According to statistics, vascular diseases of the brain account for about 42% of all abnormalities of the nervous system. In the field of neurology, cerebrovascular accidents are recognized as one of the most common ailments. Affecting a significant number of elderly people and patients of older working age, these diseases pose a serious threat not only to normal life activities, but also to the patient’s life itself. Vascular pathologies require great attention from specialists and timely and effective treatment.
When it comes to vascular pathologies, they most often mean discirculatory encephalopathy. This is a slowly progressive vascular lesion of the brain. The course of the pathology is divided into three stages in accordance with the severity of the clinical picture. At the initial stage, the symptoms are not clearly expressed, so problems arise with making a diagnosis. Some symptoms indicate mental disorders, so errors in the anamnesis often occur. As a rule, an accurate diagnosis is made after a prolonged presence of the main symptoms (dizziness, impaired coordination and cognitive functions).
Classification of vascular diseases of the brain
There are two main groups of vascular pathologies: acute and chronic cerebrovascular accidents. The first group is divided into three subgroups: transient cerebrovascular accidents, cerebral strokes, mixed strokes. Transient disorders of cerebral circulation include transient ischemic attacks and hypertensive crises. Brain strokes are ischemic and hemorrhagic. Hemorrhagic strokes are divided into subarachnoid hemorrhage, parenchymal-subarachnoid hemorrhage, and ventricular-parenchymal-subarachnoid hemorrhage. Ischemic strokes, in turn, are divided into lacunar, atherothrombotic, cardioembolic and hemodynamic stroke.
The second group includes: chronic subdural hematoma, initial manifestations of cerebrovascular insufficiency, subcortical vascular dementia, discirculatory encephalopathy. The initial manifestations of cerebrovascular insufficiency are divided into two stages. The first stage is characterized by the absence of neurological manifestations. At the second stage, neurological manifestations are clearly expressed. Discirculatory encephalopathy is the most common among chronic cerebrovascular accidents. It is divided into three main stages:
- The first stage is moderately severe, characterized by diffuse symptoms. The patient may complain of short-term headaches, periodically suffer from sleep disorders and increased irritability.
- The second stage is more pronounced; clinical manifestations form in it. The person often experiences surges in blood pressure, loss of space, and cognitive impairment. As a rule, at this stage the disease is most often diagnosed.
- The third stage is pronounced, during which irreversible changes occur in the body. Serious disturbances in memory and cerebral circulation in general appear. In rare clinical situations, complications in the form of strokes are observed (in the absence of timely consultation with a doctor).
Vascular stenosis
Atherosclerosis
Diabetes
Ulcer
4577 12 August
IMPORTANT!
The information in this section cannot be used for self-diagnosis and self-treatment.
In case of pain or other exacerbation of the disease, diagnostic tests should be prescribed only by the attending physician. To make a diagnosis and properly prescribe treatment, you should contact your doctor. Vascular stenosis: causes, symptoms, diagnosis and treatment methods.
Definition
Vascular stenosis (Greek στενός - “narrow, cramped”) is a partial or complete persistent narrowing of the lumen of blood vessels with limitation or complete cessation of blood flow.
Causes of vascular stenosis
Depending on which vessels are affected, a distinction is made between stenosis of arterial vessels (aorta, arteries, arterioles) and stenosis of venous vessels (superior vena cava, inferior vena cava, veins, venules).
Vascular stenosis can be either congenital or acquired.
The main cause of acquired stenosis of the aorta, arteries of the lower extremities, and coronary arteries of the heart is atherosclerosis, a systemic metabolic disease with predominant damage to the vascular wall. The degree of narrowing of the artery and its length may vary. When blood pressure increases, the sclerotic inner layer of the vessel (endothelium) is easily damaged, as a result, the blood clotting process is activated and a blood clot is formed.
Blockage of the vessel can lead to ischemia or necrosis of the tissue or organ.
