Vascular encephalopathy of the brain - what is it and how to treat it. Encephalopathy of the brain: symptoms, treatment, causes, consequences

Vascular encephalopathy of the brain - what is it and how dangerous is it for humans? This pathology is not an independent disease, its manifestations are associated with a violation normal nutrition brain cells, lack of oxygen and nutrients. Read this article until the end to find out how vascular encephalopathy brain, what it is and what it can lead to.

Encephalopathic damage to the brain leads to functional pathologies, due to a lack of oxygen against the background of vascular disorders.

general characteristics

Among other types of encephalopathies, vascular is characterized by slow development, which makes it difficult to diagnose. The disease occurs as a result of diseases of the blood vessels that feed the brain, leading to oxygen deficiency in the brain cells.

The vascular type of encephalopathy develops for other reasons, they are classified as follows:

1. atherosclerotic against the background of general atherosclerosis of cerebral vessels.
2. Bilirubin due to jaundice.
3. congenital, emerging on later dates pregnancy.
4. Hypertensive due to the development hypertension.
5. Hypoglycemic resulting from a deficiency of glucose in the blood.
6. hypoxic, occurs as a result of violations metabolic processes leading to oxygen starvation.
7. diabetic, due to long duration diabetes accompanied by asthenic syndrome.
8. Radiation, due to severe radiation exposure.
9. Acute psychotic azotaemia(mental disorder with overexcitation nervous system).
10. Hepatic, due to chronic inflammation liver, viral nature.
11. Portosystemic, develops against the background of portosystemic shunting and is reversible, with temporary mental disorders.
12. DEP caused by a complex of causes, including atrosclerosis and hypertension.
13. toxic due to long-term use of drugs with neurotropic properties.
14. traumatic develops after a head injury.
15. Encephalopathy of the venous type caused by a slowdown in venous outflow from cerebral vessels.
16. Encephalopathy due to Martland's syndrome typical for professional boxers.
17. encephalopathy after long-term loss consciousness or coma (postanoxic).

Thus, the disease is distinguished by the fact that it is caused precisely by violations of the supply of oxygen to the brain tissues due to vascular diseases.

Symptoms and manifestations

An outside observer can suspect a disease in a person by characteristics indicating mental disorders.

With encephalopathy, multiple symptoms of impaired mental functions are observed:

• lack of initiative in labor activity;
• insomnia at night;
• fast fatiguability
• viscosity of thinking;
• ringing or noise in the head;
• monotonous incoherent talkativeness;
• impaired coordination of movements, dizziness;
• general depression;
• lack of desires, including life;
• tearfulness;
• drowsy daytime condition;
• narrowing the range of interests;
• decrease in vocabulary;
• memory impairment and confusion;
• frequent or persistent headaches;
• emotional instability.

In behavior, a significant decrease in intelligence is found, even in simple situations, patients with encephalopathy experience difficulties with decisions and actions. The slow and gradual fading of the intellect leads, ultimately, to marked dementia.

DEP is caused by a lack of blood in the vascular bed, its slow current.

There are atherosclerotic, hypertensive and venous forms or types:

1. Atherosclerotic dyscirculatory encephalopathy occurs as a result of the development of atherosclerotic changes in the walls of blood vessels that feed the brain. Atherosclerotic plaques form on the walls of the great vessels that branch off from the aorta. These vessels narrow their lumen, the volume of blood entering the brain becomes insufficient for its normal functioning. Gradually develops dystrophy of nerve cells and their functional failure. In cerebral atherosclerosis, as a rule, higher mental functions.
2. Venous encephalopathy due to congestion in the cerebral venous system. This phenomenon is due to the fact that the veins inside cranium are squeezed. Excessive fullness of the venous bed slows down the general blood flow, impairs the supply of the brain with fresh blood saturated with oxygen. Nerve cells suffer from oxygen starvation and cease to function fully.
3. Hypertensive dyscirculatory encephalopathy already observed in young age, since high blood pressure due to narrowed arteries in the brain leads to insufficient blood circulation in brain structures ah, which leads to a marked decrease in intelligence and emotional instability. The disease is aggravated by hypertensive crises, which accelerate the development of pathology.
4. Mixed dyscirculatory encephalopathy called a combination of hypertensive and atherosclerotic forms. In this case, atherosclerosis affects the main blood vessels, that leads to high blood pressure blood in them. The mixed form manifests itself in people in adulthood and old age. This form of vascular pathology also leads to dementia if therapeutic and preventive measures are not taken.
5. Vascular leukoencephalopathy of the brain differs in that the white, and not the gray matter of the central nervous system, is affected with degenerative processes, that is, not the nerve cells, and their fibers and bonds. Symptoms of the lesion are similar to classical encephalopathy.

