Treatment for insufficient blood supply to the brain. Cerebrovascular accident. Why do cerebrovascular accidents develop?

If the heart is compared to a motor, then the brain can be compared to a control center - it is there and from there that impulses go for all the systems on which the functioning of the body depends.

Symptoms of poor blood circulation in the brain can be pronounced and almost imperceptible, but as soon as they appear, disruptions begin to occur in the body. Even if vascular diseases have not been recorded during life, age-related changes occur to everyone.

What changes are observed if all signs point to poor blood circulation in the body's control center?

Causes of cerebrovascular accidents

Cerebral circulation disorders are provoked by the following factors:

1. One of the main reasons is atherosclerosis. In the body, due to poor nutrition and slow metabolism, cholesterol plaques are deposited on the walls of blood vessels.
2. Stressful situations.
3. Arterial hypertension.
4. Violation of blood rheology.
5. Infectious diseases accompanied by vasculitis, which leads to increased vascular permeability or blockage.
6. Intoxications of various types: household and industrial.
7. Skull injuries of varying severity.
8. Scoliosis and osteochondrosis, mainly of the cervical spine, as well as anomalies of its development.
9. A disorder in the functioning of the body's main systems causes chronic fatigue syndrome.
10. Increased chronic stress and uncomfortable postures.

Types of cerebral circulatory disorders and its symptoms

There are 2 types of cerebrovascular accidents:

Type one - acute disorder. During it, two types of strokes occur - hemorrhagic and ischemic.

Hemorrhagic stroke is caused by hemorrhage that occurs when a blood vessel ruptures. A provocative factor may be a rupture of the vascular wall due to its thinning, a change in the composition of the blood, or the penetration of blood elements through the vascular wall due to its pathology.

Ischemic strokes are:

1. transient type, the vessel is not completely blocked;
2. thrombosis - the lumen of the vessel is blocked by a thrombus, which leads to hypoxia of the brain area, up to necrosis.

If signs of poor cerebral circulation have developed over the years, then the process can be diagnosed as chronic. The changes progressed and became irreversible. This condition is diagnosed as encephalopathy or chronic cerebral circulatory failure.

Symptoms of poor blood circulation to the brain

All types of cerebrovascular accidents have their own clinical characteristics. The diagnosis is made based on complaints, characteristic symptoms and examination results.

Symptoms may include the following:

• Headaches that occur systematically, crawling sensations on the scalp and limbs, tingling in the fingertips.
• Pain in the eyes when moving the eyeballs, increasing towards the end of the day.
• Frequent dizziness, periodic nausea and vomiting, not associated with eating disorders.
• Ringing in the ears, congestion.
• Frequent disturbances of consciousness of varying intensity, changes in perception.
• Decreased function of the organs of hearing and vision.
• Poor blood circulation in the extremities, varicose veins.
• Cortical disorders of the nervous system: speech disorder, impaired logical thinking, loss of the ability to form letters into words.
• Epileptic seizures.

If the patient is in acute condition, first aid must be provided within a few minutes after the onset of the disease. You can only do indirect cardiac massage in combination with artificial respiration on your own. But even when a medical resuscitation team is called, death occurs in 30% of victims. With hemorrhagic stroke, mortality increases to 45%.

Therapy for cerebrovascular accidents

In acute cases, it is possible to treat the consequences of poor blood circulation in the brain only in intensive care units of a hospital. Therapy is aimed at maintaining vital functions.

Respiratory functions are restored, efforts are made to reduce intracranial hypertension and normalize blood pressure.

If thrombosis affects the limbs, then elimination of the blood clot is carried out simultaneously with the treatment of strokes.

The recovery period takes a long time, and if the symptoms of thrombosis of the lower extremities are neglected, a gangrenous process may begin. Therapeutic measures eliminate the cause that caused the cerebral circulation disorder and gradually restore lost functions.

What to do if poor blood circulation is diagnosed in a chronic form.

Prescribed drugs that improve blood flow, thin the blood, and normalize blood pressure. Normalization of cholesterol in the blood is achieved by changing the diet and prescribing medications that help dissolve lipids.

Preventive measures for vascular disorders of the brain

To prevent the occurrence of strokes and a decrease in life skills, a significant deterioration in the quality of life, it is necessary:

• eat rationally and properly, avoid obesity;
• to refuse from bad habits;
• control blood pressure;
• move actively, taking into account your health status and your own capabilities;
• monitor blood sugar levels and the content of lipoproteins and triglycerides.

It is imperative to treat diseases associated with damage to the cardiovascular system.

Modern life moves at such a crazy pace that an ordinary person has to speed up his actions more and more, sleep less, work seven days a week, and stress has long become an integral part of our existence.

And in this rush, we sometimes have no time to look back and listen to the complaints of loved ones about poor health or to think about our own.

Therefore, is it any wonder that today the mortality rate associated with damage to the blood vessels of the brain has increased significantly, and it is already diagnosed in those who are not even 40 years old.

In order not to fall into this avalanche, which is taking over more and more lives, let’s try to understand what cerebral circulation is and what causes and mechanisms cause its disruption. This will give us the opportunity to take protective measures.

What is cerebral circulation?

So, the blood circulation that occurs in the vascular system of the spinal cord and brain is called cerebral circulation (CB).

The vessels of the brain themselves have such a unique and impeccable structure that it allows for constant blood circulation and excellent regulation of blood flow.

For example, if mental activity increases, the amount of blood that circulates in the brain does not change. This is achieved due to good redistribution of blood flow.

Blood is sent to areas with intense brain activity from areas of the brain that experience less stress.

If the brain is not filled with enough blood, this ideal form of blood supply to the brain begins to fail.

Causes of cerebrovascular accidents

Causes of cerebrovascular accidents can be:

• arterial hypertension;
• atherosclerosis;
• degenerative disorders of the cervical spine;
• physical strain and stress;
• changes in heart valves;
• rheumatic heart disease;
• diseases of the heart and blood vessels.

Also, cerebrovascular accident may be caused by:

• radiation sickness;
• complicated migraine;
• brain bleeding;
• and other factors.

Let us consider in more detail the factors causing MC disorders.

Arterial hypertension

So, hypertension, or more correctly, arterial hypertension.

This disease is characterized by sudden changes in blood pressure throughout the day. It can be either excessively low or high.

Therefore, modifications occur in the walls of small vessels that nourish the deep parts of the brain. All this leads to gradual narrowing of blood vessels, and sometimes to their closure.

In the event of another jump in high blood pressure, a vessel may rupture. As a result, blood penetrates into the brain matter - an intracerebral hematoma (bleeding into the brain) occurs.

The next factor is vascular atherosclerosis. As the disease progresses, cholesterol plaques clog the blood vessels. Controlling blood cholesterol levels in this case is very important.

Where there is narrowing and obstruction of blood flow, platelets gradually accumulate, then blood clots form. When a blood clot breaks off, it can block a blood vessel in the brain. This causes a violation of MC.

Changes in the cervical spine

As for changes in the cervical spine, diseases such as osteochondrosis and scoliosis are quite well known. But not everyone understands how serious the consequences of such diseases can be.

Since the functioning of the human body largely depends on changes in the spine, diseases of the cervical spine can eventually lead to disruption of the cervical spine.

You should not brush aside such problems as excessive physical activity or excessive tension in the muscles of the neck and back, especially when you have a sedentary job - they can also cause a violation of the MC.

Against the backdrop of stressful situations, especially if they are often repeated, an unexpected increase in blood pressure is quite a serious reason for a violation of the blood flow.

Also, one of the possible causes of cerebral circulatory disorders is the presence of traumatic brain injury, which may result in intracranial hemorrhage.

The extent of the disturbance in the circulatory process in the vessels of the brain depends on its extent.

Types of violations

Disorders of blood flow in the brain can be acute or chronic.

Acute) – begins unexpectedly and is accompanied by a long course of the disease. It is characterized by a persistent disorder of brain activity and the presence of two varieties:

• ischemic disorder (so-called cerebral infarction);
• hemorrhagic (bleeding in the brain).

Atherosclerosis very often serves as a reason for the development of ischemic circulatory disorders. It occurs during times of intense physical activity or stress and severe anxiety.

Accompanies the pre-infarction state or the myocardial infarction itself. As a rule, it occurs at night when a person is sleeping or immediately after waking up.

The development of hemorrhagic disorders of blood flow, or hemorrhages as they also say, can be facilitated by the presence of vascular aneurysms, congenital angiomas, and various arterial hypertension.

Cerebrovascular accident chronic type, or - represents insufficient blood circulation in the brain.

It, slowly progressing, leads to the formation of a mass of small-focal necrosis of brain tissue and disruption of brain functions. Over time, the disease intensifies both quantitatively and qualitatively.

