Cerebral circulation is the movement of blood through the vessels of the brain and spinal cord. The pathological process that causes cerebrovascular accident is characterized by damage to the cerebral and main arteries, cerebral and jugular veins, as well as venous sinuses. Pathologies of cerebral vessels are different: thrombosis, kinks and looping, embolism, narrowing of the lumen, vascular aneurysms. Vascular concept brain failure can generally be defined as a discrepancy in quantity necessary for the brain blood and the amount of its actual delivery.

Causes

The causes of disorders primarily include atherosclerotic vascular damage. Atherosclerosis is a disease in which a plaque forms in the lumen of a vessel, which interferes with the normal passage of blood through a narrowed area. This plaque can increase in size over time, accumulating platelets. As a result, a blood clot is formed, which either completely closes the lumen of the vessel, or breaks off and is carried away with the blood into the vessels of the brain, clogging them, leading to a stroke, that is, an acute disorder of cerebral circulation.

Another cause of the disease is considered to be hypertension, since many hypertensive patients often do not take their condition seriously when their blood pressure increases and the treatment of this disease.

Like any organ, the brain needs good rest. If a person overloads it with work, the brain gradually gets tired and exhausts all its resources. Chronic fatigue can also be attributed to the causes of circulatory disorders in the brain. Osteochondrosis cervical region the spine, due to compression of the arteries supplying the brain, disrupts its blood supply and functionality.

Head injuries such as concussions, bruises and hemorrhages do not go away without leaving a trace. They cause compression of the brain centers, which impairs cerebral circulation, which, in turn, can lead to death.

Types of violations

There are two types of cerebral circulatory disorders: chronic and acute. An acute disorder (ACVA) always develops very quickly - in a matter of hours and even minutes.

ACVA is divided into stroke and transient cerebrovascular accident:

Hemorrhagic stroke is a condition that occurs due to hemorrhage in tissue when a vessel ruptures under the influence of any factors;
Ischemic stroke– this is brain hypoxia, which developed after the lumen of the blood vessel supplying this area was closed;
Transient cerebrovascular accidents are local disturbances in the blood supply to the brain that usually do not affect vital areas and do not cause serious problems.

Chronic cerebral circulatory disorders develop over the years. On initial stage Symptoms usually do not appear, but as the disease progresses they become pronounced.

Symptoms

The symptoms of the disease will have a different picture in each individual case, but at the same time a similar clinical picture of impaired brain functionality.

Main symptoms:

subjective: dizziness, headache, tingling sensation and “crawling”;
violation motor function body: paresis (partial immobilization of a limb) and paralysis (complete loss of movement of any part of the body);
decreased functionality of the senses (hearing or vision);
sensory disturbance (weakening, loss or pain);
any changes in the cerebral cortex: writing impairment, speech problems, loss of reading ability, etc.;
epileptic seizures;
decline mental abilities, intelligence, memory, absent-mindedness.

Each of the violations has its own characteristics:

With ischemic stroke, the symptoms of cerebrovascular accident always manifest themselves acutely. With this disease, the patient’s subjective complaints are observed, there may be nausea and vomiting, as well as focal symptoms, which are changes in the system or organ for which the damaged area of the brain is responsible.
Hemorrhagic stroke occurs when blood from damaged blood vessels enters the brain cavity with further compression and such a dangerous complication as wedging of the brain stem into the foramen magnum. This disease occupies a leading position in the number of deaths among all types of cerebral circulatory disorders.
Transient ischemic attack (TIA) is a transient cerebrovascular accident that resolves over time. It is accompanied by paresis, impaired speech and visual function, drowsiness and confusion.
Chronic cerebral circulatory disorders are observed in older people and are characterized by gradual development over many years. Characteristic symptoms: decreased intelligence, mental abilities and memory. Such patients are absent-minded and sometimes aggressive.

Diagnostics

The diagnosis of the disease is made based on the following signs:

patient complaints characteristic of this disorder;
the patient has factors that contribute to the development of circulatory disorders: diabetes mellitus, high blood pressure, atherosclerosis;
duplex scanning – identification of affected vessels;
magnetic resonance imaging (MRI) - visualization of the affected area of the brain, as much as possible informative research illness.

Treatment

Acute cerebrovascular accidents require emergency assistance specialists. In case of strokes, assistance should be aimed primarily at maintaining the functionality of vital organs. Basic treatment includes ensuring the patient proper blood circulation and breathing, reducing cerebral edema, correcting water and electrolyte disturbances, and normalizing blood pressure. Such procedures must be carried out in a hospital.

Subsequent treatment involves eliminating the cause of the disorder, as well as restoring impaired functions and blood flow in the brain.

