Chronic cerebral ischemia: causes and treatment

Chronic cerebral ischemia is a dangerous disease, which is accompanied by a pathological change in nerve tissue against the background of circulatory disorders. The ailment needs timely and proper therapy, as this is the only way to avoid complications.

Of course, many people are interested in additional data. Why does chronic cerebral ischemia develop? The ICD code, a list of causes and symptoms, effective treatment regimens are, of course, important information that is worth exploring. What is the pathology dangerous? When should I see a doctor?

Chronic cerebral ischemia: ICD-10 code and general pathology information

Many people are interested in additional information about such a disease. In modern medical practice, such a pathology as chronic cerebral ischemia is quite common. ICD refers this condition to the group “Other cerebrovascular diseases” under the code I67.

This ailment develops against a background of prolonged cerebrovascular accident. As you know, nerve tissue is extremely sensitive to the level of oxygen, glucose and other nutrients. That is why their constant deficiency leads to damage to certain sections of the central nervous system. Foci of chronic cerebral ischemia, as a rule, are diffuse. In any case, pathology leads to a violation of the functions of a particular section of the central nervous system, which, of course, affects the patient's condition.

Causes of the development of the disease

It is immediately worth saying that the foci of chronic ischemia in the brain do not appear on their own. This pathology develops against the background of another disease. The list of possible reasons is very impressive:

• inflammation of the walls of blood vessels of an infectious or allergic origin;
• persistent forms of hypertension;
• atherosclerosis (the formation of plaques on the walls of blood vessels leads to a narrowing of their lumen and, consequently, an increase in blood pressure);
• hypotension;
• various injuries of the skull;
• aneurysms, anatomical abnormalities of the vascular bed of the brain;
• diseases of the endocrine glands and, accordingly, fluctuations in the hormonal background;
• various disorders of the heart;
• blood diseases;
• pathology of the excretory system;
• cerebral amyloidosis.

In addition, in modern medicine, it is customary to distinguish those risk factors, the presence of which contributes to the development of ischemia. The list of non-correctable factors (it is impossible to eliminate them) includes the hereditary predisposition and age of the patient. Correctable factors exist, and so are called, for example, smoking and other bad habits, obesity, atherosclerosis, hypertension.

Common symptoms

It is immediately worth noting that the clinical picture directly depends on the degree of chronic cerebral ischemia, as well as on the location of the foci of the pathological process. The list of possible symptoms is quite large:

• General weakness, drowsiness, fatigue - all this leads to a gradual decrease in performance.
• Brain dysfunction often leads to vision problems.
• Some patients complain of certain speech disorders.
• Violation of blood circulation and brain trophism simply cannot but affect the mental and emotional state of a person. Patients become irritable, suffer from insomnia, irritability and sudden mood swings.
• Sometimes patients complain of recurring headaches.
• Serious damage to areas of the brain is fraught with amnesia.
• Perhaps the appearance of nausea, vomiting, dizziness.
• The list of symptoms also includes sudden changes in blood pressure.
• Sometimes patients complain of numbness of the extremities, a feeling of coldness in the feet and hands, even at normal temperatures.

Unfortunately, many people attribute the appearance of all these symptoms to a common malaise. If such violations torment you constantly, then you need to see a doctor.

Chronic ischemia of the 1st degree and its symptoms

Each stage of the development of such a pathology is accompanied by a set of specific symptoms. Chronic cerebral ischemia of the 1st degree is characterized by a blurred clinical picture. At first only a slight malaise appears. Patients become weak and drowsy. Chills appear. Despite constant fatigue, it is not easy for a person to fall asleep.

Perhaps the appearance of migraines, tinnitus, dizziness. A gradual change in gait is observed - a person either legs too hard or shuffles while walking.

Chronic cerebral ischemia of the 1st degree is accompanied by emotional lability and cognitive impairment. It is difficult for the patient to concentrate, mental processes slow down, constant distraction appears. Personality disorders are also possible - excessive aggression, irritability or, on the contrary, apathy and depression appear. Perhaps a reflex reaction in contact with physical stimuli. It is worth noting that at this stage, the pathology is treated relatively easily, but, unfortunately, it is rarely diagnosed.

