What causes cerebrovascular accidents. Diagnosis and treatment of transient cerebral circulatory disorders. Doctors distinguish three stages

Insufficient nutrition of the brain is called a circulatory disorder, which can be caused by various factors. Lack of prompt treatment can lead to irreversible consequences up to and including death.

People at risk need to know the symptoms and treatment of the disorder. cerebral circulation.

Show all

Causes of pathology

The most common cause of cerebrovascular accident is hypertension. because of advanced level Pressure vessels undergo changes and lose their elasticity, which causes slow blood circulation. Even the slightest fluctuation in pressure leads to a disproportion between the need and the amount of blood delivered to the brain.

The second cause of the disease is atherosclerotic plaques in the vessels. They attach to the walls of arteries and veins, reduce their lumen, and when platelets settle on them, blood clot- thrombus. The danger of blood clots is that, growing, they can completely block the blood flow, or, breaking off, clog the vessels in the brain, resulting in an acute cerebrovascular accident - a stroke.

Prolonged stress and syndrome chronic fatigue are also the causes of the development of the disease in adulthood.

The blood circulation of the brain in children is disturbed much less frequently than in adults. This is due to the fact that in childhood atherosclerosis is extremely rare, their vessels are more elastic and not subject to changes that occur in hypertensive patients.

That is why the causes of cerebral circulatory disorders in children are different from those that provoke poor blood flow in adults.

The main causes of NCM are intrauterine fetal hypoxia, severe pregnancy, protracted labor, infections suffered by the mother during gestation. The blood circulation in the baby is affected by the mother's lifestyle during pregnancy: prolonged stress, bad habits, malnutrition. Also contributing factors are congenital diseases cordially- vascular system, pathology of the vessels of the brain and spinal cord, early arterial hypertension.

These causes can cause circulatory disorders in adulthood, but, as a rule, these conditions are detected at birth or in the first years of a child's life.

Cerebral circulation in children and adults is disturbed due to the following reasons:

Heart failure, chronic diseases of the heart and blood vessels.
Clamping of blood vessels by the cervical vertebrae.
Traumatic brain injury, brain surgery.
Vasomotor disorders of the nervous system.
infectious vasculitis.
Thrombophlebitis.
Severe intoxication with medications and narcotic drugs.
Diseases of the endocrine system.
Systemic and rheumatoid diseases.
Diabetes.
Overweight.

Regardless of the cause of impaired circulation, lack of nutrition affects not only the brain, but also all organs and systems of the body. Therefore, it is important to eliminate provoking factors in a timely manner and take measures to improve blood flow.

Classification by type

Cerebral circulation disorders are divided into two types: chronic (HNMK) and acute (ONMK).

Chronic cerebrovascular accident develops slowly, gradually affecting the brain tissue, leading to disruption of its functions and irreversible damage. The main causes of its development are arterial hypertension, vascular atherosclerosis, heart failure.

Despite the fact that stroke is considered an "senile" disease, it also occurs in childhood. Among children with cerebrovascular accidents, about 7% had a stroke.

ONMK is divided into 2 types:

1. Ischemic stroke - there is a blockage of the arteries of the brain, as a result, acute hypoxia occurs, necrotic lesions are formed, as a result of which brain cells die.
2. Hemorrhagic stroke - there is a rupture of blood vessels in the tissues, hematomas are formed, pressing on the adjacent areas of the brain.

Separately from strokes, another type is distinguished acute violation- subarachnoid hemorrhage, in which there is a rupture of blood vessels between the membranes of the brain. Most of these types cause traumatic lesions. cranium, less often internal factors: aneurysm, vasculitis, chronic diseases of the vascular system.

General symptoms

Signs of cerebrovascular accident are classified into 2 types:

1. Focal - these include hemorrhagic changes, infarction of cerebral vessels, hemorrhages between the membranes.
2. Diffuse - characterized by minor hemorrhages, cysts, tumors, small necrotic foci.

Any of the pathologies associated with poor blood flow has its own special signs, but there are also general symptoms that are characteristic of all diseases:

Impaired coordination.
Sudden headaches.
Dizziness.
Numbness of limbs and face.
Violation of cognitive functions.
Decreased vision and hearing.
Hyperexcitability, nervousness, outbursts of aggression.
Decreased memory, intellectual abilities.
Sensation of noise in the head.
Fast fatiguability.
Decreased performance.

These symptoms can appear both individually and in combination. And if three signs are observed at the same time, it is urgent to consult a doctor.

Symptoms of cerebrovascular accident acute and chronic form manifest themselves in different ways, so they should be considered separately.

Chronic circulatory disorders

Chronic NMC develops gradually, there are three stages of its progression with an increase in symptoms. For encephalopathy - an organic lesion of the brain, the following symptoms are characteristic:

1. At the first stage, the manifestations are mild. First comes fast fatiguability, headache and dizziness. The patient begins to sleep restlessly, becomes irritable and distracted, notices a memory disorder.
2. At the second stage, coordination is disturbed: the gait becomes uncertain, shaky, hand tremors may be observed. Memory becomes even worse, concentration of attention decreases, forgetfulness and irritability progress.
3. The third stage is characterized by noticeable disturbances in motor functions, unrelated speech, dementia develops.

Symptoms of encephalopathy in infants:

Lack of sucking reflex.
Disturbed sleep, causeless crying.
Increased or decreased muscle tone.
Disturbed heartbeat.
Belated first cry.
Strabismus.
Hydrocephalus.

In older children, there is a reduced activity of the child, bad memory, delayed mental and speech development.

