How to treat cerebrovascular insufficiency. Chronic disorders of cerebral circulation

The human brain requires a large amount of blood, which naturally transports oxygen. Poor circulation of the brain occurs due to violations of the arteries, blockage of blood vessels and the development of blood clots.

This pathology is considered serious, because its consequences lead to the death of tissues and the cessation of vital activity by the brain. important functions. If you find symptoms that indicate poor circulation, you should immediately send to a specialist to determine accurate diagnosis.

Signs of circulatory disorders

According to scientists, the human brain includes a large number of nerve endings and cells. Their violations lead to the most various pathologies and diseases that result in the loss of certain brain functions.

The first signs of circulatory disorders may not be traced at all or be so insignificant that they can be confused with a common migraine. After a while, the symptoms of brain dysfunction manifest themselves more and become visible and obvious.

Symptoms of poor circulation are:

1. severe headaches that are relieved only by taking medications;
2. eye pain that worsens when focusing on an object;
3. nausea and dizziness. The orientation of a person in space is deteriorating;
4. tinnitus, the intensity of which increases every day;
5. convulsions;
6. heat, high blood pressure and body temperature.

In many cases, these signs are associated with psychological problems and violations nervous system person. They show up for no reason. Symptoms come on quickly and disappear quickly. It is important to know that if you find the slightest deviations, you should contact a neurologist who will prescribe the necessary treatment.

Causes of circulatory disorders

The circulatory system has a very complex structure. The transport of oxygen and other substances is carried out with the help of arteries. Normally, the brain should receive about 25% of all oxygen supplied.

In order for it to function normally, 15% of the blood in the human body is required. If these volumes are not respected, then over time, circulatory disorders are inevitable. This is a serious pathology, the cause of which is various diseases circulatory systems.

One of the most common diseases is atherosclerosis of the vessels. Basically, it often occurs in people of advanced age or in people suffering from poor metabolism. The disease leads not only to impaired blood supply to the brain, but also to poor blood circulation in the body.

Hypertension also leads to disruption of the brain. This is due to systematic pressure drops. Processes affect the work of blood vessels and adversely affect the work of the blood supply. Depression, fatigue and nervous disorders eventually lead to pathologies of the brain.

If a person has previously had injuries or operations on the skull, then after a certain time he may feel some deviations. The physiological causes of disruption of the blood supply include sedentary work, increased exercise in any sport, spinal injuries, scoliosis, and others.

In order for the body and all its organs to function normally, you should be examined by a specialist every year and monitor your health. This is especially true for people at risk.

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The cause of the pathology is not so important, as timely consultation with a doctor and high-quality treatment are important, because violations can affect the functioning of the brain and the work of the body as a whole, its internal organs.

The danger of blood flow disorders in the brain

Violation of blood circulation leads to seizures, the consequence of which can be an ischemic stroke.

First symptoms is nausea and vomiting. In severe cases, some internal organs.

Its consequences It is a speech and musculoskeletal disorder. Elderly people have transient attacks. During them, a person’s motor function is impaired, vision is lost, paralysis of the limbs may occur.

Hemorrhagic stroke leads to impaired blood transport to the brain. In these cases, the rate of blood circulation increases, which leads to a sharp deterioration in the general condition of the body. The type of stroke is common among the elderly and is often fatal.

All strokes lead to the development of pathologies. In old age, such people may experience chronic disorders of the blood supply to the brain, as a result of which the patient may lose memory. AT best case decreases only mental activity and intellect. These are far from all the consequences that can be found in people who have experienced a stroke and various attacks.

Circulatory disorders in children

Despite the fact that pathologies in the blood flow are most common in older people, there are cases when children also suffer from various diseases. The brain of a child requires a higher percentage of blood and oxygen than that of an adult. Deviation from the norm leads to serious violations and changes in brain activity.

The structure of the brain of a child is no different from that of an adult. It has arteries and vessels that carry out brain activity. Poor circulation of the brain in children has the same symptoms as in adults.

The development of brain tissues occurs after birth, so changes in the brain can occur during this time. If a sign of a violation is detected, you should immediately go to the hospital for an examination so as not to miss the development of serious diseases, because they can affect mental development child.

Among children, brain dysfunction occurs most often in newborns. This is facilitated by pathologies that have arisen if there was insufficient oxygen supply to the child in the womb. The mother's injuries, her bad habits and infectious diseases can also affect the development of the newborn.

An important role is played by genetics and the incompatibility of the blood type of the mother and child.

Birth trauma, strangulation, prematurity of the child can cause a violation of the blood circulation of the brain. Usually the consequences are not long in coming and may appear during the first year of life.

A child is more susceptible to diseases than an adult, so treatment will not be easy. Its complexity lies in the fact that all the internal organs have not yet fully developed, and it is not known how they will react to the therapy proposed by the doctor. Medications must be chosen carefully so that no system of vital activity is affected.

