Atherosclerosis of vessels of a brain
Atherosclerosis of vessels of a brain — the process of formation of atherosclerotic plaques in cerebral vessels involving disorders of brain blood supply. Can have a subclinical current or be shown by distsirkulyatorny encephalopathy, TIA, a stroke. In diagnostics REG, UZDG, duplex scanning or MRT of cerebral vessels, and also an electroencephalography, brain KT and MPT is used. The therapy combined with purpose of gipolipidemichesky, antiagregantny, nootropic, neurometabolic, vascular pharmaceuticals. In the presence of indications surgical treatment is made.
Atherosclerosis of vessels of a brain
Atherosclerosis of vessels of a brain makes approximately the fifth part of all neurologic pathology and about a half of cardiovascular diseases. Atherosclerotic processes in cerebral vessels can start already at 20-30-year age, however, thanks to a long subclinical current, the disease demonstration usually takes place after 50 years. Clinical displays of cerebral atherosclerosis are connected with the insufficiency of brain blood circulation which is gradually developing as a result of defeat of vessels and ischemia of tissues of brain. Chronic ischemia of a brain, along with coronary heart disease, is the heaviest consequence of atherosclerosis. She can act as the reason of such complications as a stroke and dementia. In view of big prevalence and high frequency of complications atherosclerosis of vessels of a brain belongs to the most priority problems of modern neurology.
A number of the factors promoting development of cerebral atherosclerosis is known. Refer to them, first of all, age. With age atherosclerosis of vessels is in a varying degree observed at all. Earlier development of atherosclerotic changes and more bystry progressing of cerebral atherosclerosis is noted at unbalanced food (the excessive use of fats and carbohydrates, insufficient amount of vegetable food, an overeating, existence in a diet of the fried and hot dishes, etc.), a metabolic disorder (obesity, diabetes, hormonal failures), a hypodynamia, smoking, frequent reception of high doses of alcohol.
Favorable conditions for emergence and progressing of atherosclerosis are formed against the background of arterial hypertension. Often atherosclerosis and a hypertension develop in common, mutually aggravating each other. The chronic infections and intoxications making an adverse effect on a vascular wall are also the factors promoting developing of atherosclerosis of cerebral vessels. Important value has the psychoemotional state causing perception by the person of various vital events. Lack of the quiet benevolent relation leads to the fact that many situations become stressful for the person. The stress negatively influences a tone of walls of cerebral vessels and causes pressure difference. Numerous repetition of such vascular changes is a favorable basis for development of cerebral atherosclerosis.
Not all questions of an etiology of atherosclerosis are finally clear. Existence of a large number of the contributing factors suggests an idea of a polietiologichnost of this process. However there is open a question why at one patients defeat of mainly warm vessels is observed, and at others — cerebral. It is also necessary to consider a certain role of hereditary mechanisms as family cases of emergence of such complication of cerebral atherosclerosis as a stroke are widely known.
Major factor in the mechanism of development of atherosclerosis the dismetabolizm of lipids is considered. Failure in a metabolism is resulted by adjournment of cholesterol of lipoproteid of the low density (LPNP) on an internal surface of walls of cerebral vessels. Arteries of large and average caliber are involved in process mainly. Formation of a so-called atherosclerotic plaque comes stadiyno - from a fatty spot to an aterokaltsinoz. The formed atherosclerotic plaque, increasing in sizes, gradually blocks a gleam of the struck vessel more and more and can be a source of tromboembol.
In the first case because of the progressing reduction of a gleam of a vessel there is a decrease in blood supply of a certain site of a brain. In cerebral fabrics of this zone there is a hypoxia and shortage of nutrients — chronic ischemia which leads to a degeneration and death of separate neurons over time develops. Clinically this process is shown by symptoms of distsirkulyatorny encephalopathy (DEP). Expressiveness of the last depends on prevalence of atherosclerosis, caliber of the struck vessel, the sizes of an atherosclerotic plaque, extent of development of alternative (collateral) blood supply of an ischemic zone of a brain.
In the second case a part of an atherosclerotic plaque comes off it and in the form of an embol with current of blood is transferred to smaller arterial vessel, causing its sudden and full occlusion (thrombosis). Depending on the sizes of a zone of blood supply of an okklyuzirovanny artery and extent of development vascular the tranzitorny ischemic attack (TIA) or an ischemic stroke arises kollateraly. More seldom atherosclerosis of vessels of a brain acts as the reason of a hemorrhagic stroke. The rupture of a vascular wall happens because of violation of its elasticity in the place of formation of atherosclerotic deposits and is often caused by high arterial hypertension.
Clinically atherosclerosis of vessels of a brain begins to be shown when the atherosclerotic plaques which are in vessels block a cerebral blood-groove so that there is ischemia and distsirkulyatorny encephalopathy develops. According to expressiveness of disorders of cerebral blood circulation distinguish 3 stages of cerebral atherosclerosis.
