Encephalopathy
The content of the article:
- Causes and risk factors
- Forms of the disease
- Disease stages
- Symptoms of discirculatory encephalopathy
- Diagnostics
- Discirculatory encephalopathy treatment
- Possible complications and consequences
- Forecast
- Prevention
Dyscirculatory encephalopathy is a common neurological disease that is caused by slowly progressive chronic cerebrovascular accident of various etiologies.
Source: blogoduma.ru
In the general structure of vascular neurological pathology, discirculatory encephalopathy ranks first in terms of frequency in the general population. The disease is more often recorded in the elderly, but in recent years there has been an increase in the number of cases of discirculatory encephalopathy in the age group under 40.
The blood supply to the brain occurs through four arteries (two internal carotid arteries from the common carotid system and two vertebral arteries from the subclavian artery system). The carotid arteries provide 70–85% of the blood flow to the brain. The vertebral arteries that form the vertebrobasilar basin supply blood to the posterior parts of the brain (cervical spinal cord and cerebellum, medulla oblongata) and provide 15–30% of blood flow to the brain. In the brain tissue, blood is supplied by arteries that branch out from the circle of Willis, formed by the main arteries near the base of the skull. The resting brain consumes 15% of the blood volume, and at the same time 20-25% of the oxygen obtained through respiration. From the internal and external veins of the brain, blood enters the venous sinuses of the brain,which are localized between the sheets of the dura mater. The outflow of blood from the head and neck is carried out through the jugular veins, which belong to the superior vena cava system and are located on the neck.
In the case of deterioration of cerebral circulation against the background of the adverse effect of certain factors, the trophism of the brain tissue is disturbed, hypoxia develops, which entails the death of cells and the formation of foci of rarefaction of the brain tissue. Chronic ischemia of the deep parts of the brain becomes the cause of a violation of the connections between the cerebral cortex and subcortical ganglia, which, in turn, serves as the main pathogenetic mechanism of the onset of discirculatory encephalopathy.
Causes and risk factors
The main cause of discirculatory encephalopathy is chronic cerebral ischemia. In about 60% of patients, the disease is caused by atherosclerotic changes in the walls of the vessels of the brain.
In addition, discirculatory encephalopathy often occurs against the background of chronic arterial hypertension (as a result of a spastic state of the blood vessels of the brain, which leads to a depletion of cerebral blood flow) with hypertension, polycystic kidney disease, chronic glomerulonephritis, pheochromocytoma, and Itsenko-Cushing's disease.
Other diseases that can cause the pathological process include osteochondrosis of the spine, Kimmerli's anomaly, anomalies in the development of the vertebral artery, instability of the cervical spine of a dysplastic nature, as well as after a spinal injury. Dyscirculatory encephalopathy can develop in patients with diabetes mellitus, especially in cases where the patient develops diabetic macroangiopathy. Other causes of the disease include systemic vasculitis, hereditary angiopathies, craniocerebral trauma, ischemic heart disease, arrhythmias.
Source: cf.ppt-online.org
Risk factors include:
- genetic predisposition;
- hypercholesterolemia;
- overweight;
- lack of physical activity;
- excessive mental stress;
- bad habits (especially alcohol abuse);
- poor nutrition.
Forms of the disease
According to the etiological factor, discirculatory encephalopathy is divided into the following types:
- atherosclerotic - the most common form; with the progression of the disease, brain functions deteriorate;
- hypertensive - can appear at a young age, exacerbated during hypertensive crises; there is a risk of progression of intellectual and memory impairments up to profound dementia;
- venous - cerebral functions deteriorate against the background of edema, which develops due to difficulty in the outflow of blood;
- mixed - combines the features of atherosclerotic and hypertensive forms.
Depending on the nature of the course, the disease can be slowly progressive (classic), remitting and rapidly progressive (galloping).
Disease stages
In the course of discirculatory encephalopathy, three stages are determined.
- No changes in neurological status; Adequate treatment usually leads to a stable long-term remission.
- The beginning of social maladjustment, objective neurological disorders are observed, the ability to self-service remains.
- Development of vascular dementia, aggravation of neurological disorders, complete dependence of the patient on others.
Source: cf.ppt-online.org
Symptoms of discirculatory encephalopathy
Dyscirculatory encephalopathy is characterized by cognitive impairment, motor impairment, and emotional disturbances.
