Doctors sometimes indicate a syndromic diagnosis, such as cerebral angioencephalopathy. What it is? Chronic cerebrovascular accident. By the way, a fairly common disease, just ordinary people never pay attention to its wording. Often found in old age, less often in young and mature. For a long time, the disease is hidden, and when symptoms appear, it is too late to take drastic measures.
Epidemiology
Due to the non-specificity of complaints, clinical manifestations and detected changes during neuroimaging, it is quite difficult to collect statistics. To some extent, the prevalence of angioencephalopathy can be judged by the number of strokes. About half a million cases of this acute condition are recorded annually in Russia.
Specialists emphasize that cognitive disorders, impaired cognitive functions and the frequency of chronic cerebrovascular insufficiency are of particular importance in identifying discirculatory diseases of the brain. But this does not show the true picture of the prevalence of the disease.
Etiology
From what can angioencephalopathy of the brain develop? The causes of chronic circulatory disorders in the brain and, say, in the heart or lungs are the same. The main etiological factors are two:
- vascular atherosclerosis;
- increase in blood pressure.
Often they meet at the same time and exacerbate each other. In addition, other diseases of the heart and blood vessels, such as rhythm disturbance and chronic heart failure, also have an effect on cerebral circulation. Of particular importance is the presence of vascular malformation in the brain, neck or major vessels. They may not manifest themselves for a long time until another systemic disease develops. A secondary role in the depletion of cerebral circulation is played by the compression of large vessels, as well as a sharp decrease in pressure, especially in older people.
Accumulation diseases can also be the causes of brain angioencephalopathy. What it is? These are conditions when specific substances accumulate in the cells due to the pathological process: proteins, fats or carbohydrates.
In this case, vascular amyloidosis occurs in the elderly, which leads to degenerative changes in their walls. Endocrine diseases also have a certain weight. So, for example, micro - and macroantiopathies in diabetes cause chronic cerebral ischemia. Systemic disorders lead to similar consequences: rheumatism, vasculitis, blood diseases.
As a rule, it is not possible to single out any one factor, therefore, the disease is considered polyetiological. The doctor draws attention to the presence of basic factors, and considers all associated pathologies additional.
Pathogenesis
The above diseases and conditions provoke a decrease in blood circulation in the brain tissue, and, as a result, its starvation (lack of oxygen and glucose). Initially, pathological processes (signs of angioencephalopathy of the brain) appear only in small vessels. Microangiopathy develops. A large number of affected arteries causes persistent ischemia of white matter, as well as multiple lacunar infarcts. The combination of these conditions leads to disruption of the brain structures.
If atherosclerosis is the cause of angioencephalopathy, then the main arteries are affected. This leads to the fact that the level of blood flow in the brain depends on systemic hemodynamics. In the case of arterial hypertension, the perforating arteries of the brain are ischemic, in the first place.
Recently, neuropathologists and neurosurgeons classify chronic circulatory disorders according to two signs: the nature of the damage and its localization. Spilled or diffuse angioencephalopathy manifests itself in the form of a cerebral syndrome, which is divided into leukoencephalopathic and Binswangerian.
There is also focal cerebral angioencephalopathy . What it is? This is the presence of multiple hemorrhages in the nervous tissue with the formation of gaps. In practical medicine, mixed variants are more common, since one pathogenetic mechanism cannot be distinguished.
Clinical picture
Unfortunately, a general practitioner cannot always make a diagnosis such as cerebral angioencephalopathy in a timely manner. Symptoms are too nonspecific and do not alarm either the specialist or the patient. So, basically, this is emotional lability, which is inherent in older people and without any pathologies, as well as a decrease in memory and learning ability. Together, these three signs lead to the disadaptation of patients and their disability.
In addition, headache, dizziness, impaired memory and sleep, subjective noise in the head or ringing in the ears, decreased vision, weakness and fatigue can be signs not only that a person is progressing cerebral angioencephalopathy. What else could it be? The presence of vascular malformation, various infectious diseases, hypertension, asthenic syndrome and other nosologies. In addition, the body sends signals of extreme fatigue in this way.
There is a correlation between the number of complaints and the severity of discirculatory encephalopathy. The more memory, attention and thinking suffer, the less a person tells the doctor about it. Therefore, in severe cases, the patient can be sure that nothing bothers him.
