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Atherosclerosis of cerebral vessels: symptoms and treatment

Content:

Today, cerebral atherosclerosis of the cerebral arteries is one of the key factors for the violation of cerebral circulation, which occupies a leading place among the causes of death and disability in the population of highly developed countries. This typical disease of civilization, characterized by a narrowing of the lumen of intracranial vessels that feed the brain tissue, leads to the development of atherosclerotic stenosis, which is the main "culprit" of ischemic stroke, dyscirculatory encephalopathy and vascular dementia (senile dementia).



The mechanism of development of cerebral atherosclerosis

Atherosclerosis of cerebral vessels Atherosclerosis in Greek means solid, dense gruel (ἀθέρος - chaff, gruel, σκληρ плот - dense, solid). This is a chronic disease of large arteries, accompanied by lipid infiltration of the inner membrane and proliferation of connective tissue in the vascular wall. The first signs of the pathological process can be detected on average and even at a fairly young age (15-20 years).

Today, along with the generally accepted theory of lipoprotein filtration (accumulation of fatty molecules in the vascular wall), there are other hypotheses of the pathogenesis of cerebral atherosclerosis: the primary violation of the protective properties of the internal epithelium of the vessel, lipid peroxidation, deficiency of essential polyenoic fatty acids, the presence of thrombus, hemostatics and deficiencies, hemostatics, and hemostatics and deficiencies. .

At an early stage of the pathological process associated with impaired lipid metabolism, cholesterol (a water-insoluble compound that forms the basis of an atherosclerotic plaque) begins to accumulate on the surface of a previously damaged vascular wall. Gradually, calcium salts and filaments of an unformed connective tissue are deposited on this cluster, and therefore, the surface of the atherosclerotic plaque begins to acquire an irregular convex shape.

Narrowing the lumen of the vessel, cholesterol "growth" complicates the passage of blood and creates the prerequisites for the occurrence of turbulent vortexes of blood flow. This leads to the destruction of blood cells (platelets and leukocytes) and the gradual formation of a blood clot that can come off under adverse conditions for the body and block the cerebral artery. At the same time, acute cholesterol in blood vessels of the brain can provoke acute cholesterol plaque (which is softened by cholesterol esters or simply has not managed to harden) can cause obliteration.

Most often, cerebral atherosclerosis affects the internal and external carotid arteries.

Risk factors and causes of cerebral atherosclerosis

The main cause of the development of the pathological process is a violation of lipid metabolism, leading to the deposition of lipoproteins on the walls of blood vessels. Both exogenous (external) and endogenous (internal) factors can provoke this condition.

Unchangeable (non-modifiable) risk factors

  • Age (the older the person, the higher the likelihood of atherosclerosis);
  • Gender (cerebral atherosclerosis is more often detected in men due to insufficient production of estrogen, which helps break down fats);
  • Hereditary predisposition

Variable (modified) factors

  • Disruption of fat metabolism (primary and secondary hypercholesterinemia, high cholesterol, low density, low cholesterol, high density, high content of triglycerides in the blood plasma);
  • Arterial hypertension;
  • Metabolic syndrome;
  • Increased body weight, obesity;
  • Smoking;
  • Alcohol abuse;
  • Hypodynamia (sedentary lifestyle);
  • Violation of carbohydrate metabolism (diabetes);
  • Irrational diet with a predominance in the diet of animal fats;
  • Renal failure;
  • Chronic inflammatory processes;
  • Hyperfibrinogenemia (increased blood clotting);
  • High levels of homocysteine ​​in the blood;
  • Emotional overstrain, frequent stressful and conflict situations.

According to statistics, atherosclerosis of cerebral vessels is most often found in men who have reached 45-50 years old and in women over sixty.

Types of cerebral arteriosclerosis

  • Metabolic;
  • Age;
  • Inflammatory (tuberculous, syphilitic);
  • Hyalinosis (cerebral atherosclerosis, developing on the background of hypertension);
  • Toxic;
  • Allergic;
  • Menkeberg's mediacalcinosis (primary deposition of calcium salts in the middle sheath of arteries).

