Система Orphus

Symptoms of disease - violation of cerebral circulation

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

A pathologic process, causing the disturbance of cerebral blood circulation can affect the transmission and cerebral artery (aorta, brachiocephalic trunk, General, internal and external carotid, subclavian, vertebrates, basilar, spinal, radicular artery and its branches), and cerebral veins and venous sinuses, the jugular veins. The nature of the pathology of the blood vessels in the brain is different: thrombosis, embolism, a narrowing of the lumen of the, kinks, and looping, aneurysm of vessels of the brain and spinal cord.

The severity and localization of morphological changes in the brain tissue of patients with disorders of cerebral circulation are determined by the main disease, pool of blood supply to the affected vessel, mechanisms of development of the circulatory disorders, age and individual peculiarities of a patient.

Morphological signs of disturbance of cerebral blood circulation can be focal and diffuse. The focal include hemorrhagic stroke, intrathecal hemorrhage, brain infarction; to diffuse multiple different nature and different prescription small focal change the substance of the brain, minor bleeding, small fresh and organize foci of necrosis of brain tissue,  scars and small cysts.

Clinically in violation of cerebral circulation can be subjective sensations (headache, dizziness, paresthesia, etc.) without objective of neurological symptoms; organic micro symptoms without clear symptoms of the loss function of the Central nervous system; focal symptoms: motor impairments - paresis or paralysis, ekstrapiramidnye disorders, hyperkinesis, coordination disorders, disorders of sensitivity, pain; violations of the functions of the organs of the senses, focal violations of the higher functions of the bark of a large brain - aphasia, agraphia, Alexis, etc.; changes intellect, memory, and emotional-volitional sphere; seizures; psychopathological symptoms.

By the nature of disorders of cerebral circulation allocate the initial manifestations of insufficient blood supply to the brain, acute violation of cerebral circulation (passing violations, intrathecal hemorrhage, stroke), chronic, slowly progressive violations of cerebral and spinal circulation (dyscirculatory encephalopathy and myelopathy).

Clinical symptoms of the initial manifestations of insufficient blood supply to the brain are emerging, especially after the intense mental and physical work, stay in a stuffy room, headache, dizziness, noise in the head, working capacity decrease, a violation of sleep. Focal neurological symptoms such patients, as a rule, is absent or is presented scattered micro symptoms. For the diagnosis of the initial manifestations of insufficient blood supply to the brain should be the identification of objective signs of atherosclerosis, arterial hypertension, vasomotor dystonia and the exclusion of other somatic pathology, as well as neurosis.

To the acute disturbances of cerebral blood circulation include passing of blood circulation in the brain and strokes.

Transient ischemic manifest focal or cerebral symptoms (or their combination), continued less than 1 day. Most often they are observed in atherosclerosis of the brain, hypertension and in arterial hypertension.

Distinguish between transient ischaemic attacks and hypertensive cerebral crisis.

Transient ischemic attacks are characterized by the emergence of focal neurological symptoms (weakness and numbness of the extremities, shortness of speech, violation of statics, diplopia, etc.) on the background of weakly expressed or missing cerebral symptoms.

For hypertensive cerebral crises, on the contrary, is characterized by the predominance of the cerebral symptoms (headache, dizziness, nausea, or vomiting) above focal, which sometimes may not be available. Acute violation of cerebral circulation, in which the focal neurological symptoms persist for more than 1 day., it is considered a stroke.

The acute disturbances of venous blood circulation in the brain also include arterial haemorrhage and thrombosis of the cerebral veins and venous sinuses.

Chronic violations of cerebral circulation (discirculatory encephalopathy and myelopathy) are the result of progressive insufficient blood supply caused by a variety of vascular diseases.

With discirculatory encephalopathy are identified dispersed organic symptoms usually in conjunction with a violation of memory, headaches, non-systemic dizziness, irritability, etc. Allocate 3 stage of discirculatory encephalopathy.

For stage I, except the scattered mild expressed persistent organic symptoms (asymmetry of the cranial nerves, and lungs oral reflexes, inaccuracies, coordination, etc.), characterized by the presence of the syndrome, similar to asthenic form of neurasthenia (memory loss, fatigue, distraction, the difficulty of switching from one activity to another, dull headaches, non-system dizziness, difficulty sleeping, irritability, tearfulness, depressed mood). Intellect when this does not suffer.

