Discirculatory encephalopathy: how to treat it. Discirculatory encephalopathy: description, causes and treatment. Who can make a diagnosis?
Often, as people age, they suffer more and more from various neurological diseases. For some, this manifests itself in the form of increased fatigue, while others begin to experience serious problems when performing the simplest actions. About ninety percent of neurological symptoms are associated with the diagnosis of discirculatory encephalopathy, a serious disease based on dysfunction of cerebral vessels. In recent years, this disease has become increasingly common in people of young and working age. That is why it is so important to know its first manifestations and signs in order to consult a doctor in time.
Definition of disease
Discirculatory encephalopathy is a chronic brain lesion that develops due to a disruption in its blood supply. Under normal conditions, oxygen and nutrients enter the central nervous system through two large carotid arteries located in the neck. In the case when their lumen is narrowed, the brain experiences gradual starvation, which leads to serious problems in its functioning.
The internal carotid artery supplies the brain with nutritionIn medical circles, it is common to use the abbreviation DEP to refer to this diagnosis.
Stages of development of the disease
It is currently believed that the process of brain damage has some stages. There are three stages of dyscirculatory encephalopathy:
- Initial. All clinical symptoms are rather mild. It can only be suspected if a similar illness has been observed in close relatives.
- Progressive. It is characterized by an increase in motor and mental disorders. Patients quite often injure themselves and lose some social skills.
- At the terminal stage, the vast majority of patients lose the ability to perform simple tasks and actions. They need outside care.
In what cases are patients entitled to be assigned a disability group?
During the second and third stages of development of dyscirculatory encephalopathy, people almost completely lose the ability to self-care, and criticism of their behavior and other actions also disappears. Patients become dangerous not only to themselves, but also to others, as a result of which they need constant supervision. That is why such people are assigned a disability group depending on the severity of the condition (first, second or third). As additional measures for single pensioners, visits from a social worker are provided, who helps with purchasing groceries and paying for utilities.
Video: Doctor talks about DEP
Why does the disease develop?
Causes of the disease and predisposing factors:
- inflammatory processes in soft tissues;
- proliferation of fatty plaques in blood vessels;
- formation of blood clots - blood clots;
- diabetes;
- overweight (body mass index over thirty);
- brain and spinal cord injuries (bruises, concussions);
- periodic increases in blood pressure;
- hereditary predisposition (two or more relatives suffering from a similar illness);
- cardiac dysfunction.
Sex and age dependence of the development of dyscirculatory encephalopathy
Previously, it was believed that the disease occurs mainly in people of retirement age. Now doctors are observing a pronounced trend towards a decrease in the age of development of the disease. Discirculatory encephalopathy develops in people between forty-five and ninety-three, with the peak incidence occurring between fifty and sixty years. As recent studies show, men suffer from this disease much more often than the fair sex. According to doctors and scientists, this may be due not only to the level of stress, but also to the bad habits of patients. Men are also more negligent about their health and rarely seek medical help, which leads to late detection of the disease.
What classifications of the disease exist?
For the most complete and accurate diagnosis, it is necessary to know not only the type of disease, but also the nature of its course. It is for this purpose that several fundamental classifications of dyscirculatory encephalopathy have been developed.
Types of DEP by reasons and mechanisms of formation:
- The hypertensive type of the disease develops in people who have suffered from periodic fluctuations in blood pressure for a long time. It is typical for her to experience an increase in symptoms over several days, which is accompanied by excruciating headaches.
- The atherosclerotic type of the disease is formed due to a narrowing of the vascular lumen. Fatty plaques grow in the arteries, disrupting normal blood flow, which negatively affects brain function.
- Venous encephalopathy is characterized by damage predominantly to large vascular trunks of the neck. Blood clots form in them, preventing further passage of fluid.
Varieties of the disease according to the nature of the course:
- classic DEP - develops over 5–8 years;
- galloping - symptoms increase over several months;
- relapsing - alternating exacerbations and remissions.
Clinical signs of dyscirculatory encephalopathy
At the first stage of development of the disease, patients complain of persistent headaches of a pressing and aching nature. Gradually, excessive nervousness, irritability and even aggression are added to them. At the second stage, damage to the emotional and motor spheres predominates. At the same time, patients are constantly in a state of apathy, losing sensitivity to those things that previously brought joy. There is a lack of coordination of movements, frequent falls, and household injuries.
In his practical work, the author has repeatedly encountered the fact that most doctors do not distinguish DEP from depression. The appearance of anxiety and apathy is typical for both pathological conditions, but only encephalopathy is accompanied by impaired motor functions.
At the last stage, patients almost completely lose the ability to self-care. Due to constant tremors in their hands and lack of coordination, they cannot wash themselves, eat, or even go to the toilet. Elderly patients often find themselves bedridden. The victims stop recognizing loved ones and completely withdraw into themselves.
Modern methods of confirming the diagnosis
The most commonly used laboratory test is the study of blood lipid composition. A small amount of plasma is collected from a vein from the patient, after which it is sent to the laboratory. There, doctors determine the presence of healthy and harmful fats, as well as cholesterol - one of the most important substances that characterizes the level of metabolic processes occurring in the body. If the content of these components in the blood is increased, we can assume the presence of dyscirculatory encephalopathy.
Instrumental studies used to make a diagnosis:
- Electroencephalography is a technique for studying the human brain by assessing its bioelectrical activity. A special cap with electrodes is put on the patient’s head, after which the doctor uses the device to carry out the effects. The brain reacts to them with the formation of certain waves, which are recorded by the device. Based on these data, doctors can draw conclusions about the state of the nervous system.
- Magnetic resonance imaging is one of the newest techniques that allows you to look into the human body without external intervention. The computer takes a series of photographs from a variety of angles, after which it forms one three-dimensional image. With dyscirculatory encephalopathy, the images show changes in the structure of the brain matter and areas of hemorrhage.
- Ultrasound examination of the cerebral arteries provides information about their patency. Using this technique, almost all types of circulatory disorders are recorded.
Photo gallery: diagnostic tools
The MRI image shows a violation of the integrity of the brain substance The EEG procedure records the activity of brain cells Ultrasound of cerebral vessels allows to determine the location of a blood clot
Cognitive functions are a person’s ability to adequately interact with the world around them. This includes memory, attention, thinking, speech and many others. They are assessed based on several simple tests:
- The patient is asked to sequentially subtract the number seven from any three-digit number. A healthy person copes with this task in a few minutes, while patients with discirculatory encephalopathy are constantly confused and confused, since they cannot fix several numbers in their minds for a long time.
- The victim is given a sheet with numbers written in circles in different orders. He is asked to connect numbers from one to fifty with each other in ascending order. For most patients, the test takes five to ten minutes to complete, and there is a fair amount of error.
Which doctor should I contact to confirm the diagnosis and further treatment?
When the first signs of illness appear, it is recommended to immediately go to the clinic and be examined by a therapist. He will be able to give you a coupon for further consultation with several specialists: a neurologist, a cardiologist and a phlebologist (a doctor who studies venous vessels). Based on laboratory and instrumental research data, a consultation of doctors will help you choose the optimal treatment and rehabilitation plan individually for each patient.
Various treatment options for dyscirculatory encephalopathy
Immediately after confirming the diagnosis, doctors begin treatment. It consists of several stages that are suitable for each stage. For minor damage to the blood vessels of the brain, doctors prescribe a gentle diet and physiotherapy, as well as some medications. In more severe stages, surgical intervention may be used.
The main goals of therapy for dyscirculatory encephalopathy:
- improvement of cerebral blood flow;
- removal of blood clots and fatty plaques from the arterial and venous beds;
- adaptation of the patient to further existence in society;
- stimulation of metabolic processes;
- strengthening the immune system;
- increasing the strength of the vascular wall;
- prevention of complications.
Changes in diet and lifestyle during illness
When treating dyscirculatory encephalopathy, special attention must be paid to following a special diet and adjusting lifestyle. This will help not only prevent the development of many complications, but also strengthen the patient’s body. Doctors strongly recommend adhering to the rules of a healthy diet: all dishes should be prepared with a minimum amount of oil and fat, and the patient should drink at least two liters of water during the day.
