Cerebrovascular diseases (CVD) are one of the most common causes of emergency neurological care and encompass all transient or permanent disorders that occur in the brain, the largest part of the brain, and that involve the cerebral blood vessels.
It is usually defined as a stroke since, in a generic way, it includes cerebral infarction, cerebrovascular accident and other disorders. Cerebrovascular disease can be ischemic, decreased blood supply to the brain, or hemorrhagic (stroke) due to the presence of blood in the cerebral ventricles or subarachnoid space. CVDs are the second most common cause of death and the first of disability. Women are more likely to suffer from a cerebrovascular disorder.
Causes of cerebrovascular diseases
Smoking, high blood pressure and others
The following have been identified as the main causes of cerebrovascular disease:
– Smoking.
– Diabetes.
– Arterial hypertension (HTA).
– High LDL cholesterol.
– Arteriosclerosis.
One classification of CVD is to differentiate between asymptomatic brain disease such as asymptomatic carotid stenosis and symptomatic cerebrovascular disease. Of the latter, it should be noted:
– Focal brain dysfunction or transient ischemic attacks (TIA) in the carotid system and/or in the vertebrobasilar system, uncertain location or possible TIA. The transient ischemic attack lasts between 2 and 15 minutes and rarely lasts more than an hour. It is usually reversible and there is no permanent neurological deficit. Carotids are characterized by motor dysfunction of the extremities, loss of vision in one eye, sensory symptoms and language disorder (aphasia). Vertebrobasilars present motor dysfunction of any combination of upper and lower limbs, sensory symptoms on one or both sides of the body, loss of vision in one or both eyes and other disorders such as dysarthria (speech muscle disorder), dysphagia ( difficulty swallowing), diplopia (double vision), vertigo or ataxia (incoordination of movement).
– Stroke, with different temporal profile (with improvement, worsening or stable stroke) such as: cerebral hemorrhage, subarachnoid hemorrhage (SAH), cerebral infarction (thrombotic – narrowing or occlusion of the intra- or extracranial artery -, embolic – occlusion of an artery due to a mass that is released in the vessels-, hemodynamic -due to significant arterial hypotension-, atherothrombotic -due to arteriosclerosis-, cardioembolic -occlusion of an artery due to a mass of cardiac origin, lacunar -occlusion of small cerebral vessels-, of unusual cause -when the causes cannot be attributed to the previous types- or of undetermined origin -when they affect the carotid or vertebrobasilar territory but the signs do not coincide with the detritus in those types of stroke). The location can be in: the internal carotid artery, in the middle cerebral artery, in the anterior cerebral artery or in the vertebrobasilar system (vertebral artery, basilar artery or posterior cerebral artery).
– Vascular dementia or cognitive impairment secondary to cerebrovascular disease.
– Hypertensive encephalopathy. It is linked to high blood pressure with a systolic blood pressure greater than 140 millimeters of mercury (mm Hg). It may be associated with seizures and focal neurological deficit.
Symptoms of cerebrovascular diseases
Differences according to CVD
The signs and/or symptoms are different depending on whether the cerebrovascular disease occurs in the anterior or posterior cerebral circulation.
Symptoms of cerebrovascular disease of anterior cerebral circulation:
– Blindness in one eye.
– Partial absence of voluntary movement on one side (leg, arm and face).
– Sensory deficit.
– Eye deviation.
– Urinary incontinence.
– Slowness in voluntary movements (bradykinesia).
– Inability to speak or move (akinetic mutism).
– Paralysis on one side of the body.
– Language disorder.
– Difficulty performing a purposeful movement out of context but they can do it naturally (apraxia).
Symptoms of posterior circulation cerebrovascular disease:
– Vertigo.
– Lack of coordination of movement while walking (gait ataxia).
Double vision (diplopia).
– Paresthesia. Abnormal sensation of the senses such as tingling, numbness…
– Visual alterations.
– Difficulty swallowing.
– Amnesia.
– Uncontrollable and involuntary movement (nystagmus).
– Inability to move the eyeball (internuclear ophthalmoplegia).
– Speech muscle disorders (dysarthria).
– Difficulty writing correctly (dyslexia).
– Loss of strength in the lower or upper limbs.
If any of these symptoms occur, the patient must be transferred urgently so that they can receive specialized medical assistance. Time is crucial.
Diagnosis of cerebrovascular diseases
Identify the injury within 24 hours
It is crucial, if cerebrovascular disease is suspected, that care be received in a specialized emergency room, with the attention of a neurologist, and that the location of the lesion and its origin be identified before 24 hours have passed since the attack. .
To facilitate the diagnosis, blood tests, coagulation tests, electrocardiogram, computed tomography, magnetic resonance imaging and a study of cerebral blood flow will be requested. Disorders of movement, speech, vision, etc. will also be examined.
Treatment and medication of cerebrovascular diseases
Individualized
Treatments for each of the cerebrovascular diseases must be individualized. If CVD is not hemorrhagic, it can be treated pharmacologically with antiplatelet drugs. If the origin is cardioembolic, anticoagulants will be administered whenever possible. If seizures occur, they can be controlled with a benzodiazepine such as lorazepam or diazepam. Catheter thrombolysis, to treat vascular blockages, can be administered within three hours of the attack in a case of acute ischemic infarction.
Blood pressure will also be controlled, which will have to be reduced if there is a risk of hemorrhage or which will have to be monitored to avoid a sudden drop in cerebral perfusion (blood pressure gradient that crosses the brain).
In case of control of a cerebrovascular disease, it should normally be completed with physiotherapy, speech therapy, learning therapies…
Prevention of cerebrovascular diseases
Lifestyle
Preventing cerebrovascular diseases involves leading a healthy lifestyle that includes a healthy and balanced diet, avoiding saturated fats; regular moderate exercise; avoid tobacco and stress; limit alcohol consumption; do not use illegal drugs; control blood pressure, diabetes and cholesterol; and try to avoid the formation of blood clots by following the guidelines established by your doctor.
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