Risk factors for the development of atherosclerosis include:
- male gender;
- elderly age;
- smoking;
- dyslipidemia (violation of the normal ratio of blood lipids);
- diabetes,
- arterial hypertension,
- increased blood homocysteine;
- elevated levels of C-reactive protein (CRP);
- increased blood viscosity and hypercoagulable states;
- chronic renal failure.
Another disease leading to arterial stenosis is obliterating endarteritis (spontaneous gangrene) - a chronic disease of peripheral blood vessels (mainly affecting the arteries of the feet and legs).
Mostly men under the age of 25-40 are affected. Those at risk include smokers, as well as people with frostbite on their feet. Diabetic angiopathy, characterized by damage to both small vessels and large and medium-sized arteries, develops in patients with diabetes mellitus. In diabetic macroangiopathy, when large blood vessels are affected, changes characteristic of obliterating atherosclerosis are found in the wall of the great vessels. With microangiopathies, when small blood vessels are affected, thickening of the walls of microvasculature vessels (arterioles, capillaries, venules) occurs, which leads to a narrowing of the lumen and deterioration of the blood supply to organs and tissues.
Coarctation of the aorta (congenital segmental narrowing of part of the aorta that obstructs blood flow) occurs as a result of improper fusion of the aortic arches in the embryonic period. The length of the narrowing is usually 1-2 cm. The ascending aorta and branches of the aortic arch expand, their diameter increases significantly, and the walls of the arteries participating in the collateral circulation become thinner. Two modes of blood circulation are formed in the systemic circle: up to the point of obstruction to blood flow there is arterial hypertension, and distal (or below) there is hypotension.
Venous stenosis most often occurs as a result of direct damage to the vascular wall during catheter insertion and is then aggravated by the constant presence of a foreign body and mechanical irritation. Inflammation and activation of the blood coagulation system are observed in the vessel wall. These changes lead to proliferation (multiplication) of smooth muscle cells, thickening of the vein wall, and the formation of microthrombi.
Thus, risk factors for the development of central venous stenosis are: the use of a central venous catheter, infections associated with the installation of a catheter, and concomitant diseases.
Systemic vasculitis, tumor diseases and other causes of vascular stenosis are detected much less frequently.
Classification of the disease
According to the type of blood vessels:
- arterial stenosis;
- venous stenosis
Due to the occurrence:
- congenital;
- acquired.
By localization:
- Stenosis of the arteries of the lower extremities.
- Stenosis of the carotid (carotid) and cerebral arteries.
- Stenoses of the arteries of internal organs:
- renal arteries,
- mesenteric arteries etc.
- Aortic stenosis.
- Stenosis of coronary vessels.
By caliber of damage:
- stenosis of large vessels (aorta and its branches);
- stenosis of medium-diameter vessels;
- stenosis of small vessels (arterioles and capillaries).
Symptoms of vascular stenosis
Damage to the blood vessels of the brain is one of the main causes of mortality and disability in the population. 2/3 of ischemic strokes are associated with narrowing and deformation of the carotid arteries.
The risk of developing ischemic stroke is directly related to the degree of narrowing of the artery lumen.
Occlusion (closure) of the internal carotid artery leads to the development of stroke in 40% of cases.
Damages to the blood vessels of the brain can occur in several forms:
- The asymptomatic form is characterized by the absence of focal and cerebral neurological symptoms (impaired consciousness, headache, vomiting, slow pulse).
- Discirculatory encephalopathy is characterized by a predominance of general cerebral symptoms; focal neurological symptoms are absent or appear in a very mild form.
- Transient ischemic attacks manifest themselves in the form of transient disorders of cerebral circulation of the ischemic type and are accompanied by the appearance of focal neurological symptoms that resolve within 24 hours.
- The consequences of a minor stroke are an acute ischemic cerebrovascular accident with the development of neurological symptoms, which almost completely regress within a month as a result of conservative therapy.
- The consequences of a completed stroke are an acute ischemic disorder of cerebral circulation, accompanied by the development of persistent focal neurological and cerebral symptoms.
- Ischemic stroke is damage to brain tissue with disruption of its functions due to obstruction or cessation of blood flow.
