Vascular Disease Of The Brain

Symptoms Of Cerebrovascular Disease

The symptoms of cerebrovascular disease may differ slightly depending on the specific condition you have. However, stroke is the most common presentation of cerebrovascular diseases.

Strokes are characterized by sudden onset of symptoms, and survival and functional outcomes are time-sensitive. To help you identify the warning signs of a stroke, use the acronym FAST:

• Facial droop: One side of the face may appear droopy or the person may be unable to smile.
• Arm weakness: The person is unable to raise their arm above their head
• Speech difficulty: The person has slurred speech, is unable to find words, or is unable to understand what people are saying to them
• Time to call 911: Immediately seek medical attention if even one of these symptoms is present.

Other symptoms of a TIA or stroke include:

• severe headache
• vomiting and nausea
• memory loss or confusion
• numbness and tingling in the arm, leg, or face, usually on only one side of the body

number 5 on the list of leading causes of death.

For people who survive a stroke, the two most important outcomes are functional outcomes and life expectancy. These are determined by the specific condition causing the stroke, the severity of the stroke, and the individuals response to rehabilitation therapy.

A cerebrovascular disease, especially a stroke, must receive immediate medical attention to have the best outcomes.

Complications of cerebrovascular disease that may develop include:

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Bilateral Infarction And Associated Syndromes

Bilateral PCA infarction occurs in 6%13% of patients.10,12,13,34 Bilateral infarction can occur simultaneously, but more often infarction on one side precedes the other. The hallmark clinical feature is cortical blindness.229 On examination, there is the absence of blinking in response to visual threats and optokinetic reflex. Pupillary reflexes and fundus examination are normal. Although uncommon, patients may not recognize their deficits and do not admit that they cannot see .13 It has been hypothesized that the visual association area in the parietal lobe is concomitantly affected in these patients, which causes the lack of awareness of deficits.230 Patients may demonstrate confabulation or increased verbosity, possibly to compensate for the lack of visual input.231

In patients who are not completely blind, the degree of visual disturbance varies according to infarction severity, which is in part related to the size of the occluded arteries and the variability in compensatory blood supply .6 In these patients, visual field defects may develop in various patterns, including bilateral homonymous hemianopia or bilateral altitudinal hemianopia, both of which result in various types of difficulties in daily life activities.229,232,233 In some, the visual disturbances are mild and transient . Conversely, extensive bilateral PCA infarction may result in severe edema or herniation that may lead to death.234

Georgios A. Maragkos, … Christopher S. Ogilvy, in, 2022

How Is Vascular Dementia Diagnosed

In addition to a complete medical history and physical exam, your healthcare provider may order some of the following:

• Computed tomography . This imaging test uses X-rays and a computer to make horizontal, or axial images of the brain. CT scans are more detailed than general X-rays.
• FDG-PET scan. This is a PET scan of the brain that uses a special tracer to light up regions of the brain.

• Electroencephalogram . This test measures electrical activity in the brain
• Magnetic resonance imaging . This test uses large magnets, radiofrequencies, and a computer to make detailed images of the brain.
• Neuropsychological assessments. These tests can help sort out vascular dementia from other types of dementia and Alzheimer’s.
• Neuropsychiatric evaluation. This may be done to rule out a psychiatric condition that may resemble dementia.

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Treatment Of Patients With Dominant

The treatment of patients with malignant MCA infarction of the dominant hemisphere is another controversial issue. In many centers decompressive surgery was rarely done in these patients. The inability to communicate and severe hemiplegia, especially of the dominant upper extremity, were considered too disabling, and hemicraniectomy was often restricted to patients with a non-dominant-hemisphere infarction. From the randomized trials and larger prospective case series, there is currently no indication that patients with dominant malignant infarctions do not profit from treatment.27,71,75 Neither mortality nor functional outcome depends on the side of the lesion in any of the larger prospective studies.79 Indeed, the handicap caused by aphasia may be balanced by the neuropsychological deficits that are less obvious to clinical observation but may be no less disabling that is, the severe attention deficit, apraxia, and others, in patients with infarction of the non-dominant hemisphere.95,98 In addition, the long-term aphasia in dominant-hemisphere malignant MCA infarction is rarely complete and often shows improvement.52,56,80,95,96 So far, there are no indications that surgery should not be considered in patients with dominant-hemisphere infarction.