Chronic cerebral ischemia of the 2nd degree

This phase of the disease is a stage of subcompensation. Chronic cerebral ischemia of the 2nd degree is accompanied by more obvious disorders. Fatigue, weakness, headaches, emotional disturbances - all these symptoms become more pronounced. Other signs join them:

• Ataxia appears with very noticeable impaired coordination.
• Against the background of chronic cerebral ischemia, intellectual disorders gradually develop that inevitably lead to degradation of the individual.
• The patient becomes apathetic, indifferent, loses interest in the world around him.
• Man's ability to control his actions, to plan, is deteriorating.
• Against the background of chronic cerebral ischemia of the 2nd degree, the ability to professional and social adaptation is significantly reduced.

The third degree of pathology

At this stage, decompensation occurs. All the possibilities of the brain are exhausted, as a result of which the symptoms become brighter.

Serious motor impairment is observed. The patient's gait becomes unstable, it is difficult for him to move, and during walking he often loses his balance and falls. Other, more serious and dangerous violations appear:

• a person often loses consciousness, which is accompanied by complete relaxation of the muscles, lowering blood pressure, lack of reaction to light;
• urinary incontinence develops;
• swallowing processes are disturbed - it is very easy for a person to choke while eating;
• the psycho-organic syndrome develops - the patient often falls into a stupor, becomes oblivious, loses the ability to control his behavior;
• Parkinson's syndrome manifests itself, characterized by muscle rigidity, tremor, epileptic seizures.

If untreated, pathology can lead to complete dementia.

Possible complications

Chronic cerebral ischemia is a dangerous ailment. Circulatory disorders sometimes lead to complications:

• Perhaps the development of ischemic stroke or heart attack. With such pathologies, some parts of the brain tissue soften, die. Nerve cells are not regenerated, which leads to a violation of certain brain functions. It is worth noting that such violations are most often recorded in elderly patients (over 60 years old).
• Against the background of circulatory problems, encephalopathy sometimes develops. This is an organic lesion of parts of the brain that occurs without inflammation.
• The disease can lead to the development of thrombophlebitis.
• The destruction of nerve tissue in certain parts of the brain is sometimes accompanied by paralysis, dumbness, paresthesias, epileptic seizures.

Features of the clinical picture in infants

Chronic cerebral ischemia sometimes develops in newborn babies. In most cases, the development of such a pathology is associated with oxygen starvation during fetal development. The disease is characterized by very characteristic symptoms:

• Hydrocephalic syndrome is accompanied by an increase in intracranial pressure, an accumulation of cerebrospinal fluid in the ventricles of the brain. As a result of such processes, the fontanel of the child expands, and the volume of the head increases.
• The baby sometimes has tremor of the extremities, aggravation of reflexes, and a change in muscle tone. The child does not sleep well, constantly wakes up, often cries.
• Sometimes the work of the central nervous system, on the contrary, is inhibited. The motor activity of the child and muscle tone are reduced. Weakening of swallowing reflexes is observed. It is possible the appearance of strabismus, which again is associated with muscle weakness.
• The list of symptoms includes involuntary muscle spasms and cramps.
• Violation of cerebral circulation sometimes leads to the development of a coma.

Depending on the level of damage to the nervous system, the following degrees of chronic cerebral ischemia are distinguished:

• The first (mild) is accompanied by overexcitation or, conversely, lethargy of the child. These symptoms can be observed from the first days of the baby's life.
• The second degree (it is called moderate) is characterized by the appearance of seizures.
• If we are talking about the third degree, then its consequences can be very serious. Perhaps, for example, impaired motor skills, developmental delay, impaired vision and hearing.

Diagnostic measures

Only a doctor can diagnose chronic cerebral ischemia. ICD-10 refers pathology to the group of cerebrovascular diseases, therefore, in this case, differential diagnosis is extremely important:

• To begin with, a general examination and medical history are carried out. The patient’s medical history should be checked for arterial hypertension, coronary heart disease, diabetes mellitus, atherosclerosis, and previous heart attacks.
• A biochemical blood test is also mandatory. It is important to determine the level of cholesterol, glucose, lipid fractions. You also need to check the mechanisms of blood coagulation, to assess the degree of its viscosity.
• Echocardiography and electrocardiography are also performed - these procedures allow you to evaluate the functioning of the heart, detect rhythm disturbance, damage to valves and blood vessels.
• An ultrasound scan of the great vessels of the arteries is required in order to assess the nature of the blood flow.
• It is recommended to carry out spondylography of the cervical spine, as sometimes the violation of blood circulation is associated with spinal deformity.
• In order to determine abnormalities in the structure of the vessels of the brain, their angiography is performed.
• Magnetic resonance and / or computed tomography of the brain is also prescribed. Studies allow the doctor to carefully examine the structure of the organ and its vessels, determine the presence of various pathologies, tumors, etc.