There are violations two types: associated with atherosclerosis and hypertensive origin.

Symptoms and signs

What are the symptoms and signs of cerebrovascular accident?

Signs of acute disorder

Acute cerebrovascular accident has symptoms such as transient ischemic attacks and hypertensive cerebral crises.

As for transient ischemic attacks, symptoms occur unexpectedly and increase gradually. They are expressed:

• difficulty speaking;
• in violation of movement coordination;
• weakness and numbness of the limbs.

In case of hypertensive cerebral crises, occurs:

Chronic disorder

Chronic urinary function disorder differs from acute forms in its gradual development. There are three stages to this diseases:

1. On the first— the symptoms are not pronounced, the patient complains of fatigue, frequent dizziness, headache, restless sleep, increased mood swings, absent-mindedness, and forgetfulness.
2. Second phase is accompanied by some changes in gait, unsteadiness appears in movement, memory deterioration progresses, insufficient concentration of attention and perception of information is added to this, drowsiness, irritability, and decreased performance are further enhanced.
3. Third stage represents a noticeable impairment of the motor functions of the arms and legs, a striking impairment of speech and memory, and severe dementia.

Diagnostics

The threat of MC disruption is that if treatment is not carried out in the early stages, the main elements of the brain structure - neurons - die, and they cannot be revived. Therefore, it is necessary to carry out diagnostics in the early stages of the disease.

This includes making a diagnosis based on from:

• patient complaints;
• a set of blood tests: glucose, lipid spectrum, general blood test, coagulogram and others;
• examination by an ophthalmologist and diagnostics of the fundus;
• data on the detection of diseases such as atherosclerosis, diabetes mellitus, blood diseases, and hypertension in the early stages or those that have already existed for a long time;
• data obtained through testing on a special neuropsychological examination;
• data from a special scan that allows you to determine the presence of cerebral vascular lesions;
• and, if necessary, data from the examination performed using magnetic resonance imaging.

A severe result of acute and, in many cases, chronic disturbances of the circulatory system is disability. 20% of acute MV disorders end in death.

Video: Cerebrovascular accident

An educational video about how blood circulation occurs in the brain. What happens if cerebral circulation is impaired?

Cerebrovascular accident is a pathological process that leads to obstructed blood circulation through the vessels of the brain. Such a violation is fraught with serious consequences, death is no exception. An acute process can become chronic. In this case, the risk of developing, and, increases significantly. All these pathologies lead to death.

If such a pathological process is present, you should urgently consult a doctor; treatment with folk remedies or medications at your own discretion is impossible.

Etiology

Poor blood circulation in the brain can be triggered by almost any pathological process, trauma, and even severe. Clinicians identify the following most common causes of cerebrovascular accidents:

• genetic predisposition;
• head injuries;
• previous serious illnesses affecting the brain, central nervous system and nearby organs;
• increased emotional excitability;
• frequent changes in blood pressure;
• pathologies of blood vessels and blood;
• alcohol and nicotine abuse, drug use;

In addition, clinicians note that acute cerebrovascular accident may be due to age. In this case, people aged 50 years and older are at risk.

You need to understand that this disorder can be caused by frequent stress, severe nervous strain, and the body.

Classification

In international medical practice, the following classification of cerebral circulatory disorders is accepted:

• acute form;
• chronic form.

Chronic pathologies include the following subtypes:

• initial manifestations of insufficiency of blood supply to the brain;
• encephalopathy.

The last subform is divided into the following subtypes:

• hypertensive;
• atherosclerotic;
• mixed.

Acute cerebrovascular accidents (ACVA) are divided into the following subtypes:

• transient cerebrovascular accident (TCI);
• acute hypertensive encephalopathy;
• stroke.

Any of these forms is life-threatening, and at any time can provoke not only a serious complication, but also cause death.

In the chronic form, stages of development are also distinguished:

• The first is that the symptoms are vague. The person's condition indicates more;
• second – significant memory deterioration, social adaptation is lost;
• the third is almost complete personality degradation, dementia, and impaired coordination of movements.

At the third stage of development of circulatory disorders, we can talk about an irreversible pathological process. However, the patient's age and general history should be taken into account. It is inappropriate to talk about complete restoration.

Classification according to morphological changes is also used:

• focal;
• diffuse.

Focal lesions include the following:

• subarachnoid hemorrhages.

Diffuse morphological changes include the following pathological processes:

• small cystic neoplasms;
• minor hemorrhages;
• scar changes;
• the formation of small necrotic foci.

It should be understood that the disorder of any form of this pathological process can lead to death, so treatment must be started urgently.

Symptoms

Each form and stage of development has its own signs of cerebrovascular accident. The general clinical picture includes the following symptoms:

• , for no apparent reason;
• which rarely ends;
• decreased visual and hearing acuity;
• impaired coordination of movements.

Transient cerebrovascular accidents are characterized by the following additional symptoms:

• numbness of the half of the body, which is opposite to the focus of the pathology;
• weakness of arms and legs;
• speech disorder – the patient has difficulty pronouncing individual words or sounds;
• photopsia syndrome - the visibility of luminous dots, dark spots, colored circles and similar visual hallucinations;
• stuffy ears;
• increased sweating.

Since there are symptoms such as speech impairment and weakness in the limbs, the clinical picture is often confused with a stroke. It should be noted that in the case of PNMK, acute symptoms disappear within a day, which is not the case with a stroke.

In the first stage of the chronic form, the following symptoms of cerebrovascular accident may be observed:

• frequent headaches;
• drowsiness;
• – a person feels tired even after a long rest;
• harsh, hot temper;
• absent-mindedness;
• memory impairment, which manifests itself in frequent forgetfulness.

When moving to the second stage of development of the pathological process, the following may be observed:

• slight impairment of motor function, a person’s gait may be unsteady, as if intoxicated;
• concentration deteriorates, the patient finds it difficult to perceive information;
• frequent mood changes;
• irritability, attacks of aggression;
• almost constantly dizzy;
• low social adaptation;
• drowsiness;
• performance practically disappears.

The third stage of chronic cerebrovascular accident has the following symptoms:

• dementia;
• stiffness of movements;
• speech disorder;
• almost complete loss of memory;
• a person is unable to remember information.

At this stage of development of the pathological process, symptoms of almost complete degradation are observed; a person is not able to exist without outside help. In this case, we can talk about an irreversible pathological process. This is due to the fact that brain neurons begin to die already at the initial stages, which entails serious consequences if this process is not stopped in a timely manner.

Diagnostics

You cannot independently compare the symptoms and take treatment at your own discretion, since in this case there is a high risk of developing complications, including life-threatening ones. At the first symptoms, you should immediately seek emergency medical help.

To clarify the etiology and make an accurate diagnosis, the doctor prescribes the following laboratory and instrumental examination methods, if the patient’s condition allows them:

• general blood analysis;
• lipid profile;
• blood sampling for glucose testing;
• coagulogram;
• duplex scanning to identify affected vessels;
• neuropsychological testing using the MMSE scale;
• MRI of the head;

In some cases, the diagnostic program may include genetic studies if a hereditary factor is suspected.

Only a doctor can tell how to treat this disorder, after an accurate diagnosis and identification of the etiology.

Treatment

Treatment will depend on the underlying cause - depending on this, basic therapy is selected. In general, drug therapy may include the following drugs:

• sedatives;
• neuroprotectors;
• multivitamins;
• venotonics;
• vasodilators;
• antioxidants.

All drug therapy, regardless of etiology, is aimed at protecting brain neurons from damage. All funds are selected only individually. During drug therapy, the patient should constantly monitor blood pressure, as there is a high risk of stroke and heart attack.

Cerebrovascular accidents usually develop against the background of vascular diseases, mainly atherosclerosis and high blood pressure.

Atherosclerotic cerebrovascular accidents

Symptoms The clinical picture of atherosclerotic disorders is expressed by decreased performance, headaches, sleep disturbances, dizziness, noise in the head, irritability, paradoxical emotions (“joy with tears in the eyes”), hearing impairment, decreased memory, unpleasant sensations (“crawling goosebumps”) skin, decreased attention. Asthenodepressive or asthenohypochondriacal syndrome may also develop.

Cerebrovascular accident in hypertension

Symptoms With hypertension, stagnant foci of excitation may appear in the cerebral cortex, which spread to the hypothalamic region, which leads to disruption of the regulation of vascular tone (hypogalamic-endocrine system of the kidney or hypogalamic-pituitary-adrenal system).

