Chronic disorders of cerebral circulation - Causes, symptoms and treatment. MF.

Chronic disorders of cerebral circulation - discirculatory encephalopathy is a slowly progressing cerebrovascular insufficiency, cerebral circulatory insufficiency, leading to the development of many small-focal necroses of brain tissue and impairment of brain functions.

Symptoms of cerebral circulation disorder

The human brain is a unique organ that controls the center of all possibilities of the human body. The work of brain cells( neurons) requires a significant expenditure of energy, which the brain receives through the circulatory system. Features of the structure and anastomosis of the brain arteries forming a closed circle circle provide unique blood circulation in the "command post" and the intensity of metabolic processes.

Due to circulatory disorders( more often with atherosclerotic vascular lesions), a disparity exists between the need and delivery of blood to the brain. In this situation, for example, even a slight change in blood pressure can lead to the development of ischemia of the region of the brain supplied with the affected vessel and then through a whole chain of biochemical reactions to the death of neurons.

Development of clinical manifestations of discirculatory encephalopathy occurs as a result of deficiency of blood supply to the brain in hypertension, atherosclerotic damage of blood vessels, rheology of blood, as a consequence of craniocerebral trauma, intoxication, dysmetabolic disorders( for example, diabetes mellitus).

Insufficiency of cerebral circulation leads to metabolic, and subsequently to destructive changes of neurons( brain cells).Over the years, the disease is aggravated both qualitatively and quantitatively.

If the cerebrostenic syndrome is leading in the initial stages of chronic circulatory insufficiency, fatigue, emotional instability, absent-mindedness, sleep disturbances, headaches, dizziness, loss of memory for current( unprofessional) events, when the disease progresses, motor disruptions, a sharp memory loss,there are cerebral crises - from transitory transient attacks to strokes.

In the second stage of chronic cerebral circulatory insufficiency, all types of memory progressively worsen, personal changes occur - there is uncertainty, irritability, anxiety, depression, intellectual decline, the volume of perception of information decreases, attention is diminished, criticism is reduced to its condition, daytime drowsiness occurs,pain, increased dizziness and shakiness when walking, there is a noise in the head. Upon examination, the neurologist will notice the poverty of mimic reactions - hypomia, symptoms of oral automatism, the symptoms of pyramidal and extrapyramidal insufficiency. The work capacity and social adaptation of a person are significantly reduced.

With the progression of the disease( the third stage), it is possible to develop dementia( dementia), extrapyramidal insufficiency syndrome( Parkinsonian syndrome), pseudobulbar syndrome, vestibulo - atactic syndrome, gross focal lesions that lead to disability of patients.
Disorders of the psyche are characterized by intellectual-mnestic disorders - the patients are reduced to criticism to their condition, memory is reduced - they can get lost when they leave the house, do not recognize relatives, are poorly oriented or orientated in place and time, current events, behavior changes and allthe personality of a person is dementia.

Syndrome of extrapyramidal insufficiency - Parkinsonian syndrome - mimic emotional movements fade away, gait is broken - the patient walks slowly, with small "shuffling" steps, bending over, there is stiffness of movements, tremor of the head, arms, muscle tone increases.

Pseudobulbar syndrome is a violation of swallowing - patients are poppered, speech - greased, letters and words are replaced, dysphonia appears, patients can cry or laugh involuntarily, symptoms of oral automatism appear - the neurologist determines. For example, when you touch the hammer with your lips, they stretch out into the tube - the proboscis reflex.

Vestibulo - atactic syndrome - a disturbance of balance, statics and dynamics - dizziness, unsteadiness in standing and walking, imbalance, it is possible to "throw" in the sides and fall.

At this stage, patients suffer acute brain disasters - ischemic and hemorrhagic strokes.

Brain blood flow examination

For diagnostics matters:

• the presence of vascular disease for a number of years - hypertension, atherosclerosis, blood diseases, diabetes mellitus;
• characteristic complaints of the patient;
• Neuropsychological data - the MMSE scale is most common for detecting cognitive impairment( normally it is necessary to score 30 points by performing the proposed tests);
• examination of the oculist, who detected signs of angiopathy on the fundus;
• Duplex scanning data - the possibility of neuroimaging of atherosclerotic lesions of cerebral vessels, vascular malformations, venous encephalopathy;
• Magnetic resonance imaging data - detection of small hypodensitive foci in periventricular spaces( around the ventricles), zones of leukariasis, changes in liquor-containing spaces, signs of brain cortex atrophy and focal( post-stroke) changes;
• blood tests - general, for sugar, coagulogram, lipidogram.