Atheroslerotic lesion of the coronary arteries of the heart is manifested by angina pain, but can sometimes be perceived by the patient as discomfort, a feeling of heaviness, compression, tightness, distension, burning or lack of air.
Most often, the pain is localized behind the sternum or along the left edge of the sternum; it can radiate (give) to the neck, lower jaw, teeth, interscapular space, and less often to the elbow or wrist joints, mastoid processes. Pain with angina pectoris usually lasts from 1 to 15 minutes. Occurs during significant physical or emotional stress. After taking nitroglycerin or stopping the exercise, the pain stops. As angina progresses, an attack may occur with minimal exertion and then at rest.
The main symptom of renal artery stenosis is a persistent increase in blood pressure, which is difficult to respond to drug therapy. Approximately 90% of cases of renal artery stenosis are caused by atherosclerosis; in 10% of cases, stenosis occurs due to fibromuscular dysplasia, a group of diseases that affect the walls of the arterial vessel.
With renal artery stenosis, the blood supply to the kidney tissue is reduced, hormonal factors (renin-angiotensin-aldosterone system) that regulate blood volume and blood pressure are activated, and the development of chronic kidney disease is accelerated.
Stenosing damage to the vessels supplying blood to the abdominal organs (mesenteric arteries) is more often observed in middle-aged and elderly people and manifests itself as chronic abdominal ischemia syndrome, so the main complaint of patients is pain, which appears after 20-25 minutes. after eating, lasts 1-2 hours and usually subsides on its own. The pain can be localized in the epigastric region, directly under the xiphoid process, and radiate to the right hypochondrium or spread from the periumbilical region throughout the abdomen. Some patients note a feeling of constant heaviness in the abdomen, and vomiting is rarely observed.
Other symptoms of chronic abdominal ischemia are intestinal dysfunction, expressed by disturbances in its motor, secretory, absorption functions, and progressive weight loss.
Obliterating atherosclerosis of the aorta and main arteries of the lower extremities is more common in men over 40 years of age and deprives them of their ability to work. The process can be localized in large vessels (aorta, iliac arteries) or medium-sized arteries (femoral, popliteal).
Small atherosclerotic lesions of the arteries of the lower extremities may not be clinically manifest. With continued vasoconstriction, intermittent claudication occurs, which is manifested by discomfort or pain in the muscles of the lower limb during physical activity. Damage to the terminal aorta and iliac arteries can cause pain in the buttocks, thigh, and calf. Impaired patency of the femoral-popliteal segment is characterized by pain in the calf. Occlusion of the arteries of the leg usually causes pain in the calf, foot, absence or decrease in skin sensitivity in them.
With obliterating endarteritis, trophic disorders are observed (cracks, dry skin, brittle nails, ulcers), intermittent claudication, leg pain, necrosis and gangrene of the limb.
In the generalized form of obliterating endarteritis or atherosclerosis, not only the vessels of the extremities are affected, but the visceral branches of the abdominal aorta, branches of the aortic arch, cerebral and coronary arteries.
The clinical picture of diabetic macroangiopathy consists of the clinical picture of microangiopathy and atherosclerosis of the great vessels, but is characterized by a more severe and progressive course, often ending in gangrene.
The clinical picture of diabetic microangiopathy of the lower extremities is similar to that of obliterating endarteritis.
With coarctation of the aorta, symptoms depend on the severity of the disease. In the case of significant narrowing of the aorta, the parents of the newborn pay attention to the pale skin, sweating, and difficulty breathing of the child. In older children and adults, the symptoms are usually mild: high blood pressure, headache, cold extremities, nosebleeds.
Stenosis of the central veins is clinically manifested by swelling of the extremities, pain in them and trophic changes (cyanosis, thinning of the skin, cracks, ulcers, etc.).
Diagnosis of vascular stenosis
Diagnosis of the disease is based on the analysis of patient complaints, medical history data, clinical picture, data from laboratory and instrumental research methods.