stages

Because encephalopathy is vascular reasons develops gradually, then for greater accuracy of its diagnosis, it is customary to distinguish three stages of the disease:

1. Violations cerebral circulation at this stage are reversible. Appeared pathological changes in the structure and functions nervous tissue minor, their symptoms are non-specific, they resemble many other diseases, from simple overwork to the consequences of injuries. The first stage of the pathology, detected during the diagnosis, allows to reduce the violations brain function to a minimum with conservative treatment and physiotherapy procedures, a rationally organized regime of work and rest. Pay attention to the following symptoms:

• the appearance of noise in the head;
• persistent aching headaches;
• the appearance of frequent and sudden dizziness;
• restless sleep, insomnia;
• memory problems;
• lack of interest in learning new things;
• unsteady, unsteady gait.

1. It is characterized by attempts to tighten self-control over their behavior. The attitude towards other people changes, there is a feeling of unfounded anxiety. The patient begins to commit spontaneous, rash acts, loses his social status. The symptoms that appeared in the first stage of the disease are intensified:

• a noticeable weakening of memory for recent events;
• uncontrolled spontaneous actions and deeds;
• appears pseudobulbar syndrome, that is, uncontrolled movement of facial muscles, sudden tearfulness or laughter for no reason;
• there is dissatisfaction with others, malice;
• permanent depression psyche.

At this stage of the disease, the loss of socialization, conflict, inability to work permanently becomes noticeable. Such patients are disabled, their opportunities are limited.

1. Stage of dementia, dementia. Patients become limitedly capable, the basic mental functions are lost. DEP in the third stage of acquired dementia is characterized by the following signs and symptoms:

• the ability to walk independently is gradually lost;
• spontaneous emptying of the bladder and intestines;
• manifestation of symptoms of Parkinson's disease, loss of personality;
• inability to serve oneself and eat independently;
• complete disinhibition of the remaining mental functions;
• complete loss of intellectual abilities, dementia.

When the third stage of encephalopathy sets in, the patient is not able to exist without outside help, is a profound invalid. At adverse conditions, the period from the first stage of pathology to the onset of the third is approximately 5 years.

Dyscirculatory encephalopathy in 10% of cases leads to irreversible senile dementia. The video in this article demonstrates characteristic behavior patient with senile dementia.

Diagnostic procedures

Encephalopathy due to vascular insufficiency brain, requires the earliest possible diagnosis of the disease.

To confirm the initial diagnosis, which the doctor establishes with primary examination and inspection, appointed:

• laboratory tests of blood, urine, physiological tests;
• instrumental methods examinations.

In order to establish the presence of signs of impending encephalopathy, the following is carried out:

• electrocardiogram at rest and during exercise;
• measurement of blood pressure in the dynamics of the day;
• removal of an electroencephalogram;
• carrying out rheoencephalography;
• survey USDG of vessels head and neck;
• echocardiography of the heart on an ultrasound machine;
• computed tomography;

Diagnostic procedures allow you to classify the disease and prescribe treatment as the instructions say.

Treatment

For the treatment of dyscirculatory encephalopathy, drugs are prescribed that lower blood pressure and improve metabolic processes. The price of drugs is acceptable for treatment courses.

Table. Medications

In addition to drug treatment, encephalopathy is treated with other means:

• acupuncture;
• physiotherapy;
• manual therapy;
• surgical treatment;
• bioresonance stimulation;
• laser therapy.

Vascular encephalopathy is serious pathology, which is expressed in the death of neurons. This pathological process occurs due to insufficient supply of oxygen to the brain, which is necessary for normal operation neurons.

Causes of pathology

The disease may occur in different ages both in children and adults. Encephalopathy can be congenital or acquired, the second option is somewhat more common.
The genesis of congenital encephalopathy is associated with negative impact to the fetus during pregnancy. The cause of this genesis may be fetal hypoxia, exposure toxic substances on him or birth trauma. Also not excluded genetic factor, provoking the development of pathologies of the central nervous system.

