What to know about cerebrovascular disease
If a blockage, malformation, or hemorrhage prevents the brain cells from getting enough oxygen, brain damage can result.
Cerebrovascular disease can develop from a variety of causes, including atherosclerosis, where the arteries become narrow; thrombosis, or embolic arterial blood clot, which is a blood clot in an artery of the brain; or cerebral venous thrombosis, which is a blood clot in a vein of the brain.
In the United States, cerebrovascular disease is the fifth most common cause of death. In 2017, it caused 44.9 fatalities per 100,000 people or 146,383 deaths in total.
However, people can take steps to reduce their chances of developing cerebrovascular disease. In this article, we explain the symptoms, types, and treatments for these serious health problems and how to prevent them.
A cerebrovascular event can cause a severe and sudden headache.
The symptoms of cerebrovascular disease depend on the location of the blockage and its impact on brain tissue.
Different events may have different effects, but common symptoms include:
- a severe and sudden headache
- paralysis of one side of the body, or hemiplegia
- weakness on one side, also known as hemiparesis
- difficulty communicating, including slurred speech
- losing vision on one side
- loss of balance
- becoming unconscious
The American Stroke Association encourages public knowledge of the F.A.S.T. acronym as an aid in recognizing the warning signs of stroke and acting on them quickly:
- Face drooping
- Arm weakness
- Speech difficulty
- Time to call 911
Urgent medical attention is essential if anyone shows symptoms of a cerebrovascular attack because it can have long term effects, such as cognitive impairment and paralysis.
Stroke, TIA, and subarachnoid hemorrhage are types of cerebrovascular disease.
Aneurysms and hemorrhages might cause severe health problems. Blood clots can form in the brain or travel there from other parts of the body, causing a blockage.
Different types of cerebrovascular disease include:
Ischemic stroke: These occur when a blood clot or atherosclerotic plaque blocks a blood vessel that supplies blood to the brain. A clot, or thrombus, may form in an artery that is already narrow.
A stroke occurs when the lack of blood supply results in the death of brain cells.
Embolism: An embolic stroke is the most common type of ischemic stroke. An embolism occurs when a clot breaks off from elsewhere in the body and travels to the brain to block a smaller artery.
People who have arrhythmias, which are conditions that cause an irregular heart rhythm, are more prone to developing an embolism.
A tear in the lining of the carotid artery, which is in the neck, can lead to ischemic stroke. The tear lets blood flow between the layers of the carotid artery, narrowing it, and reducing blood supply to the brain.
Hemorrhagic stroke: This occurs when a blood vessel in part of the brain weakens and bursts open, causing blood to leak into the brain.
The leaking blood puts pressure on the brain tissue, leading to edema, which damages brain tissue. The hemorrhage can also cause nearby parts of the brain to lose their supply of oxygen rich blood.
Cerebral aneurysm or subarachnoid hemorrhage: These can result from structural problems in the blood vessels of the brain. An aneurysm is a bulge in the arterial wall that can rupture and bleed.
A subarachnoid hemorrhage occurs when a blood vessel ruptures and bleeds between two membranes surrounding the brain.
This leaking of blood can damage brain cells.
Here, learn more about a thrombus, which can lead to an embolism.
Cerebrovascular disease develops for a variety of reasons.
If damage occurs to a blood vessel in the brain, it will not be able to deliver enough or any blood to the area of the brain that it serves. The lack of blood interferes with the delivery of adequate oxygen, and, without oxygen, brain cells will start to die.
Brain damage is irreversible. Emergency help is vital to reduce a person's risk of long term brain damage and increase their chances of survival.
Atherosclerosis is a primary cause of cerebrovascular disease. This occurs when high cholesterol levels, together with inflammation in the arteries of the brain, cause cholesterol to build up as a thick, waxy plaque that can narrow or block blood flow in the arteries.
This plaque can limit or completely obstruct blood flow to the brain, causing a cerebrovascular attack, such as a stroke or TIA.
Diabetes is one risk factor for cerebrovascular disease.
Stroke is the most common type of cerebrovascular event.
The risk of stroke increases with age, especially if an individual or their close relative have previously had a cerebrovascular attack. This risk doubles every 10 years, between 55 and 85 years of age.
However, a stroke can occur at any age, even during infancy.
Factors that increase the risk of stroke and other types of cerebrovascular disease include:
- hypertension, which the American College of Cardiology define as blood pressure of 130/80 mm Hg or higher
- poor diet, and lack of exercise
- blood cholesterol levels of 240 milligrams per deciliter (mg/dl) or higher
The same factors increase a person's chances of a cerebral aneurysm. However, people with a congenital anomaly or have experienced head trauma may also be at higher risk of a cerebral aneurysm.
Pregnancy can also increase the chance of cerebral venous thrombosis, which is a blood clot affecting a vein in the brain.
Other risk factors of cerebrovascular disease include:
- Moyamoya disease, a progressive condition that can lead to a blockage of the cerebral arteries and their major branches
- venous angiomas, which affect around 2% of the U.S. population and rarely bleed or cause symptoms
- a vein of Galen malformation, an arterial disorder that develops in a fetus during pregnancy
Certain drugs and medical conditions can make the blood more likely to clot and increase the risk of ischemic stroke.
