Cerebral arteriosclerosis
Introduction
Introduction to brain arteriosclerosis Cerebral arteriosclerosis refers to chronic encephalopathy such as neurasthenic syndrome, arteriosclerotic dementia, and pseudobulbar paralysis caused by multiple infarction, softening, necrosis and atrophy of the brain after cerebral arteriosclerosis. Cerebral arteriosclerosis can cause acute cerebral dysfunction and chronic cerebral ischemia in TCIA, stroke, symptoms and signs are different from TCIA, stroke and vascular dementia. There is a history of TCIA or mild stroke but no obvious sequelae. It is more appropriate to diagnose cerebral arteriosclerosis. Therefore, the diagnosis of cerebral arteriosclerosis is still necessary for preservation, which is helpful to remind patients and doctors to prevent stroke early. basic knowledge The proportion of illness: 0.04% Susceptible population: middle-aged and elderly people who often occur in people over 40 years old Mode of infection: non-infectious Complications: Hyperlipidemia Diabetes and hypertension
Cause
Cause of cerebral arteriosclerosis
Causes:
Cerebral atherosclerosis mainly invades the large and middle brains with a diameter of more than 500m. The main cerebral artery lesions around the Willi's ring in the East are severely related and are closely related to hypertension. In the past, small arteries mainly assumed and regulated vascular resistance, which was high. Blood pressure mainly causes small arteriosclerosis. Recently, it has been found that the main brain of the brain accounts for 20% to 30% of the total cerebral vascular resistance, and 50% of chronic hypertension. Long-term high blood pressure will inevitably lead to atherosclerotic damage to the main arterial wall of the brain.
(two) pathogenesis
Hypertensive cerebral arteriosclerosis mainly occurs in the small perforating artery with a diameter of <200m in the brain parenchyma. When the pressure on the bloodstream side exceeds the maximum contractile force of the smooth muscle of the media, the vascular smooth muscle degeneration and necrosis, the contractility is lost, the blood vessels are passively dilated, and the intima is damaged. Increased permeability, infiltration of plasma components, leading to cellulite necrosis of small arteries, causing hypertensive encephalopathy is an acute decompensation manifestation, persistent chronic hypertension, under the action of blood flow side pressure and various vasoactive substances, arteriolar wall Structural compensation, smooth muscle hypertrophy, hyalinosis, increased connective tissue components such as collagen, protein and glycans, thickened wall, called hypertension, small arteriosclerosis, enhanced tolerance of blood vessel wall to hypertension, but regulation The systolic and diastolic function of the blood flow is reduced, and the lacunar infarction can be caused when the blood pressure is lowered. Due to the long-term hypertension, the micro-aneurysm can be formed in the thinning of the arterioles and arterioles of the arterioles or the thinning of the arterial wall, and the blood pressure is suddenly increased. This aneurysm rupture is the main cause of spontaneous cerebral hemorrhage. Long-term cerebral arteriosclerosis can cause focal subcortical white matter. Ischemic softening, CT or MRI showed leukoaraiosis, if there is obvious dementia symptoms, called Binswanger subcortical encephalopathy (Binswanger subcortical encephalopathy).
Under the action of long-term hypertension, the muscular arterial smooth muscle also undergoes the process of compensatory arterial smooth muscle from functional compensation to structural compensation. The wall is hardened, thickened and narrowed in the lumen. In order to maintain the original blood flow, the flow rate can be accelerated. Lead to vascular endothelial cell injury, endothelial cells are the key mediator of hemodynamic effects, endothelial damage causes vasomotor function, initiates hemostasis coagulation process, infiltration of blood lipoprotein, thickening of intima, atherosclerotic plaque formation The vascular lumen is further narrowed. Under hemodynamics, atherosclerotic plaque ruptures, ulcers and hemorrhage, induce thrombosis, cause arterial occlusion and cerebral infarction. It can be seen that long-term hypertension is the most cerebral atherosclerosis. An important cause.
