Ischemic brain disease impact on the psyche. A serious disease is cerebrovascular ischemia, how to deal with it? Video: cerebral ischemia

Cerebral ischemia is a condition that occurs due to a lack of oxygen as a result of insufficient blood flow to its tissues. Such a pathological process can occur in any organ that is supplied with arterial blood. It carries a lot of vital substances, without which normal functioning is impossible.

Cerebral ischemia is manifested by a rich clinical picture. At the beginning of the process, signs may not show themselves, but progression leads to pronounced symptoms. The disease occurs both in an acute form and in a chronic one (CIGM). Among the causes of ischemia, there are basic and additional.

The first includes:

Insufficiency of cerebral circulation with the transition to hypoxia - oxygen starvation. This condition is associated with a narrowing of the arterial lumen or its blockage - obturation. The progression of the process leads to necrosis - tissue necrosis - irreversible changes. If ischemia can be reversed, then the necrotic area can never be restored;
Arterial hypertension, violating vascular tone. The outcome of such a process is angiospasm, which causes oxygen deficiency, and as a result, ischemia;
Atherosclerosis, which creates a mechanical obstruction inside the artery. Blood entering the brain meets a barrier. As a result, oxygen delivery is disrupted. And the ischemia begins;
Thrombosis is the blockage of a vessel by a blood clot. Such an obstacle can arise, both initially in the brain, and be transferred from other foci;
An embolism is a formation that can block an artery and move from one vessel to another. The nature of this compound can be different - fatty, airy, medicinal. Sometimes an embolus is called a "travelling" thrombus.

Among the additional causes in the development of cerebral ischemia, an important role is played by:

Diseases of the cardiovascular system;
kidney failure;
decompression sickness;
Abnormal structure of the vascular network according to the type of compression and local arterial spasm;
External compression of the artery by a tumor or stone;
Intoxication syndrome with carbon monoxide poisoning;
hereditary angiopathy;
Large blood loss;
Amyloidosis is the deposition of an abnormal protein in the cerebral arteries;
Systemic vascular inflammation - vasculitis, angiitis;
Diabetes mellitus of any type;
Blood pathology - anemia or erythrocytosis;
Elderly age;
Overweight;
Bad habits such as smoking.

There are many reasons for the formation of ischemic disorders. But the main ones are spasms or blockades of the vascular bed by various formations - blood clots, emboli, tumors or plaques.

Symptoms

The main signs of cerebral ischemia include:

Increased fatigue and weakness;
Increased fatigue during mental and physical stress;
Decreased memory;
Dizziness, up to fainting;
Deterioration of vision and hearing;
sleep change;
Spasmodic changes in blood pressure;
Headaches, migraines;
speech disorders;
Irritability.

The decrease in the lumen of the vessel is directly proportional to the increase in symptoms. The less space remains for blood flow, the more pronounced manifestations of cerebral ischemia. Depending on the rate of progression, several types of pathological process are distinguished:

Fast, which took up to 2 years to develop;
Medium - up to 5;
Slow - more than 5.

Cerebral ischemia goes through several stages of development:

Initial, in which there is pain in the head and memory loss. Signs are expressed moderately and do not bother constantly;
Subcompensation - symptoms initial stage diseases progress. They are joined by personality changes in the form of apathy, a decrease in the circle of interests. Neurological syndromes are observed - vestibular and pyramidal, as well as coordinating;
Terminal, which is characterized by a gross defect due to the formation of multiple lacunar and cortical infarcts. vascular dementia develops.

Diagnostics

Evaluation of patients with cerebral ischemia is usually not early. It is prescribed in the stage of active symptoms due to the fact that before that the disease does not make itself felt. All diagnostic measures are divided into physical and instrumental. The first is carried out by the doctor on his own without hardware methods. This includes:

Examination of the patient;
Collection of anamnesis with fixation of complaints, concomitant pathologies.

In addition, routine laboratory tests for blood and urine are prescribed.

Instrumental diagnostics involves:

Vascular ultrasound;
Doppler tomography.

Morpho-physiological features

The process of ischemia formation has peculiar features. Pathology occurs due to insufficient blood supply to organs, including the brain. This leads to hypoxia - oxygen starvation. Against the background of such modifications, symptoms of the disease appear.

At the morphological and physiological level, during ischemia, the vessels undergo serious changes. Normally, an artery can be compared to a hose that passes the required amount of water. From the inside, its surface is even and smooth - it does not interfere, but only helps the liquid move to its destination.

The same applies to vessels. When an obstacle arises inside its lumen, whether it be an atherosclerotic plaque or a blood clot, the blood flow is mechanically disturbed. With compression from the outside - by a tumor or an abnormally formed artery, as well as as a result of repeated spasms in hypertension, the structure and shape of the vessel changes.

He is no longer able to perform his functions as before. A block inside an artery results in reduced inflow. Outwardly, it swells, as new blood flows in and meets an obstacle, and the old one does not pass to the organ that needs it. Such a vessel can burst and lead to bleeding.

However, even without this, there are many problems. The brain is one of the most demanding human organs. Its bark is the most developed department, unable to do without oxygen for more than a few minutes. Ischemia cannot last long. Soon it undergoes irreversible structural changes that cannot be corrected.

External obstructions also modify the shape of the vessel and interfere with the flow of oxygen to the brain. A change in the tone of the cerebral arteries in hypertension does not have a beneficial effect. Physiologically, with age, the arteries change their state. Their throughput is disrupted. Therefore, many elderly people suffer from a brain microcirculation disorder - ischemia.

Smoking predisposes to such processes. Nicotine causes reflex angiospasm, which is undesirable for blood vessels.

Principles of disease therapy

With cerebral ischemia, treatment with drugs of the following drug groups is possible:

Anticoagulants;
Vasodilator;
Adrenoblockers;
Means that restore blood circulation.

