Mental disorders associated with cerebral arteriosclerosis
Introduction
Introduction to mental disorders associated with cerebral arteriosclerosis Mental disorder associated with cerebral arteriosclerosis (mentaldisordercausedbycerebralarteriosclerosis) is a schizophrenia associated with vascular disease, which refers to atherosclerotic changes due to various factors such as fat metabolism, vascular wall function, endocrine, hypertension, and long-term hobby. , resulting in a small cerebral artery lumen, insufficient blood supply to the brain, and a wide and scattered ischemic changes in the brain, leading to mental disorders. Older people who are more than 50 to 60 years old, more men than women, slow onset, symptoms fluctuate, and gradually increase. Late stages often lead to infarction or bleeding. The disease is caused by fat, cholesterol metabolism disorder, resulting in cerebral arteriosclerosis, arterial connective tissue hyperplasia, narrowing of arterial lumen, reduced elasticity, increased resistance to blood flow, reduced blood flow, and chronic brain tissue Hypoxia, degeneration of brain cells, softening, necrosis or punctiform hemorrhage, and finally the formation of scars, cysts or diffuse brain atrophy, the emergence of corresponding mental disorders and neurological symptoms, in addition to the changes in brain tissue structure In addition to the direct relationship, it is also related to the personality characteristics of patients before the disease, genetic factors, functional status of the central nervous system and stress factors. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: anxiety disorder, disturbance of consciousness, tinnitus, hemiplegia, bulbar palsy, aphasia
Cause
Causes of mental disorders associated with cerebral arteriosclerosis
(1) Causes of the disease
The causes of cerebral arteriosclerosis may be related to factors such as fat metabolism disorder, arterial wall dysfunction, endocrine factors, essential hypertension and long-term hobbies, such as tobacco and alcohol. It is worth mentioning that different degrees of mental disorders and neurological symptoms are produced. It is not consistent with the pathological changes of cerebral arteriosclerosis. The organic changes of brain tissue during cerebral arteriosclerosis and the patient's personality characteristics, genetic factors, mental and psychological factors are closely related to the occurrence of mental disorders and neurological symptoms.
(two) pathogenesis
The disease is caused by fat, cholesterol metabolism disorder, resulting in cerebral arteriosclerosis, arterial connective tissue hyperplasia, narrowing of arterial lumen, reduced elasticity, increased resistance to blood flow, reduced blood flow, and chronic brain tissue Hypoxia, degeneration of brain cells, softening, necrosis or punctiform hemorrhage, and finally the formation of scars, cysts or diffuse brain atrophy, the emergence of corresponding mental disorders and neurological symptoms, in addition to the changes in brain tissue structure In addition to the direct relationship, it is also related to the personality characteristics of patients before the disease, genetic factors, functional status of the central nervous system and stress factors.
Prevention
Prevention of mental disorders associated with cerebral arteriosclerosis
The key is to prevent the occurrence and development of cerebral arteriosclerosis. Because cerebral arteriosclerosis is a part of systemic arteriosclerosis, it is also one of the main pathological factors leading to cerebrovascular disease, and arteriosclerosis develops slowly and conceals. It can be without any symptoms for a long time. It attracts people's attention, so early prevention is extremely important. There have been pathological anatomy found that there is lipid deposition on the wall of children's blood vessels, and although hypertension is often found in adults, it actually starts in childhood. According to the study, the average person age At the age of 20, the trend of cerebral arterial elasticity gradually declines. It gradually becomes obvious after 40 years old, and early symptoms will appear after 50 years old. Therefore, it is best to prevent cerebral arteriosclerosis from children and youth, such as cultivating healthy from childhood. Lifestyle, reasonable diet, develop good eating habits, consistently carry out appropriate physical exercise, do not smoke, do not drink alcohol, maintain emotional stability, avoid mental stress, etc., and study that early arteriosclerosis, after prevention and treatment on the arterial wall Atherosclerotic plaque can be eliminated, so whether it is early or late in arteriosclerosis Pole control, in order to delay disease progression and deterioration, concrete should be done:
1. The regularity of life arteriosclerotic cardio-cerebral vascular disease is gradually occurring, mostly associated with unhealthy lifestyles, accumulation of toxins in the body, environmental pollution leading to blood viscous condensation, life, work stress, smoking, alcoholism, overnutrition, blood viscosity, blood Inappropriate components (toxins), etc., seriously exceed the standard, forming arteriosclerosis, so the mood should remain stable, avoid mental stress, anxiety; always use the brain, often read newspapers, magazines, etc.; participate in physical exercise and physical labor, as much as possible Do housework, some studies have found that the incidence of cerebral arteriosclerosis and brain atrophy in the houseworkers is low.