Next, compensatory reserves are depleted, the electrolyte balance is disrupted, the release of aldosterone increases, the activity of the sympathoadrenal system and the renin-angiotensin system increases, which leads to vascular hyperreactivity and an increase in blood pressure. The development of the disease leads to a change in the type of blood circulation: cardiac output decreases and peripheral vascular resistance increases.

Against the background of the above-described changes in the vessels, cerebrovascular accident develops. One of the clinical forms of cerebrovascular accident is the initial manifestations of insufficiency of blood supply to the brain. The diagnosis is made taking into account complaints of headache, dizziness, noise in the head, decreased memory and performance, and sleep disturbances. The combination of two or more of these complaints provides an opportunity and basis for making a diagnosis, especially when these complaints are often repeated and persist for a long time. There are no organic lesions of the nervous system. It is necessary to carry out treatment of the underlying vascular disease, rational employment, work and rest regime, nutrition, sanatorium treatment, especially aimed at increasing the physiological defenses of the body.

Acute cerebrovascular accident

This term combines all types of acute cerebrovascular accidents, which are accompanied by transient or persistent neurological symptoms.

Symptoms Acute cerebrovascular accident is characterized by the appearance of clinical symptoms from the nervous system against the background of existing vascular changes. The disease is characterized by an acute onset and is characterized by significant dynamics of general cerebral and local symptoms of brain damage. There are transient disorders of cerebral circulation, which are characterized by regression of neurological signs within 24 hours after their onset, and acute disorders with more persistent, sometimes irreversible neurological symptoms - strokes.

Strokes are divided into ischemic (cerebral infarction) and hemorrhagic - blood leaking into the surrounding tissues and soaking them. Conventionally, small strokes are distinguished, in which the disease is mild and neurological symptoms (motor, speech, etc.) disappear within 3 weeks.

Transient cerebrovascular accidents

Transient cerebrovascular accidents are most often observed with hypertension or atherosclerosis of cerebral vessels.

In hypertensive cerebral crises, the autoregulation of cerebral vessels is disrupted with phenomena of cerebral tissue edema and vascular spasms. In atherosclerotic transient ischemic attacks - transient ischemia - in the zone of an atheroscleretically altered vessel as a result of the influence of extracerebral factors and a decrease in blood pressure, the trigger is most often a weakening of cardiac activity, an unfavorable redistribution of blood, an impulse from a pathologically altered carotid sinus. Often transient disorders of cerebral circulation develop as a result of microembolism of cerebral vessels, which is typical for patients with myocardial infarction in the post-infarction period, atherosclerotic cardiosclerosis, heart defects, sclerotic lesions of the aorta and great vessels of the head, as well as changes in the physicochemical properties of blood (increased viscosity and coagulation) .

Stressful situations can provoke cerebrovascular accidents. The materials for embolism and thrombosis are cholesterol crystals, masses of disintegrating atherosclerotic plaques, pieces of blood clots, and platelet conglomerates.

General cerebral symptoms. The clinical picture of transient cerebrovascular accidents can manifest as both general cerebral and focal symptoms. General cerebral symptoms include headache, dizziness, pain in the eyeballs, which increases with eye movement, nausea, vomiting, noise and congestion in the ears. Changes in consciousness are possible: stupor, psychomotor agitation, loss of consciousness, and there may be a short-term loss of consciousness. Convulsive phenomena are observed less frequently.

General cerebral symptoms are especially characteristic of hypertensive cerebral crises. An increase in blood pressure is observed in combination with autonomic disorders (feelings of chills or heat, polyuria). Meningeal phenomena - tension in the neck muscles - may be observed. In hypotensive cerebral crises, blood pressure is reduced, the pulse is weakened, and cerebral symptoms are less pronounced.

Focal symptoms. Focal neurological symptoms may appear depending on their location. If there is a circulatory disorder in the cerebral hemispheres, then most often the sensitive area is disrupted in the form of paresthesia - numbness, tingling, often localized, involving individual areas of the skin, limbs or face. Areas of decreased pain sensitivity - hyposthesia - may be detected.

Along with sensory disorders, movement disorders—paralysis or paresis, often limited (of the hand, fingers, foot)—may occur; paresis of the lower part of the facial muscles and tongue muscles is also noted. The examination reveals changes in tendon and skin reflexes, and pathological reflexes (Babinsky reflex) can be caused. Transient speech disturbances, disturbances in body diagram, loss of visual fields, etc. may also develop.

Damage to the brain stem is characterized by dizziness, unsteadiness of gait, lack of coordination, double vision, twitching of the eyeballs when looking to the side, sensory disturbances in the face, tongue, fingertips, weakness in the limbs, and swallowing disorders may also occur.

Treatment. Treatment of transient cerebrovascular accidents of atherosclerotic origin, which are assumed to be based on cerebrovascular insufficiency, must be very careful. It is impossible to say in advance whether this violation will be transient or persistent.

The patient must be provided with mental and physical rest.

When cardiac activity is weakened, cardiotonic drugs are used (sulfocamphocaine, subcutaneous cordiamine, 0.25-1 ml of 0.06% corglycone solution). In case of a sharp drop in blood pressure, administer 1-2 ml of a 1% solution of mezatone subcutaneously or intramuscularly, caffeine subcutaneously, ephedrine 0.025 g three times a day orally.

To improve blood supply to the brain, in conditions of normal or high blood pressure, a solution of aminophylline is prescribed intravenously or intramuscularly (10 ml of a 2.4% solution of aminophylline per 10 ml of isotonic sodium chloride solution intravenously or 1-2 ml of a 24% solution of aminophylline intramuscularly).

Vasodilators are prescribed mainly for transient disorders of cerebral circulation, which is accompanied by an increase in blood pressure, use a 2% solution of papaverine - 1-2 ml intravenously, or no-shpu - 1-2 ml (administer slowly!)

It is advisable to prescribe intravenous drip administration of Cavinton (preferably in a hospital setting) 10-20 mg (1-2 ampoules) in 500 ml of isotonic sodium chloride solution, after which they switch to taking the tablet drug 0.005 three times a day.

Ischemic stroke

Symptoms Ischemic stroke, or, as it is also called, cerebral infarction, develops when cerebral blood flow is disrupted (decreased). The most common cause of cerebral infarction is atherosclerosis. It is preceded by physical or mental stress. Ischemic stroke is most often observed in people over 50 years of age, but nowadays it has become “younger”.

As a result of blockage of a vessel (thrombosis, embolism, spasm), cerebrovascular insufficiency occurs, which leads to disruption of the nutrition of brain tissue - a heart attack.

Ischemic stroke is most characterized by a gradual increase in neurological symptoms - from several hours to 2-3 days. Their degree of expression can “flicker”, then decreasing, then increasing again. Characteristic of a cerebral infarction is the prevalence of focal symptoms (numbness of the face, speech impairment, weakness in the limbs, dysfunction), but there may be no headache, nausea, or vomiting. Blood pressure is either normal or low. As a rule, the temperature is not elevated, the face is pale, the lips and nasolabial triangle are slightly cyanotic. The pulse is rapid, weak, and decreased in volume. Most often, such patients experienced heart pain, which indicates angina pectoris, or these patients suffered a myocardial infarction, were observed by a cardiologist with symptoms of coronary artery sclerosis and coronary heart disease. Heart rhythm disturbances are recorded.

Hemorrhagic stroke

Symptoms Hemorrhagic stroke is hemorrhage into the substance of the brain or under the arachnoid membrane of the brain, which can also be of a mixed nature (subarachnoid-parenchymal).

Hemorrhages into the brain substance are most often observed in people with hypertension and occur in the cerebral hemispheres, less often in the cerebellum and brain stem.

Cerebral hemorrhage usually develops suddenly, at a time of physical and emotional stress. The patient falls and loses consciousness, or his consciousness becomes confused. In the initial period of hemorrhagic stroke, psychomotor agitation and automated gestures in healthy limbs and vomiting may be observed. A severe headache occurs, and there may be meningeal symptoms, but their severity is moderate. Very typical for cerebral hemorrhage is the early appearance of pronounced autonomic disorders - redness or pallor of the face, sweating, increased body temperature. Blood pressure is most often elevated, the pulse is tense, breathing is impaired (can be hoarse, periodic, rapid, rare, of varying amplitudes). Along with general cerebral and autonomic disorders, cerebral hemorrhage causes severe focal symptoms, the peculiarity of which is determined by the localization of the lesion.

With hemispheric hemorrhages, hemiparesis or hemiplegia, hemigynesthesia (decreased pain sensitivity), and gaze paresis towards the paralyzed limbs occur.

If a cerebral hemorrhage is accompanied by a breakthrough of blood into the ventricles of the brain, then there is a threat of death in 70% of cases, since vital functions are disrupted. The patient is unconscious, muscles are tense, body temperature is elevated, cold sweat and trembling are characteristic. With such symptoms, the prognosis is disappointing; patients die in the first two days after a stroke.