In addition to drug therapy, surgery is also possible. Often it is used to remove atherosclerotic plaques, blood clots and emboli. In ischemic brain disease, treatment may be of a different nature. Physiotherapy exercises and massage are used as additional methods.

Antiplatelet drugs

These drugs are aimed at reducing blood viscosity. They prevent platelets from sticking together. Such medicines are dispensed by a doctor. Self-medication is unacceptable. The most common include:

Clopidogrel. It is not recommended for use with hypersensitivity, pregnancy, lactation, liver damage;
Warfarin. Contraindicated in case of predisposition to bleeding, cerebrovascular hemorrhage, pericarditis, aneurysms, malignant hypertension, severe liver or kidney damage;
Dipyridamole is used both in the form of tablets and as a solution for injection;
Indobrufen is not indicated for stenosing atherosclerosis, decompensated chronic heart, kidney and liver failure, peptic ulcer.

Beta blockers

This pharmacological group is aimed at reducing the heart rate. They provide oxygen to the heart, and they are also prescribed for cerebral ischemia. Good feedback got:

Metaprolol - contraindications to its use are heart block, arterial hypertension, lactation;
Carvedilol;
Bisoprolol.

Beds and fibrates

Such medications are designed to lower blood cholesterol levels in cerebral ischemia for treatment. So, to reduce the formation of atherosclerotic plaques - one of the causes of pathology. These drugs are used in complex therapy to cure cerebral ischemia:

Lovastatin - indicated only for adults;
Fenofiba in tablet form. Not recommended for renal and hepatic pathologies, as well as during lactation;
Atorvastinin.

Nitrogen-containing organic preparations

Such drugs create conditions for the expansion of the blood vessels of the brain. They have an immediate positive effect. However, such drugs cannot be used for hypotension - a low level of pressure. Among the side effects are pain in the head, a decrease in blood pressure. Among the main drugs in this group are:

Nitroglycerin, which is used both in tablets, capsules, spray, and in the form of a solution for injection. In some cases, the medicine is also indicated for pregnant women. If the benefit of the drug is greater than the risk of it;
Isosorbite mononitrate, which is contraindicated in myocardial infarction, glaucoma, anemia, thyrotoxicosis, renal and hepatic insufficiency, lactation.

Anticoagulants

These funds are aimed at reducing blood clotting. It also prevents the formation of clots in the lumen of the artery - blood clots. With cerebral ischemia, such treatment is often necessary. The most commonly used anticoagulant is heparin. These funds are mainly used for the prevention of pathological conditions and less often in an acute process.

Diuretics

These drugs are able to remove excess fluid. This reduces stress on vital organs. Diuretics help fight edema of any origin. Usually they are used in complex treatment. Common drugs are:

Hypothiazide, which is contraindicated in anuria, diabetes mellitus, renal and hepatic insufficiency. It is also not recommended for children under 3 years old, including newborns;
Furosemide should not be used in women in the first half of pregnancy, with glomerulonephritis, gout, myocardial infarction;
Veroshpiron tablets are not indicated for hyperkalemia, hyponatremia, during lactation.

Nootropic dosage forms

This pharmacological group of drugs is aimed at stimulating brain cells. Lack of oxygen has a negative effect on this vital organ. And nootropics have a positive effect on memory function and mental abilities. Common tools include:

Cerebrolysin in the form of a solution for injection. It is contraindicated in renal failure, pregnancy;
Nootropil tablets are not recommended for hypersensitivity, chorea, stroke, lactation.

Antioxidants

These drugs are aimed at inhibiting oxidative processes. These include vitamins and bioflavonoids, enzymes and minerals that contain calcium, selenium and manganese. The most powerful antioxidants include vitamins A, B, C, E, as well as Vazopro or Mexidol preparations.

Folk remedies

In addition to the main line of therapy, ischemia is tried to be treated with home medicine recipes:

Freshly squeezed carrot juice;
A decoction of mint and oak bark, adonis;
Herbal compress.

Prevention

It is not easy to treat the consequences of ischemia and the pathology itself. The prognosis for each patient is individual. Allocate a risk group for this disease. Such people especially need to monitor their health. This includes:

Elderly;
Hypertension;
Suffering from diabetes;
Heavy smokers;
Proponents of malnutrition.

Constantly monitor the level of blood pressure and take the medication prescribed by the doctor;
Promptly seek help for alarming symptoms;
Adhere to a diet that excludes increased intake of cholesterol and sugar;
Annual passage of ultrasound examination of cerebral vessels and laboratory tests;
The use of drugs that improve cerebral circulation. This is especially important for people at risk and engaged in mental work;
Eliminate smoking and alcohol abuse from life.

Shoshina Vera Nikolaevna

Therapist, education: Northern Medical University. Work experience 10 years.

Articles written

Head diseases are always dangerous, but cerebral ischemia is an extremely severe disease of a chronic type that occurs due to the fact that the supply of oxygen to the body is disrupted. The whole organism is under attack, but the brain suffers first. Vessels that are responsible for moving blood and carrying oxygen throughout the body become clogged. The brain lacks nutrition, and it is irreparably affected, and in addition to feeling unwell, a person will also experience a decrease in efficiency and serious consequences.

What causes this disease

Cerebral ischemia can occur due to a wide variety of external and internal factors. When treatment is started late, especially in elderly patients, the consequences are often the most deplorable. If the pathology is not diagnosed in time, then the vascular bed of the body can be seriously affected, and one cannot do without the help of a surgeon.

Ischemia develops gradually, showing symptoms of arterial hypertension. In adult patients, it is caused by:

arteries and vessels;
a large fat mass that narrows the lumen in the vessels, due to which the blood flow is problematic;
blood clots, when the cerebral artery is completely or partially blocked;
acute form of heart failure;
hypertension.

