Chronic cerebrovascular insufficiency symptoms and treatment. Modern therapy of chronic cerebrovascular accident

It is customary to single out the initial manifestations of cerebrovascular accident as an early stage of CIMC and DE (dyscirculatory encephalopathy) - a multifocal brain lesion caused by chronic circulatory failure.

In turn, the following forms of DE are distinguished:

atherosclerotic;
hypertonic;
venous;
mixed.

Causes and pathogenesis of HNMK

As a rule, chronic cerebrovascular accident is a consequence of cardiovascular pathology. Usually HNMK develops against the background of:

vegetative-vascular dystonia;
atherosclerosis, hypertension;
diabetes
heart diseases of various etiologies;
vasculitis;
blood diseases accompanied by a violation of its rheological properties.

These pathologies change the general and cerebral hemodynamics and lead to a decrease in cerebral perfusion (less than 45-30 ml/100 g per minute). The most important factors involved in the pathogenesis of HNMK include:

changes in the extra-, intracranial sections of the vessels of the head;
lack of capacity collateral circulation;
violation of autoregulation of blood circulation;
violation of rheology.

Obesity, physical inactivity, alcohol abuse and smoking play a significant role in the progression of CNMC.

Symptoms of chronic cerebrovascular accident

On the early stages HNMK, the picture is characterized by patient complaints about a feeling of heaviness in the head, mild dizziness, unsteadiness when walking, noise in the head, fatigue, decreased attention and memory, and sleep disturbance. The initial manifestations of circulatory failure occur after psycho-emotional and / or physical overstrain, against the background of alcohol consumption, under adverse meteorological conditions. Patients have signs of vegetative-vascular and emotional lability, some slowness of thinking processes, convergence insufficiency is possible. Progression initial manifestations circulatory failure leads to next stage— DE.

Depending on the severity of manifestations, there are three stages chronic disorder cerebral circulation. In stage I, the symptoms are mild, patients usually remain functional; in stage II, the symptoms are moderate, and in Stage III patients become disabled.

With atherosclerotic encephalopathy, i.e., with DE caused by atherosclerotic lesions of the vessels that provide blood supply to the brain, in stage I, a decrease in attention and memory is noted, especially for current events, it is difficult to memorize new information, it is difficult for the patient to switch from one activity to another. At the same time, mild cognitive impairments, as a rule, are compensated for by retained household and professional skills, as well as intellectual capabilities. Often, patients complain of increased fatigue and decreased performance, often there is emotional lability with a decrease in psycho-emotional background. Note diffuse, noise in the head. Complaints of patients on instability when walking are characteristic. AT neurological status reveal minor diffuse symptoms in the form of moderate signs pseudobulbar syndrome, tendon hyperreflexia and anisoreflexia, and postural instability.

In stage II, clinical manifestations progress, cognitive impairment increases, working capacity decreases, patients become touchy and irritable. Narrowing of interests is noted, memory disorders are growing. Often there are dull headaches, dizziness, unsteadiness when walking. The neurological status reveals anisoreflexia, pseudobulbar symptoms, vestibulo-cerebellar disorders, and subcortical symptoms.

In stage III, there is a further aggravation neurological manifestations. Patients show significant disseminated neurological symptoms in the form of an increase in pyramidal insufficiency, pseudobulbar disorders, cerebellar and extrapyramidal symptoms, and impaired control. pelvic organs. Possible epileptic seizures. Stage III is characterized by pronounced violations of higher mental functions: significant cognitive impairment to dementia, probably the development of apatoabulic syndrome, pronounced emotional and personality changes. In the later stages, patients lose their self-care skills. For atherosclerotic encephalopathy, drowsiness after eating, Windscheid's triad, is typical. In stage III, Hackebush disease, or a pseudo-Alzheimer's form of atherosclerosis, can be observed - a symptom complex, the main manifestation of which is dementia. At the same time, a decrease in memory, confabulation, a pronounced narrowing of the circle of interests, uncriticality, speech disorders, gnosis and praxis are noted. Besides, in late stage Atherosclerotic encephalopathy may form the Demage-Oppenheim syndrome, which is characterized by gradually developing central tetraparesis.

Chronic hypertensive encephalopathy is a form of DE caused by arterial hypertension. Arterial hypertension leads to diffuse damage to the brain tissue, the disease progresses quite quickly with significant fluctuations blood pressure, recurring hypertensive crises. The disease can manifest itself at a fairly young age, on average at 30-50 years. In the early stages clinical picture hypertensive encephalopathy is characterized by sufficient dynamism and reversibility of symptoms. Characteristic neurosis-like syndrome, frequent headaches, predominantly occipital localization, noise in the head. In the future, signs of bilateral pyramidal insufficiency, elements of the akinetic-rigid syndrome, tremor, emotional-volitional disorders, decreased attention and memory, slowness may appear. mental reactions. As the progression progresses, personality disorders occur, the range of interests narrows, speech intelligibility is impaired, anxiety increases, weakness is noted. Patients are characterized by disinhibition.

In the III stage of hypertensive encephalopathy in patients, as a rule, pronounced atherosclerosis occurs, the condition is characterized by features typical of atherosclerotic encephalopathy - developing dementia. In the advanced stage, patients lose the ability to self-service, control pelvic functions, signs of apato-abulic or paranoid syndromes may appear.

A variant of hypertensive encephalopathy in combination with atherosclerotic brain damage is Binswanger's encephalopathy (progressive vascular leukoencephalopathy). It usually manifests itself at the age of 50 and is characterized by memory loss, cognitive impairment, motor impairment in chronic cerebrovascular accident of the subcortical type. Sometimes there are epileptic seizures. As a rule, encephalopathy in chronic cerebrovascular accident develops gradually, although stepwise progression associated with vascular crises, fluctuations in blood pressure and cardiac disorders is also possible.

