Cerebrovascular Disease

The most common warning signs of cerebrovascular disease may include some or all of the following symptoms, which are usually sudden:

• Dizziness, nausea, or vomiting
• Unusually severe headache with no known cause
• Confusion, disorientation or memory loss
• Numbness, weakness in an arm, leg or the face, especially on one side
• Trouble walking, as a result of loss of balance or coordination
• Abnormal or slurred speech
• Difficulty with comprehension
• Loss of vision in one or both eyes
• Loss of balance, coordination, or the ability to walk
• Difficulty carrying out activities that require planning and organisation
• Problems following conversation and difficulty expressing themselves
• Depression
• Mood swings, with laughter and tears occurring for no apparent reason.

The word cerebrovascular refers to blood flow in your brain. The term cerebrovascular disease includes all disorders in which an area of the brain is temporarily or permanently affected by bleeding or restricted blood flow. Cerebrovascular diseases include a number of conditions, the most common being transient ischemic attack, ischemic stroke and hemorrhagic stroke.

• Transient ischemic attack (TIA): A TIA is a temporary clot that leaves no permanent damage. Most likely an artery to the brain is temporarily blocked, causing stroke-like symptoms, but the blockage dislodges before any permanent damage occurs.
• Ischemic stroke: Ischemic stroke is by far the most common type of stroke, accounting for a large majority of strokes. It occurs as a result of an obstruction within a blood vessel supplying blood to the brain. The American Association of Neurological Surgeons divide ischemic stroke into 2 types: thrombotic and embolic. A thrombotic stroke occurs when a blood clot, called a thrombus, blocks an artery to the brain and stops blood flow. An embolic stroke is when a piece of plaque or thrombus travels from its original site and blocks an artery downstream. Hemorrhagic stroke:
• Hemorrhagic stroke occurs when a weakened blood vessel ruptures. It can be caused by hypertension, or rupture of an aneurysm or vascular malformation. An intracerebral hemorrhage occurs when there is bleeding directly into the brain tissue, which often forms a clot within the brain. A subarachnoid hemorrhage occurs when the bleeding fills the cerebrospinal fluid spaces around the brain. Both conditions are very serious.

Causes of cerebrovascular disease

The brain is irrigated by a complex structure of blood vessels, which supply different areas of the brain with the oxygen and nutrients they need to function properly. When a blood vessel in the brain ruptures or is obstructed by a clot, the lack of blood flow that results will affect brain tissue and may cause a stroke.

In some cases of cerebrovascular disease, these strokes may be so small that they are only detected on brain scans later. However, in most cases, it is crucial that proper blood flow and oxygen be restored to the brain as soon as possible. Without oxygen and important nutrients, the affected brain cells are either damaged or die within a few minutes. Once brain cells die, they cannot regenerate, and can result in devastating damage such as permanent physical, cognitive and mental disabilities.

Typically, a doctor will first ask questions about your medical and family history, conduct a physical exam and order routine blood tests. The majority of cerebrovascular problems can be identified through diagnostic imaging tests, so he or she may also order one or more of the following:

• Cerebral angiography: This procedure gives a detailed view of arteries in your brain and neck. In this test, your doctor inserts a thin, flexible needle through a small incision, usually in your groin, and guides it through your major arteries until it is properly placed in the arteries of the neck. Then your doctor injects a dye into your blood vessels to make them visible under x-ray imaging.
• Carotid ultrasound: This ultrasound is used to help detect plaque, blood clots, or other problems with blood flow in the carotid arteries. During this noninvasive procedure, a gel is placed on your skin where the transducer, a handheld device that directs the high-frequency sound waves, is to be placed. The ultrasound is turned on and images of the carotid arteries are obtained.
• Computed tomography (CT) scan: Bone, blood and brain tissue have very different densities and can easily be distinguished on a CT scan. A CT scan uses a series of x-rays to create a detailed image of your brain. It can show a brain hemorrhage, tumors, strokes and other conditions. Doctors may inject a dye into your blood vessels to view your blood vessels in your neck and brain in greater detail (CT angiography).
• Magnetic resonance imaging (MRI): An MRI uses radio waves and magnetic fields to create a 3 dimensional view of your brain. It can clearly show various types of nerve tissue, and detect brain tissue damaged by an ischemic stroke and brain hemorrhages. Your doctor may also inject a dye into a blood vessel for an image of the arteries in your head and neck (magnetic resonance angiography).
• Lumbar puncture (spinal tap): An invasive diagnostic test that uses a needle to remove a sample of cerebrospinal fluid from the space surrounding the spinal cord. This test can be helpful in detecting bleeding caused by a cerebral hemorrhage.

