関: cerebro-vascular accident、cerebrovascular accident、cerebrovascular insufficiency、cerebrovascular occlusion、CVA

WordNet

bring disorder to (同)disarray
a physical condition in which there is a disturbance of normal functioning; "the doctor prescribed some medicine for the disorder"; "everyone gets stomach upsets from time to time" (同)upset
a disturbance of the peace or of public order
of or relating to the brain and the blood vessels that supply it; "a cerebrovascular accident"
not arranged in order (同)unordered

PrepTutorEJDIC

〈U〉『無秩序』,混乱,乱雑(confusion) / 《しばしば複数形で》(社会的・政治的な)粉争,騒動 / 〈C〉(肉体的・精神的な)不調,異常,障害 / …‘の'秩序を乱す / 〈心身〉‘に'異常を起こさせる

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/05/07 11:52:28」(JST)

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Cerebrovascular disease is a group of brain dysfunctions related to disease of the blood vessels supplying the brain. Hypertension is the most important cause; it damages the blood vessel lining, endothelium, exposing the underlying collagen where platelets aggregate to initiate a repairing process which is not always complete and perfect. Sustained hypertension permanently changes the architecture of the blood vessels making them narrow, stiff, deformed, uneven and more vulnerable to fluctuations in blood pressure.

A fall in blood pressure during sleep can then lead to a marked reduction in blood flow in the narrowed blood vessels causing ischemic stroke in the morning. Conversely, a sudden rise in blood pressure due to excitation during the daytime can cause tearing of the blood vessels resulting in intracranial hemorrhage. Cerebrovascular disease primarily affects people who are elderly or have a history of diabetes, smoking, or ischemic heart disease. The results of cerebrovascular disease can include a stroke, or occasionally a hemorrhagic stroke. Ischemia or other blood vessel dysfunctions can affect the person during a cerebrovascular incident.

Classification

A 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. Severe blockage of the arteries to the brain is known as carotid stenosis.

Stroke

Carotid artery affects retina, cerebral hemisphere, or both. Retinal: Transient blackouts; the sense of a shade pulled over the eyes. Cerebral: Contralateral (opposite sided) paralysis of a single body part; paralysis of one side of the body; localized tingling, numbness; hemianopic visual loss; aphasia (loss of speech); rare loss of consciousness. Vertebrobasilar: Bilateral visual disturbance including dim, gray, or blurred vision or temporary total blindness; diplopia (double vision). Labyrinth/medulla: Vertigo; unsteadiness; nausea; vomiting. Brainstem: Slurring dysarthria (tongue weakness causing impaired speech); dysphagia (difficulty swallowing); numbness, weakness; all four limb paresthesia; drop attacks from sudden loss of postural tone are basilar in origin; a vertebrobasilar artery occlusion episode causes symptoms to be induced by abrupt position changes.

Causes

Cerebrovascular disease can be divided into embolism, aneurysms, and low flow states depending on its cause. Major modifiable risk factors include hypertension, smoking, obesity, and diabetes.

Pathophysiology

Disability-adjusted life year for cerebrovascular disease per 100,000 inhabitants in 2004.^[1]

no data

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

In a healthy, anatomical structure of the body, the carotid arteries form the main blood supply to the brain. Following a stroke, voluntary control of the muscles may be lost, depending on the type of stroke the victim is encountering. Strokes can also result from embolism or due to a ruptured blood vessel. Embolism blocks small arteries within the brain, causing dysfunction to occur. Spontaneous rupture of a blood vessel in the brain causes a hemorrhagic stroke.

Another form of cerebrovascular disease includes aneurysms. In females with defective collagen, the weak branching points of arteries give rise to protrusions with a very thin covering of endothelium that can tear to bleed easily with minimal rise of blood pressure. This can also occur with defective capillaries caused by tissue cholesterol deposition especially in hypertensive subjects with or without dyslipidemia. If bleeding occurs in this process, the resulting effect is a hemorrhagic stroke in the form of subarachnoid hemorrhage, intracerebral hemorrhage or both.

In the main structure, the carotid arteries overspread 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 and a small part of the occipital lobe. The MCA is the largest branch of the internal carotid artery. From the Basillar artery are two posterior cerebral arteries. Branches of the Basillar and PCA supply the occipital lobe, brain stem, and the cerebellum.

Ischemia is the loss of blood flow to the focal region of the brain. The beginning process of this is quite rapid. The duration of a stroke is usually two to fifteen minutes. One side of the face, hand, or arm may swell up. During this time, the person may lose conscious control and faint. Brain deficits may improve over a maximum of 72 hours. Deficits do not resolve in all cases. The neurological recovery period includes stable, to improving, brain function. Stable is the period by which neither nutrient supply is regained, nor is it lost. Improving, depending on a hospital code, generally means that the arteries gain control and blood flow functions consistently within the brain. The carotid arteries connect to the vertebral arteries. These branch off into the cerebellar and posterior meningenial arteries, which supply the back of the brain.

