Ischemia of the brain is a lack of exchange functions in the brain tissues, due to a decrease in blood flow. The brain can not fully receive oxygen and nutrients, remove oxidation and decomposition products, and waste carbon dioxide.
Brain functions deteriorate, which affects both the psychological level - the consciousness of the victim, and on all bodily functions of the human body. Most often, cerebral ischemia develops on the background of cerebral atherosclerosis.
Failure in the work of the brain threatens the vital activity of the whole organism. For example, numbness, as one of the symptoms of cerebral ischemia, is caused by the fact that sensory information is not properly processed or transmitted through neurons. The causes of temporary blindness are similar. The brain is engaged in decision-making, therefore, in patients with chronic cerebral ischemia, the inhibition of thinking processes is observed.
Today we will consider this pathology and its treatment in adults and newborns, as well as symptoms, degrees of ischemia.
CONTENTS
Brain ischemia: acute and chronic
There are two forms of the course of the disease: acute and chronic.
Acute ischemia develops on the principle of a transient ischemic attack, a micro stroke or an attack of acute cerebrovascular accident - ONMK.This is transient ischemia, otherwise - a transient impairment of cerebral circulation - PNMC or ischemic stroke. The cause of an acute condition is an obstruction of the blood flow by the embolus or a neglected chronic form of the disease. The latter, in turn, develops gradually as the bloodstream narrows.
Cholesterol plaques are lipoproteins of lower density limits. It is they that "choke" the organs, causing circulatory hypoxia. They can break away from the place of formation and circulate through the vessels. Emboli can be cholesteric or bloody. Thrombi are dangerous for the development of the inflammatory process.
Prevention of ischemia, like many other diseases, is to maintain a healthy lifestyle. It is necessary to avoid stress as much as possible, not to overeat, adhere to the "anti-cholesterol" diet, exercise, give up alcohol and smoking, and be outdoors.
Ischemia of the brain: causes of
There are background and additional prerequisites.
The first include insufficient cerebral circulation, which leads to hypoxia - oxygen starvation. It arises from the narrowing of the lumen of the artery or its complete obstruction - obturation. Without oxygen, cells can not function fully. If this process is delayed, necrosis may begin - the necrosis of the tissue, otherwise called a heart attack.
Hypoxia of the brain is typical for such pathologies as arterial hypertension and atherosclerosis due to the growth of fat deposits on the inner wall of the cerebral vessels.
Overlapping the lumen of the cerebral artery by thrombus is called thrombosis. A blood clot forms directly in the brain or is transferred with blood from another part of the body. A "traveling" thrombus is called an embolus. It is formed on the wall, but under the influence of some factors it breaks and moves through the circulatory system until it gets stuck in the narrowest point of the arterial canal. The narrowing of the lumen can be observed not in one place, but at once in several places.
Additional causes of cerebral ischemia include:
- cardiovascular diseases, accompanied by a violation of central hemodynamics. For example, acute heart failure in the background of myocardial infarction, bradycardia, tachycardia;
- ischemic kidney disease;
- caisson disease;
- vascular anomalies, for example, compression, local artery spasm;
- compression of the artery from the outside, for example, with a tumor;
- carbon monoxide intoxication;
- hereditary angiopathies;
- blood loss;
- venous pathology;
- cerebral amyloidosis with deposits of amyloid - protein-polysaccharide complex - in tissues;
- systemic vasculitis or angiitis, otherwise - arteritis;
- diabetes mellitus;
- blood diseases, for example, anemia or, conversely, erythrocytosis, which causes an increase in its viscosity;
- advanced age;
- obesity;
- smoking tobacco.
There are many causes of coronary disease, but the main one is the complete or partial overlap of the bloodstream. Factors that cause the formation of plaques or pathological protrusions of the walls of blood vessels due to tumors or other abnormalities in surrounding tissues can be very high.