It should be borne in mind that the consequences of poor blood flow can haunt the child. for a long time and even for the rest of your life. They can be different, ranging from difficulty understanding school material to cerebral edema and epilepsy, so there is no need to delay treatment. It can be provided already in the first days of life, but the risks are great. With pathologies of the brain in newborns, a fatal outcome is possible.

Diagnosis of blood supply to the brain

At the first sign of a deviation in the work of the brain, you should contact a specialized clinic for diagnosis and treatment. Once a year, it is also necessary to undergo an examination for healthy people who do not show any symptoms that indicate a disease. This must be done in order to detect the problem in time, if any.

Diagnostics is being carried out different ways. The first is an MRI of the brain. This type examination allows you to see the condition of the tissues and find out how affected parts of the brain. This method is one of the most effective, because it allows you to see even the nerve trunks and membranes. Newborn children are prescribed neurosonography. Diagnostics is carried out through a not yet overgrown fontanel.

There are many more types of examinations that a doctor can prescribe. He looks at the patient's condition, his symptoms and, based on this, determines the type of diagnosis. After that, pills and other drugs are already prescribed that are able to restore the blood supply to the brain.

Prevention

There are many ways and means to prevent diseases. They are applied in traditional medicine, as well as in folk. Traditionally, a diagnosis is made first. Only then the doctor looks at the state of the vessels of the brain, draws certain conclusions and prescribes drugs for prevention. They are always selected on an individual basis, because what suits one patient may not suit another.

Basically, drugs are prescribed that improve the blood supply to the brain. Only after them systematic use improvements can be made. Usually a whole course of drugs is prescribed, because there is no medicine in nature that can independently eliminate all problems related to the functioning of the brain.

The doctor may prescribe both pills and injections. All of them affect the arteries and blood vessels. In some cases, they expand them, and in others, on the contrary, they narrow them. For prevention, some pregnant women are prescribed drugs that allow the baby to be born healthy even if abnormalities are detected during ultrasound. In any case, you can not self-medicate. This won't end well.

In medicine, there are many ways to prevent various diseases, and this has not bypassed disorders associated with the functioning of the brain. All funds are used exclusively for preventive purposes, when the disease has not yet occurred. Before doing this, you need to consult with a specialist.

First group drugs for prevention come from India. They consist exclusively of herbs and help to strengthen general state organism. Tea is made from plants and consumed every day. The fact that there are many long-lived people in India can tell about the results of treatment.

Second group is biologically active additives that improve blood circulation. The composition of the preparations includes herbs, vitamins and minerals. They are absolutely safe and suitable for the prevention of various diseases. They should be taken with a balanced diet. Only then will the result be noticeable.

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Third group is homeopathy. Doctors have long argued about the benefits of homeopathic medicines. Some even think they can't be named medicines rather than supplements. Their goal is to improve immune system, which will improve the general condition of the body and protect it from viruses and infections.

Many doctors advise massage as a prevention of many diseases. With it, blood flow improves, a person relaxes. It is also prescribed for suspected formation of blood clots. Vitamins C and E are added to all treatment complexes. They have a beneficial effect on circulatory system. People who are obese and overweight should, for the purpose of prevention, visit a nutritionist who will prescribe a therapeutic diet.

AT traditional medicine there are drugs that help improve blood flow. If a person suffers from dizziness, then a clover-based tincture can help him, which is recommended to be infused for about three weeks, and taken at night and before meals. In the presence of poor circulation, you can use chestnut tincture. Herbs also improve the condition of the body as a whole. Any tinctures and decoctions can be taken if the doctor has given permission for this.

Physical activity and diet

As you know, physical activity can improve the condition of the body and the human body. Daily morning exercises, walks in the fresh air will help normalize the blood circulation of the brain. For this, doctors recommend breathing exercises. For quick results, you can contact a trainer, but you can do it at home. All breathing exercises found in yoga and pilates.

People who already suffer from diseases related to the blood circulation of the brain should take physical therapy or swimming. Before training, you need to tell about your symptoms and diseases not only to the doctor, but also to the coach. Then he will select those exercises that will be effective and safe.

When there is poor blood flow to the brain, nutritionists recommend monitoring your diet. Only daily proper diet nutrition can both improve the condition and worsen it. There are many foods that improve blood circulation. In order to improve your health, you need to eat fish, seafood, fruits, vegetables daily, olive oil. Dairy products also have a positive effect on the body. Only quality products should be used.

There are foods that, on the contrary, harm the blood circulation of the brain. They are most often saturated with unhealthy substances, such as cholesterol and unhealthy fats.

You should refuse such products:

1. sugar;
2. smoked meats;
3. products with synthetic flavors;
4. flour;
5. sweet carbonated drinks;
6. alcohol.

Alcohol abuse is very harmful not only for blood vessels, but also for the whole human body. This addiction causes addiction and various diseases associated with blood circulation. People suffering alcohol addiction are prone to strokes and heart attacks. Alcohol can only be consumed in moderation.

Violation cerebral circulation- one of the most dangerous pathologies. After all, the brain controls all processes in the body: breathing, heartbeat, motor activity, speech, thoughts. If such a misfortune happens, then social viability goes downhill, in the worst case, the life of a person fades away.