Venous DE is characterized by venous congestion in the skull, chronic hypoxia, and intracranial hypertension. Venous DE often develops in patients with cardiopulmonary diseases, as well as with arterial hypotension.

Diagnostic procedures for HNMK include the collection of anamnesis, taking into account information about somatic pathology(especially about cardiovascular diseases), analysis of patient complaints, neurological, neuropsychological examination. Instrumental examination involves doppler ultrasound (USDG), rheoencephalography, CT) or MRI, ophthalmoscopy and angiography. As a rule, it is necessary to examine the heart (electrocardiography - ECG, echocardiography), as well as a study of the rheological properties of the blood.

Treatment of chronic cerebrovascular accident

Arterial hypertension is one of the critical factors risk of CNMC, however, episodes of hypotension are also unfavorable for patients with DE. In the process of correction, it is advisable to maintain blood pressure at a stable level, slightly higher than the "optimal" indicators: 140-150 mm Hg. It is necessary to select medicines for chronic cerebrovascular accident, taking into account the characteristics of the patient, his reaction to prescribed drugs. For the treatment of arterial hypertension, angiotensin-converting enzyme inhibitors - ACE inhibitors (captopril, perindopril, enalapril, enalaprilat), angiotensin II receptor antagonists (candesartan, eprosartan), β-blockers (in particular, atenolol, labetalol, metoprolol, propranolol, esmolol), agonists central α-adrenergic receptors (clonidine), slow calcium channel blockers (nifedipine). Diuretics as antihypertensive therapy used only when indicated (for example, heart failure, ineffectiveness of other antihypertensive drugs) due to a possible deterioration in blood rheology.

Forecast

Usually, chronic cerebrovascular accident is characterized by a slowly progressive course, although a stepwise progression is also possible (usually after vascular crises). In stage I, the ability to work and everyday adaptation of patients in most cases is preserved, in stage II there is a slight or moderate decrease in working capacity, in stage III, patients are disabled, often unable to self-service.

The article was prepared and edited by: surgeon

cerebral circulation- blood circulation in the system of vessels of the brain and spinal cord.

The process that causes disorders of cerebral circulation can affect the main and cerebral arteries (aorta, brachiocephalic trunk, common, internal and external carotid, subclavian, vertebral, basilar, spinal, radicular arteries and their branches), cerebral veins and venous sinuses, jugular veins. The nature of the pathology of the cerebral vessels is different: thrombosis, embolism, narrowing of the lumen, kinks and looping, aneurysms of the vessels of the brain and spinal cord.

The severity and localization of morphological changes in the brain tissue in patients with cerebral circulation disorders are determined by the underlying disease, the blood supply pool of the affected vessel, the mechanisms of development of this circulatory disorder, age and individual features sick.

Morphological signs of cerebrovascular accident can be focal and diffuse. Focal include hemorrhagic stroke, intrathecal hemorrhage, cerebral infarction; to diffuse - multiple small-focal changes in the substance of the brain of different nature and different prescription, small hemorrhages, small fresh and organizing foci of necrosis of brain tissue, gliomesodermal scars and small cysts.

Clinically, with cerebral circulation disorders, there may be subjective sensations (headache, dizziness, paresthesia, etc.) without objective neurological symptoms; organic microsymptoms without clear symptoms of loss of CNS function; focal symptoms: movement disorders- paresis or paralysis, extrapyramidal disorders, hyperkinesis, coordination disorders, sensitivity disorders, pain; disturbances in the functions of the sense organs, focal disorders higher functions bark big brain- aphasia, agraphia, alexia, etc.; changes in intelligence, memory, emotional-volitional sphere; epileptic seizures; psychopathological symptoms.

By the nature of cerebrovascular disorders, there are initial manifestations of insufficient blood supply to the brain, acute cerebrovascular accidents (transient disorders, intrathecal hemorrhages, strokes), chronic slowly progressive disorders of cerebral and spinal circulation (dyscirculatory encephalopathy and myelopathy).

Clinical symptoms of the initial manifestations of insufficiency of blood supply to the brain are those that appear, especially after intense mental and physical work, stay in a stuffy room, headache, dizziness, noise in the head, decreased performance, sleep disturbance. Focal neurological symptoms in such patients, as a rule, are absent or are represented by diffuse microsymptoms. To diagnose the initial manifestations of insufficient blood supply to the brain, it is necessary to identify objective signs of atherosclerosis, arterial hypertension, vasomotor dystonia and exclude other somatic pathologies, as well as neurosis.

Acute cerebrovascular accidents include transient cerebrovascular accidents and strokes.

Transient disorders of cerebral circulation are manifested by focal or cerebral symptoms (or a combination thereof), lasting less than 1 day. Most often they are observed in atherosclerosis of cerebral vessels, hypertension and arterial hypertension.

There are transient ischemic attacks and hypertensive cerebral crises.

Transient ischemic attacks are characterized by the appearance of focal neurological symptoms (weakness and numbness of the extremities, speech difficulty, impaired statics, diplopia, etc.) against the background of mild or absent cerebral symptoms.

For hypertensive cerebral crises, on the contrary, the predominance of cerebral symptoms (headache, dizziness, nausea or vomiting) over focal ones, which sometimes may be absent, is characteristic. Acute cerebrovascular accident, in which focal neurological symptoms persist for more than 1 day, is considered a stroke.

Acute disorders of venous circulation in the brain also include venous hemorrhages, thrombosis of the cerebral veins and venous sinuses.

Chronic disorders of cerebral circulation (dyscirculatory encephalopathy and myelopathy) are the result of progressive circulatory failure caused by various vascular diseases.