Chronic circulatory disorders are usually treated with drugs that improve blood flow in the arteries and the rheological properties of the blood. They also normalize blood pressure and blood cholesterol. Normalizing blood circulation in the brain prevents the development of stroke and other serious cardiovascular diseases. vascular system. So, along with procedures, doctors often prescribe drugs to treat vascular disorders. For example, combination drug Vasobral improves blood circulation and metabolism in the brain. The components of the drug prevent blood clots, reduce the permeability of vessel walls, increase the resistance of brain tissue to lack of oxygen, and increase mental and physical performance. The drug's effectiveness in preventing headaches has been clinically proven.

Cerebrovascular accidents are a broad group of pathologies (they are also called cerebral cerebrovascular accidents) that affect the cerebral vessels (CB) and are accompanied by hypoxia and ischemia of brain tissue, development metabolic disorders and specific neurological symptoms.

On this moment, acute and chronic cerebrovascular accidents are the leading cause of disability among middle-aged and elderly patients, as well as one of the leading causes of mortality in the world.

At the same time, if recently cerebral blood flow disorders were found mainly in patients over 45 years of age, now they are diagnosed in twenty-year-olds as well.

The leading causes of the appearance of NMC are atherosclerotic damage to the vessels of the brain and neck. Young patients are more likely to experience blood flow disorders such as hemorrhagic stroke or those associated with a hypertensive crisis.

For reference. For elderly patients, the occurrence of ischemic-type cerebrovascular accidents is more typical; the risk of developing severe chronic cerebrovascular accidents also increases with age.

Significantly increases the likelihood of developing cerebrovascular accidents and a long-term decompensated course diabetes mellitus. Such patients experience severe vascular damage, microcirculation disorders, ischemic phenomena in organs and tissues, heart rhythm pathologies and a tendency to microthrombosis. In this regard, they often experience ischemic strokes with massive foci of necrosis.

One of the most common causes of the development of chronic ischemic blood flow disorders in young patients is osteochondrosis in cervicothoracic region spinal column. Office workers who lead a sedentary lifestyle often encounter this problem.

Also, common reasons occurrence of cerebrovascular accidents are:

CVS pathologies accompanied by cardiogenic thromboembolism;
rheumatic heart defects and vascular lesions;
post-infarction cardiosclerotic conditions complicated by cardiac aneurysms or atrial fibrillation;
various cardiomyopathy ;
MV prolapse ( mitral valve), accompanied by severe hemodynamic disturbances;
cerebral amyloid angiopathy;
systemic autoimmune and post-inflammatory vasculitis;
blood diseases (various hereditary coagulopathies, etc.);
aneurysms and malformations of blood vessels of the brain and neck;
coagulopathies accompanied by increased thrombus formation;
hemorrhagic diathesis;
tumors of the brain and neck;
thyroid diseases;
metastatic foci in the brain;
head and spinal injuries in the cervicothoracic region;
severe intoxication and poisoning;
neuroinfections.

Predisposing factors that significantly increase the risk of developing acute and chronic cerebrovascular accidents are:

obesity;
physical inactivity;
lipid imbalance;
smoking;
frequent physical and emotional stress;
alcohol abuse;
neuroses, depression;
chronic sleep deficiency;
hypovitaminosis;
frequent infectious diseases (especially streptococcal tonsillitis).

Types of cerebrovascular accidents

All cerebrovascular accidents are divided into those that arise acutely and those that are chronic. Separately, early manifestations of cerebral ischemia, discirculatory encephalopathies and the consequences of strokes were taken out.

For reference. Group acute changes cerebral blood flow includes transient ischemic attacks (TIAs), acute hypertensive encephalopathies and strokes. Strokes, in turn, are divided into brain infarctions and hemorrhages in brain tissue.

Chronic ischemic changes in brain tissue are divided into:

compensated;
remitting;
subcompensated;
decompensated.

Diagnosis of cerebral blood flow disorders

When symptoms of cerebrovascular accident appear, it is necessary to conduct a thorough examination in order to identify the type of circulatory disorder,
the extent of the lesion, as well as the cause of cervical cerebrovascular accident.

IN mandatory apply:

neuroimaging methods (computed tomography or magnetic resonance imaging),
Ultrasound of the vessels of the brain and neck,
cerebral angiography,
electroencephalography,
ECHO-cardiography,
daily allowance,
standard ECG.

General and biochemical blood tests, coagulation tests, lipid profile diagnostics, blood glucose determination, etc. are also performed.

Treatment of cerebrovascular accidents

Therapy depends on the type of cerebrovascular accident and the severity of the patient’s condition. All medications should be prescribed only by a neurologist. Self-medication is unacceptable and can lead to a significant deterioration of the condition.

Attention! It is necessary to understand that acute transient blood flow disorders in the absence of treatment always end in the development of ischemic strokes. Therefore, even if the symptoms of a TIA disappear a few minutes after the onset of the attack, it is still necessary to call ambulance.

