Cerebrovascular disease includes various medical conditions that affect cerebral blood vessels and cerebral circulation. The arteries that supply oxygen and nutrients to the brain are often damaged or deformed in this disorder. The most common presentation of cerebrovascular disease is ischemic stroke or mini-stroke and occasionally hemorrhagic stroke. Hypertension (high blood pressure) is the most important risk factor for stroke and cerebrovascular disease because it can alter the structure of blood vessels and cause atherosclerosis. Atherosclerosis constricts blood vessels in the brain, resulting in decreased cerebral perfusion. Other risk factors that contribute to stroke include smoking and diabetes. Narrowed cerebral arteries may cause ischemic stroke, but increased blood pressure may also cause tearing of the blood vessels, leading to hemorrhagic strokes.
Stroke usually presents with sudden neurological deficits - such as hemiplegia (weakness of one side), numbness, aphasia (language disorder), or ataxia (loss of coordination) - due to focal vascular lesions. Neurologic symptoms manifest in a matter of seconds because neurons require a continuous supply of nutrients, including glucose and oxygen, provided by the blood. Therefore, if the blood supply to the brain is inhibited, injuries and energy disorders are rapid.
In addition to hypertension, there are also many common causes of cerebrovascular disease, including congenital or idiopathic and include CADASIL, aneurysm, amyloid angiopathy, arteriovenous malformations, fistulas, and arterial dissection. Many of these diseases can be asymptomatic until an acute event, such as a stroke, occurs. Cerebrovascular disease may also present more frequently with headache or seizures. One of these diseases can cause vascular dementia because of ischemic damage to the brain.
Video Cerebrovascular disease
Signs and symptoms
The most common presentation of cerebrovascular disease is an acute stroke, which occurs when the blood supply to the brain is disrupted. Stroke symptoms are usually rapid in onset, and may include weakness of one side of the face or body, numbness on one side of the face or body, inability to produce or understand speech, vision changes, and balance difficulties. Hemorrhagic stroke can occur with severe and sudden headaches associated with vomiting, neck stiffness, and decreased consciousness. Symptoms vary depending on the location and size of the stroke involvement area. Edema, or swelling, of the brain may occur that increase intracranial pressure and may cause brain herniation. Stroke can cause coma or death if it involves the main area of ​​the brain.
Other symptoms of cerebrovascular disease include migraine, seizures, epilepsy, or cognitive decline. However, cerebrovascular disease can go undetected for years until an acute stroke occurs. In addition, patients with some rare congenital cerebrovascular disease may begin to have these symptoms in childhood.
Maps Cerebrovascular disease
Cause
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Congenital disease is a medical condition present at birth that may be related to inheritance through genes. Examples of congenital cerebrovascular disease include arteriovenous malformations, germinal matrix bleeding, and CADASIL (cerebral dominant autosomal arteriopathy with subcortical infarction and leukoencephalopathy). Arteriose malformation is an abnormal tangle of blood vessels. Typically, the capillary bed separates the arteries from the veins, which protect the blood vessels from high blood pressure that occurs in the arteries. In arterial malformations, the arteries connect directly to the vein, which increases the risk of venous rupture and bleeding. Arterial malformations in the brain have a 2-4% chance of rupture every year. However, many arterial malformations are undetectable and show no symptoms throughout a person's lifetime.
Bleeding of the germinal matrix is ​​a bleeding into the premature baby's brain caused by fragile rupture of blood vessels within the premature baby's germinal matrix. The germinal matrix is ​​a highly vascularized area in the unborn baby's brain from which brain cells, including neurons and glial cells, originate. Babies are most at risk for germinal matrix bleeding when they are premature, before 32 weeks. Stress exposed after birth, along with fragile blood vessels, increases the risk of bleeding. Signs and symptoms include flaccid weakness, seizures, abnormal posture, or irregular breathing.
