Dyscirculatory encephalopathy
Dyscirculatory encephalopathy is a slowly progressive vascular lesion of the brain, which is characterized by a violation of mental and cognitive functions. Accompanied by sensory and motor disorders.
The content of the article:
Causes of dyscirculatory encephalopathy
Mechanism of development of dyscirculatory encephalopathy
Classification of dyscirculatory encephalopathy
Initial manifestations of dyscirculatory encephalopathy
Symptoms of dyscirculatory encephalopathy of stage II-III
Diagnosis of dyscirculatory encephalopathy
Treatment of dyscirculatory encephalopathy
Prognosis and prevention of dyscirculatory encephalopathy
Dyscirculatory encephalopathy
Causes of dyscirculatory encephalopathy
The disease is provoked by pathologies and conditions characterized by a gradual decrease in the diameter of the arteries transporting blood to the brain. Such diseases include:
Atherosclerosis of cerebral vessels. Violation of lipid metabolism in arterial vessels leads to the deposition of specific lipoproteins. These formations can increase in size and become damaged. The pathological process inevitably provokes a decrease in the lumen of the vessel, which, accordingly, causes hypoxia of brain areas.
A sudden increase in blood pressure (blood pressure). The state of blood pressure depends on how well the brain will be fed. The higher the blood pressure, the more likely it is that the blood will be “forced” into the brain. This can be avoided if the vessels of the brain shrink. Since they cannot do this at the same time, violations occur in several parts of the brain at once. An increase in blood pressure occurs with pathologies such as polycystic kidney disease, hypertension, glomerulonephritis, adrenal tumor.
Pathology of the vertebral arteries, which provokes the development of a discirculatory process in the vertebral-basilar basin. The causes of blood supply disorders can be arterial malformations, Kimberly anomaly, spinal pathology, osteochondrosis, injury of the cervical spine.
Frequent changes in blood pressure, which lead to a decrease in cerebral perfusion pressure.
Diabetes mellitus, which provokes a violation of the structure of blood vessels, resulting in hypoxia of the brain.
Systemic vascular inflammation.
Smoking and alcohol abuse.
Endocrine diseases, which result in excessive narrowing or dilation of the vessels of the brain.
Mechanism of development of dyscirculatory encephalopathy
The essence of the disease is that vascular pathologies gradually lead to a violation of blood flow in them. Then the areas of the brain that received food and oxygen eventually begin to experience hypoxia (oxygen starvation). In the case of a sharp decrease in the trophic areas of the brain, they gradually begin to die off, and in their place there are foci of tissue rarefaction. Connections are lost between neighboring parts of the brain, which eventually leads to a shortage of oxygen. The mechanism of the disease formation is somewhat similar to a stroke. However, stroke is characterized by acute development of the disease, and with dyscirculatory encephalopathy, neurological deficiency progresses slowly.
Dyscirculatory encephalopathy manifests functional disorders that can be reversed with adequate and proper treatment. The more the disease progresses, the more a persistent neurological defect is formed, which leads to disability of the patient. In most cases, pathology proceeds together with neurodegenerative processes in the brain.
Classification of dyscirculatory encephalopathy
Depending on the etiology of the disease, there are several varieties of it. Namely, dyscirculatory encephalopathy can be hypertensive, atherosclerotic, venous (it appears due to compression of veins by tumors), mixed (it is a combination of hypertensive and atherosclerotic forms). The disease is also classified according to the rate of progression. Depending on this criterion, it can be slowly progressing (a new stage of pathology occurs after 5 years), rapidly progressing (one stage replaces another every two years), remitting (periods of exacerbation and remission alternate).
Initial manifestations of dyscirculatory encephalopathy
The initial stage of the disease is characterized by a gradual and inconspicuous course. Usually, various emotional disorders come to the fore.
Depression
For example, more than 65% of patients are diagnosed with depression at the initial stage of pathology. At the same time, a depressive state is almost never accompanied by depression. Its symptoms are more similar to the signs of hypochondriac neurosis, as patients complain of various disorders that have a pronounced somatic character.
Namely, patients are often diagnosed with symptoms such as back pain, noise and ringing in the ears, arthralgia, headaches, painful sensations in different parts of the body. At the initial stage of the disease, depression occurs in many patients against the background of a completely insignificant traumatic situation. Moreover, it can occur even without a pronounced reason. Doctors note that depression in dyscirculatory encephalopathy is very difficult to respond to drug therapy and psychotherapy.
Increased emotional lability
At the first stages of the development of the disease, patients have an increase in emotional lability. Namely, they complain of sudden mood swings, constant irritability, bouts of aggression, episodes of uncontrollable crying for no apparent reason. Some symptoms of the disease are similar to signs of neurasthenia. In particular, they include headaches, sleep disorders, increased fatigue, and absent-mindedness.
