Atherosclerosis of cerebral vessels: symptoms and treatment
- The mechanism of development of cerebral artery atherosclerosis
- Risk Factors and Causes of Cerebral Atherosclerosis
- Types of cerebral artery atherosclerosis
- Stages of development of cerebral atherosclerosis
- Symptoms of cerebral artery atherosclerosis
- Diagnosis of cerebral atherosclerosis
- Treatment of cerebral artery atherosclerosis
- Complications of cerebral arteriosclerosis
- Diet for atherosclerosis of cerebral vessels
- Additional recommendations for patients
Today, cerebral atherosclerosis of the cerebral arteries is one of the key factors of cerebral circulation disturbance, which takes the leading place among the causes of death and disability of 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, discirculatory encephalopathy and vascular dementia (senile dementia).
The mechanism of development of cerebral artery atherosclerosis
Atherosclerosis in Greek means solid, dense gruel (ἀθέρος - chaff, pulp, σκληρός - solid, solid). This is a chronic disease of large arteries, accompanied by lipid infiltration of the internal 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).
To date, along with the generally accepted theory of lipoprotein filtration (the accumulation of fat molecules in the vessel wall), there are other hypotheses of the pathogenesis of cerebral atherosclerosis: a primary disruption of the protective properties of the internal epithelium of the vessel, lipid peroxidation, a deficiency of essential polyene fatty acids, the presence of thrombotic, haemostatic and inflammatory factors .
At an early stage of the pathological process associated with a violation of lipid metabolism, cholesterol (a water insoluble compound that is the basis of an atherosclerotic plaque) begins to accumulate on the surface of a previously damaged vascular wall. Gradually, calcium salts and filaments of unformed connective tissue are deposited on this cluster, and the surface of the atherosclerotic plaque begins to acquire an irregular convex shape.
Narrowing the lumen of the vessel, the cholesteric "outgrowth" makes it difficult to pass the blood and creates prerequisites for the appearance of turbulent turbulence of the blood stream. This leads to the destruction of blood cells (platelets and leukocytes) and the gradual formation of a thrombus, which, under conditions unfavorable for the body, can come off and clog the cerebral artery. At the same time, it can provoke an acute disruption in the blood circulation in the vessels of the brain and lead to obliteration, which can be torn off by the cholesterol plaque (softened with cholesterol esters or simply not hardened).
Risk Factors and Causes of Cerebral Atherosclerosis
The main reason for the development of the pathological process is the violation of lipid metabolism, leading to the deposition of lipoproteins on the walls of blood vessels. This state can be provoked both exogenous (external) and endogenous (internal) factors.
Unchanged (unmodified) risk factors
- Age (the older the person, the higher the likelihood of developing atherosclerosis);
- Sex (cerebral atherosclerosis is more often detected in men due to insufficient production of estrogen, helping to break down fats);
- Hereditary predisposition.
Variable (modifiable) factors
- Disturbance of fat metabolism (primary and secondary hypercholesterolemia, high content of low density cholesterol, low level of high density cholesterol, elevated plasma levels of triglycerides);
- Arterial hypertension;
- Metabolic syndrome;
- Overweight, obesity;
- Alcohol abuse;
- Hypodinamia (sedentary lifestyle);
- Violation of carbohydrate metabolism (diabetes mellitus);
- Irrational nutrition with predominance in the diet of animal fats;
- Renal failure;
- Chronic inflammatory processes;
- Hyperfibrinogenemia (increased blood coagulability);
- High levels of homocysteine in the blood;
- Psycho-emotional overstrain, frequent stressful and conflict situations.
Types of cerebral artery atherosclerosis
- Inflammatory (tubercular, syphilitic);
- Hyalinosis (cerebral atherosclerosis, developing against the background of hypertension);
- Mediacalcinosis of Menkeberg (primary deposition of calcium salts in the middle shell of arteries).
Stages of development of cerebral atherosclerosis
- The initial stage (the formation of lipid spots and strips). These formations are yellowish or yellow-gray areas that do not rise above the surface of the vessels, prone to fusion.
- Stage of progression (formation of fibrous plaques). Dense-elastic lesions, towering above the surface of the intima, are round or oval "growths" of white or yellowish color. As a rule, they merge, sharply narrowing the vascular lumen and giving the internal surface of the artery a tuberous appearance (the so-called stenosing atherosclerosis).
- The stage of atheromatosis (the formation of a deferred atherosclerotic plaque with characteristic ulceration, hemorrhage and the imposition of thrombotic masses). At this stage, due to the breakdown of complex labile fat-protein complexes, a fine-grained tissue detritus (a pathological mass consisting of fat accumulations, cholesterol crystals, degenerated epithelial cells and connective tissue fibers) is formed in the thickness of the plaque.