The symptoms of pathology for each person will be different, since they completely depend on the severity of the process and the location of the pathological focus.

According to the severity of the process, they distinguish:

• Acute violation of cerebral circulation;
• Chronic circulatory failure.

An acute violation of the blood filling of certain vessels entails a sharp lack of oxygen and nutrients in the tissues, which causes hypoxia of the site, ischemia and further death. Therefore, the symptoms will depend on the localization of the focus.

Acute cerebrovascular accident can cause short-term pathology of transient ischemic attack (TIA) and ischemic and hemorrhagic strokes.

chronic disorder blood filling of blood vessels and nutrition of certain areas of the cortex and white matter of the brain entails the development of discirculatory encephalopathy.

Blood supply to the brain

Knowledge of the localization of the focus is very important for an objective choice of further treatment tactics and will help to quickly cope with the disease. To do this, you need to know the anatomy of the location of blood vessels in the brain.

The blood supply to the brain is provided by vessels that originate from two different sources: from the carotid arteries and vertebral. The main arteries in which blockage of the vessel or its breakthrough most often occur are the cerebral arteries: the anterior, middle, and posterior cerebral arteries.

Depending on the location of the focus of ischemia, a pool is determined in which blood circulation is disturbed. The anterior and middle cerebral arteries originate from the carotid arteries, which causes a higher incidence of lesions than the posterior cerebral artery. This is due to the fact that the force with which blood flows through the vessels of the brain is greater in the anterior and posterior cerebral arteries, since the carotid artery is located in close proximity to the heart in relation to the vertebral vessels.

Causes of circulatory disorders

The reasons for the violation of sufficient blood flow can be various pathologies and processes:

• vessel aneurysm.
• Thrombosis is the formation of a plaque on the wall of a blood vessel elevated content blood cholesterol, lipoproteins high density at the injured site of the endothelium. The plaque grows, gradually obscuring the lumen of the vessel. This results in chronic insufficiency. cerebral blood supply, which can become acute. This can happen if a blood clot completely blocks the lumen of an artery, and a part of the brain stops receiving oxygen and nutrients.
• kinks of blood vessels.
• Malformations - cluster small vessels, which intertwine with each other and form peculiar knots. They are insolvent and under any load (physical, emotional) due to increased blood flow, they can burst, which will lead to hemorrhage in the brain.
• Embolism with gas, thrombus, air.
• Hypertensive disease - increases the risk of hemorrhage due to uncontrolled blood pressure. For manifestations, there are two reasons that arise when arterial hypertension: high arterial pressure, which acts on the vessels with greater force and reduces their resistance, and the rigidity of the vascular wall (rapid wear of the vessels during elevated work in resistance to high blood flow due to hypertension).
• Chronic fatigue - the brain must receive more blood and oxygen during increased activity, which quickly depletes the body and brain activity, which can lead to chronic insufficiency cerebral circulation.
• Concussions, head injuries, bruises and hemorrhages.
• Cervical osteochondrosis - vertebrae and hernias squeeze the vertebral artery, which causes insufficient nutrition of the brain tissues of the posterior cerebral artery pool.

Acute cerebrovascular accident

Acute cerebrovascular accident causes such diseases:

1. hemorrhagic stroke;
2. Ischemic stroke;
3. Transient ischemic attack.

Symptoms of an acute disorder brain activity differ in the location of the lesion and can be observed in a patient in varying degrees and duration:

• General cerebral symptoms - dizziness, nausea, vomiting, depression of consciousness (from stupor to coma) - occurs due to swelling of the brain and tissue pressure on the meninges;
• Violation of sensitivity;
• Violation of motor activity - from mild paresis to plegia;
• Violation of the correct full-fledged activity of the sense organs;
• violation of coordination;
• Stem symptoms - violation of respiratory activity, cardiac activity, vision, hearing, swallowing (in the brain stem there are centers for the regulation of these functions);
• Decreased cognitive abilities of a person - impaired mental activity, deterioration of memory, speed of thinking;
• Convulsions, epileptic seizures.

Ischemic stroke is characterized by the fact that disorders occur against the background of normal pressure and is caused by blockage of the supply vessel. The fabric does not receive the right substances, ischemia occurs, against the background of which venous plethora may occur.

This will provide the first symptoms - nausea, vomiting, dizziness, acute headache. Further, the ischemic area ceases to perform its functions, and some of the above symptoms appear. When ineffective or untimely treatment the site is necrotic, and it is impossible to restore the lost functions.

Hemorrhagic stroke occurs when a vessel ruptures as a result of high pressure and vascular tension, aneurysm, malformation of cerebral vessels. This type of stroke, unlike ischemic stroke, is often accompanied by clouding of consciousness.

The focus of hemorrhage can be so large that the brain tissue is shifted to the side, which entails dislocation syndrome- deviation along the axis (often with ventricular hemorrhages) and further wedging of the brain stem into the foramen magnum. This is the hole through which spinal cord connects to the head. This phenomenon is very dangerous for human life.

