Chronic cerebrovascular accident - Causes, Symptoms and Treatment .MF .
Chronic ischemic attack - encephalopathy - a slowly progressive cerebrovascular insufficiency, insufficiency of the blood circulation of the brain, leading to the development of many small focal necrosis of brain tissue, and brain function disorders.
Symptoms of cerebral circulation
human brain - a unique body control center of all the possibilities of the human body.The work of brain cells (neurons) requires a considerable amount of energy that the brain receives through the circulatory system.Features of the structure and anastomosis of the brain arteries, forming a vicious circle of Willis provides a unique circulation in the "command post" and the intensity of metabolic processes.
Because of circulatory disorders (mostly in atherosclerotic lesions of vessels) follows the disproportion between the demand and the delivery of blood to the brain.In this situation, for example, even small changes in blood pressure can lead to ischemic brain region that supply the affected vessel and then through
development of clinical manifestations of vascular encephalopathy occurs as a result of brain blood supply deficiency in hypertension, atherosclerotic lesions of blood vessels, disorders of rheological properties of blood as a result of head - brain injuries, intoxication, dismetabolic disorders (eg, diabetes).
cerebrovascular insufficiency leads to metabolic and later and destructive changes of neurons (brain cells).Over the years, the disease is compounded by both qualitatively and quantitatively.
If the initial chronic circulatory failure stages leading a tserebrostenichesky syndrome - fatigue, emotional instability, confusion, sleep disturbances, headaches, dizziness, memory decline in the current (non-professional) event, with the progression of the disease appear movement disorders, a sharp weakening of memoryIt appears cerebral crises - from transient transient attacks to strokes.
In the second stage of chronic cerebrovascular insufficiency progressively deteriorating all kinds of memory, place personal changes - there is a lack of confidence, irritability, anxiety, depression, decreased intelligence, reducing the amount of information perception, exhausted mind reduced criticism to his condition, there is daytime sleepiness, quickensheadache, dizziness and shakiness is amplified when walking, there is a noise in my head.On examination, the neurologist will notice the poverty of facial reactions - gipomimiya, symptoms of oral automatism, symptoms of pyramidal and extrapyramidal disease.Significantly reduced capacity for work and social adaptation of the person.
With the progression of the disease (the third stage) may develop dementia (dementia), extrapyramidal syndrome disease (parkinsonian syndrome), pseudobulbar syndrome, vestibular - atactic syndrome, gross localized lesions leading to disability of patients.
mental disorder characterized by intellectual and mental disorders - patients with reduced criticism to his condition, loss of memory - can get lost coming out of the house into the street, do not recognize relatives, poorly oriented or not oriented in space and time, current events, it changes the behavior of the wholehuman personality - is dementia.
syndrome extrapyramidal insufficiency - Parkinsonian syndrome - fading facial emotional movement, impaired gait - patient walks slowly, little "shuffling" steps, bent, there is stiffness, tremor of the head, the hands, increased muscle tone.
pseudobulbar palsy - a swallowing disorder - patients poperhivayutsya, speech - it greased, replaced letters and words, there is hoarseness, patients may cry or laugh involuntarily, symptoms of oral automatism - defines a neurologist.For example, when you touch a hammer to his lips, they are drawn into a tube - proboscis reflex.
vestibular - atactic syndrome - this imbalance, statics and dynamics - dizziness, unsteadiness when standing or walking, instability can "cast" in the hand and fall.
