What is Cerebrovascular Disease?

Cerebrovascular disease refers to various diseases of the brain blood vessels, including cerebral atherosclerosis, thrombosis, stenosis, occlusion, cerebral arteritis, cerebral artery injury, cerebral aneurysm, intracranial vascular malformation, brain Arteriovenous fistulas and other common features are caused by ischemic or hemorrhagic accidents in the brain tissue, leading to disability or death of patients, and the incidence rate accounts for 1/4 to 1/2 of the total hospitalized cases of the nervous system.

Basic Information

English name

cerebralvascular diseases

Visiting department

Neurology, neurosurgery

Common locations

Cerebrovascular

Common causes

High blood cholesterol, low density lipoprotein, high blood pressure, tumor compression, cancer cell embolism, etc.

Causes of cerebrovascular disease

Common diseases, pathological changes and characteristics of cerebrovascular disease:

Atherosclerosis

Circulating blood caused by long-term cholesterol and low-density lipoprotein is too high and high-density lipoprotein is too low.

2. Adipose hyaline degeneration and fibrin necrosis

It is caused by hypertension and is found on the wall of perforating arteries with a diameter of less than 200 m. It occurs in the basal ganglia, the inner capsule and the thalamus.

3. Fibromuscular dysplasia

It is characterized by the occurrence of segmental fibrous tissue hyperplasia and degeneration in the middle layer of the cerebral artery, causing annular narrowing of the artery, weak middle layer of the regional tube wall, and rupture of the elastic layer, eventually expanding the arterial lumen and even aneurysm formation, which can also cause arteriovenous Fistula, aneurysm, or ischemic cerebral infarction.

4. Subacute arteriosclerotic encephalopathy (Bingswanger disease)

It is characterized by focal glial hyperplasia and degenerative changes of white matter under the cerebral cortex. Microscopic arterial involvement is the most visible, and multiple lacunar infarction is common in the basal ganglia. Patients often have a long history of hypertension with progressive dementia.

5. Amyloid angiopathy

It is characterized by the deposition of Congo-red amyloid in the middle and outer membranes of the middle and small arteries of the brain. The affected arteries are mostly subchondral cortical branches, which is a common cause of subcortical or cerebral lobe hemorrhage. It is common in the elderly. Human parietal and occipital lobe.

6. Vasculitis

Mostly related to the immune mechanism, can cause narrowing and occlusion of the lumen, and eventually lead to cerebral hemorrhage and cerebral infarction.

7. Venous and Sinus Thrombosis

It is caused by tumor compression, cancer cell embolism, parasinusitis, leukemia, pregnancy, etc., which can affect blood agglutination, damage of blood vessel wall, or hinder venous return.

8. Cerebral vasospasm

It is common after subarachnoid hemorrhage, which usually occurs 48 to 72 hours after the onset, and reaches a peak on the 5th to 7th days, which can last for 3 to 4 weeks.

Cerebrovascular disease examination

Laboratory inspection

2. Electrophysiological examination

EEG and EEG topography can record potential changes on the scalp of patients with ischemic encephalopathy; somatosensory and brainstem evoked potentials are helpful for diagnosis.

3. Cardiovascular system examination

4. Cerebrospinal fluid examination

It has a diagnostic significance for CT-negative SAH (subarachnoid hemorrhage), and it is helpful for the etiology diagnosis of cerebral infarction caused by tuberculosis, syphilis, fungi and infectious phlebitis.

5. Fundus examination

(1) The fundus artery (central retinal artery) can be used as a window to observe the internal carotid artery disease.

(2) When subarachnoid hemorrhage occurs, subvitreous sheet hemorrhage can be seen at the fundus, and signs of bleeding can still be seen after 1 to 2 weeks.

(3) The nerve fiber layer of the retinal artery is loose cotton-like, which is indirect evidence reflecting the internal carotid artery blood supply disorder.

(4) In cerebral embolic lesions, milky white shiny emboli can be found in the retinal blood vessels, indicating that they come from atherosclerotic plaques in the carotid artery.

(5) Patients with long-term hypertension have mild fundus lesions, indicating that there may be occlusion or partial stenosis of the internal carotid artery on this side.

6. Special inspection

(1) Head CT is the first choice, which can quickly identify cerebral hemorrhage, subarachnoid hemorrhage, and ischemic cerebrovascular disease.

(2) MRI (Magnetic Resonance Imaging) It is more sensitive to early cerebral ischemic stroke than CT, and more superior to infarcts of the posterior cranial fossa cerebellum and brainstem. Easy to recognize It is generally recommended to use multi-purpose CT for subarachnoid hemorrhage and acute cerebral hemorrhage, and to use MRI for cerebral ischemic stroke (cerebral infarction).