The acquired form develops in no way independent disease, and against the background of others severe pathologies nervous system. Among such pathological processes leading to the development of encephalopathy:

• non-inflammatory lesions of the structures and membranes of the brain. These pathologies lead to impaired blood supply to the brain, and the development of one of the types of encephalopathy, for example, atherosclerotic, venous or hypertensive, is already a consequence of this;
  arterial hypertension also causes problems with . As a result of this disease, the walls of blood vessels narrow and become more vulnerable. With the next jump in pressure, a rupture of the vessel may occur, which leads to a stroke, and vascular encephalopathy develops against its background;
• exposure to the toxin. Intoxication can be caused by alcohol abuse, taking narcotic substances or poisoning chemical elements, heavy metals, etc.;
• brain injury.

In addition, diseases such as diabetes mellitus, as it primarily affects blood vessels, atherosclerosis, radiation pathology, etc., can lead to encephalopathy.

Severity

Each patient and his relatives are concerned about the prognosis of the disease, what to expect after treatment. So, we can talk about the consequences of encephalopathy based on the severity of the pathology. There are three of them:

• the first degree is minimal. As a rule, the symptoms of the disease appear indistinctly, and it is possible to identify the disease only instrumentally. If treatment is undertaken at this stage, the prognosis is good in most cases. Among the symptoms, they may appear, but general, for example, the patient notes increased drowsiness and fatigue, the presence of depression and lethargy;
• second degree. Most often, in this case, the symptoms are latent or mild. In this case, the progress of the disease is underway, and treatment should be started as soon as possible. At this stage, you can notice the deterioration of memory and intellectual abilities, there is an incessant noise in the head, as well as headaches;
  the third degree is the most difficult. AT this case pronounced neurological disorders are observed. Irreversible degenerative changes occur in the brain. Unfortunately, the prognosis at this stage is unfavorable, most often the disease leads to disability.

Also regarding the prognosis, it should be noted that congenital encephalopathy is more difficult than acquired and in most cases ends in disability.

Clinical picture

Talking about symptoms is also difficult, since they depend on many factors, for example, on the cause of the disease, its severity, as well as on the individual characteristics of the organism.

To general symptoms can be attributed:

• weakness and fatigue;
• noise in the head;
• blurred vision or hearing;
• deterioration of memory, mental ability;
• depressive states;
• headache;
• disorders of coordination of movements, tremor of the limbs;
• decreased libido;
• deterioration of facial expressions and pronunciation of speech;
• insomnia, etc.

Diagnostics

Only complex diagnostics able to accurately detect encephalopathy. When the first suspicions of pathological changes in the brain and the work of its neurons appear, you should immediately consult a doctor.

Diagnostics consists of:

• laboratory research;
• instrumental diagnostics;
• collection of anamnesis and complaints of the patient.

The first thing a doctor does when treating a patient is to check his coordination of movements, ask questions about logic and attention, thereby checking whether intellectual abilities have been lost and whether memory has deteriorated.

After examining the history and conducting a series of tests, the doctor prescribes the patient to undergo laboratory tests:

• general blood test, the main indicator in it is the level of lipids;
• metabolic test, it provides an indicator of glucose, electrolytes, ammonia, oxygen and lactic acid;
  autoantibody analysis;
• analysis to determine the level of creatinine;
• BP control.

Instrumental Methods:

• ultrasound dopplerography. This procedure allows you to identify the pathology of the vessels of the brain, circulatory disorders and other nuances associated with the vessels;
• Brain MRI is also a fairly informative procedure, it allows you to track the state of brain structures, determine the presence or absence of a tumor or other formation. MRI also shows the exact localization of the death of neurons and the degree of brain damage;
• rheoencephalography as well as dopplerography allows you to assess the condition of the vessels. REG shows the thickness of the walls of cerebral vessels, their possible violations of integrity, etc.

Medical treatment

In the case of , it requires integrated approach. Treatment is aimed primarily at restoring normal blood circulation in the brain and preventing further degenerative changes in him.

For these purposes, drugs are prescribed that improve blood circulation, as well as strengthen blood vessels. These include:

• Actovegin;
• Cerebrolesin.

Nootropic drugs affect higher functions brain, so this group of drugs is indispensable in the treatment of encephalopathy. Nootropics help:

• memory improvement;
• increase the level of intelligence;
• improving concentration;
• stimulate cognitive and mental activity.

In addition to Actovegin and Cerebrolesin, the group of nootropics includes:

• Piracetam;
• Phenibut;
• Phezam.