Stages of development of cerebral atherosclerosis

  1. The initial stage (the formation of lipid spots and strips). These formations are yellowish or yellow-gray areas, not rising above the surface of the vessels, prone to merge.
  2. Stage of progression (formation of fibrous plaques). Tight-elastic lesions, towering above the surface of the intima, are round or oval "growths" of white or yellowish color. As a rule, they merge with each other, sharply narrowing the vascular lumen and giving the inner surface of the artery a hilly appearance (the so-called stenotic atherosclerosis).
  3. Stage of atheromatosis (formation of a delayed atherosclerotic plaque with a characteristic ulceration, hemorrhage and the imposition of thrombotic masses). At this stage, due to the collapse of complex labile fat-protein complexes, fine-grained tissue detritus (pathological mass consisting of fat accumulations, cholesterol crystals, degenerated epithelium cells and connective tissue fibers) is formed in the thickness of the plaque.
  4. The final stage (atherocalcinosis). It is characterized by calcification (petrification) of fibrous plaques and severe deformation of the vessels.

Symptoms of cerebral arteriosclerosis

At the initial (ischemic) stage of the disease, patients complain of impaired concentration and dull, aching headaches resulting from narrowing of the artery with an atherosclerotic plaque, stagnation of blood and insufficient oxygen supply to the brain. At an early stage, pain occurs after mental exertion, but over time they become permanent. Some patients become hot-tempered, aggressive, there is a tendency to hysterics and depression. Often, after a good rest, negative symptoms disappear without affecting the human performance.

The trombonecrotic stage of marked clinical manifestations of cerebral atherosclerosis is characterized by a slow progression of symptoms. During this period, headaches become more pronounced and prolonged, memory gradually deteriorates, sleep and disability are disturbed, thinking slows down, tinnitus appears, and excessive fussiness is noted. Patients complain of dizziness, fainting, difficulties in remembering current events (while distant memory remains intact), the development of a violation of fine motor skills of hands, a feeling of imbalance and instability in the legs. Periodic brain crises (transient ischemic attacks) characterized by severe headaches, impaired visual and speech functions, paresis of the lower half of the face, weakening or disappearance of sensitivity in the limbs, hemiparesis (paralysis of one side of the body) are characteristic of this stage of the disease. As a rule, similar symptoms are observed for 24-48 hours, after which the patient's condition is gradually restored. In this situation, we are talking about a transient cerebral circulation.

If the patient does not feel better after two days, an acute violation of cerebral circulation (ischemic stroke) arises, requiring urgent medical attention.

The final (sclerotic) stage of cerebral arteriosclerosis, which is often called the stage of vascular dementia, is characterized by abnormalities in mental activity (cognitive, emotional and behavioral). There is a complete loss of performance, the degradation of professional skills, the loss of landmarks in time and space, the inability to control their needs. The patient forgets the acquired skills, in connection with which he needs constant help in everyday life. As dementia progresses, complete degradation of the personality and maladjustment to the environment is stated, wolf appetite or aversion to food develops, spontaneous defecation and urination, visual and speech abnormalities are observed. Such patients require constant supervision.

Diagnosis of cerebral atherosclerosis

The diagnosis is made by a neurologist. This takes into account the data of the anamnesis, the patient's complaints, the clinical picture of the disease and the results of the diagnostic examination, including:

Laboratory diagnostic methods

  • Immunological blood test;
  • Biochemical analysis of blood (determination of the level of triglycerides, cholesterol, HDL, LDL).

