Cerebral ischemia
The content of the article:
- Causes and risk factors
- Forms and stages of the disease
- Symptoms of cerebral ischemia
- Cerebral ischemia in newborns
- Diagnostics
- Treatment of cerebral ischemia
- Potential consequences and complications
- Forecast
- Prevention
Cerebral ischemia, or cerebrovascular insufficiency, is dysfunction or damage to nerve tissue resulting from a decrease or complete cessation of arterial blood flow to it.
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Cerebral ischemia is a serious medical and social problem, as this pathology is one of the main causes of permanent disability, disability and mortality.
Causes and risk factors
The pathological mechanism of development of cerebral ischemia is based on insufficient supply of oxygen and nutrients to neurons, as a result of which normal functioning is disrupted and their death occurs.
Factors that can lead to the development of insufficient blood supply to the brain are:
- morphological changes in cerebral vessels - disturbances in the shape and configuration of vessels (aneurysms, vascular malformations, congenital anomalies in the structure of the walls), occlusive lesions (prolonged spasm, blood clots, atherosclerotic plaques), anomalies in the structure of large vessels;
- changes in the rheological properties of the blood and the hemostasis system - violations of the water-electrolyte balance (diseases of the endocrine system, kidneys), dysproteinemia (changes in the content of protein fractions in serum), increased tendency to thrombus formation
- disorders of cerebral and general hemodynamics - severe intoxication, severe anemia of various origins, cardiovascular diseases in the stage of decompensation;
- individual and age-related characteristics of the metabolism of nerve cells and their response to local deterioration of cerebral blood flow.
Most often, cerebral ischemia develops with a combination of atherosclerotic lesions of the cerebral vessels and arterial hypertension. Cholesterol plaques gradually increase and block the lumen of the artery, reducing blood flow in it. An increase in blood pressure causes a spasm of the arteries, as a result of which the blood flow through the partially occluded vessels is even more disturbed, and in some cases completely stops, leading to a pronounced oxygen starvation of the brain cells.
In young patients, the following pathological conditions can cause cerebral ischemia:
- inflammatory or hereditary angiopathies;
- heart rhythm disturbances;
- amyloidosis;
- arterial hypotension;
- smoking;
- alcohol abuse.
In the elderly, the risk of developing cerebral ischemia increases with:
- malignant neoplasms;
- diabetes mellitus;
- chronic heart failure;
- ischemic heart disease.
Forms and stages of the disease
According to the peculiarities of the clinical course, two forms of cerebral ischemia are distinguished:
- acute - proceeds as an acute ischemic stroke or transient disorders of cerebral circulation;
- chronic - long course, slow progression.
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The course of cerebral ischemia is divided into several stages:
- The general state of health of the patient is satisfactory, neurological symptoms are poorly expressed. Emotional and personal disorders (aggressiveness, irritability) appear, cognitive functions are impaired (slowing down of thinking abilities, decreased concentration of attention). Minor coordination and gait disturbances may occur. The ability to work is fully preserved.
- The severity of neurological symptoms increases, ataxia, dysfunction of cranial nerves, and extrapyramidal disorders appear. Cognitive and emotional impairments are increasing. Decreases professional and social adaptation.
- A number of neurological symptoms are formed: parkinsonian syndrome develops, urinary incontinence appears, and walking is impaired. Due to a sharp decrease in criticism of their condition, patients usually do not present any complaints. Significant disturbances in the emotional background are clinically manifested by psychotic disorders, apathic-abulic syndrome, disinhibition, and explosiveness. Disorders of thinking, memory, praxis, speech are expressed. Dementia develops gradually. Developing maladjustment becomes the reason for the loss of the ability not only for professional activity, but also for self-service.
Depending on the duration of the increase in the symptoms of cerebral ischemia, there are three rates of progression of the disease:
- Slow - over 5 years.
- Medium - 2 to 5 years.
- Fast - less than 2 years.
Symptoms of cerebral ischemia
The main clinical signs of chronic cerebral ischemia are emotional disturbances, impairment of memory, learning and memory ability, and movement disorders. There is a pronounced inverse relationship between impaired cognitive functions and the presence of complaints: the more the ability to cognitive activity suffers, the fewer complaints are presented by patients. Therefore, it is impossible to assess the severity of the pathological process on the basis of subjective feelings and complaints of patients.
The main symptom of cerebral ischemia in the chronic course is cognitive impairment. Simultaneously with them, motor disorders and emotional disorders arise and gradually progress.
Acute cerebral ischemia occurs suddenly, its manifestations:
- Strong headache;
- nausea, sometimes up to vomiting, and vomiting does not bring relief;
- general weakness;
- vegetative-vascular reactions (sweating, trembling, hot flashes);
- blurred vision;
- short-term disturbances of consciousness;
- focal neurological symptoms (determined by the location of the ischemic process).
With a transient disorder of cerebral circulation, the impaired neurological functions are fully restored within 24 hours. If the neurological symptoms disappear within a week, then they speak of a minor stroke. The persistence of neurological deficit for more than 7 days indicates a completed ischemic stroke.
Cerebral ischemia in newborns
The development of cerebral ischemia in newborns is caused by oxygen starvation of the fetus during pregnancy or during labor.
The following signs suggest the presence of cerebral ischemia in a newborn:
- marbling of the skin;
- flinching and wanton crying;
- sleep disorders;
- muscle atony;
- the volume of the head is more than normal;
- bulging fontanelle;
- sucking and swallowing disorders;
- breathing disorders;
- convulsive seizures.
