Leukoencephalopathy of the brain is a pathology that is characterized by damage to the white matter of the brain. White matter is formed by processes of nerve cells (axons - long processes, and dendrites - short). It provides a nerve impulse from the lower parts of the nervous system to the cerebral cortex, and vice versa. Violation of this function leads to a variety of disorders up to dementia.
Causes of the disease
In the vast majority of cases, the cause of damage to the white matter of the brain is high blood pressure and the deposition of fatty plaques in the cerebral vessels (cerebral atherosclerosis). Such forms of leukoencephalopathy are characteristic of the elderly.
Also, white matter damage can develop with such pathologies:
- oncological diseases of the blood system (leukemia);
- chronic infections with exhaustion;
- prolonged and deep disturbance of consciousness: stupor and coma;
- human immunodeficiency virus (HIV infection);
- secondary immunodeficiency in the treatment of cytostatic drugs that suppress the immune response;
- malignant oncology of the lymphatic system (lymphogranulomatosis);
- tuberculosis;
- infectious diseases affecting the brain (syphilis, tick-borne encephalitis, Lyme disease, meningitis and encephalitis of various etiologies);
- systemic diseases of the connective tissue (rheumatoid arthritis, systemic lupus erythematosus).
The cause of the development of leukoencephalopathy in infancy is often fetal hypoxia of the fetus or hypoxia in childbirth.
Classification
Depending on the causes of leukoencephalopathy of the brain, as well as the extent of the lesion, the following types of disease are distinguished:
- progressive vascular, or small-focal - occurs due to chronic circulatory disorders in the brain, which leads to a decrease in the supply of oxygen to nerve cells;
- progressive multifocal - a type of leukoencephalopathy with the worst prognosis, characterized by the presence of multiple lesions in the brain;
- periventricular - manifested by damage to the substance around the cavities of the brain (ventricles).
Small focal form
Focal cerebral leukoencephalopathy is also called vascular. It develops with prolonged damage to the cerebral vessels. The lack of blood supply to nerve cells (neurons) leads to a reduced supply of oxygen (hypoxia) to them, and then to the death of neurons (necrosis).
Vascular leukoencephalopathy of the brain: what is it? This is a pathology that most often develops in older men and women over 55 years old. According to statistics, men suffer from this disease more often.
There are a number of pathologies that increase the risk of an ailment:
- hereditary predisposition;
- increased body weight;
- decreased motor activity (lack of exercise);
- metabolic and endocrine disorders: diabetes mellitus, obesity;
- increase in blood cholesterol and the deposition of fatty plaques on the vessels of the brain (cerebral atherosclerosis);
- high blood pressure (hypertension);
- bad habits: alcohol abuse and smoking;
- improper nutrition: excessive consumption of fatty and fried foods, smoked meats and spices.
All of the above conditions are not yet a guarantee of the development of leukoencephalopathy of the brain of vascular origin. Lifestyle modification, control of cholesterol and blood pressure will help to avoid the development of pathology of the nervous system.
Often such a well-known concept as "senile dementia" is a consequence of vascular changes in the brain.
Multifocal form
As noted above, this form of the disease is the most malignant. It can end for the patient lethally.
Multifocal leukoencephalopathy of the brain occurs due to infection of the body with a polyomavirus. But the mere presence of a microorganism is not enough. Many people have it in a "sleeping" form, while it does not cause any disease. Activation of the virus occurs in violation of the body's immune response.
The development of progressive brain leukoencephalopathy is most often associated with the presence of the human immunodeficiency virus (HIV infection). Also, the disease can develop in people after exhausting long-term illnesses, for example, in cancer patients.
Pathology is characterized by rapid development. It may take several years from the onset of the disease to the death of the patient. At the same time, the vascular form develops very slowly, over decades, and very rarely leads to death.
Periventricular form
Periventricular leukoencephalopathy of the brain: what is it? This form of the disease develops with insufficient oxygen supply to the brain tissue (ischemia). There is a violation of the structure and function of both white and gray matter.
The most characteristic localization of the pathological process:
- cerebellum - is responsible for coordination of movements;
- brain stem - here are the centers of vital functions of the body - respiration, heartbeat;
- the frontal lobe of the cerebral hemispheres - here are the centers of behavior, self-awareness and the surrounding world.
The development of the periventricular form of cerebral leukoencephalopathy in a child can lead to cerebral palsy.
Symptoms of the disease
The clinical picture of the disease develops gradually. Symptoms are not specific at first. The patient is concerned about weakness, lethargy, dizziness, and increased fatigue. He can also note minor memory lows, sudden mood swings, causeless sadness and tearfulness. Pressing headaches are observed.
Further, the process progresses, and complaints are already more specific. Symptoms depend on the location of the pathological process and which conducting nerve pathways are damaged.
If the motor pathways are damaged, the patient may experience impaired movements: paresis (difficulty moving his arm or leg) or paralysis (complete immobilization of the limb). It is noteworthy that motor disorders develop on the side opposite to the localization of pathology in the brain.