Also, these drugs help improve the supply of oxygen to the brain and thereby prevent further development dystrophic processes.

Antioxidants are also widely used in the treatment of encephalopathy. They help to improve the cognitive functions of the brain, as well as improve memory, concentration and speech. Among the antioxidants, the leading role in the treatment is given to: Mexidol and Encephabol.

To prevent and eliminate accumulation excess fluid, including in the ventricles of the brain, diuretics are prescribed, or better known as diuretic drugs:

• Furosemide;
• Uregit;
• Triamzid.

A series of sedatives in the treatment of pathology is also provided. Their main task is to relieve a depressive state, a sense of fear and anxiety. It could be lungs sedatives, like Glycine or motherwort tinctures or tranquilizers, strong drugs, which are issued strictly according to the doctor's prescription.

Apart from drug treatment, appoint:

• physiotherapy procedures (electrophoresis, acupuncture, magnetotherapy, ozokerite, etc.);
• diet, with restriction of fried and salt;
• physiotherapy exercises.

Possible treatment with traditional medicine, but in this case, consultation of the attending physician is required, since not all herbs are compatible with taking the main drugs.

Vascular encephalopathy is serious illness brain, which requires timely diagnosis and adequate treatment. If the pathology was detected at the first stage, and treatment was prescribed, the person will not feel any special disorders and will be able to continue further. full life. If you start the treatment process and allow the third degree of progress, the prognosis for the patient will be disappointing.

Reading strengthens neural connections:

The vascular form of encephalopathy is total defeat brain, which is caused by insufficient supply of blood to the organ, causing ischemic changes, oxygen deficiency, causing hypoxia, and a number of diseases. Violations of cerebral circulation and, as a result, hypoxia have a detrimental effect on neuronal cells. At the initial stage pathological process a small focus of neuronal death occurs, but in the absence of appropriate therapy, more and more new areas of the brain are affected, the symptoms intensify, leading to irreversible changes.

AT last years vascular encephalopathy has become hot topic Because the age threshold for the disorder has dropped markedly, practitioners are increasingly diagnosing it in younger patients who complain of symptoms characteristic of brain pathologies. Besides, similar condition brain develops against the background of common ailments: hypertension, atherosclerosis, venous thrombophlebitis.

According to the nature of the origin of encephalopathy are divided into:

• Congenital- caused by intrauterine brain development disorder, intracranial injury, which the child received during childbirth, hereditary metabolic disorders, etc.
• Acquired- develop throughout a person's life due to the impact of negative external factors, injuries, various diseases, metabolic disorders.

Reasons for the development of the disorder

As we have already said, pathological condition can occur in a child during fetal development or during childbirth. At different periods of life, the violation can be caused by:

• Hypertension associated with pressure surges, pathological hypotension.
• Exposure to toxic compounds.
• Traumatic brain injuries.
• kidney and liver diseases, disorders of the pancreas, causing an increase the content of toxic substances in the blood and their penetration into the brain tissue.
• Effects on the brain of radioactive radiation.
• The development of malignant neoplasms.
• resulting in hypoxia.

With encephalopathy, the number of fully functioning neurons in the brain decreases, small foci of necrosis appear, blood stasis develops, and edema is observed. meninges hemorrhages. Pathological foci are most often localized in white or gray matter.

Types of pathology

Identification of the types of disorders is based on what vascular pathology caused the disorder. The most common encephalopathies are:

• atherosclerotic- develops as a result of clogging of the cerebral vessels with atherosclerotic plaques and the occurrence of hypoxia. The disorder is more often diagnosed in older people, but it is also possible at a young age with caused different reasons elevated cholesterol levels. This type of encephalopathy develops over a long period of time, but, in the absence of timely diagnosis and treatment, it can manifest itself in a sharp form, leading to serious complications.
• Hypertensive- occurs as a result acute nephritis, eclampsia, sudden surges blood pressure or a hypertensive crisis, which is the most dangerous. The encephalopathy that develops during a crisis and the changes associated with it are irreversible and have a poor prognosis.
• Venous- develops gradually, due to stagnation of blood, after the appearance of the first symptoms, may not cause a noticeable deterioration in well-being for several years. In case of effective treatment on the early stages, the violation is quite reversible, but in the absence of therapy it progresses rapidly and leads to serious consequences.