All strokes must be treated in a hospital setting. If an acute cerebrovascular accident is suspected, the patient should be urgently hospitalized by ambulance to a neurological hospital.

Prevention. It is advisable to carry out for persons with manifestations of atherosclerosis, hypertension, as well as in old age. Antiplatelet agents are prescribed in maintenance doses: acetylsalicylic acid in small doses - 0.001 7 weight in the morning; prodexin or kuralenil; indirect anticoagulants (pelentin - 0.1-0.3 g 2-3 times a day or fimilin - 0.03, twice a day, simkupar 0.004 g 3 times a day). All these drugs must be prescribed with blood monitoring, and contraindications to their use must also be strictly taken into account (liver and kidney diseases, gastric and duodenal ulcers, hemorrhoidal and uterine bleeding, increased bleeding, etc.).

These drugs are discontinued gradually, reducing the dose and increasing the interval between doses.

ACUTE CEREBRAL CIRCULATION DISORDER

Acute cerebrovascular accident may be transient or persistent, with focal brain damage ( cerebral stroke).

Transient acute cerebrovascular accident

Symptoms transient vascular cerebral disorders are observed within a few minutes, hours or recorded within a day.

Reason These disorders may include hypertensive crisis, cerebral vasospasm, atherosclerosis of cerebral vessels, heart failure, arrhythmias, collapse.

General cerebral symptoms when transient cerebrovascular accidents occur, headaches, dizziness, nausea, vomiting, stupor, disorientation, and sometimes short-term loss of consciousness occur.

Focal symptoms is expressed in the occurrence of transient paresthesia, paresis, aphasic disorders, visual disturbances, paresis of individual cranial nerves, and impaired coordination of movements.

Intensive therapy transient vascular cerebral disorders consists of stopping a hypertensive crisis, arrhythmia, if they were the cause of a secondary ischemic state of the brain.

It is possible to use drugs that improve cerebral arterial blood flow (aminophylline, trental, nootropil, etc.). Hospitalization of patients with transient cerebrovascular accidents is recommended in cases of threat of cerebral stroke, i.e. in the event that focal symptoms last more than 24 hours and the treatment measures taken are ineffective.

Intensive therapy in these cases is as follows:

Decreased blood pressure; Injections of magnesium 25% 10 ml IM or IV, papaverine 2% 2 ml, dibazol 1% 3.0 IV or IM, no-shpa 2% 2 ml IM are prescribed. The drugs of choice are clonidine 0.01% 1 ml IM or IV, droperidol 2 ml, Lasix 1% 4 ml;

Improvement of cerebral blood flow, microcirculation. For this purpose, rheopolyglucin is used intravenously;

Reducing increased blood clotting and red blood cell disaggregation. Aspirin and other anticoagulants are used;

Improvement of metabolism in the brain is carried out with the drugs Cerebrolysin, piracetam, and B vitamins.

Indications for surgical treatment is the failure of therapy in the presence of stenosis of the carotid artery or its blockage, compression of the vertebral artery, etc.

If such a condition occurs in a patient during a dental appointment, hospitalization in the therapeutic or neurological department of a multidisciplinary hospital is indicated.

Cerebral stroke or persistent acute cerebrovascular accident

Cerebral stroke is an acute cerebrovascular accident with focal brain damage. Clinically manifested severe focal and cerebral symptoms, often to the point of cerebral coma.

There are hemorrhagic and ischemic strokes.

Hemorrhagic stroke - this is a hemorrhage into the substance of the brain (apoplexy), usually develops suddenly, more often during the day, during physical and emotional stress.

Symptoms usually spicy. The patient loses consciousness and develops cerebral coma. The face is red, the eyes are averted, the head is turned towards the source of hemorrhage. On the side opposite to the hemorrhage, hemiplegia is determined and pathological reflexes are evoked. With brainstem hemorrhages, profound disturbances in breathing and the function of the cardiovascular system occur, and blood pressure is often elevated.

Ischemic stroke - this is an acute, relatively long-term or permanent cessation of blood supply to a region of the brain due to persistent spasm or thrombosis of the supply artery.

Symptoms less acute than with a hemorrhagic stroke, develop gradually, neurological symptoms depend on the location and volume of the lesion. The clinical picture of coma is the same as for hemorrhagic stroke.

Intensive therapy. Pre-hospital treatment:

In case of gross violations, mechanical ventilation is performed;

Take measures to normalize high blood pressure;

Hospitalization is indicated for all patients with cerebral stroke.

At the prehospital stage, emergency care for stroke is provided regardless of its nature.

First of all, the fight against violations of the vital functions of the body is carried out:

If breathing is impaired, for mechanical ventilation, tracheal intubation is performed or a tracheostomy is applied;

For cardiovascular disorders, selective therapy is carried out depending on the clinical manifestations. For example, when collapse develops, caffeine 10% 1 ml, prednisolone 60-90 mg, glucose 40% 20-40 ml are administered;

For elevated blood pressure, see therapy for transient cerebrovascular accident;

The fight against cerebral edema is carried out by administering Lasix 40-80 ml IV or IM, prednisolone 60-90 mg, mannitol, saline, ascorbic acid;

Elimination of hyperthermia is carried out by injection of a lytic mixture (seduxen, diphenhydramine, analgin), ice packs are placed on the area of ​​​​large vessels and to the head.

A feature of the treatment of hemorrhagic stroke is the introduction hemostatic agents: dicinone 2 ml IV or IM, aminocaproic acid 5% 100 IV. Trasylol or contrical 20,000-30,000 units IV. The patient is placed on a bed with the head end elevated, creating an elevated position for the head.

For ischemic stroke. on the contrary, all measures are aimed at improving blood supply to the brain. Reopolyglucin 400 ml IV, heparin 5,000 units 4 times a day, Cavinton, cinnarizine are prescribed. Hyperbaric oxygen therapy is prescribed.

A poor prognostic sign for strokes is a profound degree of impairment of consciousness, especially the early development of coma.

If, due to paralysis of the limbs or speech impairment, the patient needs outside help, then disability group 1 is established.

Prevention of complications when performing dental interventions in patients with impaired cerebral vascular function (post-stroke, atherosclerotic, etc.) is to control blood pressure and pulse before, during and after dental intervention. Such patients are indicated for premedication with the mandatory inclusion of a tranquilizer, analgesic and antispasmodic.

In this category of patients, increased secretion of endogenous adrenaline as a result of stress poses a risk. Therefore, to perform local anesthesia, it is necessary to use an anesthetic with a minimum content of a vasoconstrictor.

If after the intervention the patient’s general condition is complicated by hypertension or an increase in neurological symptoms, the patient must be hospitalized in a therapeutic or neurological hospital.

For patients with subcompensated or decompensated forms of cerebral circulatory insufficiency, dental interventions are performed for health reasons in a specialized hospital of a multidisciplinary hospital.

Disorders of arterial circulation of the brain: forms, signs, treatment

In recent years, the percentage of mortality from pathological lesions of cerebral vessels, which were previously associated with the aging of the body and were diagnosed only in elderly people (after 60 years), has increased significantly. Today, the symptoms of cerebrovascular accident have become younger. And people under 40 often die from strokes. Therefore, it is important to know the causes and mechanism of their development in order to prevent them. diagnostic and therapeutic measures gave the most effective results.

What are cerebrovascular accidents (CVA)

The vessels of the brain have a unique, perfect structure that ideally regulates blood flow, ensuring the stability of blood circulation. They are designed in such a way that while the flow of blood into the coronary vessels increases approximately 10 times during physical activity, the amount of circulating blood in the brain, with an increase in mental activity, remains at the same level. That is, a redistribution of blood flow occurs. Some of the blood from parts of the brain with less load is redirected to areas with increased brain activity.

However, this perfect circulatory process is disrupted if the amount of blood entering the brain does not satisfy its need for it. It should be noted that its redistribution across brain regions is necessary not only for its normal functionality. It also occurs when various pathologies occur, for example, stenosis of the lumen of the vessel (narrowing) or obstruction (closure). As a result of impaired self-regulation, the speed of blood flow slows down in certain areas of the brain and ischemicity occurs.

Types of MC violations

There are the following categories of blood flow disorders in the brain:

1. Acute (stroke), which occurs suddenly with a long course, and transient, the main symptoms of which (visual impairment, loss of speech, etc.) last no more than a day.
2. Chronic, caused by discirculatory encephalopathies. They are divided into two types: hypertensive in origin and caused by atherosclerosis.

Acute disorders

Acute cerebrovascular accident causes persistent disorders of brain activity. It comes in two types: hemorrhagic (bleeding) and ischemic (also called cerebral infarction).

