All about cerebrovascular disease (CVD): types, symptoms and treatment

Cerebrovascular disease is damage to the blood vessels of the brain, leading to chronic oxygen starvation of the brain and, as a consequence, disruption of many of its functions. The main cause of the disease is atherosclerotic vascular damage. Less commonly, the cause may be various inflammatory diseases of the brain vessels, so-called vasculitis. Cerebrovascular disease in the early stages is manifested by decreased performance, increased fatigue, decreased mood, sleep disturbances, when the patient wakes up in the middle of the night and then cannot fall asleep. Then the symptoms of cognitive impairment are added, i.e. Memory decreases, thinking slows down, mental calculation becomes difficult, and excessive fussiness appears. Subsequently, persistent headaches, tinnitus, and dizziness occur. Periodically, cerebral crises develop, which occur with severe disruption of brain functions and are manifested by the development of weakness in the limbs on one side, disturbances in speech, sensitivity, and vision. If such symptoms disappear within 48 hours, then they speak of a transient cerebrovascular accident. If symptoms persist longer, it is a stroke. In this case, gross dysfunction of the nervous system can persist until the end of life, disabling the patient. A stroke can be ischemic, when the lumen of a vessel is closed by an atherosclerotic plaque or thrombus, or hemorrhagic, when the integrity of the vascular wall is disrupted and hemorrhage occurs in the brain. Such conditions are life-threatening and require immediate medical attention.

Types

• Hemorrhagic stroke. It is characterized by necrotic processes in the walls of arteries and veins. The most common cause is long-term chronic hypertension. A sharp increase in pressure can lead to ruptures of the walls of blood vessels and the formation of hematomas. The fatal outcome of stroke is 35-60% of the total number of patients; some survivors become disabled for life, without any positive prognosis.
• Ischemic stroke.
• Occlusion of arteries and veins. Violation of the general blood flow, leading to the formation of blood clots. There are many reasons for the occurrence of occlusions: foreign bodies, tumors, plaques, aneurysms, etc.
• Hypertensive encephalopathy.
• Moyamoya disease.
• Cerebral arteritis.
• Transient ischemic attack. Cerebrovascular accident with focal neurological symptoms. The manifestations are the same as for strokes, but disappear within 24 hours. If symptoms persist longer, a stroke is diagnosed.
• Hypertensive cerebral crisis is a particular form of hypertensive crisis, characterized by a significant jump in blood pressure and aggravation of existing cerebral disorders. Symptoms most often indicate focal damage to the trunk. Women suffer more often. This type of CVD has a malignant course.
• Discirculatory encephalopathy is a concept used in domestic medicine. The disease progresses slowly, cerebral circulation disorders take on a diffuse, increasing character, and a general disturbance of higher cerebral functions occurs.

Forecast and prevention of cerebrovascular disease

Thanks to timely diagnosis and quality treatment, it is possible to significantly reduce the risk of developing irreversible consequences of cerebrovascular disease. The maximum chances for a positive prognosis remain in patients who contact doctors after the first signs of pathology appear.

Prevention of CVD becomes relevant already at the age of over 37-40 years. Failure to control body weight, a nutritious diet, normalized physical activity, and giving up bad habits (alcoholism, smoking) help prevent a fatal disease.

It is important to avoid frequent intense stress. Individuals who tend to experience frequent increases in blood pressure are advised to regularly take antihypertensive medications. When choosing such products, you should follow the advice of a specialist. Also, for preventive purposes, taking medications that improve cerebral circulation and suppress blood clotting is indicated.

Symptoms

The main symptoms that may indicate CVD and are a reason to consult a doctor:

• decreased performance due to general fatigue
• decreased emotional background, mood swings
• sleep and wakefulness disorders, problems falling asleep, insomnia, frequent awakenings
• general cognitive impairment, characterized by problems with short-term memory, the appearance of stringiness of thinking, the formation of mental cud, getting stuck in one job and the inability to switch attention to another process; there are problems with mental counting
• excessive fussiness
• headaches become constant and persistent
• cerebral crises occur occasionally, severe disturbances in brain function are observed
• the appearance of weakness in the limbs, speech impairments take on severe symptoms, sensitivity decreases or changes, and visual acuity decreases.

If you notice the slightest manifestation of the listed symptoms in yourself or your loved ones, immediately contact a neurologist. In these cases, only the timely intervention of a qualified specialist can preserve legal capacity, and in some cases even life.

Diagnosis of CVD

Primary diagnosis is carried out by a neurologist and includes:

• thorough examination of complaints, medical history and life history
• assessment and analysis of symptoms, including those preceding the disease
• full neurological examination

According to indications, additional examination methods are prescribed:

• laboratory research
• ultrasound examinations, including duplex and triplex scanning of blood vessels with Dopplerography
• functional, incl. 24-hour blood pressure monitoring and ECG
• X-ray
• MRI and CT of the brain

According to indications, a consultation with other medical specialists is prescribed, including a cardiologist, endocrinologist, therapist, nephrologist, psychotherapist, etc.

