Chronic cerebrovascular insufficiency is a disease of the elderly that develops against the background of insufficient blood circulation in the brain. Violation of blood flow leads to serious consequences and can cause encephalopathy, dementia and other serious diseases that can cause disability and complete disability of a person.

Cerebrovascular disease

This is a disease that leads to a violation of blood flow to the brain tissues. It develops for various reasons. It has specific symptoms and several stages of the course.

CVD develops in men and women over the age of 50 years. In the absence of adequate therapy, the condition progresses rapidly and leads to parkinsonism. Since the brain cells do not receive enough nutrition, as a result of which they begin to actively die.

Degenerative processes in the white medulla affect the general condition of the body. As a result, the intellectual and mental capacity of a person is significantly reduced.

Typical stages of the development of the disease:

1. At the initial stage, there are slight changes in the state of a person: memory weakens, mood decreases, frequent depressions, headaches can disturb, the process of information perception is disturbed (to a small extent).
2. At stage 2 of the development of the disease, the condition worsens, certain lapses in consciousness occur, signs of amnesia (partial) appear. Severe weakness worries, efficiency decreases, a person is in a state of apathy.
3. At stage 3, functional abilities suffer greatly. In addition to a decrease in intelligence, the patient is unable to make decisions, the process of conversational activity is disrupted. Fine motor skills are impaired, hands are shaking, the person is completely incapacitated, he is assigned a 1 or 2 disability group.

If the brain is severely affected, then it will be difficult to normalize the blood supply. Treatment will help to recover (to some extent), stop the degradation of brain tissue.

Causes

Cerebrovascular insufficiency of the chronic type of flow has several causes.

It can develop against the background of:

• cerebral embolism - a condition in which small vessels of the brain are clogged with emboli that have come off larger vessels;
• thrombosis (also caused). Thrombi block the lumen between the vessels, leading to the development of CVD;
• hemorrhagic stroke or other disease - provided that it was caused by cerebral bleeding;
• dyscirculatory encephalopathy - which, against the background of an uncompensated course, led to the development of cerebrovascular insufficiency.

And also to the development of the disease can lead to:

1. Osteochondrosis of the cervical spine.
2. Blockage of cerebral vessels by atherosclerotic plaques.
3. Previous stroke or myocardial infarction.

The causes of the disease can be conditionally divided into 2 groups:

• the main ones are various diseases against which CVD develops;
• additional - circumstances that indirectly influenced the body and caused cerebrovascular insufficiency.

The list of the main causes of pathological changes and CVD can include various diseases:

1. Hypertension.
2. Thrombosis.
3. Atherosclerosis.

But the list of additional reasons include:

• emotional overload;
• inflammatory or infectious diseases;
• previous injuries;
• overweight;
• alcohol abuse;
• addiction to smoking and drugs;
• diseases of the heart and blood vessels of various origins.

The list of reasons can also include an unhealthy lifestyle, addiction to fatty and fried foods, emotional instability, high blood clotting, etc.

Symptoms

Symptoms of cerebrovascular insufficiency

Cerebrovascular insufficiency has several specific features. The symptoms are often "intertwined" with the underlying disease that led to the development of CVD. But in most cases, patients experience:

1. Frequent or even persistent headaches (severe, often pulsating).
2. Disturbances in coordination of movements.
3. Change in visual fields, the appearance of spots before the eyes.
4. Strange behavior in patients (lethargy, apathy, bouts of irritation, causeless emotional outbursts).
5. The main signs of dementia (reduced memory, intellectual ability).
6. Sleep disturbance, the appearance of a tremor in the hands.

There are several symptoms that you should pay attention to in the first place: impaired coordination of movements, memory problems, carelessness, sloppiness, irritability.

If such signs appear, it is worth contacting a medical institution and going through a series of diagnostic procedures.

Symptoms may not bother you on an ongoing basis, but may occur from time to time - this can also be regarded as a reason to contact the appropriate specialist.

Complications

In chronic cerebrovascular insufficiency, irreversible complications may occur. This is the main danger of the disease. If it is not possible to stop the pathological process, then CVD can cause:

• strokes;
• epileptic seizures;
• dementia.

Violation of blood flow to leads to the development of hypoxia, oxygen starvation provokes the development of irreversible processes, as a result of which a person:

1. Fine motor skills are impaired.
2. Speech is completely or partially lost.
3. The coordination of movements is disturbed.
4. Memory and mental activity suffer.

As a result of such changes, a person becomes incapacitated, he cannot make decisions independently. This condition is classified as an encephalopathy.

It develops against the background of damage to large vessels of the brain. If the condition is not corrected, it will progress, resulting in irreversible consequences.

Diagnostics

Diagnosis of the disease takes place in several stages and involves a comprehensive examination, which will help to identify not only the cause of CVD, but also to choose an effective treatment for the patient.

As part of the diagnostic procedures, they carry out:

• dopplerography of the vessels of the cervical region;
• Ultrasound of the organs of the heart, abdominal cavity;
• MRI of the brain or CT;
• brain encephalogram;
• blood test to determine the level;
• ECG of the heart, ECHO;
• X-ray of the skull in various projections (general, Turkish saddle, etc.);
• they also take blood to determine the concentration of sugar;
• do monitoring of the level of blood pressure with the help of the device (daily tracking).

Diagnostic procedures for cerebrovascular insufficiency

Other tests and diagnostic procedures may be required, but their implementation is agreed with the doctor. You will need to consult a psychiatrist, neurologist, cardiologist, endocrinologist and other doctors.

But, often it is enough for the doctor to conduct a routine examination, measure the level of pressure and sugar (using a glucometer) in order to make a presumptive diagnosis to the patient. The rest of the studies will be carried out to confirm the diagnosis, their appointment is carried out after the choice of treatment regimen.

But receiving the results of tests and examinations can have an impact on therapy. The doctor can make certain adjustments to it by prescribing certain drugs.

Treatment

The therapy is carried out in several stages and involves adjusting the patient's condition. It is directed:

1. To lower blood pressure levels.
2. To lower cholesterol levels.
3. To correct the concentration of sugar.
4. To reduce the severity of changes in mental and mental function.
5. To normalize blood flow to the brain.

Therapy pursues these goals, they can only be achieved through combined treatment. Within its framework, the patient is prescribed the following medications:

• nootropics - a group of drugs that improve the functional abilities of the brain;
• vasodilators - in most cases prescribed, it improves blood flow;
• drugs that reduce the level of blood pressure - these can be various medications, it all depends on the stage of hypertension and its severity;
• statins - to correct cholesterol levels.

