Contents
cerebral ischemia – This is a decrease in blood flow caused by cerebral atherosclerosis (from the Latin cerebrum – brain).
The brain performs the following functions:
thinks;
processes information coming from the senses;
coordinates body movements;
determines the mood, creates an emotional background;
controls attention;
stores information;
generates speech.
Failure in its work threatens the life of the whole organism. Numbness, as one of the symptoms of cerebral ischemia, is caused by the fact that sensory information is incorrectly processed or not transmitted through neurons. These are the causes of temporary blindness. The brain is involved in decision-making, therefore, in patients with CCI – chronic cerebral ischemia – inhibition of thought processes is observed.
Any pathology of the higher part of the central nervous system – the central nervous system negatively affects many life factors. Symptoms may be hidden – this is typical for the initial stage of the disease. The brighter they appear, the stronger the disease is launched.
There are two forms of the course of the disease:
sharp
chronic.
The first develops according to the principle of a transient ischemic attack – TIA, a microstroke or an attack of acute cerebrovascular accident – stroke. This is transient ischemia, otherwise – a transient cerebrovascular accident – PNMK or ischemic stroke. The cause of an acute condition is blockage of the blood flow by an embolus or a neglected chronic form of the disease. The latter, in turn, develops gradually as the bloodstream narrows.
Cholesterol plaques are lipoproteins of lower density limits. It is they who “strangle” the organs, causing circulatory hypoxia. They can break away from the place of formation and circulate through the vessels. Emboli can be cholesterol or blood. Thrombi are dangerous with the possibility of developing an inflammatory process.
Prevention of ischemia, like many other diseases, is to maintain a healthy lifestyle. It is necessary, if possible, to avoid stress, not overeat, adhere to an “anti-cholesterol” diet, play sports, give up alcohol and smoking, and be outdoors.
Symptoms of cerebral ischemia
There are many symptoms of cerebral ischemia:
dysfunction of the nervous system, causing a speech disorder or vision problems;
fatigue;
general weakness;
drowsiness;
decrease in working capacity;
amnesia;
mood swings;
irritability;
nervous excitement;
insomnia
headache;
changes in blood pressure – blood pressure;
shallow and frequent breathing;
dizziness;
loss of consciousness;
nausea;
vomiting;
numbness of limbs;
feeling of coldness in the hands and feet.
As the disease progresses, symptoms may worsen. It progresses in stages. Specialists distinguish 3 stages or degrees of development of ischemia. Some even single out a fourth.
Separately, the symptoms of an ischemic attack should be listed:
bouts of zonal loss of sensitivity;
paralysis of a part or half of the body;
monocular vision loss (unilateral blindness).
Problems with the eyes arise because the signals from them come to the visual cortex of the brain, located in the occipital lobe. Local numbness is due to the fact that the neurons of the somatosensory cortex in the parietal lobe are affected, where tactile information is transmitted.
The red nucleus of the brainstem, the basal ganglia, the cerebellum and not only are “responsible” for the motor activity of a person. If the processes occurring in the motor areas of the cortex in the frontal lobes are disturbed, the patient has difficulties with the regulation of movements up to paralysis. Different parts of the brain are responsible for different factors of vital activity. Emotions are controlled by the amygdala, attention by the reticular formation, and memory by the hippocampus.
The difficulty in diagnosing some brain diseases is that their symptoms are similar to the “standard” changes in well-being in older people. Another feature of cerebral ischemia is that its signs are very individual, because. in different people, different parts of the main organ of the central nervous system are affected. In the diagnosis, observations of the patient’s relatives play an important role. They are able to give a more accurate description of the changes that are taking place. Due to the lethargy and confusion of consciousness, it is impossible to completely rely on the words of the patient.
Causes of cerebral ischemia
Distinguish between basic and additional prerequisites. The first include insufficient cerebral circulation, which leads to hypoxia – oxygen starvation. It occurs due to the narrowing of the lumen of the artery or its complete blockage – obturation. Without oxygen, cells cannot fully function. If this process is delayed, necrosis may begin – tissue necrosis, otherwise called a heart attack. Hypoxia of the brain is characteristic of such pathologies as arterial hypertension and atherosclerosis due to the growth of fatty deposits on the inner wall of the cerebral vessels.