2. The main reason for controlling blood lipid cerebral arteriosclerosis is hyperlipidemia and excessive oxidation of free radicals in the body. Therefore, diet should be high in protein, low in sodium salt, adequate in vitamins and proper amount of fat containing more unsaturated fatty acids. Such as appropriate amount of cooking oil, lean meat, milk, eggs, can eat more fish, soy products, fresh vegetables and fruits; diet can not be full, eat less sugar, do not smoke, drink less.
3. Antioxidation can be used to improve cerebral blood flow, brain cell metabolism activator and blood lipid lowering, blood viscosity and blood circulation and blood stasis. Traditional Chinese medicine should not be used too much. It should be used in a targeted manner, such as salvia miltiorrhiza, cinnarizine, Rutin, ligustrazine, ginkgo extract preparation, vitamin B1, B6, C, E, coenzyme Q-10, etc., high blood viscosity can be used in small doses of aspirin, brain cell metabolism agents are pyrithione, piracetam, cell Phosphocholine and the like.
4. Active treatment, early prevention and treatment of high blood pressure, hyperlipidemia and diabetes, which can accelerate arteriosclerosis, and promote the cultivation of good personality, actively maintain health psychology, to prevent mental disorders associated with cerebral arteriosclerosis Positive meaning.
Complication
Complications of mental disorders associated with cerebral arteriosclerosis Complications, anxiety disorder, hearing loss, tinnitus, hemiplegia, meditation, aphasia
Brain weakness syndrome, emotional vulnerability, attention and memory impairment, anxiety or madness and various hallucinations, dementia, and disturbance of consciousness. Dizziness is mainly head discomfort accompanied by tinnitus. Hemiplegia, aphasia, medullary paralysis and other localized signs.
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 cerebrovascular dementia. Arteriosclerotic psychosis caused by cerebral arteriosclerosis, Parkinson's syndrome, etc. are not classified as cerebral arteriosclerosis, but may be a serious complication. Patients with cerebral atherosclerosis often have clinical manifestations of hypertension, hyperlipidemia or diabetes.
Symptom
Symptoms of mental disorders associated with cerebral arteriosclerosis Common symptoms Fatigue-consciousness disorder, mental disorder, anger, high blood pressure, irritability, madness, dizziness, dementia
1. Psychiatric symptoms Early manifestations of this disease are cerebral weakness syndrome, emotional vulnerability, attention and memory impairment, with the development of the disease, emotional irritability or anger, or depression, anxiety or manic episodes and various hallucinations Symptoms such as delusions, personality and intellectual disorders are becoming more and more serious, and late-stage mental decline is very significant. Serious dementia can occur. If there is a stroke, there may be different levels of disturbance of consciousness, manifested as a state of consciousness, paralysis or insanity.
(1) Cerebral weakness syndrome: It is the early manifestation of this disease. Head discomfort with dizziness is accompanied by tinnitus, and irregular head and frontal occipital pain can be seen. Sleep is easy to wake up, and it is difficult to fall asleep after waking up. It is easy to fatigue, discomfort, difficulty in concentration, etc., generally progress slowly, there are obvious mental abnormalities in several years or decades, the course of the disease is volatility, there are intermittent periods.
(2) Intelligent barrier: simple cerebral arteriosclerosis, intelligent defect only shows the ability to work with memory impairment, reduced efficiency and lack of initiative, thinking, understanding is slow, severe cases cause paradox, brain parenchyma changes seriously, then There is a general loss of intelligence, even dementia.
(3) Affective Disorder: Early manifestation of emotional vulnerability, irritability, susceptibility or anger, or unreasonable anxiety, depression, anxiety, further development may lead to suicidal or manic state, and when the intelligent defect occurs, the expression is euphoric or indifferent. sluggish.
(4) Personality change: The general personality is not easy to change, especially the judgment. The patient's ability to recognize their own disease is generally good. When there is intelligence damage, there will be selfishness, squandering, childishness, laziness, and rash behavior.
(5) Illusion delusion state: Some patients may have exaggerated, murdered, defamatory and other illusions, and repeated or persistent illusions, more common with imperative auditory hallucinations.
(6) Disorder of consciousness: When there is a stroke, there is a disturbance of consciousness. The performance is paralyzed, paralyzed or insanity. It usually lasts for hours to days and is often forgotten.