The basis of therapy is nootropics (Pantocalcin, Glycine, Phenibut, Piracetam, etc.), but they are not effective in the case of monotherapy. Since it is important to eliminate the root cause of the disease: atherosclerosis, diabetes mellitus or hypertension.

If necessary, it is permissible to carry out physiotherapy procedures:

1. Electrophoresis.
2. ultrasound.
3. Exercise therapy (a set of exercises).

Individual sessions with a psychiatrist, psychologist and speech therapist help well.

In case of ineffectiveness of conservative medicine, a decision is made to perform an operative intervention (removal of a blood clot, atherosclerotic plaques, stenting, etc.)

Cerebrovascular disease is dangerous with severe complications, but if measures are taken in time, the patient's condition is corrected, the necessary manipulations are carried out, then the pathological process can be stopped. This will help (to some extent) correct the patient's condition, improve the functioning of his brain and blood flow.

hemorrhagic stroke. Hemorrhage in the brain:

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Various options for the causes and pathogenesis of cerebrovascular insufficiency are discussed, including the "steal mechanism", changes in microcirculation, increased aggregation activity of platelets and erythrocytes, and blood viscosity.

Symptoms of cerebrovascular insufficiency

With a gradual increase in cerebrovascular insufficiency, its subjective manifestations become more pronounced and prolonged. If at first GB, GoK, noise in the head, other subjective cerebral symptoms develop after mental or physical overstrain, then later they can occur without any apparent reason. Morphological changes detected using neuroimaging methods may not yet appear, and organic neurological symptoms are not detected. However, a number of patients gradually develop increased reactivity of the vascular system with a tendency to dystonic reactions of a local and general nature.

Risk factors for cerebrovascular insufficiency: hypertension, heart disease (CHD, heart failure, atrial fibrillation); SD; smoking; alcohol abuse; psycho-emotional overstrain; lesions of the main arteries of the head; obesity; lipid metabolism disorder; changes in blood rheology; hereditary burden (hypertension, stroke, myocardial infarction in the next of kin). In foreign literature there are no indications of the existence of such a form of CVP. However, when analyzing the available data, attention was drawn to the fact that individual symptoms, united by the concept of cerebrovascular insufficiency, were repeatedly and in sufficient detail described in various forms of vascular pathology, both domestic and foreign. Yes, R.A. Stallones et al., summarizing the results of a study conducted in the United States, determined the indicators of the relative risk of cerebral stroke, which amounted to 2.9 for patients with complaints of memory disorder, 2.2 for GoC, and 1.4 for frequent GBs.

Foreign literature contains data on the prognostic value of a number of subjective cerebral symptoms in the initial stages of CVD. However, NPCMs are not included in the International Classifications of Diseases IX and X revisions. The reason is the subjective nature of the signs of cerebrovascular insufficiency, which causes difficulties in the statistical registration of patients. The lack of international recognition of the significance of the problem of cerebrovascular insufficiency has recently reduced the activity of domestic scientists in studying this vascular pathology; Suffice it to say that in a literature review published in 1982 by K.F. Kanareikin, analyzed 128 sources; a large number of candidate and two doctoral dissertations were defended (L.L. Kuznetsova, 1983; D.D. Pankov, 1990); Several monographs have appeared. In the last 10 years, only a few candidate dissertations and publications have been devoted to this important issue. The exception is the Department of Neurology of the Ivanovo Medical Academy, where in 2006 four Ph.D. Unfortunately, some domestic scientists are of the opinion that the concept of cerebrovascular insufficiency, if it should be retained, is only one of the tools for an epidemiological survey of the population for the preliminary identification of persons suspicious of the presence of CVP.

Asymptomatic cerebrovascular insufficiency

A number of subclinical, asymptomatic, latent forms of cerebrovascular insufficiency are distinguished. According to these researchers, they represent the earliest manifestations of CVP, which is characterized by a violation of cerebral hemodynamics, fluctuations in blood pressure levels, autonomic disorders. At the same time, "cerebral" complaints are not noted. There are three pathogenetic variants of the subclinical form of NPNKM: angiodystonic, atherosclerotic and hypertensive. In the angiodystonic variant, only vegetovascular disorders and signs of cerebral angiodystonia are detected according to rheoencephalography.

In the group of individuals with atherosclerotic variant of this form, transient asthenic, vegetotrophic, psycho-emotional (irritability, irascibility, emotional lability), vegetovascular disorders were found; eyelid tremor; decrease or revitalization of tendon reflexes; instability in the complicated Romberg position. No age-related dynamics of these manifestations was noted. According to the REG data, these individuals showed: a decrease in the elasticity of blood vessels, weakly, moderately or sharply expressed; decreased blood filling of the arterial bed; severe hypertension or a tendency to hypertension with an increase in systolic, dicrotic and diastolic indices; angiodystonia; difficulty in venous outflow with an increase in the venous index (with age, there was a gradual decrease in blood supply to the arterial bed); an increase in signs of hypertension - an increase in systolic, diastolic and dicrotic indices, a decrease in vascular elasticity. ECG changes were detected mainly in the form of sinus arrhythmias, disturbances in the processes of repolarization and conduction. The level of atherogenic lipoproteins increased. The level of α-lipoproteins, on the contrary, decreased.

In the hypertensive variant of subclinical cerebrovascular insufficiency, compared to the atherosclerotic variant, irritability, hypochondriacal mood, and elements of weakness were more often detected. In terms of the frequency of detection of vegetovascular and vegetotrophic disorders, these patients approached the group of patients with NPCM. Cerebral hemodynamics, according to REG, was characterized by a decrease in blood supply, an increase in signs of hypertension, and difficulty in venous outflow. Signs of reduced vascular elasticity were less pronounced. Patients showed ECG changes — LV hypertrophy, disorders of repolarization processes, sinus arrhythmias. Emotional-volitional, vegetative-vascular disorders and signs of increased tone of cerebral vessels prevailed. The pathophysiological features of various variants of subclinical NPCM have been established, which is important for determining the methods of differentiated prevention.

Changes in a number of indicators (neuroimaging, ultrasound, electrophysiological, biochemical, rheological) were found, which allow objectifying NPNKM.