Symptoms in initial NMC are also reversible, but only in the initial stages. Without timely treatment the development of progressive dyscirculatory encephalopathy with irreversible damage to brain tissue is possible.

Treatment of NMC includes normalization of blood pressure and lipid profile, control of glucose levels, and prevention of thrombus formation. Neuroprotectors, drugs that improve cerebral circulation, antioxidant and antiplatelet agents, as well as anticoagulants are also prescribed.

Additionally, vitamins, omega-3 preparations, and metabolic agents are prescribed. In the presence of neuroses or increased emotional lability, the patient may be prescribed sedatives or tranquilizers.

When strokes develop, treatment is aimed at:

prevention of cerebral edema,
elimination of the source of ischemia or cessation of bleeding,
reduction in the severity of neurological symptoms,
stopping a convulsive attack,
normalization of cardiovascular activity,
elimination of respiratory disorders.

For reference. It is also mandatory to start early prevention complications and rehabilitation treatment aimed at restoring lost functions.

Prevention of stroke

Prevention of cerebrovascular accidents includes following a lipid-lowering diet, monitoring blood sugar levels, regularly monitoring blood pressure, and stopping smoking and drinking alcohol.

It is necessary to increase the consumption of fresh vegetables and fruits, nuts, juices, bran, etc.

It is also recommended to normalize body weight and increase physical activity. However, excessive physical activity is strictly contraindicated. Walking on fresh air, swimming, slow cycling, moderate orbital exercise, etc.

For reference. Overwork, stress and emotional overstrain are contraindicated. Strong tea and coffee should be replaced with herbal teas(mint, linden, chamomile, sage, thyme, yarrow, lemon balm, immortelle, etc.).

However, it must be borne in mind that for all herbs there are different indications and contraindications. Before use, you must study the list of contraindications - allergic reactions, hormonal disorders, pregnancy, etc.

A course of taking multivitamin preparations and supplements containing magnesium and potassium is also effective.

How to recognize NMC in yourself and your loved ones

NMCs in the initial stage often occur in young patients with osteochondrosis in the cervicothoracic spine. Additional risk factors include smoking large quantity cigarettes, alcohol abuse, metabolic syndrome, lack of standardized physical activity, frequent stress and overwork, chronic lack of sleep, migraine attacks.

The initial symptoms of NMC may be:

increased fatigue and decreased performance;
noise and ringing in the ears;
decreased visual acuity;
decreased learning ability and memory impairment;
constant drowsiness and muscle weakness;
irritability, nervousness or depression.

Encephalopathy

Chronic cerebrovascular disease of the discirculatory encephalopathy type most often occurs in elderly patients. Additional risk factors include smoking, obesity, sedentary lifestyle life, severe vascular atherosclerosis, pathologies of lipid metabolism, coagulopathies accompanied by increased thrombus formation, the presence of diabetes mellitus in the patient, arterial hypertension, a history of heart attack or stroke.

Symptoms of chronic disorders of cerebral blood flow appear:

progressive memory loss,
decreased intelligence (up to mental retardation),
decreased vision and hearing,
the appearance of tinnitus,
constant dizziness,
dysfunctions pelvic organs(urinary and fecal incontinence).

Severe emotional lability is also noted. Patients are prone to rapid mood swings, depressive states, mania, psychosis, attacks of irritability and aggression, and “silly” moods.

May be noted speech disorders. The patients' speech becomes slurred and muttering. They answer questions inappropriately and often talk to themselves.

For reference. The progression of symptoms of cerebrovascular accident can lead to a complete loss of the ability to self-care due to the development of senile dementia (the third stage of dyscirculatory encephalopathy).

Transient cerebrovascular accident (TIA)

The term is used to designate acute disorders of blood flow in the brain, accompanied by the occurrence of a limited area of ischemia of brain tissue, but not leading to necrosis of brain tissue (that is, not accompanied by the development of a stroke).

The clinical picture of transient cerebrovascular accidents is unstable (the duration of the developed disorders should not exceed 24 hours).

In most cases, TIA symptoms last a few minutes, rarely more than an hour. After the end of the attack, complete restoration of the altered functions is observed.

For reference. Transient disorders of cerebral circulation in adults develop against the background of the appearance of a local ischemic focus in the brain tissue, which developed due to a reversible decrease in cerebral perfusion (blood flow). Symptoms of TIA disappear immediately after full blood flow is restored.

The causes of TIA can be;

microemboli of a cardiogenic nature;
atherosclerotic lesions of cerebral vessels, leading to their narrowing;
microthrombi associated with the separation of part of an ulcerated atherosclerotic plaque.

The cause of hemodynamic disorders of blood flow is a sharp decline blood pressure due to:

stenosis of the great vessels;
hypovolemia;
blood loss;
shock states;
severe anemia;
orthostatic hypotension;
overdose of alcoholic beverages, medicinal or narcotic substances;
infectious intoxication;
hyperventilation;
severe and prolonged cough.