Although there is currently no treatment to reverse the damage that has already occurred, treatment to prevent additional strokes is very important. Once your doctor has determined the type of your cerebrovascular disease, the goal of treatment is to reduce risk factors, correct the abnormality and prevent a stroke. According to the American Association of Neurological Surgeons , stroke-preventative medication is prescribed for most people with arteries narrowed less than 50%. In more serious cases, your doctor may also recommend a medical or surgical procedure.

• Medications: Doctors use several medications to decrease the likelihood of a stroke occurring or recurring. The medication selected depends on the location, cause, severity and type of cerebrovascular disease. Two frequently prescribed types of drugs are:
  • Anti-platelet drugs: Antiplatelet drugs are medications that block the formation of blood clots by preventing the clumping of platelets. The most frequently used anti-platelet medication is aspirin. Your doctor may also consider prescribing other anti-platelet drugs such as clopidogrel (Plavix) or Aggrenox, as these agents differ in the way they work, their potency, how rapidly they work, and their cost.
  • Anticoagulants: These anti-clotting drugs include heparin and warfarin (Coumadin). Heparin is most often used over a short term and warfarin over a longer term.  The main possible side-effect of anticoagulants is bleeding. Warfarin can also interact with some other medicines and foods.
• Surgery: Carotid endarterectomy is a procedure that requires a neurosurgeon to make an incision in your carotid artery (in the neck), clear the plaque buildup, and close the artery. This helps to restore normal blood flow and can prevent future transient ischemic attacks or strokes. You may experience pain near the incision in your neck and some difficulty swallowing during the first few days after surgery. You should avoid driving and limit physical activities for a few weeks after your surgery.
• Caritod angioplasty and stenting: In patients who may be too high risk to undergo surgery, caritod angioplasty and stenting is an option. During this procedure, a thin, flexible tube with a balloon on the end is threaded through a blood vessel to the narrowed or blocked artery. The balloon is then inflated to compress the plaque against your artery walls. After that, your doctor will fit a small tube (called a stent) in your caritod artery to keep the artery open and increase the flow of blood blocked by plaques.

To reduce the risk posed by cerebrovascular disease, you need to look at your lifestyle as a whole. In particular, you need to:

• Control high blood pressure: High blood pressure is one of the most significant risk factors for cerebrovascular disease. This is because the increase in blood pressure damages the walls of the brain's blood vessels, increasing the risk of a blood clot forming or an artery rupturing. Both of these can cause a stroke. If you have high blood pressure, you are 4 times more likely to have a stroke than someone with healthy blood pressure.
• Control conditions such as high cholesterol and diabetes: If you have high cholesterol or diabetes, make sure to take your prescription medicines to help you manage these conditions. Do not stop taking your medication without consulting your doctor first, as doing so is likely to make your symptoms worse and put your health at risk.
• Stop smoking: Smoking is also a major risk factor for cerebrovascular disease because the toxins in tobacco can damage and narrow the blood vessels that supply the brain. Smoking also causes high blood pressure.
• Maintain a healthy weight: Being overweight or obese increases your risk of developing a number of serious health conditions, such as diabetes and high blood pressure, which are risk factors for cerebrovascular disease.
• Eat a healthy diet: A low-fat, high-fibre diet that includes whole grains and at least five portions of fresh fruit and vegetables a day is recommended for a healthy heart. Limit the amount of salt, sugar and saturated fat in your diet.
• Exercise regularly: In general, a minimum of 30 minutes of moderate exercise per day can keep you physically active and can help fight against cerebrovascular disease.
• Avoid or limit alcohol: Drinking excessive amounts of alcohol can increase your cholesterol and blood pressure levels. If you choose to drink, limit yourself to no more than 1 drink per day. Visit your doctor if you are finding it difficult to moderate your drinking. Treatments such as counseling and medication are available to help you reduce your alcohol intake.
• Reduce your stress levels: Reducing the amount of stress in your life may help you control your blood pressure more effectively. Try some relaxation techniques such as deep breathing, tai chi or yoga.

As well as reducing your risk of developing cerebrovascular disease, making the above changes to your lifestyle can also lower your risk of other serious health conditions, such as coronary heart disease and cancer.