Symptoms, degrees, consequences and treatment of cerebral ischemia
Cerebral ischemia is a decrease in blood flow caused by cerebral atherosclerosis (from the Latin cerebrum - brain).
The brain has the following functions:
- thinks;
- processes information coming from the senses;
- coordinates body movements;
- determines mood, creates an emotional background;
- controls attention;
- stores information;
- generates speech.
A failure in its work threatens the vital activity 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 same reasons for temporary blindness. The brain is engaged in decision-making, therefore, in patients with CCI - chronic cerebral ischemia - inhibition of thought processes is observed.
Any pathology of the upper part of the central nervous system - the central nervous system - negatively affects many factors of vital activity. Symptoms can be hidden - this is typical for the initial stage of the disease. The brighter they appear, the more the disease is started.
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, microstroke or an attack of acute cerebrovascular accident - stroke. This is transient ischemia, otherwise - a transient violation of cerebral circulation - PNMK or ischemic stroke. The cause of an acute condition is blockage of the blood flow by an embolus or an advanced chronic form of the disease. The latter, in turn, develops gradually as the bloodstream narrows.
Cholesterol plaques are lower density lipoproteins. 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. Blood clots are dangerous with the possibility of developing an inflammatory process.
Prevention of ischemia, like many other diseases, consists in maintaining a healthy lifestyle. It is necessary, if possible, to avoid stress, not to overeat, adhere to an "anti-cholesterol" diet, play sports, give up alcohol and smoking, be in the fresh air.
Content:
- Symptoms of GM ischemia
- Causes of GM ischemia
- The degree of GM ischemia
- GM ischemia in newborns
- Consequences of GM ischemia
- Diagnosis of GM ischemia
- Treatment of GM ischemia
- Neuroprotective therapy for discirculatory encephalopathy
Symptoms of cerebral ischemia
There are many symptoms of cerebral ischemia:
- dysfunction of the nervous system, causing speech disorder or vision problems;
- fatigue;
- general weakness;
- drowsiness;
- decreased performance;
- amnesia;
- sudden mood swings;
- irritability;
- nervous excitement;
- insomnia
- headache;
- drops in blood pressure - blood pressure;
- shallow and rapid breathing;
- dizziness;
- loss of consciousness;
-
nausea;
- vomiting;
- numbness of the limbs;
- feeling of coldness in the palms and feet.
As the disease worsens, symptoms may worsen. It progresses in stages. Experts distinguish between 3 stages or degrees of ischemia. Some also highlight the fourth.
The symptoms of an ischemic attack should be listed separately:
- attacks of zonal loss of sensitivity;
- paralysis of a part or half of the body;
- monocular vision loss (one-sided blindness).
Eye problems arise because signals from them go to the visual cortex of the brain, located in the occipital lobe. Local numbness is due to the fact that 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 more are responsible for human motor activity. 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, 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 symptoms are very individual, because in different people, different parts of the main organ of the central nervous system are affected. Observations of the patient's relatives play an important role in the diagnosis. They are able to give a more accurate description of the changes taking place. Due to the lethargy and confusion of consciousness, one cannot completely rely on the patient's words.
Causes of cerebral ischemia
There are basic and additional prerequisites. The first include insufficient cerebral circulation, which leads to hypoxia - oxygen starvation. It occurs due to narrowing of the lumen of the artery or its complete blockage - obstruction. Cells cannot function fully without oxygen. If this process is delayed, necrosis may begin - tissue necrosis, otherwise called a heart attack. Cerebral hypoxia is characteristic of pathologies such as arterial hypertension and atherosclerosis due to the growth of fatty deposits on the inner wall of cerebral vessels.
Blocking the lumen of a cerebral artery by a thrombus is called thrombosis. A blood clot forms directly in the brain or is carried with the blood from another part of the body. A "traveling" thrombus is called an embolus. It forms 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 part 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 impaired central hemodynamics. For example, acute heart failure on the background of myocardial infarction, bradycardia, tachycardia;
- ischemic kidney disease;
- decompression sickness;
- vascular abnormalities such as compression, local spasm of the artery;
- compression of an artery from the outside, for example, a tumor;
- carbon monoxide intoxication;
- hereditary angiopathies;
- 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, provoking an increase in its viscosity;
- advanced age;
- obesity;
- smoking.