Vascular diseases of the brain occupy a leading place in the structure of morbidity and mortality in developed countries. The earliest treatment helps maintain the main structural unit of the brain - the neuron. The dead neuron can not be resurrected .It remains to hope for the plasticity of brain cells, that is, the possibility of activation of "sleeping" neurons, the inclusion of compensatory mechanisms. .. more simply - the surviving neurons should try to "take over" the functions of the dead. This is very problematic. Therefore, all efforts should be directed at preventing the death of brain cells. Please treat your brain with due attention. Repeated headache, dizziness, increased blood pressure, violation of intellectual activity - even just distraction should lead you to a neurologist.

Treatment of cerebral circulation disorders

Treatment should be aimed at normalization of tissue cerebral blood flow, stimulation of neuronal metabolism, protection of brain neurons from factors of hypoxia, treatment of the main vascular disease.

Antihypertensive therapy - one of the most effective and important areas of prevention of the development of circulatory disorders of the brain. As non-drug therapies for arterial hypertension, effective use of table salt and alcohol is effective, reducing excess body weight, dieting, increased exercise, and a quiet lifestyle.

Application of phytotherapy is possible. It is recommended to take hawthorn infusion for ¼ cup 4 times a day before meals( 1 tablespoon of hawthorn flowers per 1 cup of hot water, 2 hours for infusion), valerian extract 2 tablets 2 to 3 times a day, medicinal fee: motherwort herb - 3 parts(3 tablespoons), flowers of hawthorn - 3 parts, flower baskets of chamomile - 1 part( 1 tablespoon of the mixture to insist 8 hours in 1 cup of boiling water, strain, take 1/2 cups 2 times a day 1 hour after meals).

But this is in addition to the medicines that are individually selected for each patient by the therapist with the condition that the constant intake of an antihypertensive drug at a minimum dosage will keep normal blood pressure figures. From the patient, hypertension requires regular medication and blood pressure monitoring. This will be both the treatment of hypertension and the prevention of stroke and re-stroke and dementia.

Increased cholesterol and low density lipoprotein in the blood serum, although not in itself correlated with the development of brain accidents, but largely affects the vascular lesions and the development of atherosclerosis and atherostosis. Therefore, people at risk must comply with a diet that restricts the consumption of cholesterol and saturated fatty acids, increase the consumption of fatty fish, seafood, low-fat dairy products, fruits and vegetables. If the diet does not reduce hypercholesterolemia prescribe drugs of the statin group - simvatin, torvakard, vabadin, atorvakor, lymer. With the development of atherosclerotic stenosis of carotid arteries up to 70 - 99% of the diameter, surgical treatment is performed - carotid endarterectomy in specialized centers. Patients with a degree of stenosis up to 60% are recommended conservative treatment with antiplatelet drugs.

For the treatment of neurological manifestations of chronic cerebral circulatory insufficiency, vasoactive drugs, drugs for improving microcirculation, neuroprotectors, antioxidants, sedatives, venotonics, B vitamins, E.

Widely used are glycine, cerebrolysin, somasin and ceraxone, piracetam preparations with a dosage of 2400 per day, solcoseryl and actovegin, mildronate, instenone, cavinton( vinpocetine, oxybral), ginkgo biloba( memoplant, ginkofar, tanakan), sermion( nitserium), betaserk( vestnorm, betagis), vasocet( venoplant, detraleks, lysine), meme, almer. These drugs are chosen by a neurologist physician individually depending on the stage of the disease and the severity of the symptoms.

Climatotherapy, psychotherapy, reflexotherapy, aromatherapy, hirudotherapy, sedative phyto-tea are useful.

Reflexotherapy - acupuncture is used to normalize the nervous system, cardiovascular. Used and classical acupuncture and auriculotherapy( acupuncture on the auricle) and su-dzhok( acupuncture on the hands).