In the works of a number of physicians with cerebrovascular insufficiency, atherogenic changes in lipid metabolism, rheology disorders, and humoral blood parameters were found. The existence of a complex of universal pathological mechanisms of dysregulation of the systems of hemostasis, hemorheology and athrombogenic activity of the vascular wall, which underlie thrombosis and atherogenesis, has been proved.

The allocation of cerebrovascular insufficiency in the classification of vascular lesions of the brain is substantiated by epidemiological, clinical and paraclinical studies. It has been shown that NPCM are a serious risk factor for the development of not only stroke, but also cardiovascular syndromes: MIMC, DE, coronary artery disease.

Criteria for cerebrovascular insufficiency

The AMS uses unified criteria for the diagnosis of cerebrovascular insufficiency, which include the following mandatory conditions.

1. The presence of the main SZ (AH, AS or a combination thereof).
2. Identification of at least two out of five "cerebral" complaints in a patient in any combination (HA, GOC, noise in the head, memory loss, mental performance), observed at least once a week during the last three months before the examination. A decrease in memory and performance in a patient is taken into account only when these disorders adversely affect his production activities and / or daily life.
3. The absence or mild severity of "competitive" diseases and conditions leading to the appearance of similar complaints (neurotic disorder, history of traumatic brain injury (TBI), somatic and oncological pathology, alcohol and drug intoxication).

The accepted differential diagnostic criteria for NPNKM are very subjective and difficult to unify. It is believed that in cerebrovascular insufficiency, complaints are unstable and may disappear under certain conditions (rest, change in the nature of work, improvement of living conditions). In addition, in the neurological status of patients with NPCM, unlike stage I DE, there is no scattered microsymptoms and only individual unstable microsymptoms can be detected.

Using the criteria developed at the NCN AMS, a number of epidemiological studies have been conducted that have shown the possibility of a unified approach to identifying individuals with NPCM syndrome, differential diagnosis of NPCM and stage I DE. The Research Institute of Neurology of the Academy of Medical Sciences and the Research Center for Preventive Medicine of the Ministry of Health conducted a joint screening under a single program in 6 cities, among 12,159 men aged 20-54 years. Vascular pathology of the brain was detected in 16.8% of patients. At the same time, its structure was dominated by the NPCM syndrome, which was noted in 65% of patients with CVD. Primary DE was diagnosed only in 0.2% of cases, but in the group older than 50-54 years, its prevalence increased to 1.1%.

The proverb says: "Extinguish the spark before the fire, take the trouble away before the impact." Cerebrovascular insufficiency is that “spark” that can lead to big trouble if they are not detected in a timely manner and appropriate therapeutic and preventive measures are not taken.

The reason for the development of chronic cerebrovascular insufficiency (CCVN) is the deterioration of the blood supply to the brain, ischemic hypoxia caused by impaired patency of atherosclerosis.
sclerotically altered vessels, and, first of all, due to atherosclerotic stenosis of the carotid arteries.
Early extracranial atherosclerosis includes intimal changes and initial asymptomatic hemodynamically insignificant atherosclerotic plaques in the carotid arteries. In this case, the term "early" does not mean the development of atherosclerosis at a young age, but indicates that the patient has the earliest stage of vascular pathology.
Normal blood flow in the vessels of the brain is 40-60 ml/100g/min. The amount of blood flow in the cerebral vessels, reduced to 20 ml / 100g / min is called the "ischemic threshold". At the same time, the first signs of a lack of high-energy phosphates in cells, a slight increase in the level of extracellular potassium, vasoconstrictor agents and stimulators of platelet aggregation in the vessels are noted (Fig. 6.9). At this threshold, electroencephalographic signals also disappear. However, all these changes still remain completely reversible, and they are the object of application of therapeutic effects.
Currently, unfortunately, there are no drugs that selectively act on cerebral circulation. At the same time, a number of drugs that have a general antispasmodic activity, cause vasodilation and improve blood circulation in various organs and tissues, can to some extent positively affect the blood supply to the brain, increase its oxygen supply, enhance its metabolic processes and therefore are widely used in the treatment of patients with CCVN.
In the past, eufillin was relatively widely used for cerebrovascular accidents. Of the modern drugs in this group, pentoxifylline (agapurine, trental) is often used.
Expand the vessels of the brain nicotinic acid and drugs containing it nikoverin, nikospan. The ability of nicotinic acid to have a hypolipidemic effect should also be taken into account. Relatively widely used in CCVN related to nicotinic acid drugs xanthinol nicotinate, picamilon.

In patients with CCVN, preparations containing dihydrated derivatives of ergot alkaloids are widely used.
Vinpocetine has gained some popularity in the treatment of cerebrovascular accidents in recent years.
A significant success in recent years is the creation of active cerebral vasodilators from the group of calcium antagonists.
Of great importance for improving cerebral circulation are agents that normalize the metabolic processes of the brain, including nootropic drugs and cerebrolysin.
Naturally, with atherosclerotic lesions of the brain vessels, anti-atherosclerotic drugs should have a positive effect.
Below we will dwell in more detail on some of the most modern and effective pharmacological agents indicated for the correction of CCVD.
Ergot alkaloids and preparations containing them have been successfully used in the clinic for more than 30 years as a means of improving cerebral circulation.
A characteristic property of ergot alkaloids is their ability to block a-adrenergic receptors, which causes vasodilation, and is most pronounced in dihydroergotamine and hydrogenated ergotoxin derivatives. In this regard, they are widely used for the treatment of disorders of the peripheral and cerebral circulation, both as separate drugs and as part of a number of combined finished drugs (Redergin, Sinepres, Christepin, Brinerdin, etc.).
A promising drug in this group is vasobral, which is a combination of dihydroergocriptine A and caffeine. Possessing a high antagonistic ability with respect to a-adrenergic receptors and reducing platelet and erythrocyte aggregation, vasobral has a positive effect on cerebral metabolism, increases cerebral blood flow and improves brain function in ischemic strokes and severe manifestations of CCVN.
Take vasobral orally 2-4 ml 2 times a day with meals with a little water.
Nicergoline (sermion) according to its chemical structure is an analogue of ergot alkaloids, containing, in addition to the ergoline nucleus, a bromine-substituted nicotinic acid residue. In addition to a-adrenergic blocking action, nicergoline has antispasmodic activity, especially in relation to cerebral vessels.
Indications for the appointment of nicergoline are acute and chronic cerebral vascular disorders, especially in early cerebrovascular accidents.