The blockage of the lumen of a cerebral artery by a thrombus is called thrombosis. A blood clot forms directly in the brain or is carried in blood from another part of the body. A “travelling” thrombus is called an embolus. It is formed on the wall, but under the influence of any factors it breaks off and moves through the circulatory system until it gets stuck in the narrowest point of the arterial canal. The narrowing of the lumen can be observed not in one place, but in several at once.
Additional causes of cerebral ischemia include:
cardiovascular diseases, accompanied by a violation of the central hemodynamics. For example, acute heart failure against the background of myocardial infarction, bradycardia, tachycardia;
ischemic kidney disease;
decompression sickness;
vascular anomalies, for example, compression, local spasm of the artery;
compression of the artery from the outside, for example, by a tumor;
carbon monoxide intoxication;
hereditary angiopathy;
blood loss;
venous pathology;
cerebral amyloidosis with deposits of amyloid – a protein-polysaccharide complex – in tissues;
systemic vasculitis or angiitis, otherwise – arteritis;
diabetes;
blood diseases, for example, anemia or, conversely, erythrocytosis, which provokes an increase in its viscosity;
advanced age;
obesity;
smoking.
There are many causes of coronary disease, but the main one is the complete or partial blocking of the bloodstream. There can be a lot of factors that cause the formation of plaques or pathological protrusions of the vessel walls due to tumors or other abnormalities in the surrounding tissues.
Degrees of cerebral ischemia
Degrees or stages differ in signs and strength of their manifestation. The disease progresses from the initial or mild to the stage of subcompensation or moderate, and then – decompensation or severe. This division is due to the coverage of the CNS. At the last stage in newborns, it is completely affected. The prognosis is unfavorable.
The increase in the manifestations of the symptoms of the disease occurs in proportion to the narrowing of the lumen of the blood duct. In addition, the more ischemic foci occur in the brain, the stronger the disease captures the body. At the last stage, a structural organic lesion of the central nervous system occurs. In infants, it is accompanied by cerebral edema. The accumulation of excess fluid in the intercellular space occurs due to excessive loads, pressure on the brain cells. This is how hydrocephalus develops.
There are 3 rates of progression of ischemia, depending on how long each stage lasts:
fast – less than 2 years;
medium – up to 5 years;
slow – more than 5 years.
After recovery, people of any age need a period of rehabilitation. Its duration and intensity of the procedures are determined by the stage the disease has reached.
Cerebral ischemia 1 degree
Otherwise, this stage is called compensated. The changes are still reversible. The disease begins with symptoms such as:
malaise;
weakness, fatigue;
chills;
insomnia;
reflexes of oral automatism or subcortical;
anisoreflexia;
emotional and personality disorders (for example, irritability, aggressiveness);
emotional lability – rapid mood swings;
depression;
disorders of cognitive functions: absent-mindedness, decreased cognitive activity, forgetfulness, inhibited thought process – stupor;
change in gait (the patient shuffles or minces with his feet);
problems with coordination of movements;
“Heavy” head, persistent migraines, dizziness, tinnitus.
Reflexes of oral automatism are normal only for small children. When approaching or touching any object to the lips, they are pulled out by a tube. The presence of these reflexes in adults indicates a violation of neural connections in the brain. With anisoreflexia, reactions to external stimuli from different sides of the body appear with different strengths. At this stage, a slight asymmetry appears.
The first degree is treated relatively easily and without aggravating consequences. Children’s cerebral ischemia is curable, but if it is not possible to achieve the disappearance of ominous symptoms in a week, the disease passes to the second stage.
Cerebral ischemia 2 degree
Subcompensation is a stage of aggravation of primary signs and deterioration of well-being. All signs of the first stage become pronounced with moderate severity of the disease.
Additionally, the following symptoms appear:
extrapyramidal disorders due to damage to the pyramids of the medulla oblongata, basal ganglia and subcortical-thalamic connections;
ataxia with impaired coordination;
intellectual-mnestic disorders leading to personality degradation;
apathy – indifference, narrowing of the circle of interests, loss of interest in the world around.
In newborns, intracranial hypertension is observed – an increase in hydrostatic pressure. It occurs mainly in areas in front of the site of blockage of the vessel. Adults at this stage can no longer cope with professional duties. They can’t concentrate on anything, even just reading. In some cases, hospital treatment is necessary.