Instrumental diagnostic methods

  • Ultrasound scan of cerebral vessels;
  • Magnetic resonance imaging;
  • Transcranial doppler sonography (assessment of the blood flow of intracranial vessels);
  • Angiography (contrast X-ray examination of the blood vessels of the brain)

Treatment of cerebral atherosclerosis

Treatment of cerebral atherosclerosis is carried out in a complex that includes pathogenetic and symptomatic therapeutic techniques and the correction of behavioral risk factors. Patients suffering from cerebral atherosclerosis, it is strongly recommended to radically revise their diet, constantly maintain blood pressure within the normal range, as well as monitor cholesterol and glucose levels in the blood. It is mandatory to give up bad habits (smoking and alcohol consumption), normalize weight, minimize neuropsychic stress, streamline work and rest, and ensure regular adequate physical exertion.

Drug treatment of cerebral atherosclerosis is aimed at improving the blood supply to the cerebral vessels, normalizing lipid metabolism and blood rheological parameters, reducing atherosclerotic plaques, slowing the development of the pathological process and correcting concomitant diseases.

Pathogenetic therapy

Drug optimization of blood circulation

For the correction of disorders arising in the microcirculatory bed, patients are recommended to take vasoactive drugs that affect vascular circulation. This group of drugs includes calcium channel blockers (nimodipine, cinnarizine, flunarizin), phosphodiesterase inhibitors (pentoxifylline, theophylline, vinpocetine), and α-blockers (nitroglycerin). A well-proven drug of multidirectional action, Tanakan, improves microcirculation and stimulates neuronal metabolic mechanisms.

Antiplatelet (antiagregatnaya) therapy

Anti-platelet therapy is a pathogenetically based treatment method aimed at correcting and preventing atherothrombosis. At present, 3 groups of anti-platelet drugs are used in clinical practice: products containing aspirin, cyclooxygenase inhibitors and thienopyridines.

The most popular drug used in the prevention and treatment of cerebrovascular pathologies is acetylsalicylic acid, which reduces the tendency of platelets to aggregate, inhibits the formation of thrombin and has an inhibitory effect on the formation of fibrin.

When taking aspirin in combination with another antiplatelet drug, clopidogrel, characterized by an alternative mechanism for suppressing platelets, the effectiveness of treatment is significantly increased, and many problems associated with the resistance of patients to aspirin are solved.

Lipid-lowering therapy

The use of hypolpidemic drugs that stabilize the structure of atherosclerotic plaques significantly slows down the progression of cerebral atherosclerosis and reduces the incidence of acute transient disorders of cerebral circulation. Statins that normalize impaired endothelial function have the greatest hypocholesterinemic activity. They have a positive effect on the proliferation of smooth muscle cells of the arteries and have anti-inflammatory, anti-thrombogenic and anti-ischemic effect. Most often, patients are prescribed simvastatin and atorvastatin, with the most pronounced hypotriglyceridemic effect.

The use of bile acid sequestrants, used in combination with statins to further reduce cholesterol levels, is shown as additional drugs.

The first hypolipidemic drug, nicotinic acid, capable of reducing the level of LDL, has a number of side effects, is less effective and has a higher toxicity.

More effective hypothriglyceridemic drugs are fibric acid derivatives (fibrates). As a rule, they are used as a means of combination therapy. Undesirable side effects include increasing the concentration of bile and the risk of developing gallstone disease.

Antihypertensive therapy

Of considerable importance in the prevention and stabilization of manifestations of cerebrovascular insufficiency is given to maintaining adequate blood pressure (at the level of 140/80 mm Hg. Art.). In the treatment of cerebral atherosclerosis, angiotensin receptor antagonists (angiocand, valsortan, ibertan, etc.) and angiotensin-converting enzyme inhibitors (enalapril, cilazapril, captopril, etc.) are used as antihypertensive drugs. When taking drugs in this group, in addition to normalizing blood pressure, improved cognitive functions of the brain.

Antioxidant Therapy

As the pathological process progresses, a decrease in plasma antioxidant properties is noted. Therefore, in the treatment of cerebral atherosclerosis, patients are prescribed vitamin E, ascorbic acid, iodine preparations, actovegin, ethyl methyl hydroxypyridine succinate.

Combined drugs

This group includes drugs that normalize the venous outflow, blood rheology and microcirculation. The most common medicines include ginkgo biloba leaf extract, dihydroergocriptine, cavinton, piracetam, and cinnarizine.