Hyperlipidemia is closely related to cerebral atherosclerosis. It has been proved that serum cholesterol (TC) > 3.9mmol / L (150mg / dl) can occur atherosclerosis, hyperlipidemia is an important promotion of cerebral atherosclerosis Factors, carotid atherosclerotic plaque degeneration, ulcers, fractures and hemorrhage can often induce thrombosis, so that the narrow arterial blood flow is significantly reduced, can be suddenly occluded, leading to thrombotic cerebral infarction, detached small embolism blocked In the distal small arteries, it can cause sudden and unpredictable TCIA or thromboembolic stroke.
Pathological changes in atherosclerosis include:
1 The fatty streak is an early lesion, which occurs mostly at the opposite side of the blood flow bifurcation. It is a local adaptive intimal thickening of mechanical force, and contains a large number of foam cells derived from macrophages or smooth muscle cells rich in lipids;
2 fibrous plaque consists of lipid-containing smooth muscle cells and connective tissue rich in collagen fibers, covering the intimal layer and protruding into the lumen of the blood vessels, and the artery may expand to accommodate the enlargement of the plaque;
3 The composite lesion is formed by hemorrhage, necrosis, ulceration, calcification and wall thrombus in atherosclerotic plaque. As the plaque increases, the part is softened by intermediate ischemia, and the surface of the plaque breaks under the force of blood flow. With plaque internal bleeding or thrombosis;
4 ulcer is a shallow depression or penetrating plaque on the plaque, containing deep hemorrhage, lipid and calcification;
5 plaque hemorrhage may be due to plaque fracture or intimal rupture, blood into the softened plaque, or into the plaque of the nourishing small blood vessels rupture (related to hypertension), there are often acute and fresh inflammatory reactions around plaque hemorrhage, Visible polymorphonuclear leukocytes and macrophage infiltration, plaque bleeding plays an important role in triggering stroke;
6 complex plaque contains a large number of lipids, and its content is closely related to the degree of arterial stenosis and cerebral ischemia. The higher the collagen content as the main component of smooth fiber plaque, the lower the risk of ischemia.
Prevention
Cerebral arteriosclerosis prevention
Control risk factors including
1. Improve the population's awareness rate, treatment rate and control rate of hypertension, and effectively monitor the blood pressure by using -blockers, angiotensin-converting enzyme inhibitors, calcium channel antagonists and diuretics.
2, to maintain blood cholesterol levels below the critical level of 5.20 ~ 6.24mmol / L, adjust the diet, appropriate selection of various lipid-lowering drugs such as statins.
3, regular monitoring of blood glucose, patients with hypertriglyceridemia should effectively control diabetes.
4, develop a healthy lifestyle, stop smoking and limit alcohol, increase outdoor sports, reduce weight, balance diet, maintain psychological balance.
Try to do the following
1. Physical exercise: Before exercise, the purpose of physical exercise should be clearly defined. Participate in a happy mood. You should master the principle of gradual and perseverance. Exercise comprehensively, strictly control the amount of exercise, avoid eating in large quantities, drinking tea, and two hours after coffee. For internal exercise, you should not eat or drink a strong drink within half an hour of exercise.
2, cultivate a healthy lifestyle, pay attention to diet control, reasonable diet, atherosclerosis patients, avoid eating the following food: sheep marrow, fat meat, pig liver, pig kidney, duck eggs, goose meat, clams, liquor, beer, etc., prevention Several foods for arteriosclerosis: ginger, milk, soybeans, garlic, onions, sea fish, tangerines, hawthorn, tea, eggplant, oatmeal, soft-shelled turtle, fungus, sweet potato.
3, nursing, arteriosclerosis caused by headache care should pay attention to the following points: health education, for those with mental retardation, mental disorders and physical mobility, to strengthen care to prevent accidents.
4, massage, acupuncture treatment of cerebral arteriosclerosis.
The disease is mainly based on diet control and physical exercise, supplemented by drug treatment, and the effect is better.
