Chronic cerebral ischemia symptoms. Prevention of chronic cerebral ischemia

Chronic cerebral ischemia is a violation of blood flow resulting from. It is known that the brain performs a series important functions for the life of the organism. And any failure in its work can lead to irreversible consequences.

Conditionally reasons chronic ischemia The brain is divided into primary and secondary. The main factors that provoked the disease include poor circulation. Because of it, there is a strong oxygen starvation, necrosis, thrombosis and, as a result, cerebral ischemia.

In the case of incomplete ischemia, tissue damage may be mild and reversible for longer. This is especially true when the collateral circulation develops in advance and more or less well complements the obstruction of the main arterial axis. Acute limb ischemia has two main causes: arterial embolism and localized arterial thrombosis: embolism accounts for about 40% of cases, acute thrombosis about 60%. Embolism is found in 0.23% of autopsy subjects with an incidence of almost 1% after myocardial infarction.

The embolism is almost always of a thrombotic nature, and its origin is heart failure in more than 75% of cases or proximal arthritis. The embolism is usually fixed with a decrease in the arterial axis calibration, therefore, often at the level of the bifurcation. Its location is remembered in almost half of the cases. Secondary thrombosis favoring transient arterial spasm may complement arterial obstruction upstream and downstream. During endocarditis, vegetation can embolize and cause acute limb ischemia.

Secondary causes of the development of the disease are most often:

diseases of the cardiovascular system;
ischemic disease kidneys;
neoplasms;
decompression sickness;
poisoning, such as carbon monoxide;
venous pathologies;
diabetes;
systemic diseases, such as vasculitis or angiitis;
obesity;
smoking;
erythrocytosis or anemia.

The causes of ischemic disease are very diverse. All of them lead to the fact that the bloodstream is blocked by various plaques, causing cerebral ischemia.
Atheromatous emboli or cholesterol crystals result in very distal ischemia and often involve other organs. The nature of the embolism is exclusively of tumor, cardiac or arterial origin. Finally, foreign body can migrate, causing an embolism.

Paradoxical emboli are of venous, thrombophlebitis, limb or pelvic, renal, hepatic, or pulmonary origin and have occurred in the arterial circulation through the atrial septal opening through the pulmonary arterial hypertension or pulmonary veins The initial lesion may be clinically rather occult, and embolism may occur in pathological, atheromatous arteries, and clinical appearance may be more favorable for arterial thrombosis.

Stages and symptoms

The main signs of the disease rarely allow it to be diagnosed. The patient feels general weakness, drowsiness, irritability, dizziness. Insomnia, loss of consciousness, nausea or vomiting may occur. Patients often complain of pressure drops, numbness of the extremities and severe headache. As the disease progresses, these symptoms increase.

Acute arterial thrombosis is most often associated with chronic lesions of the walls of the arteries. lower limb: atheromatous stenoses are more or less dense and more or less dilated, and aneurysms, whose risk of obstructive thrombosis is predominant in small-caliber arteries such as the popliteal, and which have previously led to embolism in distal arteries, are easily silenced.

Thrombosis favors the development of atheromatous plaque, slowing the arterial flow, and increasing blood viscosity. For chronic arterial lesions, collateral circulation may develop, and thrombosis usually extends to the segment between two permeable collaterals, the anastomosis of which complements the main chest, maintaining some distal flow with incomplete ischemia. Finally, distal and diffuse thrombosis, arteriocapillary, can complicate acute limb thrombophlebitis with almost complete blockage of venous return.

Chronic cerebral ischemia has several stages or degrees, as they are also called. Naturally, ischemia begins with initial stage and gradually develops until it reaches severe. With the rapid development of the disease, the brain is completely affected within 2 years, and with a slow development - in 5 years.