To clarify the cause of vascular stenosis, the following may be recommended:
- clinical blood test: general analysis, leukoformula, ESR (with microscopy of a blood smear in the presence of pathological changes);
Causes of pathology
Vascular diseases of the brain can occur for a number of reasons. As a rule, several reasons lead to the appearance of pathology. The most common ones include:
● genetic predisposition;
● narrowing and hardening of intracerebral arteries (with hypertension);
● multiple focal and/or diffuse brain lesions;
● long-term somatic diseases of the expectant mother (and during pregnancy);
● atherosclerosis of cerebral vessels;
● rheumatic lesions;
● disturbances in the functioning of the respiratory system (for example, pulmonary edema);
● abuse of alcohol and tobacco products during pregnancy;
● disturbances in metabolic processes;
● increased blood viscosity;
● fractures of the skull bones;
● heart rhythm disturbance (with atrial fibrillation, blood hemodynamics are disrupted);
● serious abnormalities in the nervous system (increased anxiety, chronic stress);
● serious abnormalities of the endocrine system (diabetes mellitus, obesity);
● development of intrauterine infections;
● difficult long labor (with injuries);
● hypertension;
● hypercholesterolemia;
● various anomalies of the cardiovascular system (for example, hypoplasia of cerebral vessels, mitral valve prolapse).
Symptoms of ischemic stroke
Almost never a cerebral infarction is asymptomatic. You may have already come across actively distributed reminders on the timely recognition of a stroke: after all, it is very important to call an ambulance and provide medical assistance to the patient as early as possible - the earlier assistance is provided, the less brain damage.
The main symptoms of ischemic stroke are:
- dizziness,
- loss of orientation in space,
- vomit,
- convulsions,
- impaired coordination, speech, vision, writing, reading, swallowing,
- inability to move individual limbs and/or perform simple manipulations such as raising two arms at the same time, brushing teeth, or turning pages of a book.
The symptoms are extremely varied. They depend primarily on which particular part of the brain was deprived of blood supply - then exactly the function for which this part is responsible will be disrupted.
At the same time, all the symptoms do not appear; you may notice one or more - and this is a good reason to immediately call an ambulance.
Risk group
The risk group includes people with infectious pathologies during the neonatal period. The likelihood of developing vascular diseases of the brain increases significantly with hemolytic anemia, surgery and head injuries. The mother’s poor lifestyle (abuse of alcohol and tobacco products) can also negatively affect the condition of the child’s brain. A family history of cardiovascular pathologies (for example, myocardial infarction or arterial hypertension in close relatives) doubles the risk of developing cerebrovascular diseases.
What's happened
A stroke is a sudden disruption of the normal blood supply to the brain.
Based on the nature of the disorders, there are two main types of stroke: ischemic (often called cerebral infarction) and hemorrhagic (including subarachnoid hemorrhage). This article will talk about ischemic stroke, which is 4 times more common than hemorrhagic stroke. The word “ischemic” literally means that there is not enough blood flowing to one or another organ - with such a stroke, blood does not flow to the brain due to blockage or severe narrowing of the main arteries. As a result, brain tissue cells die.
Diagnosis of pathology
If the symptoms described above appear, it is recommended to immediately consult a cardiologist or neurologist. During the initial examination, the specialist collects an anamnesis of the patient’s life, asks in detail about his complaints (how long ago and under what circumstances they appeared), about diseases of the cardiovascular system of his closest relatives. Based on these data, further examination is prescribed.