Nicergoline (sermion) is taken orally before meals in the form of 10 mg tablets 3 times a day. Treatment is carried out for a long time (2-3 months or more), depending on the severity of the disease, the effectiveness of treatment and tolerability. The effect develops gradually.
Vinpocetine (Cavinton) - ethyl ester of apovincaminoic acid, is a semi-synthetic derivative of the alkaloid devincane. The vasodilating effect of vinpocetine is associated with a direct relaxing effect on the smooth muscle cells of the arterial wall. The drug enhances the metabolism of norepinephrine and serotonin in brain tissues, reduces blood viscosity, and contributes to the deformability of erythrocytes.
Vinpocetine is used for neurological and mental disorders associated with cerebrovascular accident. Taken orally in the form of tablets (5 mg) 1-2 tablets 3 times a day. Maintenance dose 15 mg / day. Apply for a long time; improvement is usually observed after 1-2 weeks; course of treatment for about 2 months or more.
Calcium antagonists are more often used as antihypertensive, antianginal and antiarrhythmic drugs, but among them there are drugs with a relatively selective cerebrovascular effect.
Cinnarizine (stugeron) has a positive effect on cerebral circulation, improves microcirculation, increases the resistance of tissues to hypoxia, the ability of red blood cells to deform, and reduces increased blood viscosity. The drug has a direct antispasmodic effect on blood vessels, reduces their response to biogenic vasoconstrictor substances, and potentiates the effect of carbon dioxide on the vessels of the brain. Cinnarizine does not significantly affect systemic blood pressure, heart rate, contractility and conduction of the heart.
As a cerebrovascular agent, cinnarizine is prescribed for cerebrovascular accidents associated with vasospasm, atherosclerosis, and stroke.
The drug is taken orally after meals, the usual dose is 75 mg / day. The drug is used for a long time (courses from several weeks to several months).
Flunarizine (sibelium), like cinnarizine, blocks calcium channels, relaxes smooth muscles, improves blood circulation and oxygen supply to the brain; improves blood supply and oxygen supply to the brain; reduces vestibular disorders. Flunarizine is prescribed for adults at a dose of 15-20 mg / day; may cause weight gain, drowsiness.
Nimodipine (Nimotop) is similar in structure to nifedipine. However, a specific feature of nimodipine is its predominant effect on the blood supply to the brain, the ability to reduce
resistance of cerebral resistive vessels, increase cerebral blood flow, reduce hypoxic phenomena. Nimodipine has found application as a prophylactic and therapeutic agent for ischemic disorders of cerebral circulation. Prophylactically, it is prescribed orally every 4 hours up to 360 mg / day.
Nootropic drugs are substances that activate the higher integral activity of the brain, restore disturbed mnestic (associated with memory) and mental functions, reduce neurological deficit and increase the body's resistance to extreme influences.
The main drugs in this group are piracetam and a number of its analogues, as well as some drugs structurally related to gamma-aminobutyric acid (aminalon, phenibut, picamilon), and some others.
Particularly important in the mechanism of action of nootropics is the effect on metabolic and bioenergetic processes in the nerve cell: activation of protein and RNA synthesis, improved glucose utilization, increased ATP synthesis, antihypoxic and membrane stabilizing effects.
Piracetam (nootropil) is the main representative of the group of nootropic drugs. It has a positive effect on metabolic processes and blood circulation in the brain, stimulates redox processes, enhances glucose utilization, and improves regional blood flow in ischemic areas of the brain. Improvement of energy processes under the influence of piracetam leads to an increase in the resistance of brain tissues to hypoxia and toxic effects. There is evidence of an increase in the synthesis of nuclear RNA in the brain under the influence of piracetam.
In neurological practice, piracetam is prescribed for atherosclerosis and other diseases with CCVD symptoms. Applied inside, starting with a dose of 1.2 g / day, and adjust the dose to 2.4-3.2 g / day or more. The therapeutic effect is observed, as a rule, 2-3 weeks after the start of treatment. Subsequently, the dose is reduced to 1.2-1.6 g / day (0.4 g 3-4 times a day).
Cerebrolysin contains low molecular weight biologically active neuropeptides that cross the blood-brain barrier and go directly to neurons. The drug has an organ-specific multimodal effect on the brain, that is, it is capable of metabolic regulation, neuroprotection, functional neuromodulation and neurotrophic activity.
Cerebrolysin increases the efficiency of the anaerobic energy metabolism of the brain, improves intracellular protein synthesis, prevents the formation of free radicals, increases the survivability of the brain and prevents the death of neurons under conditions of hypoxia and

ischemia.
Treatment with cerebrolysin is indicated for various forms of neurological and psychiatric pathology, including in patients with ischemic stroke and CCVN.
It is used only parenterally in the form of intramuscular injections (up to 5 ml) and intravenous infusions (10-60 ml). Doses and duration of treatment depend on the nature and severity of the disease, as well as on the age of the patient; the standard duration of the course of treatment is 4 weeks.
Surgery. It has been established that in most cases ischemic cerebrovascular accidents are caused by atherosclerotic lesions of brachycephalic vessels.
It is important to emphasize that, according to most authors, in 60-70% of patients, strokes occur suddenly without previous neurological symptoms, which confirms the inexpediency of expectant management in case of identified carotid artery stenosis.
The ECST (European Carotid Surgery Trial) and NASCET (North American Symptomatic Carotid Endarterectomy Trial) studies have convincingly demonstrated favorable results of carotid endarterectomy in patients with symptoms of recent focal cerebral ischemia and severe carotid stenosis.
In the vast majority of cases, the results of surgical treatment are good and cerebrovascular accidents do not recur. According to the ultrasound data, after the operation, the TSC in the carotid artery increases to an average of 300 ml/min, the peak systolic frequency and the entire spectrogram normalize, the rectilinear course of the reconstructed artery is recorded on the ultrasound angiogram.
In the ACAS study (Asymptomatic Corotid Atherosclerosis Study), the authors came to the important conclusion that with stenosis of the internal carotid artery of 60% or more, even in the absence of any neurological disorders, surgical treatment is indicated for the patient, since the results of drug treatment are significantly worse. In a comparative analysis of the results of conservative and surgical treatment of patients with hemodynamically significant, but asymptomatic lesions of the carotid arteries, G. Moneta et al. revealed a statistically significant decrease in the frequency of strokes and transient ischemic attacks in the group of operated patients.
In combined forms of atherosclerosis, the question of the advisability of performing preventive brain revascularization in asymptomatic lesions of the brachycephalic arteries in patients with severe angina pectoris remains the most controversial. In these cases, the definition of indications and tactics of surgical treatment should be based on
new on the clinical picture of ischemia of the heart and brain, as well as instrumental examination data. Restoration of blood circulation of the brain and heart, thanks to combined simultaneous or staged surgical interventions on the coronary and carotid arteries, allows not only to prolong the life of patients, but also to preserve their ability to work. For patients who have undergone isolated reconstruction of the arteries of a particular region, it is necessary to establish a dynamic observation.
It has been shown that aspirin and dipyridamole can somewhat reduce the frequency of postoperative transient cerebral ischemic attacks, however, the authors consider the technically adequate performance of carotid endarterectomy to be the best preventive measure to reduce the frequency of postoperative neurological deficits.
Acute ischemic stroke occupies one of the leading places among the causes of disability and mortality in the population, despite progress in the development of methods for the treatment and prevention of cerebrovascular disorders. According to D. Nunn, 400,000 cases of ischemic stroke are recorded in the United States annually, which costs the country 1,520 billion dollars. Undoubtedly, a similar situation is developing in Russia.
Currently, there are 4 clinical variants of acute ischemic stroke:

