How is atherosclerosis of cerebral vessels manifested and how is it treated: syndromes, diagnostics, drugs

What it is

Atherosclerosis of the great vessels of the brain (another name for the disease is progressive cerebral atherosclerosis) is a chronic, slowly developing disease that ultimately leads to a depletion of cerebral blood flow. Constant malnutrition of the brain sooner or later causes stroke and / or dementia.

Causes of the disease

Atherosclerosis occurs against the background of lipid metabolism disorders (dyslipidemia), in which the balance of lipoproteins of different densities changes, and they begin to be deposited in the vascular wall, gradually deteriorating blood flow. There are many factors that influence this process: from improper diet to congenital fermentopathies. The exact chain of cause and effect of atherosclerosis is still unknown.

Risk factors that cannot be influenced

The parameters that a person cannot fix include:

genetic predisposition;
age;
floor.

Modifiable risk factors

Elimination of the following processes and conditions will significantly reduce the risk of developing cerebrosclerosis:

arterial hypertension;
smoking;
insulin resistance;
diabetes;
overweight;
hypodynamia.

Symptoms and manifestations of cerebral atherosclerosis

There is no specific symptom that can indicate atherosclerosis. It must be understood that the manifestations directly depend on which vessel is affected, and which area of the brain it feeds. Damage to a specific artery will give symptoms of a malfunction of the corresponding part of the organ that was supplied with it. The result can be a TIA (transient ischemic attack) or a stroke (it all depends on the degree of "starvation" of the nervous tissue). Frequent signs of pathology are:

chronic or very intense headaches;
periodic loss or deterioration of vision;
noise in ears;
periodic dizziness;
feeling of numbness in the face or limbs;
muscle weakness;
emotional lability;
panic attacks;
speech impairment.

Doctors call the symptoms of cerebral atherosclerosis by a general term: vascular cerebral syndromes in cerebrovascular diseases (ICD code - G46).

Features in the elderly

Atherosclerosis is much more common in old people than in young people. Old age is the most significant risk factor for the development of pathology. Moreover, it aggravates the course of diabetes and hypertension, which also affects the condition of the inner wall of the arteries. Treatment of cerebral atherosclerosis in the elderly is complicated by the blurring of symptoms, which can be confused with manifestations of concomitant pathologies. And that usually means wasting precious time. In the case of ischemic stroke, the blockage of the vessel can be removed (thrombolysis) only in the next few hours.

Classifications and variants of the course of cerebral atherosclerosis

Syndromes, which are related to cerebral vascular, are divided depending on the vessel feeding a specific area of the nervous tissue. With a deterioration in blood flow in one of the arteries of the head, the corresponding sector of the brain completely or partially loses its function, which is determined by doctors when examining a patient. As a result, doctors begin to assume the localization of atherosclerotic plaques. The main vasocerebral syndromes:

middle cerebral artery syndrome;
anterior cerebral artery syndrome;
posterior cerebral artery syndrome;
stem dysfunction syndrome;
cerebellar stroke syndrome.

According to the clinical course:

Preclinical period. Absolutely asymptomatic. It is very important at this stage to determine dyslipdemia (violation of fat metabolism), which will prevent vascular damage.
Latent period. Changes in the arteries can already be confirmed instrumentally, but the stability of the blood flow is still preserved - compensatory mechanisms are triggered.
Nonspecific clinical manifestations. At this stage, headaches, impaired memory and cognitive functions (the ability to concentrate and understand what is happening) and intermittent blindness appear. Emotional lability arises. Panic attacks, palpitations, lack of air, etc. are possible. Typically, such a patient is worried about exertional angina, arterial hypertension and other vascular pathologies.
Severe atherosclerosis. This stage is characterized by serious ischemic catastrophes: TIA or stroke. The patient is indicated for prompt medical attention, since a high degree of blockage of the vessel can be life threatening.

Non-stenosing versus stenosing type: what's the difference?

The difference between these two variants of the course of atherosclerosis is the degree of closure of the vessel with a plaque. With the non-stenosing type, it is up to 50%, with the stenosing type - more than half. Such a classification was introduced in order to determine the need for surgical intervention, but this does not mean at all that with a small blockage of the vessel, the patient does not require treatment, or nothing threatens his life. Even with a slight blockage of blood flow, the plaque can cause thrombosis, therefore, any atherosclerotic narrowing of the cerebral artery needs constant treatment and monitoring by a doctor at least once every 6 months.

Progressive atherosclerosis of the cerebral vessels

The term "progressive atherosclerosis" is usually used by doctors in case of rapid aggravation of arterial stenosis, which is often complicated by such processes as rupture, fragmentation of the plaque, and also hemorrhage into it. The emergence of such a diagnosis indicates the transition of the disease from the stage of specific clinical manifestations to severe atherosclerosis.