What to add to your diet:
- fresh vegetables and fruits;
- dairy products;
- cereals and porridges;
- lean meat, fish, shrimp, mussels;
- greens (spinach, onions, garlic, celery).
Changing your lifestyle includes not only giving up bad habits and doing as much physical activity as possible, but also maintaining a work-rest schedule. Few people know that to fully restore strength and energy, a person needs to sleep at least eight hours a day. At the same time, doctors recommend spending as little time as possible in front of the screen of computers, televisions or smartphones: it is worth devoting these hours to a walk or reading an interesting book.
Table: medications used to combat the disease
Name of drug group | Examples of active ingredients | Operating principle |
Antiplatelet agents |
| Prevents the formation of blood clots in the lumens of arteries and veins |
Anticoagulants |
|
|
Antihypertensive drugs |
| Normalize blood pressure levels, preventing the development of complications |
Correctors for cerebrovascular accidents |
| Improves blood microcirculation in the vascular bed of the brain |
Antiatherosclerotic agents |
| Prevents the formation of fatty plaques, stabilizes metabolic processes in the body |
Photo gallery: medications used for therapy
Clexane prevents the formation of blood clots Enalapril stabilizes blood pressure Nemotan is a drug intended to improve cerebral circulation
Physiotherapy for dyscirculatory encephalopathy
To improve the supply of arterial blood to the brain, special restorative procedures are used. Physiotherapy is based on the use of physical factors to improve human health. Doctors usually use this therapy in the initial stages of the disease, as well as during the rehabilitation of complex patients.
The duration of the course and the choice of technique are determined by the attending physician based on the health status of the victim.
What procedures are used in the treatment of DEP:
- Inductothermy is the use of magnetic fields of varying frequencies and strengths. Special electrodes are attached to the patient’s head, through which the main effect is carried out. Such procedures help not only to relax and get rid of the symptoms of dyscirculatory encephalopathy, but also help stabilize blood pressure.
- Galvanotherapy is the effect of direct electric current on the body. This procedure helps improve blood circulation in the vessels of the brain, and also stimulates the formation and growth of nerve cells.
- Acupuncture is an ancient Eastern teaching about special points of the human body. Using special small needles, the doctor stimulates certain areas. This promotes faster resorption of blood clots and improves metabolic processes in the body.
Photo gallery: physiotherapy used for illness
Acupuncture should only be performed by a specialist with appropriate education Using magnetic fields helps combat symptoms of DEP Galvanization improves blood microcirculation processes
Folk remedies that help with diagnosis
Medicinal plants and herbs are also used to combat dyscirculatory encephalopathy. However, do not forget that their use is only permissible as maintenance therapy. Decoctions and infusions help cope with the main symptoms of the disease, but do not affect the cause that provoked the development of the disease. That is why doctors strongly advise not to abandon traditional treatment.
During my practice, the author of the article came across a woman who used only natural remedies to treat dyscirculatory encephalopathy. Despite the short-term period of improvement, after a few months the patient began to feel much worse. Her headaches intensified, trembling in her hands increased, and coordination of movements was impaired. As a result, the woman was hospitalized in the burn department because, due to absent-mindedness and inattention, she touched a hot dish with her hand. This situation could have been avoided if she had not abandoned traditional treatment.
Traditional recipes used to combat symptoms:
- Mix thirty grams of crushed valerian root with five hop cones. Fill them with a liter of boiling water and place them in a cool, dark place for a day. The next morning, before breakfast, drink one glass on an empty stomach. Valerian and hops have a calming effect and allow you to get rid of not only headaches, but also the mental stress that constantly plagues people with dyscirculatory encephalopathy. It is recommended to undergo a course of treatment with this infusion for at least three months.
- Take two tablespoons of rose hips and place them in a ladle with 500 milliliters of water. Simmer over low heat for fifteen minutes, stirring constantly. After cooling, drink half a glass in the morning and evening. Rosehip has a pronounced tonic effect and contains a large amount of vitamin C, which is necessary for our brain. And also its use helps strengthen the immune system and protect it from the effects of bacteria and viruses. For the purpose of prevention, you can drink rose hips constantly.
- Grind twenty grams of hawthorn berries in a meat grinder or chop with a knife to a paste. Add it to tea or any other drink every evening. It is believed that hawthorn has a strengthening effect on the wall of blood vessels, preventing the formation of blood clots and fatty plaques. In order to prevent and treat DEP, it is necessary to undergo a course of twenty procedures.
Photo gallery: folk remedies used in the treatment of illness
Valerian root has a relaxing effect Rosehip is the best source of vitamin C
Hawthorn berries help strengthen the wall of blood vessels
Surgical intervention for dyscirculatory encephalopathy
Often, normal blood flow in the cerebral vessels is hampered by the presence of foreign bodies. These include not only atherosclerotic plaques (accumulation of fats in the lumen of arteries and veins), but also thrombi - blood clots. In the second and third stages of discirculatory encephalopathy, their removal with the help of medications is not possible: this is why doctors are forced to resort to surgery.
Doctors refuse surgical treatment if the patient’s age exceeds 90 years: the use of anesthesia can become a direct threat to his life and health.
What types of operations exist:
Treatment prognosis and possible complications
Discirculatory encephalopathy is a chronic progressive disease with a steady course. Despite the efforts of doctors, not everyone is able to completely get rid of its symptoms. If the disease is detected at an early stage, the prognosis for treatment is most favorable. In the case when the patient turned to the doctor too late, all that remains is to maintain his condition at a certain level and protect the body from the development of complications. The presence of other chronic or acute illnesses in the patient is also of particular importance. It is known that patients with diabetes and people suffering from high blood pressure suffer from dyscirculatory encephalopathy much more severely than others.
In his clinical practice, the author of the article came across a fifty-nine-year-old patient who was able to quite successfully fight this disease. After the diagnosis was made and confirmed, the man began to actively attend physiotherapeutic procedures, therapeutic exercises, followed a diet, took all medications and regularly consulted with a psychologist. At home, he constantly gave his brain simple exercises: he solved crosswords and equations, and solved Sudoku. Such actions helped the victim recover quite quickly and maintain his health within normal limits. After several years of this lifestyle, he began to feel much better, which greatly affected his psycho-emotional state.
What complications may occur in patients with dyscirculatory encephalopathy:
- Hemorrhagic stroke is bleeding in the brain. This is an extremely severe pathological condition, during which the vast majority of patients fall into a coma. Neurosurgeons are involved in his treatment, and the rehabilitation process can take several years.
- Impaired coordination of movements and absent-mindedness often become the causes of the development of domestic and industrial injuries. People lose the ability to self-care, and when handling cutlery they can injure or burn themselves. That is why it is so important that a loved one is always next to a patient with dyscirculatory encephalopathy.
- Hemorrhage into the eyeball and visual impairment. This disease can develop spontaneously due to a sharp jump in blood pressure. At such moments, it is necessary to immediately take the patient to the ophthalmology department, where the doctor can remove the accumulated blood without harm to the eyeball.
Photo gallery: complications of the disease
A stroke is a buildup of blood in a specific area of the brain. Burns are the most common injuries. characteristic of patients with DEP Bleeding in the eye can lead to vision loss
How long can you live with the disease?
With early diagnosis and timely treatment, patients do not have to fear for their health. On average, it takes from two to five years to transition from one stage of dyscirculatory encephalopathy. Life expectancy in patients with second and third degrees of cerebral vascular damage is reduced by seven to twelve years.
How to prevent the development of dyscirculatory encephalopathy
Often the occurrence of such a disease can be predicted long before its first signs appear. If your close relatives (father, mother, aunt, uncle, grandmother or grandfather) have dyscirculatory encephalopathy at any stage, you can safely classify yourself as a high-risk group. Currently, domestic and foreign scientists are actively developing various rules for preventing the disease. They can be both individual and collective in nature. Such health care helps not only to detect the disease in the early stages, but also to prevent its long-term consequences.