CADASIL is a congenital abnormality caused by mutations in the Notch 3 gene located on chromosome 19. The Notch 3 gene code for transmembrane proteins whose function is not well known. However, mutations lead to the accumulation of this protein in small to moderate blood vessels. This disease often appears in early adulthood with migraine, stroke, mood disorders, and cognitive impairment. MRI shows changes in white matter in the brain and also signs of recurrent stroke. Diagnosis can be confirmed by gene testing. Acquired
The cerebrovascular disease acquired is a disease acquired throughout a person's life that can be prevented by controlling risk factors. The incidence of cerebrovascular disease increases as an individual age. Causes of cerebrovascular disease acquired include atherosclerosis, embolism, aneurysm, and arterial dissection. Atherosclerosis causes narrowing of blood vessels and reduces perfusion to the brain, and also increases the risk of thrombosis, or artery blockage, in the brain. The major risk factors that can be modified for atherosclerosis include:
Controlling for these risk factors can reduce the incidence of atherosclerosis and stroke. Atrial fibrillation is also a major risk factor for stroke. Atrial fibrillation causes blood clots to form inside the heart, which can lead to the arteries in the brain and cause embolism. Embolism prevents blood flow to the brain, leading to a stroke.
An aneurysm is an abnormal swelling in a small part of the artery, which increases the risk of arterial rupture. Intracranial aneurysms are a major cause of subarachnoid hemorrhage, or bleeding around the brain in subarachnoid space. There are various hereditary disorders associated with intracranial aneurysms, such as Ehlers-Danlos syndrome, dominant autosomal polycystic kidney disease, and familial type I hyperaldosteronism. However, these unharmed individuals can also acquire aneurysms. The American Heart Association and the American Stroke Association recommends controlling for modifiable risk factors including smoking and hypertension.
Arterial discharge is a tear from the internal lining of the arteries, often associated with trauma. Disection in carotid arteries or vertebral arteries can endanger blood flow to the brain due to thrombosis, and dissection increases the risk of rupture of blood vessels.
Idiopathic
Idiopathic disease is a disease that occurs spontaneously with no known cause. Moyamoya is an example of idiopathic cerebrovascular disorder that results in narrowing and occlusion of intracranial blood vessels. The most common presentation is a stroke or transient ischemic attack, but cognitive impairment in children can also be an emerging symptom. The disease may begin to show symptoms that begin in adolescence, but some may not have symptoms until adulthood.
Pathophysiology
Mechanism of brain cell death
When a decrease in blood flow lasts a few seconds, brain tissue suffers from ischemia, or inadequate blood supply. If the interruption of blood flow does not recover within minutes, the tissue suffers from infarction followed by tissue death. When a low cerebral blood flow continues for a longer duration, this may develop into an infarct in the border zone (a poor blood flow area between the major cerebral artery arteries). In more severe cases, global hypoxia-ischemia causes extensive brain injury that causes severe cognitive sequelae called hypoxic-ischemic encephalopathy .
An ischemic cascade occurs where energetic molecular problems arise due to lack of oxygen and nutrients. The cascade produces a decrease in the production of adenosine triphosphate, or ATP, which is the high-energy molecule needed for the cells in the brain to function. ATP consumption continues despite insufficient production, this results in decreased ATP levels and lactic acidosis becoming sedentary (ionic homeostasis in missing neurons). The downstream mechanism of the ischemic cascade thus begins. The ion pump no longer transports Ca 2 from the cell, this triggers the release of glutamate, which in turn allows the calcium into the cell wall. In the end apoptosis path begins and cell death occurs.
There are several arteries that supply oxygen to different areas of the brain, and the damage or occlusion of one of them can cause a stroke. The carotid artery covers most of the cerebrum. The common carotid artery is divided into internal and external carotid arteries. The internal carotid artery becomes the anterior cerebral artery and central central artery. ACA transmits blood to the frontal parietal. Of the basilar artery are the two posterior cerebral arteries. Basilar and PCA branches provide the occipital lobe, brainstem, and cerebellum. Ischemia is the loss of blood flow to the brain's focus areas. This results in a heterogeneous area of ​​ischemia in the affected vascular area, further restricting blood flow to residual streams. Areas with blood flow less than 10 mL/100 g tissue/min are the nuclear regions (cells here die within minutes after a stroke). Ischemic penumbra with blood flow & lt; 25 ml/100g network/min, can still be used for more time (hours).
Types of stroke
There are two major divisions of stroke: ischemic and haemorrhagic. Ischemic stroke involves decreasing the blood supply to the brain area, while hemorrhagic stroke bleeds to or around the brain.