The above reasons are the main ones, but there are many others, indirect ones:

pathologies of the cardiovascular system;
blood problems, including anemia;
vasculitis;
spinal pathology;
tachycardia;
carbon monoxide poisoning.

Important! In a particular risk group are older people who have been diagnosed with diabetes.

Forms of the disease

Due to the fact that cerebral ischemia has a gradual development, there are 3 main degrees:

Ischemia of the brain 1 (initial) degree, when a person feels slightly tired and occasionally shivering. After heavy physical exertion, his hands begin to ache, and his gait becomes tired, shuffling. They are more often diagnosed with TIA - a transient ischemic attack, the symptoms of which are a change in behavior, such as irritability, absent-mindedness, unmotivated aggression.
Cerebral ischemia of the 2nd (medium) degree, when the symptoms become more pronounced. The state is no longer transient. Pathology leads to the fact that the patient cannot self-service. The cognitive sphere is disturbed, and this is the reason that the patient is not aware of his condition, his mental abilities are rapidly declining.
Ischemia of the brain 3 degrees. Ischemic attack of the brain of the 3rd degree is a complete violation of its functionality. The patient's personality has changed irreversibly, he is practically immobilized and walks under himself. It is at this stage that disability is assigned.

In addition, coronary artery disease of the brain can be chronic and acute. The latter occurs due to a sharp lack of oxygen, and if left untreated, a rapid change in brain tissue will begin, and death will occur. First aid and treatment should be immediate if the patient:

paralyzed;
suffering from paresthesia different parts body;
lost vision in one or both eyes.

The chronic form of ischemia leads to its severe form and stroke, which often ends in death.

Oxygen starvation of the brain: symptoms

Signs of cerebral ischemia are usually divided according to the degree of the disease. Therefore, the symptoms of transient ischemic attack are divided by them:

Stage 1, the changes of which can be reversed. Symptoms:

fatigue, malaise, chills;
sleep problems and unstable emotional background;
oral automatism in reflexes;
depression and disorder of cognitive functions of the personality;
disturbances in coordination and gait;
frequent headaches that are activated with other diseases.

2 stage. Cerebral ischemia at this stage is the result of the lack of treatment of stage 1 of the disease, and this transition will take only a week. His symptoms become brighter, and the following also join:

disorders of the extrapyramidal type;
incoordination with ataxia;
full start of the process of degradation of personality and intellect;
apathetic state to everything;
infants have increased hydrostatic pressure.

3 stage. Symptoms of cerebral ischemia in adults have all the signs of a pronounced decompensation of its capabilities. Such damage to brain cells provokes frequent and cortical types. All of the above symptoms are accompanied by:

fainting state;
psycho-organic type syndromes;
incontinence;
difficulty swallowing;
Parkinson's syndrome;
behavior of an inadequate type;
decreased will;
praxis failure;

Symptoms of different stages have differences in adults and children. But the last stage is terrible because it is completely irreversible and completely changes the patient, and most often ends in death.

How is cerebrovascular accident diagnosed?

Cerebral ischemia is rarely diagnosed at the initial stage, because most often there are no serious symptoms. A failure in the work of the body is attributed to something else and insignificant. Therefore, there are more and more cases when ischemic brain disease has already gained momentum and reached stage 2 or 3. A neurologist will analyze the symptoms and complaints of the patient, focusing on whether he has diseases that put the patient at risk.

For instrumental diagnostics use:

cardiograph;
blood test for cholesterol and sugar levels;
physical examination;
ultrasonic tomograph;
electroencephalograph;
doppler tomograph.

What to expect after illness?

Cerebral ischemia and prognosis after it directly depend on the stage of the disease. Complications after an ischemic attack in the brain are hypoxia and metabolic failure. Besides:

after the third stage of cerebral ischemia of the 3rd degree in the elderly, the prognosis is a guaranteed stroke and / or heart attack;
sclerotic lesions of the vascular bed of the brain, encephalopathy;
paralysis;
dumbness;
epileptic seizures;
loss of sensation;
thrombophlebitis.

Postischemic changes in the brain in newborns end with mental retardation, difficulties in learning new things. Even a brief moment of oxygen starvation of the intrauterine state will later cause complications with the health and psyche of the baby.

Preventive actions

Prevention of cerebral ischemia guarantees a reduction in the risk of suffering from this disease, given that the severe form of the disease is almost impossible to cure. Therefore, the main focus should be on sports and an active lifestyle. They will improve blood circulation and improve metabolism, and this is an obstacle to thrombosis, cholesterol. Alcohol and smoking are harmful to the whole body, which means that they should be abandoned.

It is important to eat right. After all, it is because of this that most often there are all health problems, including with the brain. Do not ignore regular medical examinations that will help identify the disease on early stage and start timely treatment. Hirudotherapy helps a lot with blood clots, so you should not exclude it just because of the fear of the process itself.

Cerebral ischemia is a disease caused by disruption of normal blood flow. It arises as a result of narrowing of the lumen of the arteries of the brain (their blockage) and causes oxygen starvation of the cells of all parts of the central nervous system. Violation of cerebral circulation is characterized by three main forms of the course of the disease:

passing(a short-term manifestation of the pathological process, often the symptoms disappear without specific treatment);
acute(ischemic stroke; persistent symptoms occur, certain parts of the brain are disturbed, urgent treatment is needed);
chronic(the symptoms of the disease gradually develop, there is a persistent deterioration in the patient's condition).

Reasons for the development of the disease

Atherosclerosis of cerebral vessels. It can occur as a result of the accumulation of various fatty deposits on the inner walls of the vessels of the brain, which provokes their blockage. Accompanied by impaired blood flow.
Thrombus formation. As a result, there is a complete blockage of the lumen of the arteries of the brain.
Heart failure.
Anemia.
Tachycardia.
Carbon monoxide poisoning.