Other forms of violation

There are a number of less common types of encephalopathy:

• Hypoxic-ischemic- the above types of disorders can also be attributed to this form, since circulatory disorders entail the development of ischemic changes in brain tissues and hypoxia. A characteristic difference This type of disorder is its frequent manifestation in children in the first month of life. It can occur during fetal development or during childbirth, leading to both minor brain damage, manifested in hyperactivity and absent-mindedness, and serious pathologies.
• Leukoencephalopathy- the most severe variant of the disorder, with which the patient can live for a maximum of two years. Sharp forms usually end fatally within a month. Focal lesion white matter is untreatable and has viral nature. Most often, the disease is diagnosed in people of advanced age, with a weakened immune system.

To date, there is no method of therapy for leukoencephalopathy. This is due to the presence of a kind of protective barrier on the approaches to the brain, through which drugs aimed at eliminating the pathogenic virus do not penetrate. The reason lies in the fact that the barrier allows only fat-soluble pharmaceuticals, while the drugs indicated in this case are mostly water-soluble.

Signs of a disorder

Common for different forms of violation are the following symptoms:

• Migraine-like headache and dizziness.
• Tinnitus.
• Decreased hearing and visual acuity.
• Sudden mood swings.
• Fast fatiguability.
• Psycho emotional disturbances- increased irritability, depression, tearfulness.
• Sleep disorders.
• Deterioration of short-term memory.
• Inability to concentrate, distraction.
• Coordination disorders.
• Numbness of fingers and toes.

There are three stages of encephalopathy:

1. Compensated- the body more or less copes with developing pathology, painful symptoms are mild. A person suffers from headache, dizziness, feeling of heaviness in the head. At night, a person cannot fall asleep, but during the day, on the contrary, he suffers from drowsiness and lethargy.
2. Subcompensated- vascular pathology progresses, lesions of the brain tissue become more extensive. The patient has an unsteady gait, constant tinnitus, symptoms of diseases that cause encephalopathy appear.
3. Decompensation- due to increasing hypoxia, atrophic phenomena develop in the cerebral cortex, the symptoms are very pronounced, therapeutic measures do not bring a tangible effect.

How to diagnose

First of all, the doctor examines the patient, listens to his complaints and studies the anamnesis. To clarify the diagnosis, the following methods are used:

• Computed and magnetic resonance imaging.
• Ultrasound examination - ultrasonic dopplerography, duplex and.
• Electroencephalography.
• Nuclear magnetic resonance.
• Biochemical analysis of blood, cerebrospinal fluid and urine.

Treatment methods for the disorder

After cerebrovascular encephalopathy has been diagnosed, treatment is prescribed, primarily aimed at eliminating the cause of the disorder. In the future, a course of integrated drug therapy, lasting from one to three months. To weaken painful symptoms and improve the condition of blood vessels, the following drugs are used:

• Angioprotectors - Etamzilat, Vasobral.
• Hypolipidimic agents that normalize elevated level saturated fatty acids and reducing the likelihood of atherosclerosis - Polisponin, Miscleron.
• Vasoactive agents - Cinnarizine, Cavinton.
• Phlebotonics used for vein pathologies - Troxevasin, Aescusan.
• Nootropics - Nootropil, Piracetam.
• Vitamin and mineral complexes.

Physiotherapy, therapeutic exercises and other procedures have a positive effect. However, you should always remember that these are auxiliary methods that work only in combination with the main therapeutic course.

Vascular encephalopathy is a common pathology of the brain, the pathogenetic processes of which are based on vascular changes.

AT domestic medicine the term "dyscirculatory encephalopathy" was widely used, but in International classification diseases of the 10th revision this disease brain most correspond to the terms "cerebral atherosclerosis", "cerebral ischemia".

It can occur in both children and adults.

Chronic ischemia of the brain - what is it? This is a brain disease that has a predisposition to progressive development, leading to neuropsychic changes.

The brain is the most sensitive organ to blood supply deficiency. human body. The volume of blood passing through the brain is about 15% of all blood in the body, while the mass of the brain is only 2% of body weight. In terms of energy, for the normal functioning of the brain, 20% of oxygen and 25% of glucose are needed from the total amount consumed by the body.

Such needs are explained by high metabolic rates. In biochemical terms, there are several variants of glucose oxidation: aerobic (that is, in the presence of oxygen) and anaerobic (in conditions of oxygen deficiency) glycolysis. The first way is optimal.