Such procedures make it possible not only to diagnose chronic cerebral ischemia, but also to determine the stage of its development and causes. The treatment of pathology depends on these factors.

Therapy of chronic ischemia

The treatment of such a pathology must necessarily be comprehensive. This disease does not require hospitalization - treatment can be carried out at home. Exceptions include only those cases that are accompanied by severe somatic pathologies, strokes, and some other complications. Therapy includes three points:

• It is extremely important to maintain normal blood pressure - this will help prevent the appearance of new lesions. In this case, two groups of drugs are used: angiotensin II receptor antagonists and angiotensin-converting enzyme inhibitors. By the way, such drugs not only reduce blood pressure, but also protect the walls of blood vessels.
• Lipid-lowering therapy is also being carried out, which helps to prevent the development of atherosclerotic vascular lesions or cope with an existing disease. Patients are prescribed statins, which not only reduce the level of harmful lipids in the blood, but also act as antioxidants and reduce blood viscosity. Of course, the diet is also important - you need to limit the amount of animal fat.
• Chronic ischemia often leads to blood clots, which is dangerous. That is why patients take antiplatelet agents, in particular, acetylsalicylic acid, dipyridamole, clopidogrel. Of course, such drugs are prescribed only after laboratory studies have confirmed the patient’s tendency to thrombosis.

This is the only way to protect nerve structures from further damage and, at least partially, restore lost brain functions. The success of therapy directly depends on the selected complex of drugs, as well as timely diagnosis (at the last stages of the development of the disease, such treatment is unlikely to provide the desired effect).

Protecting the nervous system with medication

The treatment of chronic cerebral ischemia necessarily includes the use of drugs that help protect the structures of the nervous system. Therapy in this case is aimed at:

• hemodynamic correction, which allows the brain to be provided with sufficient oxygen and energy substrates;
• protection of neurons from ischemic damage (you need to maintain the functionality and structural integrity of nerve cells).

In most cases, doctors prescribe drugs to patients that contain actovegin, piracetam, L-carnitine, gliatilin, encephabol, phenotropil, and ginkgo biloba extract. Such drugs help improve blood circulation, eliminate cramps, and increase brain resistance to oxygen deficiency. Some of the above substances have antiplatelet activity.

Other treatments

If there is an occlusal-stenotic lesion of the vessels of the brain, then the patient needs an operation involving the installation of stents on the carotid arteries. An indication for surgical intervention is cerebral vascular thrombosis (a similar condition in the absence of timely care ends with the death of the patient) - in such cases, the doctor removes the blood clot.

Today, treatment with the help of stem germ cells, which do not yet have clear morphological and functional features, is becoming more and more interesting, so they can turn into any type. How does this happen?

First, stem cells are collected from the patient, after which they are cultured in the laboratory to obtain the desired amount. Then they are again introduced into the patient's body. Together with blood, stem cells are carried throughout the body, where they are transformed into various structures. Thus, for example, it is possible to create new collateral blood flow paths, thereby restoring normal trophism of the brain.

Preventive measures

Unfortunately, specific prophylactic agents do not exist. Therefore, doctors advise only to avoid risk factors and follow some rules:

• maintain body weight within normal limits;
• Do not give up physical activity;
• eat properly;
• quit smoking and alcohol;
• avoid stressful situations;
• diseases such as hypertension and diabetes mellitus should be responsive to timely and adequate therapy.

Predictions for Patients

So, we examined why chronic cerebral ischemia develops, the ICD code, clinical features and possible complications of the disease. This, of course, is important information, but what can patients with such a diagnosis expect?

If chronic cerebral ischemia was diagnosed on time and the patient was provided with adequate medical care, then the prognosis is favorable - the pathological process can be stopped. Nevertheless, in the absence of therapy and the presence of concomitant pathologies (for example, diabetes mellitus), the ailment leads to serious disorders, reduced performance, and sometimes even disability.