Complication
Cerebral arteriosclerosis complications Complications hyperlipidemia diabetes and hypertension
Traditionally, cerebral arteriosclerosis dementia and pseudobulbar paralysis are also classified as cerebral arteriosclerosis. However, clinical and imaging studies in recent years have proved that these clinical syndromes and recurrent strokes, such as multiple lacunar infarction. Related, cerebrovascular disease classification has included cerebral vascular dementia, atherosclerotic psychosis caused by cerebral arteriosclerosis, Parkinson's syndrome, etc. are not classified as cerebral arteriosclerosis, but may be a serious complication, cerebral atherosclerosis Patients with sclerosing disease often have clinical manifestations of hypertension, hyperlipidemia or diabetes.
Symptom
Symptoms of cerebral arteriosclerosis Common symptoms Cerebral ischemia Cardiac cerebral insufficiency Brain dysfunction Fatigue Memory disorder with hypertension Blink coma Elderly leg cramps Sensory disorder
Clinical manifestation
Cerebral arteriosclerosis often occurs in middle-aged and older people over the age of 40. Men are more likely than women. People with high blood pressure, diabetes, hyperlipidemia, long-term smoking, drinking and mental stress are more common. Due to chronic chronic blood supply to the brain, brain dysfunction is caused.
Cerebral atherosclerosis can be asymptomatic without causing vascular complications and cerebral blood supply disorders, but the following manifestations are common:
1. neurasthenia syndrome such as headache, dizziness, fatigue, lack of concentration, memory loss, emotional instability, slow thinking, sleep disorders (insomnia or lethargy), etc., the condition fluctuates.
2. Carotid atherosclerotic plaque micro-emboli can occur transient cerebral ischemic attack (TCIA), such as coronary atherosclerosis caused by angina pectoris, lower extremity atherosclerosis intermittent claudication, cerebral arteriosclerosis can be in chronic brain A transient cerebral ischemic syndrome occurs on the basis of insufficiency. Foreign scholars regard angina as a clinical symptom of coronary arteriosclerosis, and treat TCIA (except cardiac) as a clinical symptom of cerebral arteriosclerosis.
3. Fundus arteriosclerosis can be seen in the arterial thinning, enhanced reflection, severe cases of silver-like and arteriovenous cross-pressure. The palmar reflex and the sucking reflex are positive. Patients with a history of stroke may have residual signs such as cranial nerve damage, hemiplegia, and partial sensory disturbance.
Examine
Examination of cerebral arteriosclerosis
Laboratory inspection
1. Cerebrospinal fluid examination: generally do not do cerebrospinal fluid examination, most patients have normal cerebrospinal fluid.
2. routine and biochemical examination of hematuria: mainly related to risk factors of cerebrovascular disease such as hypertension, diabetes, hyperlipidemia, heart disease, atherosclerosis.
Film degree exam
1. Cervical color Doppler examination: It can show the extracranial atherosclerotic plaque and ulcer of the internal carotid artery, thrombosis, stenosis or occlusion, which is helpful for cervical spondylosis.
2. Transcranial color Doppler ultrasound (TCD): can detect cerebral arterial blood flow velocity, pulsation index, assess the degree of cerebral arteriosclerosis, and detect microemboli in the brain.
3. CT and MRI examination: multiple lacunar infarction, subcortical arteriosclerotic encephalopathy, etc. can be found, and other brain organic diseases are excluded.
Diagnosis
Diagnosis and diagnosis of cerebral arterios
diagnosis
According to the patient's insidious onset, chronic cerebral insufficiency syndrome, no signs of focal brain damage, fundus and systemic arteriosclerosis, often accompanied by hypertension, hyperlipidemia and diabetes, combined with color Doppler ultrasound detected intracranial artery cranial External atherosclerotic plaque, TCD detection of cerebral arterial blood flow status, CT and MRI showed multiple luminal lesions, subcortical arteriosclerotic encephalopathy, etc.; if patients with TCIA or stroke can be diagnosed as cerebral arteriosclerosis .
Differential diagnosis
Pathologically, there are almost different degrees of arteriosclerosis in patients over 60 years old. It is not easy to diagnose cerebral arteriosclerosis in normal elderly without clinical symptoms. Clinical attention should be paid to the identification of neurosis. It is also necessary to exclude chronic intracranial lesions. Such as brain tumors, chronic infections, and brain symptoms caused by systemic diseases, there are obvious mental disorders except senile dementia, senile psychosis.