Less commonly, transient cerebrovascular accidents can occur against the background of prolonged arterial hypertension or a hypertensive crisis.

The clinical picture depends on in which vascular basin the blood flow is impaired. Carotid TIAs are accompanied by the occurrence of motor disturbances, changes in sensitivity, numbness of the limb, a feeling of tingling and crawling all over the body, speech and visual disorders, convulsions of the type of focal epileptic Jacksonian seizures (convulsions begin in the fingers and then spread to the entire affected half of the body).

Visual pathologies can be manifested by the appearance of dark spots before the eyes, decreased visual acuity, the appearance of fog before the eyes, and double vision.

Lethargy, inappropriate or aggressive behavior, and disorientation in time and space may also be observed.

Vertebrobasilar transient cerebrovascular accidents manifest themselves:

severe dizziness,
nausea and vomiting,
increased sweating,
flashing of colored spots before the eyes,
double vision,
transient blindness,
nystagmus,
swallowing disorder
transient attacks of amnesia,
loss or confusion of consciousness.

There may be numbness of the face or unilateral paralysis of the facial muscles, as well as severe coordination disorders.

Hypertensive cerebral crises

For reference. Acute cerebrovascular accidents associated with a sharp increase in blood pressure are called hypertensive cerebral crises.

The main manifestations of a crisis are severe headaches, vomiting, tachycardia, tinnitus and visual disturbances. Increased sweating, a feeling of fear, anxiety or severe lethargy and drowsiness of the patient, redness or paleness of the face, and a feeling of heat may also be noted. In some cases, severe muscle weakness may occur.

In severe cases, meningeal symptoms and seizures may occur.

Such symptoms of cerebrovascular accident are more often observed against the background of uncontrolled hypertension of the second and third stages. Predisposing factors may include severe overwork and stress, excessive salt consumption, alcohol abuse, as well as the patient having diabetes mellitus or dyscirculatory encephalopathy of the second or third stage.

Symptoms of strokes

Hemorrhagic strokes (bleeding in the brain) most often develop in young people against the background of hypertensive crises. Clinical symptoms occurs acutely. As a rule, the patient feels a severe and acute headache, after which he loses consciousness. Depending on the severity of the hemorrhage, after some time either consciousness is restored or the patient falls into a coma.

Also characteristic are vomiting, temporal and spatial disorientation, visual and speech disorders, nystagmus, lack of reaction of the pupil (on one side) to light, paralysis of the facial muscles (due to unilateral paralysis, the impression of a distorted face is created), unilateral paresis of the limbs, sensory disturbances, convulsions and etc.

For reference. Often, signs of cerebrovascular accident may be accompanied by the appearance of meningeal symptoms (vomiting, photophobia, stiff neck). Involuntary urination or bowel movements may occur.

Ischemic strokes occur more often in older patients. Symptoms can occur either acutely or gradually. The patient is noted to be lethargic, drowsy, unilateral paresis and paralysis, facial distortion, lack of pupillary response to light, decreased visual acuity, fog in front of the eyes, and nystagmus.

Patients often do not understand speech addressed to them or cannot answer the question asked of them. As a rule, speech disorders are noted.

Consciousness during ischemic strokes is usually not impaired. Convulsions are observed rarely, more often with massive ischemic foci.

Cerebrovascular accident, usually develops against the background of vascular diseases, mainly And

The main clinical forms of cerebrovascular accidents.

A. Initial manifestations of insufficiency of blood supply to the brain.

Initial manifestations of insufficient blood supply to the brain.
Initial manifestations of insufficiency of blood supply to the spinal cord.

B. Transient cerebrovascular accidents (24 hours).

Transient ischemic attacks.
Hypertensive cerebral crises. Acute hypertensive encephalopathy.
General cerebral
With focal disorders.

B. Stroke.

Subarachnoid non-traumatic hemorrhage.
Non-traumatic extradural hemorrhage.
Non-traumatic acute subdural hemorrhage.
Hemorrhagic stroke is a non-traumatic hemorrhage in the brain.
Bleeding in the brain.
Hemorrhage in the spinal cord.
Ischemic stroke (cerebral infarction).
Cerebral ischemic stroke.
Spinal ischemic stroke.
Stroke with recoverable neurological deficit, minor stroke (3 weeks).
Consequences of a previous stroke (more than 1 year).

D. Progressive cerebrovascular accidents.

Chronic subdural hematoma.
Encephalopathy.
Atherosclerotic
Hypertensive
Discirculatory myelopathy
Venous and others.

INITIAL MANIFESTATIONS OF INSUFFICIENCY OF BLOOD SUPPLY TO THE BRAIN

(NPNKM).

The diagnosis of NPNCM indicates only the initial clinical manifestations of insufficiency of blood supply to the brain, and not the onset of the disease, which sometimes remains latent for a long time.

