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cerebrovascular_disease

Cerebrovascular disease

Group of brain dysfunctions related to disease of the blood vessels supplying the brain.

Cardiovascular and cerebrovascular diseases have become the leading cause of death for people, and Neuroendovascular treatment has become the main therapeutic method.

Etiology

Hypertension is the most important cause; it damages the blood vessel lining, endothelium, exposing the underlying collagen where platelets aggregate to initiate a repairing process which is not always complete and perfect. Sustained hypertension permanently changes the architecture of the blood vessels making them narrow, stiff, deformed, uneven and more vulnerable to fluctuations in blood pressure.

A fall in blood pressure during sleep can then lead to a marked reduction in blood flow in the narrowed blood vessels causing ischemic stroke in the morning. Conversely, a sudden rise in blood pressure due to excitation during the daytime can cause tearing of the blood vessels resulting in intracranial hemorrhage. Cerebrovascular disease primarily affects people who are elderly or have a history of diabetes, smoking, or ischemic heart disease. The results of cerebrovascular disease can include a stroke, or occasionally a hemorrhagic stroke. Ischemia or other blood vessel dysfunctions can affect the person during a cerebrovascular incident.

Pathophysiology

Cystathionine β-synthase (CBS) is involved in homocysteine and hydrogen sulfide (H2S) metabolism. Both products have been implicated in the pathophysiology of cerebrovascular diseases.

Classification

The most common presentation of cerebrovascular disease is an ischemic stroke or mini-stroke and sometimes a hemorrhagic stroke. Hypertension (high blood pressure) is the most important contributing risk factor for stroke and cerebrovascular diseases as it can change the structure of blood vessels and result in atherosclerosis.


Cerebrovascular diseases have traditionally been classified, diagnosed and managed based on their luminal characteristics. However, over the past several years, several advancements in MRI techniques have ushered in high resolution vessel wall imaging (HR-VWI), enabling evaluation of intracranial vessel wall pathology. These advancements now allow us to differentiate diseases which have a common angiographic appearance but vastly different natural histories (i.e. moyamoya versus atherosclerosis, reversible cerebral vasoconstriction syndrome versus vasculitis, stable versus unstable intracranial aneurysms) 1).


Aneurysm.

Arteriovenous malformation.

Ischemic cerebrovascular disease.

Intracerebral hemorrhage.

Clinical features

Cerebrovascular disease (CVD) is the most prevalent neurological disorder today, but it has generally been considered a rare cause of auditory dysfunction. However, a substantial proportion of patients with stroke might have auditory dysfunction that has been underestimated due to difficulties with evaluation.

The numbers of patients with CVD accompanied by auditory dysfunction will increase as the population ages. Cerebrovascular diseases often include the auditory system, resulting in various types of auditory dysfunctions, such as unilateral or bilateral deafness, cortical deafness, pure word deafness, auditory agnosia, and auditory hallucinations, some of which are subtle and can only be detected by precise psychoacoustic and electrophysiological testing. The contribution of CVD to auditory dysfunction needs to be understood because CVD can be fatal if overlooked 2).

1)
Brinjikji W, Mossa-Basha M, Huston J, Rabinstein AA, Lanzino G, Lehman VT. Intracranial vessel wall imaging for evaluation of steno-occlusive diseases and intracranial aneurysms. J Neuroradiol. 2016 Nov 8. pii: S0150-9861(16)30173-0. doi: 10.1016/j.neurad.2016.10.003. [Epub ahead of print] Review. PubMed PMID: 27836652.
2)
Tabuchi S. Auditory dysfunction in patients with cerebrovascular disease. ScientificWorldJournal. 2014;2014:261824. doi: 10.1155/2014/261824. Epub 2014 Oct 23. PubMed PMID: 25401133; PubMed Central PMCID: PMC4225841.
cerebrovascular_disease.txt · Last modified: 2018/07/12 11:53 by administrador