A transient ischemic attack in the clinic is completely similar to an ischemic stroke, but differs in that the symptoms disappear without a trace within 24 hours. This syndrome is caused by a spasm of the vessels that feed the pathological area or a passing thrombus (an embolus that has independently passed beyond the occluded part.

Diagnosis of strokes consists in the correct full collection of an anamnesis of the disease and life, the identification of all clinical manifestations and instrumental methods research.

Most informative method is CT or MRI. Computed tomography is more commonly used, since its advantage is quick definition fresh blood in soft tissues. The focus can be seen not immediately, but after a few days. In this case, in order not to waste time, the diagnosis is made according to the clinic and the appropriate therapy is selected.

Treatment of acute cerebrovascular accident is basically the same, aimed at restoring damaged cells and reducing the area of ​​necrosis. To do this, use preparations of B vitamins (to restore the myelin sheath), metabolic drugs (to improve nutrition and rapid cell recovery; help cells that perform a double load), drugs aimed at eliminating complications (pulmonary edema, brain swelling, cardiac arrest, dislocation syndrome), neuroprotectors (drugs that protect brain cells from harmful influence environment).

One distinctive feature in the treatment of various types of pathology - drugs aimed at eliminating the cause of the symptoms. At ischemic stroke use drugs that can thin the blood, increase its rheological properties and fluidity. For this, direct anticoagulants are used initially, then indirect action. After normalization of blood flow, patients switch to lifelong antiplatelet therapy.

Hemorrhagic stroke, on the contrary, requires the use of hemostatic agents - prothrombin, aminocaproic acid and other drugs.

Chronic cerebrovascular accident

Dyscirculatory encephalopathy can develop due to 3 factors.

• Multi-infarction conditions - the causes of such a development of the disease will be the embolization of small vessels of the brain with blood clots from the heart. They appear as a result of the development atrial fibrillation hearts.
• Binswanger's disease provokes thickening of the walls and narrowing of the lumen of the small arteries of the brain, which often causes white matter. The death of neurons is observed locally, scattered throughout the brain tissue.
• Violation of patency main arteries that feed the brain - the vertebral and carotid arteries. The blood flow decreases over time, so there is a chronic insufficiency of blood supply to the brain.

These causes cause such symptoms as sleep disturbance, deterioration of cognitive abilities (memory becomes worse, they stop solving complex logical tasks, thinking worsens), dementia is observed (memory loss in various manifestations).

Diagnosis of the disease is carried out by collecting an anamnesis. At that moment, the doctor should suspect a certain diagnosis, which should be confirmed instrumentally.

The patient should consult with an ophthalmologist - look at the fundus, since the retina is a mirror of the vessels of the brain.

Angiography is being performed. It will identify small and large blood clots or spasms that lead to permanent occlusion of small vessels.

Drugs to improve cerebral circulation

Violation of cerebral circulation What are the symptoms

An electroencephalogram will show those small tissue lesions after blockage of blood vessels. Potentials are recorded from healthy living tissue. Electroencephalogram changes will show organic changes brain matter.

Treatment of chronic dyscirculatory encephalopathy is carried out with drugs that improve blood rheology and blood flow in the vessels. In fact, the treatment is represented by metabolic drugs that strengthen the vascular wall, reduce blood viscosity, improve its rheological properties, control thrombosis and the amount of cholesterol and lipoproteins. various groups in blood.

Correct timely treatment will help protect yourself from complications and death.

Affects the health of the whole organism. Violation in its work can lead to the fact that the tissues will no longer receive enough oxygen and nutrients. As a result of this, there will be a slowdown in metabolism or possibly even the occurrence of hypoxia. Due to such problems, serious pathologies can develop.

Clinical manifestations of the disease

In the early stages of hemodynamic disturbances, no signs appear. And even after some time, the symptoms of this disease are so non-specific that it is impossible to immediately detect the disease. The main signs of poor circulation are:

• The lack of desire is.
• Deterioration of immunity.
• Cold extremities.
• Feeling of tingling and numbness in the hands.
• Brittleness of hair and nails.
• Varicose veins.
• Constant fatigue.
• The appearance of ulcers on the legs.
• Change in skin pigmentation.
• Puffiness.

Prevalence

And the treatment of which are interrelated, can lead to a stroke. It is for this reason that as soon as a person has the first signs of such a pathology, it is necessary to immediately consult a doctor. After all, only timely and effective therapy, aimed at improving blood circulation in the brain, will avoid negative consequences.

Poor blood flow in the arms

Violation of blood circulation in the limbs leads to a deterioration in blood circulation in the body. This condition occurs due to the fact that the resulting plaques clog blood vessels.

The most common symptoms of such an ailment include numbness of the fingers, headaches, swelling in the elbows and hands, tingling, cold extremity syndrome, and deterioration of the nails.

Poor circulation in the hands occurs, as a rule, due to the following reasons:

• Abuse of caffeine, alcohol and drugs.
• Diabetes.
• smoking.
• High blood pressure.
• Sedentary lifestyle.
• Elevated cholesterol.