Atherosclerosis of the main arteries of the head

The main central vessels of the brain are called "trunk". Lipid damage to any of them causes deterioration or complete loss of many vital functions: sensitivity, movement, vision, hearing and others. Let's take a closer look at the syndromes (groups of signs) that are characteristic of each circulatory disorder in a particular artery.

Middle cerebral artery syndrome (ICD code G46.0):

Hemiparesis is muscle weakness in one of the halves of the body, such as movement disorders in the left arm and leg. Moreover, the severity of the symptom in the upper limb is much stronger than in the leg.
Hemihypesthesia is a violation of sensitivity in one of the halves of the body.
Hemianopsia is bilateral blindness in one eye (loss of the right and left visual fields).
Brachiocephalic syndrome - paresis of facial muscles on the side of the affected artery.
Prevost's syndrome is a contralateral paresis of the gaze (the eyes look in the opposite direction from paralysis of the limbs).
In case of defeat of the dominant (leading in a person) hemisphere, aphasia (speech impairment) is possible.

Anterior cerebral artery syndrome (ICD code G46.1):

Hemiparesis and hemihypesthesia are more pronounced in the leg.
Problems with urination.
Mental disorders, unreasonable aggression, memory impairment.

Posterior cerebral artery syndrome (G46.2):

Homonymous (on the same side) complete or quadrant hemianopsia (loss of vision in half of the visual field).
Gerstmann-Schilder syndrome: agnosia (inability to perceive) fingers (ours and others): lack of distinction between left and right, acalculia (cannot count) and agraphia (write).
Memory disorders.
Korsakov's syndrome.

Stem dysfunction syndrome (G46.3)

This includes many alternating syndromes (lesion on the left, and symptoms on the right, and vice versa), which are divided into 3 large groups depending on the level of localization of the pathological process.

Bulbar alternating syndromes:

Jackson's syndrome - peripheral paralysis / paresis of the muscles of the tongue (accompanied by its deviation from the median axis and twitching, as well as hemiparesis / paralysis on the opposite side.
Avelissa syndrome is unilateral paralysis of the palate and vocal cord and hemiparesis / paralysis on the opposite side.
Schmidt's syndrome - unilateral paralysis of the palate, pharynx and vocal cord, paresis / paralysis of the sternocleidomastoid and trapezius muscles (accompanied by a violent turn of the head), as well as central hemiparesis and / or hemihypesthesia on the opposite side.
Wallenberg-Zakharchenko syndrome - damage to pain and temperature sensitivity on one half of the face, dysfunction of the muscles of the palate and pharynx, a decrease in the general sensitivity of the body on the opposite side, Horner's syndrome (drooping of the eyelid, narrowing of the pupil, deep-set eyeballs), ataxia (unsteadiness when walking , loss of normal coordination of movements), dizziness.

Pontine alternating symptoms:

Miyard-Gubler syndrome is a peripheral unilateral paralysis of the facial muscles (paresis of the VII pair of cranial nerves) and hemiparesis on the opposite side.
Fauville's syndrome is a peripheral unilateral paresis of the facial muscles and the abductor muscles of the eye (inability to take one eye to the side), as well as hemiplegia / paresis on the opposite side.
Raymond Sestan's syndrome - paresis of the gaze and hemiataxia towards the focus, hemiparesis in the opposite half and impaired sensitivity according to the hemitype.
Brissot's syndrome is a unilateral spasm of the facial muscles and hemiparesis on the opposite side.
Gasperini's syndrome - homolateral paresis of the facial and trigeminal nerves (indicated by muscle paralysis and loss of sensation on one side), homolateral hearing impairment and hemihypesthesia in the opposite half.

Cerebellar stroke syndrome G46.4:

imbalance;
"Chanted" speech;
loss of coordination of movements;
tremor (shaking);
nystagmus;

Which doctor to contact

A patient with cerebral atherosclerosis is constantly monitored by a family doctor or therapist. They also need to be contacted at the first appearance of symptoms of pathology. The person will be assigned a list of tests and instrumental examinations for the correct diagnosis. After determining the patient's disease, every 6 months it is necessary to show it to a neurologist for an expert assessment of the condition.

Diagnostics: how to define cerebral atherosclerosis

To diagnose cerebral atherosclerosis, laboratory and instrumental examination methods are used. The first is aimed at determining the level of dyslipidemia and subsequent monitoring of the success of drug therapy. Hardware methods are used to search for plaques and localize stenosis, which is important for making a decision about surgical treatment.