Factors contributing to the development of cerebral ischemia

There are several groups of factors that can trigger the onset of coronary disease.

Changes in the morphological features of cerebral vessels. Such changes are characterized by congenital abnormal signs and a violation of the structure of large cerebral vessels, which is associated with the occurrence of blood clots, atherosclerotic plaques, aneurysms, and prolonged spasms.
Changes in the hematopoietic system and blood properties. With such changes, a tendency to form blood clots develops due to hypercoagulability of the blood, the content of protein formations changes, the electrolyte composition of the blood changes (in diseases endocrine system and kidney disease).
Cerebral hemodynamic disorders. As a result of severe cardiovascular diseases, anemia and toxic poisoning, there may be a violation of blood flow to the vessels of the brain.
Individual or age features metabolism in brain cells. Certain features of cerebral metabolism can provoke a different reaction of cerebral vessels to a limited blood flow to brain cells.

Magnetic resonance imaging plays an important role in the diagnosis of cerebrovascular disease. All about the prices for the MRI procedure can be obtained.

Symptoms of the disease

The development of the disease can be diagnosed at an early stage, since the most striking symptom is fatigue during active brain activity. Gradually, a number of additional signs appear, indicating a clear deterioration in the condition.

The manifestation of clinical symptoms is characterized by the rapid expansion of its sphere of influence. Among the symptoms of cerebral ischemia are the following:

significant memory impairment;
recurring focal headaches;
dizziness;
fainting;
loss of sensation;
sudden pressure drops;
nausea and vomiting;
speech disorders;
weakness.

Stages of cerebral ischemia

I stage. The patient's state of health is satisfactory, dizziness, general malaise and chills are sometimes observed. Complaints may be associated with irritability, aggressiveness, slow intellectual abilities. Sometimes there is a "shuffling" gait, coordination is disturbed. There is no threat to life.
II stage. Symptoms of cerebral ischemia are increasing. Increased emotional disturbances and cognitive functions. Professional skills, social adaptation, as well as the ability for critical thinking are reduced.
III stage. There is a pronounced Parkinson's syndrome, urinary incontinence, gait disturbance. There are practically no complaints, since the patient is unable to adequately assess his condition. Speech and memory are impaired. The patient loses the ability to daily life and suffers from maladjustment.

Diagnosis of the disease

The complexity of diagnosing the development of cerebral ischemia is due to the fact that the initial stages of the disease are not accompanied by critical complaints of the patient.

Due to the absence of nerve endings in the blood vessels, a person is not able to feel the development of the disease inside the vessel. Therefore, the detection of cerebral ischemia occurs mainly when pronounced symptoms are already observed.

Diagnosis of ischemia includes a number of studies:

study of the patient's history (the presence of concomitant diseases is possible: myocardial infarction, diabetes, angina pectoris, hypertension);
physical examination (blood pressure is measured on the limbs, the heart rate is examined, the symmetry of the pulsation in the head vessels is determined);
laboratory examination (blood sugar level is measured, blood lipid analysis is determined);
instrumental examination (ECG, ophthalmoscopy, scanning and angiography of cerebral vessels).

Treatment methods for cerebral encephalitis are well covered in the following article:.

Treatment of cerebral ischemia

The doctor can prescribe treatment only after a complete and careful examination of the patient and clarification of the factors and nature of the spread of atherosclerosis.

The ongoing therapy should be aimed at slowing down progressive changes in the vessels of the brain, preventing ischemic stroke and general disruption of the life process.
Treatment includes the use of:

drugs that improve blood circulation in the affected arteries;
agents that improve blood flow and normalize blood pressure;
drugs that restore the normal metabolism of neurons.

In the case of a severe stage of the development of the disease or insufficient effectiveness of medical methods, surgical methods are used in the treatment of ischemic disorders of the brain.

The essence of the surgical intervention: a blood clot or atherosclerotic plaque is removed from a clogged arterial vessel, which helps to restore blood circulation. Such operations are mainly performed under local anesthesia.

Consequences and prognosis

With timely diagnosis and effective therapy, the progression of the disease is suspended. However, the presence of concomitant pathologies (arrhythmia, hypertension, diabetes) can cause a decrease in performance and lead to disability of the patient.

In severe brain damage, the formation of edema of the brain tissue, massive death of neurons, and damage to the brain stem are possible. This can lead to paralysis, areflexia and dysfunction of swallowing and breathing.

Prevention of cerebral ischemia

Measures to prevent cerebral ischemia are recommended from an early age. Among the main prevention procedures:

compliance correct mode nutrition (do not overeat to exclude obesity);
playing sports (to avoid the development of hypodynamia);
giving up bad habits (do not smoke, do not abuse alcohol and drugs);
avoidance of stress.

Maintaining a healthy lifestyle will help protect your body from the occurrence and development of such a terrible and serious illness as chronic cerebral ischemia. Remember: your health is in your hands!

Chronic cerebrovascular insufficiency (dyscirculatory encephalopathy) is the most common chronic disease of the nervous system. Pathology debuts at the age of 50-60 years and in the initial stages manifests itself only as subjective symptoms. Objective signs of the disorder appear much later. Timely diagnosis and complex therapy can prevent the rapid progression of the disease and significantly prolong the period of activity and maintain the patient's performance.

Unlike the chronic form, acute ischemic lesions of the brain tissue, which are urgent conditions, develop rapidly and require prompt action to restore hemodynamics, prevent the spread of an ischemic focus, and in severe cases, emergency resuscitation.

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The concept of cerebral ischemia

Chronic cerebral ischemia (CCI) is a gradual extinction, and later the shutdown of a number of functions of the central nervous system under the influence of a gradual deterioration in the blood supply to brain structures. This state is formed as a result of a decrease in the level of hemodynamics in the cerebral vessels. As a result of diffuse or small-focal damage to the brain tissue by ischemic foci, a slowly progressive dysfunction of the brain is formed, due to a long-term oxygen starvation nerve cells.