Hemorrhagic

Hemorrhage (hemorrhagic disturbance of blood flow) can be caused by various arterial hypertension and vascular aneurysms. congenital angiomas, etc.

As a result of an increase in blood pressure, plasma and the proteins contained in it are released, which leads to plasma saturation of the walls of blood vessels, causing their destruction. A peculiar hyaline-like specific substance (a protein whose structure resembles cartilage) is deposited on the vascular walls, which leads to the development of hyalinosis. The vessels resemble glass tubes and lose their elasticity and ability to hold blood pressure. In addition, the permeability of the vascular wall increases and blood can freely pass through it, soaking the nerve fibers (diapedetic bleeding). The result of such transformations can be the formation of microaneurysms and rupture of the vessel with hemorrhage and blood entering the white medulla. Thus, hemorrhage occurs as a result of:

• Plasmic impregnation of the walls of blood vessels of the white medulla or visual thalamus;
• Diapedetic bleeding;
• Microaneurysm formations.

Hemorrhage in the acute period is characterized by the development of hematomas due to wedging and deformation of the brain stem into the tentorial foramen. In this case, the brain swells and extensive edema develops. Secondary hemorrhages occur, smaller ones.

Clinical manifestations

Usually occurs during the day, during physical activity. Suddenly your head starts to hurt and you feel nauseous. Consciousness is confused, the person breathes quickly and whistlingly, and tachycardia occurs. accompanied by hemiplegia (unilateral paralysis of the limbs) or hemiparesis (weakening of motor functions). Basic reflexes are lost. The gaze becomes motionless (paresis), anisocoria (pupils of different sizes) or divergent strabismus occurs.

Treatment of cerebrovascular accidents of this type includes intensive therapy, the main goal of which is to reduce blood pressure, restore vital (automatic perception of the outside world) functions, stop bleeding and eliminate cerebral edema. The following medications are used:

1. Blood pressure-lowering drugs - ganlioblockers ( Arfonad, Benzohexanium. Pentamin).
2. To reduce the permeability of vascular walls and increase blood clotting - Dicynone. vitamin C, Vikasol. Calcium gluconate .
3. To increase blood rheology (fluidity) - Trental, Vinkaton, Cavinton, Eufillin, Cinnarizin.
4. Inhibiting fibrinolytic activity - ACC (aminocaproic acid).
5. Decongestant - Lasix .
6. Sedatives.
7. To reduce intracranial pressure, a spinal puncture is prescribed.
8. All drugs are administered by injection.

Ischemic

ischemic cerebrovascular accident due to atherosclerotic plaque

Ischemic circulatory disorders are most often caused by atherosclerosis. Its development can be provoked by severe anxiety (stress, etc.) or excessive physical activity. May occur during night sleep or immediately upon awakening. Often accompanies a pre-infarction condition or myocardial infarction.

They may appear suddenly or grow gradually. They manifest themselves in the form of headaches, hemiparesis on the side opposite to the lesion. Impaired motor coordination, as well as visual and speech disorders.

Pathogenesis

An ischemic disorder occurs when insufficient blood flows to a particular area of ​​the brain. In this case, a focus of hypoxia arises, in which necrotic formations develop. This process is accompanied by disruption of basic brain functions.

Treatment uses injections of medications to restore normal functioning of the cardiovascular system. These include: Korglykon, Strophanthin, Sulphocamphocaine, Reopoliklyukin, Cardiamin. Intracranial pressure decreases Mannitol or Lasix .

Video: causes of different types of strokes

Transient cerebrovascular accident

Transient cerebrovascular accident (TCI) occurs against the background of arterial hypertension or atherosclerosis. Sometimes the reason for its development is their combination. The main symptoms of PNMK are as follows:

• If the focus of the pathology is located in the basin of the carotid vessels, the patient’s half of the body (on the side opposite to the focus) and part of the face around the lips become numb; paralysis or short-term paresis of the limbs is possible. Speech is impaired and an epileptic seizure may occur.
• If the blood circulation in the vertebrobasilar area is impaired, the patient's legs and arms become weak, he becomes dizzy, it is difficult for him to swallow and pronounce sounds, photopsia occurs (the appearance of luminous points, sparks, etc. in the eyes) or diplopia (doubling of visible objects). He becomes disorientated and has memory lapses.
• Signs of cerebrovascular accident due to hypertension are manifested in the following: the head and eyeballs begin to hurt very much, the person experiences drowsiness, he or she experiences stuffiness in the ears (like on an airplane during takeoff or landing) and nausea. The face turns red and sweating increases. Unlike strokes, all these symptoms disappear within 24 hours. For this they received the name “transient attacks”.

Treatment of PNMK is carried out with antihypertensive, tonic and cardiotonic drugs. Antispasmodics are used to improve blood flow in the brain. and calcium channel blockers. The following medications are prescribed:

Dibazol, Trental, Clonidine, Vincamine, Euphyllin, Cinnarizine, Cavinton, Furasemide. beta blockers. Alcohol tinctures of ginseng and Schisandra chinensis are used as tonics.

Chronic cerebrovascular accidents

Chronic cerebrovascular accident (CVA), unlike acute forms, develops gradually. There are three stages of the disease:

1. At the first stage, the symptoms are vague. They are more like chronic fatigue syndrome. A person gets tired quickly, his sleep is disturbed, he often hurts and feels dizzy. He becomes hot-tempered and absent-minded. His mood often changes. He forgets some minor points.
2. At the second stage, chronic cerebrovascular accident is accompanied by significant memory impairment. Minor impairments in motor functions develop, causing unsteadiness in gait. There is a constant noise in my head. A person perceives information poorly, having difficulty concentrating his attention on it. He is gradually deteriorating as a person. Becomes irritable and unconfident, loses intelligence, reacts inadequately to criticism, and often becomes depressed. He constantly feels dizzy and has a headache. He always wants to sleep. Performance is reduced. He adapts poorly socially.
3. In the third stage, all symptoms intensify. Personality degradation turns into dementia. memory suffers. Having left home alone, such a person will never find his way back. Motor functions are impaired. This manifests itself in hand tremors and stiffness of movements. Speech impairment and uncoordinated movements are noticeable.

The last stage of chronic cerebral obstruction is brain atrophy and neuron death, the development of dementia

Cerebrovascular accident is dangerous because if treatment is not carried out in the early stages, neurons die - the main units of the brain structure, which cannot be resurrected. Therefore, diagnosing the disease in the early stages is so important. It includes:

• Identification of vascular diseases that contribute to the development of cerebrovascular accidents.
• Making a diagnosis based on patient complaints.
• Conducting a neuropsychological examination using the MMSE scale. It allows you to detect cognitive impairment by testing. The absence of violations is indicated by 30 points scored by the patient.
• Duplex scanning to detect damage to cerebral vessels due to atherosclerosis and other diseases.
• Magnetic resonance imaging, which allows identifying small hypodense (with pathological changes) foci in the brain.
• Clinical blood tests: complete blood count, lipid profile, coagulogram, glucose.

Etiology

The main causes of cerebrovascular accident are as follows:

1. Age. They mainly occur in people who have entered their fifth decade.
2. Genetic predisposition.
3. Traumatic brain injuries.
4. Overweight. Obese people often suffer from hypercholesterolemia.
5. Physical inactivity and increased emotionality (stress, etc.).
6. Bad habits.
7. Diseases: diabetes mellitus (insulin-dependent) and atherosclerosis.
8. Hypertension. High blood pressure is the most common cause of strokes.
9. In old age, problems with blood flow in the brain can result from:
   • atrial fibrillation,
   • various diseases of the hematopoietic organs and blood,
   • chronic thrombophlebitis,
   • heart defects.

Treatment

For chronic disorders of blood flow in the brain all therapeutic measures are aimed at protecting brain neurons from death as a result of hypoxia, stimulate metabolism at the neuronal level, normalize blood flow in brain tissue. Medicines for each patient are selected individually. They should be taken in a strictly prescribed dosage, constantly monitoring blood pressure.

In addition, for cerebral circulatory disorders accompanied by neurological manifestations, antioxidants, venotonics, vasodilators, neuroprotectors, drugs that increase blood microcirculation, sedatives and multivitamins are used.

Chronic cerebrovascular accident can also be treated using traditional medicine, using various herbal teas and herbal teas. Particularly useful is an infusion of hawthorn flowers and a collection that includes chamomile, cudweed and motherwort. But they should be used as an additional treatment course that enhances the main drug therapy.