For stage II is typical progressive deterioration of memory (including professional), reduced efficiency, personality changes (viscosity thoughts, narrowing the circle of interests, apathy, often circumlocution, irritability, pugnaciousness, etc.), reduced intelligence. Typical daytime sleepiness in a bad night sleep. Organic symptoms are more pronounced (easy dysarthria, reflexes oral automatism and other pathological reflexes, micro bradykinesia, tremor, a change in muscle tone, coordination and sensitive disorders).
Stage III is characterized as a weighting of mental disorders (up to dementia), and the development of neurological syndromes associated with predominant lesion of a certain area of the brain. This can be pseudobulbar palsy, Parkinson's disease, cerebellar ataxia, a pyramid failure. Frequent stroke figuratively the upcoming deterioration of a condition characterized by the emergence of new focal symptoms and strengthening of the existing signs of cerebrovascular insufficiency.

Discirculatory myelopathy also has a progressive course, in which we can roughly distinguish three stages. Stage I (NiMH) is characterized by the moderate strain of muscles of the extremities, and rarely weakness of the limbs. Subsequently, at the second stage (subcompensated) weakness in the limbs progressively growing, there are violations of the sensitivity of the segmental and conductive type, changes in the reflex area. In the third stage of the developed paresis or paralysis, expressed violations of the sensitivity, pelvic disorders.

The nature of the focal syndromes depends on the localization of the pathological centers on log and the widths of the spinal cord. Possible clinical syndromes are poliomyelitis, piramydny, syringomyelia, amyotrophic lateral sclerosis, posterior pole, cross lesions of the spinal cord.

To chronic disturbances of venous blood circulation include venous congestion that causes osteoporosis encephalopathy and myelopathy. He is a consequence of cardiac or pulmonary-cardiac insufficiency, compression extracranial veins in the neck, etc. The difficulties of venous outflow from the cavity of the skull and spinal canal may long be compensated; the decompensation possible headaches, seizures apnoea, cerebellar symptoms, violations of the cranial nerves. Venous encephalopathy is characterized by a variety of clinical manifestations. There may be hypertensive (pseu-dotumor-like) syndrome, the syndrome of multiple microfocal brain damage, asthenic syndrome. To venous encephalopathy include cough syncope (laryngeal epilepsy), developing the disease, leading to venous stagnation in the brain. Venous myelopathy is a private option discirculatory myelopathy and clinically not significantly different from the last.



Which diseases there is violation of cerebral circulation

Causes of violations of cerebral circulation

The main cause of bleeding in the brain is high blood pressure. With his sharp rise may occur rupture of the vessel, the result of which is the output of blood in the substance of the brain and develops intracerebral a hematoma.

More rare cause of bleeding - the rupture of the aneurysm. Arterial aneurysm, attributable, as a rule, to congenital pathology is a sacculated protrusion on the side of the vessel. The walls of the bulge do not have such a powerful muscle and elastic frame, what is the normal vessel. Therefore, sometimes it is enough just to the relatively small jump of pressure, which is observed in completely healthy people with physical exertion or emotional stress, to the wall of the aneurysm rupture.

Along with sacculated aneurysms occasionally occur and other congenital anomalies of the circulatory system, creating a threat of a sudden hemorrhage.
In those cases, when the aneurysm is located in the walls of blood vessels, which are on the surface of the brain, break it leads to the development of not intracerebral, and subarachnoid (subarachnoid) hemorrhage, located under of a membrane surrounding the brain. Subarachnoid hemorrhage does not lead directly to the development of focal neurological symptoms (paresis, disorders of speech, etc.), but when it expressed cerebral symptoms: a sudden sharp («knife») headache, often with subsequent loss of consciousness.

Brain infarction usually develops due to blockage of one of the cerebral vessels or large (trunk) of a vessel of the head, in which the flow in the blood to the brain.

Main vessels are four: the right and the left internal carotid arteries, supplying most of the left and right hemisphere of the brain, and the right and left spinal artery, then merging into the main artery and thus increasing blood flow brain stem and cerebellum and the occipital lobes of the brain hemispheres.