Thrombosis may occur on a prior arterial pons of a prosthetic or venous nature, or on an arterial segment already treated by angioplasty with or without an endoprosthesis, due to the common factors already described, with fibrinous "alluvium" of the lumen of the eye, prosthesis with atheromatous degeneration of the vein in the bypass area, restenosis, myo-intimal hyperplasia, or false aneurysm at bypass implantation with degradation of the arterial layer upstream or downstream, or after a forced or extended position dotting or compressing the bypass.

Ischemia of the brain of the 1st degree is the initial stage, when all changes are still reversible. Symptoms of the disease, in addition to the main ones, are:

anisoreflexia;
depression;
aggressiveness;
cognitive disorders;
problems with coordination and gait;
migraine;
noise in ears.

Ischemia of the 2nd degree is characterized by an aggravation of the primary symptoms, as well as a rapid deterioration in well-being. New features of this stage include:

The prevalence of this cause increases with the number of arteriopathy undergoing revascularization. Trauma, including arterial trauma during medical research and gestures, traumatic openings or spontaneous openings where the false canal compresses the residual lumen of the iliac or fetal arteries, aortic ruptures that can interrupt the arterial flow of one or both iliac axis, internal or external compressions, and finally arterial spasms, usually bilateral or localized , and due to intra-arterial injection in a drug addict.

ataxia with impaired coordination;
extrapyramidal disorders;
disorders leading to personality change;
apathy.

3 degree of cerebral ischemia means that all changes are already irreversible. The patient cannot control his behavior and move independently. Also occur:

loss of consciousness;
urinary incontinence;
Babinski's syndrome;
Parkinson's syndrome;
mental disorders (dementia).

Warning: Fainting may be accompanied by sharp drops blood pressure and thready pulse. During loss of consciousness, there is a possibility of asphyxia. As for the inability of the patient to control his behavior, this condition consists in:

characteristic clinical picture is realized by an embolism at the level of a healthy embryonic artery. The beginning is cruel, in the form severe pain hip, which may have a "whiplash" character along the arterial path. Pain quickly spreads throughout the limb and is accompanied by numbness of the limbs, with a feeling of cold, tingling, maximum on the limb of the limb and muscle impotence, preventing any movement of the limb.

Interrogation indicates the time of onset and therefore the duration of ischemia, the height of the painful and impotent territory, the age of the patient and the search for history cardiovascular disease, potentially emboligenic with its recent evolution, its treatment. However, other cardiovascular and other clinical circumstances should be investigated.

forgetfulness;
stupor;
explosiveness.

Many people know what Parkinson's syndrome is. In the case of cerebral ischemia, the patient develops epileptic seizures, pastural instability, bradykinesia, and tremor. At this stage of the disease, a person is practically unable to perform the simplest actions. For example, it is difficult for him to even clench his fist. And because of mental disorders, a complete disintegration of personality occurs.

Examination comparing the two lower extremities finds a patch of skin rising more or less high on the extremities and discoloration of the nail beds. There is flattening of the superficial veins, which may even be excavated into a gutter. skin surface.

Palpation reveals skin cooling, pressure pain ankle joint, calf muscles, and on the other - the insensitivity of the skin to a pinch or puncture. The arterial impulse is not felt for femoral artery, and depending on the level of arterial obstruction, a femoral pulse is perceived or not. Paradoxically, the femoral pulse can be more prominent than on the contralateral side by stopping the systolic wave at an arterial obstruction. The pulse may be irregular. We must look for one or more masses more or less pulsating in the arterial pathways.

Ischemia in newborns

Chronic cerebral ischemia in infants is a fairly common occurrence. All the fault of cerebral hypoxia that occurred during childbirth. The disease is also divided into 3 stages, but problems often arise with its diagnosis, since not all symptoms can be tracked. Therefore, experts combined all the signs into the following syndromes:

Depending on the absence or presence of atheromatous disease arterial pulse the opposite lower limb is present or not located on different stages. Auscultation of the arterial axes of the extremities, abdomen, and neck requires possible breathing.

