Cerebral arteriosclerosisIt refers to chronic encephalopathy such as neurasthenic syndrome, arteriosclerotic dementia, pseudobulbar palsy, etc. caused by multiple cerebral infarction, softening, necrosis and atrophy after cerebral arteriosclerosis.Cerebral arteriosclerosis can cause transient ischemic attack (TIA), stroke and chronic cerebral ischemia.
TCM disease name
Cerebral arteriosclerosis
Foreign name
Cerebral Arteriosclerosis
Visiting department
Neurology
Multiple population
Middle aged and elderly men over 40
Common diseases
Intracranial
Common causes
Diffuse cerebral arteriosclerosis with decreased cerebral blood flow
Cerebral arteriosclerosis occurs on the basis of diffuse cerebral arteriosclerosis, and its essence is the reduction of cerebral blood flow.The decrease of cerebral blood flow is universal, and it is difficult to form effective collateral circulation for compensation.Therefore, when artery stenosis progresses rapidly, or cerebral blood flow perfusion decreases sharply due to insufficient hemodynamics and increased blood viscosity, a series of neurological or mental symptoms will appear.Cerebral atherosclerosis mainly invades the large and middle cerebral arteries with a diameter of more than 500 microns, and is closely related to hypertension.Long term hypertension will inevitably lead to atherosclerotic damage of the main cerebral artery wall.
clinical manifestation
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Cerebral arteriosclerosis often occurs in middle-aged and elderly people over 40 years old, more men than women, and more people with hypertension, diabetes, hyperlipidemia, long-term smoking, drinking and mental stress.The brain function declines due to long-term chronic blood supply insufficiency of the brain.The disease may be asymptomatic before it causes vascular complications and cerebral blood supply disorders.The following behaviors are common:
1. Neurasthenia syndrome
Such as headache, dizziness, fatigue, inattention, memory loss, emotional instability, thinking retardation, sleep disorders (insomnia or lethargy), and so on. The disease fluctuates.
2. Carotid atherosclerosis
TIA can occasionally occur, just as coronary atherosclerosis causes angina pectoris and lower limb atherosclerosis causes intermittent claudication, cerebral arteriosclerosis can cause transient cerebral ischemia syndrome on the basis of chronic brain dysfunction.Foreign scholars regard angina pectoris as the clinical symptom of coronary arteriosclerosis, and TIA (except cardiogenic) as the clinical symptom of cerebral arteriosclerosis.
3. Fundus arteriosclerosis
It can be seen that the artery becomes thinner and the reflection is enhanced. In serious cases, it appears as silver filament and arteriovenous cross indentation.Positive palm chin reflex and sucking reflex, patients with stroke history may leave positioning signs such as cerebral nerve damage, hemiplegia, hemisensory disturbance, etc.
inspect
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1. Laboratory inspection
Routine and biochemical examination of blood, urine and stool are mainly used for hypertension, diabetes, hyperlipidemia, heart disease, atherosclerosis and other diseases.
2. Imaging examination
(1) Color ultrasound examination of neckIt can show atherosclerotic plaques and ulcers, thrombus, stenosis or occlusion of the internal carotid artery extracranial segment, which is helpful to exclude vertebral artery type cervical spondylosis.
(2) Transcranial Color Doppler Ultrasound (TCD)It can detect the blood flow velocity and pulsatility index of cerebral artery, evaluate the degree of cerebral arteriosclerosis, detect microemboli in cerebral artery, etc.
(3) CT and MRIMultiple lacunar infarcts, subcortical arteriosclerotic encephalopathy, etc. can be found, and other organic brain diseases can be excluded.
diagnosis
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According to the insidious onset of the disease, the patient showed chronic brain dysfunction syndrome, no signs of focal brain function damage, eyeground and systemic arteriosclerosis, often accompanied by hypertension, hyperlipidemia and diabetes, combined with color ultrasound to detect atherosclerotic plaque in the extracranial segment of the internal carotid artery, TCD to detect cerebral artery blood flow status,CT and MRI showed multiple lacunar foci, subcortical arteriosclerotic encephalopathy, etc;Patients with TIA or stroke can be diagnosed as cerebral arteriosclerosis.
differential diagnosis
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From a pathological point of view, almost all people over 60 years old have arteriosclerosis of different degrees, and it is not easy to diagnose cerebral arteriosclerosis for normal elderly people without clinical symptoms.In clinical practice, attention should be paid to the differentiation of neurosis, and attention should also be paid to the exclusion of chronic intracranial diseases such as brain tumors, chronic infections, and brain symptoms caused by systemic diseases. In case of obvious mental disorders, senile dementia, senile psychosis, etc. should be excluded.
complication
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Atherosclerotic psychosis and Parkinson's syndrome caused by cerebral arteriosclerosis should not be classified as cerebral arteriosclerosis, but can be serious complications.Patients with cerebral arteriosclerosis often have clinical manifestations of hypertension, hyperlipidemia or diabetes at the same time.
treatment
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1. Patients with headache, dizziness, memory loss, inattention and other symptoms can choose brain activators such as piracetam, dihydroergotoxine mesylate, vitamin E and amitriazine/roxacin, calcium channel antagonists, vasodilators, ginkgo preparations and other symptomatic treatments. Patients with anxiety and depression can be treated symptomatically,Sleep disorder can be improved by short-term use of low-dose benzodiazepines.
2. Patients with carotid atherosclerosis can choose antiplatelet drugs and clopidogrel.Carotid endarterectomy is feasible for carotid stenosis>75% to prevent cerebral thrombosis.
prognosis
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The prognosis of cerebral arteriosclerosis is generally good.But because it can exist alone, it also has the possibility of stroke in the future.Therefore, the prognosis of patients is related to the risk factors such as hypertension, hyperlipidemia or diabetes, and the prognosis of secondary stroke.