There are many causes of ischemic disease, but the main one is complete or partial blockage of the bloodstream. There can be a lot of factors that cause the formation of plaques or pathological protrusions of the walls of blood vessels due to tumors or other abnormalities in the surrounding tissues.
The degree of cerebral ischemia
The degrees or stages differ in signs and the strength of their manifestation. The disease progresses from initial or mild to subcompensation or moderate, and then to decompensation or severe. This division is due to the coverage area of the central nervous system. At the last stage in newborns, it is completely affected. The prognosis is poor.
The intensification of 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 appear in the brain, the more the disease takes over the body. At the last stage, structural organic damage to 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 stress, pressure on the brain cells. This is how hydrocephalus develops.
There are 3 rates of ischemia progression, 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 rehabilitation period. Its duration and intensity of the procedures performed are determined by what stage the disease has reached.
Ischemia of the brain 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: distraction of attention, decreased cognitive activity, forgetfulness, inhibited thought process - stupor;
- change in gait (the patient shuffles or minces his legs);
- problems with coordination of movements;
- "Heavy" head, constant migraines, dizziness, tinnitus.
Oral automatism reflexes are only normal for young 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 manifest themselves with different strengths. At this stage, slight asymmetry appears.
The first degree is treated relatively easily and without aggravating consequences. Infantile cerebral ischemia is curable, but if the ominous symptoms cannot be achieved within a week, the disease progresses to the second stage.
Cerebral ischemia 2 degrees
Subcompensation is a stage of aggravation of primary signs and deterioration of well-being. All signs of the first stage become pronounced with an average 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 and mnestic disorders leading to personality degradation;
- apathy - indifference, narrowing the range 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 vessel blockage. Adults at this stage can no longer cope with their professional duties. They cannot concentrate on anything, not even just read. In some cases, hospital treatment is necessary.
All syndromes continue to progress. Tearfulness may appear. The peculiarity of the moderate degree is that mental disorders occur. But the ability to self-service remains. As soon as it disappears, the patient needs constant care.
Cerebral ischemia grade 3
Decompensation occurs when all the capabilities of the brain are exhausted. At the last stage of the development of the disease, multiple lacunar and cortical infarctions occur in the brain. The patient cannot move independently, loses balance. Symptoms associated with a severe degree:
- fainting;
- psychoorganic syndrome;
- urinary incontinence - incontinence;
- swallowing disorder - choking while eating;
- Parkinson's syndrome (parkinsonian), more precisely, amiostatic or akinetic-rigid;
- disinhibition - inappropriate behavior;
- apathy-abulic syndrome with a decrease in willpower;
- Babinsky discoordinator 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 the absence of their response to light. It is difficult to listen to the pulse, it is threadlike. The patient needs to be given first aid, turn him to one side. There is a danger of asphyxiation during fainting. The muscles of the tongue are so relaxed that it can block the oxygen supply.
The psychoorganic syndrome consists of 3 components. This is forgetfulness, stupor and explosiveness - the inability to control your behavior. Emotional breakdowns become characteristic of a person, he quickly goes into a state of extreme excitement, inadequately reacts strongly to what is happening.
Parkinsonism combines:
- tremor;
- muscle rigidity - constant increased tone;
- epileptic seizures;
- postural instability - the inability to maintain balance;
- hypomimia - poverty of involuntary mimic reactions (Bekhterev-Notnagel symptom);
- bradykinesia - slowing down of movements, 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 a fist. Praxis is translated from Greek as "action".
Mental deviations lead to a disorder of perception of the real world and, as a consequence, disorganization of behavior. Psychiatric disorders reach complete personality breakdown.
Symptoms of various degrees of coronary artery 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. It is not easy to diagnose the disease in babies. at this age, it is impossible to identify some symptoms of ischemia.
All signs are combined into syndromes:
- Hydrocephalic. The head is enlarged, the fontanel area is enlarged, intracranial pressure is increased. It is caused by the accumulation of cerebrospinal fluid (CSF). It is formed in the brain and circulates through the spinal cord. Cerebrospinal fluid overflowing under the bones of the skull causes hydrocephalus;
- Syndrome of increased neuro-reflex excitability. Changes in muscle tone, flinching, tremors - involuntary trembling of the limbs, exacerbation of reflexes, constant crying and restless sleep;
- Comatose. Unconsciousness with a lack of coordinating function of the brain;
- Syndrome of central nervous system depression. Reduced muscle tone, decreased motor activity, weakened sucking and swallowing reflexes, squint and facial asymmetry may appear;
- Convulsive. Paroxysmal twitching of the whole body appears. Cramps or spasms are involuntary muscle contractions.