1. transient ischemic attacks;
2. progressive ischemic stroke;
3. stroke with reverse development (small stroke);
4. complete acute ischemic stroke, in which in the first days there is no further deterioration or improvement of neurological deficit.

1. 02% solution 2 times per hour, after 2 hours the dose is increased to 2 mg (10 ml) per 1 hour (average injection rate 30 μg / kg / hour), monitoring hemodynamic parameters to avoid a sharp decrease in blood pressure. Prophylactically, nimodipine is prescribed orally at 30 mg every 4 hours, starting from the 4th day of the stroke for 21 days.

Table 6.14
Classification of ischemia of the lower extremities according to R.Fontaine.

Summarizing the above, it is possible to determine realistically feasible methods and ways to prevent cerebrovascular accidents in cardiovascular diseases:

1. Active detection and adequate treatment of patients with arterial hypertension, including those with a mild form.
2. Prevention of cardioembolic stroke in patients with cardiac arrhythmias (use of anticoagulants or antiplatelet agents).
3. In patients with carotid stenosis, prevention of the development of CCVN, transient ischemic attacks and stroke.

Cerebrovascular disease (CVD): symptoms, causes, consequences and treatment of pathology

Medical statistics are an extremely accurate thing, and errors here are rare. Therefore, it can be called a proven, but no more pleasant fact that in recent years the number of patients who have been diagnosed with cerebrovascular disease has increased significantly. It is all the more sad that among athletes - seemingly the healthiest group of the population - the mortality rate from acute disorders of the cerebral vessels is firmly held in second place after coronary heart disease.

What is CVB?

Cerebrovascular disease, or CVD, is a disease that causes pathology of the cerebral vessels and, as a result, impaired cerebral circulation. Usually, CVD develops against the background of atherosclerosis and hypertension. The disease is extremely dangerous, first of all, because very often its final stage is a stroke - an acute violation of the blood circulation of the brain, leading to death or disability.

There are acute and chronic types of cerebrovascular diseases. The acute ones are:

• acute hypertensive encephalopathy ;
• transistorized ischemic attack ;
• hemorrhagic or ischemic stroke .

The chronic form of CVD is dyscircular encephalopathy, which, in turn, is divided into types:

• cerebral thrombosis . Narrowing and blockage of blood vessels by blood clots or plaques;
• cerebral embolism . Blockage of blood vessels by clots formed in larger arteries (for example, in the heart) and caught in the bloodstream into small ones;
• cerebral bleeding . Rupture of a vessel in the brain, which is the cause of a hemorrhagic stroke.

Dyscircular encephalopathy can develop gradually, and then turn into an acute form of CVD.

Important fact
Oddly enough, embolization and thrombosis of cerebral vessels can be caused by operations aimed at reconstructing blood circulation in other arteries: stenting, replacement of a heart valve with an artificial one, coronary artery bypass grafting. This once again proves that the human body is a very complex system and third-party intervention, even for good purposes, does not always lead to a positive result.

Causes of the disease

The main factor in the occurrence of cerebrovascular disorders is, as we have already mentioned, cerebral atherosclerosis. Also, to a lesser extent, CVD can occur due to inflammatory vascular disease.

Concomitant causes that can cause and exacerbate the disease:

• diabetes;
• gout;
• inflammatory diseases;
• overweight;
• osteochondrosis of the cervical spine;
• various pathologies of cardiac activity;
• smoking and excessive alcohol consumption.

Symptoms of cerebrovascular disorders

The primary symptoms of CVD usually go unnoticed, as they can be attributed to ordinary fatigue and overwork. Agree, few people would think to see a doctor for headaches, minor sleep disturbances, increased fatigue and decreased performance? With the development of cerebrovascular insufficiency, the symptoms become more pronounced: severe pain appears, often mistaken for migraines, intellectual activity disorders, insomnia, dizziness, tinnitus, irritability, loss of sensation in the extremities. The next stage of the manifestation of the disease is characterized by fainting, depression, temporary visual impairment.

If the patient does not go to the hospital for examination and medical help, CVD, if left untreated, leads to transistor ischemic attacks and stroke.

Consequences of cerebrovascular pathology

Not always, although very often, cerebrovascular disorders lead to a stroke. Other consequences of chronic disorders can be serious cognitive impairment: memory impairment, mental activity, spatial orientation up to vascular dementia (in 5-15% of cases). Decreased coordination is possible: staggering gait, uncertainty and lack of control of movements. Also, patients may develop Binswanger's disease (subcortical atherosclerotic encephalopathy), which is characterized by gradual dementia, loss of the ability to self-care in everyday life, dysarthria, and even epileptic seizures.

CVD treatment

To avoid the development of the disease, it is necessary to undergo an examination when symptoms of the first stage appear. Most often, computed and magnetic resonance imaging, vascular ultrasound, encephalography, and contrast x-rays are used to detect the disease. When making a diagnosis of "CVD" and identifying the nature and degree of violations, the patient is prescribed a course of therapy.