Causes Of Peripheral Vascular Disease

In most cases the cause is atherosclerosis, the build-up of fatty deposits within the blood vessel that reduces blood flow to the area. Commonly this occurs in the body where a blood vessel kinks or subdivides.Apart from fatty deposits, other causes of peripheral vascular disease include:

• Diabetes high blood sugar damages and weakens blood vessels, causing them to narrow.
• Obstruction a blood clot may lodge within the blood vessel.
• Infection can cause scarring and narrowing of the blood vessels. Syphilis or salmonellosis, for example, can lead to peripheral vascular disease.
• Arteritis inflammation of arteries. Some autoimmune diseases can cause arteritis.
• Blood vessel defects blood vessels may be unusually narrow at birth. The cause is unknown.
• Blood vessel spasms conditions such as Raynauds disease may cause narrowing of blood vessels in response to certain factors, including cold temperatures or stress.

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Causes And Risk Factors

The cause of microvascular ischemic disease isnt completely understood. It can be the result of plaque buildup and hardening that damages the small blood vessels nourishing the brain. This is the same process that narrows and damages blood vessels to the heart and can lead to heart attacks.

Damage can block blood flow through the blood vessels in the brain, depriving brain cells of oxygen. Or, it can cause blood vessels in the brain to leak and bleed, which can damage neighboring neurons.

Risk factors for microvascular ischemic disease include:

• high blood pressure

Reducing The Risk Of Stroke

Taking blood platelet inhibitors, including Clopidogrel and Plavix, can reduce the risk of stroke before it occurs. These can help prevent stroke in people with a history or high chance of having a cerebrovascular attack.

Historically, doctors recommended that people took a daily dose of aspirin to reduce the risk of a heart attack or stroke. However, current guidelines urge people to speak with their doctor before taking daily low-dose aspirin. This is because aspirin increases the risk of bleeding.

Doctors prescribe statins to lower and manage high cholesterol levels and decrease the risk of ischemic stroke and heart attack.

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How Is Vascular Disease Diagnosed

Your healthcare provider will want to do a physical exam and get your medical history, as well as a history of which diseases are in your family. It helps your healthcare provider look for vascular disease when you take your shoes and socks off before they examine you.

Depending on the type of vascular disease your provider suspects, they may do blood tests and imaging.

What Is Microvascular Disease Of The Brain

Microvascular disease of the brain is a condition that affects the communication between large arteries supplying blood to the brain and their smaller arterial branches, according to the National Institutes of Health. The development of microvascular disease in the brain is related to microscopic brain bleeds and silent cerebral strokes.

Microvascular disease is caused by age-related changes in the brain and has also been linked to hypertension. The effects of diseased brain arterioles show up in imaging studies as subcortical lesions, as well as in strokes caused by the blockage of the small blood vessels that go deep into the brain, in microbleeds and in white matter lesions, according to NIH. The disease has been linked to broader vascular conditions such as vascular dementia, a condition caused by the loss of blood supply to parts of the brain, according to the Alzheimers Association.

MRI scan studies have revealed that increased levels of uric acid in the blood is one of the causes of cerebral microvascular disease, according to NIH. Other causes of the disease include hypertension, diabetes, smoking, high cholesterol and a sedentary lifestyle, according to NetWellness. The changes caused by microcascular changes, such as vascular cognitive impairment, are often concurrent with other conditions such as Alzheimers disease, reports the Alzheimers Association.

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The University Of Michigan Cerebrovascular Program

Our team of neurosurgeons and interventional neuroradiologists treat patients who require urgent care for a stroke or bleeding in the brain. We also consult upon patients who are considered stable, but require diagnosis and treatment for a condition like a cerebral aneurysm or a cerebral arteriovenous malformation .

Experience, outcomes and quality of life are all things that people suffering from a cerebrovascular condition need to consider when looking for treatment options. As one of only a few places in the country that offers comprehensive expertise treating the most complex cerebrovascular disorders with both advanced microsurgery, radiosurgery, and minimally invasive endovascular treatment options, U-M is leading the way in patient safety, patient satisfaction and quality outcomes.