Also, during ischemia, interneurons weaken, causing an insufficient amount to perform vital functions to be present. The neuroglis become congested or maintain loss during a cerebrovascular accident. If impulse amount ceases, then life itself will cease and the victim may enter the stage of clinical death. Neural pathways weaken, therefore decreasing action potential. The neural arc, which in general consists of sensory and motor neurons, weaken as well. The muscles become paralyzed, in some cases for life. Paralysis also includes the weakening of the receptors in the body, unless improvement is made. Cerebrovascular damage to the brain is what makes it difficult for receptors to receive the impulse and transmit it of a neuron. This chemical reaction is then transmitted creating a poor reflex to the body. The meninges that also protect the brain and spinal cord are deeply weakened, allowing the victim to suffer vast transmission of diseases or unstable growth or maintenance if the victim is not in resting position. Infection of the brain may then lead to inflammation and conditions such as Alzheimer's Disease.

During the stage of paralysis, the spinal tracts do not have much to do with the enduring condition of cerebrovascular disease, either, in time may shorten the life of a victim who is suffering because the nutrient supply is weakened in transmission during cerebrovascular disease. Descending and ascending tracts will generally be cut off during cerebrovascular disease, which conduct impulses down from the cord of the brain. This is known as anesthesia in a minor case.

In a healthy body, the cerebrospinal fluid (also known as CSF) may also weaken the choroid plexus, into a network of brain capillaries. Certain types of hydrocephalus ("water" or CSF on the brain) may be treated by using a shunt (medical) or a cerebral shunt, which involves inserting a hollow tube through a blocked channel so the CSF can be used to be drained to another portion of the body. The dermatomes are a skin surface area which is regulated by the spinal cord. During a stroke, these may be damaged.

Vascular dementia usually involves arterioles and capillaries rather than the larger cerebral arteries. Blockages and ruptures occur all over the brain, but most severely in the white matter. Microscopic examination may reveal various things in the brain such as coagulated blood, lipid deposits, and other debris caused by ruptured vessels.

Epidemiology

The most common forms of cerebrovascular disease are cerebral thrombosis (40% of cases) and cerebral embolism (30%), followed by cerebral hemorrhage (20%).^[2]

Cerebrovascular disease is primarily one of old age; the risk for developing it goes up significantly after 65. 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. CVD occurs more rarely in younger people due to conditions such as syphilis that lead to artery damage and strokes.

References

^ "WHO Disease and injury country estimates". World Health Organization. 2009. Retrieved Nov 11, 2009.
^ Page 117 in: Henry S. Schutta; Lechtenberg, Richard (1998). Neurology practice guidelines. New York: M. Dekker. ISBN 0-8247-0104-6.

UpToDate Contents

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1. 脳卒中評価の概要 overview of the evaluation of stroke
2. 脳卒中の病因、分類、および疫学 etiology classification and epidemiology of stroke
3. 急性脳卒中の初期評価およびマネージメント initial assessment and management of acute stroke
4. 虚血性脳卒中の二次予防の概要 overview of secondary prevention of ischemic stroke
5. 頸動脈内膜剥離術および頸動脈ステント留置術の麻酔 anesthesia for carotid endarterectomy and carotid stenting

English Journal

Cerebroprotective action of angiotensin peptides in stroke.

Regenhardt RW, Bennion DM, Sumners C.Author information *Department of Physiology and Functional Genomics and McKnight Brain Institute, University of Florida, 1600 SW Archer Road, PO Box 100274, Gainesville, FL 32610-0274, U.S.A.AbstractThe goal of the present review is to examine the evidence for beneficial actions of manipulation of the RAS (renin-angiotensin system) in stroke, with particular focus on Ang-(1-7) [angiotensin-(1-7)] and its receptor Mas. The RAS appears to be highly involved in the multifactorial pathophysiology of stroke. Blocking the effects of AngII (angiotensin II) at AT1R (AngII type 1 receptor), through the use of commonly prescribed ACE (angiotensin-converting enzyme) inhibitors or AT1R blockers, has been shown to have therapeutic effects in both ischaemic and haemorrhagic stroke. In contrast with the deleterious actions of over activation of AT1R by AngII, stimulation of AT2Rs (AngII type 2 receptors) in the brain has been demonstrated to elicit beneficial effects in stroke. Likewise, the ACE2/Ang-(1-7)/Mas axis of the RAS has been shown to have therapeutic effects in stroke when activated, countering the effects of the ACE/AngII/AT1R axis. Studies have demonstrated that activating this axis in the brain elicits beneficial cerebral effects in rat models of ischaemic stroke, and we have also demonstrated the cerebroprotective potential of this axis in haemorrhagic stroke using stroke-prone spontaneously hypertensive rats and collagenase-induced striatal haemorrhage. The mechanism of cerebroprotection elicited by ACE2/Ang-(1-7)/Mas activation includes anti-inflammatory effects within the brain parenchyma. The major hurdle to overcome in translating these results to humans is devising strategies to activate the ACE2/Ang-(1-7)/Mas cerebroprotective axis using post-stroke treatments that can be administered non-invasively.
Clinical science (London, England : 1979).Clin Sci (Lond).2014 Feb;126(3):195-205. doi: 10.1042/CS20130324.
The goal of the present review is to examine the evidence for beneficial actions of manipulation of the RAS (renin-angiotensin system) in stroke, with particular focus on Ang-(1-7) [angiotensin-(1-7)] and its receptor Mas. The RAS appears to be highly involved in the multifactorial pathophysiology o
PMID 24102099

Use and safety of antipsychotics in behavioral disorders in elderly people with dementia.