All syndromes continue to progress. There may be tearfulness. The peculiarity of the moderate degree is that mental disorders occur. But the ability to self-service still remains. As soon as it disappears, the patient needs constant care.
Cerebral ischemia 3 degree
Decompensation occurs when all the possibilities of the brain are exhausted. At the last stage of the development of the disease, multiple lacunar and cortical infarcts occur in the brain. The patient cannot move independently, loses balance. Accompanying severe symptoms:
fainting;
psychoorganic syndrome;
urinary incontinence – incontinence;
swallowing disorder – choking while eating;
Parkinson’s syndrome (parkinsonian), or rather, amyostatic or akinetic-rigid;
disinhibition – inappropriate behavior;
apathetic-abulic syndrome with decreased willpower;
Babinsky’s discoordinating syndrome, praxis disorders;
psychotic disorders up to dementia – dementia.
Sudden loss of consciousness is accompanied by a sharp drop in blood pressure, muscle relaxation, dilated pupils, and their lack of reaction to light. The pulse is difficult to hear, it is threadlike. The patient needs to be given first aid, turn him to the side. During fainting there is a danger of asphyxia. The muscles of the tongue are so relaxed that it can cut off oxygen.
Psychoorganic syndrome consists of 3 components. This is forgetfulness, stupor and explosiveness – the inability to control one’s behavior. Emotional breakdowns become characteristic of a person, he quickly goes into a state of extreme excitement, inadequately strongly reacts to what is happening.
Parkinsonism combines:
tremor;
muscle rigidity – constant increased tone;
epileptic seizures;
postural instability – inability to maintain balance;
hypomimia – poverty of involuntary facial reactions (Bekhterev-Notnagel symptom);
bradykinesia – slow movement, stiffness.
The French neuropathologist J. Babinski was the first to describe a syndrome that occurs due to damage to the cerebellum or the prefrontal region of the brain. The patient cannot perform the simplest voluntary actions, for example, clench and unclench his fist. Praxis in Greek means “action”.
Mental deviations lead to a disorder in the perception of the real world and, as a result, disorganization of behavior. Psychiatric disorders reach the complete disintegration of the personality.
Symptoms of various degrees of coronary disease in adults and children are somewhat different. The last stage is terrible because the consequences can no longer be avoided, ischemia will forever leave an imprint on the life of the patient and his loved ones.
cerebral ischemia in newborns
The cause of the disease is hypoxia in the womb or during childbirth. It is divided into 3 degrees according to the duration of oxygen starvation of the brain. Diagnosing the disease in babies is not easy, because. at this age, it is impossible to identify some symptoms of ischemia.
All signs are combined into syndromes:
hydrocephalic. The head is enlarged, the area of the fontanel is enlarged, intracranial pressure is increased. This is caused by the accumulation of CSF – cerebrospinal fluid. It is produced in the brain and circulates through the spinal cord. Cerebrospinal fluid overflowing the space under the bones of the skull causes hydrocephalus;
Syndrome of increased neuro-reflex excitability. Changes in muscle tone, shudders, tremors – involuntary trembling of the limbs, exacerbation of reflexes, constant crying and restless sleep;
Comatose. Unconscious state with lack of coordinating function of the brain;
CNS depression syndrome. Reduced muscle tone, reduced motor activity, weakened sucking and swallowing reflexes, strabismus and facial asymmetry may appear;
Convulsive. Appear paroxysmal twitching of the whole body. Cramps or spasms are involuntary muscle contractions.
The severity of cerebral ischemia in newborns and in adults differs somewhat due to age characteristics:
First degree (mild). Lethargy or overexcitation of the child from the first days of life.
Second degree (moderate). Convulsions appear. Treatment is carried out in a hospital.
Third degree (severe). The child is immediately placed in intensive care, because. there is a threat to his life. Structural ischemic damage to the brain in a newborn leads to organic damage to the central nervous system. Inevitable consequences such as ataxia – motor disorder, lag in psychomotor development, convulsive seizures, impaired hearing and vision.
Constant monitoring of pediatricians in the first week of life, as well as a set of ongoing studies, helps to detect neurological abnormalities in children in time. Pediatrics every year improves the methods of treatment of ischemia. If earlier such a diagnosis was a sentence, and the baby was doomed to disability, now in the first stages the disease can be cured without painful consequences. This is a feature of infancy. So, a mild degree is treated with a course of special massage.