With dyscirculatory encephalopathy, diffuse organic symptoms are detected, usually in combination with memory impairment, headaches, non-systemic dizziness, irritability, etc. There are 3 stages of dyscirculatory encephalopathy.

For stage I, in addition to diffuse, unsharply pronounced persistent organic symptoms (asymmetry of cranial innervation, light oral reflexes, inaccuracies in coordination, etc.), the presence of a syndrome similar to the asthenic form of neurasthenia is characteristic (memory impairment, fatigue, absent-mindedness, difficulty switching from one activity to another). another, dull headaches, non-systemic dizziness, bad dream, irritability, tearfulness, depressed mood). The intellect does not suffer.

Stage II is characterized by a progressive deterioration of memory (including professional), a decrease in working capacity, personality changes (viscosity of thought, a narrowing of the circle of interests, apathy, often verbosity, irritability, quarrelsomeness, etc.), and a decrease in intelligence. Daytime sleepiness is typical with poor night sleep. organic symptoms more distinct (mild dysarthria, reflexes of oral automatism and other pathological reflexes, bradykinesia, tremor, change muscle tone, coordination and sensory disorders).
Stage III is characterized as weighting mental disorders(up to dementia), and development neurological syndromes associated with a predominant lesion of a certain area of the brain. It can be pseudobulbar palsy, parkinsonism, cerebellar ataxia, pyramidal insufficiency. Stroke-like worsening of the condition is frequent, characterized by the appearance of new focal symptoms and an increase in previously existing signs of cerebrovascular insufficiency.

Dyscirculatory myelopathy also has a progressive course, in which three stages can be conventionally distinguished. Stage I (compensated) is characterized by the appearance of moderate fatigue of the muscles of the limbs, less often by weakness of the limbs. Subsequently, in stage II (subcompensated), weakness in the limbs progressively increases, sensitivity disorders appear in the segmental and conduction type, changes in reflex sphere. In stage III, paresis or paralysis, severe sensory disturbances, and pelvic disorders develop.

The nature of focal syndromes depends on the localization of pathological foci along the length and diameter of the spinal cord. Possible clinical syndromes are polio, pyramidal, syringomyelic, amyotrophic lateral sclerosis, posterior columnar, transverse lesions of the spinal cord.

Chronic venous circulation disorders include venous congestion, causing venous encephalopathy and myelopathy. It is a consequence of cardiac or pulmonary heart failure, compression of extracranial veins in the neck, etc. Difficulties in venous outflow from the cranial cavity and spinal canal can be compensated for a long time; with decompensation, headaches are possible, seizures, cerebellar symptoms, dysfunction of cranial nerves. Venous encephalopathy is characterized by a variety clinical manifestations. There may be hypertensive (pseudotumor) syndrome, syndrome of disseminated small-focal lesions of the brain, asthenic syndrome. Venous encephalopathy also includes bettolepsy (cough epilepsy), which develops in diseases that lead to venous congestion in the brain. Venous myelopathy is a particular variant of dyscirculatory myelopathy and does not differ significantly from the latter clinically.

Symptoms of circulatory disorders in the vessels of the brain

In the early stages, the disease is asymptomatic. However, it progresses rapidly and gradually its symptoms completely incapacitate a person, his working capacity is seriously impaired, a person loses the joy of life and cannot fully live.

So, the symptoms of cerebrovascular accident include:

Headache is the main alarm bell, but people often ignore it, believing that the pain is caused by fatigue, weather, or other reasons
pain in the eyes - its peculiarity lies in the fact that it noticeably increases during movement eyeballs especially in the evening
dizziness - when such a phenomenon is noted regularly, it should by no means be ignored
nausea and vomiting - usually this symptom occurs in parallel with the above
ear congestion
ringing or noise in the ears
convulsions - this symptom is less common than others, but still occurs
numbness - in violation of blood circulation in the vessels of the brain, it occurs absolutely for no reason
tension of the head muscles, especially pronounced in the occipital
weakness in the body
fainting
skin blanching
decrease in heart rate

There are also various disorders of consciousness, such as:

Alterations in perception, such as feeling overwhelmed
memory impairment - a person remembers his past perfectly, but often forgets about plans, about where everything is
distraction
rapid fatigue and, as a result, a decrease in working capacity
irascibility, slight excitability, tearfulness
constant drowsiness or vice versa insomnia

Causes of cerebrovascular disorders

Causes this disease very diverse. Usually they are associated with other abnormalities in the work of the cardiovascular system, for example, with vascular atherosclerosis or hypertension. Atherosclerosis is a blockage of blood vessels with cholesterol plaques, so it is simply necessary to monitor the concentration of cholesterol in the blood. And for this you should monitor your daily diet.

Chronic fatigue also often causes circulatory disorders in our brain. Unfortunately, people often do not realize the seriousness of their condition and reach terrible consequences. But chronic fatigue syndrome can lead not only to a failure in blood circulation, but also to disturbances in work. endocrine system, central nervous system and gastrointestinal tract.

Various traumatic brain injuries can also cause disorders. It can be an injury of any severity. Injuries with intracranial hemorrhage are especially dangerous. It is quite natural that the stronger this hemorrhage, the more serious consequences it can lead to.

The problem of a modern person is a regular sitting in front of a computer monitor in an uncomfortable position. As a result of this, the muscles of the neck and back are greatly overstrained and blood circulation in the vessels, including the vessels of the brain, is disturbed. Excessive exercise can also be harmful.

Circulatory problems are also closely related to diseases of the spine, especially its cervical. Be careful if you are diagnosed with scoliosis or osteochondrosis.

