Atherosclerosis Of Cerebral Vessels

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

What is cerebral atherosclerosis?

Atherosclerosis of the cerebral vessels is a steadily progressive systemic lesion of the vessels located in the corresponding organ. In medicine, you can find other definitions of this disease, for example, cerebral atherosclerosis or atherosclerotic lesions of cerebral vessels, but the essence remains unchanged. The work of the central nervous system is disrupted, which gradually leads to irreversible consequences.

The etiopathogenetic mechanism of the development of atherosclerosis of the brain is associated with metabolic disorders of a protein-lipid nature, with damage to the intima of cerebral vessels by the products of their decay and directly by the fatty complexes themselves, with the formation of atherosclerotic plaques.

According to statistics, in the vessels of the brain, atherosclerosis most often affects the arteries of the subcortical nodes, arteries of the thalamus and pons. In most cases, the formations are formed as fibrous plaques, lipoidosis is less common.

Men are more susceptible to damage than women. In them, serious atherosclerotic changes begin to affect the vessels of the brain 10 years earlier. However, at an older age (after 55 years and older), both women and men suffer from this pathology of the cerebral vessels to about the same extent. Statistics inexorably indicate that in recent years there has been an increasing number of sick people of young age, barely 30 years old.

In addition, certain atherosclerotic lesions of the cerebral vessels are most often observed in people who suffer from hypertension.

Content:

Symptoms of cerebral atherosclerosis

Causes of the disease

Diagnostics

Treatment of cerebral atherosclerosis

Diet

Prevention

Symptoms of cerebral atherosclerosis

Among the obvious signs indicating the development of pathological lesions of the cerebral vessels, one can single out:

Bad memory. Severe memory loss, which manifests itself in forgetting events that have occurred in recent times. At first, memory impairments make themselves felt episodically, they are especially noticeable only after mental and physical fatigue. As atherosclerosis progresses, the failures become more and more noticeable, but the memory of past events persists for a long time. On the subject: 15 substances that speed up the brain and improve memory.
Decreased mental performance, which manifests itself in the form of rapid fatigability. The patient is not able to focus his attention on a certain object for a long time, to concentrate his own thoughts.
Emotional lability is another common symptom of cerebrovascular atherosclerosis. At the same time, a person's mood is characterized by instability, variability. That is, even minor events lead to the appearance of a brightly colored emotional reaction. Most often, such people are tearful, prone to depression and increased anxiety, they often have fears for their own health, there is lack of confidence in their own abilities.
Insomnia. Patients often complain of regular insomnia.
Headache. The invariable companions of this type of cerebrovascular disease are headaches and frequent dizziness. They differ in that they arise during the period when a person changes his position from horizontal to vertical. That is, in other words, he gets out of bed, and not even with a jerk, but rather slowly.
Epilepsy is another striking symptom of progressive cerebral atherosclerosis of the vessels of the brain, observed in older people. It is expressed in the occurrence of seizures.
Senestopathy, as symptoms of atherosclerosis of the vessels of the brain, is manifested in the fact that a person complains of tingling in the face, numbness of the legs, and the appearance of heat in the occipital region.
Cheyne-Stokes breathing or periodic breathing, which is characterized by certain cycles: shallow breaths are replaced by deep ones, after the seventh breath, breathing again becomes rare, then there is a pause and the cycle repeats. Most often, such breathing is observed when the arteries that feed the medulla oblongata are damaged by atherosclerosis.
Ataxia is more often observed with damage to the arteries, feeding the cerebellum or the vestibular apparatus. It is expressed in the inconsistency of the movements of various muscles, in the loss of balance when walking and standing, in the inaccuracy and awkwardness of movements, while the strength of the limbs is not lost.
In addition, in patients, to one degree or another, speech, auditory and visual disturbances, as well as transient paralysis, are manifested. It is often difficult for the patient to tolerate loud sounds, an irritable reaction to light may occur.

It is advisable to distribute the symptoms of atherosclerosis of the vessels of the brain over several periods, for a clearer understanding of the progression of the disease:

The first stage is characterized by pseudo-neuroasthenic manifestations with recurrent headaches, tinnitus, sleep disorders, intolerance to bright light, loud sound, decreased performance and other manifestations of a similar nature.
The second stage of the development of the disease is marked by more pronounced clinical manifestations, with the development of depression, anxiety-delusional symptoms, with confusion.
The third stage is characterized by the development of dementia with severe memory impairment. Dementia is formed against the background of organic brain lesions by atherosclerosis. A person becomes helpless, disorientation in time may occur, however, generally accepted norms of behavior remain intact for a long time.