General examination includes, at a minimum, cardiac auscultation requiring arrhythmia, valvulopathy, lung auscultation, palpation of other peripheral arteries, measurement of blood pressure, search for possible hemodynamic imbalance. These clinical findings present a picture of acute sensorimotor ischemia, which is a therapeutic emergency of - due to the limited duration of the viability of ischemic tissues, not exceeding six hours, which justifies a quick transfer in the center vascular surgery, after injection of analgesic and heparin, with clinical protocol transmission.

Hydrocephalic. Children with this syndrome have an increased head size, increased intracranial pressure. The reason is the accumulation of cerebrospinal fluid and its circulation through the spinal cord.
Syndrome of neuro-reflex excitability. The baby has a change in muscle tone, a tremor occurs, bad dream, crying.
Comatose. The child is unconscious.
Syndrome of oppression of the central nervous system. Muscle tone changes, swallowing and sucking reflexes are weakened. Strabismus may develop.
Convulsive syndrome. Appear severe convulsions and twitching of the muscles of the body.

Consequences

Cerebral ischemia, even at the initial stage, can lead to various complications. Most often, hypoxia or metabolic disorders occur, leading to the appearance of other pathologies:

If the picture is less typical: incomplete ischemia, pre-existing atherosclerosis, suspected aneurysm, etc. Additional functional and morphological studies can be performed if obtained without loss of time to assist the therapeutic decision by indicating the condition of the arterial tree.

Arteriography, which can determine the state of the ascending arterial bed, the level and degree of obstruction, the presence of collateral circulation with more or less good addition of obstruction, with or without opacification re-opening beds d downstream. In more general plan, an arteriogram will be performed during detoxification of the arteries.

heart attack or stroke;
encephalopathy;
dumbness;
paralysis;
epilepsy;
paresthesia;
thrombophlebitis.

Some parts of the brain tissue die during a stroke and are no longer restored. And although modern medicine uses various methods treatment (for example, using stem cells), their effectiveness is questionable by many.

Therapeutic management requires a minimum overall score. This immediate diagnosis is important for therapeutic choice, but it should not distinguish ischemia as a priority. Before the arterial embolism table: cardiac arrhythmia, characteristic EG tracing in favor of complete arrhythmia in atrial fibrillation, common etiology in the elderly, need to continue anticoagulant treatment after arterial decomposition, to conduct ultrasound or thrombus in the left atrium.

Specific therapeutic treatment. mitral valve, possibly an already operated or mechanical aortic valve, is another embolic etiology and also requires investigation and therapeutic management. Infective endocarditis may be complicated by septic embolism, which is often multiple. The absence of overt heart disease may lead to the search for paroxysmal rhythm disturbances, and Holter-E may be required to detect them. The absence of cardiopathy should also lead to embolic arteriopathy: more or less ulcerative aortic artery, thoracic and abdominal aorta, iliac axis, aortic aneurysm, iliac, femoral or popliteal, or even look for the cause of a paradoxical embolism.

With encephalopathy, brain cells are destroyed, and with paralysis, a person loses the ability to move. And paresthesia leads to a loss of sensitivity and even more so, to a loss of speech with a full understanding of what is happening. In children, paresthesia can provoke mental retardation.

Chronic cerebral ischemia (CCI) develops very slowly and is almost asymptomatic in the first stages. Signs of the disease appear when the changes are almost irreversible. In any case, the success of treatment depends largely on how long the hypoxia of the brain lasted and how it affected the body.
Acute arterial thrombosis in an atheromatous patient, known or discovered in this case, may lead to typical acute ischemia or acute ischemia: the clinical onset is abrupt, but pain may be less intense, especially distal, pain alternating with areas of cutaneous cyanosis, neurologic deficits may be reduced to paresthesia, and decreased calf, foot, and capillary impulse strength may persist at the level of unregulated layers.

