Atherosclerosis of cerebral vessels (cerebral atherosclerosis) - symptoms and treatment

Symptoms

Among the symptoms of cerebral atherosclerosis are:

• Certain signs of cerebral atherosclerosis include the following symptomatic picture:
• Sleep problems: insomnia, disturbing dreams, difficulty getting up and problems falling asleep again;
• Loss of sensation in half of the body;
• Severe, frequently recurring headaches;
• Increased cholesterol levels in blood tests:
• Changes in gait and loss of coordination;
• Changes in vision, flickering of “spots” before the eyes, tinnitus;
• Emotional changes: irritability, depression, tearfulness and anxiety;
• Hot flashes and sweating of the face;
• Increased fatigue, constant weakness and absent-mindedness;
• Trembling of the chin and limbs;
• Memory impairment, problems with short-term memory;
• The appearance of facial asymmetry. Source: L.S. Bizhanova. Ischemic brain disease // Bulletin of KazNMU, No. 2, 2015, pp. 241-242 Shabir O.

Clinical signs do not appear immediately. This happens long after cholesterol has begun to be deposited. Symptoms appear after the lumen of the arteries and capillaries of the brain narrows so much that 15% or more less blood begins to flow to the organs.

Signs of the disease depend on the stage:

1. In the first stages, the disease makes itself felt only after physical or emotional stress and quickly passes when the patient goes into a state of rest. The main symptom is asthenia, accompanied by fatigue, weakness, decreased alertness, and general lethargy. Rarely, sleep is disturbed, insomnia or daytime sleepiness occurs. Mostly, patients complain of headaches, tinnitus, and memory impairment. In the latter case, patients remember the past well, but do not remember new information well.

2. As the disease progresses, anxiety, suspiciousness, depression, and mood swings appear. Memory impairments become more pronounced, to the point that the patient does not remember what happened to him today. There is a constant headache and noise in the ears, speech is persistently impaired - it becomes unclear, diction changes, patients feel dizzy and have unsteady gait. Hearing and vision also deteriorate, limbs and head shake, and a person stops thinking logically and clearly.

3. At the last stage of atherosclerosis, dementia develops; the patient may behave like a child or become aggressive and tearful. Most people completely or partially lose their memory and cease to be interested in the world around them and the events in it. The ability to navigate in time and space is lost, the patient needs constant care because he loses self-care skills in everyday life. This stage is irreversible.

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:

1. 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.
2. 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.
3. 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).

Diagnostics

A neurologist deals with this disease. First, the doctor collects anamnesis, interviews the patient about complaints, and conducts a series of tests. So, the following factors indicate the presence of the disease:

• The patient cannot look up;
• Reflexes are weakened or excessively increased, most often asymmetrically;
• In a standing position, legs together, arms extended forward, the patient cannot maintain balance;
• When the patient stretches his arms forward, his fingers tremble and become weak;
• Closing his eyes, a person cannot bring his finger to the tip of his nose.

These are indirect signs that only allow us to make an assumption about the presence of atherosclerosis. Therefore, a comprehensive examination is then carried out with consultations of other doctors - ENT, ophthalmologist, etc., depending on the existing disorders. At the medical office, you can get advice from related specialists on any disease, including in cases of suspected cerebral atherosclerosis. Source: Berwick J, Francis SE. Neurovascular dysfunction in vascular dementia, Alzheimer's and atherosclerosis // BMC Neurosci. 2021 Oct 17;19(1):62. doi:10.1186/s12868-018-0465-5.

In addition, it is necessary to undergo a biochemical analysis of the blood lipid spectrum (cholesterol, triglycerides, etc.)

List of instrumental studies:

• REG – radioencephalogram;
• Angiography of cerebral vessels;
• Duplex head scanning;
• Ultrasound Dopplerography of cerebral vessels;
• MRI of cerebral vessels;
• CT – computed tomography;
• EEG – electroencephalogram.

The diagnostic capabilities of a medical doctor allow you to accurately diagnose atherosclerosis, the extent of the disease and choose an effective treatment regimen.

Treating atherosclerosis

• Shishkin A.A.
• Volkov A.M.
• Kabirov A.V.
• Baranov V.S.

