Disturbance of cerebral circulation

Description:

Cerebral circulation is a blood circulation which arises in system of vessels of a head and spinal cord. At the pathological process causing disturbances of cerebral circulation the main and brain arteries (an aorta, a brachiocephalic trunk, and also the general, internal and outside sleepy, vertebral, subclavial, spinal, basilar, radicular arteries and their branches), brain and jugular veins, venous sine can be affected. On character pathology of vessels of a brain happens various: thrombosis, embolism, excesses and looping, narrowing of a gleam, aneurism of vessels of a head and spinal cord.

Symptoms of Disturbances of cerebral circulation:

Clinically at disturbances of cerebral circulation there can be subjective feelings (a headache, dizziness, paresthesias, etc.) without objective neurologic symptoms; organic microsymptomatology without accurate symptoms of loss of the TsNS function; focal symptoms: motive disturbances - paresis or paralyzes, extrapyramidal disorders, hyperkinesias, lacks of coordination, disorders of sensitivity, pain; disturbances of functions of sense bodys, focal disturbances of the highest functions of bark of a great brain - aphasia, agraphia, an alexia, etc.; changes of intelligence, memory, emotional and strong-willed sphere; epileptic seizures; psychopathological symptomatology.

On the nature of disturbances of cerebral circulation allocate initial manifestations of insufficiency of blood supply of a brain, acute disorders of cerebral circulation (passing disturbances, the subshell hemorrhages, strokes), the chronic slowly progressing disturbances of cerebral and spinal blood circulation (distsirkulyatorny encephalopathy and a myelipathy).

Clinical symptoms of initial manifestations of insufficiency of blood supply of a brain are appearing, especially after hard mental and physical activity, stay in the stuffy room, the headache, dizziness, noise in the head, decrease in working capacity, a sleep disorder. The focal neurologic symptomatology at such patients, as a rule, is absent or is presented by scattered microsymptoms. Diagnosis of initial manifestations of insufficiency of blood supply of a brain requires identification of objective symptoms of atherosclerosis, arterial hypertension, vasculomotor dystonia and an exception of other somatic pathology, and also neurosis.

Refer passing disturbances of blood circulation in a brain to acute disorders of cerebral circulation and strokes.

Passing disturbances of cerebral circulation are shown by the focal or all-brain symptoms (or their combination) proceeding less than 1 days. Most often they are observed at atherosclerosis of vessels of a brain, an idiopathic hypertensia and at arterial hypertension.

Distinguish the tranzitorny ischemic attacks and hypertensive cerebral crises.

The Tranzitorny ischemic attacks are characterized by emergence of focal neurologic symptomatology (weakness and numbness of extremities, difficulty of the speech, disturbance of a statics, a diplopia, etc.) against the background of poorly expressed or absent all-brain symptoms.

Dominance of all-brain symptoms (headache, dizziness, nausea or vomiting) over focal which can sometimes be absent, on the contrary, is characteristic of hypertensive cerebral crises. The acute disorder of cerebral circulation at which the focal neurologic symptomatology remains more than 1 days is considered a stroke.

In a brain carry to acute disorders of venous blood circulation also venous hemorrhages, thrombosis of brain veins and venous sine.

Chronic disturbances of cerebral circulation (distsirkulyatorny encephalopathy and myelipathy) are result of the progressing insufficiency of blood supply caused by various vascular diseases.

At distsirkulyatorny encephalopathy scattered organic symptoms usually in combination with memory disturbance, headaches, not rotatory vertigo, irritability, etc. come to light. Allocate 3 stages of distsirkulyatorny encephalopathy.

For the I stage, except scattered unsharply expressed rack of organic symptomatology (asymmetry of a cranial innervation, easy oral reflexes, inaccuracy of coordination, etc.), existence of a syndrome similar to an asthenic form of a neurasthenia is characteristic (a memory impairment, fatigue, absent-mindedness, difficulty of switching from one activity to another, stupid headaches, not rotatory vertigoes, a bad dream, irritability, tearfulness, the suppressed mood). The intelligence at the same time does not suffer.

The progressing memory impairment (including professional), decrease in working capacity, change of the personality (viscosity of a thought, narrowing of a focus of interest, apathy, often loquacity, irritability, unsociability, etc.), decrease in intelligence is characteristic of the II stage. Day drowsiness at a bad night dream is typical. Organic symptoms are clearer (an easy dysarthtia, reflexes of oral automatism and other pathological reflexes, a bradykinesia, a tremor, change of a muscle tone, coordination and sensitive frustration).
The III stage is characterized as weighting of mental disturbances (up to dementia), and development of the neurologic syndromes connected with preferential defeat of a certain area of a brain. It can be pseudobulbar paralysis, parkinsonism, a cerebellar ataxy, pyramidal insufficiency. The coming aggravations of symptoms which are characterized by emergence of new focal symptoms and strengthening of earlier being available signs of cerebrovascular insufficiency are frequent insultoobrazno.

The Distsirkulyatorny myelipathy also has the progressing current in which it is conditionally possible to allocate three stages. The I stage (compensated) is characterized by emergence of moderately expressed fatigue of muscles of extremities, is more rare weakness of extremities. In the subsequent in the II stage (subcompensated) weakness in extremities progressively increases, disturbances of sensitivity on segmented and conduction type, changes in the reflex sphere appear. Paresis or paralyzes, the expressed sensitivity disturbances, pelvic frustration develop in the III stages.