Causes.

Etiological factors are:

vasomotor dystonia.
Detection of these diseases is an indispensable condition for diagnosing NPNCM.

Pathogenesis.
Cholesterol and other fats circulate in the blood in combination with proteins - lipoproteins. Changing qualitatively, they are perceived by the body as autoantigens, against which antibodies are produced and biologically active substances(histamine, serotonin), which has a polyological effect on the vascular wall, increasing its permeability and disrupting metabolic processes.
In addition, there are many factors that contribute to poor circulation and the development of atherosclerosis:

Nervous-mental stress;
Inactivity;
Excessive caloric content of food;
Vasomotor dystonia.

Prolonged overexcitation of the cerebral cortex leads to overexcitation of the hypothalamic-pituitary-adrenal system. There is an increased release of cotecholamines and a disruption of all types of metabolism, especially in the walls of blood vessels, and blood pressure increases. There are also risk factors.

Clinical symptoms.
For atherosclerotic disorders expressed by decreased performance, headaches, sleep disturbances, dizziness, noise in the head, irritability, paradoxical emotions (“joy with tears in the eyes”), hearing loss, memory loss, unpleasant sensations(“goosebumps”) on the skin, decreased attention. Astheno-depressive or astheno-hypochondriacal syndromes may also develop).
For hypertension stagnant foci of excitation may appear in the cerebral cortex, which spread to the hypothalamic region, which leads to disruption of the regulation of vascular tone (hypothalamus - endocrine system of the kidney or hypothalamic-pituitary-adrenal system).
Next, compensatory reserves are depleted, the electrolyte balance is disrupted, the release of aldosterone increases, the activity of the sympathetic-adrenal system and the renin-angiotensin system increases, which leads to vascular hyperreactivity and an increase in blood pressure. The development of the disease leads to a change in the type of blood circulation: cardiac output decreases and peripheral vascular resistance increases.

Against the background of the above-described changes in the vessels, Cerebrovascular accident (CVA).
One of clinical forms NMK are the initial manifestations Insufficiency of blood supply to the brain (IBC).

Diagnosis.
The diagnosis is made taking into account complaints of headache, dizziness, noise in the head, memory loss and decreased performance, and sleep disturbances.
The combination of two or more of these complaints provides an opportunity and basis for making a diagnosis, especially when these complaints are often repeated and persist for a long time. Organic lesions there is no nervous system.

TREATMENT.

Treatment of the underlying vascular disease.
Rational employment, regime of work, rest, nutrition, means aimed at increasing the physiological defenses of the body, sanatorium treatment.
In case of established vascular disease of the brain, along with medications surgical treatment is used (for occlusive lesions of the carotid and vertebral arteries).

Cerebral circulation is the movement of blood in the vascular system of the brain and spinal cord. In a pathological process that causes cerebrovascular accidents, 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, and venous sinuses may be affected. The nature of the pathology of cerebral vessels can be different: thrombosis, embolism, kinks and looping, narrowing of the lumen, aneurysms of the vessels of the brain and spinal cord.

The concept of cerebral vascular insufficiency is generally defined as a state of imbalance between the need and supply of blood to the brain. It is most often based on the restriction of blood flow in atherosclerotic narrowed cerebral vessels. In this case, a temporary decrease in systemic blood pressure may cause the development of ischemia in the area of the brain supplied by a vessel with a narrowed lumen.

Based on the nature of cerebral circulatory disorders, the initial manifestations of insufficiency of blood supply to the brain are distinguished:

acute cerebrovascular accidents (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 failure, leading to the development of many small-focal necrosis of brain tissue and impaired brain function.

Transient cerebrovascular accidents - an acute disorder of cerebral functions of vascular origin, which is characterized by the suddenness and short duration of dyscirculatory disorders in the brain and is expressed by general cerebral and focal symptoms. The most important criterion for transient cerebrovascular accidents 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 cerebrovascular accidents arise as a result of local cerebral ischemia and are manifested by focal neurological disorders and, less commonly, 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 resolve within 24 hours, the disease is regarded as a transient ischemic attack. If neurological disorders persist for more than a day, ischemic stroke is diagnosed.

Causes of cerebrovascular accidents

The main reason is atherosclerosis. This is a disease accompanied by the formation of fatty plaques on the inner walls of the arteries, gradually blocking them and impeding blood flow through them. Before clinical symptoms appear, the narrowing of the carotid artery can be 75%. Platelets accumulate in affected areas, forming blood clots, the separation of which from the wall of a blood vessel can lead to blockage of blood vessels in the brain. Blood clots can also form in the brain. Other causes of cerebrovascular accidents are heart and blood vessel diseases, degenerative changes cervical spine. Stroke can be caused by rheumatic heart disease, changes in the heart valves, migraines, stress and physical strain. Impaired cerebral circulation can be a consequence of trauma, for example, resulting from a short-term pinching of the neck by 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. Cerebral circulation disorders can be caused by: cerebral bleeding, radiation sickness, complicated migraine, etc.