Myelopathy is also a chronic disorder. cervical, its three stages are accompanied by certain signs:

1. The first or compensated stage is accompanied by increased fatigue, weakness and slight weakness in the muscles.
2. At the subcompensated stage muscle weakness progresses, reflexes and sensitivity decrease, muscle spasms occur.
3. On last stage arise: paralysis, paresis, disruption of the organs, the almost complete absence of reflexes.

The disease may be accompanied by fever and fever. It is worth noting that the symptoms can manifest themselves in different ways, depending on the severity of the disease and the state of the human body. Availability chronic pathologies promotes more rapid progression of HNMK.

Signs of an acute course of the disease

According to statistics, about 70% of patients did not feel the symptoms of a stroke, the only thing that felt tired and weak, but attributed this to general malaise. There is the concept of "microstroke", in which the patient feels a sharp headache, faints, feels numbness of the limbs, but does not attach any importance to this, especially since after rest the condition improves. And the patient does not even suspect that he has suffered a transient ischemic attack or a lacunar stroke that affects vessels of small diameter.

Transient ischemic attack- violation of cerebral circulation with rapidly disappearing symptoms.

Symptoms of this condition:

A sharp decrease in the clarity of speech.
Strong headache.
Visual impairment of a short duration.
Loss of coordination.

With lacunar stroke, there are no pronounced symptoms, which is difficult to diagnose, and threatens with serious consequences.

What the patient may feel:

Slight incoherence of speech.
Movement disorders.
Tremor of hands and chin.
Involuntary movements of the hands.

These conditions require urgent medical intervention to avoid irreversible consequences.

With ischemic and hemorrhoidal stroke, the symptoms are more pronounced. The main signs are a sharp, often throbbing, headache, a distortion of the muscles of the face to one side, and a sharp violation of motor functions.

Other signs:

Sharp pain on one side of the head.
Dizziness.
Expansion of one pupil (from the side of the stroke).
Incoherent speech.
Decreased vision, double vision.
Numbness of the face or limbs.
Nausea.
Sharp weakness.

The severity of symptoms varies from person to person. Three tests can be performed to identify signs of acute circulatory disorders:

1. Ask to smile.
2. Raise both hands.
3. Say your name.

With a stroke, the patient will not be able to smile evenly - the smile will be skewed, one arm will remain in place or will rise much more slowly. Speech will become slurred or disappear completely. The manifestation of these symptoms requires urgent hospitalization.

How to determine stroke in children?

The symptoms of stroke in children are similar to those in adults, but there are some special differences. You can suspect a stroke in newborns if you have the following signs:

Cramps of the limbs.
Swollen fontanel.
Respiratory failure.
Lag in development.
Involuntary rhythmic eye movements.

The risk group includes children with intrauterine growth retardation, born in rapid labor, with congenital diseases of the heart and blood vessels.

In younger children preschool age the symptoms of a stroke are the same as in adults, but the difficulty in diagnosing is that babies cannot always complain of feeling unwell.

When to be concerned:

Speech deteriorates sharply, or the child stops talking completely.
There are involuntary movements of the limbs.
One of the pupils is greatly dilated.
Motor functions are impaired or completely absent.
There is a hearing loss.
The perception of speech is sharply reduced.
The occurrence of seizures.
Involuntary defecation and urination.

An older child may complain that his head hurts, he feels numbness in his arms or legs, he sees flies in front of his eyes. If these signs are present, parents should put the child to bed and call ambulance.

Therapy Methods

Treatment of cerebrovascular accident requires a long time. Therapeutic actions aimed at providing normal level blood circulation, normalization of blood pressure, lowering cholesterol levels, maintaining normal amount electrolytes, removal of edema and elimination of the causes of the disease.

First stage inpatient care includes the removal of vitally dangerous conditions, intensive therapy is carried out with the help of painkillers, antioxidants, anticonvulsants.

What drugs are prescribed:

1. If the cause of the disease is too thick blood and a tendency to thrombosis, anticoagulant drugs are prescribed: Curantil, Fragmin, Clexane, Curantil, Thrombo ACC. For children, Heparin injections are most often chosen.
2. Calcium channel blockers - improve microcirculation, relax arteries, prevent the formation of blood clots. These include: Veropamil, Finoptin, Lomir, Gallopamil, Bepredil, Forid. Children these drugs are contraindicated, and they are prescribed only as a last resort.
3. Antispasmodic drugs: Noshpa, Drotaverine hydrochloride. They relieve vascular spasms, due to which blood flow improves and blood pressure decreases.
4. Vasoactive drugs inhibit platelets, dilate blood vessels and improve intercellular metabolism of the brain. Means of this group: Vasobral, Nicergoline, Sermion. In childhood, Cinnarizine, Vinpocetine, Eufillin.
5. Neurotropic and nootropic drugs for children and adults are mandatory for admission. They relieve the effects of hypoxia, improve intercellular metabolism, promote the formation of new choroid plexus. In addition, they have a positive effect on cognitive functions, restore speech, memory, improve psycho-emotional mood. Most effective means: Cerebrolysin, Cortexin, Piracetam, Encephabol, Gliatilin, Mexidol, Pantogam.

Timely treatment of the chronic form will help to avoid complications and the occurrence of acute cerebrovascular accident. Unfortunately, in most cases, stroke leaves consequences, and requires constant supportive treatment.

In some cases, when blood circulation is disturbed, an operation is prescribed. The main indications for surgery:

1. Extensive hemorrhages and hematomas.
2. Blockage of blood vessels by thrombi and atherosclerotic plaques.
3. Tumors and cysts of the brain.
4. Damage to blood vessels.
5. Lack of positive dynamics from conservative treatment.

There are several types of interventions, and the attending physician decides which one to choose based on the severity and cause of the disease. The prognosis after surgery is usually positive, provided that the patient complies with all recommendations during the rehabilitation period.