Multiple foci of ischemia in the brain

The causes of cerebral ischemia, experts call a violation of blood circulation in the cerebral vessels associated with arterial hypertension and atherosclerotic lesions of the vascular bed. Quite often during inspection the combination of the specified conditions comes to light.

Against the background of disorders that form with a systematic increase in blood pressure and the deposition of atherosclerotic plaques on the walls of blood vessels, any factor that changes vascular tone can lead to deterioration in the course of the disease:

emotional stress,
taking vasoconstrictor drugs that provoke a rise in blood pressure;
atmospheric pressure drop, increased meteorological sensitivity of the patient;
intoxication of the body;
smoking;
a sharp change in ambient temperature, for example, when going outside in winter time(particularly often important in conditions that contribute to a decrease in the elasticity of the vascular wall, for example, with atherosclerosis of cerebral vessels, as well as in old age);
intense physical activity, especially unusual for a particular person, contributing to an increase in blood pressure;
systematic lack of sleep, long work at night (these factors contribute to a failure in the system of production and release of vasoconstrictor hormones into the blood).

Various degrees of spasm blood vessel- one of the causes of cerebrovascular insufficiency

Classification

Chronic ischemia of the brain goes through the following stages of development:

Stage	Manifestations
1 degree	Compensated manifestation of malaise, weakness, increased fatigue, sleep disturbance in the form of insomnia and difficulty falling asleep, chills, headache, migraine, tinnitus, oral automatism reflex (less often), psycho-emotional instability
2 degree	Dizziness, general malaise, tinnitus, decreased performance, memory impairment, recurrent headaches
3 degree	The appearance of disinhibition, the presence of mental manifestations, apato-abulic syndrome, speech disorders, impaired thinking, apraxia, the gradual formation of dementia with loss of self-service skills

The course of the chronic form

Chronic ischemia of the central nervous system is characterized by a progressive type of course. The rate of progression of the pathology is from extremely slow to galloping, lightning fast. The latter option is most typical for the onset of the disease in young age(especially against the background of severe arterial hypertension, regardless of its pathology).

The course of acute ischemia

Acute cerebral ischemia develops as a result of the cessation of blood flow through the vessels supplying the central nervous system and in the absence of its recovery within a few minutes. In this case, a cerebral infarction is formed. Most often, this condition is observed with thrombosis or embolism of the afferent cerebral arteries.

Depending on the mechanism of development, the following forms of acute ischemia of the central nervous system are distinguished:

Thrombus in the lumen of the vessel

The localization zone of the ischemic focus coincides with the area of branching of the affected (thrombosed or spasmodic) blood vessel.

According to the persistence of ischemic lesions of brain tissues, acute cerebral ischemia is classified as follows:

Name of the pathology	Description of manifestations
Transient ischemic damage to the nervous tissue (transient ischemic attack)	Clinical symptoms of disorders persist for no more than a day after the onset of manifestations (more often, the signs of the disease regress within the first 5-20 minutes)
small stroke	Complete recovery of impaired functions occurs within 24-72 hours. A recovery period of up to 1 week is allowed
completed stroke	Characterized by an increase in clinical symptoms for several hours, after which stabilization of the patient's condition is noted.
Progressive stroke (stroke in progress)	Gradual increase in focal neurological symptoms, which lasts from several hours to 2-3 days (which is most typical for acute cerebrovascular accident in the vertebrobasilar basin)

Ischemic stroke clinic

The clinical symptoms of ischemic stroke depend on the location of the pathological focus and the set of functions performed by the affected group of nerve cells.

A typical picture of the development of acute cerebrovascular accident of the ischemic type is the sudden onset of hemiparesis and hemianesthesia in an elderly person with atherosclerotic lesions of the cerebral or other groups of vessels.

A characteristic feature is the formation of paresis of the facial muscles on the side of the ischemic focus.

Lower facial asymmetry in ischemic stroke

Paresis of the extremities and hemianesthesia develop on the side opposite to the localization of the ischemic focus.

Typical position of paretic limbs in hemiparesis after ischemic stroke - Wernicke-Mann position

Treatment

Therapy of cerebral ischemia is carried out in the following areas:

Direction	Description of therapy
Normalization of blood pressure	Basic therapy in the form of a systematic intake of antihypertensive drugs
With cardiogenic problems that led to cerebral ischemia, normalization of cardiac activity	Antiarrhythmic therapy medicines appropriate action, and if it is ineffective - the installation of an artificial pacemaker. Cardiotonic drugs that improve the contractility of the heart muscle
Minimizing the impact of cerebral atherosclerosis	Hypocholesterolemic therapy: Zokor; Liprimar; Atorvastatin; Simvastatin
Normalization of hemodynamics and microcirculation in the pools of cerebral vessels	Course therapy with vasodilator drugs
Minimizing the pathological impact of existing ischemia	Course intake of drugs that have an antioxidant effect
Prevention of thrombus formation and improvement of blood rheology	Continuous therapy with systematic administration of antiplatelet agents

When diagnosing advanced stages of cerebral ischemia, it is often necessary to treat disorders that have arisen as a complication of cerebral ischemia:

Pathological condition	Correction approaches
Cognitive impairment	Nootropic Therapy: Piracetam, Phenotropil and Noopept
depressive state	Antidepressants, psychotherapy
Sleep disturbance	Compliance with the regime of the day, moderate activity, walks in the fresh air, exclusion of daytime sleep, sleeping pills
Behavioral disorders	Psychotherapy, sedatives, daily routine, systematic monitoring of the patient
Speech disorder	vasoactive therapy, special exercises, according to the indications of classes with a speech therapist
memory impairment	Vasoactive, nootropic therapy, special exercises to restore memory function and prevent the progression of the disorder
Movement and sensation disorders	Vasodilator pharmacotherapy, physiotherapy, exercise therapy

Surgical

When diagnosing the degree of narrowing of the lumen of the afferent cerebral vessel by more than 70%, it is possible to make a decision on the surgical removal of a thrombus (embolus).