Brain ischemia: symptoms of
Symptoms of cerebral ischemia can be distinguished a lot:
- dysfunction of the nervous system causing speech disorder or vision problems;
- fatigue;
- general weakness;
- drowsiness;
- reduced performance;
- amnesia;
- sharp mood swings;
- irritability;
- is a nervous stimulation;
- insomnia
- headache;
- blood pressure changes - blood pressure;
- surface and frequent breathing;
- dizziness;
- loss of consciousness;
- nausea;
- vomiting;
- numbness of limbs;
- sensation of cold in the palms and soles of the feet.
As the disease worsens, the symptoms may become worse. It progresses in stages. Specialists distinguish the stage 3 or degree of development of ischemia .Some singled out a fourth.
Separately, list the symptoms of ischemic attack:
- attacks of zone loss of sensitivity;
- paralysis of the site or half of the body;
- monocular vision loss( unilateral blindness).
Problems with the eyes arise because the signals from them enter the visual cortex, located in the occipital lobe. Local numbness is due to the fact that the neurons of the somatosensory cortex are affected in the parietal lobe, where tactile information is transmitted.
The red core of the brainstem, the basal ganglia, the cerebellum and not only "respond" to the motor activity of a person. When the processes that occur in the motor regions of the cortex in the frontal lobes are violated, the patient has difficulty regulating movements up to paralysis. Different factors of vital activity are responsible for different parts of the brain. Emotions are governed by amygdala, attention is given to the reticular formation, memory is to the hippocampus.
The complexity of diagnosing certain brain diseases is that their symptoms are similar to "standard" changes in the state of health of the elderly. Another feature of cerebral ischemia - its signs are very individual, tk.different people are affected by different parts of the central organ of the central nervous system.
In the diagnosis of an important role played by observations of relatives of the patient. They are capable of giving a more accurate description of the changes occurring. In connection with the inhibition and confusion of consciousness completely rely on the patient's words can not.
Diagnosis of cerebral ischemia
Diagnosing ischemia is not easy, becauseher symptoms are very similar to the symptoms of such diseases as:
- progressive supranuclear palsy;
- corticobasal degeneration;
- multisystem atrophy;
- Parkinson's disease;
- brain tumor;
- Alzheimer's disease;
- normotensive hydrocephalus;
- idiopathic dysbasia;
- ataxia.
In order to avoid mistakes, a neurologist should use an integrated approach. A physical examination is carried out. The state of the respiratory and cardiovascular systems is evaluated, the neurological status is determined.
Ultrasonography is prescribed - ultrasound of one of the following types:
- ultrasound dopplerography - UZDG;
- duplex vessel scanning - DS.
To determine the neurological status, the doctor evaluates the patient's condition:
- clarity of consciousness;
- pupil response to light;
- consistency of movements of the eyeballs;
- facial expressions, the ability to grimace;
- symmetry of the face;
- movement of the language;
- speech;
- memory;
- muscular strength and tonus of the extremities;
- coordination of movements;
- sensitivity;
- tendon reflexes.
Doppler tomography or dopplerography only shows blood flow velocity. DS of the cerebral arteries is also performed for the study of the cerebral canals. But duplex scanning shows the vessel, its lumen, wall, location and character of the blood flow.
Angiography of MR( magnetic resonance) or CT( computer tomography) of the species may be required. This is a kind of X-ray study using contrasting staining of blood with iodine. Unlike ultrasound, special preparation and additional studies are required here: fluorography and electrocardiograms - ECG.Before the procedure, you should not eat or drink. The coloring substance is injected through the puncture, a catheter may be required.
Neurologists use specific tests for diagnosis. For example, a finger-jagging test or Romberg's posture: standing, legs together, with closed eyes and arms extended forward. To identify comorbidities, ECHO-CG, general and biochemical blood tests are used. For neuromonitoring also use electroencephalography - EEG, cardiography.
Diagnostics believe that left- and right-hemispheric ischemia differ in concomitant syndromes. If the focus of the disease is located in the left hemisphere, then the treatment is easier and faster.
Ischemia of the brain: degrees - 1, 2, 3
The degrees or stages differ in the signs and strength of their manifestation. The disease progresses from the initial or mild to the subcompensation or medium-heavy, and then - decompensation or severe. This division is due to the area covered by the CNS.At the last stage in the newborn, she is completely stricken. The outlook is unfavorable.