Cognitive impairment
It has been proven that in 90% of cases of the disease, various cognitive impairments become noticeable in the early stages. Such disorders include the inability to concentrate on something, memory impairment, difficulties with planning, fatigue even after a minor mental load. A typical manifestation of pathology is considered to be a violation of the ability to reproduce information with complete preservation of memory.
Motor disorders
In addition to all the above violations, patients may also complain of motor disorders. In particular, doctors note such manifestations as instability when walking and severe dizziness. Episodes of vomiting and nausea may occur. It is necessary to differentiate dyscirculatory encephalopathy from vestibular ataxia, since dizziness in the first case is observed only during walking.
Symptoms of dyscirculatory encephalopathy of stage II-III
After the transition of dyscirculatory encephalopathy to the second or third stage, the patient’s motor and cognitive impairments worsen. Namely, he is diagnosed with a serious deterioration of memory, a decrease in intelligence, difficulties with performing previously feasible intellectual actions. Doctors note that patients themselves cannot adequately assess their intellectual abilities, and also greatly overestimate their performance.
The more the disease worsens, the more difficult it is for patients to communicate with other people. They also have difficulty navigating in space. At the third stage of the disease, its symptoms become very pronounced and significantly reduce the quality of life of the patient: he has a personality disorder, a thinking disorder, and deep dementia gradually develops. Over time, patients lose the ability to work at all, and also lose self-service skills.
Apathy
Apathy is considered the most characteristic symptom of mental health disorders at the last stage. Patients have a persistent loss of interest in their previously favorite activities, there is no motivation to do anything. Usually, patients at the third stage of dyscirculatory encephalopathy are engaged in extremely unproductive activities or do nothing at all, showing complete indifference to themselves and others.
Motor disorders
If at the initial stage of the disease, motor disorders are almost invisible and do not bother the patient, then later they become more noticeable to others. Characteristic signs of such disorders are slow walking and shuffling gait. It is usually quite difficult for patients to start walking and it is also not easy to stop. All these motor disorders are very similar to the signs of Parkinson’s disease. Dyscirculatory encephalopathy differs from this disease in the absence of motor disorders in the hands.
At the last stage, patients have severe symptoms such as paresis, speech disorders, tremor, urinary incontinence, pseudobulbar syndrome. Rare epileptic seizures are also possible. Due to motor disorders, patients often fall, especially when turning and stopping. During such accidental falls, they can get a severe bruise or even a fracture of the limb.
Diagnosis of dyscirculatory encephalopathy
Timely and accurate diagnosis of the disease plays a crucial role in its further treatment, since it allows you to start vascular therapy of cerebral circulation in time. An important diagnostic method is regular neurological examination of people at risk (for example, diabetics and hypertensive patients). It is advisable for elderly patients to undergo regular examination by a neurologist. In neurology, it is customary to distinguish several diagnostic criteria, upon detection of which a diagnosis of “dyscirculatory encephalopathy” is made:
Pronounced neurological and neuropsychological symptoms (in descending order of importance — cognitive disorders, impaired coordination of movements and walking).
Symptoms of cerebrovascular disease and lesions of brain structures, as well as vascular changes in the brain.
Other neurological diseases with similar symptoms are excluded.
In the initial stages of the disease, it can be difficult for the patient to notice cognitive impairments independently. To identify them, it is necessary to pass a number of diagnostic tests. To make a diagnosis, a neurologist may need to consult an ophthalmologist who performs an ophthalmoscopy. Instrumental techniques play an important role in the diagnosis of pathology: REG, EEG, Echo-EG, MRA and duplex scanning of cerebral vessels.
MRI of the brain is usually prescribed in order to distinguish the disease from such neurological diseases as multiple encephalomyelitis, Alzheimer’s disease, Creutzfeldt-Jakob disease. It is also extremely important to correctly establish the etiological factor that caused the disease. To do this, the patient is prescribed a consultation with a cardiologist, a blood sugar test, determination of cholesterol, lipoproteins. According to the indications, patients can be prescribed a consultation with an endocrinologist and a neurologist, daily monitoring of blood pressure, an ECG for the diagnosis of arrhythmia.
Treatment of dyscirculatory encephalopathy
Treatment of the disease must necessarily be comprehensive: it includes drug therapy, physiotherapy, diet and other methods. The main goal of drug therapy is to improve blood flow to the brain, as well as the normalization of the nervous system and the restoration of normal vascular function. That is why, in most cases, patients are prescribed a set of medications. For the treatment of dyscirculatory encephalopathy , the following drugs are prescribed:
Lisinopril. It is used to lower the pressure. It is prescribed if hypertension has become the cause of the disease. The drug acts as follows: it does not allow a special enzyme to increase pressure, and also promotes relaxation of smooth muscles in the vessels.