Symptomatic therapy

As drugs for the symptomatic treatment of cerebral atherosclerosis, antidepressants (amitriptyline), psychotropic drugs (halopyridol) and tranquilizers (diazepam, phenazepam) are used. With the development of vascular dementia syndrome, patients are recommended to take cholinesterase inhibitors that affect the metabolism of the neurotransmitter systems of the brain.

Surgical treatment of cerebral arteriosclerosis

Patients with hemodynamically significant occlusive-stenotic lesion of the main arteries of the brain are recommended surgery (arterial stenting, percutaneous transluminal angioplasty, bypass surgery and vascular prosthetics, carotid endarterectomy). Most often, the internal carotid arteries undergo surgical correction. The indication for the operation is the presence of a loose atherosclerotic plaque or overlapping of more than 70% of the vessel lumen.

Non-drug treatment

Non-drug methods of exposure include special therapeutic exercises, adequate physical and intellectual stress, rational psychotherapy and adequate participation of the patient in social life.

Complications of cerebral atherosclerosis

  • Dyscirculatory encephalopathy, accompanied by inability to prolonged exertion, mood swings and meteorolability;
  • Psychopathic personality changes;
  • Epileptic seizures;
  • Brain (ischemic) stroke.

Diet for cerebral atherosclerosis

In atherosclerosis of cerebral vessels it is recommended to minimize the consumption of fatty, meat and dairy foods, salt, smoked meat, eggs, chocolate, cocoa, strong coffee and tea. К противопоказанным продуктам относят крепкие мясные, грибные и рыбные бульоны, субпродукты, жирные и соленые сыры, консервы, жирные сорта рыб, рыбью икру, кремовые изделия, сдобную выпечку, острые и соленые закуски, а также щавель, шпинат, редьку и редис.

В дневной рацион пациента должны входить овощи (лук, чеснок, картофель, капуста, морковь, бобовые, баклажаны), зелень, ягоды и фрукты, растительное масло (подсолнечное, оливковое, соевое, кукурузное), морепродукты и нежирное мясо птицы, мед (при сахарном диабете не более чайной ложки), простокваша, кефир, нежирный творог, пшеничные отруби, грецкие орехи (1-2 шт. в сутки), морская капуста.

Пищу предпочтительнее отваривать или готовить на пару. Для предотвращения сгущения крови следует сбалансировать питьевой режим (до 1,5 литров воды в сутки). Калорийность суточного рациона должна составлять 2000-2500 калорий.

Дополнительные рекомендации для пациентов, страдающих нарушением мозгового кровообращения

Для предотвращения развития церебрального атеросклероза следует неукоснительно соблюдать врачебные рекомендации, включающие в себя:

  • постоянный и курсовой прием лекарственных препаратов;
  • отказ от курения и потребления алкогольных напитков;
  • регулярный контроль веса и артериального давления;
  • соблюдение низкокалорийной диеты;
  • потребление в пищу продуктов, богатых витаминами;
  • выполнение специальных оздоровительных упражнений;
  • ежедневные прогулки на свежем воздухе.

Patients suffering from impaired memory are advised to make an action plan for the day, as well as record all the necessary information and maintain intellectual activity (listen to music and radio programs of interest, read, watch TV, memorize poems, communicate with relatives and friends). It is necessary for such patients to maintain an independent lifestyle for as long as possible, to carry out feasible household chores and to maintain physical activity. To avoid a fall, use additional means of support and take precautions (take a shower in a sitting position, wear comfortable non-slip shoes, use special handles and handrails in the bathroom and in the toilet, etc.).

Forecasts

Cerebral atherosclerosis is a chronic pathology characterized by a very long course. Active treatment in the early stages of the disease leads to an improvement in the patient’s condition and delayed development of the pathological process. In acute disorders of cerebral circulation and extensive damage to the brain tissue, the prognosis is extremely unfavorable.


| June 14, 2015 | | 1 171 | Cardiology
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