As a conclusion

For the treatment to positive effect must adhere healthy lifestyle life, give up bad habits, exercise therapy. You should give up junk and fatty foods, reduce stress and get more rest.

Impaired blood circulation of the brain is a disease that requires constant monitoring. If the patient has such a diagnosis in the anamnesis, he needs to visit a neurologist and a therapist twice a year, as well as undergo examinations: EEG, ECG, general analysis blood, platelet count, vascular ultrasound, and others according to indications.

Cerebrovascular accident is one of the most dangerous pathologies. After all, the brain controls all processes in the body: breathing, heartbeat, motor activity, speech, thoughts. If such a misfortune happens, then social viability goes downhill, in the worst case, the life of a person fades away.

The symptoms of pathology for each person will be different, since they completely depend on the severity of the process and the location of the pathological focus.

According to the severity of the process, they distinguish:

Acute violation of cerebral circulation;
Chronic circulatory failure.

An acute violation of the blood filling of certain vessels entails a sharp lack of oxygen and nutrients in the tissues, which causes hypoxia of the site, ischemia and further death. Therefore, the symptoms will depend on the localization of the focus.

Acute cerebrovascular accident can cause short-term pathology of transient ischemic attack (TIA) and ischemic and hemorrhagic strokes.

Chronic violation of the blood vessels and nutrition of certain areas of the cortex and white matter of the brain entails the development of dyscirculatory encephalopathy.

Blood supply to the brain

Knowledge of the localization of the focus is very important for an objective choice further tactics treatment and help to quickly cope with the disease. To do this, you need to know the anatomy of the location of blood vessels in the brain.

The blood supply to the brain is provided by vessels that originate from two different sources: from the carotid arteries and vertebral. The main arteries in which blockage of the vessel or its breakthrough most often occur are the cerebral arteries: the anterior, middle, and posterior cerebral arteries.

Depending on the location of the focus of ischemia, a pool is determined in which blood circulation is disturbed. The anterior and middle cerebral arteries originate from the carotid arteries, which causes a greater incidence of lesions than the posterior cerebral artery. This is due to the fact that the force with which blood flows through the vessels of the brain is greater in the anterior and posterior cerebral arteries, since the carotid artery is located in close proximity to the heart in relation to the vertebral vessels.

Causes of circulatory disorders

The reasons for the violation of sufficient blood flow can be various pathologies and processes:

vessel aneurysm.
Thrombosis is the formation of a plaque on the wall of a blood vessel elevated content blood cholesterol, lipoproteins high density at the injured site of the endothelium. The plaque grows, gradually obscuring the lumen of the vessel. In this case, there is a chronic insufficiency of cerebral blood supply, which can turn into an acute one. This can happen if a blood clot completely blocks the lumen of the artery, and the part of the brain stops receiving oxygen and nutrients.
kinks of blood vessels.
Malformations are an accumulation of small vessels that intertwine and form peculiar knots. They are also untenable under any load (physical, emotional) due to high current blood can rupture, leading to bleeding in the brain.
Embolism with gas, thrombus, air.
Hypertensive disease - increases the risk of hemorrhage due to uncontrolled blood pressure. There are two causes for manifestations that occur with arterial hypertension: high blood pressure, which acts on the vessels with greater force and reduces their resistance, and the rigidity of the vascular wall (rapid wear of the vessels during elevated work in resistance to high blood flow due to hypertension).
Chronic fatigue - the brain must receive more blood and oxygen at increased activity which quickly depletes the body and brain activity, which can lead to chronic insufficiency cerebral circulation.
Concussions, head injuries, bruises and hemorrhages.
Cervical osteochondrosis - vertebrae and hernias are crushed vertebral artery, which causes insufficient nutrition of the brain tissues of the basin of the posterior cerebral artery.

Acute cerebrovascular accident

Acute cerebrovascular accident causes such diseases:

hemorrhagic stroke;
Ischemic stroke;
Transient ischemic attack.

Symptoms of acute impairment of brain activity vary by the location of the lesion and can be observed in the patient in varying degrees and duration:

General cerebral symptoms - dizziness, nausea, vomiting, depression of consciousness (from stupor to coma) - occurs due to swelling of the brain and tissue pressure on the meninges;
Violation of sensitivity;
Violation motor activity- from mild paresis to plegia;
Violation of the correct full-fledged activity of the sense organs;
violation of coordination;
Stem symptoms - violation of respiratory activity, cardiac activity, vision, hearing, swallowing (in the brain stem there are centers for the regulation of these functions);
Decreased cognitive abilities of a person - a violation mental activity, deterioration of memory, speed of thinking;
Convulsions, epileptic seizures.

Ischemic stroke is characterized by the fact that violations occur against the background of normal pressure and are caused by blockage of the supply vessel. The tissue does not receive the necessary substances, ischemia occurs, against the background of which venous plethora may occur.

This will provide the first symptoms - nausea, vomiting, dizziness, acute headache. Further, the ischemic area ceases to perform its functions, and some of the above symptoms appear. With ineffective or untimely treatment, the site becomes necrotic, and it is impossible to restore the lost functions.

Hemorrhagic stroke occurs when a blood vessel ruptures as a result of high pressure and vascular tension, aneurysm, malformation of cerebral vessels. This type of stroke, unlike ischemic stroke, is often accompanied by clouding of consciousness.

The focus of hemorrhage can be so large that the brain tissue is shifted to the side, which entails a dislocation syndrome - a deviation along the axis (often with ventricular hemorrhages) and further wedging of the brain stem into the foramen magnum. This is the hole through which spinal cord connects to the head. This phenomenon is very dangerous for human life.