- The final stage (atherocalcinosis). Characterized by calcification (petrification) of fibrous plaques and severe deformation of the vessels.
Symptoms of cerebral artery atherosclerosis
At the initial (ischemic) stage of the disease, patients complain of impaired concentration and dull, aching headaches that result from arterial narrowing of the atherosclerotic plaque, stagnation of blood and insufficient supply of brain oxygen. At an early stage, pain occurs after a mental load, but over time they acquire a permanent character. Some patients become quick-tempered, aggressive, there is a tendency to hysterics and depression. Often, after a good rest, negative symptoms pass, not reflecting on the performance of a person.
For the thrombonekrotic stage of severe clinical manifestations of cerebral atherosclerosis, slow progression of symptoms is characteristic. In this period, headaches become more pronounced and prolonged, memory gradually deteriorates, sleep and disability are disrupted, thinking is slowed, noise in the ears arises, and excessive fussiness is noted. Patients complain of dizziness, fainting, the emergence of difficulties with the memorization of current events (while remote memory remains safe), the development of violations of fine motor skills, a sense of disturbed balance and instability in the legs. Periodic occurrences of cerebral crises (transient ischemic attacks) characterized by severe headaches, violation of visual and speech functions, paresis of the lower half of the face, fainting or disappearance of sensitivity in the limbs, hemiparesis (paralysis of one side of the body) are typical for this stage of the disease. Typically, this symptomatology is observed for 24-48 hours, after which the patient's condition is gradually restored. In this situation, it is a transient disorder of cerebral circulation.
If after two days the patient does not become lighter, there is a suspicion of acute cerebrovascular accident (ischemic stroke) requiring urgent medical attention.
The final (sclerotic) stage of cerebral artery atherosclerosis, 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 efficiency, the degradation of professional skills, the loss of landmarks in time and space, inability to control their needs. The patient forgets the acquired skills, in connection with which he needs constant help in everyday life. With the progression of dementia, complete degradation of the personality and disadaptation to the surrounding environment are noted, a wolfish 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 history of the patient, the patient's complaints, the clinical picture of the disease and the results of the diagnostic examination, which include:
Laboratory diagnostic methods
- Immunological analysis of blood;
- Biochemical blood test (determination of triglycerides, cholesterol, HDL, LDL).
Instrumental diagnostic methods
- Ultrasound scanning of cerebral vessels;
- Magnetic resonance imaging;
- Transcranial dopplerography (assessment of the blood flow of intracranial vessels);
- Angiography (contrast radiography of the blood vessels of the brain)
Treatment of cerebral artery atherosclerosis
Treatment of cerebrovascular atherosclerosis is carried out in a complex that includes pathogenetic and symptomatic therapeutic techniques and correction of behavioral risk factors. Patients suffering from cerebral atherosclerosis, it is strongly recommended to radically revise their diet, maintain blood pressure at normal levels, and monitor the level of cholesterol and glucose in the blood. It is mandatory to abandon bad habits (smoking and consumption of alcoholic beverages), normalize weight, minimize neuropsychic stress, regulate the mode of work and rest, and ensure regular adequate physical activity.
Medical treatment of cerebral atherosclerosis is aimed at improving blood supply to cerebral vessels, normalization of lipid metabolism and rheological parameters of blood, reduction of atherosclerotic plaques, slowing down the development of pathological process and correction of concomitant diseases.
Medical optimization of blood circulation
To correct the disorders occurring in the microcirculatory bed, patients are recommended to take vasoactive drugs that affect the vascular circulation. This group of drugs includes calcium channel blockers (nimodipine, cinnarizine, flunarizine), phosphodiesterase inhibitors (pentoxifylline, theophylline, vinpocetine) and α-adrenoblockers (nitroglycerin). The drug of multidirectional action, Tanakan, improving microcirculation and stimulating neuronal metabolic mechanisms has proved to be quite good.
Antiplatelet (antiaggregate) therapy
Antithrombocyte therapy is a pathogenetically grounded method of treatment aimed at correction and prevention of atherothrombosis. At present, 3 groups of antiplatelet drugs are used in clinical practice: agents 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, suppresses the formation of thrombin and has an inhibitory effect on the formation of fibrin.
When taking aspirin in combination with another antiplatelet agent, clopidogrel, characterized by an alternative mechanism of platelet suppression, the effectiveness of treatment increases significantly, and many problems associated with the resistance of patients to aspirin.