One common cause is bleeding in the brain due to high blood pressure. With a sharp rise in blood pressure, a vessel may rupture, causing blood to enter the brain, causing an intracerebral hematoma. A more rare cause of hemorrhage is a ruptured aneurysm. Typically related to congenital pathology, an arterial aneurysm is a sac-like protrusion on the wall of a 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 activity, emotional stress in quite healthy people, leads to 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 consult a doctor as soon as possible for treatment of chronic fatigue syndrome. This condition a person can lead to disruption of the functioning of such body systems as endocrine, digestive, and, of course, cardiovascular.

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

Symptoms of cerebrovascular accident

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

headache after intense mental and physical work;
dizziness, noise in the head;
decreased performance;
memory loss;
absent-mindedness;
sleep disturbance.

Focal neurological symptoms in such patients are usually absent or represented by scattered 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 diagnosis it is important:

the presence of vascular disease for a number of years - hypertension, atherosclerosis, blood disease, diabetes mellitus;
characteristic complaints of the patient;
data from neuropsychological studies - the most common MMSE scale for identifying cognitive impairment (normally you need to score 30 points by completing the proposed tests);
examination by 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), zones of leukariasis, changes in liquor-containing spaces, signs of atrophy of the cerebral cortex and focal (post-stroke) changes;
blood tests - general, sugar, coagulogram, lipidogram.

Recurrent headache, dizziness, increased blood pressure, disturbance intellectual activity- even just absent-mindedness should lead you to a neurologist.

Treatment of cerebrovascular accidents

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

Therapeutic measures include:

improvement of cerebral blood flow;

rapid activation of collateral circulation;

improvement of microcirculation;

relieving cerebral edema;

improving brain metabolism.

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

To reduce high blood pressure Dibazol is indicated in 2-3 ml of 1% solution IV or 2-4 ml of 2% solution IM, papaverine hydrochloride in 2 ml of 2% solution IV, no-spa in 2 ml of 2% solution IM or 10 ml of 25% magnesium sulfate solution intramuscularly.

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

Patients with severe form of PNMK shown parenteral administration antiplatelet agents during the first three days, then it is necessary to take acetylsalicylic acid 0.5 g orally 3 times a day after meals for a year, and if ischemic attacks are repeated, for two years to prevent the formation of cellular aggregates (microemboli), and therefore , for the prevention of recurrence of PNMC and cerebral stroke. If there are contraindications for the use of acetylsalicylic acid ( peptic ulcer stomach) we can recommend bromocamphor orally 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 cellular elements.

With cerebral edema dehydration therapy is carried out: furosemide (Lasix) orally 40 mg IV or IM 20 mg during the first day. To improve metabolism in the brain, Amin Alon, Cerebrolysin, and B vitamins are prescribed.

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

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

Cerebral circulation- blood circulation in the vascular system of the brain and spinal cord.

The process that causes cerebral circulatory disorders 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 cerebral vessels can be 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 brain tissue in patients with cerebrovascular accidents are determined by the underlying disease, the blood supply to the affected vessel, the mechanisms of development of this circulatory disorder, the age and individual characteristics of the patient.

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

Clinically, with cerebrovascular accidents, there may be subjective sensations (headache, dizziness, paresthesia, etc.) without objective neurological symptoms; organic microsymptoms without clear symptoms of loss of central nervous system function; focal symptoms: motor disorders - paresis or paralysis, extrapyramidal disorders, hyperkinesis, coordination disorders, sensitivity disorders, pain; dysfunction 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.

According to the nature of cerebral circulatory disorders, initial manifestations of insufficiency of cerebral blood supply are distinguished, acute cerebral circulatory disorders (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 insufficient blood supply to the brain are headaches, dizziness, noise in the head, decreased performance, and sleep disturbances, especially after intense mental and physical work, staying in a stuffy room. Focal neurological symptoms in such patients are usually absent or represented by scattered 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 cerebral circulatory disorders and strokes.

Transient cerebrovascular accidents are manifested by focal or general cerebral symptoms (or a combination thereof) lasting less than 1 day. They are most often observed in cerebral atherosclerosis, 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 limbs, difficulty speaking, static disturbances, diplopia, etc.) against the background of mild or absent cerebral symptoms.

Hypertensive cerebral crises, on the contrary, are characterized by a predominance of general cerebral symptoms (headache, dizziness, nausea or vomiting) over focal ones, which sometimes may be absent. An 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 cerebrovascular accidents (dyscirculatory encephalopathy and myelopathy) are the result of progressive insufficiency of blood supply caused by various vascular diseases.