Laboratory diagnostics of cerebral atherosclerosis

When determining pathology, doctors evaluate the following indicators (the range of norms is indicated in brackets):

triglycerides (0.41-1.8 mmol / l);
cholesterol (3.2 - 5.6 mmol / l);
HDL cholesterol (HDL): male (0.7 - 1.73 mmol / l) (0.86 - 2.28 mmol / l)
LDL cholesterol (LDL): male (2.25 - 4.82 mmol / l), women. (1.92 - 4.51 mmol / L)
Apoliprotein A1: male (1.05 - 1.75 mmol / l), women. (1.05 - 2.05 mmol / l)
Apoliprotein B: husband. (0.66 - 1.33 g / l) (0.6 - 1.17 g / l)
Atherogenic coefficient (2.2 - 3.5)

Instrumental examinations

High mortality and frequent disability of patients with cerebrovascular accidents stimulate medical science to constantly improve equipment. Let's talk about the modern approach to the definition of cerebral atherosclerosis.

Doppler ultrasonography of the vessels of the head

This examination belongs to ultrasound techniques. It will show the speed and symmetry of blood flow in the great arteries of the brain. This is not the most accurate diagnostic method, but it is quite simple, fast and safe. The error can be caused by a banal displacement of the sensor, therefore, two reports from different doctors on the same day can present different data, which will undermine a person's adherence to treatment.

CT angiography of cerebral vessels

This method is much more informative than the previous one. But, unfortunately, it is more expensive and has risks: an X-ray is used, which involves some exposure to radiation, and the contrast used can cause an allergic reaction. Also, you will not have this test until you bring a creatinine clearance blood test. The risk of "side effects" is not great: the dose of radiation exposure is minimal and is not capable of causing negative consequences once, and allergic reactions are extremely rare and can be successfully controlled with medications.

What kind of examination to pass to reliably determine the problem? The choice is up to the physician who has assessed your clinical picture. The routine use of CT angiography is often not justified. If a person does not have neurological complaints, and he does not go beyond the norm during the tests, then there will be no need for tomography. But if it is necessary to determine the lesion against the background of vivid symptoms, this examination becomes the standard of diagnosis.

MRI angiography of cerebral vessels

The method is based on the effect of a magnetic field. The technique involves the use of contrast, but the negative influence of X-rays is no longer there. Claustrophobia can be a problem - the patient needs to lie still in an enclosed space for 20 minutes. An obstacle to MRI will be the presence of metal prostheses, plates and electronics. The indications for examination are the same as for CT angiography.

Doctor's advice: preventive check-up

Let's imagine a middle-aged person (up to 45 years old) without risk factors (mentioned above). By standards, it does not require special testing in the absence of symptoms. When unfavorable circumstances appear / determine, doctors will advise him to take a lipid profile every two years. Confirmed diagnosis of cerebral atherosclerosis requires the determination of blood fats every 3 months.

Treatment: how to deal with the disease

Let's take a look at what treatment methods are offered by modern standards. They are based on the principles of evidence-based medicine.

Non-drug treatments

The pre-drug stage consists in changing the way of life to eliminate risk factors, more precisely in:

quitting smoking;
moderate alcohol consumption;
physical activity;
proper nutrition (Mediterranean diet);
fight stress;
the fight against excess weight.

Preparations for atherosclerosis of cerebral vessels

For effective treatment of cerebral atherosclerosis, it is necessary not only to correct lipid metabolism, but also to eliminate all possible diseases that damage the vessel wall. Most often, pathology arises in vulnerable places: bifurcations (bifurcations of arteries), bends. For many, it is combined with hypertension and diabetes, which aggravates the development of the disease. These pathologies cause disturbances in vascular tone and metabolism, which impairs the susceptibility of dyslipidemia to treatment. What do doctors prescribe for cerebral atherosclerosis according to the protocols, and what drugs are our patients waiting for?

Interference with cholesterol absorption

Angio-exchange resins. The class includes drugs that adsorb cholesterol. These include Cholestyramine and Gemfibrozil. The effect appears after a month of administration and persists for several weeks after the drug is discontinued.

Vegetable sorbents. These agents block the absorption of exogenous cholesterol in the intestine. They need a lot of fluids and sometimes cause dyspepsia. The representative of the group is the drug Guarem.

A c-CoA transferase blocker is a substance under development. High hopes are pinned on him in the medical community. The mechanism of action is to inhibit the capture of cholesterol from the intestines.

We must remember that 2/3 of cholesterol is produced by our body and the problem is not always an excessive intake of it from the outside.