Causes and risk factors

The reasons for the development of cerebrovascular malformations are not fully understood. It is possible that there is unfavorable heredity, although the occurrence of pathology is sometimes associated with disrupted pregnancy.

Cerebrovascular stenosis and aneurysms most often occur against the background of the following diseases:

• Diabetes.
• High blood cholesterol levels.
• High blood pressure.
• Physical inactivity and obesity.
• Eating disorder.

Risk factors

In addition to the causes of brain disease that can be controlled, non-modifiable risk factors include:

• Hereditary predisposition: Those with a family history of cerebrovascular disease and related conditions are at greater risk.
• Gender: Women are more likely to develop a cerebral aneurysm followed by hemorrhage in the cerebellum.
• Ethnicity: African Americans are more likely to suffer from cerebrovascular disease due to a greater risk of high blood pressure.

Treatment of CVD

When treating CVD, a systematic approach to the patient’s body condition is very important. Here are just a few of the hundreds of aspects that should be taken into account by a neurologist when prescribing a course of treatment for CVD:

• If blood pressure correction is necessary, it should be done gradually, avoiding a sharp decrease in pressure, as this can lead to a worsening of encephalopathy (brain damage). To normalize blood pressure in patients with CVD, it is recommended to use drugs from the ACE inhibitor group.
• Antiplatelet drugs are indicated for all patients suffering from vascular diseases or having a predisposition to their development.
• The use of acetylsalicylic acid derivatives is recommended as basic therapy for CVD.
• For patients with lipid metabolism disorders that cannot be corrected, statins are prescribed. Contraindications to statins are liver failure, myopathies and atherosclerosis (presence of plaques in blood vessels).

The general course of treatment is selected individually and is based on a thorough study of each specific case of CVD. The neurologist will take into account all the nuances of the disease and prescribe:

• medications that improve metabolism, blood circulation and restoration processes in nervous tissue
• Medicines can also be used in injection form, including intravenous drips in a cozy day hospital
• classic massage

Treatment is prescribed only by a competent neurologist. Self-medication is not only inappropriate - it is contraindicated.

Complications arising from cerebrovascular disease

Cerebrovascular disease is one of the pathologies that can cause a significant deterioration in the quality of life. Often, already at the initial stages of the destructive process, the patient has difficulties with full communication with family members and colleagues. This condition is associated with weakening intellectual capabilities and increasing social disorientation.

The progression of CVD often provokes sudden fainting, which can lead to various injuries. Mental disorders give rise to a reluctance to eat food in a timely manner and to take care of one’s appearance.

If a person suffering from cerebrovascular disease has affected certain areas of the brain, malfunctions in the functioning of internal organs cannot be ruled out. The patient may lose the ability to swallow and digest food normally. Possible auditory and visual disturbances, weakening of speech ability, development of vascular dementia, accompanied by loss of spatial orientation and the ability to move normally. People with such disorders become dependent on others and need their constant support and control.

When occurring acutely, cerebrovascular disease increases the risk of developing life-threatening conditions, among which the leading place belongs to strokes (ischemic, hemorrhagic), dementia, cerebrovascular coma, subarachnoid hemorrhages (bleeding into the cavity between the meninges - soft and arachnoid).

FAQ

Does CVD only occur in older people?

Naturally, CVB occurs more often in old age, but it also happens in young people. Especially in the presence of congenital vascular anomalies and predisposition. Therefore, it is incorrect to base the diagnosis of this disease only on age.

I had a stroke. Could it happen again?

Recurrent strokes are quite common. Especially if adequate preventive treatment is not carried out. With regular monitoring by a neurologist and following the doctor’s recommendations, the likelihood of recurrent strokes is significantly reduced.

What tests should I undergo if I have cerebral vascular disease?

The scope of necessary laboratory and instrumental tests should be determined by a neurologist at the appointment, because it is individual. Most often, laboratory tests examine indicators of blood clotting, kidney and liver function, pancreas and blood lipid metabolism; from instrumental studies: ultrasound examination of blood vessels, brain tomography and others.

Management of patients with cerebrovascular diseases and headache

The general principles of management of this category of patients are the determination of the etiopathogenetic cause of existing disorders, a thorough diagnostic search in order to identify primary or secondary forms of hypertension, treatment of existing diseases and modification of risk factors for the development of CVD and the progression of chronic cerebrovascular accidents. In particular, it is necessary to control glucose and blood pressure levels, adequate antihypertensive therapy, correct metabolic disorders, stop smoking, take statins and antiplatelet therapy, and regular physical activity.

The choice of further treatment tactics in patients with CICI is based on determining the nature and severity of existing disorders, reducing the degree and preventing the progression of detected disorders. Therapy for patients with CICI should be aimed, if possible, at the pathological mechanisms of disease development, which is not always possible in real clinical practice. The most accessible medicinal method of intervention is symptomatic therapy, which makes it possible to reduce the severity of various disorders in the patient, especially in the earliest stages of the pathological process, thereby significantly improving his quality of life.

