Types, Causes, and Symptoms of Cerebrovascular Disease

Overview

In the word “cerebrovascular”, the “cerebro” means the large part of the brain and “vascular” means arteries and veins. The word cerebrovascular refers to the blood flow in the brain. 

All disorders in which a region of the brain is affected by ischemia or bleeding and where one or more of the cerebral blood vessels are involved in the pathological process are encompassed within this category.

The Blood Flow to the Brain

The heart sends blood up to the brain via two sets of arteries: the carotid arteries and the vertebral arteries. 

The carotid arteries are situated in the front of the neck. The carotid arteries are divided into the external and internal arteries next to the top of the neck. 

The external carotid arteries transport blood to the face, and the internal carotid arteries supply blood to the skull.

Within the skull, the internal carotid arteries divide into two large arteries: 

The anterior cerebral and middle cerebral arteries. 

There are also several other smaller arteries inside the skull, namely ophthalmic, posterior communicating and anterior choroidal arteries. The brain’s anterior two-thirds receive their blood supply from these arteries.

The vertebral arteries branch out alongside the spinal column. The vertebral arteries combine to form a single basilar artery close to the brain stem, which is situated adjacent to the base of the skull. 

The vertebrobasillar system extends many small branches into the brain stem and diverges to create the posterior cerebellar and posterior meningeal arteries, which supply blood to the back third of the brain. The jugular and other veins transport blood out of the brain.

The blood supply to the brain is done only by its two sets of major arteries. Hence, it is crucial that these arteries are healthy. At most times, the fundamental cause of an ischemic stroke is carotid arteries obstructed with a fatty build-up called plaque. 

When a hemorrhagic stroke occurs, an artery in or on the surface of the brain gets ruptured or leaks, creating bleeding and harm in or around the brain.

Whatever the root cause or medical condition may be, it is necessary that sufficient blood flow and oxygen be restored to the brain within a matter of minutes. Deprivation of oxygen and essential nutrients, the affected brain cells are either irreversibly damaged or die within a few minutes.

When brain cells die, they cannot regenerate, and catastrophic damage may happen, sometimes leading to physical, cognitive and mental disabilities. 

Types of cerebrovascular disease

Ischemic Stroke

Ischemic stroke occurs when a blood clot or atherosclerotic plaque obstructs a blood vessel that supplies blood to the brain. A clot may form in an artery which is already narrow. A stroke happens when the lack of blood supply leads to the death of the brain cells.

Dissection

A tear in the lining of the carotid artery, which is located in the neck, can result in ischemic stroke. The tear allows blood to flow between the layers of the carotid artery, narrowing it and lowering the blood supply to the brain. Carotid or vertebral artery dissections are frequently associated with trauma. Nevertheless, they can sometimes occur spontaneously.

Embolic Stroke

An embolic stroke happens when a clot breaks off from elsewhere in the body and moves to the brain to obstruct a smaller artery. People suffering from arrhythmias, which are conditions that cause an irregular heart rhythm, are more vulnerable to developing embolism.

Cerebral Aneurysm

This can happen due to structural problems in the blood vessels of the brain. An aneurysm is basically a bulge in the arterial wall that can rupture and bleed. The leaking of blood can harm brain cells. 

Hemorrhagic Stroke

When a blood vessel in the part of the brain weakens and bursts open, making blood leak into the brain. The leaking blood adds pressure on the brain tissue, leading to oedema, which harms brain tissue. The haemorrhage can also cause adjacent parts of the brain to stop having their supply of oxygen-rich blood. 

There are two types of hemorrhagic stroke.

• Intracerebral haemorrhage: It happens when an artery in the brain breaks and bleeds into the nearby tissue.
• Subarachnoid haemorrhage: When a blood vessel breaks and bleeds between two membranes surrounding the brain. 

Symptoms of cerebrovascular disease

Symptoms of cerebrovascular disease differ depending on what area of your brain is affected. The common symptoms include:

• Fainting
• Balance problems
• Delirium
• Paralysis or weakness on one side of your body or face
• Sudden, very severe headache
• Loss of vision or visual field cut or double vision
• Trouble speaking or understanding speech
• Slurred speech
• Sensory changes in one side of the body or face

Cerebrovascular Diagnostic Tests

Most of the cerebrovascular problems can be identified via diagnostic imaging tests. These tests enable neurosurgeons to view arteries and vessels surrounding the brain and the brain tissue itself.

• Cerebral angiography
• Computed tomography (CT or CAT scan)
• Carotid duplex (also called carotid ultrasound)
• Doppler ultrasound
• Electroencephalogram (EEG)
• Lumbar puncture (spinal tap)
• Magnetic Resonance Angiogram (MRA)
• Magnetic Resonance Imaging (MRI)

Risk Factors

Strokes are more common in older adults. However, they can occur at any age. Stroke prevention can help minimize disability and death caused by the disease. The controllable or treatable risk factors for stroke are:

• Smoking
• Diabetes
• High blood cholesterol
• High blood pressure
• Carotid or other artery disease: History of transient ischemic attacks (TIAs)
• Physical inactivity and obesity

Recent studies show evidence that people getting hormone replacement therapy (HRT) have an overall 29 per cent increased risk of stroke, specifically ischemic stroke.

Uncontrollable risk factors

• Age: People of all ages can get strokes, even children. However, the older you are, the higher your risk of stroke.
• Gender: Men are more vulnerable to stroke than women
• Heredity and race: The risk of getting a stroke is high if a parent, grandparent, sister or brother has had a stroke. Black people have a much greater risk of death from a stroke than Caucasians do because they are more exposed to diabetes, high blood pressure, & obesity.
• Heart attack or prior stroke: Those who have had a stroke are at a much higher risk of having another one. Those who have had a heart attack are also at a higher risk of having a stroke.

Treatments

The treatment depends upon the type of cerebrovascular disease that one is affected by. However, the treatment focuses on improving the brain’s blood flow. According to the cause of the Loss of blood flow, the doctor will choose among different treatment options.

The majority of cerebrovascular diseases are treated with medications. These medications are blood pressure medications, cholesterol medication, and blood thinners.

Medications are normally given to people whose arteries are less than 50 per cent narrowed or blocked. In extreme cases, surgery to eliminate blockages or to insert a stent may be needed. 

If brain function has already been diminished or altered by cerebrovascular disease, then you may required to have physical therapy, occupational therapy and speech therapy as a major part of the recovery process.

Conclusion

A healthy lifestyle, encompassing a balanced diet and consistent physical activity, can greatly reduce the risk of cerebrovascular diseases. 

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