(7) Memory impairment: There are short-range and long-term memory defects, no transient memory impairment, name, location, date, number, etc. are the first to forget, often affected by memory impairment.
2. Physical symptoms and signs Most patients have headaches, dizziness, heavy feelings such as heavy occipital sensation, and some symptoms such as tinnitus, numbness of the limbs, and vertigo attacks. Non-localized pathological signs such as increased muscle tone often appear in the early stage. Deep reflex asymmetry, palmar reflex and pharyngeal reflex, etc. If there is a stroke episode, there are localized signs such as hemiplegia, aphasia, and medullary paralysis. About 1/5 of the patients have seizures and 1/3 have diabetes. Because arteriosclerosis often involves the heart, kidney and retinal artery, and the corresponding pathological symptoms and signs of the affected organs appear.
(1) Most patients have headaches, dizziness and other symptoms, can have tinnitus, numbness of the limbs, facial muscle convulsions, dizziness.
(2) There are often minor, non-localized neurological signs in the early stage, such as weakened light response, asymmetry or small pupil size, facial muscle asymmetry, head, hand, tongue tremor, increased muscle tone, and asymmetry of tendon reflex , palmar reflexes are positive and cold in the hands and feet, cyanosis, facial sweating and other autonomic symptoms.
(3) After the onset of stroke, there may be hemiplegia, aphasia, unilateral nerve paralysis and other signs of cerebral vascular target organs.
(4) 15% to 20% of patients may have epilepsy, with a major episode.
(5) More than half of the patients have high blood pressure.
Examine
Examination of mental disorders associated with cerebral arteriosclerosis
The results of laboratory tests consistent with cerebral arteriosclerosis, such as increased serum cholesterol and triglycerides, are non-specific tests for mental disorders.
EEG can have mild diffuse abnormalities. The cerebral blood flow map shows that the main peak becomes dull, the beat wave decreases or disappears, the rise time is prolonged, the amplitude is reduced, and the brain Doppler ultrasound scan shows arteriosclerosis changes. CT examination can also be performed. It shows atrophy of the brain and enlargement of the ventricles.
Diagnosis
Diagnosis and diagnosis of mental disorders associated with cerebral arteriosclerosis
Diagnostic criteria
The age of onset is 50-60 years old, and the 40-year-old is not uncommon. There are more males than females. Generally, there is no obvious inducement, and gradually there are symptoms similar to neurasthenia. At the same time, there are emotional instability, near memory is obviously reduced, and the disease develops slowly. Symptoms Often different weight and fluctuations, the course of disease is generally longer, although long-term illness, personality remains relatively complete, self-knowledge is also good, physical examination can see the fundus artery and systemic arteriosclerosis signs, blood tests can see blood cholesterol, increased blood lipids, brain The blood flow diagram often shows cerebral arteriosclerosis-like changes. The CT scan of the head can show atrophy of the cerebral gyrus and enlargement of the ventricles. These characteristics can be used as a basis for the diagnosis of this disease.
Differential diagnosis
1. The early symptoms of neurasthenia are similar, but the age of neurasthenia is 40 years old. Symptoms often worsen after the brain, relieve after rest, memory loss is obvious, no neurological signs and laboratory evidence do not support the diagnosis of cerebral arteriosclerosis. .
2. The key to mental disorders associated with essential hypertension lies in the differential diagnosis of primary disease, that is, the differential diagnosis of cerebral arteriosclerosis and essential hypertension, which is difficult to identify clinically because, often, both primary diseases are simultaneously Existence, in general, patients with mental disorders associated with essential hypertension have an earlier age of onset, and have had a history of hypertension for many years before the onset of mental symptoms. Mental factors are often the predisposing factors, and mental symptoms occur more rapidly. Fear, anxiety, and disturbance of consciousness are common, and mental disorders associated with cerebral arteriosclerosis are more common in autonomic nervous system symptoms.
3. Intracranial tumors with some focal symptoms and progressive development of cerebral arteriosclerosis associated with mental disorders should be differentiated from intracranial tumors, the latter often present headaches and obvious in the morning, due to cough, increased strength, accompanied by Vomiting, optic disc edema, shorter duration, faster progression, CT or magnetic resonance imaging can help identify intracranial lesions.
4. Others with obvious depression or anxiety should pay attention to the identification of depression, anxiety, and seizures should be differentiated from primary epilepsy or other symptomatic epilepsy, clear physical signs and laboratory tests can be Distinguish functional psychosis.
