| Cerebrovascular disease |
|
Cerebral angiogram of a carotid-cavernous fistula
|
| Classification and external resources |
| ICD-10 |
I60-I69 |
Cerebrovascular disease is a vascular disease of the cerebral circulation. Arteries supplying oxygen to the brain are affected resulting in one of a number of cerebrovascular diseases.[1] Most commonly this is a stroke or mini-stroke and sometimes can be a hemorrhagic stroke.[1] Any of these can result in vascular dementia.[2]
Hypertension (high blood pressure) is the most important contributing cause because it damages the blood vessel lining exposing collagen where platelets aggregate to initiate a repair. If maintained hypertension can change the structure of blood vessels ( narrow, deformed).[3]
Blood pressure affects blood flow in narrowed vessels causing ischemic stroke, a rise in blood pressure can cause tearing of vessels leading to intracranial hemorrhage.[4]
Contents
- 1 Associated medical condition
- 2 Causes
- 3 Pathophysiology
- 4 Evaluation
- 5 Treatment
- 6 Epidemiology
- 7 References
- 8 Further reading
Associated medical condition
- Transient ischemic attack (TIA) leaves little to no permanent damage within the brain. The symptoms of this include facial weakness, visual impairment, loss of coordination or balance, a sudden headache, and mental confusion with unintelligible speech.[5] Severe blockage of the arteries to the brain is known as carotid stenosis.[6]
- Ischemic stroke,the most common, is due to a blood clot that completely blocks a blood vessel (in the brain).[7]
- Subarachnoid haemorrhage where blood leaks out of blood vessels on to the surface of the brain.[1]
Causes
Cerebrovascular disease can be divided into embolism, aneurysms, and low flow states depending on its cause.[8] Major modifiable risk factors include:[9]
- hypertension
- smoking
- obesity
- diabetes.
Pathophysiology
Pathophysiologically, once a stroke has occurred, voluntary control of the muscles may be lost, depending on the type of stroke the individual is encountering.[10] Strokes can also result from embolisms,furthermore, embolism blocks small arteries causing damage to occur.[4] Spontaneous rupture of a blood vessel in the brain causes a hemorrhagic stroke.[11] Another form of cerebrovascular disease includes aneurysms.Cerebral aneurysms can be genetic in nature, due to a wall deformity of the artery. Such aneurysms are common in individuals with genetic diseases ( connective tissue disorders, polycystic kidney disease, and arteriovenous malformations).[12]
The carotid arteries cover the majority of the cerebrum. The common carotid artery divides into the internal and the external cartoid arteries. The internal carotid artery becomes the anterior cerebral artery and the middle central artery. The ACA transmits blood to the frontal parietal. From the basilar artery are two posterior cerebral arteries. Branches of the basilar and PCA supply the occipital lobe, brain stem, and the cerebellum.[13] Ischemia is the loss of blood flow to the focal region of the brain.This produces heterogeneous areas of ischemia at the affected vascular region, furthermore blood flow is limited to a residual flow.Regions with blood flow of less than than 10 mL/100 g of tissue/min are core regions( cells here die within minutes of a stroke).The ischemic penumbra with a blood flow of <25 ml/100g tissue/min, remain usable for more time(hours).[14]
An ischemic cascade occurs where an energetic molecular problem arises.ATP consumption continues in spite of, insufficient production, this causes total levels of adenosine triphosphate to decrease and lactate acidosis to become established(ionic homeostasis in neurons is lost). The downstream mechanisms of the ischemic cascade thus begins. Ion pumps no longer transport Ca2+ out of cell, this triggers release of glutamate, which in turn allows calcium into cell walls. In the end the apoptosis cascade is initiated and cell death occurs.[15]
Evaluation
Diagnosis of cerebrovascular disease if done by:(among other diagnosis)[16]
- Clinical history
- Physical exam
- Neurological examination
Treatment
Treatment for cerebrovascular disease includes medication, lifestyle changes and surgery.[4]
Examples of medications are:
- Antiplatelets (Aspirin, Clopidogrel)
- Blood thinners (Heparin, Warfarin )
- Antihypertensives (ACE inhibitors, Beta blockers)
- Anti-diabetic medications
Surgical procedures include:
- Endovascular surgery and Vascular surgery (for future stroke prevention)
Epidemiology
Disability-adjusted life year for cerebrovascular disease per 100,000 inhabitants in 2004.[17]
less than 250
250–425
425–600
600–775
775–950
950–1125
1125–1300
1300–1475
1475–1650
1650–1825
1825–2000
more than 2000
Worldwide, it is estimated there are 31 million stroke survivors, though about 6 million deaths were due to cerebrovascular disease (2nd most common cause of death in the world and 6th most common cause of disability).[18]
Cerebrovascular disease primarily occurs with advanced age; the risk for developing it goes up significantly after 65 years of age. CVD tends to occur earlier than Alzheimer's Disease (which is rare before the age of 80). In some countries such as Japan, CVD is more common than AD.[medical citation needed]
The amount of individuals ( adults) who had a stroke is 6.4 million, in 2012, this corresponds to 2.7% in the U.S. With approximately 129,000 deaths in 2013 (U.S.)[19]
References
- ^ a b c "Cerebrovascular disease - Introduction - NHS Choices". www.nhs.uk. Retrieved 2015-09-01.