People who have been found poor circulation in the hands, you need to eat more foods containing fiber, and also try to consume low-fat foods, because most often it is because of such food that plaques are formed that block blood vessels. That is why, with such a disease, many patients are advised to lose weight.

Those who wish to improve blood circulation in the limbs should definitely consume foods rich in vitamins E and C. You should also drink enough water in case of poor blood circulation. With this ailment, watermelon juice is especially useful.

Patients are strongly advised to support the body and spine in correct position to ensure continuous blood flow without obstruction or obstruction. To prevent numbness of the hands, keep them in a comfortable position during sleep.

Impaired blood circulation in the legs

Poor circulation in the extremities can lead to many health problems. If no action is taken with such an ailment, the consequences can be severe.

The main cause of circulatory disorders in the legs is various. This problem arises when plaque forms on the walls of the peripheral arteries. fatty matter, which hardens. The formed hardening complicates the movement of blood through the veins and arteries.

Often, the use of drugs and certain drugs, a sedentary and unhealthy lifestyle lead to a violation of blood circulation. Quite often, poor blood flow to the legs is observed with atherosclerosis. These problems also occur in people who suffer from anemia, smoke a lot and eat improperly.

When blood circulation is disturbed, tingling appears in the lower extremities, convulsions, black and blue spots that occur most frequently in calf muscles as well as a feeling of numbness.

To obtain an accurate diagnosis, the patient will have to undergo one of next examinations: arterial angiography, dopplerography, CTA or MRA. To check how well blood is flowing through the limbs, doctors compare the blood pressure levels of the ankles and hands.

Therapeutic measures depend on the severity of the blockage of the veins and arteries. Mild and moderate forms of the disease are treated with medications and various creams. It also recommends aerobics.

Severe circulatory disorders in the legs are treated exclusively with a surgical procedure: endarterectomy, angioplasty, peripheral shunting, revascularization, or atherectomy.

Consequences of poor circulation

If circulation problems are not treated, myocardial infarction can occur. Moreover, the risk of stroke increases. In some cases, poor circulation leads to critical ischemia. It will be possible to avoid such complications only if you are regularly examined.

Improving blood circulation in folk ways

If poor circulation is diagnosed, what should be done in this case? For fast elimination disease, the main treatment should be combined with folk remedies.

To do effective remedy, it is necessary in a glass with warm water dissolve a small spoonful of edible salt and the same amount of sea salt. This fluid should be drawn in through the nostrils and the breath held for a few seconds. This solution should be treated for about 10 days.

To improve blood circulation in the legs, the following recipe will help: a pod of chopped hot pepper, a tablespoon of dry mustard and a little sea ​​salt. Everything is mixed and poured with a glass of vodka. The resulting mixture is infused for at least 10 days in a dark place. Limbs are rubbed with this tool, after which woolen socks are put on. It is better to do the procedure before going to bed.

Helps a lot with this problem. saline solution. To do this, 5 tablespoons of sea salt are diluted in a glass warm water. Then a small piece of cotton is soaked in the solution and inserted into the nose for 20 minutes, keeping the head thrown back.

Prevention of blood flow disorders

To avoid problems with the circulatory system, it is necessary first of all to lower cholesterol, and also to overcome physical inactivity. Rejection bad habits helps reduce the risk of developing similar pathologies. In addition, it is important to treat on time infectious diseases causing complications.

Transient cerebrovascular accident (TICH)- short-term acute ischemia of the brain, accompanied by transient cerebral and focal symptoms, completely disappearing within no more than 24 hours from the onset of the attack. Clinical manifestations are varied, depending on the type and topic of PNMK. Diagnosis is carried out retrospectively and includes neurological, ophthalmological and cardiological examinations, the study of cerebral blood supply (USDG, duplex scanning, MRA), radiography and CT of the spine. Treatment of PNMK is aimed at normalizing cerebral blood supply and metabolism, preventing relapses and preventing the occurrence of stroke. With hemodynamically significant occlusion of large arteries, surgical treatment by angiosurgeons is possible.

General information

A transient disorder of cerebral circulation has an etiology and development mechanisms similar to ischemic stroke. hallmark is its short duration (lasting no more than a day) and the transient nature of all emerging symptoms. It is generally accepted in the world and domestic neurology that cases when clinical manifestations of acute cerebrovascular accident (ACV) persist for longer than 24 hours are usually regarded as a stroke.

Transient cerebral circulatory disorders include transient ischemic attack (TIA) and cerebral variant of hypertensive crisis. CIMC is one of the most common forms of cerebral circulatory disorders. However, it is difficult to obtain reliable statistical data on the structure of the morbidity of PNMK, since, on the one hand, many patients do not seek medical help in a timely manner, and on the other hand, it is difficult for doctors to diagnose the fact of PNMK based only on the anamnesis data.