In the second variant of oxidation, an insufficient number of ATP molecules (an energy source) is formed - only 2 instead of 33. In addition, toxic metabolic products accumulate in the brain cells. In case of violation of normal functioning, damage to brain tissues and blood vessels develops, including changes in the walls of blood vessels:

• permeability is broken;
• increases the ability of platelets to aggregate;
• changes in vascular reactivity.

Varieties

Vascular encephalopathy can be acute or chronic, depending on the presence of signs of cerebral dyscirculation. From the point of view of specialist morphologists, this division is rather conditional, since involutive processes always underlie.

Involution occurs by encephalomalacia (that is, necrosis). The morphological substrate is diffuse or small-focal atrophic changes cerebral cortex and cerebellar structures with subsequent development of hydrocephalus or leukoaraiosis (rarefaction of white matter). This process is called small-focal encephalopathy. vascular genesis". Macroscopically, these changes appear:

• atrophy;
• diffuse changes in white matter;
• the presence of lesions.

There are several flow options. chronic ischemia brain:

1. Stable.
2. Slowly progressing.
3. Slowly progressive with paroxysms and transient disorders cerebral circulation.
4. Remitting.
5. Rapidly progressing.
6. The most common variant is the relapsing course, which is characterized by recurring temporary improvements.

In addition to encephalopathy of vascular origin, there are many others, in the development of which different etiological factors play a role.

Depending on the causes, the main types of encephalopathies are distinguished:

• toxic;
• hepatic;
• hypertensive;
• perinatal;
• venous encephalopathy;
• chronic traumatic and others.

By the way! A disease such as meningitis very often leads to the subsequent development of encephalopathy. That is why it is very important to recognize in time in order to start treatment.

It should be noted that in the International Classification of Diseases there is a code for unspecified encephalopathy, and under the heading "Other specified brain lesions" encephalopathy caused by radiation is indicated.

Perinatal encephalopathy refers to disorders that appear between the 28th week of gestation and up to 7 days in the postpartum period.

Recently, there has been an overdiagnosis of this pathology. In this regard, the consequences of perinatal encephalopathy, as a rule, are absent, since the nervous system of the child develops very quickly.

Enough serious consequences occur in approximately 4% of cases with a clearly established diagnosis: perinatal lesions of the nervous system, which, in addition to hypoxic-ischemic encephalopathy, lead to birth trauma, congenital anomalies and metabolic disorders, infections.

In such a situation, the presence of both mild neurological symptoms and disability of patients is possible, it depends on many factors.

Causes of the disease

The factors under the influence of which vascular encephalopathy often occurs include:

• heart diseases;
• degenerative diseases of the spine, especially the cervical region;
• metabolic disorders, in particular diabetes mellitus;
• atherosclerosis;
• arterial hypertension;
• lesions of the main vessels (arteries) of the head by the type of occlusion.

Among heart diseases special meaning have arrhythmias. In addition to these factors, the disease can provoke a lifestyle: physical inactivity, smoking, a radical change in living conditions with the presence of psycho-traumatic factors, chronic alcohol dependence.

Other causes include head injuries, infectious diseases, substances coming from outside: drugs, oral contraceptives. In more rare cases chronic cerebral ischemia due to venous insufficiency(venous encephalopathy), blood pathology, rheumatic vasculitis or others.

Stages and symptoms

Vascular encephalopathy of the brain can develop due to the influence of two factors: a lack of blood supply of a permanent nature and a change in the volume of incoming blood.

The last factor is due to several reasons:

• disorders of the heart;
• change in vascular tone (private option -);
• reduction in volume or redistribution of circulating blood.

According to some sources, there are initial manifestations of insufficiency of blood supply to the brain (NPNKM). This period is characterized by the presence of a subjective symptom complex, including headache, dizziness, sleep and memory disorders, fatigue, general weakness. The criterion for the presence of NPCM is the reappearance once a week for 3 months of 2 or more of the listed complaints.

Forms and manifestations of chronic cerebral ischemia are diverse and depend on the degree of damage to blood vessels and nervous tissue. There are 3 stages:

• 1st - compensated;
• 2nd - subcompensated;
• 3rd - decompensated.

Signs of vascular encephalopathy increase in accordance with the stage from moderate to pronounced, with the appearance of concomitant symptoms.

In the 1st stage, the development of a neurasthenic syndrome with a predominance of subjective complaints is noted. Headaches can be vague, often described by patients as heaviness or "stale head". Somatic complaints may be associated. AT without fail when examining the nervous system, individual manifestations of organic disorders are noted.