Our patients are also privy to our NeuroInterventional Radiology suite a first of its kind in the nation which allows us to both detect and repair aneurysms, strokes and other cerebrovascular conditions all in the same room. The suite reduces the wait time between diagnosis and treatment in both urgent and elective cases, and gives our physicians the necessary information to safely and quickly plan minimally invasive treatment, when indicated.

The suite allows U-M physicians to perform both CT and CT angiography scans that are needed before an interventional procedure, and then to perform the procedure without moving the patient.

Hemorrhagic Transformation Of Stroke

Hemorrhagic transformation is a common consequence of ischemic stroke and frequently accompanies moderate to large infarcts without any specific therapy. The overall incidence of HT in untreated ischemic strokes ranges from about 7% to 40%. Symptomatic intracerebral hemorrhage occurs in approximately 6% of patients receiving IV thrombolysis for acute ischemic stroke and has been associated with high morbidity and mortality . Most hemorrhagic transformations are diagnosed 24 to 48 hours after ischemia and occur due to reperfusion of an ischemic damaged endothelium . ICH is usually attributed to thrombolytics if within 24 to 36 hours of treatment. HT of infarct can range from petechial hemorrhages to large hematomas. Four types of HT have been defined including hemorrhagic infarction or parenchymal hematoma . The parenchymal hematoma type 2 or larger hematomas with mass effect may be associated with neurologic deterioration and poor outcomes . The majority of hemorrhagic transformations in arterial infarcts are smaller than the field of the infarct. FLAIR and DWI sequences may be helpful to assess the nonhemorrhagic regions and to show that the blood is within a larger ischemic infarct in a vascular distribution.

Table 5.3 TYPES OF HEMORRHAGIC TRANSFORMATION IN ISCHEMIC STROKE

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What Is Microvascular Ischemic Disease

Microvascular ischemic disease is an umbrella term that refers to a variety of changes in the small blood vessels of your brain. Depending on the severity of these changes, they can cause a range of complications from difficulty focusing to a stroke.

Microvascular ischemic disease has many names, such as:

• Cerebral small vessel disease .
• Chronic microvascular ischemic disease.
• Small vessel ischemic disease.

Vascular Malformations Of The Brain

Synonyms of Vascular Malformations of the Brain

• Cerebral Malformations, Vascular

Subdivisions of Vascular Malformations of the Brain

• Arteriovenous Malformation
• Venous Malformations

General Discussion

As the name suggests, vascular malformations of the brain is an umbrella term for at least six conditions in which blood vessels of the brain are affected. Such malformations are classified into several types in which the symptoms, severity, and causes vary. These types of VMB are: arteriovenous malformations , abnormal arteries and veins cavernous malformations , enlarged blood-filled spaces venous angiomas , abnormal veins telangiectasias , enlarged capillary-sized vessels vein of Galen malformations and mixed malformations .

Signs & Symptoms

Vascular malformations of the brain may cause headaches, seizures, strokes, or bleeding in the brain . Some researchers believe that the type of malformation determines the symptoms and progression of the disease. Other researchers believe that only the severity rather than the type of malformation is important.

Venous angiomas involve enlarged, tangled, and twisted veins that vary in size but do not involve the arteries. The site of these growths is most often just after the capillary stage of the vessel . They may be isolated defects or associated with cavernous malformations. The defect shows itself as a crown of small veins that meet to form part of a larger vein .

Causes

Affected Populations

Related Disorders

Diagnosis

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How Is Vascular Dementia Treated

Because many different disease processes can result in different forms of vascular dementia, there may not be one treatment for all. However, vascular dementia is often managed with medications to prevent strokes and reduce the risk of additional brain damage. Some studies suggest that medications that are used to treat Alzheimer’s might benefit some people with an early form of vascular dementia. Treating modifiable risk factors like high blood pressure, diabetes, high cholesterol, and problems with the rhythm of the heartbeat can help prevent additional stroke. Living a healthy lifestyle is important to help reduce the risk factors of vascular dementia.

How Is Microvascular Ischemic Disease Treated

There arent specific treatments for microvascular ischemic disease. Currently, treatment focuses on reducing risk factors and staving off complications, such as dementia and stroke.