Etiology and pathogenesis

PNMC is based on a decrease in blood flow through the arteries supplying the brain. There are many factors leading to such dyscirculatory changes. In the first place among them - atherosclerosis and hypertension. Etiofactors also include diabetes mellitus, infectious-allergic and systemic vasculitis (Kawasaki disease, periarteritis nodosa, Wegener's granulomatosis), vascular lesions in collagenoses. A certain role is played by congenital malformations of blood vessels - pathological tortuosity, hypoplasia.

Main pathogenic mechanism the occurrence of PNMK in this case is an arterio-arterial embolism. Emboli are particles of a parietal thrombus that forms in the lumen of a pathologically altered vessel, or decays atherosclerotic plaque. The source of emboli can be thrombi that form in the cavities of the heart during acquired or birth defects, myxoma, post-infarction aneurysm. An embolus formed in a large artery with a blood flow enters terminal branches cerebral vessels, leading to their occlusion and a sharp decrease in blood supply to the corresponding part of the brain.

A transient disorder of cerebral circulation can repeatedly occur with occlusion of the carotid arteries. Etiofactors of hypertensive cerebral crisis are spasm of cerebral arteries and venous deposition of blood. PNMC in the vertebrobasilar basin occurs during compression vertebral artery due to instability of the cervical spine, osteochondrosis, cervical spondylosis, spinal injury. In some cases, the cause of PNMK becomes compensatory arterial spasm, which develops with severe arterial hypotension, for example, with acute blood loss, myocardial infarction, severe arrhythmias. With occlusion of the subclavian artery, the development of PNMK is possible according to the “steal” mechanism, when collateral blood supply arm goes from the vertebrobasilar basin to the detriment of cerebral blood flow.

The main pathogenetic factor that ensures the short duration of cerebral ischemia in MIMC is a well-developed system collateral circulation. Thanks to it, in arterial occlusion, blood flow is quickly redistributed along alternative bypass routes in such a way that it provides sufficient blood supply to the ischemic area and full recovery its functions within 1 day from the moment of occlusion. If this does not happen, irreversible changes occur in ischemic cerebral cells, leading to more persistent neurological disorders and classified as ischemic stroke.

Symptoms of PNMK

Typically sudden and acute development. Cerebral symptoms PNMK are headache, weakness, nausea (maybe vomiting), blurred vision, vegetative-vascular reactions (hot flashes, trembling, sweating, etc.), short-lived disorders of consciousness. Focal symptoms entirely depend on the topic of the ischemic process. On average, PIMC lasts from several minutes to several hours. Complete restoration of disturbed neurological functions within a day is pathognomonic.

ICA in the ICA (internal carotid artery) system is characterized by variable zones of hypesthesia and/or paresthesia, covering certain areas of the skin of the extremities or face on the side opposite (heterolateral) to the ischemic focus. May be observed central paresis extending to local muscle groups or one limb. Hemihypesthesia and hemiparesis are less common. Muscle strength is usually moderately reduced. Anisoreflexia is typical, sometimes pathological reflexes of Rossolimo and Babinsky are present. Often there is aphasia or dysarthria. Perhaps a decrease in visual acuity in one eye, the appearance of a paroxysm of Jacksonian epilepsy, in some cases turning into a generalized epileptic seizure.

PNMK in the vertebrobasilar basin manifests itself as systemic dizziness with tinnitus, vegetative disorders, vestibular ataxia (discoordination of movements, unsteadiness of gait, instability in the Romberg position, etc.), visual disturbances in the form of metamorphopsias, photopsies, loss of visual fields. Horizontal nystagmus is noted. Possible dysarthria, dysphonia, diplopia, dysphagia, the occurrence of alternating syndromes. PNMC in the vertebrobasilar basin is usually accompanied by a headache in the occiput, the intensity of which is associated with head movements.

A transient disorder of cerebral circulation in the region of the brain stem is manifested by systemic dizziness, paresis of the oculomotor muscles, hearing loss, and double vision. May appear transient disorders swallowing and articulation, hemianopsia, local hypoesthesia of the skin of the face. At PNMK in the region medulla oblongata(reticular formation, lower olives) are marked by the so-called. drop attacks - transient paroxysms of immobility as a result of a sharp muscle weakness. With PNMK in the medial sections temporal lobe there is a short-term Korsakov's syndrome - a loss of orientation in the environment and time, combined with a memory disorder about current events.

It should be noted that simultaneous stenosis of several arteries of the head is possible, leading to the occurrence of transient ischemia in several vascular beds. In such cases, the MIMC clinic combines the symptoms of damage to all cerebral areas involved in the ischemic process.

PNMK diagnostics

AT rare cases Patients are examined by a neurologist directly during MIMC. More often, patients who have undergone PNMC at home come to the consultation of a neurologist, while an ischemic episode can be recorded by a local therapist or an emergency doctor. Some patients do not even know about the stroke, but with a detailed questioning, it is possible to reveal the presence of such attacks in the past. Identification in the anamnesis of PNMK is important in choosing further tactics for managing the patient.