Speech problems (aphasia) are also common. It can be of two types: motor (the patient understands what they are told, but cannot independently express his thoughts) and sensory (the patient can speak, but does not understand what he has heard and read).
In the presence of foci of damage in the cerebellum, coordination of movements is impaired.
In case of damage to the medulla oblongata, there are problems with swallowing liquid and solid foods, which can lead to food getting into the upper respiratory tract and suffocation. Further, the pathology in the medulla oblongata progresses, which leads to respiratory failure and palpitations.
In the absence of timely treatment, the psyche and intelligence of the patient suffer. He may not recognize his loved ones, may not understand who he is and where he is. In the future, the patient completely loses the ability to self-care and needs outside help.
Most cases of encephalopathy are characterized by a slow development of symptoms. Therefore, often even in the absence of treatment, the patient can live without a significant neurological deficit. But forms such as multifocal encephalopathy develop very quickly and lead to death.
Diagnostic Methods
The first step in the diagnosis of any neurological disease is a thorough conversation with the patient. During the conversation, the doctor should clarify the following questions:
- what complaints the patient presents;
- how long ago he began to note a violation of his condition;
- how quickly symptoms developed and in what sequence they appeared;
- one of the next of kin suffers or has suffered brain leukoencephalopathy;
- Does the patient have concomitant diseases: arterial hypertension, diabetes mellitus, atherosclerosis;
- the rapid development of the disease should alert the doctor about the possible presence of HIV infection, which also needs to be asked.
Next, the doctor conducts a neurological examination of the patient. It includes examination of reflexes, muscle tone, motor function, a state of tactile and pain sensitivity.
Only after these stages the patient is given a referral for additional examinations.
Additional diagnostic methods
First of all, it is necessary to conduct a series of laboratory tests, first of all, a blood test is done. This method helps to establish the presence of an inflammatory process in the body, cholesterol and glucose levels. It is also necessary to measure the patient's blood pressure.
The patient is examined for the presence of narcotic substances and alcohol in the blood, since abuse of them can cause the development of brain leukoencephalopathy.
For an accurate diagnosis, it is mandatory to conduct instrumental methods for diagnosing the brain:
- electroencephalography - shows a decrease in the activity of nerve cells in the brain;
- computed tomography is an X-ray method that allows you to see the foci of a violation of the structure of the brain;
- magnetic resonance imaging is the most effective method that allows you to examine the central nervous system to the smallest detail and see the lesions;
- Doppler ultrasound - helps to see circulatory disorders in the brain due to a clear display on the monitor of blood flow through the vessels;
- brain biopsy with histological examination - is a microscopic examination of a small piece of brain tissue, it is used only in extreme cases with the ineffectiveness of other diagnostic methods.
The answer to the question "What is it: cerebrovascular vascular leukoencephalopathy?" help to give contrast magnetic resonance imaging. This method is more effective than classic. It is carried out by intravenous administration of a contrast medium. Contrast builds up in the vessels of the brain and allows you to see the shape, configuration of the vessels, their relationship to the surrounding tissues.
Disease treatment
Unfortunately, this ailment can be attributed to the category of incurable diseases. But timely prescribed therapy and regular medication will help control this disease. Treatment of leukoencephalopathy of the brain is strictly individual. It depends on the cause of the disease, the severity.
The most commonly used groups of drugs are:
- preparations for improving cerebral circulation - Actovegin, Trental;
- Nootropics (drugs that increase metabolic processes in the brain) - Cerebrolysin, Fezam;
- vitamins are especially useful for the nervous system; vitamins of group B, vitamins E and A;
- corticosteroids (used for inflammation of the brain or hypoxia to reduce swelling) - "Dexamethasone", "Prednisolone";
- antiviral agents with the viral nature of encephalitis - "Zovirax", "Cytoferon";
- antidepressants - "Fluoxetine";
- antiretroviral therapy for diagnosed HIV infection.
In addition to drug therapy, non-drug methods are also used:
- physiotherapy;
- manual therapy;
- psychotherapy;
- reflexology.
Disease prognosis
How many live with leukoencephalopathy of the brain depends on a number of factors:
- forms of the disease;
- how early therapy began;
- Does the patient regularly take drugs.
The most malignant is the multifocal form. Life expectancy with this form is up to 1 year. Therefore, for all HIV-infected people, antiretroviral therapy is vital. Timely treatment started is an effective prevention of multifocal leukoencephalopathy and other HIV-associated diseases.
What do they write on the Internet?
In social networks and other sites, there are many diverse discussions and reviews about brain leukoencephalopathy. Unfortunately, most people who have been diagnosed with this are scared and completely unaware of their condition and predictions.
Many people think leukoencephalopathy is a sentence. However, it is not. It was previously noted that the multifocal form really most often ends in death. But this is the most rare type of disease.
Other forms of the disease are characterized by a chronic, slowly progressing course, which can be controlled by timely prescribed drugs.
Therefore, everyone who is diagnosed with "leukoencephalopathy" should know that this is not a sentence, but only an occasion to more diligently monitor their health and fight the disease.