Removal of an intravascular thrombus

According to indications, it is allowed to install a stent - a kind of internal frame that prevents excessive narrowing of the lumen of the blood vessel.

A stent inside a vessel

Treatment with folk methods

With the initial manifestations of chronic cerebral ischemia, along with drug therapy, effective and folk methods treatment:

It must be understood that the changes formed as a result of ischemia require systematic monitoring by a specialist and medical correction.

Pathology should be treated comprehensively, folk methods should play only a supporting role.

Rehabilitation

The rehabilitation program after acute cerebrovascular accident includes a mandatory therapeutic gymnastics to restore motor function and prevent the development of contractures.

With severe paresis that prevents walking, it is recommended to fix the affected foot in bedridden patients with a special orthosis, giving it a natural position - at a right angle to the lower leg.

Orthosis for fixing the foot

Forecast

The prognosis for cerebral ischemia in an adult depends on the degree of the disease at which treatment was started, the completeness of therapeutic measures, the presence of concomitant pathology, and the course of the rehabilitation period.

In the case of acute ischemia, the prognosis depends on the activity during the rehabilitation period (with ischemic stroke - about 6 months). In the case of obliteration of a small caliber vessel, a small focus is formed that does not lead to disability. Such patients live almost full lives. With the extensive size of the pathological focus, ischemic stroke can lead to disability.

A prognostically unfavorable sign is the occurrence of repeated acute cerebrovascular accidents.

Ischemia in newborns

Cerebral ischemia of newborns develops due to the influence of the following factors:

Disease of a pregnant woman (cardiovascular system, bronchopulmonary tract, genitourinary system, infectious and inflammatory origin, from the endocrine system).
Too young (less than 18) or late age of the woman in labor (more than 35 years).
Non-compliance with the daily routine of a pregnant woman.
The presence of bad habits in a pregnant woman (smoking, alcohol abuse or other toxic substances).
Pathology of pregnancy: severe toxicosis before childbirth, oligohydramnios, multiple pregnancy, pathology of the umbilical cord or placenta, premature or late birth.
Problems arising during childbirth: entanglement of the fetus with the umbilical cord, caesarean section, use of pharmaceutical drugs, for example, to stimulate labor, birth trauma, difficult prolonged, too early birth, large sizes fetus.

The main factor provoking cerebral ischemia in newborns is pronounced disorder hemodynamics between placenta and uterus.

Clinical picture

Cerebral ischemia of newborns is manifested by the following clinical syndromes:

Syndrome	Manifestation
hyperexcitability	The child often shudders, there is a tremor of certain parts of the body (limbs, especially in the distal parts, head, lower jaw), restless sleep. The baby is crying for no apparent reason
Inhibition of the activity of the central nervous system	Decreased muscle tone, reduced physical activity, weakening of sucking and swallowing reflexes, strabismus, facial mimic asymmetry
Hypertension-hydrocephalic syndrome	Increased head size, increased intracranial pressure
Coma	Consciousness is absent. The functions of the brain (coordination of movements) are sharply suppressed, up to the absence
convulsive syndrome	Attacks of tonic, clonic or tonic-clonic convulsions, accompanied by loss of consciousness

Cerebral ischemia in a newborn begins to manifest itself in the first hours after birth. The severity of symptoms allows specialists of the maternity hospital to diagnose the severity of the pathology:

Severity	Description
1 degree (mild)	Oppression or excitement of the child in the first week of life. With timely medical care, the signs of pathology quickly regress without serious consequences for the body.
2 degree	Symptoms in the form of agitation, lethargy, convulsions are observed for a period of more than a week. With adequate therapy, pathology is curable
3 degree	A newborn baby in the 3rd degree of cerebral ischemia is subject to hospitalization in the intensive care unit. In most cases, this degree of pathology leads to the development of disorders that are difficult to treat. The condition is manifested by ataxia, retardation of psychomotor development, hearing and vision disorders, focal lesions, convulsive seizures

Treatment

The main goal of therapy for this disorder is to restore hemodynamics, normal activity of damaged areas of the brain and prevent the development of hypoxia in other structures of the central nervous system. To achieve these goals, massage and drug therapy are used.

Consequences

An analysis of the consequences of cerebral ischemia in newborns makes it possible to determine the severity of the disorder, to detect the presence or absence of concomitant diseases, to assess the completeness and timeliness of therapy, as well as the adequacy of restorative measures in the rehabilitation period.

The most common consequences of pathology:

headache;
sleep disorders;
mental retardation;
irritability;
epilepsy or epileptiform syndrome;
difficulties in learning.

- cerebrovascular insufficiency, caused by a progressive deterioration in the blood supply to the brain tissue. The clinical picture of chronic cerebral ischemia consists of headaches, dizziness, cognitive decline, emotional lability, motor and coordination disorders. The diagnosis is made on the basis of symptoms and data from ultrasound / ultrasound of the cerebral vessels, CT or MRI of the brain, and hemostasiogram studies. Therapy of chronic cerebral ischemia involves hypotensive, lipid-lowering, antiplatelet therapy; if necessary, surgical tactics are chosen.

General information

Chronic cerebral ischemia is a slowly progressive dysfunction of the brain resulting from diffuse and/or small-focal damage to the brain tissue in conditions of a long-term cerebral blood supply insufficiency. The concept of "chronic cerebral ischemia" includes: dyscirculatory encephalopathy, chronic ischemic brain disease, vascular encephalopathy, cerebrovascular insufficiency, atherosclerotic encephalopathy, vascular (atherosclerotic) secondary parkinsonism, vascular dementia, vascular (late) epilepsy. Of the above names, the term "dyscirculatory encephalopathy" is most often used in modern neurology.