(3) Positron emission tomography (PET) can detect blood flow, metabolism and other physiological indicators of brain lesions, so as to determine whether ischemic lesions are reversible, whether there are other special information for reference in treatment options, and monitor and judge treatment The effect is also related to the complex abnormal manifestations in the course of the disease.

(4) Single-photon emission computed tomography (SPECT) can understand the changes in blood perfusion, metabolism, nerve receptors and other functions of the brain, and provide powerful help for early diagnosis of various cerebrovascular diseases and observation of treatment effects.

(5) Doppler understands the speed and direction of blood flow in the blood vessel, the level of blood pressure and the size of the blood vessel diameter, and combines various methods such as spectrum analysis, blood flow resistance, pulsation index, compression test, and drug test to diagnose various Cerebrovascular diseases, identification of therapeutic effects, screening of therapeutic drugs, research of cerebral hemorheology, etc.

Cerebrovascular disease diagnosis and differential diagnosis

Detailed inquiry

Onset, symptoms, procedures, past medical history, risk factors for cerebrovascular disease (family history, tobacco and alcohol addiction, obesity, contraceptives, etc.).

2. Physical examination

Positive neurological signs were found.

3. Preliminary judgment

(1) With or without brain lesions.

(2) The pathological nature of the lesion (bleeding, infarction, mixed lesions).

(3) The location of the lesion (brain, cerebellum, brain stem, diffuse, localized).

(4) Involved cerebral blood vessels (neck, intracranial, carotid artery, vertebral artery, ICA, MCA, ACA, PCA, etc.).

(5) Possible causes (hypertension, cardiogenic, congenital, metabolic disease, brain injury, etc.).

4. Laboratory inspection

5. Electrophysiological examination

EEG and EEG topography can record potential changes on the scalp of patients with ischemic encephalopathy; somatosensory and brainstem evoked potentials are helpful for diagnosis.

6. Cardiovascular system examination

7. Cerebrospinal fluid examination

It has a diagnostic significance for CT-negative SAH (subarachnoid hemorrhage), and it is helpful for the etiology diagnosis of cerebral infarction caused by tuberculosis, syphilis, fungi and infectious phlebitis.

8. Fundus examination

(1) The fundus artery (central retinal artery) can be used as a window to observe the internal carotid artery disease.

(2) When subarachnoid hemorrhage occurs, subvitreous sheet hemorrhage can be seen at the fundus, and signs of bleeding can still be seen after 1 to 2 weeks.

(3) The nerve fiber layer of the retinal artery is loose cotton-like, which is indirect evidence reflecting the internal carotid artery blood supply disorder.

(4) In cerebral embolic lesions, milky white shiny emboli can be found in the retinal blood vessels, indicating that they come from atherosclerotic plaques in the carotid artery.

(5) Patients with long-term hypertension have mild fundus lesions, indicating that there may be occlusion or partial stenosis of the internal carotid artery on this side.

9. Special inspection

(1) CT of the head is the first choice, which can quickly identify cerebral hemorrhage (uniform high density, no gyrus morphology), subarachnoid hemorrhage (increased density of sulci and cerebral cistern), and ischemic cerebrovascular disease ( Low-density lesions are visible 6 hours after the onset, but shifts in the midline structure are rare).

(2) MRI (Magnetic Resonance Imaging) It is more sensitive to early cerebral ischemic stroke than CT, and more superior to infarcts of the posterior cranial fossa cerebellum and brainstem. Easy to recognize It is generally recommended to use multi-purpose CT for subarachnoid hemorrhage and acute cerebral hemorrhage, and to use MRI for cerebral ischemic stroke (cerebral infarction).

(3) Positron emission tomography (PET) can detect blood flow, metabolism and other physiological indicators of brain lesions, so as to determine whether ischemic lesions are reversible, whether there are other special information for reference in treatment options, and monitor and judge treatment The effect is also related to the complex abnormal manifestations in the course of the disease.

(4) Single-photon emission computed tomography (SPECT) can understand the changes in blood perfusion, metabolism, nerve receptors and other functions of the brain, and provide powerful help for early diagnosis of various cerebrovascular diseases and observation of treatment effects.

(5) Doppler understands the speed and direction of blood flow in the blood vessel, the level of blood pressure and the size of the blood vessel diameter, and combines various methods such as spectrum analysis, blood flow resistance, pulsation index, compression test, and drug test to diagnose various Cerebrovascular diseases, identification of therapeutic effects, screening of therapeutic drugs, research of cerebral hemorheology, etc.

(6) Xenon-enhanced CT (XeCT) is used to diagnose cerebrovascular disease, determine prognosis, and observe treatment effects.

(7) Cerebral angiography The most direct way to observe the blood vessels in the brain. It can understand the shape, distribution, thickness, displacement, occlusion, and stenosis of blood vessels. (AVM), etc.).