- ^ "Vascular dementia - Causes - NHS Choices". www.nhs.uk. Retrieved 2015-09-01.
- ^ Prakash, Dibya (2014-04-10). Nuclear Medicine: A Guide for Healthcare Professionals and Patients. Springer Science & Business Media. p. 142. ISBN 9788132218265.
- ^ a b c "Stroke: MedlinePlus Medical Encyclopedia". www.nlm.nih.gov. Retrieved 2015-09-01.
- ^ "Transient Ischemic Attack Information Page: National Institute of Neurological Disorders and Stroke (NINDS)". www.ninds.nih.gov. Retrieved 2015-09-01.
- ^ "Carotid Artery Stenosis information. Internal carotis occlusion | Patient". Patient. Retrieved 2015-09-01.
- ^ "Stroke: MedlinePlus". www.nlm.nih.gov. Retrieved 2015-09-01.
- ^ Corporation, Surgisphere. Clinical Review of Surgery | ABSITE Review. Lulu.com. p. 146. ISBN 9780980210347.
- ^ "Cerebrovascular disease - NHS Choices - Risks and prevention". www.nhs.uk. Retrieved 2015-09-01.
- ^ Information, National Center for Biotechnology; Pike, U. S. National Library of Medicine 8600 Rockville; MD, Bethesda; Usa, 20894. "Stroke - National Library of Medicine". PubMed Health. Retrieved 2015-09-01.
- ^ Herman, Irving P. (2007-02-16). Physics of the Human Body. Springer Science & Business Media. p. 488. ISBN 9783540296041.
- ^ "Cerebral Aneurysms Fact Sheet: National Institute of Neurological Disorders and Stroke (NINDS)". www.ninds.nih.gov. Retrieved 2015-09-02.
- ^ Cipolla, Marilyn J. (2009-01-01). "Anatomy and Ultrastructure".
- ^ "Ischemic Stroke: Practice Essentials, Background, Anatomy".
- ^ Xing, Changhong; Arai, Ken; Lo, Eng H.; Hommel, Marc (2012-07-01). "Pathophysiologic cascades in ischemic stroke". International journal of stroke : official journal of the International Stroke Society 7 (5): 378–385. doi:10.1111/j.1747-4949.2012.00839.x. ISSN 1747-4930. PMC 3985770. PMID 22712739.
- ^ "Stroke. Diagnosis and Therapeutic Management of Cerebrovascular Disease | Revista Española de Cardiología (English Version)". www.revespcardiol.org. Retrieved 2015-09-01.
- ^ "WHO Disease and injury country estimates". World Health Organization. 2009. Retrieved Nov 11, 2009.
- ^ Ward, Helen; Toledano, Mireille B.; Shaddick, Gavin; Davies, Bethan; Elliott, Paul (2012-05-24). Oxford Handbook of Epidemiology for Clinicians. OUP Oxford. p. 310. ISBN 9780191654787.