While studying at the Department of Neurology, the author of the article, together with his classmates and teachers, participated in the organization of an open conference dedicated to the problem of preventing dyscirculatory encephalopathy. At this event, everyone could not only receive the most accurate, accessible and detailed information about the disease, but also undergo special testing, during which the presence or absence of the first symptoms of the disease was determined. As it turned out, about 30% of all patients were, to one degree or another, predisposed to the development of dyscirculatory encephalopathy, while in 7% the diagnosis was previously confirmed by a neurological examination. The age of most of the victims ranged from fifty to eighty-nine years, and only in one man the first signs of the disease were suspected at the age of forty. At the end of the conference, everyone was given medical recommendations on the prevention of complications and further progression of dyscirculatory encephalopathy, and doctors prescribed additional examinations for patients from risk groups.
How to protect yourself from developing the disease:
Discirculatory encephalopathy is a fairly common disease that occurs to one degree or another in every second person over sixty years of age. If you or your loved ones have been diagnosed with this, there is no need to worry again: with a timely and competent approach to treatment, there is no need to fear the development of complications. And also, do not forget about the rules of individual prevention: no one can take care of your health better than you yourself. This is why it is so important to undergo medical examinations every year and report to the doctor about any complaints you have.
Discirculatory encephalopathy is a condition of the body in which blood circulation in the vascular bed of the brain is disrupted. Constant lack of blood flow unbalances not only the basic functions, but also the structure of the organ. Multiple lesions that form in the human brain do not appear instantly, but can grow over many years.
It is the slow, almost imperceptible course of the disease that leads to irreparable consequences that have a detrimental effect on important brain tissues.
Discirculatory encephalopathy is one of the most common diseases of the human nervous system. As a rule, this disease is treated by neurologists. According to general medical examination data, 5-6% of the population suffers from pathology. At a young age, it is quite rare; most often the disease is typical for people over 40 years of age.
Discirculatory encephalopathy of the 1st degree is the beginning of the disease itself. DEP 1 occurs with minimal symptoms, and in most cases, many patients do not realize that they have a serious neurological disease.
Minor worries, which most often manifest themselves in the form of headaches, dizziness or poor quality of sleep, are attributed to fatigue, prolonged exposure to the sun, or overwork. This is how the initial stage most often manifests itself.
Classification of the disease
Based on the reasons, the main types of DEP are distinguished:
- hypertensive,
- atherosclerotic,
- venous,
- mixed,
- with a different etiology.
Neurological disease is divided into three stages: initial, moderate and severe.
Causes
This disease does not occur on its own, but is a consequence or complication of some other disease. Most often, this neurological disorder can be observed in the following pathological conditions:
- Atherosclerosis of the brain.
- Hypertension, arterial hypertension.
- Disturbance of systemic hemodynamics.
- Vegetative-vascular dystonia.
- Vasculitis.
- Many blood diseases.
- Connective tissue pathologies.
Risk factors:
- diabetes,
- smoking,
- elevated cholesterol, triglycerides,
- excess weight;
- oral contraception;
- hypertension,
- burdened hereditary.
Symptoms and manifestations of the disease
Stage I (compensated) is characterized by an erased clinical picture. The symptom complex of the pathological condition is intermittent in nature and can alternate with long-term ones. Clear periods of remission. As a rule, this stage goes unnoticed. Only with random studies can one observe changes in the vascular bed and the emergence of foci with blood flow deficiency.
The disease begins with hyperdynamic cerebrospinal gravis. It manifests itself as: disinhibition, lack of restraint, mild excitability, anxious sleep, changeable mood. Later, non-systemic dizziness, headaches, and decreased “operative” memory appear. A person suffering from stage 1 disease often complains of fatigue, which at first may go away on its own, after a night or day rest. Over time, the feeling of fatigue does not go away, increased fatigue is added even from simply sitting on the sofa in front of the TV.
With DEP, a reaction to stimuli may occur; the patient reacts too violently to loud music, bright lights, rapidly changing pictures or commercials. During a medical examination, facial asymmetry may be noticeable in patients with the first degree of circulatory impairment.
Stage II (subcompensated) is the stage of increasing symptoms, when the symptom complex becomes more severe and becomes permanent. The first “bells” indicated above begin to bring serious inconvenience. Psychopathological syndromes deepen, constant noise appears in the head, cerebrovascular disease changes shape and becomes hypodynamic. The patient feels fatigue, loss of strength, lethargy, loss of attention, depressed mood, and tearfulness. As there are more and more small lesions, amyostatic, pseudobulbar syndromes, or pyramidal insufficiency appear. The headache is mostly constant, and medications aimed at eliminating pain rarely help.
Dizziness intensifies and can often be observed at rest. At this stage of the disease, paralysis of the legs appears. A slight loss of vision begins, a patient with this diagnosis sees worse; when examining the fundus, the arteries are narrowed, and the venous capillaries, on the contrary, are dilated.
Stage III (decompensated) is the final stage of the disease. A CT or MRI of the brain clearly shows a reduced density of brain tissue, perivascular lacunae, and atrophy of the brain cortex. The previously formed symptom complex sharply worsens, a picture of damage to a specific area of the brain can be traced: paresis, cerebellar disorders, memory suffers sharply, speech is impaired, and vascular parkinsonism develops. More often than in the subcompensated stage, epileptic seizures are possible, the general somatic condition is sharply affected, and the risk of stroke is high.
Dementia, which occurs due to dyscirculatory encephalopathy, mainly leads to the loss of all previously acquired skills. The patient begins to forget simple, familiar things: the names of his friends and relatives, telephone numbers, dates of birth, to the point of unrecognizability of his loved ones.
The gait of patients becomes unsteady, slightly reminiscent of shuffling. At this stage of the disease, attacks resembling an epileptic attack may occur, and later incontinence of physiological functions occurs.
Complications
Discirculatory encephalopathy, as an independent disease, rarely leads to any complications. They arise due to the underlying disease, which was the cause of DEP. For example, a person may experience an ischemic stroke, develop malignant hypertension, and change the composition of the blood.
Diagnosis of the disease
Symptoms of the disease help to correctly diagnose the disease. For an accurate final diagnosis, examination using computed tomography is primarily used. With its help, you can clearly establish the degree of the disease, since each of them is characterized by certain changes in the brain.
At the initial stage, a CT scan of the brain will show lesions of minimal size.
The second degree more clearly indicates that the furrows and ventricles of the brain are dilated and there are small lesions of the white matter.
The third degree of DEP is represented by pronounced brain atrophy and foci located in the deep parts of the brain.
Ultrasound Dopplerography (Doppler ultrasound) will show the presence of narrowing of the vessel or its complete blockage.
A biochemical blood test necessary to accurately detect blood clots. Patients are prescribed a blood test for coagulation and cholesterol.
Treatment of the disease
Once a diagnosis has been made, treatment is prescribed. First of all, treatment of DEP must be comprehensive and necessarily symptomatic.
Drug treatment
Medications are prescribed to treat the underlying disease:
- atherosclerotic drugs (Polysponin, Cetamifene, Miscleron, Tribusponin);
- antihypertensive drugs (Prestarium, Enap, Clonidine, Arifon);
- venotonics (Troxevasin, Redergin, Pentoxifylline, Eufillin);
- disaggregants (Curantil, Trombo, Trental, Ass);
- vasoactive drugs (Vincamine, Complamin, Kaviton, Cinnarizine);
- nootropics (Piracetam, Cerebrolysin, Nootropil, Encephabol);
- sedatives, antidepressants.
Surgery
In some cases, surgery is indicated. It is carried out after a thorough collection of neurological analysis, based on laboratory reports and the conclusions of diagnostic studies.
Traditional treatment
In addition to drug therapy, nonspecific treatment is necessarily prescribed:
- Drink rosehip infusion instead of tea. You can add honey. the fruits are infused in a thermos.
- In 15 – 20 minutes. Before breakfast, take the hawthorn infusion prepared the day before. Make it using 2 tbsp. spoons of herbal raw materials for two cups of water. It is advisable to infuse in a thermos.
- Onion juice is mixed with honey (1:2). Take before meals.
- Mix a liter of vodka and 100 gr. propolis. Take a teaspoon before meals.
Disease prevention
Preventive measures should mainly be aimed at maintaining a healthy lifestyle, active physical activity and complete cessation of smoking and alcohol. Physical activity that should be aimed at training the muscles of the lower extremities
In a timely manner, it is necessary to undergo a full course of treatment for underlying diseases that can cause dyscirculatory encephalopathy.