An important symptom that should be known both to the patients themselves and their relatives with cerebral atherosclerosis is a cerebral or hypertensive crisis. It is accompanied by headaches, and quite intense, there may be weakness in one upper or lower limb. Often, a crisis is accompanied by visual and speech disorders. As a rule, it lasts up to 2 days, and then the patient's condition stabilizes. If symptoms persist after this time interval, then it makes sense to assume that these manifestations are signs of a stroke.

After suffering a crisis, the patient is complacent, may be in a euphoric state, while all interests are reduced to everyday issues, and normal working capacity is lost.

Causes of atherosclerosis of the brain

The factors leading to the development of atherosclerosis, localized in the vessels of the brain, are identical to the risks that form atherosclerosis of any blood pathway. It is important to remember that any atherosclerotic plaque can develop over several decades.

Influence on the speedy progression of the pathological process can be:

Smoking. The World Health Organization claims that it is the intake of tobacco smoke into the body that becomes a factor provoking the development of cerebral atherosclerosis. Its action is multifactorial, but the most dangerous effect is the narrowing of the cerebral arteries and the gradual loss of their elasticity.
High blood pressure. If arterial hypertension remains for a long time without the proper therapeutic effect, then this leads to a thickening and narrowing of the blood vessels of the brain, as a result of which the risk of atherosclerotic plaques and stroke increases.
Diabetes. With the development of the disease, there is a violation of the processing in the body of not only glucose, but also lipids, which ultimately have a detrimental effect on the vessels of the brain. Moreover, diabetes mellitus leads to high blood pressure. In combination with the existing arterial hypertension, diabetes mellitus increases the risk of developing pathological vascular lesions by 4 times.
Obesity. In overweight people, as a result of lipid and carbohydrate metabolism disorders, a stable increase in blood cholesterol occurs, which is a powerful factor provoking the development of atherosclerosis. Moreover, the problem of overweight is relevant at this point in time, according to statistical data, about 25% of the Russian population suffers from obesity. Moreover, these people are of working age.
High blood cholesterol. Regardless of what leads to an increase in its amount, the risk of developing cerebral atherosclerosis increases several times. Especially the danger increases against the background of a stably elevated level of LDL.
Male or gender reason. It is under the age of 60 that men have a great chance of getting a diagnosis of cerebral atherosclerosis. Although after a woman passes menopause, the chances of suffering from atherosclerosis of the brain are equated. This is due to the fact that the level of estrogen, which inhibits the development of atherosclerosis in the female body, decreases significantly after menopause.
Heredity. If the family had relatives who at an early age suffered from atherosclerosis of the cerebral vessels, then the risk of a similar pathology increases significantly.
A diet high in saturated fat has a negative effect on the health of blood vessels, including the brain. This, first of all, leads to an increase in cholesterol levels and an early proliferation of atherosclerotic plaques. In addition, in the presence of a hereditary predisposition, a diet high in fat can provoke an increased action of the existing genes responsible for increasing cholesterol levels. As a result, its synthesis will become anomalous.
Minimal physical activity or physical inactivity is one of the most powerful factors in the progression of cerebral atherosclerosis. Any load: walking, running, swimming - accelerates the elimination of HDL from the body and helps prevent disease.
Age is a factor provoking the development of pathology, which cannot be excluded. The first fatty spots on the vessels are found already at the age of 10 years, and they become most pronounced on average by 50 years. This is due to both the action of other provoking reasons and a slowdown in metabolic fatty, carbohydrate, vitamin processes in the body. Disruptions in the functioning of the immune system, endocrine gland, liver, multiple infections, etc.
Stress and bad habits in general are the cause of many diseases, and cerebral atherosclerosis is no exception.

Diagnostics of the cerebral atherosclerosis

In order to establish the presence of a lesion, it is often necessary to visit several specialists. Indeed, in addition to neurological disorders, the patient often complains of hearing and vision disorders. In addition, clinical symptoms are often not observed at all, or a person does not attach due importance to them, and the first serious reason for a comprehensive diagnosis is, at best, a cerebral crisis, and at worst a stroke.

If atherosclerosis of the cerebral vessels is suspected, the patient should be referred from any specialist to a neurologist. Further clarification of the diagnosis and necessary for this study are assigned to them. In the diagnosis of cerebral vascular disease at this point in time, methods based on ultrasound prevail.