Consequences of cerebral ischemia
The severity of the consequences is determined not only by the stage and form of the disease, but also by what ailments have developed due to ischemia. The main negative factors of this disease are hypoxia and metabolic disorders.
They provoke the development of other pathologies:
ischemic stroke or heart attack (necrosis) of the brain (more often in people over 60 years old);
chronic dyscirculatory encephalopathy or sclerosis of cerebral vessels;
paralysis;
sensitivity disorder – paresthesia;
silent;
epilepsy;
thrombophlebitis.
During a stroke, part of the brain tissue softens and dies. Nerve cells do not regenerate. Modern methods of treatment include the use of stem cells. The latest technology is designed to replenish dead cells of any type. There are many conflicting opinions about its use. There are clinics that actively use this technique.
Encephalopathy is an organic brain lesion that occurs without inflammation. Brain tissue degeneration occurs, cells and intercellular substance are destroyed. Paralysis in translation from ancient Greek means “relaxation”, immobility. It affects the part of the body opposite to that in which the focus of the disease is located. If the area of the destroyed neurons is large, then tetraplegia can occur – paralysis of the limbs, or the person will completely lose the ability to move.
The feeling of numbness may be accompanied by tingling, burning, “crawling”, aggravated by physical exertion. Paresthesia also has a mirror character. It occurs due to dysfunction of the thalamus, the parietal lobe of the brain. The centers that regulate speech are located in the left hemisphere of the brain. A patient with a clear mind understands everything, but cannot speak.
Consequences for newborns can be expressed in mental retardation and learning difficulties. A small person will cruelly pay even for a relatively short-term oxygen starvation during fetal development. Compliance by a pregnant woman with all the doctor’s prescriptions is the key to the health of her baby.
CCI – chronic cerebral ischemia – differs from the acute form in that it progresses slowly and secretly. Even close people do not always immediately notice the ongoing negative changes. The lack of timely treatment leads to the emergence of new pathological abnormalities.
The severity of the consequences of ischemia is determined by how much the blood duct was closed, how quickly it narrowed, it depends on the duration of treatment and the general condition of the body. The sooner the therapeutic course is started, the more favorable the prognosis.
Diagnosis of cerebral ischemia
Diagnosing ischemia is not easy, because. its symptoms are very similar to those of diseases such as:
progressive supranuclear palsy;
corticobasal degeneration;
multisystem atrophy;
Parkinson’s disease;
a brain tumor;
Alzheimer’s disease;
normotensive hydrocephalus;
idiopathic dysbasia;
ataxia.
In order to avoid mistakes, the neurologist must use an integrated approach. A physical examination is carried out. The state of the respiratory and cardiovascular systems is assessed, the neurological status is determined.
Ultrasound examination is prescribed – ultrasound of one of the types:
ultrasound dopplerography – UZDG;
duplex scanning of blood vessels – DS.
To determine the neurological status, the doctor assesses the patient’s condition:
clarity of consciousness;
pupillary reaction to light;
coordination of eyeball movements;
facial expressions, the ability to grimace;
facial symmetry;
tongue movements;
speech;
memory;
muscle strength and tone of the limbs;
coordination of movements;
sensitivity;
tendon reflexes.
Doppler tomography or dopplerography shows only the speed of blood flow. DS of the cerebral arteries is also performed to study the cerebral canals. But duplex scanning shows the vessel, its lumen, wall, location and nature of the blood flow.
MR (magnetic resonance) or CT (computed tomography) angiography may also be required. This is a type of X-ray examination using contrast staining of blood with iodine. Unlike ultrasound, special preparation and additional studies are required here: fluorography and electrocardiogram – ECG. Do not eat or drink before the procedure. The dye is injected through a puncture, a catheter may be required.
Neurologists use specific tests when diagnosing. For example, a finger-nose test or Romberg’s pose: standing, legs together, eyes closed and arms extended forward. To identify concomitant pathologies, ECHO-KG, general and biochemical blood tests are used. Electroencephalography (EEG) and cardiography are also used for neuromonitoring.