Gareri P, De Fazio P, Manfredi VG, De Sarro G.Author information From the *Elderly Health Care, Ambulatory Center for Dementia, ASP Catanzaro; †Department of Science of Health, School of Medicine and Surgery, University "Magna Græcia" of Catanzaro, Clinical Pharmacology and Pharmacovigilance Unit, and ‡Psychiatry Unit,"Mater Domini" University Hospital, Catanzaro, Italy.AbstractIn recent years, the use of antipsychotics has been widely debated for reasons concerning their safety in elderly patients affected with dementia. To update the use of antipsychotics in elderly demented people, a MEDLINE search was conducted using the following terms: elderly, conventional and atypical antipsychotics, adverse events, dementia, and behavioral and psychotic symptoms in dementia (BPSD). Owing to the large amounts of studies on antipsychotics, we mostly restricted the field of research to the last 10 years.Conventional antipsychotics have been widely used for BPSD; some studies showed they have an efficacy superior to placebo only at high doses, but they are associated with several and severe adverse effects. Atypical antipsychotics showed an efficacy superior to placebo in randomized studies in BPSD treatment, with a better tolerability profile versus conventional drugs. However, in 2002, trials with risperidone and olanzapine in elderly patients affected with dementia-related psychoses suggested the possible increase in cerebrovascular adverse events. Drug regulatory agencies issued specific recommendations for underlining that treatment of BPSD with atypical antipsychotics is "off-label." Conventional antipsychotics showed the same likelihood to increase the risk of death in the elderly as atypical agents, and they should not replace the atypical agents discontinued by Food and Drug Administration warnings. Before prescribing an antipsychotic drug, the following are factors to be seriously considered: the presence of cardiovascular diseases, QTc interval on electrocardiogram, electrolytic imbalances, familiar history for torsades des pointes, concomitant treatments, and use of drugs able to lengthen QTc. Use of antipsychotics in dementia needs a careful case-by-case assessment, together with the possible drug-drug, drug-disease, and drug-food interactions.
Journal of clinical psychopharmacology.J Clin Psychopharmacol.2014 Feb;34(1):109-23. doi: 10.1097/JCP.0b013e3182a6096e.
In recent years, the use of antipsychotics has been widely debated for reasons concerning their safety in elderly patients affected with dementia. To update the use of antipsychotics in elderly demented people, a MEDLINE search was conducted using the following terms: elderly, conventional and atypi
PMID 24158020

Triptans and serious adverse vascular events: Data mining of the FDA Adverse Event Reporting System database.

Roberto G, Piccinni C, D'Alessandro R, Poluzzi E.Author information Department of Medical and Surgical Sciences - Pharmacology Unit, University of Bologna, Italy.AbstractAIM: The aim of this article is to investigate the vascular safety profile of triptans through an analysis of the United States Food and Drug Administration Adverse Event Reporting System (FDA_AERS) database with a special focus on serious and unexpected adverse events.
Cephalalgia : an international journal of headache.Cephalalgia.2014 Jan;34(1):5-13. doi: 10.1177/0333102413499649. Epub 2013 Aug 6.
AIM: The aim of this article is to investigate the vascular safety profile of triptans through an analysis of the United States Food and Drug Administration Adverse Event Reporting System (FDA_AERS) database with a special focus on serious and unexpected adverse events.METHODS: A CASE/NON-CASE analy
PMID 23921799

Japanese Journal

妊産婦の脳血管障害における院内連携システムの確立

宮﨑のどか,近藤真哉,古株哲也 [他]
日本医療マネジメント学会雑誌 14(2), 58-62, 2013-09
NAID 40019797038

脳血管障害 ADL障害に対するアプローチ(疾患別セミナー,第47回日本理学療法士協会全国学術研修大会(鹿児島))

伊藤克浩
理学療法学 40(4), 256-258, 2013-06-20
NAID 110009615778

脳血管障害患者の座位訓練における循環動態連続計測

湯地忠彦,松村健太,山越健弘 [他]
生体医工学 = Transactions of Japanese Society for Medical and Biological Engineering : 日本エム・イー学会誌 51(2), 127-134, 2013-04
NAID 40019741410

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リンク元	「脳血管障害」「cerebro-vascular accident」「cerebrovascular occlusion」「cerebrovascular insufficiency」「脳循環障害」
関連記事	「disorder」「cerebrovascular」