The essence of the treatment, first of all, is to restore the normal blood supply to the vessels of the brain, that is, to expand the vessels. Therefore, the patient is prescribed antiplatelet agents (aspirin) and vasodilator drugs (mefacor, papaverine). Nootropics are also used to improve memory and cognitive functions. In severe forms and acute cerebrovascular insufficiency, the method of angioplasty (mechanical expansion of the vessel with a catheter with a balloon) and endarterectomy (removal of blood clots), arterial stenting is used.

Also, the complex of treatment includes measures to normalize and support blood pressure, get rid of excess weight. During the rehabilitation period, physiotherapeutic procedures, physiotherapy exercises, classes with a speech therapist and a psychologist are shown to restore speech and cognitive functions (if such a need exists).

If the patient has had a cerebrovascular stroke, the treatment will be much longer and more complicated.

Disease prevention

To prevent the development of cerebrovascular disease of the brain, one should try to adhere to a hypocholesterol diet (exclude fried, pickled, salted, smoked foods, fatty meat, etc.), take measures to get rid of excess weight, bad habits, in particular, smoking. It is also necessary to constantly monitor blood pressure. Athletes do not need to be reminded that it is worth leading an active lifestyle, on the contrary, it is worth drawing their attention to the fact that excessive loads should not be allowed.

After 45-50 years, it is necessary to undergo an annual preventive examination, since the risk of developing CVD increases in older and older age. During the clinical examination, concomitant diseases can also be identified that can cause chronic cerebrovascular insufficiency, and their timely treatment will help maintain a healthy state of the brain vessels.

Where can I go if I have CVD?

A diagnosis of "cerebrovascular disorder syndrome" can be made at any age, even in the absence of visible symptoms and, it would seem, to people who are completely not at risk of developing such a disease. If the doctors have issued such a verdict to you or your loved one, you should immediately take measures to heal and recover from the illness. To do this, you should choose a reliable clinic where doctors have experience in treating circulatory disorders of the brain.

One such clinic that provides comprehensive medical and psychological care to patients with CVD and even stroke is a rehabilitation center. Qualified neurospecialists, cardiologists, surgeons develop an individual course of treatment for the patient, and physiotherapists, psychologists, speech therapists conduct restorative procedures and classes that help the patient return to a full-fledged active life. Full board is organized in the center, comfortable double and single rooms are equipped, a professional chef offers a menu based on the recommended diet. The clinic building is located in an ecologically clean area of ​​the Moscow region, surrounded by a pine forest. It will be nice to spend time and walk here.

License of the Ministry of Health of the Moscow Region No. LO-50-01-009095 dated October 12, 2017

Thursday, 01.03.2018

Editorial opinion

Statistics show that cerebrovascular disorders are one of the main causes of not only strokes, but also such phenomena as senile dementia. Therefore, do not neglect the advice of doctors - after 50 years, be sure to undergo an annual examination, drink over-the-counter vasodilating and strengthening the walls of blood vessels on the recommendation of a doctor (validol, drotaverine, cordafen, ascorutin) and dietary supplements (for example, Blueberry Forte). Stick to healthy eating habits and quit smoking. As you know, the best treatment is prevention, and in the case of cerebrovascular diseases, preventive measures are fully justified.

Content

Headaches, fatigue, dizziness, fainting, speech and vision disorders, decreased intelligence, limb paralysis, coma, death. Cerebrovascular diseases are the second most common cause of death in the group of diseases of the cardiovascular system. For this reason, it is very important to notice the first signs of pathology in time and start treatment.

What is cerebrovascular disease

According to the International Classification of Diseases of the Tenth Revision (ICD-10), cerebrovascular diseases include conditions in which the cerebral vessels of the brain pathologically change, causing a violation of cerebral blood flow. This can cause a blockage or rupture of an artery, leading to destruction of brain tissue, disability, and death.

The situation is dangerous primarily because the brain is the main organ of the central nervous system, which controls all the processes occurring in the body, including processing the information that comes to it from the senses. It deciphers and reproduces sounds, is responsible for negative and positive emotions, attention, memory, coordination, thinking.

For the most part, the brain consists of neurons (parenchyma) and glial (stroma) cells:

• Neurons process, store and transmit information using chemical or electrical signals. They are connected to each other by synaptic connections, interacting through which they transmit impulses that control the work of the whole organism.
• Glial cells are the helpers of neurons. They provide conditions for the correct transmission of nerve impulses and support the work of the parenchyma.

The work of neurons requires large energy costs, which the main organ of the nervous system receives through the blood supplied to it through a network of blood vessels. Between the brain tissues and plasma there is a blood-brain barrier that protects the main organ of the central nervous system from various infections and selectively passes substances that have entered the blood into it.

If there is damage to the vessels, their rupture or blockage, this negatively affects the work of the main organ of the central nervous system, and it ceases to cope with its duties. The body immediately reacts to this with symptoms of varying severity, depending on the type of lesion. If you do not pay attention to them in time and do not engage in treatment, the consequence may be personality degradation, paralysis, and death.

Causes

Thinning, rupture, blockage of cerebral vessels cause various reasons. Among them are:

• Atherosclerosis. The deposition of cholesterol plaques on the veins and arteries, which after some time harden and replace the healthy tissues of the vessel walls, which makes them brittle. In addition, during this process, the veins and arteries are injured, due to which blood clots form. As the plaque grows, the lumen of the vessels narrows, which causes an increase in blood pressure and a deterioration in blood flow.
• Arterial hypertension. A persistent increase in blood pressure leads to an increase in the load on the walls of blood vessels, their fragility and subsequent disruption of cerebral blood flow. It is especially dangerous if the situation is accompanied by atherosclerosis, spasm, thrombosis or other diseases that have caused damage or blockage of blood vessels.
• Osteochondrosis of the cervical region. With him, due to the displacement of the disc, there was a narrowing of the arteries through which blood enters the brain.
• Diabetes. Glucose is the only source from which the brain extracts energy. If he is not able to absorb it in the right amount, energy starvation begins, which leads to the death of neurons. In addition, diabetes causes problems with blood clotting, atherosclerosis.
• Congenital pathologies in the structure of blood vessels. These changes in the main organ of the central nervous system are of great importance.

Cerebrovascular disease can develop due to traumatic brain injury, brain tumors, gout. Elderly people are at risk: over time, wear of all organs and systems, including blood vessels, occurs. Smoking, alcoholism, constant long-term stress, sedentary lifestyle, obesity also negatively affect blood vessels and cause their destruction.