Causes

Among the main etiological factors, atherosclerosis and arterial hypertension are considered, and a combination of these two conditions is often detected. Other cardiovascular diseases can also lead to chronic ischemia of cerebral circulation, especially accompanied by signs of chronic heart failure, cardiac arrhythmias (both permanent and paroxysmal forms of arrhythmia), often leading to a drop in systemic hemodynamics. The anomaly of the vessels of the brain, neck, shoulder girdle, aorta (especially its arch) is also important, which cannot manifest themselves before the development of atherosclerotic, hypertonic or other acquired process in these vessels.

Recently, a large role in the development of chronic cerebral ischemia is assigned to venous pathology, not only intracranial, but also extracranial. Compression of blood vessels, both arterial and venous, can play a certain role in the formation of chronic cerebral ischemia. It is necessary to take into account not only spondylogenic influence, but also compression by altered adjacent structures (muscles, tumors, aneurysms). Another cause of chronic cerebral ischemia may be cerebral amyloidosis (in elderly patients).

Clinically detectable encephalopathy is usually of mixed etiology. In the presence of the main factors in the development of chronic cerebral ischemia, the rest of the variety of causes of this pathology can be interpreted as additional causes. Identification of additional factors that significantly aggravate the course of chronic cerebral ischemia is necessary to develop the correct concept of etiopathogenetic and symptomatic treatment.

The main causes of chronic cerebral ischemia are atherosclerosis and arterial hypertension. Additional causes of chronic cerebral ischemia: cardiovascular diseases(with signs of CSU); heart rhythm disorders, vascular anomalies, hereditary angiopathy, venous pathology, vascular compression, arterial hypotension, cerebral amyloidosis, systemic vasculitis, diabetes mellitus, blood diseases.

IN last years consider 2 main pathogenetic variants of chronic cerebral ischemia based on the following morphological features: the nature of the damage and the predominant localization. With bilateral diffuse lesions of the white matter, a leukoencephalopathic (or subcortical Biswanger) variant of dyscirculatory encephalopathy is isolated. The second is a lacunar variant with the presence of multiple lacunar foci. However, in practice, mixed options are very common.

The lacunar variant is often due to direct occlusion of small vessels. In the pathogenesis of diffuse lesions of the white matter, the leading role is played by repeated episodes of a drop in systemic hemodynamics - arterial hypotension. The cause of the fall in blood pressure may be inadequate antihypertensive therapy, a decrease in cardiac output. In addition, persistent cough, surgical interventions, orthostatic hypotension (with vegetative-vascular dystonia) are of great importance.

In conditions of chronic hypoperfusion - the main pathogenetic link of chronic cerebral ischemia - the compensation mechanisms are depleted, the energy supply of the brain is reduced. First of all, functional disorders develop, and then irreversible morphological disorders: a slowdown in cerebral blood flow, a decrease in the level of glucose and oxygen in the blood, oxidative stress, capillary stasis, a tendency to thrombosis, and depolarization of cell membranes.

Symptoms

The main clinical manifestations of chronic cerebral ischemia are polyform movement disorders, memory and learning impairment, and emotional disturbances. Clinical features of chronic cerebral ischemia - progressive course, staging, syndromicity. It should be noted that there is an inverse relationship between the presence of complaints, especially those reflecting the ability for cognitive activity (attention, memory), and the severity of chronic cerebral ischemia: the more cognitive functions suffer, the fewer complaints. Thus, subjective manifestations in the form of complaints cannot reflect either the severity or the nature of the process.

The core of the clinical picture of dyscirculatory encephalopathy is currently recognized as cognitive impairment, detected already in stage I and progressively increasing to stage III. In parallel, emotional disorders develop (inertia, emotional lability, loss of interest), a variety of motor disorders (from programming and control to execution of both complex neokinetic, higher automated, and simple reflex movements).

Stages of development

I stage. The above complaints are combined with diffuse microfocal neurological symptoms in the form of anisoreflexia, non-rough reflexes of oral automatism. There may be slight changes in gait (slowness of walking, small steps), a decrease in stability and uncertainty when performing coordinating tests. Often noted emotional and personality disorders (irritability, emotional lability, anxiety and depressive traits). Already at this stage, mild cognitive disorders of the neurodynamic type occur: exhaustion, fluctuating attention, slowing down and inertia of intellectual activity. Patients cope with neuropsychological tests and work that does not require time tracking. Patient life is not limited.
II stage. It is characterized by an increase in neurological symptoms with the possible formation of a mild, but dominant syndrome. Separate extrapyramidal disorders, incomplete pseudobulbar syndrome, ataxia, CN dysfunction according to the central type (proso- and glossoparesis) are revealed. Complaints become less pronounced and not so significant for the patient. Emotional disorders worsen. Cognitive function increases to a moderate degree, neurodynamic disorders are supplemented by dysregulatory ones (fronto-subcortical syndrome). The ability to plan and control one's actions is deteriorating. The performance of tasks that are unlimited in time is disrupted, but the ability to compensate remains (the ability to use hints remains). It is possible to show signs of a decrease in social and professional adaptation.
III stage. It is characterized by a vivid manifestation of several neurological syndromes. Impaired walking and balance (frequent falls), urinary incontinence, parkinsonism. In connection with the decrease in criticism of one's condition, the volume of complaints decreases. Behavioral and personality disorders manifest as explosiveness, disinhibition, apathetic-abulic syndrome, and psychotic disorders. Along with neurodynamic and dysregulatory cognitive syndromes, operational disorders appear (impaired speech, memory, thinking, praxis), which can develop into dementia. In such cases, patients slowly become maladaptive, which manifests itself in professional, social and even daily activities. Quite often, disability is stated. Over time, the ability to self-service is lost.