Curantil. This drug is able to effectively strengthen and protect blood vessels, expand capillaries, while increasing their lumen, does not allow platelets to stick together.
Nimodipine. It is an inhibitor of calcium, which blocks its entry into the smooth muscles of the vessels. Due to this, the tone of the vessels decreases, they relax, become wider, which entails the activation of blood flow to the brain.
Atenolol. The drug belongs to the group of beta-blockers. It reduces the pulse rate and blood pressure, as well as normalizes the work of the heart, helps to remove excess water from the body.
Aspirin. It makes the blood liquid, does not allow blood clots to stick together, so it is possible to avoid clogging of blood vessels with blood clots.
Veroshpiron. It is an effective diuretic that activates the process of removing sodium and water from the body, and also retains useful potassium in it. This way it is possible to reduce blood pressure and blood volume.
Vasobral. Significantly improves blood flow to the brain, improves metabolism, restores brain function, reduces the likelihood of clots, strengthens the walls of blood vessels.
Tincture of ginseng. A natural remedy that lowers the level of cholesterol in the blood. The drug also improves the functioning of blood vessels, brain and heart, reduces cholesterol in the blood, increases efficiency and reduces fatigue.
Physical therapy
Of great importance in the treatment of the disease is physiotherapy, which provides therapeutic effects on the body due to physical factors. Usually physiotherapy procedures are carried out in courses of 10-20 procedures. For the treatment of the disease, such a technique as electroson is well suited. It allows you to stimulate the brain by exposing it to currents of low frequency and strength. The procedure is carried out as follows: electrodes are applied to the eyelids, after which the current penetrates into the brain through the bundles of blood vessels. Electroson activates metabolic processes in white and gray matter, and also establishes new connections between nerve cells.
Galvanotherapy
In the treatment of pathology, galvanotherapy is actively used, which provides for the effect of weak currents on the collar zone. Due to this, the capillaries expand and the movement of blood in them improves. This procedure allows you to eliminate pain, improve cell nutrition and metabolic processes.
UHF
UHF is considered another effective treatment method. This method involves the influence of a high-frequency electromagnetic field on the body, which causes an ion current to appear in the blood. Due to this, the blood begins to move more actively through the small capillaries, supplying much more oxygen to the cells.
Massage and baths
Therapy of dyscirculatory encephalopathy also provides for the appointment of a bath and massage. The ideal solution will be carbon dioxide, oxygen and radon baths, which dilate blood vessels and normalize blood circulation. A variety of massage techniques are used in the treatment of pathology. For example, acupuncture massage can improve brain function. In addition, it is shown even to people with high blood pressure. With the help of a conventional massage, the doctor manages to effectively relieve the spasm of the muscles that squeeze the arteries.
Special diets
Doctors may advise the patient to adhere to a special diet during treatment. The most effective diets are considered to be Mediterranean and low-calorie. The main principles of the Mediterranean diet are the inclusion of vegetables and fruits, rice, seafood, low—fat cheese, nuts and dairy products in the diet. A low-calorie diet provides for limiting the caloric content of the diet to 2500 kcal. It is advisable to completely abandon fatty foods and limit the amount of salt.
Prognosis and prevention of dyscirculatory encephalopathy
Correct and timely treatment can significantly slow down the progress of the disease. However, do not forget that sometimes the disease develops extremely quickly — its stages change each other every two years.
The most unfavorable prognosis for patients is a combination of pathology with degenerative changes in the brain, acute circulatory disorders, hypertensive crises, hyperglycemia.
In case of serious complications, a patient with dyscirculatory encephalopathy may be assigned a certain disability group. Usually, disability is given when it is difficult for a patient to serve himself independently, and he cannot perform work duties due to illness. Depending on the patient’s condition , he may be assigned one of three disability groups:
Group III — the patient was diagnosed with stage 2 of the disease, life disorders are moderately pronounced, but it is difficult for him to perform professional duties. A person may sometimes need outside help.
Group II — the patient has stage 2 or 3 of the disease, memory impairment is observed, strokes occur, there are neurological abnormalities. In addition, he is not able to do his job without help.
Group I — the disease has reached the third stage. The patient has dementia, memory loss, circulatory disorders.
In order to prevent the disease, it is necessary to regularly monitor weight, reduce alcohol consumption, give up smoking, control cholesterol levels, maintain normal blood sugar levels, monitor blood pressure. Normalization of lipid metabolism is considered the best prevention of pathology, hypotensive therapy is effective, regular medical examinations.