A transient ischemic attack in the clinic completely resembles an ischemic stroke, but differs in that the symptoms disappear without a trace within 24 hours. This syndrome is caused by a spasm of the vessels that feed the pathological area or a passing thrombus (an embolus that has independently passed beyond the occluded part.

Diagnosis of strokes consists in the correct full collection of an anamnesis of the disease and life, the identification of all clinical manifestations and holding instrumental methods research.

The most informative method is CT or MRI. More often used computed tomography, since its advantage is the rapid determination of fresh blood in soft tissues. The focus can be seen not immediately, but after a few days. In this case, in order not to waste time, the diagnosis is made according to the clinic and the appropriate therapy is selected.

Treatment of acute cerebrovascular accident is basically the same, aimed at restoring damaged cells and reducing the area of necrosis. To do this, use preparations of B vitamins (to restore the myelin sheath), metabolic drugs (to improve nutrition and quick recovery cells; help cells that perform a double load), drugs aimed at eliminating complications (pulmonary edema, brain swelling, cardiac arrest, dislocation syndrome), neuroprotectors (drugs that protect brain cells from harmful influence environment).

One distinctive feature in the treatment of various types of pathology - drugs aimed at eliminating the cause of the symptoms. In ischemic stroke, drugs are used that can thin the blood, increase its rheological properties and fluidity. For this, anticoagulants of direct action are used initially, then indirect action. After normalization of blood flow, patients switch to lifelong antiplatelet therapy.

Hemorrhagic stroke, on the contrary, requires the use of hemostatic agents - prothrombin, aminocaproic acid and other drugs.

Chronic cerebrovascular accident

Dyscirculatory encephalopathy can develop due to 3 factors.

Multi-infarction conditions - the causes of such a development of the disease will be the embolization of small vessels of the brain with blood clots from the heart. They appear due to the development of atrial fibrillation of the heart.
Binswanger's disease provokes thickening of the walls and narrowing of the lumen of the small arteries of the brain, which often causes white matter. The death of neurons is observed locally, scattered throughout the brain tissue.
Violation of the patency of the main arteries that feed the brain - the vertebral and carotid arteries. The blood flow decreases over time, so there is a chronic insufficiency of blood supply to the brain.

These causes cause symptoms such as sleep disturbance, cognitive decline (becomes worse memory, stop solving complex logical tasks, thinking worsens), dementia (memory loss in various manifestations) is observed.

Diagnosis of the disease is carried out by collecting an anamnesis. At that moment, the doctor should suspect a certain diagnosis, which should be confirmed instrumentally.

The patient should consult with an ophthalmologist - look at the fundus, since the retina is a mirror of the vessels of the brain.

Angiography is being performed. It will identify small and large blood clots or spasms that lead to permanent occlusion of small vessels.

Drugs to improve cerebral circulation

Violation of cerebral circulation What are the symptoms

An electroencephalogram will show those small tissue lesions after blockage of blood vessels. Potentials are recorded from healthy living tissue. Changes in the electroencephalogram will show organic changes in the substance of the brain.

Treatment of chronic dyscirculatory encephalopathy is carried out with drugs that improve blood rheology and blood flow in the vessels. In fact, the treatment is represented by metabolic drugs that strengthen the vascular wall, reduce blood viscosity, improve its rheological properties, control thrombosis and the amount of cholesterol and lipoproteins. various groups in blood.

correct timely treatment will help protect yourself from complications and death.

The brain is a “mystical” organ that can fill us with incredible sensations, show our own “movie”, a dream, accumulate experience and wisdom that allows us to think. This is an organ that controls and regulates the work of the whole organism as a whole and each organ and system separately; providing the necessary balance for our body, protection, compensatory reactions to violations. This small organ, weighing about 1400-1500 g (2% of body weight), has incredible abilities that have not yet been fully explored.

What does the brain need? Working without rest day and night, he is in dire need of oxygen (the brain consumes 20% of all oxygen entering the body) and nutrients, without which he cannot do even a few minutes. It is a known fact that oxygen reserves are not created in the brain, and there are no substances capable of nourishing it in anaerobic (in the absence of oxygen) conditions. That is, nerve cells the brain constantly needs oxygen, glucose and "cleaning" (cleansing from the waste products of cells).

Excursion to physiology

An uninterrupted supply of substances necessary for the nerve cells of the brain, and purification from waste is carried out by the cerebral circulatory system, where arterial blood carries oxygen and nutrition to the brain, and the venous - takes out toxins and metabolic products.

The vessels of the brain have a peculiar, perfect structure that ideally regulates blood flow, ensuring its stability. They are designed in such a way that with increased blood flow to large vessels, a strong pulse of blood coming from the heart is weakened due to the numerous bends (siphons) of the vessels along the vascular bed, which contribute to the pressure drop and smooth out the pulsating blood flow. Due complex mechanisms regulation with an increase in total blood pressure, pressure in the brain for a long time remains stable. Regulatory systems make it possible to redistribute blood flow from brain regions with less stress to areas with enhanced brain activity.

The brain has an autonomous system of regulation, which allows it to be in a healthy functional state and control the processes of continuous adaptation of the organism to constantly changing conditions of external and internal environment. At functional rest, the brain receives 750 ml of blood per minute, which is 15% of cardiac output. In children, blood flow activity is 50-55% higher, and in the elderly it is 20% lower than in a person in adulthood.

It should be noted that the gray matter of the brain (cell bodies of neurons) is provided with blood more intensively than the white matter (pathways), which is due to the greater activity of the cells. Thus, during intense mental work, the local blood flow in the cerebral cortex can increase by 2-3 times compared to the state of rest.

The brain has the richest capillary network. Nerve cells are not only intertwined, but also pierced by capillaries. The vessels of the brain are interconnected by collaterals (“bridges”). Arterial collateral circulation of the brain, important for maintaining normal blood flow, plays a particularly significant role in compensating for circulatory disorders in case of blockage of one of the cerebral arteries.

