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​​​What is cerebrovascular disease?

The following are the most common forms of cerebrovascular disease:

  • Cerebral thrombosis is a blood clot/plaque that forms in the brain's blood supply
  • Cerebral embolism is a clot or air bubble that blocks blood flow that's traveling in the body
  • Cerebral hemorrhage is the escaping of blood from a ruptured blood vessel
  • Aneurysms is swelling of the artery wall; protrusions can develop with a very thin wall due to weak parts in arteries. These can tear and cause brain bleeds. 

 


What causes cerebrovascular diseases?

Cerebrovascular disease occurs when there is restrictions in blood flow due to vessel narrowing, clot formation, blockage or blood vessel rupture. Lack of sufficient blood flow affect brain tissue and may cause a stroke. 

 


What are the symptoms of cerebrovascular disease?

The symptoms of cerebrovascular disease depend on the location of the hemorrhage, thrombus or embolus and the extent of cerebral tissue affected. General symptoms of a hemorrhagic or ischemic event include motor dysfunction, such as paralysis of one side (hemiplegia) and weakness on one side of the body (hemiparesis). Early in a cerebrovascular attack (CVA), you may experience weakness (flaccid paralysis) followed by increased muscle tone and spasticity; you could also lose your gag reflex or ability to cough. You could also lose half of your visual field (homonymous hemianopia) and the ability to recognize an object (agnosia).

Other symptoms of a cerebrovascular attack may include:

  • Vomiting
  • Seizures
  • Fever
  • Confusion that leads to a complete loss of consciousness
  • Labored or irregular breathing
  • Pauses in breathing (Apnea)
  • Bowel and bladder incontinence

Communication deficits may occur such as:

  • Difficulty or discomfort in swallowing (Dysphagia)
  • Difficulty putting thoughts into words (Aphasia)
  • Difficulty articulating speech or slurred speech (Dysarthria)
  • Difficulty planning or performing tasks (Apraxia)

 


How are cerebrovascular diseases diagnosed?

Your physician will look for specific neurological, motor and sensory deficits that include changes in vision or visual fields, abnormal reflexes, abnormal eye movements, muscle weakness, decreased sensation and other changes. Other tests can include:

  • Cerebral angiography; arteries cannot be seen in an X-ray, so contrast dye is used to view them. A local anesthetic is given, the artery is punctured in the leg and a needle is inserted into the artery. A catheter is inserted through the needle into the artery; it is then threaded through the main vessels of the abdomen and chest until it is placed in the arteries of the neck. The contrast dye is then injected into the neck area through the catheter, and x-ray pictures are taken.
  • Carotid duplex; an ultrasound is used to help detect plaque, blood clots or other problems with blood flow in the carotid arteries. This procedure is also known as a doplar ultrasound.
  • CT Scan; this uses special x-ray equipment to obtain image data from different angles around the body and then uses computer processing of the information to show 3-D images and cross-sectional images of the body tissues and organs.
  • Electroencephalogram (EEG); this uses small metal discs (electrodes) placed on a person's scalp to pick up electrical impulses that are printed out as brain waves.
  • Lumbar puncture (spinal tap); needles are used 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. 
  • MRI; this imaging test uses radio waves and a powerful magnetic field to produce a detailed 3-D or 2-D images of the body tissues and organs.
  • Cerebral Magnetic Resonance Angiogram (MRA); this is done in an MRI machine and provides images of the arteries located in the head and neck and can help detect blockage and aneurysms.

 


How are cerebrovascular diseases treated?

Blood platelet inhibitors including aspirin, dipyridamole, ticlopidine, and clopidogrel are effective in reducing the risk of stroke. Cholesterol-lowering medications called statins are usually given to reduce the risk of ischemic stroke.

 

A stroke is a medical emergency and should be evaluated immediately when symptoms occur by calling 911.

Other treatments include:

  • Carotid endarterectomy is a procedure where an incision is made in the carotid artery. The plaque is removed allowing the blood to flow again and the artery is repaired with sutures or a graft. 
  • Carotid angioplasty and stenting involve a balloon-tipped catheter that is inserted into the artery. The balloon is inflated so it presses against the plaque, making it flat and reopening the artery. A slender metal tube, the stent, is fitted inside the carotid artery to improve blood flow to the arteries that were blocked by plaque; it also prevents the artery from collapsing or closing up after the procedure is finished.