Every person will have different risk factors, so treatment is highly personalized. In general, treatment may include:

• Adopting healthy habits, such as exercising and eating more nutrients.
• Taking medications to lower high blood pressure and control cholesterol and glucose levels.

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How Do You Treat Pvd

The two main goals of PVD treatment is to stop the disease from progressing and to help you manage your pain and symptoms so you can remain active. The treatments will also lower your risk for serious complications.

First-line treatment typically involves lifestyle modifications. Your doctor will suggest a regular exercise program that includes walking, a balanced diet, and losing weight.

If you smoke, you should quit. Smoking directly causes reduced blood flow in vessels. It also causes PVD to get worse, as well as increasing your risk of heart attack and stroke.

If lifestyle changes alone arent enough, you may need medication. Medications for PVD include:

• cilostazol or pentoxifylline to increase blood flow and relieve symptoms of claudication
• clopidogrel or daily aspirin to reduce blood clotting
• atorvastatin, simvastatin, or other statins to lower high cholesterol
• angiotensin-converting enzyme inhibitors to lower high blood pressure
• diabetes medication to control blood sugar, if you have diabetes

Significant artery blockages may require surgery like angioplasty or vascular surgery. Angioplasty is when your doctor inserts a catheter or long tube into your artery. A balloon on the tip of the catheter inflates and opens up the artery. In some cases, your doctor will place a small wire tube in the artery, called a stent, to keep it open.

Vascular surgery allows for blood to bypass the narrow area through vein grafting.

Cerebrovascular Diseases And Stroke

Cerebrovascular diseases include many disorders of the brains blood vessels that impair cerebral circulation. The brain requires a significant portion of the bodys blood flow, and any reduction can result in stroke. Stroke is the fifth leading cause of death in the United States and is the leading cause of adult disability. At Columbia Neurosurgerys Cerebrovascular Center, our physicians and surgeons are experts in the diagnosis and treatment of cerebrovascular diseases , and in the prevention and treatment of ischemic and hemorrhagic stroke.

There are often several methods available to treat a cerebrovascular disorder, as well as a burgeoning array of new technologies. One important reason that Columbia has excellent outcomes treating patients with cerebrovascular diseases is our ability to navigate these options, taking into account each patients wishes and individual circumstances, making the right recommendation to treat each patients specific problem. Our expertise in the use of the latest surgical tools and technologies gives each patient the best chance to make a full recovery.

Common cerebrovascular diseases that we treat include:

• Cerebral aneurysms, both adult and pediatric
• Cerebrovascular malformation

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How Is Vascular Disease Treated

Eating healthier and exercising more can help with many vascular diseases. For others, you may need to take medicine or have a surgical procedure. Vascular disease treatments vary depending on the condition.

Peripheral artery disease treatment

• Peripheral artery disease: Diet, exercise, medicine, surgery.
• Intestinal ischemic syndrome: Pain medicine, clot-busting drugs, surgical removal of blood clot. Angioplasty, stenting or bypass surgery for chronic cases.
• Renal artery disease: Low-salt, heart-healthy diet. High blood pressure medicine, statins.
• Popliteal entrapment syndrome: Surgery to release the popliteal artery.
• Raynaudâs phenomenon: Keep hands and feet warm. Take medicine that helps blood vessels stay open .
• Buergerâs disease: Quit tobacco products. Warm up fingers and toes. Take medicine to open blood vessels.

Treatment of carotid artery issues

• Carotid artery disease: Healthier diet. Blood thinners and cholesterol-lowering medicine. Plaque removal . Angioplasty and stenting to keep the artery open.
• Carotid artery dissection: Antiplatelets, anticoagulants, stenting.
• Carotid body tumors: Surgical removal of the tumor.
• Carotid artery aneurysm: Antihypertensives, cholesterol-lowering medicine, clot-busting medicine. Bypass or stent-graft surgery.

Venous disease treatment

Blood clot treatment

Aortic aneurysm treatment

Fibromuscular Dysplasia

• Blood thinners, medicine for pain.
• Angioplasty. Surgery to prevent an artery rupture.

Lymphedema

Vasculitis