Classification of cerebrovascular diseases

According to ICD-10, cerebrovascular disorders belong to the class of diseases of the circulatory system and go under the code I60-I69. The group includes the following diseases:

• Subarachnoid hemorrhage. There is a rupture of blood vessels and outflow of blood into the cavity located between the pia mater and arachnoid. Among the causes are traumatic brain injury, rupture of an arterial aneurysm. It leads to disability even with timely treatment, in fifty percent of cases death occurs.
• Intracerebral hemorrhage (hemorrhagic stroke). Outflow of blood into the parenchyma. The main reason is hypertension. Mortality - 40%.
• Cerebral infarction (ischemic stroke). Due to impaired blood supply, the tissues starve, which leads to the death of neurons. As a result, homeostasis is disturbed, water from the blood plasma seeps into the brain, which causes swelling and displacement of individual parts inside the skull. Mortality - 56%.
• Diseases that do not lead to cerebral infarction, in which blockage and stenosis of the precerebral arteries occurs. These include embolism (blockage of blood vessels by foreign particles that penetrated into the structures of the main organ of the central nervous system with the bloodstream), narrowing of the veins and arteries, thrombosis, complete or partial obstruction.
• brain aneurysm. Expansion of the lumen of the vessels due to their thinning without rupture, except for the congenital form.
• Hypertensive encephalopathy (hypertensive crisis). Violation of cerebral blood flow, accompanied by neurological symptoms. It is a complication of hypertension.
• Moyamoya disease. Progressive pathological changes in the vessels of the brain, in which their slow narrowing occurs, up to complete occlusion (blockage).

Cerebrovascular diseases, according to ICD-10, also include dissection of the cerebral arteries without rupture, non-purulent thrombosis of the intracranial venous system, and cerebral atherosclerosis. This includes vasculitis (inflammation of the central vessels), a progressive vascular leukoencephalopathy that affects the white matter.

Diseases that lead to damage to the cerebral vessels of the brain manifest themselves in acute, chronic or transient forms. They can be mild, moderate or severe. Acutely occurring diseases of a severe nature lead to rapid death. Qualified assistance should be provided in the first five to ten minutes, and it is not always effective. These diseases include:

• intracerebral hemorrhage;
• ischemic stroke;
• stroke of unspecified origin;
• acute hypertensive encephalopathy.

Chronic cerebrovascular insufficiency is caused by blockage of the lumen of blood vessels. The disease proceeds slowly, the patient's condition worsens in stages. If the patient pays attention to the deterioration of health in time and begins treatment, the course of the disease can be slowed down. If measures are not taken to stop this process, the disease can become acute. This group includes:

• narrowing and stenosis of cerebral vessels;
• cerebral thrombosis;
• encephalopathy (subcortical, hypertensive, atherosclerotic, dyscirculatory);
• cerebral arteritis.

Cerebrovascular disease may be transient. In this case, the cerebral functions of vascular origin are sharply disrupted, which are manifested by mixed, cerebral or focal symptoms. Transient cerebrovascular pathology is completely reversible during the day: after an attack, only a slight malaise may remain. These diseases include:

• Transient ischemic attack (microstroke). It develops due to a decrease in blood supply. The difference from a stroke is that the disease is not accompanied by irreversible damage to a part of the brain.
• Hypertensive cerebral crisis. Characteristic for hypertension 2 and 3 stages. There is a sudden increase in blood pressure, accompanied by manifestations of cerebral symptoms. There are varying degrees of severity. The duration of the malaise can last several days, with a severe course of the disease, death is possible. If symptoms do not go away within a day, see a doctor immediately.

Symptoms of cerebrovascular pathology

In most cases, cerebrovascular disease develops over a long period of time. The first signs (dizziness, memory impairment) are associated with oxygen starvation, lack of nutrients, energy that the brain extracts from glucose. Over time, the situation worsens, symptoms of a cognitive disorder appear, when mental abilities and the ability to analyze the situation decrease. Then problems with coordination begin, a person is not able to move normally. In severe cases, coma and death occur.

Primary

The patient rarely pays attention to the first signs of cerebrovascular disease, taking everything for a common malaise. You should be alert and consult a doctor if the following symptoms regularly make themselves known:

• frequent mood swings;
• irritability;
• fast fatiguability;
• reduced performance;
• tolerable headaches;
• dizziness;
• insomnia;
• noise in the ears and head;
• cardiopalmus;
• dry mouth;
• memory deterioration.

As the disease progresses

If cerebrovascular disease is not treated, the condition worsens. Against the background of oxygen starvation, noise in the head, migraines increase, dizziness becomes more frequent and appears even when tilting and turning the head. The patient often cannot fall asleep, during the day he feels drowsiness and weakness. The following symptoms directly indicate problems with the vessels of the brain:

• problems with the sensitivity of individual parts of the limbs;
• transient visual impairment;
• speech disorder;
• possible short-term fainting lasting a few seconds;
• deterioration of mental abilities, intelligence;
• concentration is disturbed;
• memory problems appear;
• depression, apathy, neurosis, psychosis, a keen attention to one's own health.

Complications

In severe cases, cerebrovascular disease is accompanied by convulsions, tremors, problems with gait, and speech. Reflexes disappear, vision is greatly reduced. Further, the situation worsens, it may come:

• paralysis and paresis of the limbs;
• violation of the functions of the pelvic organs (problems with urination, defecation);
• loss of the ability to move and navigate in space;
• dysphagia (trouble swallowing);
• dementia (dementia);
• microstroke;
• stroke;
• cerebrovascular coma;
• cerebral crisis;
• death.

Diagnostics

Having found symptoms in yourself that indicate cerebrovascular pathology, you should consult a doctor. After examining the patient and clarifying the symptoms, the doctor will prescribe a series of examinations aimed at making an accurate diagnosis:

• general blood analysis;
• biochemical analysis of plasma, among which is the analysis of cholesterol and lipoproteins;
• blood coagulation analysis;
• Ultrasound of cerebral vessels (duplex and triplex scanning);
• angiography - a method of contrast X-ray examination of blood vessels, with which you can determine thrombosis, atherosclerosis, narrowing of the lumen, hematoma, the presence of tumors;
• EEG (electroencephalography) - shows the activity of neurons;
• scintigraphy - after introducing radioisotopes into the blood, it helps to detect problems with the blood supply to the brain;
• magnetic resonance imaging (MRI) - detects tumors, aneurysms and other vascular diseases;
• CT (computed tomography) - shows the presence of hemorrhages, inflammation, tumors.

