Cerebrovascular Diseases

 

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Cerebovascular disease

Cerebrovascular Diseases and Critical Care Overview

What is cerebrovascular disease?

Cerebrovascular disease is an umbrella term for conditions that impact the blood vessels in your brain. “Cerebro” refers to your brain and “vascular” refers to your blood vessels (arteries and veins).

Cerebrovascular diseases may cause a reduction of blood flow to your brain (ischemia) or bleeding (hemorrhage) in a part of your brain. Both conditions are generally referred to as “stroke.” Blood vessel diseases in the brain can lead to strokes, as well as many other vascular conditions.

If you or your loved one have a cerebrovascular disease, it’s important to restore blood flow to the brain as soon as possible. Otherwise, brain cells can quickly die and cause permanent disability or death.

 

People who have strokes and other brain and blood vessel conditions (cerebrovascular diseases) benefit from being evaluated and treated by the doctors of the specialty group for cerebrovascular diseases and critical care. Your neurologist works with doctors trained in brain and nervous system surgery (neurosurgeons), cardiologists, and others to ensure you get exactly the care you need.

You may be seen in the Heart Brain Clinic, one of the first such advanced multidisciplinary clinics in the United States. At this clinic, you'll experience real-time collaborative consults by teams of subspecialists probing the heart-brain linkage driving stroke. The Heart Brain Clinic is available on Mayo's campuses in Florida and Minnesota.

Mayo Clinic's campuses in Florida and Minnesota are each certified as a Comprehensive Stroke Center by The Joint Commission, a national organization that evaluates and accredits hospitals and staff. Mayo Clinic's campus in Arizona, and the Mayo Clinic Health System sites in Eau Claire, Wisconsin, La Crosse, Wisconsin, and Mankato, Minnesota, are certified as Primary Stroke Centers by The Joint Commission.

 

What blood vessels do cerebrovascular diseases affect?

Cerebrovascular diseases can affect both arteries and veins. The most commonly affected cerebral blood vessels that supply blood to your brain include:

• Carotid arteries: These blood vessels run along the front of your neck. The majority of people have a carotid artery on the right and one on the left.
• Vertebral arteries: These blood vessels run along the back of your neck. The majority of people have a vertebral artery on the right and one on the left.

What are the types of cerebrovascular disease?

Stroke is the most common type of cerebrovascular disease. Other types of cerebrovascular disease include, but aren’t limited to:

• Arteriovenous malformation (AVM).
• Brain aneurysm.
• Brain bleed, hemorrhage (intracranial hemorrhage).
• Carotid artery disease (carotid artery stenosis).
• Cervical artery dissection.
• Reversible cerebral vasoconstriction syndrome.
• Subarachnoid hemorrhage (SAH).
• Transient ischemic attack (TIA) or mini stroke.
• Hereditary hemorrhagic telangiectasia (HHT).
• Moyamoya disease.

 

Conditions and treatments

·         Amyloid angiopathy of the brain

·         Antiphospholipid syndrome with neurological symptoms

·         Arteritis (vasculitis) of brain or neck arteries

·         Brain aneurysm (ruptured or unruptured)

·         Brain AVM (arteriovenous malformation)

·         Carotid artery disease

·         Carotid bruit

·         Carotid dissection

·         Cavernous malformations

·         Central nervous system arteritis

·         Cerebral autosomal dominant arteriopathy with subcortical infarct and leukoencephalopathy (CADASIL)

·         Cerebral microbleeds by MRI

·         Dural arteriovenous fistulas

·         Genetic disorders of stroke and other cerebrovascular diseases

·         Intracerebral hemorrhage of any cause

·         Intracranial venous malformations

·         Moyamoya disease

·         Other brain arteritis or vasculitis syndromes

·         Small vessel white matter disease

·         Spinal arteriovenous malformation (AVM)

·         Stroke

·         Stroke prevention

·         Subarachnoid hemorrhage

·         Takayasu's arteritis

·         Transient ischemic attack (TIA)

·         Vasculitis of central nervous system

·         Venous (dural) sinus thrombosis

·         Vertebral or basilar artery stenosis or occlusion

 

 

What causes cerebrovascular disease?

Causes of cerebrovascular disease may include:

• Blood clot that spontaneously forms in a blood vessel in your brain. This is “thrombosis” and usually happens in areas where your blood vessel is narrow or irregular.
• Blood clot that travels to your brain from elsewhere in your body (embolism). The most common type of embolism is when a clot travels from your heart to your brain.
• Blood vessel rupture (hemorrhage). This usually occurs in conjunction with uncontrolled high blood pressure.
• Plaque build-up in the arteries (atherosclerosis) in your brain.
• Structural problems in your brain’s blood vessels.
• Traumatic brain injury (TBI).

What are the symptoms of cerebrovascular disease?

Symptoms of cerebrovascular disease vary depending on what area of your brain is affected. Common symptoms include:

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

DIAGNOSIS AND TESTS

How is cerebrovascular disease diagnosed?

Cerebrovascular disease is a medical emergency that needs a quick diagnosis. A healthcare provider will first ask about your medical history. They’ll do a physical exam to look for:

• Mental status (degree of alertness and understanding of surroundings).
• Abnormal eye movements or vision changes as above.
• Weakness or paralysis.
• Reduced or abnormal sensations.
• Different aspects of speech like fluency, comprehension and naming.
• Loss of balance and coordination.
• Vertigo or room spinning sensation.

If your provider suspects cerebrovascular disease, they’ll sometimes use tests such as:

• Cerebral angiography.
• Coronary computed tomography angiogram.
• Electrocardiogram (EKG).
• MRI (magnetic resonance imaging).
• Spinal tap (lumbar puncture).

These tests help your provider figure out the cause of the cerebrovascular disease. You might need other tests, too, depending on your situation.

MANAGEMENT AND TREATMENT

How is cerebrovascular disease treated?

Treatment for cerebrovascular disease depends on your specific condition. To limit damage to your brain, you’ll need to begin treatment as soon as possible after symptoms start.

Your provider will usually treat you with medications to improve blood flow to your brain. These medications may include:

• Blood pressure medications.
• Blood thinners (anticoagulants).
• Cholesterol-lowering drugs.
• Blood sugar medications.

If you have severe blockage in your blood vessels, you may need surgery. Types of surgery may include:

• Carotid angioplasty, where your surgeon inflates a balloon-tipped catheter inside of your artery to open it.
• Carotid endarterectomy, where your surgeon makes a cut (incision) in your carotid artery to remove plaque.
• Carotid stenting, when your surgeon inserts a narrow metal tube (stent) into your carotid artery to improve blood flow.
• Catheter-directed mechanical thrombectomy, when your surgeon inserts a catheter into your artery along with a device to suck out the blood clot.

PREVENTION

How can I reduce my risk of cerebrovascular disease?

You can lower your risk of cerebrovascular disease by following a healthy lifestyle. It’s smart to:

• Control high blood pressure (hypertension).
• Eat a hypertension diet low in salt, fat and calories.
• Exercise.
• Limit your intake of alcohol.
• Don’t use recreational drugs.
• Maintain a healthy weight.
• Manage your sugar and cholesterol levels.
• Quit smoking.
• Reduce stress.
• See your provider for regular checkups.
• Take a blood thinner if needed for conditions such as heart arrhythmia.
• Weigh the risk of blood clots vs. the benefits of hormone therapy for menopause symptoms.