Diagnostics

For chronic cerebral ischemia, the following components of the anamnesis are characteristic: myocardial infarction, coronary heart disease, angina pectoris, arterial hypertension (with damage to the kidneys, heart, retina, brain), atherosclerosis of the peripheral arteries of the extremities, diabetes mellitus. A physical examination is carried out to identify the pathology of the cardiovascular system and includes: determining the safety and symmetry of the pulsation in the vessels of the limbs and head, measuring blood pressure in all 4 limbs, auscultation of the heart and abdominal aorta in order to detect cardiac arrhythmias.

The purpose of laboratory research is to determine the causes of chronic cerebral ischemia and its pathogenetic mechanisms. It is recommended to carry out a general blood test, PTI, determination of blood sugar, lipid spectrum. To determine the degree of damage to the substance and vessels of the brain, as well as to identify underlying diseases, the following instrumental studies are recommended: ECG, ophthalmoscopy, echocardiography, spondylography cervical, UZDG of the main arteries of the head, duplex and triplex scanning of extra- and intracranial vessels. In rare cases, an angiography of the cerebral vessels is indicated (to detect vascular anomalies).

The above complaints, characteristic of chronic cerebral ischemia, can also occur with various somatic diseases, oncological processes. In addition, such complaints are often included in the symptom complex of borderline mental disorders and endogenous mental processes. Great difficulties are caused by the differential diagnosis of chronic cerebral ischemia with various neurodegenerative diseases, which, as a rule, are characterized by cognitive disorders and any focal neurological manifestations. Such diseases include progressive supranuclear palsy, corticobasal degeneration, multiple system atrophy, Parkinson's disease, Alzheimer's disease. In addition, it is often necessary to differentiate chronic cerebral ischemia from a brain tumor, normotensive hydrocephalus, idiopathic dysbasia, and ataxia.

Treatment

The goal of treating chronic ischemia of cerebral circulation is to stabilize the destructive process of cerebral ischemia, stop the rate of progression, activate sanogenetic mechanisms for compensating functions, prevent ischemic stroke (both primary and repeated), as well as treat concomitant somatic processes.

Chronic cerebral ischemia is not considered an absolute indication for hospitalization if its course was not complicated by the development of a stroke or severe somatic pathology. Moreover, in the presence of cognitive disorders, removing the patient from his usual environment can aggravate the course of the disease. Treatment of patients with chronic cerebral ischemia should be carried out by a neurologist on an outpatient basis. Upon reaching stage III cerebrovascular disease, patronage is recommended.

Medical treatment chronic cerebral ischemia is carried out in two directions. The first is the normalization of brain perfusion by influencing different levels of the cardiovascular system. The second is the effect on the platelet link of hemostasis. Both directions contribute to the optimization of cerebral blood flow, while also performing a neuroprotective function.
Antihypertensive therapy. Maintaining adequate blood pressure plays an important role in the prevention and stabilization of chronic cerebral ischemia. When prescribing antihypertensive drugs, sharp fluctuations in blood pressure should be avoided, since with the development of chronic cerebral ischemia, the mechanisms of autoregulation of cerebral blood flow are upset. Among the antihypertensive drugs developed and introduced into clinical practice, two pharmacological groups should be distinguished - angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists. Both of them have not only angiohypertensive, but also an angioprotective effect, protecting target organs suffering from arterial hypertension (heart, kidneys, brain). The antihypertensive efficacy of these groups of drugs increases when they are combined with other antihypertensive drugs (indapamide, hydrochlorothiazide).
Lipid-lowering therapy. In addition to diet (restriction of animal fats), it is advisable to prescribe lipid-lowering agents (statins - simvastatin, atorvastatin) in patients with atherosclerotic lesions of the cerebral vessels and dyslipidemia. In addition to their main action, they improve the function of the endothelium, reduce blood viscosity, and have an antioxidant effect.
antiplatelet therapy. Chronic cerebral ischemia is accompanied by activation of the platelet-vascular link of hemostasis, therefore, the appointment of antiplatelet drugs is required, for example, acetylsalicylic acid. If necessary, other antiplatelet agents (clopidogrel, dipyridamole) are added to the treatment.
Combined drugs. Given the variety of mechanisms underlying chronic cerebral ischemia, in addition to the basic therapy described above, patients are prescribed agents that normalize the rheological properties of blood, venous outflow, microcirculation, which have angioprotective and neurotrophic properties. For example: vinpocetine (150-300 mg/day); ginkgo biloba leaf extract (120-180 mg/day); cinnarizine + piracetam (75 mg and 1.2 g/day, respectively); piracetam + vinpocetine (1.2 g and 15 mg/day, respectively); nicergoline (15-30 mg/day); pentoxifylline (300 mg/day). These drugs are prescribed twice a year in courses of 2-3 months.
Surgery. In chronic cerebral ischemia, the development of an occlusive-stenosing lesion of the main arteries of the head is considered an indication for surgical intervention. In such cases, reconstructive operations are performed on the internal carotid arteries - carotid endarterectomy, stenting of the carotid arteries.

Forecast and prevention

Timely diagnosis and the appointment of adequate treatment can stop the progression of chronic cerebral ischemia. When severe course disease aggravated by concomitant pathologies (hypertension, diabetes mellitus, etc.), there is a decrease in the patient's ability to work (up to disability).

Preventive measures to prevent the occurrence of chronic cerebral ischemia must be carried out from an early age. Risk factors: obesity, physical inactivity, alcohol abuse, smoking, stressful situations, etc. Treatment of diseases such as hypertension, diabetes mellitus, atherosclerosis should be carried out exclusively under the supervision of a specialist doctor. At the first manifestations of chronic cerebral ischemia, it is necessary to limit the consumption of alcohol and tobacco, reduce the amount of physical activity, and avoid prolonged exposure to the sun.