A gradual and hardly noticeable beginning of the development of the pathological process is characteristic. At the initial stage of discirculatory encephalopathy in the clinical picture, emotional disorders usually prevail. Approximately 65% of patients complain of depression and low mood. They are characterized by fixation on discomfortable sensations of a somatic nature (pain in the back, joints, internal organs, headache, noise or ringing in the ears, etc.), which are not always caused by existing diseases. The depressive state in discirculatory encephalopathy, as a rule, occurs under the influence of a minor psychotraumatic cause or spontaneously, it is difficult to correct with the help of antidepressants and psychotherapeutic techniques. In 20% of cases, the severity of depression reaches a significant degree.
Other symptoms of dyscirculatory encephalopathy at the initial stage include irritability, bouts of aggression towards others, sudden mood swings, bouts of uncontrollable crying for insignificant reasons, distraction, increased fatigue, sleep disorders. In 90% of patients, memory impairment, decreased concentration of attention, difficulties in planning and / or organizing any activity, rapid fatigue during intellectual exertion, slowing of the pace of thinking, decreased cognitive activity, difficulty in switching from one type of activity to another are observed. Sometimes there is increased reactivity to external stimuli (loud sound, bright light), asymmetry of the face, deviation of the tongue from the midline, oculomotor disorders, the appearance of pathological reflexes, instability when walking,nausea, vomiting and dizziness while walking.
Stage II discirculatory encephalopathy is characterized by aggravation of cognitive and movement disorders. There is a significant deterioration in memory and attention, a noticeable intellectual decline, difficulties in performing previously feasible intellectual tasks, apathy, and a loss of interest in previous hobbies. Patients are not able to critically assess their condition, overestimate their intellectual capabilities and working capacity, they are characterized by egocentrism. With the progression of the pathological process, patients lose the ability to generalize, orientate in time and space, daytime sleepiness and poor night sleep are noted. A typical manifestation of discirculatory encephalopathy at this stage is a slow shuffling walking in small steps ("skier's gait"). In the process of walking, it is difficult for the patient to start moving and just as difficult to stop. At the same time, motor disturbances in the work of the upper limbs are not observed.
Source: golovnie-boli.com
In patients with stage III discirculatory encephalopathy, pronounced disorders of thinking are observed, and the ability to work is lost. With further progression of the pathological process, the ability to self-service is lost. Patients with this stage of the disease are often engaged in some kind of unproductive activity, but in most cases they have no motivation for any activity, indifference to the events taking place around them, surrounding and to themselves is noted. Severe speech disorders, urinary incontinence, tremors, paresis or paralysis of the extremities, pseudobulbar syndrome, in some cases - epileptiform seizures develop. Patients often fall while walking, especially when cornering and stopping. When discirculatory encephalopathy is combined with osteoporosis, fractures occur during such falls (most often - a hip fracture).
The main neurological manifestations of the disease include revitalization of tendon reflexes, expansion of reflexogenic zones, vestibular disorders, muscle stiffness, and clonuses of the lower extremities.
Diagnostics
The diagnosis of discirculatory encephalopathy is established on the basis of severe symptoms of the disease for six months or more.
For the diagnosis, complaints and anamnesis are collected. Since cognitive impairment in the early stages of the disease may go unnoticed by the patient and his loved ones, special diagnostic tests are recommended. For example, the patient is asked to repeat individual words after the doctor, draw a dial with arrows that indicate a specific time, and then again recall the words that the patient repeated after the doctor, etc.
Source: golovnie-boli.com
Doppler ultrasound of the vessels of the head and neck, duplex scanning and magnetic resonance angiography of the vessels of the brain are performed. In a number of cases, computed tomography is prescribed, which makes it possible to assess the degree of brain damage and determine the stage of discirculatory encephalopathy (at stage I of the disease, minor organic lesions of the brain are determined, at II - small foci with a low density of white matter, expansion of the furrows and ventricles of the brain, on Stage III - severe atrophy of the brain).
Magnetic resonance imaging of the brain makes it possible to differentiate discirculatory encephalopathy with Alzheimer's disease, Creutzfeldt-Jakob disease, disseminated encephalomyelitis. The most reliable signs indicating this disease is the detection of foci of "silent" cerebral infarctions.
Source: uziprosto.ru
According to the indications, electroencephalography, echoencephalography, rheoencephalography are prescribed.