At the 2nd stage, there is a progressive decrease in working capacity, increased fatigue appears. Behavioral disorders occur, sleep disturbances and a decrease in memory functions are observed. An objective examination reveals pathological reflexes, visual disturbances, and impaired coordination of movements.

At the 3rd stage, dementia develops, respectively, the patient no longer complains. The intellect is reduced, the patients are indifferent, the manifestation of emotions is sluggish, blunted, disturbances of consciousness, psychoses are noted. Symptoms are grouped into characteristic neurological disorders syndromes: pseudobulbar, vascular dementia, pyramidal, ataxic, vascular parkinsonism.

Patients often have pyramidal syndrome which may occur after a stroke. Initially, it is expressed moderately, characteristic minimal manifestations paresis, anisoreflexia, that is varying degrees expressiveness tendon symptoms on the right and left side.

Pseudobulbar syndrome is expressed in speech disorders with symptoms of dysarthria (impaired pronunciation), dysphagia (swallowing disorder), episodes of violent crying and laughter are characteristic. In addition, urinary incontinence, memory and intelligence disorders are common.

Chronic cerebral ischemia is characterized by a variety of manifestations and complaints, a combination of several syndromes in one patient. However, motor and cognitive disorders are considered to be fundamental signs in the picture of the disease.

Emotional disturbances are quite typical. At the first stage, they have the character of anxiety-depressive, neurosis-like states, and subsequently intellectual disorders and memory impairments are added, which constitutes the syndrome of vascular dementia.

There is a classification of the severity of the disease, which is based on the degree social adaptation patient.

There are 3 stages:

1. The patient is socially adapted, independently serves himself. Problems arise only in situations of increased stress.
2. The patient needs little help under normal circumstances.
3. The patient needs permanent care due to the inability to perform even elementary tasks.

Diagnostics

For the diagnosis of vascular encephalopathy, it is important to combine the study of the nervous system with functional methods and load tests.

For the diagnosis of "chronic cerebral ischemia" there are a number of clinical criteria on which the attending physician relies.

Important diagnostic value have instrumental methods of examination: ultrasound, radiological and radionuclide.

MR angiography has wide possibilities in detecting stenosis or occlusion of arteries. To assess cognitive functions, a neuropsychological analysis is carried out with a study of memory parameters, emotional state and attention.

Treatment

Exist general principles treatment of patients with chronic cerebral ischemia. One of the main directions is the exclusion of risk factors, that is, the treatment of the underlying disease - arterial hypertension, diabetes, atherosclerosis.

An important step in the treatment of patients in the initial stages of the disease is the normalization of lifestyle: the rejection of bad habits, weight loss with overweight, increase physical activity, which should be regular and dynamic. Required proper organization daily routine with the establishment of the optimal alternation of work and rest. Effective at the first stage is psychotherapy.

In addition, physiotherapeutic methods of treatment are widely used: from physiotherapy exercises before laser therapy and hyperbaric oxygen therapy.

Depending on the indications, the following groups of drugs are prescribed for patients with cerebral encephalopathy:

• antiplatelet agents; antioxidants;
• vasoactive drugs;
• nootropics;
• neurotrophic drugs.

In some cases, in the presence of stenosis of the main arteries, surgical treatment is the most effective.

Prevention and consequences of encephalopathy

To prevent the development of vascular encephalopathy, it is necessary to exclude the influence of risk factors. With the development of the disease, the consequences can be serious, and in some cases irreversible.

Outcome depends on severity pathological changes. Severe vascular encephalopathy leads to disability of the patient with a complete loss of not only the ability to work, but also the skills of independent consumer services due to impaired memory functions, motor and cognitive disorders.

At the initial stage of the disease, the doctor is able to provide effective help, it is necessary to follow the recommendations after discharge at the end of inpatient treatment and regular outpatient follow-up to assess the condition.

The term "encephalopathy" refers to brain damage of a non-inflammatory nature. This pathology classified into different kinds depending on the etiology of development. This article talks about vascular (dyscirculatory) encephalopathy, indicates what it is and why it develops, also describes its main clinical manifestations and principles of treatment.