- Initial stage. Symptoms have passing character, often arise at psychoemotional and physical overworks and disappear in the conditions of rest. The asthenic syndrome takes place: weakness, unusual fatigue, the increased irritability, slackness, difficulties with concentration of attention. Periodic sleep disorders in the form of an insomniya and/or day drowsiness, the dizzinesses sometimes arising are possible. Some decrease in rate of thinking, ability to remember and keep new information in memory is noted. Many patients during this period to the forefront have a complaint to the headache which is combined with noise in the head, ears or one ear.
- The progressing cerebral atherosclerosis. Mnestichesky frustration and psychoemotional changes in character are aggravated. The general background of mood decreases, the depression can develop. The patient becomes hypochondriac and disturbing. Violations of memory become accurately expressed — the patient and his relatives say that he cannot remember an event of the present day, confuses them. Noise in the head gains constant character. The vestibular ataxy, a speech illegibility is noted. The tremor of fingers or the head is possible, decrease in sight and some relative deafness is often observed. Ability to productive professional activity is gradually lost.
- Dementia. Intellectual decrease progresses, memory blackouts, violation of the speech, apathy, untidiness, total disappearance of interests are observed. The patient loses ability to be guided in a situation and in time, loses skills of self-service, demands supervision.
In the neurologic status of patients with cerebral atherosclerosis depending on a stage of a disease look paresis up, horizontal , some anizorefleksiya, symmetric increase or slackness of reflexes, instability in Romberg's pose, a tremor of the extended fingers of hands, violation of koordinatorny tests can come to light. After the had stroke existence of paresis and other neurologic deficiency is possible. Oftalmoskopiya who is carried out by the ophthalmologist can reveal atherosclerotic changes of vessels of a retina. At a hearing impairment consultation of the otolaryngologist with an audiometriya is shown.
More precisely vascular researches allow to diagnose atherosclerosis of vessels of a brain. The most available of them is REG. UZDG of vessels of the head, duplex scanning and MRT of vessels of a brain are more informative. Carrying out vascular researches in dynamics, assessment of degree of occlusion of carotids and main intrakranialny arteries is important. For the analysis of a functional condition of a brain EEG, for the purpose of visualization of cerebral fabrics (is used especially during diagnosis of strokes) — brain KT and MPT.
treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!
It is impossible to cure cerebral atherosclerosis, but by timely, regular and complex therapy it is possible to slow down its progressing. First of all it is necessary to eliminate the factors aggravating development of atherosclerotic process. It is necessary to keep to a vegetable diet with an exception of nutrients with the high content of cholesterol (meat, eggs, margarine, fish canned food, sausage, fast food), to enter daily foot walks, to lower psychoemotional loading, to exclude smoking and reception of alcohol, to optimize body weight. Hypertensive persons need careful selection of hypotensive treatment. Correction of a lipidic range of blood which is appointed by results of a research of content of cholesterol and lipids in blood is important. Gipolipidemichesky pharmaceuticals are appointed: , , , gemfibrozit, etc.
Pathogenetic treatment of cerebral atherosclerosis aims to improve metabolism and blood supply of neurons, to increase their resistance to ischemia conditions, to warn a tromboobrazovaniye, to improve mnestichesky functions. As antiagregantny therapy long reception of a tiklid or small doses of acetilsalicylic acid is appointed. Vascular therapy is carried out by medicines of a pentoksifillin and vinpotsetin, nifedipine. Neurometabolic treatment includes purpose of vitamins of group B, glycine, medicines biloba. Improvement of cognitive abilities is promoted by reception of nootrop: piracetam, pikamilon, nitsergolin and so forth.
Repeated TIA, the had small stroke, occlusion of carotids with reduction of its gleam more than for 70% are indications to surgical treatment of cerebral atherosclerosis. Distinguish 2 types of operations: an endarterektomiya (removal of an atherosclerotic plaque together with the site vessel intims) and creation of the vascular shunt making a detour obturirovanny an atherosclerotic plaque of the site of an artery. According to indications neurosurgeons make a carotid endarterektomiya, formation extra- an anastomoza, prosthetics of a brakhiotsefalny trunk and other operations.
Forecast and prevention of atherosclerosis
The forecast of cerebral atherosclerosis is very variable. A lot of things depend on age of the patient, timeliness of the begun medical actions, an opportunity to completely eliminate the available risk factors. The stroke and dementia from which the rough invalidization of the patient results act as the heaviest complications of atherosclerosis of cerebral vessels and the lethal outcome is possible.
The best prevention of atherosclerosis of any localization is the healthy lifestyle meaning reasonable physical activities, a balanced diet, stay in the fresh air, a quiet rhythm of life with adequate alternation of work and rest. The prevention of development of atherosclerotic process is the exception of the life of all factors promoting its progressing including spiteful reactions (anger, rage, offense, irritation, etc.) which provoke tonic changes of cerebral vessels. Timely arrangement of the way of life, adequate treatment, if necessary improvement of a brain blood-groove by a surgical way — all these actions can be referred to the measures of secondary prevention of cerebral atherosclerosis allowing to avoid its such complications as a stroke and dementia.