The existence of cardiovascular risk factors, cardiovascular antecedents, previous therapies, favorable circumstances favoring this etiology, as well as the absence of an obvious embolic outbreak, the discovery of arterial anomalies, other territories. If the state of the limb leaves time, an arterial echopler and, if necessary, arteriography can confirm this hypothesis, showing a constancy of the signal at the level of one or more arteries of the leg, more or less atheromatous lesions diffuse collateral circulation designed to reperfusion the arterial bed below thrombosis, possibly one or multiple aneurysms, these studies guide therapeutic gestures according to the lesions observed and the clinical situation.

Diagnosis and treatment

from correct and timely diagnosis The disease depends on the treatment, as well as a favorable prognosis for the patient. The doctor must necessarily talk with the patient, noting all the symptoms of ischemia, and also use following methods diagnostics:

Thrombosis of arterial bypass surgery is self-diagnosed in some cases. Regular monitoring of vascular surgery can reduce this risk of complications by diagnosing pathological changes which can be corrected by a preventive gesture. Hypercoagulable thrombosis will be diagnosed in the presence of a family and personal history of causative pathology already known or detected in the presence of ischemia in patients treated with heparin, but abnormalities of coagulation factors are unknown. which is not always easy to demonstrate in these emergency situations where anticoagulant therapy is rapidly introduced, blue phlebitis results in severe painful swelling of the extremities with cyanosis and cooling of the skin, which distinguishes it from white banal phlebitis.

Magnetic resonance or computed tomography. They allow you to identify inflamed foci of the brain, dilated ventricles and atrophic changes.
Ultrasound. With its help, the vessels of the brain, their tortuosity, anomalies, and impaired blood flow are examined.

For the treatment of chronic cerebral ischemia are used as medicinal methods as well as surgical . Attention: concerning surgical intervention, then it could be stenting carotid arteries or endarterectomy. And drugs that are used to treat cerebral ischemia are usually divided into several groups:

Antihypertensive therapy. It aims to maintain normal blood pressure. It is important that the patient does not experience pressure fluctuations. Most often, two types of drugs are used - antagonists or inhibitors. They can be combined with hydrochlorothiazide or indapamide.
antiplatelet therapy. Due to the activation of the platelet-vascular link of hemostasis, patients with cerebral ischemia are prescribed antiplatelet drugs, for example, Dipyridamole.
Lipid-lowering therapy. Such drugs, such as Atorvastatin or Simvastatin, improve endothelial function and reduce blood viscosity.
Combined drugs. If necessary, the doctor may prescribe a course of medications that are taken in the complex. It can be Piracetam and Cinnarizine.

Folk remedies

Recipes traditional medicine with cerebral ischemia should be used only with the permission of the doctor. The most effective are the following methods:

It will take 1 tbsp. l. galega officinalis, which is poured with 500 ml of boiling water and infused for several hours. Drink the infusion should be 100 ml 2-3 times before each meal. Galega officinalis can be replaced with sweet clover.
It is necessary to take in equal parts hop cones, catnip, nonea, chistets, white birch leaves and pour 1 tbsp. l. mixture pour 500 ml of boiling water. Insist for at least 3 hours and take 100 ml before meals.

Prevention

Unfortunately, cerebral ischemia is deadly disease and the complications are quite serious. Therefore, as a preventive measure, it is necessary:

Be outdoors more often.
Stick to proper nutrition. It can be a light diet, in which vegetables and fruits take up most of the products.
Get rid of bad habits. Alcohol and smoking are the first enemies of blood vessels.
Avoid stressful situations.
Play sports often. Physical exercise should be moderate.

Cerebral ischemia is a dangerous and insidious disease, which long time may be asymptomatic. Therefore, it is important to reduce the number of factors that can trigger the disease. This is especially true for those people who are at risk. That is, they have a suitable age, predisposition or concomitant diseases.

Cerebral ischemia is a common medical professionals name for circulatory insufficiency in the brain. In the literature, you can also find the concept of "dyscirculatory encephalopathy", these terms are identical.