The initial stage of CIGM often occurs in fairly young patients of working age, in whom hypertension, dizziness, asthenic and vegetative manifestations, as well as cCI in the form of a slowdown in the pace of cognitive processes, decreased concentration and impaired executive functions, significantly affect professional, and over time - and for household activities. In this case, the use of drugs with a multimodal mechanism of action, which can effectively, safely and pathogenetically influence existing disorders, is important for patients with CICI.

One of these drugs is Vasobral® (Chiesi Pharmaceuticals LLC), which is a combination of a dihydrogenated ergot derivative α-dihydroergocriptine and caffeine, which improves its absorption. Most of the universal effects of the drug Vasobral® are due to the blockade by α-dihydroergocriptine of α1- and α2-adrenergic receptors of vascular smooth muscle cells and a stimulating effect on dopamine and serotonin receptors [32]. According to experimental data, when using the drug Vasobral®, the aggregation of platelets and erythrocytes decreases, the permeability of the vascular wall decreases, metabolic processes in the brain improve and the resistance of cerebral tissues to hypoxia increases [3]. The second component, caffeine, has a direct stimulating effect on the central nervous system, mainly on neurons of the cerebral cortex, increases mental and physical performance, reducing fatigue and drowsiness, and also increases the bioavailability of α-dihydroergocryptine [32].

In one of the studies [3] involving 293 patients with the initial stages of CICI, 3 months of use of the drug Vasobral® showed a significant decrease in the severity of CI and subjective manifestations in the form of headache, dizziness and other nonspecific symptoms, and an improvement in the quality of life of these patients. The authors of the study [3] demonstrated the feasibility of long-term therapy with Vasobral®, since positive clinical dynamics increased throughout 3 months. therapy and was more significant than after 1 month. use of this medicine. In addition, there was a high patient adherence to therapy with Vasobral® and its good tolerability in patients with CICI in the presence of arterial hypertension, against the background of antihypertensive therapy.

In another open multicenter study [33] of the drug Vasobral® in 1341 patients (average age 59 years) with stages I and II CICM for 1 month. a significant improvement in the condition was shown in the vast majority of patients - in 82.1% of cases. This was manifested in a decrease in the intensity and frequency of headaches, improved concentration, memory and increased mental performance. The best effect was observed when high doses of the drug were prescribed, with good tolerability of treatment, no registered side effects or undesirable interactions with other drugs used by patients with CICI [33].

A survey of 1,189 patients with CVD taking Vasobral® as the main drug or as part of complex therapy, using a specially designed questionnaire, found that the most valuable properties of the drug, in their opinion, were a positive effect on memory, thinking, dizziness and other symptoms that impair them habitual functioning (75% of patients), as well as an affordable price (69%) and almost constant availability of the drug in the pharmacy network (70%) [34]. A similar test of 419 neurologists showed that 22% of respondents consider this drug the most effective drug among other medications, especially in the initial stages of CICI. Doctors considered the advantages of the drug to be good tolerability of the course of treatment (18%), a wide range of indications and clinical effects observed in practice (17%) [34].

Treatment stories

Case No. 1

Patient K., 49 years old, suffered headaches, nausea and dizziness after stress at work. Blood pressure was 190/100 mmHg. After 2 hours, difficulties (blurredness) in speech and numbness in the right hand suddenly appeared, which lasted for about an hour. The next day I went to see a neurologist at the EXPERT Clinic. The patient was diagnosed with a transient ischemic attack and hospitalization in a neurological hospital was recommended, which he refused. In this regard, the patient was prescribed treatment and examination. The patient underwent a course of intramuscular and intravenous drip injections in the day hospital of the EXPERT Clinic. Headaches and dizziness have completely regressed. During examination, patient K. was found to have significant stenosis of the left internal carotid artery due to an atherosclerotic plaque. The patient was referred for consultation with an angioneurosurgeon and subsequently underwent a planned operation, during which the stenosis was eliminated and adequate blood circulation in the left internal carotid artery was restored.

Diseases causing cerebrovascular insufficiency

Osteochondrosis as the root cause of cerebrovascular disease

Due to the long-term and strong influence of provoking factors, diseases develop that subsequently lead to the appearance of cerebrovascular insufficiency:

1. Atherosclerosis. This common disease causes cholesterol plaques to stick to the inner surface of the vascular walls. Subsequently, such vessels cannot fully perform their functions.
2. Vasculitis. Accompanied by inflammatory phenomena that interfere with normal blood circulation.
3. Osteochondrosis. Accompanied by the development of vertebrobasilar insufficiency with inhibition of blood flow in the vertebral vessels.
4. Hypertension. An increase in pressure in the arteries provokes their spasm.
5. The formation of blood clots also leads to cerebrovascular insufficiency due to blockage of blood vessels.

It is often difficult to determine the underlying cause of cerebrovascular disease. So in some cases the diagnosis remains unspecified.