Treatment of cerebrovascular disorders

Therapy of cerebrovascular pathology is aimed at restoring a full blood supply to brain cells, eliminating the symptoms of the disease. In most cases, it is impossible to get rid of the cause that provoked the disease. However, actions can be taken to slow the progression of cerebrovascular disease. This can be done with medical therapy, in severe cases, surgery may be required. The sooner treatment begins, the greater the chance of avoiding stroke and other complications.

For the treatment of cerebrovascular pathology, the doctor may prescribe physiotherapy procedures. Among them is hyperbaric oxygen therapy, which saturates the blood with oxygen and ensures that it enters the affected area of ​​the brain. For this purpose, the patient is placed in a special chamber, where he breathes pure oxygen for some time. This procedure reduces the symptoms of oxygen deficiency, stops the development of complications.

Medical therapy

Cerebrovascular pathologies require long-term treatment. In most cases, medications must be taken for the rest of your life (for example, antidiabetic drugs). If you fully comply with the recommendations of the doctor, you can get rid of the symptoms of the disease, significantly reduce the manifestations, and prevent complications. The following types of drugs will help correct the course of cerebrovascular pathology:

• Antihypertensive drugs (Amniasin, Anaprilin, Naviten) - lower high blood pressure.
• Antihypoxants (Ketoprofen, Imidazole, Gutimin, Amtizol). They increase the body's resistance to oxygen starvation by maintaining energy metabolism at the level necessary to maintain the integrity and functioning of the cell.
• Cardiovascular drugs, which include vinpocetine (Cavinton). It has antioxidant, vasodilating, neuroprotective effects. Affects the metabolism in the brain tissues, which contributes to the expansion of blood vessels, improving blood supply. Promotes resistance to hypoxia.
• Anticoagulants (Fenilin, Heparin). Prevent the appearance of blood clots, reduce blood clotting.
• Antiplatelet agents (Aspirin, Curantil). Prevent thrombosis.
• Hypocholesterolemic drugs (Lipostat, Lovastatin). Reduce the level of cholesterol in the blood, preventing the appearance of atherosclerotic plaques.
• Nootropic drugs (pyrrolidone derivatives - Piracitam, Omaron). Stimulate mental activity, improve memory, cognitive functions. Increase the resistance of the brain to adverse effects, hypoxia.
• Osmotic diuretics (Furosemide, Mannitol). Used to relieve cerebral edema. They increase the osmotic pressure in the plasma, due to which water leaves the swollen tissues, and the volume of circulating blood increases.
• Antioxidants (Cerebrolysin, Actovegin). They neutralize oxidative processes, primarily the action of free radicals, protect cell membranes from destruction, and contribute to their restoration. Antioxidants improve energy metabolism, are neuroprotective.

Calcium channel blockers (Cinarizine, Corinfar, Cardil) inhibit the entry of calcium ions into the middle of cells through calcium channels. Calcium ions contribute to the formation and conduction of electrical impulses, provide contraction of the vascular walls, improve blood circulation. Their use improves blood circulation, relieves oxygen starvation, lowers blood pressure, and reduces platelet aggregation.

For the treatment of cerebrovascular pathology, vasodilator drugs (Pentoxifylline, Trental), drugs from the group of angioprotectors and tissue regeneration stimulants are prescribed. Agents with membrane stabilizing activity (Propranolol, Talinolol) can be prescribed, which inhibit the sodium channels of cell membranes, which contribute to the formation of an action potential. These drugs have anesthetic and antiarrhythmic effects.

Surgical intervention

If cerebrovascular disease is severe and medical therapy does not help, the doctor may prescribe surgery. It could be:

• Balloon angioplasty. A type of bloodless intervention, which is used to expand narrowed blood vessels. Restoration of blood flow occurs with the help of a special balloon, the size of which in a deflated state is 2-3 mm. After entering the body, it is directed to the place where the maximum narrowing of the lumen occurred, and inflated.
• Stenting. After the vessel is enlarged with a balloon, the risk of its narrowing remains. For this reason, a metal frame (stent) is installed in the expanded area, which in the future will not allow the vessel to shrink.
• Endarterectomy. An operation in the neck area to remove cholesterol plaques on the carotid arteries, through which blood moves from the aorta to the brain.
• Extra-intracranial anastomosis. Manipulation is done with a complete blockage of the artery, a pronounced persistent narrowing or the impossibility of its restoration. During the operation, an artery that does not participate in the blood supply to the brain is surgically connected to an artery located on its surface. This allows you to redirect the flow of blood around the clogged artery, improve blood supply to the main organ of the central nervous system and avoid the risk of stroke.

ethnoscience

As a complex therapy, after consulting a doctor, you can use folk remedies. It should be remembered: ignoring drug treatment in favor of herbal infusions alone will lead to the development of the disease, complications, disability, and death. Simultaneously with treatment, attention should be paid to weight loss, proper nutrition, and in case of diabetes, control glucose levels. You should quit smoking and alcohol.

For the treatment of cerebrovascular disease, you can use the funds prepared as follows:

• Grind dry peony roots, pour boiling water, leave for an hour. Drink a tablespoon five times a day.
• Pass lemon and orange through a meat grinder, mix with liquid honey, keep a day in a cold place. Take 1 tbsp. l. three times a day.
• Pour 100 g of pine needles with 1 liter of boiling water, let it brew. Squeeze the juice from half a lemon, add to the infusion. Drink on an empty stomach for three months, 1 tbsp. l.
• Drink tincture of celandine 0.5 tsp. three times a day for two weeks.

Prevention

In order to prevent the development of cerebrovascular pathology, it is necessary to monitor health from an early age. Hypertensive patients should constantly measure blood pressure, not allowing it to exceed 140/90 Hg. Art. If this happens, steps should be taken to normalize it. Preventive measures include the following:

• monitor weight;
• adhere to proper nutrition, limit the use of animal fats, salt;
• avoid stress, emotional stress, physical overstrain;
• do not smoke, limit alcohol consumption, ignore drugs;
• lead a mobile lifestyle, give preference to walking, walks in nature;
• exercise daily;
• avoid situations that can lead to head injury;
• normalize the regime of work and rest;
• get enough sleep.

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