• Shishkin Andrey Andreevich

  Candidate of Medical Sciences. Surgeon, proctologist, phlebologist at SM-Clinic. Proficient in all modern methods of conservative and surgical treatment of diseases of the veins of the lower extremities (including sclerotherapy, EVLT - endovasal laser coagulation, traditional phlebectomy)
  Read more

• Volkov Anton Maksimovich

  Phlebologist, surgeon at SM-Clinic. Performs operations with a modern proprietary method of treating varicose veins using a laser (modified endovenous laser coagulation. M-EVLC).
  Surgical treatment of varicose veins of any complexity (phlebectomy, miniphlebectomy) More details

• Kabirov Alexander Vitalievich

  Cardiovascular surgeon at SM-Clinic. Candidate of Medical Sciences Proficient in all modern methods of conservative and surgical treatment of diseases of the veins of the lower extremities (including sclerotherapy, EVLT - endovasal laser coagulation, traditional phlebectomy)
  More details

• Baranov Vladimir Sergeevich

  Cardiovascular surgeon at SM-Clinic. Candidate of Medical Sciences Treats lower varicose veins using non-surgical and surgical methods (aesthetic sclerotherapy, ECHO sclerotherapy, stem sclerotherapy, phlebectomy, miniphlebectomy, EVLT).
  More details

Treatment

The basis of treatment for this pathology is lifestyle adjustments. This means:

• lipid-restricted diet,
• rejection of bad habits,
• physical activity regimen,
• avoiding stress,
• treatment of chronic diseases.

The focus of drug therapy is the use of lipid-lowering drugs, antiplatelet, antihypertensive and antioxidant drugs, drugs to improve microcirculation and symptomatic therapy. Therapy, as a rule, takes a very long time and depends on the stage at which it was started.

In case of severe stenotic processes, surgical treatment is recommended for the patient. Most often, surgical intervention is performed on the internal carotid arteries. Source: E.A. Shirokov. Stenosing atherosclerosis of the cerebral arteries: modern strategies for diagnosing and treating patients // Consilium Medicum, vol. 18, no. 9, 2021, pp. 37-42.

Treatment for this disease is aimed at ensuring that metabolic processes are restored, and harmful cholesterol no longer settles on the walls of blood vessels. At the same time, attention is also paid to restoring blood circulation and normalizing the nutrition of brain tissue.

Drug therapy

This is the most important part of the comprehensive treatment of atherosclerosis. Patients may be prescribed several groups of medications:

• Statins - reduce the size of cholesterol plaques, reduce the risk of narrowing of the main arteries of the brain, and stop the growth of plaques.
• Antiplatelet agents – reduce blood viscosity and prevent blood clots.
• Fibrates are similar in action to statins, but do not affect the size of plaques, but lower the triglyceride content in the blood.
• Means for restoring vascular function.
• Bile acid sequestrants prevent cholesterol from being absorbed from food.
• Nootropics and medications that improve metabolic processes in nervous tissue.
• Hypotensives that stabilize blood pressure and help prevent stroke.
• Vitamin and mineral complexes to improve the general condition of the body. They must contain vitamins A, C, group B and nicotinic acid.

Medicines are taken in long courses, and most of them are taken for life with periodic dosage adjustments.

Surgical treatment

Operation is a last resort, indications for it:

• narrowing of the lumen of the carotid artery by 70% or more;
• condition after a minor stroke;
• recurrent ischemic attacks.

Surgical options:

• bypass - the formation of a vessel bypassing the one affected by cholesterol deposits;
• endarterectomy - a procedure to remove cholesterol plaques along with a small amount of tissue that lines the vessel from the inside;
• stenting using endoscopic technology - an expanding structure impregnated with a composition that dissolves cholesterol is installed in the vessel.

Operations can be performed under general anesthesia or local anesthesia. An anesthesiologist is consulted before the operation. The length of hospital stay varies depending on the technique, as do recommendations for the recovery period. SM-Clinic doctors inform patients in detail about all the nuances and are ready to answer any questions related to treatment at the initial consultation. Consultation on the operation is free of charge.