So that an accurate diagnosis is made, the patient can be sent to:

Duplex scanning. First of all, this study provides information about the state of the extracranial arteries that feed the brain. In combination with ultrasound examination of the cranial arteries, doctors get a fairly complete picture of having atherosclerosis. This kind of study allows you to assess the degree of narrowing of the vessel, to determine the nature of the existing atherosclerotic plaque.
Transcranial Doppler ultrasound is a study that allows you to assess the state of the intracranial vessels.
Angiographic examination of cerebral vessels. This is one of the varieties of X-ray methods. It is known that the vessels are not visible on x-rays, therefore angiographic examination involves the introduction of a contrast agent intravenously. However, due to the high trauma, this method can be carried out only on strict indications.
Computed tomography is used primarily in stroke patients. It is necessary to clarify the affected area and determine the tactics of further treatment of cerebral atherosclerosis.
Additionally, you will need an immunological blood test and the detection of cholesterol levels.
Magnetic resonance therapy is also used to study the state of the cerebral vessels and provides the most accurate information about the atherosclerotic plaques present. However, not every polyclinic has a tomograph at its disposal, therefore this research method is not as popular as research carried out using ultrasound.

If, according to the results of the studies, the neurologist sees that the vasoconstriction exceeds 50%, then the patient is sent for a consultation and possible further examination to a vascular surgeon. He re-evaluates the condition of the admitted patient and then decides on the cost-effectiveness of the surgical intervention.

Treatment of cerebral atherosclerosis

Therapy for this pathology is a long and often lifelong process. The solution to this problem is dealt with by a neurologist whose duties include identifying people with similar problems, assessing the severity of the disease and implementing conservative therapy. First of all, it is designed to improve the blood supply to the brain, to become the prevention of arterial thrombosis.

Drug treatment

As for therapy with drugs, the modern scheme of exposure is reduced to:

Antiplatelet therapy, which aims to reduce the risk of ischemic stroke. The drugs used for this purpose are acetylsalicylic acid and clopidogrel. However, a preliminary study of hemostasis is required.
Reducing cholesterol. In parallel, drugs are used to lower blood cholesterol levels. These can be statins (inhibiting the synthesis of cholesterol in the liver, lowering LDL and raising HDL) - lovastatin, atorvastatin, simvastatin, pravastatin, as well as fibrates (lowering cholesterol and triglyceride levels) - gemfibrozil, fenofibrate, clofibrate. In addition, anionic exchange resins or bile acid sequestrants are prescribed, which promote the elimination of cholesterol, examples of these agents: hestyramine, colestipol. Ezetimibe, atromide, miscleron, etc. will help to reduce the absorption of cholesterol in the small intestine.
In addition, in complex therapy, patients are prescribed drugs aimed at preventing the development of circulatory disorders. It can be coronary artery disease, as well as drugs that dilate the arteries and anticoagulants with the threat of blood clots in the vessels of the brain.
Iodine preparations and diosponin will help reduce cerebral ischemic disorders. In addition, for the same purpose, calcium iodine, potassium iodide or iodine solution can be prescribed. The drugs are taken in courses to exclude iodism.

Read more: Drugs for the treatment of atherosclerosis

Surgery

When hemodynamically significant stenoses are found, or complete blockage of the arteries, or unstable plaques, the vascular surgeon decides whether surgery is necessary. Modern medicine has reached significant heights in the matter of conducting reconstructive operations on the vessels, including the brain.

At the moment, the following types of surgical intervention are available:

Endarterectomy. It is based on the fact that fat build-up is eliminated by an open method. For this, a skin incision is made in order to gain access to the clogged vessel. After that, the surgeon stops blood flow in this place, the wall of the blood pathway is quickly dissected and the fatty deposits are removed. After such manipulations, the surgeon can only sew up the damaged area with a vascular suture. In this way, plaques on extracranial vessels can be removed.
Stents and balloons. To eliminate atherosclerotic formation on the intracranial vessels, stents and balloons are used. That is, endoscopic removal of the atherosclerotic plaque is necessary. For this, an endoscope with a stent is inserted into the widest vessel, and then under constant X-ray monitoring, it is advanced to the place where there is a narrowing of the artery due to the presence of plaque. It is there that the stent is installed, which, by increasing the lumen of the vessel, restores the flow of blood through it.