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Depending on the severity of clinical manifestations, several degrees of severity of cerebral ischemia in newborns are distinguished:
- Lightweight. It is manifested by excessive depression or excitement of the child, which persists during the first week of life.
- Average. Focal neurological symptoms appear, and seizures may occur.
- Heavy. A pronounced neurological deficit, respiratory and cardiac disorders are characteristic.
Diagnostics
Diagnosis of cerebral ischemia is sometimes difficult, since its symptoms are similar to those of a number of other diseases, in particular:
- cortico-basal degeneration;
- progressive supranuclear palsy;
- Parkinson's disease;
- multisystem atrophy;
- Alzheimer's disease;
- brain tumors;
- ataxia;
- idiopathic dysbasia;
- normotensive hydrocephalus.
A comprehensive examination begins with examining the patient, determining the neurological status, assessing the state of the cardiovascular and respiratory systems. In order to determine the neurological status, the following is assessed:
- clarity of consciousness;
- consistency of eyeball movements;
- pupil response to light;
- facial symmetry;
- the ability to grimace, facial expressions;
- speech;
- tongue movements;
- coordination of movements;
- muscle tone and muscle strength;
- memory;
- tendon reflexes;
- sensitivity.
An instrumental study carried out with suspected cerebral ischemia includes the following methods:
- angiography of cerebral vessels;
- computed and / or magnetic resonance imaging of the brain;
- electroencephalography;
- duplex scanning of the carotid arteries;
- transcranial dopplerography.
Treatment of cerebral ischemia
Treatment of cerebral ischemia can be conservative or surgical. Its goal is to completely restore, or at least significantly improve, cerebral blood flow.
The drug therapy regimen includes drugs of the following groups:
- neuroprotectors - protect the neurons of the brain from hypoxic damage;
- vasodilators - due to the expansion of the lumen, blood flow through the cerebral arteries improves;
- anticoagulants - reduce the risk of blood clots, improve the rheological properties of blood;
- hypolipidemic - lower cholesterol in the blood and thereby reduce the rate of progression of atherosclerosis.
The methods of physiotherapy (magnetotherapy, electrophoresis, physiotherapy exercises, massage, myoelectrostimulation) are of great importance in the complex treatment of cerebral ischemia. Microcurrent electroreflexotherapy has a good therapeutic effect, which normalizes cerebral circulation and improves neuronal function.
Surgical treatment of cerebral ischemia is indicated for severe stenosis of the cerebral arteries or their blockage by atherosclerotic plaque, thrombus. The following operations are most often performed:
- carotid endarterectomy;
- thrombectomy;
- stenting of the carotid arteries.
One of the experimental methods for the treatment of cerebral ischemia is the use of mesenchymal stem cells. These cells, once in the affected areas of the brain, attach to tissues and contribute to the development of a collateral (bypass) network of blood vessels.
Popular folk methods of treating cerebral ischemia (garlic tincture, dill water, walnut leaf infusion) are ineffective. Self-medication poses a serious threat to the life and health of patients, since the progression of hypoxic processes can cause irreversible damage to the neurons of the brain, and, ultimately, the death of the patient.
Potential consequences and complications
The severity and severity of the long-term consequences of cerebral ischemia are determined by the form and stage of the disease. The most common complications are:
- ischemic stroke - accompanied by softening and death of a portion of the brain tissue;
- articulation disorders, up to dumbness;
- dysfunction of the pelvic organs;
- persistent disorders of swallowing and breathing;
- areflexia;
- paralysis;
- paresthesia;
- encephalopathy;
- epilepsy.
Difficulties in learning and mental impairment can become long-term consequences of cerebral ischemia in newborns.
Forecast
With timely diagnosis and adequate therapy, the progression of chronic cerebral ischemia slows down significantly. The prognosis worsens in the presence of severe concomitant pathology (hypertension, arrhythmia, diabetes mellitus).
Complications of cerebral ischemia usually develop in case of late seeking medical help or severe acute cerebrovascular insufficiency, occurring with intracranial hypertension, damage to the stem structures and massive neuronal death.
An unfavorable prognosis is observed in patients with ischemic stroke - about 20% of them die in the first days of the disease; in surviving patients, complete recovery of impaired neurological functions, as a rule, does not occur.
Prevention
Prevention of cerebral ischemia should begin at an early age. It is necessary to exclude the influence of the following risk factors:
- stressful situations;
- hypodynamia;
- smoking;
- obesity;
- alcohol abuse.
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It is important to timely identify diseases that contribute to cerebrovascular accident, in particular, atherosclerosis, diabetes mellitus, arterial hypertension, and carry out their systematic treatment.
When the first signs of chronic cerebral ischemia appear, it is necessary:
- be examined by a neurologist;
- receive systematic treatment;
- quit smoking and drinking alcoholic beverages;
- avoid prolonged exposure to the sun;
- normalize the level of physical exertion (refusal of excessive loads, regular exercise therapy);
- normalize body weight.
Compliance with these rules can slow the progression of chronic cerebral ischemia and significantly reduce the risk of serious complications.
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Elena Minkina Doctor anesthesiologist-resuscitator About the author
Education: graduated from the Tashkent State Medical Institute, specializing in general medicine in 1991. Repeatedly passed refresher courses.
Work experience: anesthesiologist-resuscitator of the city maternity complex, resuscitator of the hemodialysis department.
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!