The main cause of cerebral hemorrhage is high blood pressure. With its sharp rise, a rupture of the vessel may occur, resulting in the release of blood into the substance of the brain and the development of an intracerebral hematoma.

A more rare cause of hemorrhage is a ruptured aneurysm. An arterial aneurysm, usually related to congenital pathology, is a saccular protrusion on the vessel wall. The walls of such a protrusion do not have such a powerful muscular and elastic frame as the walls of a normal vessel have. Therefore, sometimes only a relatively small pressure jump, which is observed for quite healthy people at physical activity or emotional stress for the wall of the aneurysm to rupture.

Along with saccular aneurysms, other congenital anomalies of the vascular system are sometimes observed, creating a threat of sudden hemorrhage.
In cases where an aneurysm is located in the walls of vessels located on the surface of the brain, its rupture leads to the development of not intracerebral, but subarachnoid (subarachnoid) hemorrhage, located under arachnoid surrounding the brain. Subarachnoid hemorrhage does not directly lead to the development of focal neurological symptoms (paresis, speech disorders, etc.), but cerebral symptoms: sudden sharp ("dagger") headache, often followed by loss of consciousness.

A cerebral infarction usually develops as a result of blockage of one of the cerebral vessels or a large (main) vessel of the head, through which blood flows to the brain.

There are four main vessels: the right and left internal carotid arteries, supplying most of the right and left hemispheres of the brain, and the right and left vertebral arteries, which then merge into the main artery and supply blood to the brainstem, cerebellum and occipital lobes of the cerebral hemispheres.

The causes of blockage of the main and cerebral arteries may be different. So, during an inflammatory process on the heart valves (with the formation of infiltrates or with the formation of a parietal thrombus in the heart), pieces of a thrombus or infiltrate can come off and come with the blood flow to the cerebral vessel, the caliber of which smaller size piece (embolus), and as a result, clog the vessel. Particles of a decaying atherosclerotic plaque on the walls of one of the main arteries heads.

This is one of the mechanisms for the development of cerebral infarction - embolic.
Another mechanism for the development of a heart attack is thrombotic: the gradual development of a blood clot (blood clot) at the location of an atherosclerotic plaque on the vessel wall. Atherosclerotic plaque filling the lumen of the vessel leads to a slowdown in blood flow, which contributes to the development of a blood clot. The uneven surface of the plaque favors the adhesion (aggregation) of platelets and other blood elements in this place, which is the main frame of the resulting thrombus.

As a rule, some local factors for the formation of a blood clot are often not enough. The development of thrombosis is facilitated by such factors as a general slowdown in blood flow (therefore, thrombosis of the cerebral vessels, as opposed to embolism and hemorrhage, usually develops at night, during sleep), increased blood clotting, increased aggregation (gluing) properties of platelets and red blood cells.

What is blood clotting, everyone knows from experience. A person accidentally cut his finger, blood begins to flow from it, but gradually a blood clot(thrombus) and the bleeding stops.
Blood clotting is essential biological factor contributing to our survival. But both reduced and increased clotting threatens our health and even our very lives.

Increased coagulability leads to the development of thrombosis, reduced - to bleeding with the slightest cuts and bruises. Hemophilia is a disease associated with reduced coagulability blood and having a hereditary character, many members of the reigning families of Europe suffered, including the son of the latter Russian emperor Tsarevich Alexei.

Violation of normal blood flow can also be the result of a spasm (strong compression) of the vessel, which occurs as a result of a sharp contraction of the muscle layer vascular wall. A few decades ago, spasm was given great importance in the development of cerebrovascular accidents. Currently, cerebral infarctions are mainly associated with spasm of cerebral vessels, which sometimes develop several days after a subarachnoid hemorrhage.

With frequent rises in blood pressure, changes can develop in the walls of small vessels that feed the deep structures of the brain. These changes lead to narrowing, and often to the closure of these vessels. Sometimes after another sharp rise in blood pressure ( hypertensive crisis) in the circulatory system of such a vessel develops a small infarction (called in the scientific literature "lacunar" infarction).

In some cases, cerebral infarction can develop without complete blockage of the vessel. This is the so-called hemodynamic stroke. Imagine a hose that you use to water your garden. The hose is clogged with silt, but the electric motor, lowered into the pond, works well, and there is enough water jet for normal watering. But a slight bend in the hose or a deterioration in the operation of the motor is enough, instead of a powerful jet, a narrow stream of water begins to flow out of the hose, which is clearly not enough to water the ground well.

The same can occur under certain conditions with the blood flow in the brain. For this, the presence of two factors is sufficient: a sharp narrowing of the lumen of the main or cerebral vessel that fills it atherosclerotic plaque or as a result of its inflection plus a drop in blood pressure due to a deterioration (often temporary) in the work of the heart.

Mechanism transient disorders cerebral circulation (transient ischemic attacks) is in many ways similar to the mechanism of development of cerebral infarction. Only compensating mechanisms for transient cerebrovascular accidents work quickly, and the developed symptoms disappear within a few minutes (or hours). But one should not hope that compensation mechanisms will always cope so well with the violation that has arisen. Therefore, it is so important to know the causes of cerebrovascular accident, which makes it possible to develop methods for preventing (preventing) repeated disasters.

Treatment of cerebrovascular accident

Various diseases of the cardiovascular system are the most common ailments among the population of the planet. A violation of cerebral circulation in general is an extremely dangerous thing. Brain - the most important body our body. Its poor functioning leads not only to physical abnormalities, but also to a violation of consciousness.

