During endarterectomy, an atherosclerotic plaque is removed from the affected vessel.

Shunting involves creating a workaround for blood flow. For this, a piece of artery or vein is taken from another part of the body and sewn into the vessel before and after the obstruction. Another way is to staple the affected artery with another vessel of the brain.

Methods of traditional medicine

Folk remedies cure the disease is impossible. However, help improve blood circulation, memory, relieve a headache.

For the preparation of the Crimean collection take 1 tablespoon of a mixture of flowers and rosehips, linden, oregano, horsetail, birch leaves, sweet clover, plantain, coltsfoot, raspberry fruits and dill seeds. Steamed in a glass of , infused for 20 minutes. Drink 3 times a day before meals for 3 months. The tool stimulates the brain, tones.

Drink hawthorn relieve pain in the head. A glass of berries steamed in a water bath for 10 minutes. The resulting broth insist 12 hours and drink a glass 3 times a day before meals.

Prevention

For the treatment of DEP, prevention of its occurrence and transition to more severe stages it is recommended to lead a healthy lifestyle. The patient is advised to give up alcohol and smoking. It is necessary to exclude semi-finished products, fried food from meat, replace fatty meat with lean meat, eat more vegetables, fruits, sea lean fish. It is recommended to control your weight, walk, play sports, taking into account the general condition, age.

It is important to ensure a normal rest, sleep at least eight hours a day. Take vitamins when needed.

Disability

Patients diagnosed with grade 2 DEP receive 3rd disability group. With a significantly reduced vital activity in the second stage, as well as with 3rd degree dyscirculatory encephalopathy, the 2nd group is prescribed. Patients who have impaired memory, signs of deep damage to motor functions, are assigned a disability of the 1st group.

Forecast

When DEP 1, the prognosis is favorable. The development of the disease is unlikely to stop, but it is possible to reduce the severity of symptoms and lead a full life. For this it is important to observe a healthy lifestyle, to adhere to medical recommendations.

When the disease passes to the second stage, recovery can only be said if the cause that caused it can be eliminated surgically. Otherwise, the disease progresses. Gradually, the patient’s condition will worsen, leading to disability. Timely complex treatment of DEP 2 allows you to delay the appearance of signs of the third stage for up to 10 years.

Dyscirculatory encephalopathy is a complex disease that destroys the emotional, cognitive and motor sphere of a person’s life. The prognosis may be favorable for early detection of pathology, its treatment and prevention. Severe symptoms indicate an organic lesion and is difficult to treat.

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