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Cerebrovascular disease

Cerebrovascular disease
Classification and external resources
ICD-10 I60-I69

Cerebrovascular disease is a vascular disease of the cerebral circulation. Arteries supplying oxygen to the brain are affected resulting in one of a number of cerebrovascular diseases.[1] Most commonly this is a stroke or mini-stroke and sometimes can be a hemorrhagic stroke.[1] Any of these can result in vascular dementia.[2]

Hypertension (high blood pressure) is the most important contributing cause because it damages the blood vessel lining exposing collagen where platelets aggregate to initiate a repair. If maintained hypertension can change the structure of blood vessels ( narrow, deformed).[3]

Blood pressure affects blood flow in narrowed vessels causing ischemic stroke, a rise in blood pressure can cause tearing of vessels leading to intracranial hemorrhage.[4]

Contents

  • Associated medical condition 1
  • Causes 2
  • Pathophysiology 3
  • Evaluation 4
  • Treatment 5
  • Epidemiology 6
  • References 7
  • Further reading 8

Associated medical condition

  • Transient ischemic attack (TIA) leaves little to no permanent damage within the brain. The symptoms of this include facial weakness, visual impairment, loss of coordination or balance, a sudden headache, and mental confusion with unintelligible speech.[5] Severe blockage of the arteries to the brain is known as carotid stenosis.[6]
  • Ischemic stroke,the most common, is due to a blood clot that completely blocks a blood vessel (in the brain).[7]

Causes

Cerebrovascular disease can be divided into embolism, aneurysms, and low flow states depending on its cause.[8] Major modifiable risk factors include:[9]

Pathophysiology

Pathophysiologically, once a stroke has occurred, voluntary control of the muscles may be lost, depending on the type of stroke the individual is encountering.[10] Strokes can also result from embolisms,furthermore, embolism blocks small arteries causing damage to occur.[4] Spontaneous rupture of a blood vessel in the brain causes a hemorrhagic stroke.[11] Another form of cerebrovascular disease includes aneurysms.Cerebral aneurysms can be genetic in nature, due to a wall deformity of the artery. Such aneurysms are common in individuals with genetic diseases ( connective tissue disorders, polycystic kidney disease, and arteriovenous malformations).[12]

Brain infarct

The carotid arteries cover the majority of the cerebrum. The common carotid artery divides into the internal and the external cartoid arteries. The internal carotid artery becomes the anterior cerebral artery and the middle central artery. The ACA transmits blood to the frontal parietal. From the basilar artery are two posterior cerebral arteries. Branches of the basilar and PCA supply the occipital lobe, brain stem, and the cerebellum.[13] Ischemia is the loss of blood flow to the focal region of the brain.This produces heterogeneous areas of ischemia at the affected vascular region, furthermore blood flow is limited to a residual flow.Regions with blood flow of less than than 10 mL/100 g of tissue/min are core regions( cells here die within minutes of a stroke).The ischemic penumbra with a blood flow of <25 ml/100g tissue/min, remain usable for more time(hours).[14]

An ischemic cascade occurs where an energetic molecular problem arises.ATP consumption continues in spite of, insufficient production, this causes total levels of adenosine triphosphate to decrease and lactate acidosis to become established(ionic homeostasis in neurons is lost). The downstream mechanisms of the ischemic cascade thus begins. Ion pumps no longer transport Ca2+ out of cell, this triggers release of glutamate, which in turn allows calcium into cell walls. In the end the apoptosis cascade is initiated and cell death occurs.[15]

Evaluation

Diagnosis of cerebrovascular disease if done by:(among other diagnosis)[16]

Treatment

Treatment for cerebrovascular disease includes medication, lifestyle changes and surgery.[4]

Examples of medications are:

Surgical procedures include:

Epidemiology

Disability-adjusted life year for cerebrovascular disease per 100,000 inhabitants in 2004.[17]
  less than 250
  250–425
  425–600
  600–775
  775–950
  950–1125
  1125–1300
  1300–1475
  1475–1650
  1650–1825
  1825–2000
  more than 2000

Worldwide, it is estimated there are 31 million stroke survivors, though about 6 million deaths were due to cerebrovascular disease (2nd most common cause of death in the world and 6th most common cause of disability).[18]

Cerebrovascular disease primarily occurs with advanced age; the risk for developing it goes up significantly after 65 years of age. CVD tends to occur earlier than Alzheimer's Disease (which is rare before the age of 80). In some countries such as Japan, CVD is more common than AD.