Etiology of vascular encephalopathy

The development of this disease is based on cerebral ischemia, which occurs due to various vascular pathologies. In almost 60% of cases, it is caused by atherosclerosis of the cerebral vessels. Ranked 2nd among etiological factors is arterial hypertension. It most often occurs in hypertension and chronic pathologies kidneys (for example, with polycystic or glomerulonephritis).

Since the vertebral arteries are responsible for 30% of blood circulation in the brain, the presence of certain congenital malformations of these vessels, their damage against the background of osteochondrosis of the spine or as a result of injuries leads to the development of the so-called syndrome vertebral artery, which is manifested by signs of encephalopathy. In addition, diabetes mellitus should be noted in the etiology. Against this background, develops diabetic angiopathy with chronic ischemia of brain tissues, systemic vasculitis and hereditary lesions vessels, head trauma, arterial hypotension.

Encephalopathy of vascular origin leads to a deterioration in blood circulation in the brain. This is accompanied by hypoxia and trophic disorders, which ultimately causes the death of nerve cells. The most sensitive to chronic ischemia are the subcortical structures and white matter. At first, vascular encephalopathy appears only functional disorders, which at correct therapy are reversible. In the absence of therapy, permanent neurological defects occur.

Clinical manifestations

The onset of the disease is almost imperceptible. initial stage vascular dystonia, as a rule, is characterized by disturbances in the emotional sphere. In 65% of cases, these are depressive states. In addition, somatic complaints are observed. So, patients report headaches, pain back, joints, different bodies resulting in a difficult diagnosis. hallmark depression is that they arise under the influence of a minor psychotraumatic factor or without its influence. Psychotherapy or a course of antidepressants does not give positive results.

As the disease progresses, patients become emotionally labile. Their mood changes drastically overexcitability or even aggression towards others. There are also complaints that mimic neurasthenia. This sleep disturbance, fatigue and absent-mindedness, headaches.

Such complaints are often combined with cognitive impairment. Among them are memory impairment, the inability to concentrate or remember information just received, low speed thinking and rapid fatigue from mental activity. In addition, register movement disorders which include dizziness and unsteady gait. Sometimes walking provokes nausea and even vomiting.


At the subcompensated stage of the disease, cognitive and motor disorders are aggravated, intelligence is reduced. Patients cannot adequately assess their condition, they are not oriented in space. Of change emotional sphere deep apathy and lack of motivation for any activity should be noted.

Patients gradually develop a specific gait (the so-called "skier's gait"). They move slowly, the steps are small, during the movement of the foot they do not completely come off the floor, so walking is accompanied by a specific shuffling. It is important to note that it is quite difficult for patients to start moving forward or stop. Such manifestations resemble Parkinson's disease, so sometimes such symptoms are called "vascular parkinsonism."

Vascular encephalopathy of the brain in the stage of decompensation is manifested by speech disorders, a decrease in the swallowing reflex, there is a tremor of the limbs and discoordination. Vision is also reduced and hearing worsens, which makes it difficult for patients to adapt to environment. Brain tissue is actively destroyed. At the same time, there appear epileptic seizures. Dementia (acquired dementia) is formed.

Features of treatment

Therapy is carried out taking into account the etiology of brain lesions, and drugs are prescribed that improve microcirculation and cerebral blood flow, protect nerve cells from ischemia and lack of oxygen. Be sure to treat the underlying disease that led to vascular encephalopathy. So, if there is an atherosclerotic lesion of the cerebral vessels, special lipid-lowering drugs and drugs that lower cholesterol (for example, Lipamide, Essentiale, Clofibat) are prescribed. In the presence of diabetes, it is imperative to control the level of glucose in the blood and, if necessary, prescribe hypoglycemic drugs. If arterial hypertension is the cause of the lesions, antihypertensive drugs are prescribed.

If encephalopathy is accompanied by insufficient venous outflow, Troxevasin or Aescusan is used. Angioprotectors are often used to strengthen blood vessels. To improve microcirculation, it is recommended to take Aspirin or Curantil. Also, to improve blood flow and prevent vasospasm, No-shpu or Cinnarizine is prescribed.

The complex treatment includes vitamins and drugs with neuroprotective properties that improve the functioning of neurons in conditions permanent shortage oxygen. As a rule, pyrrolidone derivatives (Piracetam), GABA derivatives (for example, Aminalon), membrane stabilizing agents (Cereton), as well as drugs of animal origin (for example, Actovegin or Cerebrolysin) are prescribed.

With proper treatment, it is possible to slow the progression of even compensated vascular encephalopathy.