Hormone replacement therapy (HRT) may increase the risk of an attack in a person who already has atherosclerosis or carotid artery disease.
A cerebrovascular event requires emergency treatment. Rapid assessment and treatment are crucial because a person must receive stroke medications within a specific time from the onset of symptoms.
In the case of an acute stroke, the emergency team may administer a medication called tissue plasminogen activator (tPA) that breaks up the blood clot.
A neurosurgeon must evaluate an individual who has a brain hemorrhage. They may carry out surgery to reduce the increased pressure that a bleed causes.
A carotid endarterectomy involves making an incision in the carotid artery and removing the plaque. This allows the blood to flow again. The surgeon then repairs the artery with sutures or a graft.
Some people may require carotid angioplasty and stenting, which involves a surgeon inserting a balloon-tipped catheter into the artery. They will then inflate balloon so that it reopens the artery.
Afterward, the surgeon fits a slender, metal mesh tube, or stent, inside the carotid artery to improve blood flow in the previously blocked artery. The stent helps to prevent the artery from collapsing or closing up after the procedure.
As a cerebrovascular event can cause permanent brain damage, people may experience temporary or permanent disability following one.
For this reason, they may require a range of supportive and rehabilitative therapies so that they can retain as much function as possible.
These might include:
- Physical therapy: This aims to restore mobility, flexibility, and limb function.
- Speech therapy: This may help people communicate more clearly and regain speech after a stroke or cerebrovascular attack.
- Occupational therapy: This can help a person access facilities that support a return to work and daily life.
- Psychological therapy: Physical disability can create unexpected emotional demands and require intensive readjustment. A person might benefit from visiting a psychiatrist, psychologist, or counselor after a cerebrovascular event if they feel overwhelmed.
Reducing the risk of stroke
Taking blood platelet inhibitors, including, Dipyridamole, Ticlopidine, and clopidogrel, can reduce the risk of stroke before it occurs. These can help prevent stroke in people with a history or high chance of having a cerebrovascular attack.
Historically, doctors recommended that people took a daily dose of aspirin to reduce the risk of a heart attack or stroke. However, current guidelines urge people to take aspirin only if they are at high risk of experiencing a cardiovascular event and have a low risk of bleeding.
This is because aspirin increases the risk of bleeding.
Doctors prescribe statins to lower and manage high cholesterol levels and decrease the risk of ischemic stroke and heart attack.
Any cerebrovascular event is a medical emergency, and anyone who recognizes the symptoms must contact 911 for evaluation and support. Early diagnosis is key to reducing brain damage.
At the hospital, a doctor will ask about the individual's medical history and look for specific neurological, motor, and sensory difficulties, including:
- changes in vision or visual fields
- reduced or altered reflexes
- abnormal eye movements
- muscle weakness
- decreased sensation
A doctor may use a cerebral angiography, vertebral angiogram, or carotid angiogram to identify a vascular abnormality, such as a blood clot or a blood vessel defect. These involve injecting dye into the arteries to reveal any clots and display their size and shape on CT or MRI imaging.
A CAT scan can help a doctor diagnose and detect hemorrhagic strokes, as it can distinguish between blood, bone, and brain tissue. However, it does not always reveal damage from an ischemic stroke, especially in the early stages.
An MRI scan can detect even early stage strokes.
An electrocardiogram (EKG or ECG) can detect cardiac arrhythmia, which is a risk factor for embolic strokes.
Adopting a healthful diet can help a person preserve their vascular health.
Methods reduce the risk of cerebrovascular disease include:
- getting at least 150 minutes of moderate to intense physical exercise every week
- eating a balanced diet that supports vascular health, such as the DASH diet, which the National Heart, Lung, and Blood Institute recommend
- maintaining a healthy body weight
- managing blood cholesterol and blood pressure with diet and medications if necessary
Individuals with heart arrhythmia should seek consultation with their doctor and discuss whether they should be taking a blood thinner to prevent strokes.
Stroke and other cerebrovascular events can cause death, but with rapid medical attention, a full or partial recovery is possible. People with cerebrovascular disease should follow healthy lifestyle tips and their doctor's instructions to reduce the chance of an attack.
The outlook depends on the type of event, its severity, and how quickly a person receives treatment.
Cerebrovascular disease can cause death or may lead to long term disability. However, some people will make a full recovery.
Prompt treatment and a lifestyle that reduces the risk of stroke are the best ways to improve the outlook for a person with cerebrovascular disease.
Are cardiovascular and cerebrovascular diseases linked?
Cardiovascular disease is a disease of the blood vessels in the heart, and cerebrovascular disease is a disease of the blood vessels in the brain. The same risk factors cause them.
Additionally, cardiovascular disease can predispose a person to a blood clot in the vessels of the heart, which can travel, causing an embolic stroke in the brain.Heidi Moawad, MD Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.