Diagnosticians believe that left- and right-hemispheric ischemia differ in concomitant syndromes. If the focus of the disease is located in the left hemisphere, then the treatment is easier and faster.
Treatment of cerebral ischemia
Both conservative and surgical methods are used. The operation is indicated if all the measures taken do not improve the clinical picture or an ischemic attack occurs with the possibility of death. Conservative treatment begins with the elimination of the cause of the disease – problems with filling the brain with blood.
Microcurrent electroreflexotherapy – ERT improves the functioning of the neurons of the cerebral cortex and normalizes blood circulation.
Drugs used for drug treatment can be divided into several groups:
neuro- or cerebroprotectors that protect brain neurons;
reducing the permeability of the walls of blood vessels, strengthening them, stimulating blood circulation. Vasodilating and anticoagulant or blood-thinning drugs are used;
hypolipidemic, correcting lipid metabolism.
Treatment of coronary disease of the brain follows the scheme: neurons – vessels – metabolism. As a result, cells are again saturated with oxygen, intercellular metabolism returns to normal. Normalization of blood pressure is necessary for the prevention of ischemic attacks and strokes.
After the restoration of normal blood flow, motor skills do not return immediately. A rehabilitation period is needed. A course of massage is required, physiotherapy exercises – exercise therapy, electro- and / or magnetophoresis.
Surgery with occlusive-stenotic lesions of the cerebral vessels, it passes through the operation of stenting the carotid arteries, thrombectomy – to remove the thrombus, carotid endarterectomy.
stem cells. There is growing interest in stem cell therapy. It is a source of natural regeneration. Before the procedure, a biomaterial is taken from the patient. Mesenchymal (germ) stem cells are isolated from the resulting cell culture and cultured to the desired volume.
Transplantation – introduction – occurs twice using a dropper. The procedure lasts no more than an hour. The patient can then return home. New cells are carried through the bloodstream to the affected areas. They attach to healthy tissues and begin to multiply. Stem cells also create new networks of collateral pathways. These are auxiliary, roundabout, lateral vessels that carry blood around the main channel.
If the patient turned to the neurologist too late, then serious consequences can no longer be avoided. Unfortunately, cerebral ischemia is a disease with a frequent fatal outcome. Inattentive attitude to one’s health always ends with the occurrence of pathologies. In cases of cardiovascular diseases, the lack of timely treatment is fraught with death.
Neuroprotective therapy for dyscirculatory encephalopathy
Cerebrovascular disorders caused by atherosclerosis and hypertension affect more and more people every year. General statistics for this group of diseases indicates an annual increase in patients with acute disorders of cerebral circulation.
Diagnosis and Diagnosis
Dyscirculatory encephalopathy (chronic cerebral ischemia) is a progressive diffuse brain injury caused by a violation of the supply of oxygen and nutrients to brain cells due to a gradual deterioration in the blood supply to the brain tissues.
Separate statistics on the incidence of CCI – chronic cerebral ischemia, or dyscirculatory encephalopathy, are not currently maintained, according to doctors, 7 people out of 1000 suffer from the disorder.
The main clinical manifestations of chronic cerebral ischemia are:
headache;
dizziness, unsteadiness and unsteadiness when walking;
memory impairment and decreased concentration;
slowing down of thought processes;
emotional disturbances, unexplained anxiety, trouble falling asleep and other sleep disturbances.
The development of the disease occurs gradually, against the background of atherosclerosis of cerebral vessels in combination with arterial hypertension (hypertension). The combination of two diseases leads to the formation of multiple foci of hypoperfusion, that is, reduced blood supply to tissues.
Since brain tissues require more oxygen than any other tissue, oxidative or oxidative stress builds up over time – a lack of oxygen disrupts the natural process of breathing and the functioning of brain cells. Chronization of the process leads to the depletion of the internal resources of cell protection and their gradual death.
Against the background of slow destruction of brain tissues as a result of oxygen starvation, the symptoms of CCI become more pronounced, and changes in the patient’s brain become irreversible and cannot be corrected.
Early diagnosis of chronic cerebral ischemia and adequate therapy allows the patient to almost completely restore the process of oxygen supply to the brain tissues. The later the disease is detected, the more cells die irrevocably, however, proper treatment can slow down the growth of hypoperfusion foci and ensure tissue repair.