The treatment of this disease includes not only taking medicines but also a complete change in your lifestyle. As mentioned above, the development of circulatory disorders in the vessels of the brain contribute cholesterol plaques. So, it is necessary to take measures to prevent an increase in the level of cholesterol in the blood. And the main measures are proper nutrition. First of all, do the following:

Limit the amount you use as much as possible. table salt
give up alcoholic beverages
if you have overweight- You urgently need to get rid of them, because they create an extra load on your blood vessels, and this is simply unacceptable with this disease
In some people, blood vessels, including capillaries, are fragile. These people often bleed gums, nosebleeds are not uncommon. How to get rid of this scourge?

Dissolve in a glass of water at room temperature a teaspoon of well-peeled (food) and finely ground sea salt. Chill saline solution draw in with your nostrils and hold your breath for about 3-4 seconds. Repeat the procedure every morning for 10-12 days, and nosebleeds will stop.

This method also helps well: prepare a rich brine(five tablespoons of coarse sea salt per glass warm water). Make two swabs out of cotton, soak them in the prepared solution and insert them into your nose. Lie with your head thrown back for 20 minutes. It is also useful to rinse your mouth with the same solution: the gums will stop hurting and bleeding.

Take two tablespoons of dry mustard, two pods of crushed hot pepper, a tablespoon of sea salt. Mix all ingredients and add two glasses of vodka. Leave the mixture in a dark place for 10 days. With the resulting tincture, actively rub your feet at night. After rubbing, put on woolen socks and go to bed.

Treatment of age-related changes in the circulatory system in the elderly

Age-related changes in the vessels and heart in to a large extent limiting adaptive capabilities and create prerequisites for the development of diseases.

Changes in the vessels. The structure of the vascular wall changes with age in each person. The muscle layer of each vessel gradually atrophies and decreases, its elasticity is lost and sclerotic seals of the inner wall appear. This greatly limits the ability of blood vessels to expand and narrow, which is already a pathology. The big ones suffer first. arterial trunks especially the aorta. In elderly and old people, the number of active capillaries per unit area is significantly reduced. Tissues and organs cease to receive the amount of nutrients and oxygen they need, and this leads to their starvation and the development of various diseases.

As each person ages small vessels more and more “clogged” with lime deposits and peripheral vascular resistance increases. This leads to some increase in blood pressure. But the development of hypertension is largely hampered by the fact that with a decrease in the tone of the muscle wall large vessels the lumen of the venous bed expands. This leads to a decrease in the minute volume of the heart (minute volume - the amount of blood ejected by the heart per minute) and to an active redistribution peripheral circulation. The coronary and cardiac circulations are usually almost unaffected by the decrease in cardiac output, while the renal and hepatic circulations are greatly reduced.

decline contractility heart muscle. The older a person becomes, the more muscle fibers of the heart muscle atrophy. The so-called "senile heart" develops. There is a progressive sclerosis of the myocardium, and in place of the atrophied muscle fibers of the heart tissue, non-working fibers develop. connective tissue. The strength of heart contractions gradually decreases, more and more violated metabolic processes, which creates conditions for energy-dynamic insufficiency of the heart in conditions of intense activity.

In addition, in old age, conditional and unconditioned reflexes regulation of blood circulation, the inertia of vascular reactions is increasingly revealed. Studies have shown that with aging, the effects on the cardiovascular system of various brain structures change. In turn, the feedback also changes - the reflexes coming from the baroreceptors of large vessels are weakened. This leads to dysregulation of blood pressure.

As a result of all the above reasons, with age physical performance heart drops. This leads to a limitation of the range of reserve capabilities of the body and a decrease in the efficiency of its work.

Points of influence in circulatory disorders

With weak blood flow and blockage of blood vessels, one should grab the index finger and thumb of one hand middle finger other hand. Acupressure carry out by pressing with medium force with a fingernail thumb to a point that is located under the nail bed. Massage should be done on both hands, devoting 1 minute to it.

Points of influence for thirst. If you feel thirsty, you should act on a calming point. The peculiarity of this BAP is that so far it has not been possible to determine other points associated with the mucous membrane in the human body. The point is located at a distance of about 1 cm from the tip of the tongue. The massage consists in the form of a light biting of this point with the front teeth (incisors) with a rhythm of 20 times in 1 minute.

Points of influence in sleep disorders. For insomnia, acupressure of the lower part should be performed. auricle. Massage should be performed with index and thumbs, clasping the earlobe on both sides. Biologically active point located in the middle of the lobe. Sleep will come faster (Yulia massage more often with right side than on the left.

Picture. Points of influence for influenza, runny nose, catarrh of the upper respiratory tract

Acupressure does not replace the necessary medical treatment, especially if surgical intervention is urgently needed (for example, with appendicitis, its purulent stage).

Chronic violation of cerebral circulation (cerebral vascular insufficiency) is characterized by a decrease in blood supply to the brain. This condition is very common among older people in developed countries due to the high prevalence of atherosclerosis. In most cases, damage occurs carotid artery. A pair of carotid arteries, one on each side of the neck, running parallel to the jugular vein, are the main arteries that supply blood to the brain.

As a rule, cerebral vascular insufficiency develops in the area of bifurcation of the carotid artery - splitting of the carotid artery into internal and outer branch. Such splitting is similar to a stream that has split into two streams. In a bifurcation, as well as in a bifurcation in a water flow, slags accumulate. Severe symptoms begin to appear in most cases only when the blockage of the artery reaches 90 percent. This situation is similar to what happens in coronary heart disease.

Symptoms of chronic cerebrovascular accident are due to a decrease in blood flow and oxygen supply to the brain. The interruption of blood supply and oxygen supply leads to a stroke. The official definition of stroke is "loss of nerve function for at least 24 hours due to lack of oxygen." Some strokes are mild; others result in paralysis, coma, or speech impairment, depending on which part of the brain was involved. Mini-strokes, or transient ischemic attacks, can lead to loss of nerve function for an hour or more, but less than 24 hours. TIAs can lead to transient symptoms of cerebral vascular insufficiency: dizziness, tinnitus, blurred vision, confusion, and so on.