(8) Magnetic resonance angiography (MRA) is not suitable for those who have a pacemaker or a metallic foreign body in the skull.

(9) Non-traumatic angiography (CTA) requires more contrast agents and may cause drug reactions.

Cerebrovascular disease treatment

(A) medical treatment

1. Processing principles applicable to the entire group

(1) Non-surgical treatment is required, and those who need surgical treatment need systematic non-surgical treatment before, during and after surgery, and even for life.

(2) The purpose of treatment is to provide normal or adequately nutritious blood to damaged brain tissue, maintain normal brain function and vitality, and remove accumulated metabolites from the brain.

(3) Fully consider and give full play to the automatic regulation mechanism of brain tissue and the abundant collateral circulation.

(4) Eliminate risk factors and causes.

(5) Completely rest in bed, monitor vital signs and nerve signs, and avoid mental and psychological depression and stimulation.

(6) Routine use of antibiotics is not required at the beginning of the onset. It is estimated that patients with a longer coma and who have been tracheostomy can be recommended.

(7) Intensify nursing to prevent various complications, including inhalation and fallout pneumonia, urinary tract infections, skin pressure ulcers, and lower extremity venous thrombosis.

2. Suitable for those with intracranial hemorrhage

(1) Control of blood pressure It is necessary for patients with hypertension to lower blood pressure moderately. It is advisable to maintain diastolic blood pressure at about 95 mmHg, and it is advisable to administer antihypertensive drugs intravenously.

(2) Give hemostatic agents such as Li Hemostatic, aminobenzoic acid (PAH), 6-aminohexanoic acid, etc.

(3) Tracheotomy should be performed in patients with a longer coma to keep breathing unobstructed .

3. Suitable for those with subarachnoid hemorrhage

(1) There are two methods to clear the bleeding : chemical removal (Elliot's solution) and intraoperative irrigation, the latter is better.

(2) Treatment of luminal stenosis to relieve vasospasm: common methods include slow intra-arterial injection of 0.3% papaverine solution, intra-arterial injection of nimoton solution and "3H" treatment (hypertension, high blood volume and blood dilution).

(3) Prevention of cerebral infarction Under the premise of blood pressure and diabetes control in patients, hormones can be used to stabilize lysosomes and cell membranes; calcium channel blockers can prevent intracellular calcium overload, and barbiturate can reduce the infarct area.

4. Applicable to cerebral ischemic stroke

(1) In the treatment of TIA, the most common cause is the loss of emboli in the heart. Early anticoagulation therapy, oral warfarin, and maintenance therapy should be performed for at least half a year. Most of them can stop or less TIA, and then continue with aspirin .

(2) Control of hypertension.

(3) Treatment of abnormal blood components, such as hyperglycemia and hyperlipidemia.

(B) surgical treatment

Cerebral ischemic stroke

(1) The options for external carotid artery stenosis are: Carotid artery thrombectomy (CEA) . Angioplasty, or autogenous saphenous vein bypass, or artificial blood vessel transplantation. Carotid artery bypass is only applicable to those with complete occlusion of extracranial arteries. Fogarty catheter method is an alternative to the above-mentioned arterial bypass surgery that cannot be used.

(2) Intracranial arterial embolization, stenosis and occlusion are available as follows: Extracranial-intracranial arterial anastomosis is commonly used with superficial temporal artery and middle cerebral artery (STA-MCA) anastomosis, occipital artery-inferior cerebellar artery (OA-PICA) Anastomosis. (pedicled or free) Omentum intracranial transplantation (IOT) is suitable for those who have ligated or occluded the external carotid artery, or the intracranial artery is too small for arterial anastomosis. Temporal muscle brain attachment is suitable for those who are unable to undergo intracranial transplantation of the omentum. Intracranial arterial thrombectomy is suitable for cases of intracranial internal carotid artery or MCA main embolism, and the onset time is less than 24 hours.

2. hemorrhagic stroke

(1) Cranial hematoma removal can be divided into craniotomy or craniotomy. At the end of the operation, those with high cranial pressure should be decompressed with bone flaps. Those who have bleeding into the ventricle should be placed in the ventricle for continuous drainage. Or intermittent injection of recombinant streptokinase into the ventricle to promote the dissolution of blood clots.

(2) Simple skull drilling and puncture hematoma drainage are limited to emergency situations as a means to obtain more relief time in order to further prepare for craniotomy.

(3) Endoscopic hematoma removal can be performed by stereotactic cerebral hematoma fragmentation and suction .

3. Other cerebrovascular diseases

(1) Neck clipping of intracranial aneurysms.

(2) Fistula blockage of carotid cavernous sinus fistula.

(3) Percutaneous angioplasty.

(4) Stent implantation, used for those who have damage to the cerebral arterial wall and tend to form aneurysms, such as carotid injury, carotid pseudoaneurysm, etc.