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

Stage I, in addition to scattered, mildly expressed persistent organic symptoms (asymmetry of cranial innervation, slight oral reflexes, inaccuracy of coordination, etc.), is characterized by the presence of a syndrome similar to the asthenic form of neurasthenia (memory deterioration, fatigue, absent-mindedness, difficulty switching from one activity to another). another, dull headaches, unsystematic dizziness, poor sleep, irritability, tearfulness, depressed mood). Intellect does not suffer.

Stage II is characterized by progressive deterioration of memory (including professional memory), decreased performance, personality changes (viscosity of thought, narrowing of interests, apathy, often verbose, irritability, quarrelsomeness, etc.), decreased intelligence. Daytime sleepiness with poor night sleep is typical. Organic symptoms are more distinct (mild dysarthria, reflexes of oral automatism and other pathological reflexes, bradykinesia, tremor, changes in muscle tone, coordination and sensory disorders).
Stage III is characterized by both worsening mental disorders (up to dementia) and the development of neurological syndromes associated with predominant defeat specific area of the brain. These may be pseudobulbar palsy, parkinsonism, cerebellar ataxia, pyramidal insufficiency. Stroke-like deterioration of the condition, characterized by the appearance of new focal symptoms and strengthening of previously existing signs of cerebrovascular insufficiency.

Discirculatory myelopathy also has a progressive course, in which three stages can be roughly distinguished. Stage I (compensated) is characterized by the appearance of moderately severe fatigue of the muscles of the limbs, less often weakness of the limbs. Subsequently, in stage II (subcompensated), weakness in the limbs progressively increases, sensory disturbances of the segmental and conduction type, and changes in the reflex sphere appear. 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 poliomyelitis, pyramidal, syringomyelic, amyotrophic lateral sclerosis, posterior columnar, transverse spinal cord lesions.

Chronic disorders of the venous circulation 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, seizures, cerebellar symptoms, dysfunction cranial nerves. Venous encephalopathy is characterized by a variety of clinical manifestations. Hypertensive (pseudotumor) syndrome, scattered small-focal brain lesion syndrome, and asthenic syndrome may be observed. Venous encephalopathy also includes bettolepsy (cough epilepsy), which develops in diseases leading to venous stagnation in the brain. Venous myelopathy is a particular variant of discirculatory myelopathy and clinically does not differ significantly from the latter.

Symptoms of circulatory disorders in the vessels of the brain

On early stages the disease is asymptomatic. However, it progresses quickly and gradually its symptoms completely incapacitate a person, performance is seriously impaired, the person loses the joy of life and cannot live fully.

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 is that it noticeably intensifies during the movement of the eyeballs, especially in the evening
dizziness - when such a phenomenon is observed regularly, it should in no case be ignored
nausea and vomiting - usually this symptom manifests itself in parallel with the above
stuffy ears
ringing or noise in the ears
cramps - this symptom manifests itself less frequently than others, but still occurs
numbness - when blood circulation in the vessels of the brain is impaired, it occurs absolutely for no reason
tension in the head muscles, especially pronounced in the occipital muscles
weakness in the body
fainting
pale skin
decrease heart rate

Various disorders of consciousness are also noted, such as:

Changes in perception, such as feeling dazed
memory impairment - a person remembers his past perfectly, but often forgets about plans, about where things are
absent-mindedness
fast fatiguability and, as a consequence, decreased performance
short temper, easy excitability, tearfulness
constant drowsiness or, on the contrary, insomnia

Causes of cerebrovascular accidents

The causes of this disease are very diverse. They are usually associated with other abnormalities in the cardiovascular system, for example, vascular atherosclerosis or hypertension. Atherosclerosis is the 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 poor circulation in our brain. Unfortunately, people often do not realize the seriousness of their condition and end up dire consequences. But chronic fatigue syndrome can lead not only to disruption of blood circulation, but also to disruptions in the functioning of the endocrine system, central nervous system and gastrointestinal tract.

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

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

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

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

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

Along with saccular aneurysms, other congenital anomalies of the vascular system are sometimes observed, creating the threat of sudden hemorrhage.
In cases where the aneurysm is located in the walls of vessels located on the surface of the brain, its rupture leads to the development not of intracerebral, but of subarachnoid hemorrhage, located under the brain. arachnoid surrounding the brain. Subarachnoid hemorrhage does not directly lead to the development of focal neurological symptoms (paresis, speech impairment, etc.), but it causes general cerebral symptoms: a 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 blood most right and left hemispheres of the brain, and right and left vertebral artery, which then merge into the main artery and supply blood to the brainstem, cerebellum and occipital lobes cerebral hemispheres.

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

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 thrombus (blood clot) at the location of the atherosclerotic plaque on the vessel wall. An atherosclerotic plaque filling the lumen of a 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 area, which constitutes the main framework of the resulting thrombus.