Fresh air before bed, as well as walks away from city transport, help improve the psychosomatic state of the body.
Using sedatives to avoid stress - all these measures will help avoid irritability and overwork.
Nutrition for dyscirculatory encephalopathy
Food should be as rich as possible in vitamins and various minerals. Vegetables and fruits rich in ascorbic acid should always be present in the daily menu, since vitamin C has a positive effect on blood vessels. Tomatoes and eggplants, potatoes and peppers, onions and garlic help quickly break down fats in the body. Oatmeal and rice are the best means of strengthening arteries. Patients are advised to follow a Mediterranean diet.
Problems with blood supply, narrowing of veins and arteries in the cervical area causes diffuse damage to areas of the brain.
Dyscirculatory encephalopathy (DEP) of the brain negatively affects the general condition, negatively affects health and psycho-emotional state.
The disease occurs with a complex of negative symptoms. Only timely treatment prevents disability.
Lack of oxygen and nutrients against the background of stenosis of the main arteries and veins after a certain period provokes disruption of the functioning of brain cells. Diffuse tissue damage negatively affects the speed of reactions, psycho-emotional state, motor, mental, and physical activity.
You should consult a neurologist if you have frequent headaches, memory loss, insomnia, or vestibular disorders. Consultation with a specialist is needed if problems arise with the perception and processing of information, emotional instability develops, coordination is reduced, gait has changed, and dizziness and nausea occur when walking.
Encephalopathy on MRI
Early diagnosis and timely initiation of treatment for dyscirculatory encephalopathy (DEP) prevents severe neurological disorders and reduces the risk of impairment of mental and cognitive functions.
Inattention to the manifestations of pathology against the background of diffuse brain damage leads to increased disorders of the emotional-volitional sphere, problems with motor activity, performance, memory, vision, and hearing.
Causes of dyscirculatory encephalopathy
Diffuse disorders in the vessels and tissues of the brain develop in conditions and diseases that impair blood flow in the arteries and veins.
The condition with DEP resembles a stroke in many ways, but the narrowing of the lumen of the vessels leading to the brain does not occur abruptly, but gradually.
Discirculatory encephalopathy, unlike apoplexy, progresses at a low speed.
With the development of DEP, a negative effect on the vessels supplying the brain with oxygen and nutrients provokes hypoxia, certain areas of sensitive tissue die, and zones of leukoaraiosis appear. Foci of tissue rarefaction are located in different parts of the brain.
In the initial stage of dyscirculatory encephalopathy, the zones near the affected areas take over the function of dead cells, but gradually the connection between them weakens. Oxygen deficiency and disruption of tissue trophism negatively affect brain function. In the absence of competent treatment for DEP, a person is highly likely to become disabled.
The main reasons for the development of dyscirculatory encephalopathy:
- Periodic increase in blood pressure. Consistent perfusion pressure ensures adequate nutrition of brain cells. Impaired blood supply and limited oxygen have a negative impact on brain activity.
- Atherosclerosis of cerebral vessels. Excessive accumulation of lipoproteins on the inner wall of arteries and veins narrows the lumen of blood vessels, increases the risk of thrombosis, and provokes a deficiency of oxygen and nutrients.
Atherosclerosis of cerebral vessels
Dyscirculatory encephalopathy often develops under negative conditions and pathologies of various kinds:
- diabetes;
- thrombosis of cerebral arteries and veins;
- endocrine diseases, against the background of which the blood vessels of the brain are noticeably narrowed or dilated;
- smoking, excessive drinking;
- permanent forms of arrhythmias, in which the brain receives critically small amounts of nutrients and oxygen;
- hereditary pathologies of blood vessels;
- inflammation of arteries and veins of a systemic nature;
- decrease in perfusion pressure against the background of hypotension as a consequence of vegetative-vascular dystonia and other pathologies.
Risk factors:
- obesity;
- smoking;
- low physical activity;
- thrombosis of arteries and veins;
- diabetes;
- frequent stress;
- chronic fatigue;
- heart and vascular diseases;
- addiction to alcohol.
The prognosis for each stage of encephalopathy is different. can lead to disability if not adequately treated.
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Read about the treatment of discirculatory encephalopathy with medications.
Symptoms
Manifestations of dyscirculatory encephalopathy depend on the type and stage of the disease. You need to know the main signs of diffuse brain damage, the appearance of which requires urgent consultation with a neurologist.
Classic symptoms of dyscirculatory encephalopathy:
- headache in the temporal and occipital zone;
- often there is pain, a feeling of pressure in the eye area, sometimes nausea and vomiting occur;
- problems with sleep appear, irritability increases;
- the quality of vision and smell changes for the worse, the person hears weaker;
- worried about fluctuations in blood pressure;
- memory deteriorates, interest in understanding the world disappears, it is difficult to reproduce and evaluate the information received;
- there are sudden mood swings, possible nervous tics: vocal, motor;
- Negative personal changes occur: a person becomes suspicious, aggressive, irritated more often than before;
- causes discomfort: increased sweating, nausea, dry mouth.
Classification
Based on the speed of development, doctors distinguish the following types of discirculatory encephalopathy:
- Rapidly progressive. The stages of the disease alternate more often than after 24 months.
- Remitting. This type of DEP is characterized by periods of relapse and remission.
- Slowly progressive. The stages of pathology alternate every 5 years or less.
1st degree
Features of the flow:
- character changes, anxiety and tearfulness appear;
- periodic headaches, decreased performance;
- after mental stress, a person quickly gets tired;
- it is difficult to remember new data, the acuity of thinking decreases;
- a person confuses events;
- when walking, dizziness and mild nausea appear.
2nd degree
Characteristic features:
- constant headache;
- lethargy, chronic fatigue;
- poor memory;
- insomnia;
- depression, anxiety, irritability, panic attacks;
- there is a strange noise in the head;
- difficult to reproduce speech;
- convulsive syndrome occurs;
- facial expressions become poorer;
- Flashes of light appear periodically before your eyes;
- trembling of hands and head appears;
- fine motor skills are impaired;
- sometimes difficult to swallow;
- hearing level decreases;
- movements are slow, awkward;
- it is difficult to carry out production tasks: at this stage of DEP, most people receive a disability group.
3rd degree
Symptoms and signs:
- neurological and cognitive impairments are pronounced, others notice how a person’s character and attitude towards life have changed dramatically against the backdrop of a severe form of DEP;
- apathy appears, difficulty with orientation in space;
- the functions of the sense organs are noticeably reduced, motor activity is impaired;
- a person cannot concentrate, is engaged in unimportant or useless activities;
- a characteristic sign is reluctance to do anything even at the request of loved ones;
- a shuffling gait appears, hands tremble, paralysis is possible;
- Fecal and urinary incontinence often occurs;
- At this stage, DEP is often bothered by painful cramps.
Doctors distinguish several types of dyscirculatory encephalopathy:
- Venous. The negative process is a consequence of the pressure of tumors on extra- and intracranial veins. This type of DEP occurs in pulmonary and heart failure.
- Hypertensive. Doctors detect most cases of diffuse damage to brain tissue in young people. The rate of progression of DEP depends on the number of hypertensive crises: the more sudden jumps in blood pressure, the higher the risk of cerebrovascular accident.
- Mixed. This type of DEP develops with a combination of factors that cause hypertensive and venous forms of pathology.
- Atherosclerotic. A common type of DEP associated with diffuse damage to areas of the brain. The walls of arteries and veins become denser and lose elasticity due to the deposition of harmful cholesterol and other lipid complexes. Plaques on the walls of blood vessels narrow the lumen for blood flow, and vascular dysfunction and inflammation develop.
Diagnosis of dyscirculatory encephalopathy
If diffuse brain damage is suspected, the doctor conducts an examination, clarifies complaints, and clarifies the clinical picture. Next, the neurologist prescribes a comprehensive examination and, if indicated, refers you to other specialists for consultation.
Stages of dyscirculatory encephalopathy
The doctor’s task is to identify neuropsychological and neurological signs that signal stenosis of arteries and veins, diffuse damage to brain tissue, and the development of DEP. After a conversation and study of clinical manifestations, you need to figure out how quickly the pathology progresses.