Stages
There are three stages of angioencephalopathy:
- Subjective complaints of impaired memory and attention are accompanied by small focal symptoms: a decrease in the pupil reflex, the appearance of coarse reflexes of oral automatism. Light changes in gait, self-doubt, irritability.
- At this stage, neurological symptoms increase and one dominant symptom crystallizes. It can be extrapyramidal disorders, pseudobulbar syndrome, ataxia, impaired cranial nerve function. Cognitive function suffers more severely, and professional and social adaptation decreases.
- In patients, several syndromes predominate. Gross violations of gait, cerebellar disorders, parkinsonism, disruption of the pelvic organs attract attention. At this stage, criticism of their condition is reduced and there may be no complaints at all. Patients become helpless, like children, because they develop dementia.
Neurological symptoms
There are a number of syndromes that accompany angioencephalopathy of the brain. What it is? This is a set of symptoms that indicate damage to a specific structure of the central nervous system.
- Vestibular syndrome. Patients show complaints of dizziness, instability when walking, they have nystagmus and impaired coordination. Such a clinic indicates damage to the cerebellum or damage to the frontotemporal tract due to a decrease in blood flow in the internal carotid artery.
- Pyramidal syndrome is manifested by enhanced tendon reflexes, as well as the appearance of pathological reactions, often asymmetric. The presence of paresis indicates that a person had a history of stroke.
- Parkinsonism is characterized by slower movements, decreased facial expressions, muscle rigidity in the legs. Patients often fall, because I can’t stop in time due to a violation of locomotion. All this indicates the defeat of cortical-striatal and cortical-stem neurons.
- Pseudobulbar syndrome appears with damage to the cortical-nuclear pathways. Patients have difficulty speaking and swallowing, as well as episodes of “violent” emotions.
- Organochromatic syndrome, as a rule, is accompanied by anxiety-depressive disorders, impaired cognitive functions.
Diagnostics
As in the case of any other disease, the neuropathologist must collect a full history of life and disease in order to determine the rate of progression of symptoms and the presence of concomitant somatic pathologies. Then conduct a physical examination: count the pulse and measure blood pressure, listen to heart sounds, blood flow on large arteries of the upper half of the body. Then conduct neurological tests.
The next stage is laboratory diagnostics. This helps to clarify the cause of angioencephalopathy. The patient is asked to take a clinical blood test, blood biochemistry, and blood coagulation test for glucose level. Then it goes through neuroimaging: computed tomography (CT), magnetic resonance imaging (MRI), electroencephalography (EEG). All this allows you to determine the level of cerebral circulation and identify areas of pathology. Additionally, electrocardiography (ECG) and ultrasound may be prescribed to confirm diseases of the cardiovascular system.
Indications for hospitalization
No clinical protocol indicates the need for therapy in a hospital with a diagnosis of cerebral angioencephalopathy. Treatment, prognosis and prevention of this disease, as a rule, take place on an outpatient basis. Exceptions are cases when the course of the disease was complicated by decompensation of somatic pathology or a stroke developed.
Neuropathologists believe that forcibly removing patients from their usual environment can only worsen the course of the disease. Therefore, at the last stage, it is preferable to carry out patronage at home, rather than transporting the patient to a medical institution.
Treatment
The goal is achieved, the diagnosis of cerebral angioencephalopathy is made, treatment should be started as soon as possible to slow down the development of the pathological process. In addition, they carry out the prevention of strokes and therapy of somatic pathologies.
Treatment is aimed at improving perfusion of brain tissue by affecting the cardiovascular system, as well as correcting the rheological properties of blood. This suggests the treatment of atherosclerosis and arterial hypertension, as the main factors for the development of ischemia.
Folk remedies
Some elderly patients believe that they should not "poison" themselves with pills, but need to look for other ways. Such paradoxical thinking can manifest angioencephalopathy of the brain. Treatment with folk remedies is not welcome among doctors, since it provokes an aggravation of symptoms.
Alternative medicine experts recommend using the roots of Marena dyeing and Moroznika Caucasian, stalks of Saberelnik marsh, Balm Magic Trio, tinctures from garlic and cranberries, and much more to improve cerebral circulation. The effectiveness of these elixirs is very doubtful, so do not get carried away with such experiments. Better go to a competent doctor.