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

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

Increased coagulability leads to the development of thrombosis, while decreased coagulability leads to bleeding from the slightest cuts and bruises. Hemophilia, a disease accompanied by reduced blood clotting and having a hereditary nature, suffered from many members of the reigning families of Europe, including the son of the latter Russian Emperor Tsarevich Alexei.

Disruption of normal blood flow can also be a consequence of spasm (strong compression) of the vessel, which occurs as a result of a sharp contraction of the muscular layer of the vascular wall. Several decades ago, spasm was considered to be of great importance in the development of cerebrovascular accidents. Currently, spasm of cerebral vessels is mainly associated with cerebral infarctions, which sometimes develop several days after subarachnoid hemorrhage.

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

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

The same thing can happen under certain conditions with 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 an atherosclerotic plaque filling it or as a result of its kinking plus a drop in blood pressure that occurs due to a deterioration (often temporary) in the functioning of the heart.

The mechanism of transient cerebrovascular accidents (transient ischemic attacks) is in many ways similar to the mechanism of development of cerebral infarction. Only compensatory mechanisms for transient disorders of cerebral circulation 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 accidents, which allows us to develop methods for preventing repeated disasters.

Treatment of cerebrovascular accidents

Various diseases of the cardiovascular system are the most common ailments among the world's population. And cerebrovascular accident is generally an extremely dangerous thing. Brain - most important organ our body. Its poor functioning leads not only to physical abnormalities, but also to impaired consciousness.

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

Limit the amount you consume as much as possible. table salt
give up alcoholic drinks
if you have extra pounds, you urgently need to get rid of them, since they create extra stress on your blood vessels, and this is simply unacceptable for this disease
For some people blood vessels, including capillaries, are fragile. Such people often have bleeding gums, and often have nosebleeds. How to get rid of this scourge?

Dissolve a teaspoon of well-cleaned (edible) and finely ground sea salt in a glass of water at room temperature. Inhale the cool saline solution through 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 works well: prepare a saturated salt solution (five tablespoons of coarse sea salt per glass warm water). Make two cotton swabs, 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: your gums will stop hurting and bleeding.

Take two tablespoons of dry mustard, two pods of chopped 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. Actively rub your feet with the resulting tincture at night. After rubbing, put on wool socks and go to bed.

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

Age-related changes in blood vessels and the heart significantly limit adaptation capabilities and create the preconditions for the development of diseases.

Changes in blood 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 compactions of the inner wall appear. This greatly limits the ability of blood vessels to expand and narrow, which is already a pathology. Large arterial trunks, especially the aorta, are primarily affected. In older and older people, the number of active capillaries per unit area decreases significantly. Tissues and organs stop receiving the amount they need nutrients and oxygen, and this leads to their starvation and the development of various diseases.

As each person ages, small vessels become more and more “clogged” with lime deposits and peripheral vascular resistance increases. This leads to a slight increase in blood pressure. But the development of hypertension is significantly hampered by the fact that with a decrease in the tone of the muscular wall of large vessels, the lumen of the venous bed expands. This leads to a decrease in cardiac output (minute volume is the amount of blood ejected by the heart per minute) and to active redistribution of peripheral circulation. Coronary and cardiac circulation usually suffers little from a decrease in cardiac output, while renal and hepatic circulation are greatly reduced.

Decreased contractility of the heart muscle. The older a person gets, the more muscle fibers the heart muscle atrophies. The so-called “senile heart” develops. Progressive myocardial sclerosis occurs, and in place of the atrophied muscle fibers of the cardiac tissue, fibers of non-working connective tissue develop. The strength of heart contractions gradually decreases, metabolic processes are increasingly disrupted, which creates conditions for energetic-dynamic heart failure under conditions of intense activity.

In addition, in old age, conditioned and unconditioned reflexes of blood circulation regulation appear, and the inertia of vascular reactions is increasingly revealed. Research has shown that with aging, the influences on cardiovascular system various structures brain 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, the physical performance of the heart decreases with age. 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 for circulatory disorders

In case of weak blood flow and blockage of blood vessels, you should use the index finger and thumb of one hand to grab the middle finger of the other hand. Acupressure carry out by pressing with medium force with your thumbnail on the point located under the nail bed. The massage should be done on both hands, spending 1 minute each.

Points of influence for thirst. When a feeling of thirst occurs, you should act on a soothing point. The peculiarity of this BAT is that it is still in human body It was not possible to identify other points associated with the mucous membrane. The point is located at a distance of approximately 1 cm from the tip of the tongue. The massage consists of lung shape biting this point with the front teeth (incisors) with a rhythm of 20 times per 1 minute.

Points of intervention for sleep disorders. For insomnia, acupressure of the lower part should be performed. auricle. The massage should be carried out with the index and thumb, clasping the earlobe on both sides. Biologically active point located in the middle of the lobe. Sleep will come faster (or massage more often on the right side than on the left.

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

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