An important point in diagnosis is the identification of atherosclerosis, the presence of harmful cholesterol deposits and the inflammatory process in the arteries and veins.
If MRI or CT do not confirm the development of other pathologies, then the neurologist diagnoses “dyscirculatory encephalopathy” and develops a treatment regimen.
Treatment and prevention of dyscirculatory encephalopathy
After confirming diffuse damage to brain tissue and identifying stenosis of the great vessels, DEP therapy is carried out under the guidance of a neurologist.It is necessary to consult an endocrinologist, cardiologist, psychotherapist, or vertebrologist if pathologies of other organs are identified against which DEP develops.
In severe cases of brain tissue damage, the help of a vascular surgeon will be needed to determine the method of surgical intervention.
Treatment of dyscirculatory encephalopathy includes several elements:
- drug therapy;
- physiotherapy;
- psychotherapy sessions, relaxation;
- a complex of exercise therapy to normalize blood pressure and reduce the clinical manifestations of DEP;
- Spa treatment;
- special gymnastics for training the vestibular apparatus;
- correction of work and rest schedules to reduce the risk of relapse of DEP;
- giving up alcohol and smoking.
Drugs
The doctor selects a set of medications depending on the stage of DEP and the presence of background pathologies:
- To stabilize and reduce blood pressure: Nimodipine, Enalapril, Corvitol, Ampril.
- Drugs that reduce the rate of platelet deposition on the walls of arteries and veins: Curantil, Clopidogrel.
- To stabilize neuronal membranes in DEP: Cereton.
- Diuretics to stabilize blood pressure and prevent the accumulation of excess fluid. The type of diuretics is selected by the doctor: Furosemide, Aquaphor, Amiloride, Clopamide, Hydrochlorothiazide.
- Antioxidants to reduce the negative effect on brain cells: Actovegin, Tocopherol, Mexidol.
- To improve the condition of arteries and veins during the development of DEP: Stugeron, Vinpocetine.
- To lower cholesterol: Mevacor, Phytostatin, Lipodemin, Questran, Gemfibrozil, Lescol.
- To activate metabolism in brain cells, reduce the degree of cognitive impairment: Nootropil, Cerebrolysin, Aminalon, Gingko biloba extract.
- To eliminate signs of vertebrobasilar insufficiency. Vegetotropic and vasoactive drugs have a good effect: Sermion, Cinnarizine, Belloid, Vasobral, Cavinton, Betaserc, Tanakan.
- Drugs to reduce high blood pressure in DEP. Medicines must be taken strictly as prescribed by the doctor. Tablets stop the dangerous manifestations of a hypertensive crisis: Reserpine, Clonidine, Moxonidine, Methyldopa.
- Antidepressants with sedative and analeptic effects. If a person can perform professional duties (at the first stage of DEP), then doctors prescribe injections of the drug Prozac without the effect of drowsiness once a day. For discirculatory encephalopathy, the neurologist selects the names on an individual basis: it is advisable to prescribe a lower daily dose of antidepressants than for endogenous depression.
Additional therapies
To eliminate the negative symptoms of DEP and restore optimal clearance in the arteries and veins that deliver blood to the brain, the doctor selects a set of diverse procedures. It is important to adhere to the schedule specified by the specialist and attend all sessions.
If you experience negative sensations during therapy or feel worse, you should promptly report the discomfort to the physiotherapist and your doctor.
To eliminate cognitive impairment, cerebral complications, and restore blood supply to the brain, the following methods of physiotherapeutic treatment are prescribed:
- physiotherapeutic procedures: laser therapy, electrosleep, UHF heating in the neck area, galvanic currents on the collar area, therapeutic baths;
- acupuncture, reflexology, use of the Lyapko applicator;
- conversations with a psychotherapist.
Operation
Indications for surgical treatment:
- severe damage to important main arteries in the head area;
- occlusion or narrowing of more than 2/3 of the lumen of the vessel;
- active increase in cognitive impairment and neurological signs;
- critical narrowing of the arteries due to a microstroke.
Types of surgical intervention in the internal carotid artery:
- extra-intracranial microanastomosis is performed with complete occlusion;
- endarterectomy is prescribed for severe stenosis.
The last degree of brain encephalopathy is the most severe. In some cases, death occurs, but supportive treatment is possible.
You can read more information about dyscirculatory encephalopathy and its symptoms.
Preventive measures
To reduce the risk of relapse of DEP, you need to follow the recommendations of a neurologist:
- properly organize work and rest schedules, do not overwork mentally and physically;
- avoid stress, attend psychotherapy sessions or conduct autogenic training at home, master relaxation techniques;
- periodically donate blood to check your cholesterol levels, adjust your diet, take medications if your levels increase;
- give up smoked meats, pickled vegetables, spices, pickles;
- reduce consumption of foods containing bad cholesterol: pork, eggs, offal, refractory fats;
- avoid excess body weight: excess weight increases the risk of damage to arteries and veins;
- engage in physical exercise according to the method suggested by the doctor. Moderate physical activity is necessary for good vascular health;
- maintain blood sugar levels at optimal levels;
- limit table salt - consume no more than 5 g of bulk product per day;
- stop smoking, alcohol;
- stick to a low-calorie diet, get more plant foods, fresh fruits and vegetables, nuts, herbs, low-fat cottage cheese, kefir;
- do not overeat, especially at night, to reduce the load on the heart;
- for prophylactic purposes, take long-term courses of medications according to a regimen developed by a doctor. You should not wait until the next hypertensive crisis is coming: modern antihypertensive drugs in small doses stabilize blood pressure, side effects are rare. To achieve a positive result, you need to take half (a third, a quarter) of the tablet in the morning and evening or 1 time throughout the day (the regimen depends on the type of drug).
Overwhelming physical labor, negative factors in hazardous work (vibration, high temperature, gas pollution), nervous strain, night shifts are factors that increase the risk of exacerbations in DEP.
It is necessary to choose an occupation in which the likelihood of conflicts, stressful situations, and overload will be minimal. It is important to create a pleasant psychological microclimate at home and in the team, to get enough rest, otherwise relapses of dyscirculatory encephalopathy cannot be avoided.
If signs indicating problems with cerebral circulation appear, you should immediately visit a neurologist and get examined. Early diagnosis of dyscirculatory encephalopathy (DEP), complex therapy to restore the patency and function of arteries and veins prevents ischemic disorders of brain function.
Video on the topic
The goal of treatment of chronic cerebrovascular insufficiency is stabilization, suspension of the destructive process of cerebral ischemia, slowing down the rate of progression, activation of sanogenetic mechanisms of function compensation, prevention of both primary and recurrent stroke, therapy of major background diseases and accompanying somatic processes.
Treatment of an acutely occurring (or exacerbation of) chronic somatic disease is considered mandatory, since against this background the phenomena of chronic cerebral circulatory failure are significantly increasing. They, in combination with dysmetabolic and hypoxic encephalopathy, begin to dominate the clinical picture, leading to incorrect diagnosis, non-core hospitalization and inadequate treatment.
Indications for hospitalization
Chronic cerebral circulatory failure is not considered an indication for hospitalization if its course is not complicated by the development of a stroke or severe somatic pathology. Moreover, hospitalization of patients with cognitive disorders and removal from their usual environment can only worsen the course of the disease. Treatment of patients with chronic cerebrovascular insufficiency is assigned to the outpatient clinic service; if cerebrovascular disease has reached stage III of discirculatory encephalopathy, home patronage is necessary.
Drug treatment of dyscirculatory encephalopathy
The choice of medications is determined by the main areas of therapy noted above.
The main ones in the treatment of chronic cerebral circulatory failure are considered to be 2 areas of basic therapy - normalization of brain perfusion by influencing different levels of the cardiovascular system (systemic, regional, microcirculatory) and influencing the platelet component of hemostasis. Both of these directions, optimizing cerebral blood flow, simultaneously perform a neuroprotective function.
Basic etiopathogenetic therapy, affecting the underlying pathological process, primarily implies adequate treatment of arterial hypertension and atherosclerosis.