With a high intensity of blood flow in the vessels of the brain, the blood pressure in them is maintained at a relatively constant level. complex chain regulatory mechanisms protects the brain from a drop in blood pressure and hypoxia (decrease in oxygen). On the way of blood flow to the brain, there are many sensitive cells (pressoreceptors, chemoreceptors) that can respond to blood pressure and regulate the heart rhythm and vascular tone.

The activity of the vasomotor centers of the brain is associated not only with the nervous and humoral mechanisms regulation, but also with an autonomous regulation system that allows, despite significant fluctuations in total arterial pressure, to maintain cerebral blood flow at a constant level.

Thus, the cerebral circulation is provided with complex regulatory mechanisms that allow maintaining the constancy of the intake of the substances it needs.

With excessive blood supply to the brain, its excessive hydration (accumulation of fluid) can occur, followed by the development of edema and damage to vital centers that are incompatible with life. The reason for the redundancy of blood supply can be, for example, an increase in systemic arterial pressure up to 160-170 mm Hg. Art. and higher.

In the problem of impaired blood supply to the brain great attention given to the arteries. But no less significant venous circulation. Through the veins, waste substances (slags) are removed with the blood - that is, the brain is cleansed. Thanks to these vessels, a constant intracranial pressure is maintained.

Violation of the venous outflow leads to stagnation of blood and accumulation of fluid in the brain, causes hydrocephalus with compression of the brain centers, contributes to the occurrence of phlebitis and thrombophlebitis.

There is another feature of the veins of the brain that must be taken into account. The wall of a venous vessel in the brain does not have a valve apparatus, unlike, for example, the veins of the extremities (valves help withstand stress by moving the blood up and preventing it from moving in the opposite direction). Therefore, venous blood in the vessels of the brain is freely passed in both directions, depending on the pressure that has arisen. This creates the danger of a rapid spread of infection from the sinuses and eye sockets, which is facilitated by the atomic features of the structure of the nose and its paranasal sinuses located in close proximity to the brain. When coughing, venous pressure increases, it becomes possible to reverse venous flow, stagnation, hypoxia of the brain. There are cases of loss of consciousness during a coughing fit in the presence of a chronic respiratory disease and in young children, when they "come in" in a cough with an illness and in crying with a cry until they cough.

It becomes clear why long-term respiratory disorders, accompanied by constant swelling and coughing, can cause cerebrovascular accidents. Because they not only cause brain hypoxia, but also disrupt venous outflow and, being a constant focus of infection, contribute to its penetration into the brain.

Observe the manifestations of congestion in the brain (dilated, blood-filled vessels of the fundus), for example, an oculist can. But this is also visible to the naked eye: red, swollen eyes after sleep (due to alcohol intake the day before, overeating at night, lack of sleep) are a symptom of congestion in the brain.

After a brief excursion into physiology, it becomes clear that the causes of deterioration in cerebral circulation can be associated with impaired blood flow to the brain and outflow of blood from the brain.

What happens when blood pressure rises?

At first, vascular tone is slowly disturbed. Over time, while maintaining elevated blood pressure (BP), there may be small hemorrhages in the brain and strokes.

As a result of a constant increase in blood pressure in hypertension, plasma is released (part of the blood without shaped elements), which ultimately leads to the destruction of the walls of blood vessels.

How does this happen? A specific protein (a hyaline-like substance resembling cartilage in its structure) is deposited on the walls of blood vessels, which leads to the development of hyalinosis. Vessels become like glass tubes, lose their elasticity and ability to hold blood pressure. In addition, the permeability of the vascular wall increases, and blood can freely pass through it, impregnating nerve fibers(diapedetic bleeding). The result of such transformations can be the formation of microaneurysms and rupture of the vessel with hemorrhage and blood entering the white medulla. The resulting edema and hematomas lead to the following hemorrhages (hemorrhagic stroke).

Atherosclerosis that accompanies hypertension, or existing without it (which is rare) contributes to cerebral ischemia - insufficient supply of nutrients and oxygen to the tissues (except for atherosclerotic plaques that narrow the lumen of the arteries, the blood itself is thick and viscous).

Acute circulatory disorders are strokes (hemorrhagic and ischemic). But it all starts with transient disorders of cerebral circulation against the background of hypertension and atherosclerosis, as well as obesity, diabetes mellitus, and respiratory diseases that often accompany them.

Symptoms of cerebrovascular accident

When a focus with impaired blood supply is formed in the brain, the patient may become numb half of the body (on the side opposite to the site of the lesion) and part of the face around the lips, short-term paresis of the limbs or other parts of the body and face is possible. Speech is impaired, an epileptic seizure may occur.

In case of circulatory disorders, depending on the site of the lesion, the legs and arms may weaken, the head may feel dizzy, it may be difficult for the patient to swallow and pronounce sounds, photopsia occurs (appearance of luminous dots, sparks, etc. in the eyes) or diplopia (bifurcation visible objects). A person loses orientation, he has memory lapses.

Signs of cerebrovascular accident against the background of hypertension are manifested in the following: the head begins to hurt and eyeballs, a person experiences drowsiness, he has stuffy ears (as in an airplane during takeoff or landing) and bouts of nausea. The face turns red, sweating increases.

Unlike strokes, all these symptoms, which are called "transient attacks", disappear within a day.