At this stage, patients suffer acute brain catastrophe - ischemic and hemorrhagic strokes.
survey in violation of cerebral circulation
To diagnose matters:
• presence of vascular disease for a number of years - hypertension, atherosclerosis, blood diseases, diabetes mellitus;
• typical complaints of the patient;
• neuropsychological research data - the most common scale MMSE for detecting cognitive impairment (normally need to score 30 points by performing tests proposed);
• survey of the oculist, found signs of angiopathy in the fundus;
• Data duplex scanning - the ability imaging of atherosclerotic lesions of the brain vessels, vascular malformations, venous encephalopathy;
• data MRI - detection of small lesions in the periventricular gipodensivnyh spaces (around the ventricles), leykarioza zones change likvorosoderzhaschih spaces, signs of atrophy of the cerebral cortex and focal (post-stroke) changes;
• blood tests - general, sugar, coagulation, lipidogram.
cerebrovascular diseases occupy a leading place in the structure of morbidity and mortality in developed countries.Most early treatment helps to preserve the main structural unit of the brain - neuron. impossible to resurrect dead neurons .It is hoped the plasticity of brain cells, that is, the ability to activate "sleeping" neurons, the inclusion of compensatory mechanisms ... to put it simply - the surviving neurons should attempt to "take over" the dead functions.This is very problematic.Therefore, all efforts should be directed at preventing brain cell death.Please treat your brain with due care.Repeated headache, dizziness, increased blood pressure, infringement of intellectual activity - even just a distraction should lead you to a neurologist.
Treatment of cerebrovascular accidents
Treatment should be aimed at the normalization of the tissue in cerebral blood flow, stimulation of neuronal metabolism, protect brain neurons from hypoxia factors, treatment of the underlying disease.
Antihypertensive therapy - one of the most effective and important areas of prevention of disorders of brain circulation.As a non-drug therapies for hypertension effectively decrease the use of salt and alcohol, reducing excess body weight, diet, increase physical activity, relaxed lifestyle.
Perhaps the use of herbal medicine .It is recommended to take an infusion of hawthorn on ¼ cup 4 times a day before meals (1 tablespoon of hawthorn flowers to 1 cup of hot water, to insist 2 hours), valerian extract 2 tablets 2 - 3 times a day, the drug fee: motherwort herb - 3 partsgrass cudweed - 3 parts, flowers of hawthorn - 3 parts, flower baskets chamomile - part 1 (1 tablespoon mixture insist 8:00 in 1 cup of boiling water, strain, take 1/2 cup 2 times a day 1 hour after meal).
But this is in addition to the drugs, which are individual for each patient, the therapist selects with the proviso that the chronic administration of antihypertensive agent in the minimum dosage will maintain normal blood pressure numbers.From the patient's hypertension requires regular medication and blood pressure control.It will be and treatment of hypertension and prevention of stroke and recurrent stroke and dementia.
Increased cholesterol and LDL in serum, although in itself does not correlate with the development of cerebral accidents, but largely affects the vascular lesion and the progression of atherosclerosis and aterostenoza.Therefore, persons at risk need to follow a diet with restriction of consumption of cholesterol and saturated fatty acids increase consumption of fatty fish, seafood, low-fat dairy products, fruits and vegetables.If dieting does not reduce hypercholesterolemia prescribed drugs of statins - simvatin, torvakard, vabadin, atorvakor, Lipitor.With the development of atherosclerotic carotid stenosis and 70 - 99% of the diameter surgical treatment - carotid endarterectomy in specialized centers.Patients with a degree of stenosis of 60% is recommended conservative treatment with the appointment of antiplatelet drugs.
for the treatment of neurological manifestations of chronic cerebrovascular insufficiency used vasoactive drugs, drugs to improve microcirculation, neuroprotective, anti-oxidants, sedatives, venotoniki, vitamins B, E
widely used glycine, Cerebrolysin, somazinu and tserakson, drugs piracetam at a dosage2400 per day, solkoseril and aktovegin, mildronat, instenon, cavinton (vinpocetine, Oxybral) preperaty ginkgo - biloba (memoplant, ginkofar, tanakan) Sermion (nitserium) betaserk (vestinorm, betagis) vazoket (venoplant, detraleks, lysine) meme, Almeria.These drugs picks neurologist individually depending on the stage of the disease and the severity of symptoms.
Useful climate, psychotherapy, reflexology, aromatherapy, hirudotherapy, sedative teas.