To diagnose vascular diseases of the brain, they resort to laboratory and instrumental diagnostics. First of all, the patient is prescribed a general and biochemical blood test to determine the level of cholesterol, glucose, triglycerides, lipoproteins and prothrombin index (PTI). These substances affect the functioning of the heart and blood vessels. Biochemical indicators are very important in making a diagnosis. An increased level of leukocytes indicates the presence of an inflammatory process in the body. Among the instrumental diagnostic methods, the following are in particular demand:
● electrocardiography (ECG). This is a simple technique that does not require additional preparation. The essence of an ECG is to record the electrical potentials of the heart, due to which it is possible to detect changes in rhythm, electrolyte deficiency and other initial signs of cardiovascular pathologies;
● Doppler ultrasound of the vessels of the neck and brain (USDG). This is a modern, highly informative diagnostic method. It is used to determine damage to the arteries and indicates insufficient blood supply to the brain. With its help, it is possible to assess blood flow in the vessels of the neck and head;
● duplex scanning of blood vessels. Thanks to color contrast of flows during duplex scanning, it is possible to more clearly distinguish between moving and stationary objects (blood and vessels, respectively);
● ultrasound examination of the heart (ultrasound). This technique makes it possible to visually view the contractions of the heart muscle, assess the condition of its valves, and diagnose heart failure;
● echocardiography (EchoCG). Sometimes specialists prescribe echocardiography in addition to an ECG. This is a highly accurate examination method, with its help it is possible to assess the condition and determine the size of the valves;
vascular magnetic resonance imaging (MRI). This is a completely safe technique for the body (there is no radiation), it shows the lumen and patency of large vessels, and makes it possible to detect abnormalities in vascular development.
3. Symptoms and diagnosis
The clinical picture of blockage of the blood vessels supplying the brain can vary over a very wide range.
Symptoms depend, first of all, on the location and extent of the ischemic area. Early warning signs may include frequent dizziness and headaches, decreased memory and intellectual productivity, presyncope and sudden short-term fainting (syncope), false tactile sensations (paresthesia).
With more pronounced pathology, numbness, partial paralysis, certain speech disorders (articulation disorders, inability to quickly update the necessary words, impoverishment of vocabulary), various dysfunctions in the field of recognition, coordination of movements and spatial orientation, fine motor skills (in particular, writing) are added. , emotional response, behavior, physiological processes and many others.
With stroke, the same focal symptoms develop, by definition, acutely, catastrophically; Unlike disorders of brain activity during transient attacks or crises, such symptoms are persistent.
Diagnosis of suspected thromboembolism includes a mandatory consultation with a neurologist, as well as, if indicated, a number of related specialists (cardiologist, neurosurgeon, etc.). The most informative instrumental research methods are X-ray contrast multislice computed tomography (MSCT in angiographic mode), Dopplerography (ultrasound assessment of the patency of the great vessels), and MRI angiography.
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Prevention of vascular diseases of the brain
Vascular diseases of the brain are easier to prevent than to cure. To do this, experts recommend leading a healthy lifestyle: engaging in moderate sports, drinking about 1-1.5 liters of water per day (to avoid dehydration), eating properly and following a diet. The diet involves limiting table salt and foods containing large amounts of animal fats (for example, sour cream and fatty meats). Fresh vegetables and fruits should prevail in the daily diet. A split diet is recommended (4-5 meals per day).
The intake of alcoholic beverages should be minimized (or completely abandoned). The emotional component is the key to good health, so you should not be exposed to stressful situations. Sleep should be complete (at least 7 hours of sleep per day are required). Moderate physical activity should be regular; it significantly improves the condition of the body. These include: swimming, yoga, Pilates, cycling.
Exercising and proper nutrition help prevent the appearance of excess weight, while they train the cardiovascular system. At least once a year it is required to undergo a study of the state of cerebral circulation (especially for those who are at risk). This will allow timely detection of pathology.
In order to prevent the progression of multi-infarction conditions, patients are prescribed combination therapy (antiplatelet and anticoagulant). The most suitable anticoagulants are selected depending on blood clotting parameters. If any signs of bleeding appear, it is important to contact a specialist promptly.
Vascular diseases of the brain are often accompanied by dizziness. To prevent them, doctors prescribe medications that affect the autonomic nervous system. To prevent cognitive impairment (memory deterioration, increased inattention), drugs that improve metabolism are prescribed. In the presence of movement disorders, therapeutic exercises, physiotherapy, massage and other methods of rehabilitation therapy are useful.