Chronic cerebrovascular accident (HNMK) in contrast to acute forms develops gradually. There are three stages of the disease:

In the first stage, the symptoms are vague. They are more like chronic fatigue syndrome. A person quickly gets tired, becomes quick-tempered and absent-minded, forgets some insignificant moments. His sleep is disturbed, his mood often changes, his head hurts and is dizzy.
In the second stage, chronic cerebrovascular accident is accompanied by a significant deterioration in memory, minor impairments in motor functions develop, causing unsteady gait. Arises in the head constant noise. A person does not perceive information well, with difficulty concentrating his attention on it. Becomes irritable and insecure, loses intelligence, reacts inadequately to criticism, often becomes depressed. He gradually degrades as a person and poorly adapts socially. He is constantly dizzy and has a headache. He always wants to sleep. Performance has been significantly reduced.
In the third stage, all symptoms intensify. The degradation of the personality turns into dementia, memory suffers. Leaving the house alone, such a person will never find his way back. motor functions impaired, which manifests itself in hand tremor, stiffness of movements. Speech impairment, uncoordinated movements are noticeable.

Consequences of cerebrovascular accidents

Disability is a sad result of acute and in many cases chronic disorders of cerebral circulation.

Acute cerebrovascular accident is severe consequences. In most cases, a person who has had a stroke becomes completely helpless. He cannot eat on his own hygiene procedures, dress up, etc. Such people have a completely impaired ability to think. They lose track of time and do not orient themselves in space at all.

Some people still have the ability to move. But many people after a violation of cerebral circulation forever remain bedridden. Many of them keep a clear mind, understand what is happening around them, but are devoid of speech and cannot express their desires and feelings in words.

How to prevent cerebrovascular accidents

The ability to protect yourself from this serious illness, regardless of which category it belongs to, exists. Only many people neglect it.

This is an attentive attitude to your health and all the changes that occur in the body.

Agree that healthy person headaches should not occur. And if you suddenly feel dizzy, it means that there is some kind of deviation in the work of the systems responsible for this organ.

Elevated temperature is an indication of a malfunction in the body. But many go to work with a temperature of 37 ° C, considering it normal (explaining this by the fact that the tests did not reveal anything).

Is there transient numbness in the extremities? Most people rub them without asking the question: why is this happening?

It's not okay to live permanently drug treatment at chronic diseases nose and respiratory tract, do not associate them with existing internal violations and not think about the consequences (because there is no time, because the ENT doctor will perform the procedure and it will become easier for a while).

It is not normal to live with obesity and diabetes without thinking about the consequences by indulging your eating habits.

After all, all these are satellites of the first minor changes in the system of cerebral blood flow.

Often, an acute cerebrovascular accident is preceded by a transient one. But since its symptoms disappear within a day, not every person is in a hurry to see a doctor in order to be examined and receive the necessary medical treatment.

Today, physicians are armed with effective drugs - thrombolytics. They literally work wonders, dissolving blood clots and restoring cerebral circulation. However, there is one "but". For achievement maximum effect they must be administered to the patient within three hours of the onset of the first symptoms of a stroke. Unfortunately, in most cases, applying for medical care carried out too late, when the disease has passed into severe stage and the use of thrombolytics is already useless. In the case of chronic disorders, taking only thrombolytics and blood thinners does not give the desired result, since it is necessary to identify and eliminate real reasons leading to these disturbances.

And here again the instructions of the great Avicenna are recalled: "Set up food, sleep, wakefulness ... and the disease will recede."

Chronic cerebrovascular insufficiency (CCI) is a brain dysfunction characterized by slow progression. It is one of the most common pathologies in neurological practice.

Etiological factors

The reason for the development of insufficiency, which is especially common in elderly and senile patients, is small-focal or diffuse damage to brain tissue. It develops against the backdrop of a long existing problems With cerebral circulation, since during ischemia the central nervous system receives less oxygen and glucose.

Most common causes chronic ischemia:

One of etiological factors anomalies in the development of the aortic arch and vessels of the neck and shoulder girdle. They may not make themselves felt until development and. A certain importance is attached to the compression (compression) of blood vessels by bone structures (with curvature of the spine and osteochondrosis) or tumors.

Blood circulation can also be disturbed due to deposits of a specific protein-polysaccharide complex - amyloid on vascular walls. Amyloidosis leads to dystrophic changes in the blood vessels.

In older people, one of the risk factors for CVD is often low blood pressure. With it, arteriosclerosis is not excluded, that is, damage to the small arteries of the brain.

Symptoms of chronic cerebrovascular insufficiency

Important:Syndromicity, staging and a progressive course are among the main clinical features of CNMC!

It is customary to distinguish 2 main stages of chronic cerebral ischemia:

initial manifestations;
encephalopathy.

The initial stage develops with a decrease in the flow (debit) of blood from normal indicators, constituting 55 ml / 100 g / min, up to 45-30 ml.

Typical patient complaints:

In the early stages of cerebral blood flow insufficiency, symptoms appear after exercise or psycho-emotional stress, fasting and drinking alcohol.

During the examination, when determining the neurological status, no signs are detected focal changes in the CNS. Special neuropsychological tests allow to identify disorders of thinking functions (in a mild form).

Note:up to 450,000 cases of acute cerebrovascular accident – strokes – are diagnosed annually in our country. According to various sources, vascular dementia affects from 5% to 22% of elderly and senile people.

Dyscirculatory encephalopathy (DE) develops against the background of a decrease in blood flow rate to 35-20 ml/100 g/min. Changes are usually due to common pathologies vessels.

Note:significant changes in hemodynamics are noted if there is a narrowing of the main vessels up to 70-75% of the norm.

DE forms:

venous;
hypertonic;
atherosclerotic;
mixed.

Dyscirculatory encephalopathy is divided into 3 stages depending on the severity of neurological symptoms.