Antihypertensive therapy
A major role in preventing and stabilizing the manifestations of chronic cerebrovascular insufficiency is assigned to maintaining adequate blood pressure. There is information in the literature about the positive effect of normalizing blood pressure on the resumption of an adequate response of the vascular wall to the gas composition of the blood, hyper- and hypocapnia (metabolic regulation of blood vessels), which affects the optimization of cerebral blood flow. Maintain blood pressure at 150-140/80 mm Hg. prevents the increase in mental and motor disorders in patients with chronic cerebrovascular insufficiency. In recent years, it has been shown that antihypertensive drugs have a neuroprotective property, that is, they protect surviving neurons from secondary degenerative damage after a stroke and/or chronic cerebral ischemia. In addition, adequate antihypertensive therapy helps prevent the development of primary and repeated acute cerebrovascular accidents, the background of which is often chronic cerebral circulatory failure.
It is very important to start antihypertensive therapy early, before the development of a pronounced “lacunar state”, which determines the disconnection of cerebral structures and the development of the main neurological syndromes of dyscirculatory encephalopathy. When prescribing antihypertensive therapy, sharp fluctuations in blood pressure should be avoided, since with the development of chronic cerebral circulatory failure, the mechanisms of autoregulation of cerebral blood flow are reduced, which will depend to a greater extent on systemic hemodynamics. In this case, the autoregulation curve will shift towards higher systolic blood pressure, and arterial hypotension (
Currently, a large number of antihypertensive drugs from different pharmacological groups have been developed and introduced into clinical practice to provide blood pressure control. However, the data obtained on the important role of the renin-angiotensin-aldosterone system in the development of cardiovascular diseases, as well as on the connection between the content of angiotensin II in the central nervous system and the volume of ischemia of brain tissue, allow today in the treatment of arterial hypertension in patients with cerebrovascular pathology to give preference to drugs influencing the renin-angiotensin-aldosterone system. These include 2 pharmacological groups - angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists.
Both angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists have not only antihypertensive, but also organoprotective effects, protecting all target organs affected by arterial hypertension, including the brain. The PROGRESS (prescription of the angiotensin-converting enzyme inhibitor perindopril), MOSES and OSCAR (prescription of the angiotensin II receptor antagonist eprosartan) studies have proven the cerebroprotective role of antihypertensive therapy. It is especially worth emphasizing the improvement in cognitive functions while taking these drugs, given that cognitive disorders are present to one degree or another in all patients with chronic cerebrovascular insufficiency and are the dominant and most dramatic disabling factors in severe stages of dyscirculatory encephalopathy.
According to the literature, it is possible that angiotensin II receptor antagonists influence degenerative processes occurring in the brain, in particular in Alzheimer’s disease, which significantly expands the neuroprotective role of these drugs. It is known that recently most types of dementia, especially in old age, are considered as combined vascular-degenerative cognitive disorders. It should also be noted the putative antidepressant effect of angiotensin II receptor antagonists, which is of great importance in the treatment of patients with chronic cerebrovascular insufficiency, who often develop affective disorders.
In addition, it is very important that angiotensin-converting enzyme inhibitors are indicated for patients with signs of heart failure, nephritic complications of diabetes mellitus, and angiotensin II receptor antagonists can provide angioprotective, cardioprotective, and renoprotective effects.
The antihypertensive effectiveness of these groups of drugs increases when they are combined with other antihypertensive drugs, often with diuretics (hydrochlorothiazide, indapamide). The addition of diuretics is especially indicated in the treatment of elderly women.
Lipid-lowering therapy (treatment of atherosclerosis)
For patients with atherosclerotic lesions of cerebral vessels and dyslipidemia, in addition to a diet with limited animals and the predominant use of vegetable fats, it is advisable to prescribe lipid-lowering drugs, in particular statins (atorvastatin, simvastatin, etc.), which have a therapeutic and preventive effect. Taking these drugs in the early stages of dyscirculatory encephalopathy is more effective. Their ability to reduce cholesterol levels, improve endothelial function, reduce blood viscosity, stop the progression of the atherosclerotic process in the main arteries of the head and coronary vessels of the heart, have an antioxidant effect, and slow down the accumulation of beta-amyloid in the brain has been shown.
Antiplatelet therapy
It is known that ischemic disorders are accompanied by activation of the platelet-vascular hemostasis, which determines the mandatory prescription of antiplatelet drugs in the treatment of chronic cerebrovascular insufficiency. Currently, the effectiveness of acetylsalicylic acid is most well studied and proven. Enteric-soluble forms are used predominantly at a dose of 75-100 mg (1 mg/kg) daily. If necessary, other antiplatelet agents (dipyridamole, clopidogrel, ticlopidine) are added to treatment. Prescribing drugs in this group also has a preventive effect: it reduces the risk of developing myocardial infarction, ischemic stroke, and peripheral vascular thrombosis by 20-25%.
A number of studies have shown that only basic therapy (antihypertensive, antiplatelet) is not always sufficient to prevent the progression of vascular encephalopathy. In this regard, in addition to the constant intake of the above groups of drugs, patients are prescribed a course of treatment with agents that have antioxidant, metabolic, nootropic, and vasoactive effects.
Antioxidant therapy
As chronic cerebrovascular insufficiency progresses, there is an increasing decrease in protective sanogenetic mechanisms, including the antioxidant properties of plasma. In this regard, the use of antioxidants such as vitamin E, ascorbic acid, ethylmethylhydroxypyridine succinate, and Actovegin is considered pathogenetically justified. Ethylmethylhydroxypyridine succinate (Mexidol) can be used in tablet form for chronic cerebral ischemia. The initial dose is 125 mg (one tablet) 2 times a day with a gradual increase in dose to 5-10 mg/kg per day (maximum daily dose - 600-800 mg). The drug is used for 4-6 weeks, the dose is reduced gradually over 2-3 days.
Use of combination drugs
Considering the variety of pathogenetic mechanisms underlying chronic cerebral circulatory failure, in addition to the above-mentioned basic therapy, patients are prescribed drugs that normalize the rheological properties of blood, microcirculation, venous outflow, and have antioxidant, angioprotective, neuroprotective and neurotrophic effects. To exclude polypharmacy, preference is given to drugs that have a combined effect, a balanced combination of medicinal substances in which eliminates the possibility of drug incompatibility. Currently, quite a large number of such drugs have been developed.
Below are the most common drugs with a combined effect, their doses and frequency of use:
- ginkgo biloba leaf extract (40-80 mg 3 times a day);
- vinpocetine (5-10 mg 3 times a day);
- dihydroergocriptine + caffeine (4 mg 2 times a day);
- hexobendine + etamivan + etophylline (1 tablet contains 20 mg hexobendine, 50 mg etamivan, 60 mg etophylline) or 1 tablet forte, which contains 2 times more content of the first 2 drugs (taken 3 times a day);
- piracetam + cinnarizine (400 mg niracetam and 25 mg cinnarizine, 1-2 capsules 3 times a day);
- vinpocetine + piracetam (5 mg of vinpocetine and 400 mg of piracetam, one capsule 3 times a day);
- pentoxifylline (100 mg 3 times a day or 400 mg 1 to 3 times a day);
- trimethylhydrazinium propionate (500-1000 mg 1 time per day);
- nicergoline (5-10 mg 3 times a day).
These drugs are prescribed in courses of 2-3 months, 2 times a year, alternating them for individual selection.
The effectiveness of most drugs that affect blood flow and brain metabolism is manifested in patients with early, that is, stages I and II of dyscirculatory encephalopathy. Their use in more severe stages of chronic cerebrovascular insufficiency (in stage III discirculatory encephalopathy) can give a positive effect, but it is much weaker.
Despite the fact that they all have the above-described set of properties, one can focus on some selectivity of their action, which may be important in the choice of drug, taking into account the identified clinical manifestations.
- Ginkgo biloba leaf extract accelerates vestibular compensation processes, improves short-term memory, spatial orientation, eliminates behavioral disorders, and also has a moderate antidepressant effect.
- Dihydroergocryptine + caffeine acts primarily at the level of microcirculation, improving blood flow, tissue trophism and their resistance to hypoxia and ischemia. The drug helps improve vision, hearing, normalize peripheral (arterial and venous) circulation, reduce dizziness and tinnitus.