To identify the etiological factor, it is required to consult a cardiologist with measuring blood pressure, conducting an electrocardiogram, coagulological blood tests, biochemical blood tests (determination of total cholesterol, high and low density lipoproteins, glucose). To clarify the diagnosis, it may be necessary to consult an ophthalmologist with an ophthalmoscopy and determination of visual fields. To determine neurological disorders, a consultation with a neurologist is required.
Discirculatory encephalopathy treatment
Treatment of discirculatory encephalopathy is aimed at eliminating the etiological factor, improving cerebral circulation, protecting nerve cells from hypoxia and ischemia.
At the initial stages of the disease, patients are shown sanatorium treatment.
The basis of the pathogenetic therapy of the disease is made by drugs that improve cerebral hemodynamics (calcium channel blockers, phosphodiesterase inhibitors). When an increased platelet aggregation is detected, antiplatelet agents are used. With arterial hypertension - antihypertensive drugs, which helps to prevent the development of complications and slow the progression of the disease. In the case of a high concentration of cholesterol in the blood, which does not decrease with a diet, lipid-lowering drugs are prescribed. To reduce the severity of cognitive impairment, nootropics are used.
An example of such a drug is Gliatilin. Gliatilin is an original nootropic drug of central action based on choline alfoscerate. The use of Gliatilin helps to eliminate dizziness, headaches and unsteadiness when walking. During the course of treatment, vitality rises, improvements in mental processes become noticeable, and short-term and long-term memory is restored. The phosphate formula of Gliatilin promotes better absorption of the drug and allows for rapid delivery of the active substance to the central nervous system. Gliatilin accelerates the transmission of nerve impulses between neurons, protects them from damage and has a positive effect on the structure of cell membranes. Gliatilin is well tolerated and has long established itself as an effective agent in the fight against discirculatory encephalopathy.
For dizziness, vasoactive and vegetotropic drugs are prescribed. In the presence of disturbances in the emotional sphere, antidepressants with analeptic effect, which are taken in the morning, and antidepressants with a sedative effect, which are taken in the afternoon, are indicated. Vitamin therapy is indicated.
Of the methods of physiotherapy, electrophoresis of drugs, magnetotherapy, oxygen therapy, reflexology, and balneotherapy are effective.
The main goals of psychotherapy for discirculatory encephalopathy of the brain are psychological adaptation to the environment, mental and social readaptation, and elimination of asthenic manifestations.
With a narrowing of the lumen of the internal carotid artery up to 70% and the rapid progression of the disease, surgical treatment is indicated (carotid endarterectomy, formation of an extra-intracranial anastomosis). In case of anomalies of the vertebral artery, its reconstruction is carried out.
For movement disorders, therapeutic exercises with a gradual increase in load, balance therapy are indicated.
A prerequisite for the effectiveness of treatment is the rejection of bad habits, the correction of excess body weight, adherence to a diet with restriction of animal fats, cholesterol-containing foods, table salt. In patients with the initial stages of dyscirculatory encephalopathy, exacerbations are often caused by psychoemotional overstrain, occupational hazards (work at night, vibration, work in conditions of high air temperature, increased noise level), which is why it is recommended to avoid these adverse factors.
Possible complications and consequences
In the absence of timely adequate treatment, there is a risk of developing vascular dementia.
The rapid progression of the pathological process, against the background of which developed cerebral discirculatory encephalopathy (ischemic strokes, systemic connective tissue diseases, malignant forms of arterial hypertension), leads to disability.
Forecast
Timely, correctly selected treatment at stages I and II of the disease can significantly slow down the progression of the pathological process, prevent disability and increase the life expectancy of patients without reducing its quality. The prognosis worsens with acute disorders of cerebral circulation, hypertensive crises, poorly controlled hyperglycemia.
Prevention
In order to prevent the development of discirculatory encephalopathy, it is recommended:
- timely treatment of diseases that can lead to the development of discirculatory encephalopathy;
- sufficient physical activity;
- balanced diet;
- body weight correction;
- rejection of bad habits;
- rational mode of work and rest.
For the purpose of early detection of discirculatory encephalopathy, it is recommended to undergo regular preventive examinations by a neurologist for persons at risk (patients with hypertension, diabetes mellitus, atherosclerotic vascular changes, elderly persons).
YouTube video related to the article:
Anna Aksenova Medical journalist About the author
Education: 2004-2007 "First Kiev Medical College" specialty "Laboratory Diagnostics".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