The amount of individuals ( adults) who had a stroke is 6.4 million, in 2012, this corresponds to 2.7% in the U.S. With approximately 129,000 deaths in 2013 (U.S.)[19]

References

  1. ^ a b c "Cerebrovascular disease - Introduction - NHS Choices". www.nhs.uk. Retrieved 2015-09-01. 
  2. ^ "Vascular dementia - Causes - NHS Choices". www.nhs.uk. Retrieved 2015-09-01. 
  3. ^ Prakash, Dibya (2014-04-10). Nuclear Medicine: A Guide for Healthcare Professionals and Patients. Springer Science & Business Media. p. 142.  
  4. ^ a b c "Stroke: MedlinePlus Medical Encyclopedia". www.nlm.nih.gov. Retrieved 2015-09-01. 
  5. ^ "Transient Ischemic Attack Information Page: National Institute of Neurological Disorders and Stroke (NINDS)". www.ninds.nih.gov. Retrieved 2015-09-01. 
  6. ^ "Carotid Artery Stenosis information. Internal carotis occlusion | Patient". Patient. Retrieved 2015-09-01. 
  7. ^ "Stroke: MedlinePlus". www.nlm.nih.gov. Retrieved 2015-09-01. 
  8. ^ Corporation, Surgisphere. Clinical Review of Surgery | ABSITE Review. Lulu.com. p. 146.  
  9. ^ "Cerebrovascular disease - NHS Choices - Risks and prevention". www.nhs.uk. Retrieved 2015-09-01. 
  10. ^ Information, National Center for Biotechnology; Pike, U. S. National Library of Medicine 8600 Rockville; MD, Bethesda; Usa, 20894. "Stroke - National Library of Medicine". PubMed Health. Retrieved 2015-09-01. 
  11. ^ Herman, Irving P. (2007-02-16). Physics of the Human Body. Springer Science & Business Media. p. 488.  
  12. ^ "Cerebral Aneurysms Fact Sheet: National Institute of Neurological Disorders and Stroke (NINDS)". www.ninds.nih.gov. Retrieved 2015-09-02. 
  13. ^ Cipolla, Marilyn J. (2009-01-01). "Anatomy and Ultrastructure". 
  14. ^ "Ischemic Stroke: Practice Essentials, Background, Anatomy". 
  15. ^ Xing, Changhong; Arai, Ken; Lo, Eng H.; Hommel, Marc (2012-07-01). "Pathophysiologic cascades in ischemic stroke". International journal of stroke : official journal of the International Stroke Society 7 (5): 378–385.  
  16. ^ "Stroke. Diagnosis and Therapeutic Management of Cerebrovascular Disease | Revista Española de Cardiología (English Version)". www.revespcardiol.org. Retrieved 2015-09-01. 
  17. ^ "WHO Disease and injury country estimates". World Health Organization. 2009. Retrieved Nov 11, 2009. 
  18. ^ Ward, Helen; Toledano, Mireille B.; Shaddick, Gavin; Davies, Bethan; Elliott, Paul (2012-05-24). Oxford Handbook of Epidemiology for Clinicians. OUP Oxford. p. 310.  
  19. ^ "FastStats". www.cdc.gov. Retrieved 2015-09-01. 

Further reading

  • Chan, Pak H. (2002-03-28). Cerebrovascular Disease: 22nd Princeton Conference. Cambridge University Press.  
  • Mark, Steven D.; Wang, Wen; Fraumeni, Joseph F.; Li, Jun-Yao; Taylor, Philip R.; Wang, Guo-Qing; Guo, Wande; Dawsey, Sanford M.; Li, Bing (1996-04-01). "Lowered Risks of Hypertension and Cerebrovascular Disease after Vitamin/Mineral Supplementation The Linxian Nutrition Intervention Trial". American Journal of Epidemiology 143 (7): 658–664.  
  • Ning, MingMing; Lopez, Mary; Cao, Jing; Buonanno, Ferdinando S.; Lo, Eng H. (2012-12-01). "Application of proteomics to cerebrovascular disease". Electrophoresis 33 (24).  
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