Violation of blood circulation and a decrease in blood entering the brain leads to the fact that the brain begins to experience oxygen hunger, neurons experience a shortage of substances that feed them, and this leads to impaired signaling to the brain. As a result, there are frequent cases of mental disorders, metabolic disorders in the body due to the process of ischemia. During an illness, brain tissue lesions occur in the brain, which gradually expand.

Violations in circulatory system usually occur due to blockage, damage or narrowing, so cerebral ischemia is classified as a cerebrovascular disease, and it has a sufficient prevalence.

If the disease is not treated for a long time, it leads to hypoxia ( oxygen starvation) neurons of the brain, because of this, cysts can form in the cerebral cortex. and for its vessels - due to insufficient blood saturation nutrients and oxygen, the vessels of the vessel walls lose their self-regulation function, they can expand or contract arbitrarily, which, in turn, leads to headaches and dizziness.

Neglect of chronic cerebral ischemia often leads a person to disability. chronic disorder blood circulation of the brain causes loss of sensitivity, immobilization, helplessness, it is no coincidence that the disease is classified as a disease of the central nervous system, because in the process of its development, the functions for which the brain and nervous system are responsible are disturbed, and to be more precise, their healthy relationship.

With such complications, the patient is usually given a third disability group, he needs home care, because he is not even able to eat or go to the toilet on his own.

It must be remembered that the development of cerebral ischemia leads to dangerous lethal consequences.

You can name a lot of reasons that cause a violation of the blood circulation of the brain and chronic develops. So, they lie in the following factors:

genetic predisposition. The disease is not inherited, but if a person in the family had relatives suffering from cerebral ischemia, then the risk of getting sick is much higher;
atherosclerosis. A common cause is atherosclerosis, because with this disease the vessels of the brain suffer, atherosclerosis contributes to the formation of plaques on the walls of blood vessels and slows down blood circulation. As a result, brain hypoxia develops;
diabetes;
pathology in venous system(thrombophlebitis);
blood diseases. In ischemia, indicators such as blood viscosity and coagulability are important. If they are above or below a certain value, then this is a violation, which will not be slow to affect general condition blood flow in the body and, in particular, in the brain;
spinal diseases. It is worth remembering that the main arteries through which blood aspires to the brain are located within the spine and neck. Accordingly, impaired blood circulation in the spine immediately affects the state of the brain and its cells. To diseases of the spine that can have Negative influence arteries and vessels include osteochondrosis, spondylarthrosis, etc.;
elderly age. This factor simply shows the pattern that the older a person is, the more he is at risk of circulatory disorders;
bad habits and malnutrition. Alcohol, smoking, harmful fatty or smoked foods - all this contributes to vasoconstriction, the development of atherosclerosis, and this, as already mentioned, has a very negative effect on blood flow to the brain;
permanent changes in blood pressure. This reason applies to a lesser extent to people suffering from vegetative-vascular dystonia, to a greater extent - to people who develop hypertension. Constant pressure surges adversely affect the functionality of blood vessels.

Degrees of ischemia

In medicine, it is customary to distinguish three degrees of development of chronic cerebral ischemia.

cerebral ischemia is characterized emotional disorders and deterioration in general well-being. The patient may begin headaches, mostly pressing, and dizziness. Because of this, often with this degree of ischemia, problems with hearing and vision begin, however, they are quite short-lived. The stage of chronic cerebral ischemia in the 1st degree is also typical of its neurological disorders. It is important to start treatment at the stage of ischemia and the first degree in time to prevent further development diseases.
ischemia of the second degree is characterized by a worsening of symptoms, that is, all the same symptoms appear as in the first stage, but only they become more frequent and serious. Neurological disorders are so pronounced that they can be diagnosed by the patient himself. And most importantly, what happens in the second stage of cerebral ischemia is the loss of working capacity (complete or partial). Cerebral ischemia of the 2nd degree gives rise to helplessness in a person, he needs constant help in everyday situations, not to mention the fact that he has to forget about any work - physical or mental;
ischemia of the third degree is the most dangerous form of the disease, often its result is death. In the third stage, dementia develops, because the brain loses many functions and is not able to communicate normally with nervous system. Memory worsens, attention disappears, a person becomes distracted, and his reflexes are completely inhibited. For patients with ischemia of the third degree, cases are not uncommon epileptic seizures and loss of consciousness.