- ^ "FastStats". www.cdc.gov. Retrieved 2015-09-01.
Further reading
- Chan, Pak H. (2002-03-28). Cerebrovascular Disease: 22nd Princeton Conference. Cambridge University Press. ISBN 9781139439657.
- Mark, Steven D.; Wang, Wen; Fraumeni, Joseph F.; Li, Jun-Yao; Taylor, Philip R.; Wang, Guo-Qing; Guo, Wande; Dawsey, Sanford M.; Li, Bing (1996-04-01). "Lowered Risks of Hypertension and Cerebrovascular Disease after Vitamin/Mineral Supplementation The Linxian Nutrition Intervention Trial". American Journal of Epidemiology 143 (7): 658–664. ISSN 0002-9262. PMID 8651227.
- Ning, MingMing; Lopez, Mary; Cao, Jing; Buonanno, Ferdinando S.; Lo, Eng H. (2012-12-01). "Application of proteomics to cerebrovascular disease". Electrophoresis 33 (24). doi:10.1002/elps.201200481. ISSN 0173-0835. PMC 3712851. PMID 23161401.
|
Wikimedia Commons has media related to Cerebrovascular diseases. |
|
Cerebrovascular diseases (G45–G46 and I60–I69, 430–438)
|
|
Brain ischemia/
cerebral infarction
(ischemic stroke/TIA) |
| TACI, PACI |
- precerebral: Carotid artery stenosis
- cerebral: MCA
- ACA
- Amaurosis fugax
|
|
| POCI |
- precerebral: Anterior spinal artery syndrome
- Vertebrobasilar insufficiency
- Subclavian steal syndrome
- brainstem: medulla
- Medial medullary syndrome
- Lateral medullary syndrome
- pons
- Medial pontine syndrome/Foville's
- Lateral pontine syndrome/Millard-Gubler
- midbrain
- Weber's
- Benedikt
- Claude's
- cerebral: PCA
- Lacunar stroke
- Dejerine–Roussy syndrome
|
|
| General |
- cerebral: Cerebral venous sinus thrombosis
- CADASIL
- Binswanger's disease
- Transient global amnesia
|
|
|
Intracranial hemorrhage
(hemorrhagic stroke) |
| Extra-axial |
- Epidural
- Subdural
- Subarachnoid
|
|
| Cerebral/Intra-axial |
|
|
| Brainstem |
|
|
|
| Aneurysm |
- Cerebral aneurysm
- Intracranial berry aneurysm
- Charcot-Bouchard aneurysm
|
|
| Other/general |
|
|
|
Index of the central nervous system
|
|
| Description |
- Anatomy
- meninges
- cortex
- association fibers
- commissural fibers
- lateral ventricles
- basal ganglia
- diencephalon
- mesencephalon
- pons
- cerebellum
- medulla
- spinal cord
- Physiology
- Development
|
|
| Disease |
- Cerebral palsy
- Meningitis
- Demyelinating diseases
- Seizures and epilepsy
- Headache
- Stroke
- Sleep
- Congenital
- Injury
- Neoplasms and cancer
- Other
- Symptoms and signs
- head and neck
- eponymous
- lesions
- Tests
|
|
| Treatment |
- Procedures
- Drugs
- general anesthetics
- analgesics
- addiction
- epilepsy
- cholinergics
- migraine
- Parkinson's
- vertigo
- other
|
|
Index of the circulatory system
|
|
| Description |
- Anatomy
- Arteries
- head and neck
- arms
- chest
- abdomen
- legs
- Veins
- head and neck
- arms
- chest
- abdomen and pelvis
- legs
- Development
- Cells
- Physiology
|
|
| Disease |
- Congenital
- Neoplasms and cancer
- Lymphatic vessels
- Injury
- Vasculitis
- Other
- Symptoms and signs
|
|
| Treatment |
- Procedures
- Drugs
- beta blockers
- channel blockers
- diuretics
- nonsympatholytic vasodilatory antihypertensives
- peripheral vasodilators
- renin–angiotensin system
- sympatholytic antihypertensives
- vasoprotectives
|
|
|