Ischemic
- Ischemic stroke, most commonly caused by blood vessel blockage in the brain, is usually caused by thrombosis or embolism from the source of the proximal artery or heart, causing the brain to be deprived of oxygen. Neurologic signs and symptoms should persist for more than 24 hours or brain infarction is demonstrated, especially by imaging techniques.
- Transient ischemic attack (TIA) is also called mini-stroke . This is a condition in which blood flow to an area of ​​the brain is inhibited, but the bloodstream quickly recovers and the brain tissue can fully recover. Symptoms are only temporary, leaving no residual symptoms, or long-term deficits. To diagnose this entity, all neurological signs and symptoms should be completed within 24 hours without evidence of brain infarction in brain imaging.
Hemorrhag
- Subarachnoid haemorrhage occurs when blood leaks out of the damaged vessels into the cerebrospinal fluid in the subarachnoid space around the brain. The most common cause of subarachnoid hemorrhage is an aneurysm rupture due to weakened blood vessel wall and increased stress of the wall. Neurological symptoms are generated by the effects of blood mass on the nerve structure, from the effects of blood toxins on brain tissue, or by increased intracranial pressure.
- Intracerebral haemorrhage is a direct bleeding to the brain rather than around the brain. Causes and risk factors include hypertension, blood-thinning drugs, trauma, and arteriovenous malformations.
Evaluation
The diagnosis of cerebrovascular disease is done by (among other diagnoses):
- clinical history
- physical checks
- Neurological examination.
It is important to distinguish symptoms caused by strokes from those caused by syncope (fainting) which is also a decrease in cerebral blood flow, almost always common, but they are usually caused by systemic hypotension from various origins: cardiac arrhythmias, myocardial infarction, hemorrhagic shock,.
Treatment
Treatment for cerebrovascular disease may include treatment, lifestyle changes and/or surgery, depending on the cause.
Examples of drugs are:
- antiplatelets (aspirin, clopidogrel)
- blood thinners (heparin, warfarin)
- antihypertensive (ACE inhibitor, beta blocker)
- anti-diabetic drugs.
Surgical procedures include:
- endovascular surgery and vascular surgery (for future stroke prevention).
Prognosis
Prognostic factors: Glasgow's lower coma score, higher pulse rate, higher respiratory rate and lower arterial oxygen saturation levels are a prognostic feature of hospital mortality rates in acute ischemic stroke.
Epidemiology
Worldwide, an estimated 31 million people with stroke, although about 6 million deaths caused by cerebrovascular disease (the second most common cause of death in the world and the 6th most common cause of disability).
Cerebrovascular disease mainly occurs in elderly; the risk of developing it increases significantly after age 65. CVD tends to occur earlier than Alzheimer's Disease (which rarely occurs before age 80). In some countries like Japan, CVD is more common than AD.
In 2012 6.4 million Americans (adults) had a stroke, which is equivalent to 2.7% in the US. With about 129,000 deaths by 2013 (US)
Geographically, the "stroke belt" in the US has long been known, similar to the "diabetic belt" covering all Mississippi and parts of Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, North Carolina, Ohio, Pennsylvania, South. Carolina, Tennessee, Texas, Virginia, and West Virginia.
See also
- Cerebral infarction
- Stroke
References
Further reading
- Chan, Pak H. (2002-03-28). Cerebrovascular Disease: The Princeton Conference 22 . Cambridge University Press. ISBN: 9781139439657.
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Mark, Steven D.; Wang, Wen; Fraumeni, Joseph F.; Li, Jun-Yao; Taylor, Philip R.; Wang, Guo-Qing; Guo, Wande; Dawsey, Sanford M.; Li, Bing (1996-04-01). "Reducing the Risk of Hypertension and Cerebrovascular Disease after Supplementation of Vitamins/Minerals, Intervention of Linxian Nutritional Interventions". American Journal of Epidemiology . 143 (7): 658-664. doi: 10.1093/oxfordjournals.aje.a008798. ISSNÃ, 0002-9262. PMID 8651227. -
Ning, MingMing; Lopez, Mary; Cao, Jing; Buonanno, Ferdinando S.; Lo, Eng H. (2012-12-01). "Practice of proteomics for cerebrovascular disease". Electrophoresis . 33 (24): 3582-3597. doi: 10.1002/elps.201200481. ISSN0173-0835. PMCÃ, 3712851 . PMID 23161401.
External links
Source of the article : Wikipedia
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