If the ischemic disease of the brain has reached the third stage, then it has already made changes in the human body that cannot be prevented. Treatment of a patient at stage 3 of the degree is to alleviate his symptoms for a while. But a timely visit to the hospital (at the first stage of the development of the disease) has a very good chance of stopping the progression of the disease and its retreat.

Symptoms

In the very embryo of chronic ischemia, he rarely sees a doctor, because its symptoms at the initial stage are reduced to fatigue, fatigue, headache (mainly in the evening). More serious symptoms appear a little later - these can be dizziness, worsening sleep (frequent awakenings), irritability, short-term memory loss. If these symptoms appear, you should immediately make an appointment with a doctor.

It is also worth being examined by a specialist if in the recent past there has been a supratentorial brain injury - a blow to the occipital lobe of the skull. The fact is that it is an incompressible liquor liquid. Therefore, when a blow to the back of the head occurs, first of all, not cracks and damage, but defects blood vessels. Therefore, if a person has had a traumatic brain injury, he is recommended to undergo an MRI or CT scan of the brain in order to. This is how chronic cerebral ischemia develops.

So, frequent symptoms CCI (chronic cerebral ischemia) are:

pressing headaches. The head becomes as if heavy, the pain presses on the forehead, temples;
frequent mood swings, irritability;
unsteady walking (staggering, change in gait);
impaired hearing, vision, memory;
sleep disturbances (frequent awakenings, insomnia and daytime sleepiness, weakness).

The above symptoms are typical for the first and second degrees of cerebral ischemia, but in the third stage of CCI they develop into something more. Patients with the third degree of ischemia can (tremor of the hands and head), dementia, impossibility of intellectual activity, epilepsy.

The initial diagnosis of chronic cerebral ischemia includes:

general clinical examination, questioning the patient about complaints and descriptions of symptoms that have already manifested themselves;
cardiological examination (electrocardiography or echocardiography);
blood chemistry. The patient's blood is carefully examined, revealing such parameters as viscosity, coagulation, the presence of cholesterol, the content of lipid fractions and glucose;
CT ( computed tomography) or MRI (magnetic resonance imaging) of the brain;
doppler.

All these diagnostic methods are mandatory, since it is possible to detect circulatory disorders in the brain only with the help of a set of procedures.

Brain treatment

It is worth remembering that cerebral ischemia is treatable only at its first stage. In the second and third stages, the processes occurring in the body are mostly irreversible and can have fatal consequences.

The first degree of ischemia allows specialists to prevent most severe symptoms. Moreover, a timely visit to the doctor can often identify other existing diseases, because ischemia often occurs as a result of other ailments, which also cause damage and disruption of the blood vessels.

correct ambulatory treatment includes not only medications but also lifestyle changes, diet. The doctor will definitely recommend not to eat fried, smoked and salty foods - they are harmful to the activity of blood vessels. You need to eat fresh vegetables, fruits, dairy products, drink green tea. These ingredients tone the state of blood vessels, make their walls more elastic.

Among the drugs and drugs that doctors usually prescribe are:

Atorvastatin, Simvastatin - with atherosclerosis and the formation of plaques on the vessels of the brain;
Piracetam, Encephabol - to resume normal metabolism inside the brain;
Cardiomagnyl - to reduce blood clotting.

In addition, head and neck massages and physiotherapy procedures can become an integral part of the treatment. individual means treatment prescribed by the attending physician.