Atherosclerosis is one of the main causes of cerebrovascular insufficiency. During the development of this process, high cholesterol levels combined with inflammation in the walls of the arteries in the brain can lead to the accumulation of cholesterol on the vessel wall in the form of a thick, waxy plaque (plaque). This plaque can restrict or completely block blood flow to the brain, causing stroke, transient ischemic attacks, or dementia, which can lead to a host of other health complications.

The most common forms of cerebrovascular disease of the brain are thrombosis (40% of cases) and cerebral embolism (30%), followed by cerebral hemorrhages (20%).

Another form of cerebrovascular disease involves aneurysms. In women with defective collagen, weak key arterial junctions result in very thinly covered endothelial protrusions that can easily rupture with minimal increase in blood pressure. It can also occur in poor capillaries caused by cholesterol deposition in tissues, especially in hypertensive patients with or without dyslipidemia. If bleeding occurs, the result is a hemorrhagic stroke in the form of subarachnoid hemorrhage, intracerebral hemorrhage or both.

A drop in blood pressure during sleep can lead to a marked decrease in blood flow in constricted blood vessels, causing an ischemic stroke in the morning hours. And vice versa, sharp rise blood pressure due to daytime arousal can lead to rupture blood vessels, which results in intracranial hemorrhage. Cerebrovascular disease primarily affects older people or those with a history of diabetes, smoking, ischemic disease hearts.

Symptoms

Symptoms of cerebrovascular accident depend on the degree of damage to brain cells and the localization of the area of the brain with impaired blood flow. In acute disorders of cerebral circulation (hemorrhagic or ischemic stroke), movement disorders develop, such as hemiplegia or hemiparesis.

In chronic disorders of cerebral circulation (it is also called dyscirculatory encephalopathy), the symptoms develop gradually and manifest themselves with symptoms such as memory impairment, dizziness, headaches. At first, the patient does not have disorders intellectual abilities. But as there is a chronic lack of oxygen in the brain tissues, memory impairments begin to progress, personality disorders occur, and intelligence is significantly reduced. In the future, the patient develops severe intellectual-mnestic and cognitive impairments and dementia is formed, extrapyramidal disorders and cerebellar ataxia may also develop.

The reasons

Chronic cerebrovascular insufficiency is most often associated with atherosclerosis, hypertension, as well as heart disease, accompanied by chronic circulatory failure. In addition, CNMC may be associated with vascular abnormalities and diseases (vasculitis), venous anomalies, diabetes mellitus, and various blood diseases that result in chronic hypoxia brain.

Also, chronic cerebrovascular accident occurs as a result of acute disorders cerebral circulation such as ischemic or hemorrhagic stroke.

An ischemic stroke occurs when a blood vessel that supplies blood to the brain becomes blocked by a blood clot. A clot may form in an artery that is already narrowed. Also, a clot can break away from the vessel wall somewhere in the body and get through the bloodstream to the brain.

Ischemic strokes can also be caused by blood clots that form in the heart. These clots enter the brain through the bloodstream and can become lodged in the small arteries of the brain.

Certain medications and medical conditions can increase blood clotting and cause a blood clot to form and increase your risk of developing ischemic stroke. A hemorrhagic stroke occurs when a blood vessel in a specific part of the brain becomes weak and ruptures, causing blood to leak into the brain and the blood damages brain cells. Some people have defects in the blood vessels in the brain that make a hemorrhagic stroke more likely.

Diagnostics

The diagnosis of chronic cerebrovascular accident is made on the basis of a combination of examination data, symptoms, neurological signs, results of brain neuroimaging (MRI, CT or MSCT), angiography of cerebral vessels.

The doctor may detect the presence of certain neurological, motor and sensory deficits, such as changes in vision or visual fields, impaired reflexes, abnormal eye movements, muscle weakness, decreased sensation, and other changes. In addition, certain tests help determine the presence of intellectual-mnestic disorders.

Laboratory research methods are prescribed for the diagnosis of somatic diseases.

Treatment

If there are diseases such as hypertension, diabetes mellitus or other diseases, then, first of all, it is necessary to compensate for the underlying disease.

Used to treat chronic cerebrovascular accident various medicines - vascular preparations(trental, cavinton, sermion, etc.) nootropics, metabolic drugs, antioxidants. Antiplatelet agents such as aspirin, dipyridamole are prescribed to prevent blood clots. Statins can be used for high cholesterol levels in the blood.

Sometimes, to eliminate a violation of blood flow, it is required surgical treatment such as carotid endarterectomy. Treatments such as carotid angioplasty and stenting are also used.

Prevention

The development of cerebrovascular disease can be prevented to some extent by following following recommendations: stop smoking, regular physical exercises, healthy eating With low content fat maintenance normal weight, blood pressure control, hypertension control, avoidance chronic stress and lowering blood cholesterol levels.

Cerebral circulation is the movement of blood in the vascular system of the brain and spinal cord. In a pathological process that causes cerebrovascular accident, the main and cerebral arteries (aorta, brachiocephalic trunk, as well as common, internal and external carotid, vertebral, subclavian, spinal, basilar, radicular arteries and their branches), cerebral and jugular veins, venous sinuses can be affected. By the nature of the pathology of the vessels of the brain is different: thrombosis, embolism, kinks and looping, narrowing of the lumen, aneurysms of the vessels of the brain and spinal cord.