It should be understood that cerebral atherosclerosis is classified as a chronic disease, so treatment is most often lifelong. Depending on how timely the diagnosis was carried out and the treatment started, the prognosis will also depend. In the practice of neurologists, extensive forms of atherosclerosis of the vessels of the brain are known, which, nevertheless, allowed people not only to live for a long time, but also to remain efficient. However, there are often cases when the first clinical manifestation of this disease ends with a stroke and death for a person. Therefore, doctors distinguish such an important role in the timely diagnosis of the disease and its qualified treatment.

Neurologist M. M. Sperling in his lecture "How to treat cerebral atherosclerosis?"

Diet for atherosclerosis of the vessels of the brain

It is impossible to get rid of the pathology of the vessels of the brain or to prevent bouts of exacerbation of the disease without observing a certain diet. As a dietary option, doctors recommend a number of tables tailored to the basic needs of the sick person.

However, each of them is based on several principles:

For patients who are overweight and for those whose body weight is not below normal, it is worth reducing the calorie content of food consumed per day. The reduction should be 10 to 15% of the total calories.
Decrease, up to the complete elimination of foods containing animal fats and large amounts of cholesterol from the diet. First of all, we are talking about egg yolks, caviar, brains, fatty meat and fish.
Reducing the volume of foods that contain large amounts of vitamin D.
Limiting the amount of salt consumed.
Refusal from rich broths and fish soup.
Eating foods that are rich in lipotropic substances. It can be cottage cheese, herring (but only thoroughly soaked), oatmeal, cod.
The use of vegetable oils in the menu, not only sunflower, but also corn, linseed, cotton.
Eating large amounts of unprocessed fruits and vegetables.
The introduction of fasting days, especially if you are overweight. It can be kefir, cottage cheese, apple, oat and other types of mini diets for one day.
Do not forget about proteins, they should be at least 30 g in the daily menu. Sources can be: fish, eggs, meat, dairy products with a low percentage of fat.

In particular, for the treatment of pathology of cerebral vessels of an atherosclerotic nature, therapeutic diet No. 10 may be suitable. Its purpose is to reduce the amount of cholesterol in the blood, improve blood circulation. Its peculiarity lies in the fact that the patient is offered to limit the amount of fluid consumed to 1.5 liters per day. This is not only about tea or coffee, but also about water. The maximum number of kilocalories per day should not be more than 2500, and if a sick person is obese, this figure decreases by 700 kcal. At the same time, the products are not salted during cooking, they must not be fried. Meals are divided into six sets.

In addition, many doctors recommend a Mediterranean diet, which reduces the risk of complications from atherosclerosis by more than 50%.

With atherosclerosis of the vessels of the brain, the diet will have to be adhered to for a long time, perhaps even throughout life. Therefore, it is worth getting used to the consumption of foods such as oatmeal, cabbage, garlic, cottage cheese. A correctly drawn up nutritional regimen can not only alleviate the patient's condition, but also serve as a therapeutic and prophylactic agent.

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Prevention of cerebrovascular atherosclerosis

Preventive measures for this disease should be not only primary, but also secondary. This is due to the fact that such a pathology tends to flow in waves, active phases pass into the process of regression and vice versa. Therefore, it is so important with the help of prevention not only to prevent the disease itself, but also to stop its progression.

It is necessary to timely treat diseases that lead to the development of cerebral atherosclerosis. First of all, we are talking about pathologies of the thyroid gland - about hypothyroidism and diabetes mellitus. It is equally important to normalize metabolic processes in the body, since slow metabolism leads to excess weight.

Those people who have relatives in the family with early development of atherosclerosis of the cerebral vessels need to more carefully monitor their own diet, limit the consumption of animal fats. When diagnosing lipid metabolism disorders, it is necessary to take iodine preparations as a preventive measure.

Instrumental examination of blood vessels after the age of 40 is an excellent means of prevention and early detection of atherosclerotic changes in the vessels of the brain.

With regard to secondary prevention, it is primarily aimed at preventing the progression of the disease. It includes all measures from primary prevention, as well as adherence to a dietary regime, the use of drug treatment. We must not forget about the important role that is assigned to adequate physical exercise and physiotherapy exercises.

It is important to remember that, despite the development of modern medicine, atherosclerosis of the cerebral vessels is a serious problem leading to high mortality among the population. Therefore, the disease is much easier, if not completely prevent, then significantly delay its development with the help of preventive measures.

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".