Character of focal syndromes depends on localization of the pathological centers on a longitudinal axis and diameter of a spinal cord. Possible clinical syndromes are poliomiyelitichesky, pyramidal, siringomiyelicheskiya, an amyotrophic side sclerosis, zadnestolbovy, cross damage of a spinal cord.

Refer the venous stagnation causing venous encephalopathy and a myelipathy to chronic disturbances of venous blood circulation. It is a consequence cordial or a pulmonary heart, a prelum of extracranial veins in a neck, etc. Difficulties of venous outflow from a head cavity and the vertebral channel can is long to be compensated; at a decompensation headaches, convulsive attacks, cerebellar symptoms, dysfunctions of cranial nerves are possible. Venous encephalopathy is characterized by a variety of clinical manifestations. The gipertenzionny (pseudo-tumorous) syndrome, a syndrome of scattered melkoochagovy damage of a brain, an asthenic syndrome can be observed. Carry to venous encephalopathy also a bettolepsy (tussive epilepsy) developing at the diseases resulting in venous stagnation in a brain. The venous myelipathy is private option of a distsirkulyatorny myelipathy and clinically significantly does not differ from the last.

Reasons of Disturbances of cerebral circulation:

High arterial pressure is the main reason for a hematencephalon. At its sharp rise there can come the rupture of a vessel, a blood exit in substance of a brain is a consequence of what and the intracerebral hematoma develops.

More rare reason of hemorrhage - a rupture of aneurism. The arterial aneurism relating, as a rule, to inborn pathology represents meshotchaty protrusion on a vascular wall. Walls of such protrusion have no so powerful muscular and elastic framework what have walls of a normal vessel. Therefore sometimes it is enough only rather small jumping up of pressure which is observed at quite healthy people at an exercise stress or emotional pressure that the wall of aneurism became torn.

Along with meshotchaty aneurisms also other congenital anomalies of vascular system creating threat of an accidental hemorrhage are sometimes observed.
When aneurism is located in walls of the vessels which are on the surfaces of a brain, a gap it leads to development not of the intracerebral, but subarachnoid (subarachnoidal) hemorrhage which is located under the arachnoid membrane surrounding a brain. Subarachnoidal hemorrhage directly does not lead to development of focal neurologic symptoms (paresis, disturbances of the speech, etc.), but at it all-brain symptoms are expressed: a sudden sharp ("knife-like") headache, it is frequent with the subsequent loss of consciousness.

The heart attack of a brain develops usually owing to obstruction of one of brain vessels or a big (main) vessel of the head on which blood to a brain inflows.

Main vessels four: right and left internal carotid arteries, krovosnabzhayushchy the most part of the right and left cerebral hemisphere, both right and left vertebral the arteries merging then in the main artery and the brainstem supplying with blood, a cerebellum and occipital shares of cerebral hemispheres.

The reasons of obstruction of the main and brain arteries can be different. So at inflammatory process on heart valves (with formation of infiltrates or at formation of pristenochny blood clot in heart) pieces of blood clot or infiltrate can come off and with a blood flow to come to a brain vessel which caliber is less than the size of a piece (embolus) and thereof to cork a vessel. Particles of the breaking-up atherosclerotic plaque on walls of one of the main arteries of the head can become emboluses also.

Such is one of mechanisms of development of a heart attack of a brain - embolic.
Other mechanism of development of a heart attack - tromboticheskiya: gradual development of blood clot (a blood clot) in the location of an atherosclerotic plaque on a vascular wall. The atherosclerotic plaque filling a vessel gleam leads to delay of a blood-groove that promotes development of blood clot. The uneven surface of a plaque favors in this place to pasting (aggregation) of thrombocytes and other elements of blood that makes the main framework of the formed blood clot.

As a rule, one local factors for formation of blood clot are often not enough. Development of thrombosis is promoted by such factors as the general delay of a blood-groove (therefore fibrinferments of brain vessels contrary to embolisms and hemorrhages usually develop at night, in a dream), increase in coagulability of blood, increase in the aggregation (sticking together) properties of thrombocytes and erythrocytes.

What is coagulability of blood, on experience knows everyone. The person cut accidentally a finger, from it blood begins to flow, but gradually on site a cut the blood clot (blood clot) is formed and bleeding stops.
Coagulability of blood - the necessary biological factor promoting our survival. But the coagulability both lowered, and increased threatens our health and even our life.

The increased coagulability leads to development of thromboses, lowered - to bleedings at the slightest cuts and bruises. Hemophilia - the disease which is followed by the lowered coagulability of blood and having hereditary character many members of reigning surnames of Europe and among them the son of the last Russian emperor Crown Prince Alexey had.

Treatment of Disturbances of cerebral circulation:

Thrombolysis: medicamentous recovery of passability of the vessel corked with blood clot. At the beginning it is necessary to exclude hemorrhagic defeat.
Control of such vital functions as blood pressure, breath, functions of kidneys in the conditions of an intensive care.
Anticoagulants: medicamentous failure of an intravascular blood coagulation to prevent development of the IDCS. Remedial gymnastics and physiotherapy exercises for recovery of the broken functions of an organism (paresis, paralyzes).