The intensification of symptoms of the disease occurs in proportion to the narrowing of the lumen of the bloodstream. In addition, the more ischemic foci occur in the brain, the stronger the disease captures the body. At the last stage, a structural organic lesion of the central nervous system occurs. In the of babies it is accompanied by brain edema. The accumulation of excess fluid in the intercellular space is due to excessive loads, pressure on the brain cells. This is how hydrocephalus develops.
There are 3 rates of progression of ischemia depending on how long each stage lasts:
- fast - less than 2 years;
- average - up to 5 years;
- slow - more than 5 years.
After recovery, people of any age need a rehabilitation period. Its duration and intensity of the procedures performed are determined by the stage of the disease.
First degree of cerebral ischemia
Otherwise this stage is called compensated. The changes are still reversible. The disease begins with such signs as:
- malaise;
- weakness, rapid fatigue;
- chills;
- insomnia;
- reflexes of oral automatism or subcortical;
- anisoreflection;
- emotional-personality disorders( eg, irritability, aggressiveness);
- emotional lability - a quick change of mood;
- depression;
- disorders of cognitive functions: attention deficit, decreased cognitive activity, forgetfulness, inhibited thought process - stupor;
- change in gait( patient shuffles or semenitis with feet);
- coordination problems;
- "heavy" head, permanent migraines, dizziness, tinnitus.
Reflexes of oral automatism are normal only for small children. When you approach or touch any object to your lips, they stretch out a tube. The presence of these reflexes in adults indicates a violation of neural connections in the brain. When anisoreflexion, reactions to external stimuli from different sides of the body manifest themselves with varying strength. At this stage, a slight asymmetry appears.
The first degree is treated relatively easily and without aggravating consequences. Children's ischemia of the brain is curable, but if the ominous symptoms do not disappear within a week, the disease goes to the second stage.
Second degree of cerebral ischemia
Subcompensation is the stage of aggravation of primary signs and deterioration of well-being. All the signs of the first stage become pronounced with an average severity of the disease.
Additionally, the following symptoms appear:
- extrapyramidal disorders due to damage to the pyramids of the medulla oblongata, basal ganglia and subcortical-thalamic connections;
- ataxia with impaired coordination;
- is an intellectual-mnestic disorder that leads to personal degradation;
- apathy - indifference, narrowing of the circle of interests, loss of interest in the world around.
In newborns, intracranial hypertension is observed - an increase in hydrostatic pressure. It occurs predominantly in the areas before the occlusion of the vessel. Adults at this stage no longer cope with professional duties. They can not concentrate on anything, even just read. In some cases, treatment in the hospital is necessary.
All syndromes continue to progress. Tearfulness may appear. The peculiarity of the moderate degree is that there are mental disorders. But the ability to self-service remains. As soon as it disappears, the patient needs constant care.
Third degree of cerebral ischemia
Decompensation occurs when all the possibilities of the brain are exhausted. At the last stage of the development of the disease in the brain, multiple lacunar and cortical infarctions occur. The patient can not move independently, loses balance.
Concomitant severe symptoms:
- syncope;
- psychoorganic syndrome;
- urinary incontinence - incontinence;
- swallowing disorder - choking with food;
- Parkinson's syndrome( Parkinsonian), more precisely, amyostatic or akinetic-rigid;
- disinhibition - inadequate behavior;
- apatiko-abulic syndrome with reduced willpower;
- discordant syndrome of Babinsky, violations of praxis;
- psychotic disorders up to dementia - dementia.
Sudden loss of consciousness is accompanied by a sharp drop in blood pressure, relaxation of the muscles, dilated pupils, lack of their response to light. The pulse is audible with difficulty, it is filiform. The patient needs first aid, turn it to one side. During fainting, there is a danger of asphyxia. The muscles of the tongue are so relaxed that it can block the access of oxygen.