People with increased weight who are at risk for developing atherosclerosis due to high cholesterol need to pay attention to nutrition. There are special diets for them, which you can learn about from a nutritionist who monitors the organization of nutrition for patients undergoing treatment in an inpatient department of any hospital. Dietary products include everything of plant origin, seafood and fish. But milk products, on the contrary, should be low in fat.

If cholesterolemia is significant and the diet does not give the necessary results, medications included in the statin group are prescribed: Liprimar. Atorvakar, Vabarin, Torvacard, Simvatin. With a large degree of narrowing of the lumen between the walls of the carotid arteries (more than 70%), a carotid endarterectomy (surgical operation) is required, which is performed only in specialized clinics. For stenosis less than 60%, conservative treatment is sufficient.

Rehabilitation after acute cerebrovascular accident

Drug therapy can stop the progression of the disease. But she is unable to regain the ability to move. Only special gymnastic exercises can help with this. You need to be prepared for the fact that this process is quite long and be patient. The patient’s relatives must learn to perform massage and therapeutic exercises, since they will have to do them for him for six months or more.

Kinesiotherapy is indicated as the basis for early rehabilitation after dynamic cerebrovascular accident in order to fully restore motor functions. It is especially necessary in the restoration of motor skills, as it contributes to the creation of a new model of the hierarchy of the nervous system for the physiological control of the motor functions of the body. The following techniques are used in kinesitherapy:

1. Gymnastics “Balance”, aimed at restoring coordination of movements;
2. Feldenkrais reflex exercise system.
3. The Voight system, aimed at restoring motor activity by stimulating reflexes;
4. Microkenisotherapy.

Passive gymnastics “Balance” is prescribed to every patient with cerebrovascular accidents as soon as consciousness returns to him. Usually, relatives help the patient perform it. It includes kneading the fingers and toes, flexing and straightening the limbs. Exercises begin to be performed from the lower extremities, gradually moving upward. The complex also includes kneading the head and cervical regions. Before starting the exercises and finishing the gymnastics, you should use light massaging movements. It is imperative to monitor the patient's condition. Gymnastics should not cause him to become overtired. The patient can independently perform eye exercises (squinting, rotating, fixing the gaze at one point, and some others). Gradually, with the improvement of the patient's general condition, the load is increased. An individual recovery method is selected for each patient, taking into account the characteristics of the course of the disease.

Photo: basic passive gymnastics exercises

Feldenkrais Method is a therapy that has a gentle effect on the human nervous system. It promotes the complete restoration of mental abilities, motor activity and sensuality. It includes exercises that require smooth movement when performed. The patient must focus on their coordination, making each movement meaningfully (consciously). This technique forces one to divert attention from the existing health problem and concentrate it on new achievements. As a result, the brain begins to “remember” previous stereotypes and returns to them. The patient constantly studies his body and its capabilities. This allows you to find quick ways to get him moving.

The methodology is based on three principles:

• All exercises should be easy to learn and remember.
• Each exercise must be performed smoothly, without overstraining the muscles.
• While performing the exercise, the sick person should enjoy the movement.

But most importantly, you should never divide your achievements into high and low.

Additional rehabilitation measures

Breathing exercises are widely practiced, which not only normalizes blood circulation, but also relieves muscle tension that occurs under the influence of gymnastic and massage loads. In addition, it regulates the respiratory process after performing therapeutic exercises and gives a relaxing effect.

In case of cerebrovascular accidents, the patient is prescribed bed rest for a long time. This can lead to various complications, for example, disruption of natural ventilation of the lungs, the appearance of bedsores and contractures (mobility in the joint is limited). Prevention of bedsores involves frequent changes of position of the patient. It is recommended to turn him over on his stomach. At the same time, the feet hang down, the shins are located on soft pillows, and under the knees there are cotton wool discs covered with gauze.

1. Place the patient's body in a special position. In the first days, he is transferred from one position to another by his relatives caring for him. This is done every two or three hours. After stabilizing blood pressure and improving the general condition of the patient, they are taught to do this on their own. Getting the patient into bed early (if well-being allows) will prevent contractures from developing.
2. Perform the massage necessary to maintain normal muscle tone. The first days it includes light stroking (if muscle tone is increased) or kneading (if muscle tone is decreased) and lasts only a few minutes. Subsequently, the massage movements intensify. Rubbing is allowed. The duration of massage procedures also increases. By the end of the first half of the year, they can be completed within an hour.
3. Perform physical therapy exercises, which, among other things, effectively combat synkinesis (involuntary muscle contractions).
4. Vibration stimulation of paralyzed parts of the body with an oscillation frequency of 10 to 100 Hz gives a good effect. Depending on the patient's condition, the duration of this procedure can vary from 2 to 10 minutes. It is recommended to carry out no more than 15 procedures.

For cerebrovascular accidents, alternative treatment methods are also used:

• Reflexology, including:
  1. Treatment with odors (aromatherapy);
  2. classic version of acupuncture;
  3. acupuncture at reflex points located on the ears (auricolotherapy);
  4. acupuncture of biologically active points on the hands (su-Jack);
• Treatment with leeches (hirudotherapy);
• Pine baths with the addition of sea salt;
• Oxygen baths.

Video: stroke prevention and rehabilitation

Read more about comprehensive rehabilitation after strokes and ischemic attacks by following the link.

Consequences of NMC

Acute cerebrovascular accident has serious consequences. In 30 cases out of a hundred, people who have suffered this disease become completely helpless.

1. He cannot eat, perform hygiene procedures, dress, etc. on his own. Such people have a completely impaired ability to think. They lose track of time and have absolutely no orientation in space.
2. Some people retain the ability to move. But there are many people who, after a cerebrovascular accident, remain bedridden forever. Many of them maintain a clear mind, understand what is happening around them, but are speechless and cannot express their desires and feelings in words.

connection between areas of brain damage and vital functions

Disability is a sad result of acute and in many cases chronic cerebrovascular accident. About 20% of acute cerebrovascular accidents are fatal.

But it is possible to protect yourself from this serious disease, regardless of what category of classification it belongs to. Although many people neglect it. This is an attentive attitude to your health and all the changes occurring in the body.

• Agree that a healthy person should not have headaches. And if you suddenly feel dizzy, it means that some kind of deviation has arisen in the functioning of the systems responsible for this organ.
• An increase in temperature is evidence of problems in the body. But many people go to work when it is 37°C, considering it normal.
• Do you experience short-term numbness in your limbs? Most people rub them without asking the question: why is this happening?

Meanwhile, these are the companions of the first minor changes in the blood flow system. Often an acute cerebrovascular accident is preceded by a transient one. But since its symptoms disappear within 24 hours, not every person rushes to see a doctor to undergo an examination and receive the necessary drug treatment.

Today, doctors have effective drugs - thrombolytics. They literally work wonders, dissolving blood clots and restoring cerebral circulation. However, there is one “but”. To achieve maximum effect, they must be administered to the patient within three hours after the first symptoms of a stroke appear. Unfortunately, in most cases, seeking medical help is too late, when the disease has reached a severe stage and the use of thrombolytics is no longer useful.

Cerebral circulation- blood circulation in the vascular system of the brain and spinal cord.

The severity and localization of morphological changes in brain tissue in patients with cerebrovascular accidents are determined by the underlying disease, the blood supply to the affected vessel, the mechanisms of development of this circulatory disorder, the age and individual characteristics of the patient.

Morphological signs of cerebrovascular accident can be focal or diffuse. Focal ones include hemorrhagic stroke, intrathecal hemorrhages, cerebral infarction; to diffuse - multiple small-focal changes in the brain substance of varying duration, small hemorrhages, small fresh and organizing foci of necrosis of brain tissue, gliomesodermal scars and small cysts.

Clinically, with cerebrovascular accidents, there may be subjective sensations (headache, dizziness, paresthesia, etc.) without objective neurological symptoms; organic microsymptoms without clear symptoms of loss of central nervous system function; focal symptoms: motor disorders - paresis or paralysis, extrapyramidal disorders, hyperkinesis, coordination disorders, sensitivity disorders, pain; dysfunctions of the sense organs, focal disorders of the higher functions of the cerebral cortex - aphasia, agraphia, alexia, etc.; changes in intelligence, memory, emotional-volitional sphere; epileptic seizures; psychopathological symptoms.

According to the nature of cerebral circulatory disorders, initial manifestations of insufficiency of cerebral blood supply are distinguished, acute cerebral circulatory disorders (transient disorders, intrathecal hemorrhages, strokes), chronic slowly progressive disorders of cerebral and spinal circulation (dyscirculatory encephalopathy and myelopathy).