Aromatherapy - "smell treatment", is the use of natural essential oils. For example, geranium can calm or arouse, depending on the situation and individual characteristics of a person, bergamot, lemon, lemon, sandal - soothe the nervous system, jasmine, ylang-ylang relieve emotional overexcitation. The smell of tangerine has an antidepressant effect.

Hirudotherapy - treatment with leeches - is used for hypertension, atherosclerosis, varicose veins, thrombophlebitis, insomnia, chronic fatigue syndrome. Hirudin, contained in the saliva of leeches improves the rheological properties of blood - "fluidity."This leads to an improvement in microcirculation, normalization of metabolic processes in tissues, a decrease in hypoxia, an increase in immunity, and a drop in blood pressure.

Hirudotherapy

With sedative purpose in hypertensive disease, oxygen and coniferous baths are used on fresh and sea water.

All patients with dyscirculatory encephalopathy should be on a dispensary record with a neurologist, should be examined and regularly inspected and undergo permanent or course treatment.
It is possible to have a sanatorium treatment.

In time, diagnosed discirculatory encephalopathy and properly selected complex treatment prolong active, full-fledged life.

Consultation of a doctor on the topic Chronic cerebrovascular accident

Question: Which sanatoria are indicated for discirculatory encephalopathy of stage 1?
Answer: sanatoriums for patients with cardiovascular and nervous system diseases are shown. In Ukraine, there are sanatoriums in Odessa, the Crimea, Berdyansk, Poltava - "Azure", "Berdyansk", "Grove", "Chervona Kalina". .. In Russia - sanatoriums of the Moscow region - Barvikha, Valuyevo, Mikhailovskoye, "Pines", the sanatorium "Kolos" of the Kostroma region, the sanatorium named after Vorovsky of the Yaroslavl region, the sanatoriums of Kislovodsk, Yessentuki, Yekaterinburg, Baikal. .. Sanatoriums of the Riga seashore. Slovenia - Rogaška Slatina, Czech Republic - Mariánské Lázně, Jáchymov, Hungary - Heviz resort Hungary, Bulgaria - Velingrad resort, Sandanski. In principle, with diseases of the cardiovascular system, it is not useful to change the climate zone abruptly, therefore there are sanatoriums in each climatic zone, suburbs of regional centers, around natural water basins.

Question: After a stroke, my doctor told me that I will have to constantly drink medicine. True?
Answer: true. As a prevention of recurrent stroke, basic therapy is prescribed, which must be taken continuously: antiaggregants, antihypertensives, statins. Preparations and dosages are individually prescribed by a doctor. In addition, the courses are treated with vascular drugs, antioxidants, neuroprotectors, vitamins, antidepressants, tranquilizers. .. depending on the clinical manifestations and the stage of encephalopathy.

Question: what is it and how is the MMSE scale evaluated?
Answer: this is a scale for assessing the patient's mental status.

Assay	Estimate
1. Time Orientation: What is the date( day, month, year, day of the week, time of year)	0 - 5
2. Orientation in place: Where are we? Country, Region, City, Clinic, Floor.	0 - 5
3. Perception: Repeat three words: pencil, house, penny	0 - 3
4. Concentration and account: Serial account( "from 100 take away7 ") - five times either: Say the word" earth "on the contrary	0 - 5
5. memory Remember 3 words( see point 3)	0 - 3
6. Speech: We show the pen and watch, we ask:"How is this called?" We ask you to repeat the sentence: "No if, and or but"	0 - 2
Execution of the 3-step command: "Take the rightand fold it on the table »	0 - 1
Read:" Read and execute " 1. Close the eyes of 2. Write the
proposal 3. Draw the drawing	0 - 3
Generalscore:	0-30

30-28 points - norm, cognitive impairment is absent
27 - 24 points - cognitive impairment
23 - 20 points - dementia of mild severity
19 - 11 points - moderate degree of dementia
10 - 0scores - severe dementia

Question: how can I improveknead?
Answer: you need to constantly "use the brain" - read, remember, retell, solve crossword puzzles. .. Improve cerebral activity - cerebrolysin, glycine, piracetam, pramistar, memoplant, somazine. With dementia - meme, almer.

Doctor neurologist Kobzeva S.V.