The psychoorganic syndrome consists of 3 components. It is forgetfulness, stupor and explosiveness - inability to control one's behavior. Emotional failures become a person, he quickly passes into a state of extreme excitement, inadequately reacts strongly to what is happening.
Parkinsonism combines:
- tremor;
- muscle rigidity - constant increased tone;
- epileptic seizures;
- postural instability - inability to maintain balance;
- hypomia - poverty of involuntary mimic reactions( Bekhterev-Notnagel symptom);
- bradykinesia - slowing movements, stiffness.
French neuropathologist J. Babinski( Babinsky) for the first time described the syndrome that arises from the defeat of the cerebellum or the prefrontal area of the large brain. The patient can not perform simple arbitrary actions, for example, compress and unclench the fist. Praxis in translation from Greek - "action".
Mental abnormalities lead to a disturbance of the perception of the real world and, as a consequence, disorganization of behavior. Psychiatric disorders achieve complete disintegration of the personality.
Symptoms of different degrees of ischemic disease in adults and children vary slightly. The last stage is terrible because the consequences can no longer be avoided, ischemia will forever leave an imprint on the life of the patient and his loved ones.
Ischemia of the brain in newborns
The cause of the disease is hypoxia in the womb or during childbirth. It is divided into 3 degrees according to the duration of oxygen starvation of the brain. Diagnosis of the disease in children is not easy, tk. At this age, it is impossible to identify certain symptoms of ischemia.
All signs are combined into syndromes:
- Hydrocephalous .The head is enlarged, the area of the fontanel is enlarged, intracranial pressure is increased. This is caused by the accumulation of cerebrospinal fluid. It forms in the brain and circulates through the dorsal. The cerebrospinal fluid overflowing the space under the bones of the skull causes hydrocephalus;
- Syndrome of the raised nervous reflex excitability .Change in muscle tone, trembling, tremor - involuntary trembling of the limbs, exacerbation of reflexes, constant crying and restless sleep;
- Comatose .Unconscious state with lack of coordinating function of the brain;
- Syndrome CNS depression of the .Muscle tone is reduced, motor activity is reduced, sucking and swallowing reflexes are weakened, strabismus and asymmetry of the face may appear;
- Convulsive .There are paroxysmal jerking of the whole body. Cramps or spasms are involuntary muscle contractions.
The severity of cerebral ischemia in newborns and adults differs somewhat due to age-related features:
- First degree ( light ).Lethargy or overexcitement of the child from the first days of life.
- Second degree ( medium-heavy ).Cramps appear. The treatment is carried out in a hospital.
- Third degree ( heavy ).The child is immediately placed in the intensive care unit.there is a threat to his life. Structural ischemic brain damage in a newborn leads to an organic lesion of the central nervous system. Inevitable consequences such as ataxia - motor disorder, lag in psychomotor development, convulsive seizures, hearing and vision impairment.
In time to detect neurological abnormalities in children helps the constant observation of pediatricians in the first week of life, as well as a set of ongoing studies.
Pediatrics is improving every year the methods of treatment of ischemia. If earlier such a diagnosis was a verdict, and the baby was doomed to disability, now at the first stages the disease can be cured without painful consequences. This is a feature of infantile age. So, an easy degree is treated with the help of a special massage course.
Ischemia of the brain: treatment of
Both conservative and surgical methods are used. The operation is indicated if all measures taken do not improve the clinical picture or cause an ischemic attack with the possibility of a lethal outcome. Conservative treatment begins with the elimination of the cause of the disease - problems with filling the brain with blood.
Microcurrent Electroflexotherapy - ERT improves the functioning of neurons in the cerebral cortex and normalizes blood circulation.
The preparations used for drug treatment can be divided into several groups:
- neuro- or cerebroprotectors that protect the neurons of the brain. For example, nootropic Cerebrolysin or antioxidant Mexidol ;
- reducing the permeability of the walls of blood vessels, strengthening them, stimulating blood circulation. vasodilators and anticoagulant or aspirating preparations are used;
- lipid-lowering , corrective lipid exchange.