Brain Facts
- The average brain weight is 1300-1400 grams. That is, having a mass of no more than 2% of the entire body, it consumes a quarter of all energy.
- The brain is 60% fat.
- Has no pain receptors. Therefore, when neurosurgeons perform operations, they inject painkillers only into the scalp
- From large doses of alcohol, the brain loses the ability to create memories. Therefore, when a person has a large dose of alcohol, he does not remember the events that occur.
- The brain often doesn’t care whether you actually do something or imagine it in pictures. If you imagine a dangerous and extreme situation in your mind, your heart rate will immediately increase. This feature of our psyche has long been known to athletes. Many of them do visualization before competitions: they imagine all sorts of situations that could happen to them during tournaments. Research has proven that this method improves the performance of athletes because it prepares their muscles and body.
- There is a phenomenon known as phantom pain. For example, when a person's leg is amputated, he still experiences pain in it. This happens because there are nerve endings in the brain that are responsible for sensing pain in that leg.
Identified changes
Changes that were identified during the study may indicate the presence of certain diseases. MAG ultrasound (deciphering was given above) can show the presence of signs of diseases that are worth familiarizing yourself with.
Atherosclerosis
It is characterized by the presence of atherosclerotic plaques (cholesterol), which lead to blockage of blood vessels or a significant narrowing of their lumen. Depending on the degree of vascular damage, drug or surgical treatment may be prescribed.
Temporal arteritis
Occurs exclusively in people over 50 years of age. This disease is characterized by granulomatous giant cell inflammation, which affects not the transcranial, but the extracranial branches of the temporal and carotid arteries.
Diabetes
In case of diabetes mellitus, decoding of MAG ultrasound
will show the deposition of calcium salts on small arteries. Otherwise, this manifestation is called “Mönckeberg calcific sclerosis.”
Hypoplasia
It is the most common pathology affecting the vertebral artery. The reduction in the diameter of the artery will be less than two millimeters, and characteristic deviations in the flow curve will also appear.
Principles of treatment
The treatment regimen is selected individually and depends on the specific diagnosis. Most vascular problems can be treated with medications, without the need for surgery. All patients, regardless of the type of vascular disorder, are also given advice on proper nutrition and other aspects of life.
Nutrition and lifestyle
Fatty foods, bad habits, a sedentary lifestyle and excess weight are the main factors that trigger pathological processes in blood vessels. Treatment with medications will not be effective if you do not follow simple rules:
- completely exclude fried and fatty foods, salty foods and sweets in large quantities from the diet;
- give up bad habits: smoking and alcohol;
- pay attention to simple physical activity, including walks in the fresh air;
- normalize sleep and wakefulness - the body needs at least 8 hours of sleep daily;
- avoid stress.
Diet and normal physical activity will allow you to gradually lose excess weight without stressing the body. Extra pounds are also one of the main causes of heart and vascular diseases.
IMPORTANT! Exercises to maintain muscle tone should be discussed with your doctor. Thus, with varicose veins, sports are allowed provided that an elastic bandage or bandage is used. Heart defects are a contraindication to intense exercise, but walking is allowed.
Medicines
Medicines are prescribed individually. Patients often have to take several drugs at the same time, which belong to different pharmacological groups. To normalize blood pressure, medications are needed to control it; for varicose veins, venotonics; for high cholesterol levels, lipid-lowering medications. To monitor their effectiveness, it is necessary to periodically undergo routine examinations and monitor blood counts.
Surgical intervention
Most often, surgical treatment is necessary for thrombosis. The operation is prescribed if there is a risk of a blood clot breaking off or in case of complete blockage of the vessel with the formation of pockets. It is performed by resection of the section of the artery or vein that contains the blood clot. Modern medicine also offers less invasive techniques. They involve installing a shunt to ensure normal blood supply to the tissues.
Treatment of vascular problems is carried out after a complete diagnosis of their condition. It should be understood that the doctor’s recommendations should be followed throughout life. Failure to follow simple rules can lead to exacerbation of the disease, including after successful drug or surgical treatment.
