Cerebrovascular disease refers to a group of conditions that affect the supply of blood to the brain, causing limited or no blood flow to the affected areas.
There are a number of ways in which cerebrovascular disease can develop, one of the most common is atherosclerosis.
Atherosclerosis is where high cholesterol levels, coupled with inflammation in the arteries of the brain, cause cholesterol to build up in the vessel as a thick, waxy plaque.
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Fast facts on cerebrovascular disease
Here are some key points about cerebrovascular disease. More detail and supporting information is in the main article.
- Cerebrovascular disease is a generic term for a group of conditions
- Early in a cerebrovascular attack, the individual may have communication deficits
- Symptoms due to cerebral hemorrhage include a severe headache that comes on quickly
- A stroke is a medical emergency, and 911 should be called immediately
What is cerebrovascular disease
The most common forms of cerebrovascular disease are:
Cerebral thrombosis - a blot clot/plaque that forms in the brain's blood supply
Cerebral embolism - blood flow is blocked by a clot or air bubble that traveled from somewhere else in the body
Cerebral hemorrhage - escaping of blood from a ruptured blood vessel
Another form of cerebrovascular disease involves aneurysms (a swelling of the artery wall). Weak parts in arteries can develop protrusions with a very thin wall, which can tear and cause brain bleeding. Females with defective collagen can be especially susceptible.
Aneurysms can also occur with defective capillaries caused by cholesterol deposits, especially in people with hypertension (high blood pressure). If bleeding occurs in this process, it can result in a stroke.
Cerebrovascular disease primarily affects people who are elderly or have a history of diabetes, smoking, high blood pressure, or ischemic heart disease.
Symptoms of cerebrovascular disease
Symptoms of cerebrovascular disease vary depending on a number of factors.
The signs and symptoms of cerebrovascular disease depend on the location of the hemorrhage, thrombus, or embolus and the extent of cerebral tissue affected.
General signs and symptoms of a hemorrhagic or ischemic event include motor dysfunction, such as hemiplegia (paralysis of one side) and hemiparesis (weakness on one side of the body).
Early in a cerebrovascular attack (CVA), the patient may experience weakness (flaccid paralysis), followed by increased muscle tone and spasticity. They may lose their gag reflex or ability to cough.
Communication deficits may also occur, such as:
- Dysphagia - difficulty or discomfort in swallowing
- Aphasia - difficulty putting thoughts into words
- Dysarthria - difficulty articulating speech or slurred speech
- Apraxia - difficulty planning or performing tasks
They may develop spatial and perceptual deficits, such as the loss of half of their visual field (homonymous hemianopia) and the inability to recognize an object (agnosia).
Other signs and symptoms of a CVA may include:
- Confusion that leads to a complete loss of consciousness
- Labored or irregular breathing
- Apnea - pauses in breathing
- Bowel and bladder incontinence
Symptoms due to cerebral hemorrhage (brain bleeding)
Signs and symptoms due to a hemorrhagic CVA may include a severe headache that develops quickly, nuchal rigidity (stiff neck), and hemiplegia, as well as some of the other symptoms listed above. As the hematoma (blood clot) gets larger, the patient's neurologic symptoms may worsen, causing loss of consciousness.
Strokes are medical emergencies. If you notice any of these symptoms in yourself or someone around you, call 911 right away. In a stroke, time is brain!
Causes of cerebrovascular disease
Ischemic stroke occurs when a blood vessel that supplies blood to the brain is blocked by a blood clot or plaque. A clot may form in an artery that is already very narrow; this is called a thrombus. If the thrombus results in the death of brain cells, this is called a stroke.
Alternatively, a clot may break off from somewhere else in the body and travel up to the brain to block a smaller artery; this is called an embolism and may cause an embolic stroke. This condition is more common in people who have arrhythmias, such as atrial fibrillation.
Ischemic stroke can be caused by a tear in the lining of the carotid artery.
Certain drugs and medical conditions can make the blood more likely to clot and raise the risk of ischemic stroke.
A common cause of ischemic stroke in people under age 40 is a tear in the lining of the carotid artery. The tear lets blood flow between the layers of the carotid artery.
This causes narrowing of the carotid artery and reduced blood flow to the brain.
Hemorrhagic stroke occurs when a blood vessel in part of the brain becomes weak and bursts open, causing blood to leak into the skull and put pressure on the brain.
Some people have defects in the blood vessels of the brain that make this more likely. The flow of blood that occurs after the blood vessel ruptures damages brain cells.
Major risk factors that individuals have control over include hypertension, smoking, obesity, and diabetes.
Diagnosing cerebrovascular disease
A doctor may use a stethoscope to detect abnormal sounds of blood flow (called bruit) on the neck. However, in severe cases of atherosclerosis, the bruit is less common.
A physician may look for specific neurological, motor, and sensory deficits such as changes in vision or visual fields, abnormal reflexes, abnormal eye movements, muscle weakness, decreased sensation, and other changes.
A cerebral angiography, vertebral angiogram, or carotid angiogram are also sometimes used. In these procedures, dye is injected into the arteries to visualize the size and shapes of the arteries, and to look for clots.
CAT scan - used to diagnose and detect hemorrhagic strokes, because blood, bone, and brain tissue can be easily told apart. It is important to note that damage from ischemic stroke sometimes cannot be detected by this scanning method, especially early on.
MRI scan - more sensitive for detecting strokes, especially early strokes.
EKG - may be used to see if there is a cardiac arrhythmia present, which is a risk factor for embolic strokes.
Treatment options for cerebrovascular disease
In the case of an acute stroke, a medication called tPA (tissue plasminogen activator) may be given. This medication breaks up the blood clot.
A stroke is a medical emergency and should be evaluated immediately when symptoms occur by calling 911.
Some medications for stroke can only be given within a certain time period from the start of the symptoms, so time is of the essence.
Blood platelet inhibitors including Aspirin, Dipyridamole, Ticlopidine, and Clopidogrel, are effective in reducing the risk of stroke. These drugs are also used in treating patients with a history of stroke or patients at risk of a stroke event.
Cholesterol-lowering medications, called statins, are typically given for cerebrovascular disease to reduce risk of ischemic stroke.
Carotid endarterectomy is a procedure where an incision is made into the carotid artery, and the plaque is removed allowing the blood to flow again. Then the artery is repaired with sutures or a graft.
In carotid angioplasty and stenting, a balloon-tipped catheter is inserted into the artery; then the balloon is inflated so that it presses against the plaque, squashing it flat and reopening the artery. A tiny, slender metal mesh tube (stent) is fitted inside the carotid artery to improve the blood flow in the arteries blocked by plaque. The stent helps by preventing the artery from collapsing or closing up after the procedure is complete.
Brain bleeds must be evaluated by a neurosurgeon, who may do a procedure to reduce the pressure caused by the brain bleed.
Preventing Cerebrovascular Disease
Cerebrovascular disease can be best prevented by abiding by the following recommendations:
- Stop smoking
- Regular physical exercise
- Eat heart-healthy diet with a low fat content
- Maintain healthy weight
- Control blood pressure
- Lower blood cholesterol with diet and medications if necessary
- Individuals with heart arrhythmia should ask their doctor if they should be taking a blood thinner to prevent strokes