Treatment of ischemic disease of the brain proceeds according to the scheme: neurons - vessels - metabolism. As a result, the cells are again saturated with oxygen, the intercellular metabolism comes back to normal. Normalization of blood pressure is necessary for the prevention of ischemic attacks and strokes.
After restoration of normal blood flow, motor skills do not return immediately. We need a rehabilitation period. Requires a course of massage, exercise therapy - exercise therapy, electro- and / or magnetophorez.
Surgical treatment in the occlusive-stenotic lesion of cerebral vessels is performed through the operation of stenting of the carotid arteries, thrombectomy - to remove thrombus, carotid endarterectomy.
Stem Cells. The treatment with stem cells is of increasing interest. This is the source of natural regeneration. Before the procedure, the patient takes a biomaterial. From the resulting cell culture, mesenchymal( embryonic) stem cells are isolated and cultured to the desired volume.
Transplantation - administration - occurs twice using a dropper. The procedure lasts no more than an hour. Then the patient can return home. New cells with blood flow are transferred to the affected areas. They attach themselves to healthy tissues and begin to multiply. Stem cells also create new networks of collateral pathways. These are auxiliary, roundabout, side vessels, carrying blood around the main bed.
Folk methods of treatment are very doubtful. This application is infused with leaves of walnuts, dill water, garlic tincture. Of course, useful plants can contribute, for example, to the dilution of blood, but hoping only for them is deadly dangerous.
If the patient turned to the neurologist too late, then serious consequences can not be avoided. Unfortunately, cerebral ischemia is a disease with a frequent fatal outcome. Inattention to one's health always ends with the appearance of pathologies. In cases of cardiovascular disease, the lack of timely treatment is fraught with death.
Consequences of cerebral ischemia
The severity of the consequences is determined not only by the stage and form of the disease, but also by the kinds of ailments that developed on the basis of ischemia. The main negative factors of this disease are hypoxia and metabolic disorders.
They provoke the development of other pathologies:
- ischemic stroke or cerebral infarction( necrosis) of the brain( more often in people older than 60 years);
- chronic dyscirculatory encephalopathy or cerebral vascular sclerosis;
- paralysis;
- Sensitivity disorder - paresthesia;
- dumbness;
- epilepsy;
- thrombophlebitis.
In stroke, part of the brain tissue softens, dies. Nerve cells do not regenerate.
The modern methods of treatment include the use of stem cells. The newest technology is designed to replenish dead cells of any type. There are many conflicting opinions about its application. There are clinics that actively use this technique.
Encephalopathy is an organic lesion of the brain that proceeds without inflammation. There is a degeneration of the brain tissue, cells and intercellular substance are destroyed. Paralysis in translation from ancient Greek - "relaxation", immobility. It affects the part of the body opposite to the one in which the focus of the disease is located. If the area of the destroyed neurons is large, tetraplegia can occur - limb paralysis, or the person will completely lose the ability to move.
Feeling of numbness can be accompanied by tingling, burning, "creeping crawling", which increase with physical activity. Paresthesia also has a mirror image. It arises from the dysfunction of the thalamus, the parietal lobe of the brain. The centers that regulate speech are located in the left hemisphere of the brain. A patient with a clear consciousness understands everything, but can not speak.
Consequences for newborns can be expressed by mental retardation and learning difficulties. A small person will brutally pay even for a relatively short-term oxygen starvation during the period of intrauterine development. Observance of a pregnant woman all the prescriptions of a doctor is the guarantee of her baby's health.
HIGM - chronic cerebral ischemia - differs from the acute form in that it progresses slowly and secretively. Even close people do not always immediately notice the ongoing negative changes. The absence of timely treatment leads to the emergence of all new pathological abnormalities.
The degree of severity of the consequences of ischemia is determined by how closed the blood duct was, how quickly its narrowing occurred, it depends on the duration of treatment and the general condition of the body. The faster the therapeutic course is initiated, the more favorable the prognosis.
Author: Andrey V. Sokov, neurologist, source: http: //www.ayzdorov.ru/ lechenie_ishemiya_golovnogo_mozga.php