You can find out more about discounts on preoperative examinations by following the link.

Why is high cholesterol dangerous?

Elevated cholesterol levels lead to the risk of developing coronary artery disease and myocardial infarction, ischemic stroke and gangrene of the extremities!

It is necessary to reduce the concentration of total cholesterol in the blood: a decrease in the concentration of total cholesterol in the blood by 10% leads to a reduction in mortality from heart disease by 20%. Little physical activity (physical inactivity), excess nutrition and smoking have a bad effect on cholesterol levels.

Physical exercise and weight loss reduce the concentration of cholesterol and triglycerides, thereby preventing the development of atherosclerosis.

Diet

Changing your diet is also a way to improve your well-being and is a great help for other treatment methods. Atherosclerosis very often progresses precisely against the background of poor nutrition and lifestyle, so it is necessary

• follow a certain diet:
• reduce consumption of red and fatty meats and meat in general;
• limit the consumption of confectionery products and baked goods;
• eat as few egg yolks as possible;
• limit solid vegetable fats – margarine – in the diet;
• completely eliminate alcohol, sausages, fast food, and canned food.

Recommended products include vegetables (fresh, pickled, dried), cereals (rice, buckwheat, barley, millet, oats, flax, etc.), dried, fresh and dried fruits, turkey and chicken fillets, river and sea fish.

You need to eat at least 5 times a day at the same time in small portions. It is necessary to avoid fried foods and prepare food using the methods of boiling, steaming, stewing, and baking.

Stages of disease development

There are 3 stages in the pathogenesis of atherosclerosis. Systemic arterial damage occurs against the background of changes in protein and lipid metabolism.

First

At the initial stage, a fat spot is formed. In areas of vessel branching, microcracks appear on the walls, and a local slowdown in blood circulation occurs. The walls of blood vessels swell and become loose, but thanks to protective mechanisms the body still manages to dissolve lipids.

When these resources are depleted, complex compounds of lipids and proteins are formed. They are deposited on the inner surface of the vascular walls.

Second

In areas of lipid deposits, connective tissue begins to grow: an atherosclerotic plaque is formed. At an early stage of formation, it has a semi-liquid form and undergoes dissolution.

But there is also danger at this stage. Due to their loose structure, plaques can spread and clog arteries. The vascular walls lose their elasticity and become ulcerated, which leads to the formation of blood clots.

Third

The plaque thickens and calcium salts accumulate in it. Gradually it grows, narrowing the arterial lumen. The blood supply to the organ that the artery supplies is disrupted. When the lumen of a vessel is blocked by a blood clot or plaque decay products, a heart attack or gangrene develops.

Possible risks associated with atherosclerosis

The most dangerous complication is a stroke. If at the same time the patient has poor eating habits, is overweight, moves little and is regularly exposed to stress, then with an 80% probability he will become disabled as a result, unable to care for himself. The mortality rate is also high.

Prevention

To prevent cerebral atherosclerosis, you need to avoid smoking, follow a diet, and keep yourself in good shape with moderate physical activity. It is very important to establish a psycho-emotional background, protect yourself from stress, and if this is not possible, then take courses of sedatives and amino acids, for example Glycine.

* You can read more about the conditions here - Treatment on credit or in installments.

Which specialist should you contact?

First of all, a person suffering from these symptoms should visit a general practitioner (general practitioner or family doctor). He will be able to draw up a clinical picture and, in the case of early stages, recommend treatment, including changes in diet, lifestyle, vitamin therapy, and the use of medications.

In the case of later stages of the disease, based on the described signs, the therapist will refer the patient to a doctor of narrow specialization - a neurologist.

The neurologist will prescribe a detailed examination on an outpatient or inpatient basis. After this, the primary diagnosis will be confirmed.

If abnormalities in the lipid spectrum are detected, a consultation with a nutritionist will be scheduled.

Often cerebral atherosclerosis is accompanied by weight gain and signs of diabetes mellitus. In this case, a conversation with an endocrinologist will be prescribed.

If the examination reveals a plaque that interferes with normal hemodynamics, then a consultation with a vascular surgeon will be needed regarding surgical treatment methods.