Clinical symptoms of the initial manifestations of insufficient blood supply to the brain are headaches, dizziness, noise in the head, decreased performance, and sleep disturbances, especially after intense mental and physical work, staying in a stuffy room. Focal neurological symptoms in such patients are usually absent or represented by scattered microsymptoms. To diagnose the initial manifestations of insufficient blood supply to the brain, it is necessary to identify objective signs of atherosclerosis, arterial hypertension, vasomotor dystonia and exclude other somatic pathologies, as well as neurosis.

Acute cerebrovascular accidents include transient cerebral circulatory disorders and strokes.

Transient cerebrovascular accidents are manifested by focal or general cerebral symptoms (or a combination thereof) lasting less than 1 day. They are most often observed in cerebral atherosclerosis, hypertension and arterial hypertension.

There are transient ischemic attacks and hypertensive cerebral crises.

Transient ischemic attacks are characterized by the appearance of focal neurological symptoms (weakness and numbness of the limbs, difficulty speaking, static disturbances, diplopia, etc.) against the background of mild or absent cerebral symptoms.

Hypertensive cerebral crises, on the contrary, are characterized by a predominance of general cerebral symptoms (headache, dizziness, nausea or vomiting) over focal ones, which sometimes may be absent. An acute cerebrovascular accident, in which focal neurological symptoms persist for more than 1 day, is considered a stroke.

Acute disorders of venous circulation in the brain also include venous hemorrhages, thrombosis of the cerebral veins and venous sinuses.

Chronic cerebrovascular accidents (dyscirculatory encephalopathy and myelopathy) are the result of progressive insufficiency of blood supply caused by various vascular diseases.

With discirculatory encephalopathy, scattered organic symptoms are detected, usually in combination with memory impairment, headaches, non-systemic dizziness, irritability, etc. There are 3 stages of discirculatory encephalopathy.

Stage I, in addition to scattered, mildly expressed persistent organic symptoms (asymmetry of cranial innervation, slight oral reflexes, inaccuracy of coordination, etc.), is characterized by the presence of a syndrome similar to the asthenic form of neurasthenia (memory deterioration, fatigue, absent-mindedness, difficulty switching from one activity to another). another, dull headaches, unsystematic dizziness, poor sleep, irritability, tearfulness, depressed mood). Intellect does not suffer.

Stage II is characterized by progressive deterioration of memory (including professional memory), decreased performance, personality changes (viscosity of thought, narrowing of interests, apathy, often verbose, irritability, quarrelsomeness, etc.), decreased intelligence. Daytime sleepiness with poor night sleep is typical. Organic symptoms are more distinct (mild dysarthria, reflexes of oral automatism and other pathological reflexes, bradykinesia, tremor, changes in muscle tone, coordination and sensory disorders).
Stage III is characterized by both worsening mental disorders (up to dementia) and the development of neurological syndromes associated with predominant damage to a certain area of ​​the brain. These may be pseudobulbar palsy, parkinsonism, cerebellar ataxia, pyramidal insufficiency. Stroke-like deterioration of the condition is frequent, characterized by the appearance of new focal symptoms and an increase in previously existing signs of cerebrovascular insufficiency.

Discirculatory myelopathy also has a progressive course, in which three stages can be roughly distinguished. Stage I (compensated) is characterized by the appearance of moderately severe fatigue of the muscles of the limbs, less often weakness of the limbs. Subsequently, in stage II (subcompensated), weakness in the limbs progressively increases, sensory disturbances of the segmental and conduction type, and changes in the reflex sphere appear. In stage III, paresis or paralysis, severe sensory disturbances, and pelvic disorders develop.

The nature of focal syndromes depends on the localization of pathological foci along the length and diameter of the spinal cord. Possible clinical syndromes are poliomyelitis, pyramidal, syringomyelic, amyotrophic lateral sclerosis, posterior columnar, transverse spinal cord lesions.

Chronic disorders of the venous circulation include venous congestion, causing venous encephalopathy and myelopathy. It is a consequence of cardiac or pulmonary-heart failure, compression of extracranial veins in the neck, etc. Difficulties in venous outflow from the cranial cavity and spinal canal can be compensated for a long time; with decompensation, headaches, seizures, cerebellar symptoms, and dysfunction of the cranial nerves are possible. Venous encephalopathy is characterized by a variety of clinical manifestations. Hypertensive (pseudotumor) syndrome, scattered small-focal brain lesion syndrome, and asthenic syndrome may be observed. Venous encephalopathy also includes bettolepsy (cough epilepsy), which develops in diseases leading to venous stagnation in the brain. Venous myelopathy is a particular variant of discirculatory myelopathy and clinically does not differ significantly from the latter.

Symptoms of circulatory disorders in the vessels of the brain

In the early stages, the disease is asymptomatic. However, it progresses quickly and gradually its symptoms completely incapacitate a person, performance is seriously impaired, the person loses the joy of life and cannot live fully.

So, the symptoms of cerebrovascular accident include:

A headache is a major warning sign, but people often ignore it, believing that the pain is caused by fatigue, weather or other reasons.
pain in the eyes - its peculiarity is that it noticeably intensifies during the movement of the eyeballs, especially in the evening
dizziness - when such a phenomenon is observed regularly, it should in no case be ignored
nausea and vomiting - usually this symptom manifests itself in parallel with the above
stuffy ears
ringing or noise in the ears
convulsions - this symptom appears less frequently than others, but still occurs
numbness - when blood circulation in the vessels of the brain is impaired, it occurs absolutely for no reason
tension in the head muscles, especially pronounced in the occipital muscles
weakness in the body
fainting
pale skin
decrease heart rate

Various disorders of consciousness are also noted, such as:

Changes in perception, such as feeling dazed
memory impairment - a person remembers his past perfectly, but often forgets about plans, about where things are
absent-mindedness
rapid fatigue and, as a consequence, decreased performance
short temper, easy excitability, tearfulness
constant drowsiness or, on the contrary, insomnia

Causes of cerebrovascular accidents

The causes of this disease are very diverse. They are usually associated with other abnormalities in the cardiovascular system, for example, vascular atherosclerosis or hypertension. Atherosclerosis is the blockage of blood vessels with cholesterol plaques, so it is simply necessary to monitor the concentration of cholesterol in the blood. And for this you should monitor your daily diet.

Chronic fatigue also often causes poor circulation in our brain. Unfortunately, people often do not realize the seriousness of their condition and end up with dire consequences. But chronic fatigue syndrome can lead not only to disruption of blood circulation, but also to disruptions in the functioning of the endocrine system, central nervous system and gastrointestinal tract.

Various traumatic brain injuries can also cause disorders. These can be injuries of any severity. Injuries with intracranial hemorrhage are especially dangerous. It is quite natural that the stronger the hemorrhage, the more serious consequences it can lead to.

The problem of modern man is regularly sitting in front of a computer monitor in an uncomfortable position. As a result, the muscles of the neck and back are greatly overstrained and blood circulation in the vessels, including the vessels of the brain, is disrupted. Excessive exercise can also be harmful.

Circulatory problems are also closely related to diseases of the spine, especially the cervical region. Be careful if you are diagnosed with scoliosis or osteochondrosis.

The main cause of cerebral hemorrhage is high blood pressure. With a sharp rise, a vessel may rupture, resulting in the release of blood into the brain substance and the development of an intracerebral hematoma.

A more rare cause of hemorrhage is a ruptured aneurysm. An arterial aneurysm, usually a congenital pathology, is a saccular protrusion on the wall of a vessel. The walls of such a protrusion do not have such a powerful muscular and elastic framework as the walls of a normal vessel have. Therefore, sometimes only a relatively small jump in pressure, which is observed in completely healthy people during physical activity or emotional stress, is enough for the wall of the aneurysm to rupture.

Along with saccular aneurysms, other congenital anomalies of the vascular system are sometimes observed, creating the threat of sudden hemorrhage.
In cases where an aneurysm is located in the walls of vessels located on the surface of the brain, its rupture leads to the development of not intracerebral, but subarachnoid (subarachnoid) hemorrhage, located under the arachnoid membrane surrounding the brain. Subarachnoid hemorrhage does not directly lead to the development of focal neurological symptoms (paresis, speech disturbances, etc.), but it causes general cerebral symptoms: a sudden sharp (“dagger”) headache, often followed by loss of consciousness.

A cerebral infarction usually develops as a result of blockage of one of the cerebral vessels or a large (main) vessel of the head, through which blood flows to the brain.

There are four main vessels: the right and left internal carotid arteries, which supply blood to most of the right and left hemispheres of the brain, and the right and left vertebral arteries, which then merge into the main artery and supply blood to the brain stem, cerebellum and occipital lobes of the cerebral hemispheres.