Vascular concept brain failure generally defined as a state of disproportion between the need for and delivery of blood to the brain. It is based, most often, on the restriction of blood flow in atherosclerotically narrowed cerebral vessels. In this case, a temporary decrease in systemic blood pressure can cause the development of ischemia in the brain area supplied by a vessel with a narrowed lumen.

According to the nature of cerebral circulation disorders, the initial manifestations of insufficiency of blood supply to the brain are distinguished:

acute disorders of cerebral circulation (transient disorders, intrathecal hemorrhages, strokes);

chronic slowly progressive disorders of cerebral and spinal circulation (dyscirculatory encephalopathy and myelopathy).

Chronic cerebrovascular accident- Dyscirculatory encephalopathy is a slowly progressive cerebrovascular insufficiency, cerebral circulatory insufficiency, leading to the development of many small-focal necrosis of the brain tissue and impaired brain function.

Transient disorders of cerebral circulation - acute disorder brain function vascular genesis, which are characterized by the suddenness and short duration of dyscirculatory disorders in the brain and are expressed by cerebral and focal symptoms. The most important criterion for transient disorders of cerebral circulation is the complete reversibility of focal or diffuse neurological symptoms within 24 hours. The following forms are distinguished: transient ischemic attacks and hypertensive crises.

Ischemic disorders of cerebral circulation arise due to local ischemia of the brain and are manifested by focal neurological disorders and less often by a disorder of consciousness. Local cerebral ischemia develops due to thrombosis or embolism outside or intracranial arteries, in rare cases cerebral hypoperfusion due to systemic hemodynamic disorders. In cases where neurological disorders disappear within a day, the disease is regarded as a transient ischemic attack. When saving neurological disorders for more than a day, ischemic stroke is diagnosed.

Causes of cerebrovascular disorders

The main reason is atherosclerosis. This disease is accompanied by the formation of fatty plaques on inner walls arteries with their gradual blockage and difficulty in blood flow through them. Before manifestation clinical symptoms narrowing of the carotid artery can be 75%. Platelets accumulate in the affected areas, blood clots are formed, the detachment of which from the wall of the blood vessel can lead to blockage of the cerebral vessels. Blood clots can also form in the brain. Other causes of cerebral circulation disorders are diseases of the heart and blood vessels, degenerative changes cervical spine. Stroke can be caused by rheumatic heart disease, changes in heart valves, migraines, stress, and physical overexertion. A cerebrovascular accident can be the result of an injury, for example, resulting from a short-term infringement of the neck with a seat belt (the so-called "whiplash") in a traffic accident. Due to a slight tear in the wall of the carotid artery, blood begins to collect in it, which leads to blockage of the artery. Violation of cerebral circulation can cause: cerebral bleeding, radiation sickness, complicated migraine, etc.

One common cause is cerebral hemorrhage due to high blood pressure. With a sharp rise in blood pressure, a vessel rupture can occur, as a result of which blood enters the substance of the brain, an intracerebral hematoma appears. A rarer cause of hemorrhage is a ruptured aneurysm. As a rule, related to congenital pathology, arterial aneurysm is a protrusion in the form of a bag on the wall of the vessel. The walls of such a protrusion, unlike the walls of a normal vessel, do not have a sufficiently powerful muscular and elastic frame. Therefore, sometimes a relatively small increase in pressure, which can be observed during physical exertion, emotional stress in quite healthy people, leads to a rupture of the aneurysm wall.

In addition, it is very important to remember that cerebrovascular accidents can develop against the background of chronic fatigue syndrome. In this case, a person should see a doctor as soon as possible to treat chronic fatigue syndrome. This state a person can lead to disruption of the functioning of such body systems as the endocrine, digestive, and, of course, cardiovascular.

And the constant stressful situations that a person gets into also do not give him health. In addition to cerebrovascular accident and arterial hypertension stress can lead to the development nervous breakdowns, dysfunction of the central nervous system. Yes, and circulatory disorders of the brain in stressful situations can also be quite serious.

Symptoms of cerebrovascular accident

Clinical symptoms of the initial manifestations of insufficient blood supply to the brain are:

headache after intense mental and physical work;
dizziness, noise in the head;
decrease in working capacity;
memory loss;
distraction;
sleep disturbance.

Focal neurological symptoms in such patients, as a rule, are absent or are represented by diffuse microsymptoms. To diagnose the initial manifestations of insufficient blood supply to the brain, it is necessary to identify objective signs of atherosclerosis, arterial hypertension, vasomotor dystonia and exclude other somatic pathologies, as well as neurosis.

Diagnosis of cerebrovascular accident

For diagnostics, it matters:

the presence of a vascular disease for a number of years - hypertension, atherosclerosis, blood diseases, diabetes mellitus;
characteristic complaints of the patient;
data from neuropsychological studies - the most common MMSE scale for detecting cognitive impairment (normally, you need to score 30 points by completing the proposed tests);
examination of an ophthalmologist who discovered signs of angiopathy in the fundus;
duplex scanning data - the possibility of neuroimaging of atherosclerotic lesions of cerebral vessels, vascular malformations, venous encephalopathy;
magnetic resonance imaging data - detection of small hypodense foci in the periventricular spaces (around the ventricles), leukariosis zones, changes in liquor-containing spaces, signs of atrophy of the cerebral cortex and focal (post-stroke) changes;
blood tests - general, for sugar, coagulogram, lipidogram.

Recurring headache, dizziness, high blood pressure, intellectual disability - even just absent-mindedness should lead you to a neurologist.

Treatment of cerebrovascular accident

Treatment should be aimed at preventing the development of recurrent CMI and cerebral stroke. In mild cases (disappearance of symptoms of circulatory disorders within a few minutes), treatment is possible in an outpatient setting. In severe cases lasting more than 1 hour, and with repeated violations, hospitalization is indicated.