Signs of the 1st stage:

(there are problems with remembering new information);
decreased ability to concentrate;
decrease in mental and physical performance;
high fatigue;
dull (cephalgia), increasing with psycho-emotional experiences and mental stress;
problems with switching from one task to another;
frequent;
unsteadiness when walking;
deterioration in mood;
emotional instability.

The working capacity of patients with the 1st stage is preserved. During neurological examination a moderate impairment of memory and a decrease in attention are revealed. Reflexes are moderately increased; their intensity on the right and left is slightly different.

Signs of the 2nd stage:

progression of memory disorders;
severe deterioration of sleep;
frequent cephalgia;
transient dizziness and instability in an upright position;
darkening in the eyes when changing the position of the body (standing up);
touchiness;
irritability;
reduction of needs;
slow thinking;
pathological attention to minor events;
a clear narrowing of the circle of interests.

The 2nd stage is characterized not only by a decrease in working capacity ( II-III group disability), but also problems with the social adaptation of the patient. In the course of the study of the neurological status, vestibulo-cerebellar disorders, poverty and slowing down of active movements with a specific increase in muscle tone are revealed.

Signs of the 3rd stage:

thinking disorders, growing to dementia ();
tearfulness;
slovenliness;
(not always);
pronounced decrease in self-criticism;
pathological lack of will;
weakening control over sphincters (involuntary urination and defecation);
frequent drowsiness after eating.

Note:for patients on this stage The development of pathology is very characteristic of the Winsheid triad, i.e., a combination of memory impairment, headaches and episodes of dizziness.

Patients with the 3rd stage of discirculatory encephalopathy are disabled; they are given the I group of disability.

Diagnostics

The diagnosis is made on the basis of the clinical picture, the patient's complaints, and the results obtained from the study of the brain and blood vessels.

Note:between the number of patient complaints about a decrease in the ability to memorize and the severity of chronic ischemia, there is Feedback. The greater the impairment of cognitive functions, the fewer complaints.

During the examination of the fundus, blanching of the disc is detected optic nerve and atherosclerotic changes in the vessels. Palpation determines the compaction of the arteries that feed the brain - carotid and temporal.

Among the instrumental research methods that are necessarily used to verify the diagnosis include:

dopplerography;
angiography;
rheoencephalography with additional samples;
aorta and other main vessels;
the brain and vessels of the "cerebral pool" (the main method of neuroimaging);
electroencephalography.

Additional data are obtained from laboratory tests for the metabolism of lipid compounds, taking an electrocardiogram and biomicroscopy of the conjunctival vessels.

Important:atherosclerosis cerebral vessels often combined with atherosclerotic lesions of the arteries of the legs and coronary vessels.

task differential diagnosis is the exclusion of brain diseases that have a non-vascular etiology. It is known that the functions of the central nervous system can be disturbed for the second time not against the background of diabetes mellitus, lesions of the respiratory system, kidneys, liver and digestive tract.

Measures for the treatment and prevention of CNMC

When the first symptoms of chronic cerebral ischemia are detected, it is strongly recommended to periodically conduct a comprehensive course of treatment. It is necessary to prevent or slow down the development of pathological changes.

Primary prevention of HNMK is in the competence of specialists general practice – family doctors and local therapists. They should carry out explanatory work among the population.

Basic preventive measures:

compliance with a normal diet;
making adjustments to the diet (reducing the amount of carbohydrates and fatty foods);
timely treatment of chronic diseases;
rejection of bad habits;
regulation of the work regime, as well as sleep and rest;
struggle with psycho-emotional overstrain (stress);
active lifestyle (with dosed physical activity).

Important: primary prevention pathology should begin in adolescence. Its main focus is the elimination of risk factors. Overeating should be avoided, and. Secondary prevention is needed to prevent episodes of acute disorders of cerebral blood flow in patients diagnosed with chronic ischemia.

Treatment vascular insufficiency suggests rational pharmacotherapy. All drugs should be prescribed only by a local doctor or a narrow specialist, taking into account general condition and individual features the patient's body.

Patients are shown a course of vasoactive drugs (Cinnarizine, Cavinton, Vinpocetine), antisclerotic drugs and antiplatelet agents to reduce blood viscosity ( Acetylsalicylic acid, Aspirin, Curantyl, etc.). Additionally, antihypoxants are prescribed (to combat oxygen starvation brain tissue) and vitamin complexes(including and ). The patient is recommended to take neuroprotective preparations, which include amino acid complexes (Cortexin, Actovegin, Glycine). To combat some secondary disorders of the central nervous system, the doctor may prescribe drugs from the group of tranquilizers.

Important:is of great importance for maintaining blood pressure indicators at the level of 150-140 / 80 mm Hg.

Often, the selection of additional combinations of drugs is required if the patient is diagnosed with atherosclerosis, hypertension and (or) coronary insufficiency. Making certain changes to standard scheme treatment is necessary for diseases of the endocrine system and metabolic disorders - diabetes, thyrotoxicosis and obesity. Both the attending physician and the patient must remember: medications should be taken full courses, and after a break of 1-1.5 weeks, start a course of another medication. If there is an obvious need to use different drugs on the same day, it is important to maintain a time interval of at least half an hour between doses. Otherwise, their therapeutic activity may decrease, and the likelihood of developing side effects(including allergic reactions) - increase.

People who have clinical signs of cerebrovascular insufficiency are advised to refrain from visiting baths and saunas in order to avoid overheating of the body. It is also advisable to reduce the time spent in the sun. Climbing mountains and staying in areas located at an altitude of more than 1000 m above sea level poses a certain danger. It is necessary to completely abandon nicotine, and minimize the consumption of alcoholic beverages (no more than 30 ml of "absolute alcohol" per day). Consumption strong tea and coffee should be reduced to 2 cups (approximately 100-150 ml) per day. Excessive physical activity is unacceptable. You should not sit in front of a TV or PC monitor for more than 1-1.5 hours.