The causes of blockage of the main and cerebral arteries may be different. Thus, during an inflammatory process on the heart valves (with the formation of infiltrates or the formation of a parietal thrombus in the heart), pieces of the thrombus or infiltrate can break off and, with the blood flow, come to a cerebral vessel, the caliber of which is smaller than the size of the piece (embolus), and as a result clog the vessel. Particles of disintegrating atherosclerotic plaque on the walls of one of the main arteries of the head can also become emboli.

This is one of the mechanisms for the development of cerebral infarction - embolic.
Another mechanism for the development of a heart attack is thrombotic: the gradual development of a thrombus (blood clot) at the location of the atherosclerotic plaque on the vessel wall. An atherosclerotic plaque filling the lumen of a vessel leads to a slowdown in blood flow, which contributes to the development of a blood clot. The uneven surface of the plaque in this area favors the adhesion (aggregation) of platelets and other blood elements, which constitutes the main framework of the resulting thrombus.

As a rule, local factors alone are often not enough for the formation of a blood clot. The development of thrombosis is facilitated by factors such as a general slowdown in blood flow (therefore, thrombosis of cerebral vessels, as opposed to embolisms and hemorrhages, usually develop at night, during sleep), increased blood clotting, and increased aggregation (gluing) properties of platelets and red blood cells.

Everyone knows from experience what blood clotting is. A person accidentally cuts his finger, blood begins to flow from it, but gradually a blood clot (thrombus) forms at the site of the cut and the bleeding stops.
Blood clotting is a necessary biological factor that contributes to our survival. But both decreased and increased coagulability threatens our health and even our very lives.

Increased coagulability leads to the development of thrombosis, while decreased coagulability leads to bleeding from the slightest cuts and bruises. Hemophilia, a disease accompanied by reduced blood clotting and of a hereditary nature, suffered from many members of the reigning families of Europe, including the son of the last Russian emperor, Tsarevich Alexei.

Disruption of normal blood flow can also be a consequence of spasm (strong compression) of the vessel, which occurs as a result of a sharp contraction of the muscular layer of the vascular wall. Several decades ago, spasm was considered to be of great importance in the development of cerebrovascular accidents. Currently, spasm of cerebral vessels is mainly associated with cerebral infarctions, which sometimes develop several days after subarachnoid hemorrhage.

With frequent increases in blood pressure, changes can develop in the walls of small vessels that supply deep structures of the brain. These changes lead to narrowing and often closure of these vessels. Sometimes, after another sharp rise in blood pressure (hypertensive crisis), a small infarction develops in the circulatory system of such a vessel (called a “lacunar” infarction in the scientific literature).

In some cases, cerebral infarction can develop without complete blockage of the vessel. This is a so-called hemodynamic stroke. Let's imagine a hose from which you water a garden. The hose is clogged with silt, but the electric motor, lowered into the pond, works well, and the stream of water is enough for normal watering. But a slight bend in the hose or a deterioration in the performance of the motor is enough, and instead of a powerful stream, a narrow stream of water begins to flow out of the hose, which is clearly not enough to water the ground well.

The same thing can happen under certain conditions with blood flow in the brain. For this, the presence of two factors is sufficient: a sharp narrowing of the lumen of the main or cerebral vessel by an atherosclerotic plaque filling it or as a result of its kinking, plus a drop in blood pressure occurring due to a deterioration (often temporary) in the functioning of the heart.

The mechanism of transient cerebrovascular accidents (transient ischemic attacks) is in many ways similar to the mechanism of development of cerebral infarction. Only compensatory mechanisms for transient disorders of cerebral circulation work quickly, and the developed symptoms disappear within a few minutes (or hours). But one should not hope that compensation mechanisms will always cope so well with the violation that has arisen. Therefore, it is so important to know the causes of cerebrovascular accidents, which allows us to develop methods for preventing repeated disasters.

Treatment of cerebrovascular accidents

Various diseases of the cardiovascular system are the most common ailments among the world's population. And cerebrovascular accident is generally an extremely dangerous thing. The brain is the most important organ of our body. Its poor functioning leads not only to physical abnormalities, but also to impaired consciousness.

Treatment for this disease includes not only taking medications, but also completely changing your lifestyle. As mentioned above, cholesterol plaques contribute to the development of circulatory disorders in the vessels of the brain. This means that it is necessary to take measures to prevent an increase in blood cholesterol levels. And the main measures include proper nutrition. First of all, do the following:

Limit the amount of table salt you consume as much as possible.
give up alcoholic drinks
if you have extra pounds, you urgently need to get rid of them, since they create extra stress on your blood vessels, and this is simply unacceptable for this disease
Some people's blood vessels, including capillaries, are fragile. Such people often have bleeding gums, and often have nosebleeds. How to get rid of this scourge?

Dissolve a teaspoon of well-cleaned (edible) and finely ground sea salt in a glass of water at room temperature. Inhale the cool saline solution through your nostrils and hold your breath for about 3-4 seconds. Repeat the procedure every morning for 10-12 days, and nosebleeds will stop.

This method also works well: prepare a saturated salt solution (five tablespoons of coarse sea salt per glass of warm water). Make two cotton swabs, soak them in the prepared solution and insert them into your nose. Lie with your head thrown back for 20 minutes. It is also useful to rinse your mouth with the same solution: your gums will stop hurting and bleeding.

Take two tablespoons of dry mustard, two pods of chopped hot pepper, a tablespoon of sea salt. Mix all ingredients and add two glasses of vodka. Leave the mixture in a dark place for 10 days. Actively rub your feet with the resulting tincture at night. After rubbing, put on wool socks and go to bed.

Treatment of age-related changes in the circulatory system in old age

Age-related changes in blood vessels and the heart significantly limit adaptation capabilities and create the preconditions for the development of diseases.

Changes in blood vessels. The structure of the vascular wall changes with age in each person. The muscle layer of each vessel gradually atrophies and decreases, its elasticity is lost and sclerotic compactions of the inner wall appear. This greatly limits the ability of blood vessels to expand and narrow, which is already a pathology. Large arterial trunks, especially the aorta, are primarily affected. In older and older people, the number of active capillaries per unit area decreases significantly. Tissues and organs cease to receive the amount of nutrients and oxygen they need, and this leads to their starvation and the development of various diseases.

As each person ages, small vessels become more and more “clogged” with lime deposits and peripheral vascular resistance increases. This leads to a slight increase in blood pressure. But the development of hypertension is significantly hampered by the fact that with a decrease in the tone of the muscular wall of large vessels, the lumen of the venous bed expands. This leads to a decrease in cardiac output (minute volume is the amount of blood ejected by the heart per minute) and to active redistribution of peripheral circulation. Coronary and cardiac circulation usually suffers little from a decrease in cardiac output, while renal and hepatic circulation are greatly reduced.

Decreased contractility of the heart muscle. The older a person gets, the more muscle fibers of the heart muscle atrophy. The so-called “senile heart” develops. Progressive myocardial sclerosis occurs, and in place of the atrophied muscle fibers of the cardiac tissue, fibers of non-working connective tissue develop. The strength of heart contractions gradually decreases, metabolic processes are increasingly disrupted, which creates conditions for energetic-dynamic heart failure under conditions of intense activity.

In addition, in old age, conditioned and unconditioned reflexes of blood circulation regulation appear, and the inertia of vascular reactions is increasingly revealed. Research has shown that with aging, the effects of various brain structures on the cardiovascular system change. In turn, the feedback also changes - the reflexes coming from the baroreceptors of large vessels are weakened. This leads to dysregulation of blood pressure.

As a result of all the above reasons, the physical performance of the heart decreases with age. This leads to a limitation of the range of reserve capabilities of the body and a decrease in the efficiency of its work.

Points of influence for circulatory disorders

In case of weak blood flow and blockage of blood vessels, you should use the index finger and thumb of one hand to grab the middle finger of the other hand. Perform acupressure by pressing with medium force with your thumbnail on a point located under the nail bed. The massage should be done on both hands, spending 1 minute each.

Points of influence for thirst. When a feeling of thirst occurs, you should act on a soothing point. The peculiarity of this BAP is that so far it has not been possible to identify other points associated with the mucous membrane in the human body. The point is located at a distance of approximately 1 cm from the tip of the tongue. The massage consists of lightly biting a given point with the front teeth (incisors) with a rhythm of 20 times per 1 minute.

Points of intervention for sleep disorders. For insomnia, acupressure of the lower part of the auricle should be performed. The massage should be carried out with the index and thumb, clasping the earlobe on both sides. The biologically active point is located in the middle of the lobe. Sleep will come faster (or massage more often on the right side than on the left.

Drawing. Points of influence for influenza, runny nose, catarrh of the upper respiratory tract

Acupressure does not replace necessary medical treatment, especially if surgical intervention is urgently needed (for example, with appendicitis, its purulent stage).