There are usually no significant abnormalities in the neurological status after MIMC. The appointment of additional examinations is mandatory - consultations with an ophthalmologist with perimetry and ophthalmoscopy; coagulograms, determination of blood sugar, cholesterol and lipids; REG, duplex scanning or ultrasound of the vessels of the head and neck, MRI of the brain, MR angiography. As a rule, examinations fix signs of chronic cerebral ischemia and dyscirculatory encephalopathy; it is possible to identify occlusion of the carotid or vertebral arteries.

The study of the vertebral arteries is carried out using REG and ultrasound with functional tests(for example, with rotations and tilts of the head), supplemented by an X-ray of the spine in cervical region or CT scan of the spine. When diagnosing thrombosis main vessels that feed the brain, a consultation with a vascular surgeon is recommended to decide on the advisability of surgical treatment. In the presence of cardiovascular disease consultation with a cardiologist, ECG, daily monitoring of blood pressure, ultrasound of the heart.

PNMK treatment

In mild cases, when PNMK lasts no more than an hour, therapy is carried out in an outpatient setting. For more severe manifestations or repeated PNMK, treatment is indicated in a neurological hospital. The main objectives in the treatment of PNMK are the improvement of cerebral circulation and the restoration of adequate metabolism of cerebral tissues.

Appointed medical preparations that improve blood rheology (pentoxifylline, dextran). The course of treatment is recommended 3-5 daily intravenous drip injections. Then appointed long-term use acetylsalicylic acid. Bromocamphor is recommended for patients with PNMK who have contraindications to taking salicylates (for example, in the presence of gastric ulcer). Of the neurometabolites, piracetam, porcine cerebral hydrolyzate, is widely used. gamma-aminobutyric acid, vitamins gr. AT.

Normalization of blood pressure numbers is important. For this purpose, intravenous or intramuscular administration of dibazol, papaverine, intramuscular administration of magnesium sulfate, drotaverine are carried out. With systemic dizziness and severe autonomic symptoms prescribe belladonna alkaloids, phenobarbital, belladonna extract, diazepam, according to indications - chlorpromazine. Sedative therapy with valerian, trioxazine, tazepam, or elenium is recommended for 1-2 weeks from the moment of MIMC.

Diagnosed stenosis carotid artery exceeding 70% of its lumen is an indication for surgical treatment. On an individual basis, the selection of the most suitable surgical tactics- eversion or classic carotid endarterectomy, stenting, prosthetics, carotid-subclavian bypass. Also, according to indications, stenting or prosthetics of the vertebral artery is performed.

Forecast and prevention of PNMK

In terms of the complete elimination of the neurological deficit that has arisen, PNMK has a favorable prognosis. Unfavorable is the typical repeatability for PNMK. The frequency of relapses can reach up to several times a year. Each subsequent episode of MIMC increases the likelihood of ischemic stroke. The prognosis is most favorable for PNMK in the basin of the internal auditory artery. With localization of disorders in the carotid basin, the prognosis is worse than with LIMC of the vertebrobasilar region. Typically, these patients have a stroke within 1 year.

The basis for the prevention of PNMK is a healthy lifestyle, excluding factors that adversely affect the state of blood vessels, such as smoking, taking large doses alcohol, excessive consumption of animal fats. To preventive measures includes control of blood pressure, blood sugar, lipid spectrum; adequate treatment of arterial hypertension, diabetes, vascular diseases. Secondary prevention PNMK consists in regular observation by a neurologist with the passage repeated courses vascular therapy.

Violation of cerebral circulation is of two types: acute and chronic. Both pathologies lead to different pathologies. Acute cerebrovascular accident leads to a stroke. Chronic cerebrovascular accident, in turn, leads to the development of discirculatory encephalopathy.

The disease is characterized by neurological and mental disorders. With a stroke, they develop within hours and days, with dyscirculatory encephalopathy, symptoms can develop for decades. In addition to clinical picture, acutely developing at the time of circulatory disorders, pathology leads to long-term consequences, for example, to a decrease in intelligence and memory impairment.

Acute disorders include:

• transient ischemic attack;
• ischemic stroke;
• hemorrhagic stroke;
• hemorrhage in the subarachnoid space.

Each of these pathologies has its own clinical picture and treatment. Chronic cerebrovascular accident is independent disease, which also has a peculiar symptomatology, diagnosis and approaches to treatment.

The reasons

Causes of ischemic stroke:

1. Thromboembolism. Develops vascular disorders. More often occurs against the background of existing atherosclerosis. Educated atherosclerotic provokes the development of a blood clot, which is prone to separation and blockage of the arteries.
2. Hemodynamic factors: a sudden decrease in blood pressure (collapse), a decrease in circulating blood volume or due to a heart rhythm disorder.
3. Arterial hypertension. Occurs due to persistently high blood pressure.

The reasons hemorrhagic stroke:

• Aneurysm, dissection of the cerebral arteries.
• Blood diseases.
• Vascular insufficiency due to inflammation of the walls of arteries and veins.
• Hypertonic disease.

The reasons subarachnoid hemorrhages:

1. Traumatic: traumatic brain injury.
2. Non-traumatic: arterial rupture due to aneurysm, violation of blood coagulation systems, cocaine addiction.