- Hexobendine + etamivan + etophylline improves concentration, integrative brain activity, normalizes psychomotor and cognitive functions, including memory, thinking and performance. It is advisable to slowly increase the dose of this drug, especially in elderly patients: treatment begins with 1/2 tablet per day, increasing the dose by 1/2 tablet every 2 days, bringing it up to 1 tablet 3 times a day. The drug is contraindicated in epileptic syndrome and increased intracranial pressure.
Metabolic therapy
Currently, there are a large number of drugs that can influence the metabolism of neurons. These are drugs of both animal and chemical origin that have a neurotrophic effect, chemical analogues of endogenous biologically active substances, agents affecting cerebral neurotransmitter systems, nootropics, etc.
Drugs such as Cerebrolysin and polypeptides of the cerebral cortex of livestock (polypeptide cocktails of animal origin) have a neurotrophic effect. It must be taken into account that in order to improve memory and attention in patients with cognitive disorders caused by cerebral vascular pathology, fairly large doses should be administered:
- Cerebrolysin - 10-30 ml intravenously, 20-30 infusions per course;
- polypeptides of the cerebral cortex of livestock (cortexin) - 10 mg intramuscularly, per course - 10-30 injections.
Domestic drugs glycine and Semax are chemical analogues of endogenous biologically active substances. In addition to their main effect (improving metabolism), glycine can produce a slight sedative effect, and Semax can produce an stimulating effect, which should be taken into account when choosing a drug for a particular patient. Glycine is a non-essential amino acid that affects the glutamatergic system. The drug is prescribed at a dose of 200 mg (2 tablets) 3 times a day, the course is 2-3 months. Semax is a synthetic analogue of adrenocorticotropic hormone, its 0.1% solution is administered 2-3 drops into each nasal passage 3 times a day, the course is 1-2 weeks.
The concept of “nootropic drugs” combines various drugs that can cause an improvement in the integrative activity of the brain and have a positive effect on memory and learning processes. Piracetam, one of the main representatives of this group, has the noted effects only when given in large doses (12-36 g / day). It should be borne in mind that the use of such doses by elderly people may be accompanied by psychomotor agitation, irritability, sleep disturbance, as well as provoke an exacerbation of coronary insufficiency and the development of epileptic paroxysm.
Symptomatic treatment of dyscirculatory encephalopathy
With the development of vascular or mixed dementia syndrome, background therapy is enhanced with agents that affect the exchange of the main neurotransmitter systems of the brain (cholinergic, glutamatergic, dopaminergic). Cholinesterase inhibitors are used - galantamine 8-24 mg/day, rivastigmine 6-12 mg/day, glutamate NMDA receptor modulators (memantine 10-30 mg/day), D2/D3 dopamine receptor agonist with α2-noradrenergic activity piribedil 50-100 mg/day. The last of these drugs is more effective in the early stages of dyscirculatory encephalopathy. It is important that, along with improving cognitive functions, all of the above drugs are able to slow down the development of affective disorders, which may be resistant to traditional antidepressants, and also reduce the severity of behavioral disorders. To achieve the effect, the drugs should be taken for at least 3 months. You can combine these means, replace one with another. If the result is positive, taking an effective drug or drugs for a long time is indicated.
Dizziness significantly impairs the quality of life of patients. Some of the above drugs, such as vinpocetine, dihydroergocriptine + caffeine, ginkgo biloba leaf extract, can eliminate or reduce the severity of vertigo. If they are ineffective, otoneurologists recommend taking betahistine 8-16 mg 3 times a day for 2 weeks. The drug, along with reducing the duration and intensity of dizziness, reduces the severity of autonomic disorders and noise, and also improves motor coordination and balance.
Special treatment may be required if affective disorders (neurotic, anxiety, depressive) occur in patients. In such situations, antidepressants that do not have an anticholinergic effect (amitriptyline and its analogues), as well as intermittent courses of sedatives or small doses of benzodiazepines, are used.
It should be noted that the division of treatment into groups according to the main pathogenetic mechanism of the drug is very arbitrary. For broader acquaintance with a specific pharmacological agent, there are specialized reference books; the task of this guide is to determine directions in treatment.
Surgical treatment of dyscirculatory encephalopathy
In case of occlusive-stenotic lesions of the main arteries of the head, it is advisable to raise the question of surgical elimination of the obstruction of vascular patency. Reconstructive operations are often performed on the internal carotid arteries. This is carotid endarterectomy, agency of the carotid arteries. The indication for their implementation is the presence of hemodynamically significant stenosis (overlapping more than 70% of the vessel diameter) or a loose atherosclerotic plaque, from which microthrombi can break off, causing thromboembolism of small vessels of the brain.
Approximate periods of incapacity for work
The disability of patients depends on the stage of dyscirculatory encephalopathy.
- At stage I, patients are able to work. If temporary disability occurs, it is usually due to intercurrent illnesses.
- Stage II of dyscirculatory encephalopathy corresponds to disability group II-III. Nevertheless, many patients continue to work, their temporary disability can be caused by both a concomitant disease and an increase in the phenomena of chronic cerebral circulatory failure (the process often occurs in stages).
- Patients with stage III dyscirculatory encephalopathy are disabled (this stage corresponds to disability group I-II).
Further management
Patients with chronic cerebrovascular insufficiency require constant background therapy. The basis of this treatment is blood pressure correcting drugs and antiplatelet drugs. If necessary, substances are prescribed that eliminate other risk factors for the development and progression of chronic cerebral ischemia.
Non-drug methods of influence are also of great importance. These include adequate intellectual and physical activity, feasible participation in social life. For frontal dysbasia with disorders of gait initiation, freezing, and the threat of falls, special gymnastics are effective. Stabilometric training based on the principle of biofeedback helps reduce ataxia, dizziness, and postural instability. For affective disorders, rational psychotherapy is used.
Patient Information
Patients should follow the doctor’s recommendations for both continuous and course use of medications, control blood pressure and body weight, quit smoking, follow a low-calorie diet, and eat foods rich in vitamins.
It is necessary to carry out health-improving exercises, use special gymnastic exercises aimed at maintaining the functions of the musculoskeletal system (spine, joints), and take walks.
It is recommended to use compensatory techniques to eliminate memory disorders, write down the necessary information, and draw up a daily plan. Intellectual activity should be maintained (reading, memorizing poems, talking on the phone with friends and family, watching television, listening to music or radio programs of interest).
It is necessary to perform feasible household duties, try to lead an independent lifestyle for as long as possible, maintain physical activity while taking precautions to avoid falling, and, if necessary, use additional means of support.
It should be remembered that in older people, after a fall, the severity of cognitive impairment increases significantly, reaching the severity of dementia. To prevent falls, it is necessary to eliminate risk factors for their occurrence:
- remove carpets that could cause the patient to trip;
- use comfortable non-slip shoes;
- if necessary, rearrange the furniture;
- attach handrails and special handles, especially in the toilet and bathroom;
- Showers should be taken in a sitting position.
Forecast
The prognosis depends on the stage of dyscirculatory encephalopathy. Using these same stages, it is possible to evaluate the rate of disease progression and the effectiveness of treatment. The main unfavorable factors are severe cognitive disorders, often paralleled by an increase in episodes of falls and the risk of injury, both traumatic brain injury and limb fractures (primarily the femoral neck), which create additional medical and social problems.
website - a medical portal about the heart and blood vessels. Here you will find information about the causes, clinical manifestations, diagnosis, traditional and folk methods of treating cardiac diseases in adults and children. And also about how to keep the heart healthy and blood vessels clean until old age.
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The authors of the site are practicing medical specialists. Each article is a concentrate of their personal experience and knowledge, honed over years of study at the university, received from colleagues and in the process of postgraduate training. They not only share unique information in articles, but also conduct virtual consultations - answer questions you ask in the comments, give recommendations, and help you understand the results of examinations and prescriptions.
All topics, even those that are very difficult to understand, are presented in simple, understandable language and are intended for readers without medical training. For your convenience, all topics are divided into sections.
Arrhythmia
According to the World Health Organization, arrhythmias, irregular heartbeats, affect more than 40% of people over 50 years of age. However, they are not the only ones. This insidious disease is detected even in children and often in the first or second year of life. Why is he cunning? And because it sometimes disguises pathologies of other vital organs as heart disease. Another unpleasant feature of arrhythmia is the secrecy of its course: until the disease goes too far, you may not be aware of it...