Therapeutic measures include:

improvement of cerebral blood flow;

rapid inclusion of collateral circulation;

improvement of microcirculation;

removal of cerebral edema;

improved metabolism in the brain.

To improve cerebral blood flow normalization of blood pressure and increased cardiac activity are shown. For this purpose, corglicon is prescribed 1 ml of a 0.06% solution in 20 ml of a 40% glucose solution or strophanthin 0.25-0.5 ml of a 0.05% solution with glucose IV.

To reduce high blood pressure dibazol is shown in 2-3 ml of a 1% solution in / in or 2-4 ml of a 2% solution in / m, papaverine hydrochloride in 2 ml of a 2% solution in / in, no-shpa 2 ml of a 2% solution in / m or 10 ml of 25% magnesium sulfate solution IM.

To improve microcirculation and collateral circulation use drugs that reduce the aggregation of blood cells. Rapid-acting antiplatelet agents include rheopolyglucin (400 ml IV drip), eufillin (10 ml of a 2.4% IV solution in 20 ml of a 40% glucose solution).

Patients with severe PNMK shown parenteral administration antiplatelet agents during the first three days, then it is necessary to take 0.5 g of acetylsalicylic acid orally 3 times a day after meals for a year, and with the repetition of ischemic attacks and for two years to prevent the formation of cell aggregants (microemboli), and therefore , for the prevention of recurrence of PNMK and cerebral stroke. If there are contraindications for use acetylsalicylic acid (peptic ulcer stomach) it is possible to recommend bromcamphor inside 0.5 g 3 times a day, which has the ability not only to reduce platelet aggregation, but also to accelerate the disaggregation of blood cells.

With cerebral edema carry out dehydration therapy: furosemide (lasix) orally at 40 mg / in or / m at 20 mg during the first day. To improve metabolism in the brain, a min alon, cerebrolysin, and B vitamins are prescribed.

As symptomatic therapy with an attack of systemic dizziness, atropine-like drugs are indicated - belloid, bellataminal, as well as cinnarizine (stugerop), diazepam (seduxen) and chlorpromazine. It is advisable to use sedative therapy for 1-2.5 weeks (valerian, oxazepam - tazepam, trioxazine, chlordiazepoxide - elenium, etc.).

With PNMK in the system of the internal carotid artery in persons young age angiography is indicated to resolve the issue of surgical intervention. Surgery used for stenosis or acute blockage of the carotid artery in the neck.

The human brain is the organ that works most intensively and requires the most energy. He especially needs oxygen and. A neuron (nerve cell) is constantly active. Every second he needs molecules that are carriers of energy. If he does not receive them, then he dies quickly enough. If oxygen completely stops flowing to the brain, then death will occur in 5-7 minutes. At chronic insufficiency cerebral circulation death nerve cells happens gradually.

Causes of chronic cerebrovascular insufficiency

The main causes of chronic disorders of cerebral blood flow:

Atherosclerosis is a disease in which cholesterol plaques grow on the vessel wall, gradually blocking its lumen.
Hypertonic disease. With high blood pressure, there is no adequate blood supply to organs and tissues.
Increased blood clotting. However, in the vessels various organs, including the brain, blood clots form.
Atrial fibrillation, heart defects. In these conditions, the heart is unable to adequately supply blood to the brain.
Diseases of the red bone marrow and other hematopoietic organs. In the red bone marrow, no enough red blood cells, so the blood cannot carry enough oxygen.

Risk factors for the development of chronic cerebrovascular accident are: age over 50 years, overweight body, hereditary predisposition(the presence of the disease in close relatives).

Symptoms of chronic cerebrovascular accident

The disease proceeds in three stages.

In the first stage of chronic cerebrovascular accident, the symptoms resemble chronic fatigue. The patient complains of increased fatigue, poor sleep at night and constant drowsiness daytime, dizziness, . He often forgets about many little things. A person becomes irritable, his mood changes quickly.

In the second stage, memory impairments increase. A person forgets not only insignificant, but also important things, including those related to his profession. The patient experiences constant tinnitus headache, . He is very bad at assimilating new information, and because of this, its performance decreases. There is a lack of self-confidence, high irritability.

Gradually there is a degradation of the patient as a person. The gait becomes shaky, the movements are uncertain.

In the third stage, dementia develops. Memory is greatly reduced. A person constantly forgets what he did and what he wanted a few minutes ago. Leaving the house, he cannot find his way back. Coordination of movements is disturbed, hands constantly tremble.

What can you do?

Nerve cells are unable to divide and multiply. If the neuron is dead, it will never be possible to restore it. It is only possible to restore functions to some extent at the expense of neighboring cells. Therefore, chronic cerebrovascular accident should be treated in the early stages. It is necessary to consult a therapist or neurologist. It is worth remembering that cardiovascular disease ranks first among the causes of death in older people.

What can a doctor do?

In case of chronic cerebrovascular accident, an examination is prescribed:
Duplex scanning of cerebral vessels: a study that helps evaluate cerebral blood flow.
Rheovasography is a study of the vessels of the brain.
Computed and magnetic resonance imaging of the head.
Examination: the doctor assesses the state of the fundus vessels, as they are associated with the vessels of the brain and allow an indirect assessment of their condition.
Blood tests: general, biochemical.
Tests to detect intellectual disabilities. For example, the MMSE technique is popular today.

Treatment of chronic disorders of cerebral circulation is carried out with the help of medications. They use funds aimed at improving cerebral circulation, lowering blood pressure and cholesterol levels in the blood, neuroprotectors (protecting nerve cells from damage), nootropics (improving the functioning of nerve cells),.
After the course of treatment, rehabilitation is carried out, which includes physiotherapy exercises, physiotherapy, and spa treatment.