The use of gipoltypidemic drugs stabilizing the structure of atherosclerotic plaques significantly slows the progression of cerebral atherosclerosis and reduces the frequency of acute transient disorders of cerebral circulation. The greatest hypocholesterolemic activity is possessed by statins, which normalize the disturbed function of the endothelium. They have a positive effect on the proliferation of smooth muscle cells of the arteries and have anti-inflammatory, antithrombogenic and antiischemic effects. Most often, patients are prescribed simvastatin and atorvastatin, with the most pronounced hypotriglyceridemic action.
As additional preparations, the use of bile acid sequestrants used in combination with statins to further lower cholesterol is indicated.
The first lipid-lowering drug, nicotinic acid, capable of lowering LDL, has a number of side effects, is less effective and has a higher toxicity.
More effective hypotriglyceridemic drugs are derivatives of fibrin acid (fibrates). As a rule, they are used as a combination therapy. To undesirable side effects include increased bile concentration and the risk of developing cholelithiasis.
An important role in the prevention and stabilization of manifestations of cerebral circulatory insufficiency is paid to maintaining adequate blood pressure (at the level of 140/80 mm Hg). In the treatment of cerebral atherosclerosis, antagonists of angiotensin receptors (angiocand, valsortan, ibertan, etc.) and angiotensin-converting enzyme inhibitors (enalapril, cilazapril, captopril, etc.) are used as antihypertensive medications. When taking drugs of this group, in addition to normalizing blood pressure, the cognitive functions of the brain improve.
As the pathological process progresses, the antioxidant properties of the plasma decrease. Therefore, in the treatment of cerebral artery atherosclerosis, patients are prescribed vitamin E, ascorbic acid, iodine preparations, actovegin, ethyl methylhydroxypyridine succinate.
Combined action drugs
This group includes drugs that normalize venous outflow, rheological properties of blood and microcirculation. The most common medicinal products include the extract of ginkgo biloba leaves, dihydroergocryptin, cavinton, pyracetam and cinnarizine.
Antidepressants (amitriptyline), psychotropic drugs (halopyridol) and tranquilizers (diazepam, phenazepam) are used as medications for the symptomatic treatment of cerebral arteriosclerosis. With the development of the syndrome of vascular dementia, patients are recommended to take cholinesterase inhibitors that affect the exchange of neurotransmitter systems of the brain.
Surgical treatment of atherosclerosis of cerebral vessels
Patients with a hemodynamically significant occlusal-stenosing lesion of the main arteries of the brain are recommended surgical intervention (stenting of the arteries, percutaneous transluminal angioplasty, shunting and vascular prosthetics, carotid endarterectomy). The most common surgical correction is internal carotid artery. Indication for the operation is the presence of loose atherosclerotic plaque or the overlap of more than 70% of the lumen of the vessel.
Complications of cerebral arteriosclerosis
- Dyscirculatory encephalopathy, accompanied by inability to prolonged loads, mood swings and meteorolability;
- Psychopathic personality changes;
- Epileptic seizures;
- Brain (ischemic) stroke.
Diet for atherosclerosis of cerebral vessels
With atherosclerosis of cerebral vessels it is recommended to minimize the consumption of fatty, meat and milk dishes, salt, smoked products, eggs, chocolate, cocoa, strong coffee and tea. Contraindicated products include strong meat, mushroom and fish broths, by-products, fatty and salty cheeses, canned food, fatty fish, caviar, cream products, baked pastries, spicy and salty snacks, and sorrel, spinach, radish and radish.
The daily diet should include vegetables (onions, garlic, potatoes, cabbage, carrots, legumes, eggplants), herbs, berries and fruits, vegetable oil (sunflower, olive, soybean, corn), seafood and lean poultry meat, honey Diabetes mellitus is not more than a teaspoon), yogurt, kefir, low-fat cottage cheese, wheat bran, walnuts (1-2 pcs per day), sea kale.
Additional recommendations for patients suffering from cerebrovascular accident
To prevent the development of cerebral atherosclerosis, medical recommendations should be strictly observed, including:
- Constant and course medication;
- Refusal from smoking and consumption of alcoholic beverages;
- Regular monitoring of weight and blood pressure;
- Adherence to a low-calorie diet;
- Consumption of foods rich in vitamins;
- Performance of special health improvement exercises;
- Daily walks in the fresh air.
Patients with memory impairment are recommended to make a plan of activities for the day, and also record all necessary information and support intellectual activity (listen to music and interesting broadcasts, read, watch television, memorize poems, and communicate with relatives and friends). Such patients need as long as possible to lead an independent way of life, to perform feasible work around the house and keep the motor activity. To avoid falling, use additional supports and follow 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.).
Cerebral atherosclerosis is a chronic pathology, which is 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 a delay in the development of the pathological process. With acute disorders of cerebral circulation and extensive damage to brain tissue, the prognosis is extremely unfavorable.