Reflexology - acupuncture is used to normalize the activity of the nervous system, cardiovascular.Used and classical acupuncture and auriculotherapy (ear acupuncture on) and Su-Jok (acupuncture on the hands).
Aromatherapy - «treatment of smells", is the use of natural essential oils.For example, geranium can soothe or excite, depending on the situation and the individual characteristics of a person, bergamot, melissa, lemon and sandalwood - soothe the nervous system, jasmine, ylang-ylang relieve emotional excitement.The smell of mandarin has antidepressant action.
Hirudotherapy - treatment with leeches - used in 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 of microcirculation, normalization of metabolic processes in tissues, decrease of hypoxia, enhance immunity, reduces blood pressure.
with sedative purpose for hypertension use oxygen and coniferous baths on the fresh and sea water.
All patients with circulatory encephalopathy should consist followed up by a neurologist should be screened regularly inspected and undergo permanent or course treatment.Perhaps
sanatorium - resort treatment.
time to diagnose encephalopathy and correctly picked up a comprehensive treatment prolong an active, full life.
Doctor's consultation on chronic cerebral circulation
Question: Which resorts are indicated for vascular encephalopathy stage 1?
A: shows a sanatorium for patients with diseases of the cardiovascular system and nervous system.In Ukraine - a sanatorium in Odessa, Crimea, Berdyansk, Poltava - "Azure", "Berdyansk", "Grove", "Chervona viburnum" ... In Russia - a sanatorium near Moscow - "Barvikha", "Valuevo", "Mikhailovskoye""Pines", sanatorium "Kolos" Kostroma region, sanatorium Yaroslavl region name Thieves, sanatoria of Kislovodsk, Yessentuki, Yekaterinburg, Baikal ... Riga seaside resorts.Slovenia - Rogaska Slatina, Czech Republic - Spa Marianske Lazne, Jachymov, Hungary - Spa Hévíz Hungary, Bulgaria - resort Velingrad, Sandanski.In principle, in diseases of the cardio - vascular system abruptly change the climate zone is not useful, so there is a sanatorium in every climatic zone, the suburbs of the regional centers around natural water pools.
Question: after stroke me the doctor said he will always have to drink the medicine.True?
Answer: true.As prevention of recurrent stroke is assigned to basic therapy, which must be taken continuously: antiplatelet agents, antihypertensives, statins.Formulations and dosages individually prescribed by the physician.Besides the courses we treat vascular drugs, antioxidants, neuroprotective, vitamins, antidepressants, tranquilizers ... depending on the clinical manifestations and stages of encephalopathy.
question: what and how to evaluate the MMSE?
Answer: This scale assessment of mental status of the patient.
| 1. Orientation Time: |
Name the date (day, month, year, day of week, time of year)
|0 - 5|
| 2. Orientation in place: |
Where are we?(Country, region, city, hospital, floor)
|0 - 5|
| 3. Perception: |
Repeat three words: pencil, house, penny
|0 - 3|
| 4. The concentration of attention and expense: |
Serial account ( "100 take away 7") - or five times:
say the word "land" on the contrary
|0 - 5|
| 5. Memory Recall |
3 words (see item 3.)
|0 - 3|
| 6. Speech: |
Showing pen and clock, ask: "what is it called?»
Please repeat the sentence: "There is no if and or but»
|0 - 2|
| a 3-stage command: |
«Take a sheet of paper, fold it in half with his right hand and put it on the table»
|0 - 1|
| Reading "Read and follow» |
1. Close your eyes
2. Write a proposal
|0 - 3|
|3. Srisuyte drawing||0 - 3|
30 - 28 points - normal, cognitive impairment no
27 - 24 points -
cognitive impairment 23 - 20points - dementia mild degree
19 - 11 points - moderate dementia severity
10 - 0 points - severe dementia
question: how can we improve memory?
answer should always "use brains" - to read, memorize, recite, crossword puzzles ... Improve brain activity - Cerebrolysin, glycine, piracetam, pramistar, memoplant, somazina.When dementia - meme, Almeria.
neurologist Kobzev SV