The severity of cerebral ischemia in newborns and in adults is somewhat different due to age characteristics:
- First degree (easy). 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 brain damage in a newborn leads to organic damage to the central nervous system. Inevitable consequences such as ataxia - motor disorder, delayed psychomotor development, seizures, hearing and vision impairment.
The constant monitoring of pediatricians in the first week of life, as well as a set of studies, helps to detect neurological abnormalities in children in time. Pediatrics every year improves the methods of treating ischemia. If earlier such a diagnosis was a verdict, and the baby was doomed to disability, now in the early 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.
See also: Pine cones - an effective treatment for post-stroke and post-infarction conditions
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 on the basis of ischemia. The main negative factors of this disease are hypoxia and metabolic disorders.
They provoke the development of other pathologies:
- ischemic stroke or infarction (necrosis) of the brain (more often in people over 60);
- chronic discirculatory encephalopathy or cerebral vascular sclerosis;
- paralysis;
- sensitivity disorder - paresthesia;
- dumbness;
- epilepsy;
- thrombophlebitis.
With a stroke, part of the brain tissue softens and dies. Nerve cells are not regenerated. Modern methods of treatment include the use of stem cells. The latest technology is designed to replace dead cells of any type. There are many conflicting opinions about its application. There are clinics that actively use this technique.
Encephalopathy is an organic lesion of the brain that occurs without inflammation. Dystrophy of the brain tissue 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 may occur - paralysis of the limbs, or the person will completely lose the ability to move.
Feeling of numbness can be accompanied by tingling, burning, “creeping creeps”, aggravated by physical exertion. Paresthesia also has a mirror-like 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 consciousness understands everything, but cannot speak.
The consequences for newborns can be expressed as mental retardation and learning difficulties. A small person will pay dearly even for a relatively short-term oxygen deprivation during intrauterine development. Compliance by a pregnant woman with all doctor's prescriptions is a guarantee of the health of her baby.
HIGM - chronic cerebral ischemia - differs from the acute form in that it progresses slowly and secretly. Even close people do not always immediately notice the negative changes taking place. 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
Ischemia is not easy to diagnose because its symptoms are very similar to those of diseases such as:
- progressive supranuclear palsy;
- cortico-basal degeneration;
- multisystem atrophy;
- Parkinson's disease;
- a brain tumor;
- Alzheimer's disease;
- normotensive hydrocephalus;
- idiopathic dysbasia;
- ataxia.
In order to avoid mistakes, the neuropathologist must use an integrated approach. A physical examination is performed. The state of the respiratory and cardiovascular systems is assessed, the neurological status is determined.
An ultrasound examination is prescribed - ultrasound of one of the types:
- ultrasound dopplerography - USDG;
- duplex scanning of vessels - DS.
To determine the neurological status, the doctor assesses the patient's condition:
- clarity of consciousness;
- pupil response to light;
- consistency 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 imaging or Doppler imaging only shows blood flow velocity. 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 blood flow.
You may also need angiography MR (magnetic resonance) or CT (computed tomography) of the type. This is a type of X-ray examination using iodine contrast staining of blood. Unlike ultrasound, this requires special preparation and additional research: fluorography and electrocardiogram - ECG. Do not eat or drink before the procedure. The dye is injected through the puncture, a catheter may be needed.
Neurologists use specific tests for diagnosis. For example, finger-nose test or Romberg's pose: standing, legs together, with closed eyes and arms extended forward. ECHO-KG, general and biochemical blood tests are used to identify concomitant pathologies. For neuromonitoring, electroencephalography is also used - EEG, cardiography.
Diagnostics 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 a fatal outcome. Conservative treatment begins with eliminating the cause of the disease - problems with filling the brain with blood.
Microcurrent electroreflexotherapy - ERT improves the functioning of neurons in the cerebral cortex and normalizes blood circulation.
The drugs used for drug treatment can be divided into several groups:
- neuro- or cerebroprotective agents that protect the neurons of the brain. For example, the nootropic Cerebrolysin or the antioxidant Mexidol;
- reducing the permeability of the walls of blood vessels, strengthening them, stimulating blood circulation. Vasodilator and anticoagulant or blood thinning drugs are used;
- hypolipidemic, correcting lipid metabolism.