Plisov Vladimir, medical commentator

The brain, like any other organ, needs a constant supply of oxygen and useful substances. The role of transport is performed by blood, and therefore, with the slightest circulatory disorders, the organ receives less of its “food”, its productivity drops, and its functions are disrupted. And, of course, cerebrovascular accident (CVD) is one of the most serious and dangerous violations circulation. The most famous type of NMC is a cerebral stroke.

Causes of NMC

There are many risk factors that can lead to cerebrovascular accident:

genetic predisposition,
congenital or acquired thinness and fragility of blood vessels,
atherosclerosis, thrombophelitis,
excessively thick blood
hypertension,
heart defects,
violations heart rate and other CVD diseases,
scoliosis, osteochondrosis, compression of the spinal and carotid arteries,
TBI and spinal injury,
diabetes,
obesity,
individual response to hormonal contraceptives,
body exhaustion,
combination of nicotine and alcohol,
a sharp load on the body (mental, physical, sharp drops temperatures, etc.).

With age (after 60 years), the risk of developing a violation of cerebral circulation increases significantly.

Acute cerebrovascular accident (ACV)

This is the most well-known form of NMC - stroke. There are 2 types of strokes:
ischemic stroke (cerebral infarction), in which, due to thrombosis, blood stops flowing to a certain part of the brain, hypoxia develops and neurons die;
hemorrhagic stroke, in which a vessel ruptures (usually also due to a blood clot) and, in fact, hemorrhage in the brain tissue.

Stroke Symptoms

Sudden sharp headaches
Sharp nausea
Rapid breathing and heartbeat
Impaired speech and coordination of movements
Paresis and paralysis in the side of the body opposite to the lesion in the brain
Double vision
Confusion
Possible divergent strabismus, pupils have different diameters

A stroke requires immediate hospitalization and treatment in a neurological hospital. With timely treatment, the survival rate is high, but the patient's disability occurs in about 20% of stroke cases.

Treatment of stroke

Stroke treatment has several stages:

cupping acute condition(drugs are prescribed to lower blood pressure, reduce vascular permeability, increase blood fluidity, relieve cerebral edema),
restorative drug therapy,
physical rehabilitation, restoration of affected body functions (walking, speech).

The most important stage of recovery is kinesitherapy in the rehabilitation center. Also, patients who have had a stroke are recommended to undergo a course of psychotherapy.
Transient cerebrovascular accident (TICH)
A condition that resembles a stroke in symptoms, but is less acute, and passes within a day.

Symptoms

Severe headache, possible nausea
Ear congestion, dizziness, double vision and flickering in the eyes, fainting
Weakness in the body, it is difficult for the patient to stand, it is necessary to take a horizontal position
Speech disorder
Numbness (rarely, paresis or paralysis) of the side of the body opposite the BCM
May develop an epileptic seizure
Possible amnesia

PNMK treatment

Treatment of transient disorders of cerebral circulation is aimed at relieving spasm of cerebral vessels, lowering blood pressure, cardiotonic and tonic drugs are used.
Chronic cerebrovascular accident (CNI)
This condition does not have pronounced symptoms and develops gradually, therefore it is often found in a neglected state, when the degradation of the personality has already begun.

Symptoms

1st stage

Frequent headaches, dizziness, possible fainting
Rapid fatigue, drowsiness
Intermittent eye pain
Ringing in the ears, sensation of fullness
Possible nausea or lack of appetite
Goosebumps or numbness in limbs, parts of the body, or face
Confusion, difficulty concentrating
Memory disorders (a new word is poorly remembered, some word may “fly out of the head”, the patient may not remember some insignificant event at all)

It is very important to detect and start treatment of CNMC at this stage, which has a positive prognosis.
2nd stage
Added to the above symptoms:

significant memory impairment
constant noise in the head
unsteadiness of gait, hand tremor,
constant sleepiness,
it is difficult for the patient to concentrate and understand information,
gradual decline in intelligence
appear depressive states, self-doubt, inadequate and aggressive behavior.

At this stage, it is still possible to slow down and partially reverse the manifestations of cerebrovascular accident.
3rd stage (last)

Complete degradation of personality
Dementia, amnesia (the patient, having left the house, will not be able to find his way back, because he does not remember the address, what the house looks like, who the relatives are)
Stiffness and sharp uncoordinated movements
Speech disorders

Diagnosis and treatment of cerebrovascular disorders

Violation of cerebral circulation is very dangerous, because due to acute or chronic deficiency oxygen and nutrients, neurons die (and nerve cells, as you know, do not regenerate), which “take with them” the health of the entire nervous system. At timely diagnosis and adequate treatment the brain can create new neural connections, and living neurons will take over the functions of dead ones. But this must be done in time, while the defeat has not yet become too extensive.
For the diagnosis of cerebrovascular disorders

carry out objective examination patient,
collecting personal and family history,
MRI or CT scan, EEG,
REG and doppler of cerebral vessels and brain-feeding arteries,
complete blood count, coagulogram, blood biochemistry.

It is necessary to conduct an examination and treatment of acute cerebrovascular accident in a hospital. If you suspect a chronic disorder, it is important to contact a neurologist as soon as possible. Aksimed, a modern neurology clinic in Kyiv, offers its clients:

consultation with an experienced neurologist,
diagnostics on the latest equipment,
effective treatment in a neurological hospital,
recovery in a rehabilitation center after strokes and other disorders in the functioning of the nervous system.

Don't neglect your health! Specialists of the Aksimed clinic remind: NMC is dangerous due to its consequences, but a cerebrovascular accident diagnosed in time can be cured and maintain activity, vigor and a high quality of life.