Causes a blockage of the trunk and cerebral arteries can be different. So when the inflammatory process in heart valves (with the formation of infiltrates or in the formation of a wall surface blood clot in the heart) pieces of a blood clot or infiltrate can break off and with the blood flow to come to a brain vessel, the calibre of which is less than the size of the piece (embolus), and due to the sealed vessel. Embolus can become and particles decaying atherosclerotic plaques on the walls of one of the main arteries of the scalp.

This is one of the mechanisms of development of a heart attack brain - embolic.
Another mechanism of the development of heart attack - thrombotic: the gradual development of a thrombus (blood clot) in the location of the atherosclerotic plaque on the wall of the vessel. Atherosclerotic the plate, fill lumen of the vessel, leads to slower blood flow, which contributes to the development of a blood clot. The rough surface of the plaque favors in this place bonded (aggregation) of platelets and other elements of the blood, which constitutes the main frame of the forming blood clot.

As a rule, some local factors for the formation of a clot is often insufficient. The development of thrombosis by such factors, as a General slowing down of blood flow (and therefore thrombosis of cerebral vessels in contrast to the embolisms and bleeding usually develop at night, in a dream), increase in blood coagulability, increase of aggregation (adhesives) properties of thrombocytes and erythrocytes.

What is the coagulation of the blood, of the experience, everyone knows. Man accidentally cut your finger, it starts to pour blood, but gradually on the site of a cut formed a blood clot (thrombus) and the bleeding stops.
Blood clotting is a necessary biological factor contributing to our survival. But as decreased, and increased coagulation threatens our health, and even our very lives.

Increased coagulation of leads to the development of thrombosis, reduced - to bleeding at the slightest cuts and bruises. Hemophilia, a disease, accompanied by decreased blood clotting and having a hereditary character, suffered many members of the Royal families of Europe, and among them the son of the last Russian Emperor, Tsarevich Alexei.

Disruption of the normal blood flow can also be a result of spasm (strong compression) of a vessel, coming as a result of a sharp reduction of the muscular layers of the vascular wall. A few decades ago spasm attached great importance to the development of disorders of cerebral circulation. In the present with a spasm of the cerebral vessels associated mainly infarction of the brain, which can sometimes develop after a few days after subarahnoidalnogo bleeding.

With frequent elevation of blood pressure may develop changes in the walls of small blood vessels that feed the deep structure of the brain. These changes lead to a narrowing, and often the closing of the blood vessels. Sometimes after another sharp rise in arterial pressure (hypertension) in the basin of the circulation of such a vessel is developing a small heart attack (called in the scientific literature «lacunar» heart attack).

In some cases, myocardial brain can develop without full blockage of the vessel. This is the so-called hemodynamic stroke. Imagine a hose, from which you irrigate the garden. The hose is clogged with silt, but the electric motor, dropped in a pond, works well, and jets of water is enough for the normal irrigation. But enough small kink hose or degradation of performance of the engine, as instead of a powerful jet from a hose begins to flow a stream of water, which is clearly not enough to well-watered land.

The same may occur under certain conditions and with blood flow in the brain. It's enough of a two factors: a sharp narrowing of the lumen of the artery or cerebral vessel filling his atherosclerotic plaque or as a result of its inflection plus a fall in blood pressure, coming from the deterioration (often temporary) work of the heart.

The mechanism of transient disturbance of cerebral circulation (transistor ischemic attack) in many respects similar to the mechanism of development of a heart attack the brain. Only coping mechanisms during the transient disturbances of cerebral blood circulation work quickly, and developed the symptoms within a few minutes (or hours) disappear. But it is not necessary to hope, that the compensation mechanisms will be always so good to cope with the violation. Why it is so important to know the causes of the violation of cerebral circulation, that enables to develop methods of prevention (prophylaxis) of recurrent disasters.



Which doctor should I contact if there is a violation of cerebral circulation

  • Cardiologist
  • Therapeutist
  • Family doctor
  • Neurologist
  • Vascular surgeon (angiosurgeon)
  • Resuscitator


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