Decreased synthesis of endogenous cholesterol and triglycerides

This class of drugs includes HMG-CoA reductase inhibitors or well-known statins. Their main representatives are Simvastatin, Lovastatin, Rosuvastatin, Atorvastatin. These drugs are very effective, but at the same time they cannot be widely used. They are prohibited for children, pregnant women, lactating people, people with liver damage. Among the most unpleasant side effects are rhabdomyolysis, myopathy, alopecia, impotence, and liver failure. This category of funds is included in the treatment protocols of most countries, being in the first line of recommendations.

Fibric acid derivatives - better known as fibrates: Tykor, Lipanor, Bezalip. Now it is recommended to use a new generation agent - Fenofibrate - or fenofibric acid derivatives. Often used for concomitant type II diabetes mellitus.

In severe dyslipidemia, it is possible to use a combination of a statin with fibrate.

Unsaturated fatty acids

This group includes substances that increase the breakdown of atherogenic lipids. Representatives: Omakor, Eikonol, thioctic acid preparations. The FDA (the leading American drug certification body in the United States) classifies these drugs as dietary supplements.

Endotheliotropic drugs

The manufacturers of these funds claim that they reduce the amount of cholesterol in the intima (the inner lining of the vessel). The range includes: Parmidin, Misoprostol, Policosanosis, vitamins A, E, C.

Science does not stand still - scientists are working to find new drugs for the treatment of atherosclerosis. Cyclodextrin, which dissolves cholesterol crystals in experiments, is considered promising. AEM-28 also made a lot of hype - a peptide capable of not only surprisingly quickly lowering the level of atherogenic lipoproteins and triglycerides, but also having an anti-inflammatory effect. Perhaps the solution will be drugs that inhibit the translation of apolipoprotein mRNA - the stakes are very high.

Recovery of memory and cognitive abilities

None of the existing drugs have shown high efficacy in the treatment of vascular dementia, which is responsible for the loss of cognitive functions and memory. A person and his relatives should understand that such a diagnosis means the death of a part of the brain. This entails an irreversible limitation of the patient in something. The main task is the care and prevention of ischemia - taking pills for pressure, blood thinners. As for help: here time is the best healer. Neuroplasticity has not been canceled, although in old age the processes of neuronal recovery are not so active, but every day new connections are created in the brain. And only full-fledged stable rehabilitation can speed up this process.

In the medical environment, the use of memantine and cholinesterase inhibitors is very popular, but, I repeat, studies prove their low efficiency and economic inexpediency. These agents are indicated for the combination of vascular dementia with Alzheimer's disease.

Relief of symptoms

Headaches are relieved by non-steroidal anti-inflammatory drugs. The most popular of them are: Aspirin, Ibuprofen, Paracetamol. With an increase in intracranial pressure (which is not uncommon in vascular dementia), Diacarb can be used.

To eliminate dizziness, Betaserc or Dimenhydrinat can be used. If the condition worsens, we recommend that you immediately consult a doctor for a consultation - this symptom can be life-threatening.

For tinnitus (tinnitus), doctors often use Phenibut, which relieves anxiety and dizziness. Sometimes, stable extraneous tinnitus can be a sign of an aneurysm.

Continuous tablets

On a stable basis, drugs are used for the permanent treatment of cerebral atherosclerosis:

to correct lipid metabolism;
to lower blood pressure - see the list of medicines here;
for the treatment of diabetes.

The list of drugs can be supplemented depending on the presence of concomitant diseases. A person with cerebral atherosclerosis should be compensated. This means that he needs to receive pills for all chronic pathologies in order to remain in a stable condition.

Is there a surgical treatment

Endovascular surgery is used to treat atherosclerosis of the brain. They consist in inflating the narrowing site with a special balloon and placing a stent (spring), which will prevent the vessel from narrowing. Stents vary in composition and cost. Cheap designs carry the risk of re-clogging. The technique is relevant for:

severe stenosis, when more than half of the vessel lumen is closed by a plaque;
inability to improve the patient's quality of life with medication;
no contraindications.

How can the patient's quality of life be improved, and what is the prognosis

A team of specialists should work on the patient's social and physical recovery: a rehabilitation therapist, therapist, and a neurologist. It is imperative to modify the patient's lifestyle: proper nutrition and daily activity are of enormous importance, along with the constant intake of the necessary medications.

The course of atherosclerosis and its prognosis are influenced by many factors. This pathology is a kind of bomb that, having exploded, leaves some of the vital organs (heart attack, stroke) without power. A person in certain cases can live for years with severe dementia. And sometimes a sudden heart attack knocks down a young, able-bodied man. It is important to understand that only a healthy lifestyle is the only way to happily meet old age, and if the disease overtook you, treat it correctly.