The development of chronic cerebrovascular accident is based on damage to small vessels, which causes microangiopathy. This pathology develops due to:

• diabetes;
• hypertension disease:
• bad habits: alcohol and smoking;
• transferred inflammatory diseases brain.

Signs of impaired brain activity in ischemic stroke develop within 2-3 hours. In most patients, a few days before an acute disorder, blood pressure decreases. Clinical picture:

1. Cerebral symptoms: acute headache, drowsiness, lethargy, apathy, possibly mental agitation. Cephalgia is accompanied by nausea and vomiting. Autonomic disorders: feeling of heat influx, sweating, shortness of breath, palpitations, tremor, dry mouth.
2. Focal neurological signs. They are determined by the localization of ischemia. However acute insufficiency blood in the brain is almost always accompanied by the following symptoms: complete absence or partial weakening of the force in skeletal muscles, loss of visual fields, speech and sensitivity disorder, violation of the volitional sphere, violation of the ability to recognize objects by tactile sensation, violation of the accuracy of purposeful movements and walking.

Symptoms in violation of cerebral circulation by type hemorrhagic stroke:

• Cerebral symptoms: acute cephalgia, confusion, disorientation, mixed consciousness, nausea and vomiting, drowsiness or agitation.
• Specific brain signs: speech disorder, convulsions appear at the beginning of a hemorrhage, memory loss, stupefaction of criticism in relation to one's painful state. With hemorrhage in the brain stem sections, a violation of the cardiovascular and respiratory system, gradually oppressed consciousness.

Insufficient blood supply to the brain against the background subarachnoid hemorrhage:

1. Sharp and sudden headache like a blow to the head. Pulsation in occipital region. Nausea and repeated vomiting.
2. confused consciousness. Patients are drowsy, stunned, may fall into a coma.
3. Hypertension syndrome: dilated pupil, decreased visual acuity, impaired coordination.
4. bad job oculomotor nerve: drooping eyelids, strabismus, double image in the eyes.
5. Seizures.
6. Hemiparesis, hemiplegia - a decrease or complete absence of muscle strength on one side of the body.

Due to the strong release of adrenaline into the blood, blood pressure rises. Developing cardiopulmonary failure, violated heartbeat. 3% of subarachnoid hemorrhage is fatal.

Insufficient blood circulation of the brain in transient ischemic attack with two types of clinical picture.

The first is an ischemic attack with a lack of blood circulation in the vertebrobasilar basin (it happens with cervical osteochondrosis):

• Dizziness, autonomic disorders, double vision, vomiting, involuntary movements eye.
• Simple visual hallucinations.
• Alternating syndromes - simultaneous damage to the cranial nerves on one side of the head, and a violation of the motor and sensory spheres on the other.
• Disorientation in space, amnesia.

The second variant of the clinical picture is circulatory disorders in carotid arteries. Signs:

1. Impaired muscle strength on one side of the body or in only one limb.
2. Decreased sensation on one side of the body, or in the fingers.
3. Speech disorder.
4. Violation of orientation in space.

The clinical picture of dyscirculatory encephalopathy consists of a variety of symptoms that depend on the location of chronic blood insufficiency in the brain. Symptoms are usually divided into groups:

1. Cognitive impairment: absent-mindedness, decreased memory, decreased intelligence.
2. Emotional disorders: irritability, inability to control emotions, outbursts of anger, frequent mood swings.
3. movement shift.
4. Pseudobulbar disorders: violation of swallowing, lowering of the voice, slow speech, sometimes violent laughter and crying.
5. poor work of the cerebellum: disorder of coordination, walking.
6. Vegetative disorders: hyperhidrosis, dizziness.

With venous encephalopathy, there is a violation of the outflow of blood and leads to the development of intracranial hypertension syndrome, which is manifested by bursting headaches, dizziness, nausea, vomiting, decreased vision and tinnitus.

Progressive dyscirculatory encephalopathy leads to pelvic disorders: Patients sometimes do not hold back urine or feces.

Cognitive disorders in vascular diseases are long-term consequences of acute or chronic cerebral circulation. Thus, patients often develop vascular dementia and other cognitive disorders. Patients have impaired social adaptation, they require care, often hygiene care. The long-term consequences of the violation are amnesia, a decrease in the intelligence quotient, confused thinking. Mental damage can reach such an extent that patients forget the faces of close relatives.

Prevention

The basis of acute and chronic circulatory disorders of the brain is mainly changes in hemodynamics, blood pressure, blood composition and integrity vascular walls. So, in order to avoid vascular pathologies of the brain, two main ailments should be prevented - atherosclerosis and hypertension.

For this, basic skills are enough right image life: regular and dosed physical exercises with an emphasis on cardio training, reducing alcohol consumption, smoking cessation, food restriction, leading to an increase in low and very low density lipoproteins in the blood. Also, people whose family members have had a stroke, heart attack or suffer from hypertension are recommended to measure blood pressure once a day and control its level. It should be remembered that the risk of brain complications appears when blood pressure exceeds 140/90 mm Hg.