- how to detect arrhythmia at an early stage;
- which forms are the most dangerous and why;
- when is enough for the patient, and in what cases is surgery indispensable;
- how and how long do they live with arrhythmia;
- which attacks of arrhythmia require an immediate call to the ambulance, and for which it is enough to take a sedative pill.
And also everything about the symptoms, prevention, diagnosis and treatment of various types of arrhythmias.
Atherosclerosis
The fact that excess cholesterol in food plays a major role in the development of atherosclerosis is written in all newspapers, but why then in families where everyone eats the same way, often only one person gets sick? Atherosclerosis has been known for more than a century, but much of its nature remains unsolved. Is this a reason to despair? Of course not! The site’s specialists tell you what successes modern medicine has achieved in the fight against this disease, how to prevent it and how to effectively treat it.
- why margarine is more harmful than butter for people with vascular damage;
- and why it is dangerous;
- why cholesterol-free diets don't help;
- what will patients with;
- how to avoid and maintain mental clarity into old age.
Heart diseases
In addition to angina pectoris, hypertension, myocardial infarction and congenital heart defects, there are many other cardiac ailments that many have never heard of. Did you know, for example, that it is not only a planet, but also a diagnosis? Or that a tumor can grow in the heart muscle? The section of the same name talks about these and other heart diseases in adults and children.
- and how to provide emergency care to a patient in this condition;
- what to do and what to do so that the first does not turn into the second;
- why the heart of alcoholics increases in size;
- Why is mitral valve prolapse dangerous?
- What symptoms can you use to suspect that you and your child have heart disease?
- which cardiac diseases are more threatening to women and which ones to men.
Vascular diseases
Vessels permeate the entire human body, so the symptoms of their damage are very, very diverse. Many vascular diseases do not bother the patient much at first, but lead to serious complications, disability and even death. Can a person without medical education identify vascular pathology in himself? Of course, yes, if he knows their clinical manifestations, which this section will talk about.
In addition, here is the information:
- about medications and folk remedies for the treatment of blood vessels;
- about which doctor to contact if you suspect vascular problems;
- what vascular pathologies are deadly?
- what causes veins to swell;
- How to keep your veins and arteries healthy for life.
Varicose veins
Varicose veins (varicose veins) are a disease in which the lumens of some veins (legs, esophagus, rectum, etc.) become too wide, which leads to impaired blood flow in the affected organ or part of the body. In advanced cases, this disease is cured with great difficulty, but at the first stage it can be curbed. Read how to do this in the “Varicose veins” section.
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You will also learn from it:
- what ointments exist for the treatment of varicose veins and which one is more effective;
- why doctors prohibit some patients with varicose veins of the lower extremities from running;
- and who it threatens;
- how to strengthen veins with folk remedies;
- how to avoid blood clots in affected veins.
Pressure
- such a common illness that many consider it... a normal condition. Hence the statistics: only 9% of people suffering from high blood pressure keep it under control. And 20% of hypertensive patients even consider themselves healthy, since their disease is asymptomatic. But the risk of getting a heart attack or stroke is no less! Although it is less dangerous than high, it also causes a lot of problems and threatens with serious complications.
In addition, you will learn:
- how to “deceive” heredity if both parents suffered from hypertension;
- how to help yourself and your loved ones during a hypertensive crisis;
- why blood pressure increases at a young age;
- how to keep your blood pressure under control without medications by eating herbs and certain foods.
Diagnostics
The section devoted to the diagnosis of heart and vascular diseases contains articles about the types of examinations that cardiac patients undergo. And also about indications and contraindications to them, interpretation of results, effectiveness and procedures.
You will also find answers to questions here:
- what types of diagnostic tests even healthy people should undergo;
- why is angiography prescribed for those who have suffered a myocardial infarction and stroke;
Stroke
Stroke (acute cerebrovascular accident) is consistently among the ten most dangerous diseases. People at greatest risk of developing it are people over 55 years of age, hypertensive patients, smokers and those who suffer from depression. It turns out that optimism and good nature reduce the risk of strokes by almost 2 times! But there are other factors that effectively help avoid it.
The section dedicated to strokes talks about the causes, types, symptoms and treatment of this insidious disease. And also about rehabilitation measures that help restore lost functions to those who have suffered from it.
In addition, here you will learn:
- about the differences in clinical manifestations of strokes in men and women;
- about what a pre-stroke condition is;
- about folk remedies for treating the consequences of strokes;
- about modern methods of rapid recovery after a stroke.
Heart attack
Myocardial infarction is considered to be a disease of older men. But the greatest danger it poses is not for them, but for people of working age and women over 75 years of age. It is in these groups that mortality rates are highest. However, no one should relax: today heart attacks overtake even the young, athletic and healthy. More precisely, underexamined.
In the “Heart Attack” section, experts talk about everything that is important to know for everyone who wants to avoid this disease. And those who have already suffered a myocardial infarction will find here many useful tips on treatment and rehabilitation.
- about what diseases a heart attack is sometimes disguised as;
- how to provide emergency care for acute pain in the heart area;
- about differences in the clinical picture and course of myocardial infarction in men and women;
- about an anti-heart attack diet and a heart-safe lifestyle;
- about why a person suffering from a heart attack must be taken to a doctor within 90 minutes.
Pulse abnormalities
When we talk about pulse abnormalities, we usually mean its frequency. However, the doctor evaluates not only the speed of the patient’s heartbeat, but also other indicators of the pulse wave: rhythm, filling, tension, shape... The Roman surgeon Galen once described as many as 27 of its characteristics!
Changes in individual pulse parameters reflect the state of not only the heart and blood vessels, but also other body systems, for example, the endocrine system. Want to know more about this? Read the materials in the section.
Here you will find answers to questions:
- why, if you complain of pulse irregularities, you may be referred for a thyroid examination;
- whether a slow heart rate (bradycardia) can cause cardiac arrest;
- what does it mean and why is it dangerous;
- how heart rate and the rate of fat burning when losing weight are interrelated.
Operations
Many heart and vascular diseases, which 20–30 years ago doomed people to lifelong disability, can now be successfully cured. Typically surgically. Modern cardiac surgery saves even those who until recently were given no chance to live. And most operations are now performed through tiny punctures, rather than incisions, as before. This not only gives a high cosmetic effect, but is also much easier to tolerate. It also reduces the postoperative rehabilitation time by several times.
In the “Operations” section you will find materials about surgical methods for treating varicose veins, vascular bypass surgery, installation of intravascular stents, heart valve replacement, and much more.
You will also learn:
- which technique does not leave scars;
- how operations on the heart and blood vessels affect the patient’s quality of life;
- what are the differences between operations and vessels;
- for what diseases is it performed and what is the duration of a healthy life after it;
- What is better for heart disease - to be treated with pills and injections or to undergo surgery.
Rest
“Rest” includes materials that do not correspond to the topics of other sections of the site. Here you can find information about rare cardiac diseases, myths, misconceptions and interesting facts regarding heart health, unclear symptoms and their significance, the achievements of modern cardiology and much more.
- about providing first aid to yourself and others in various emergency conditions;
- about the child;
- about acute bleeding and methods to stop it;
- o and eating habits;
- about folk methods of strengthening and healing the cardiovascular system.
Drugs
“Medicines” is perhaps the most important section of the site. After all, the most valuable information about a disease is how to treat it. We do not provide here magical recipes for curing serious illnesses with one tablet; we honestly and truthfully tell everything about the drugs as they are. What are they good for and what are they bad for, for whom are they indicated and contraindicated, how do they differ from their analogues, and how do they affect the body. These are not calls for self-medication, this is necessary so that you have good command of the “weapons” with which you have to fight the disease.
Here you will find:
- reviews and comparisons of drug groups;
- information about what can be taken without a doctor’s prescription and what should not be taken under any circumstances;
- a list of reasons for choosing one or another means;
- information about cheap analogues of expensive imported drugs;
- data on the side effects of heart drugs that manufacturers are silent about.
And many, many more important, useful and valuable things that will make you healthier, stronger and happier!
May your heart and blood vessels always be healthy!