Treatment of ischemic brain disease is carried out according to the scheme: neurons - blood vessels - metabolism. As a result, the cells are again saturated with oxygen, the intercellular metabolism returns to normal. Normalization of blood pressure is necessary to prevent ischemic attacks and strokes.
After normal blood flow is restored, motor skills do not return immediately. A rehabilitation period is required. A course of massage is required, physiotherapy exercises - exercise therapy, electro- and / or magnetopharesis.
On the subject: 3 products that save ischemia
Surgical treatment for occlusive-stenotic lesions of cerebral vessels is carried out through the operation of stenting of the carotid arteries, thromboectomy - in order to remove a thrombus, carotid endarterectomy.
Stem cells. Stem cell therapy is of growing interest. It is a source of natural regeneration. Before the procedure, a biomaterial is taken from the patient. From the obtained cell culture, mesenchymal (embryonic) stem cells are isolated and cultured to the required volume.
Transplantation - introduction - occurs twice with the help of a dropper. The procedure lasts no more than an hour. The patient can then return home. New cells are transported through the bloodstream to the affected area. They attach to healthy tissue and begin to multiply. Stem cells also create new networks of collateral pathways. These are auxiliary, roundabout, lateral vessels that carry blood bypassing the main channel.
Traditional methods of treatment are highly questionable. This is the use of infusion on the leaves of walnuts, dill water, garlic tincture. Of course, beneficial plants can contribute, for example, to thinning the blood, but relying only on them is deadly.
If the patient consults a neurologist too late, then serious consequences cannot be avoided. Unfortunately, cerebral ischemia is a frequently fatal disease. An inattentive attitude to one's health always ends with the emergence of pathologies. In cases of cardiovascular disease, the lack of timely treatment is fraught with death.
Neuroprotective therapy for discirculatory encephalopathy
Cerebrovascular disorders, provoked by atherosclerosis and hypertension, affect more and more people every year. General statistics for this group of diseases indicate the annual increase in patients with acute cerebrovascular accidents.
Diagnosis and diagnosis
Dyscirculatory encephalopathy (chronic cerebral ischemia) is a progressive diffuse brain damage caused by impaired supply of brain cells with oxygen and nutrients due to a gradual deterioration of the blood supply to the brain tissues.
Separate statistics on the incidence of CCI - chronic cerebral ischemia, or discirculatory encephalopathy, are currently not kept, according to doctors, 7 out of 1000 people suffer from the disorder.
The main clinical manifestations of chronic cerebral ischemia are:
- headaches;
- 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 the vessels of the brain in combination with arterial hypertension (hypertension). The combination of the 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, oxidative, or oxidative, stress builds up over time - a lack of oxygen disrupts the natural breathing process 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 the slow destruction of brain tissue as a result of oxygen starvation, the symptoms of CCI become more pronounced, and the changes in the patient's brain become irreversible and not amenable to correction.
How do I stop the process?
Early diagnosis of chronic cerebral ischemia and adequate therapy allows the patient to almost completely restore the process of supplying oxygen 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.
For over 20 years, sequential therapy with the original Mexidol® has been the gold standard in antioxidant therapy. The first stage, the so-called saturation phase, lasts 14 days and consists of a course of intravenous or intramuscular injections. To ensure a gradual cumulative effect, the dosage of the drug at the first stage is 500 mg, or 10 ml per day intravenously or intramuscularly. Since the Mexidol solution can be administered intramuscularly, the course of injections is possible at home.
After two weeks, the patient's condition begins to improve, and in order to maximize the therapeutic effect, therapy continues with Mexidol® FORTE 250 - 1 tablet 3 times a day. Tableted stage of therapy - the phase of maximizing the therapeutic effect - lasts 2 months.
Since CCI is a chronic condition, treatment is performed twice a year, in spring and autumn. The regularity of prophylactic courses of the drug allows you to avoid seasonal exacerbations of the disease and deterioration of the patient's condition, including stroke.
Author of the article: Sokov Andrey Vladimirovich | Neurologist
Education: In 2005 completed an internship at the IM Sechenov First Moscow State Medical University and received a diploma in Neurology. In 2009, completed postgraduate studies in the specialty "Nervous diseases".
