Cerebrovascular

Introduction

Introduction to cerebrovascular fistula

Cerebral vasospasm (cerebralangiospasm) refers to the atherosclerotic plaque of the internal carotid artery or vertebral basilar artery system, which narrows the vascular lumen and causes eddy currents. When the eddy current accelerates, it stimulates the blood vessel wall to cause vasospasm and transient ischemic attack. The symptoms disappear when the vortex decelerates. However, some scholars believe that due to the special nature of the cerebral vascular structure, it is not easy to occur. Early use of vasodilators and expanders can significantly reduce and terminate the clinical onset of TIA. You can use 20mg of betahistine injection to add 500ml of 5% glucose injection, or 500ml of low molecular weight dextran or 706 generation plasma. Wei Nao Lu Tong, Xi Biling, etc. may also have a certain effect.

basic knowledge

The proportion of illness: 0.02%

Susceptible people: young women, mental workers have a relatively high incidence

Mode of infection: non-infectious

Complications: nausea and vomiting headache, tinnitus

Pathogen

Cerebral vasospasm

Mechanical stimuli (30%):

Encapsulation of blood clots, vascular dystrophy, etc. caused by destruction of the vascular wall structure; oxidation of oxyhemoglobin into methemoglobin and release of oxygen free radicals; other various vasoactive substances such as 5-HT, catecholamine, hemoglobin and arachidonic acid The vasoconstriction of metabolites; increased intracranial pressure, excessive dehydration treatment without timely replenishment of blood volume; and factors such as vascular wall inflammation and immune response. In addition, the balance of sympathetic / parasympathetic, self-regulation mechanism of cerebral blood flow is also a research hotspot.

Functional factors (30%):

Simple cerebral vasospasm refers to the abnormal contraction state of the cerebral artery over a period of time. It is a functional disease, that is to say, the disease is caused by various factors, cerebrovascular dysfunction, and there is no substantial damage or pathological damage to the cerebral blood vessels. Most of the patients are young people, and the self-regulation ability is better, so the prognosis is good, most of them. After treatment and relaxation, the patient can recover completely. The disease does not occur with hemiplegia and psychotic abnormalities. However, if combined with intracranial aneurysms, or cerebral arteriosclerosis, high blood pressure and other diseases, it is easy to cause cerebral hemorrhage, if not treated in time, there may be paralysis or other nervous system symptoms or even life-threatening.

Other factors (40%):

Emotional fluctuations, angry excitement, psychological disorders, stress is the most common cause of cerebral vasospasm. Most of the patients are students, especially high school entrance examination students, intense study life, lack of sleep time, no chance to relax, most likely to occur Cerebrovascular spasm, insomnia can also cause cerebral vasospasm. For young women, the incidence of mental workers is relatively high.

Prevention

Cerebrovascular spasm prevention

Cerebral vasospasm is like muscle spasm of tension headache, because the cerebral blood vessels are also composed of smooth muscles. All measures of relaxation can treat or relieve cerebral vasospasm. "Comprehensive physical therapy" includes acupoint injection therapy, acupuncture therapy, fumigation. Therapy, PT, OT, ST rehabilitation training, medicated bath therapy, medicated bath therapy, wax therapy, pedicure, comprehensive treatment plus medication, can make most patients recover. The following should be noted in daily life:

1. Reasonable meal

It is recommended to eat more fresh fruits and vegetables and eat less greasy food. It is recommended to drink red wine (50 ~ 100mml) and green tea, eat yellow food (such as carrots, sweet potatoes, corn, tomatoes, etc.) black fungus and oatmeal.

2, moderate exercise

The best exercise is walking. It is very safe to master the "three-five-seven" movement. Three means walking 3 kilometers per day for more than 30 minutes; five refers to exercising five times a week; seven refers to heart rate after exercise plus age of about 170. This amount of exercise is moderately intense. In addition, you can also jog according to your personal situation, Yujia, Tai Chi, cycling, swimming and so on. In patients with exercise equivalent to walking or jogging for 3 km, cerebral vasospasm can be prevented.

3. Smoking cessation limit

The danger of smoking is unquestionable and should be resolved to quit. If you are not able to quit smoking completely, it is recommended to limit your daily smoking to less than 5. Drink moderately, it is recommended to drink a small amount of red wine, beer should not exceed 300ml, white wine should not exceed 25ml, can not drink alcohol.

4, psychological balance

A healthy lifestyle is important, and among all health care measures, the psychological balance is the most critical. Eliminate concerns about the disease, establish a correct attitude towards the disease, maintain a calm state of mind and a happy state of mind, avoid emotional agitation, and almost antagonize all internal and external disadvantages.

Complication

Cerebrovascular complications Complications, nausea and vomiting, headache, tinnitus

1, the formation of brain diseases endangered life: cerebral vasospasm if combined with intracranial aneurysms, or cerebral arteriosclerosis, hypertension and other diseases, it is easy to cause cerebral hemorrhage, if not treated in time, there may be sputum or other nervous system symptoms Even life-threatening.

2, severe headache, vomiting: patients with cerebral vasospasm will have severe headache, vomiting, neck stiffness, physical examination of meningeal irritation, lumbar puncture, brain CT, Doppler or cerebral angiography can confirm the diagnosis, the disease The condition is serious, and if it is not treated in time, it may cause paralysis or other nervous system symptoms, and even life-threatening.

3, repeated headache and dizziness: clinically we found that most cerebral vasospasm is a chronic course, patients with repeated headaches, dizziness, memory loss, mood disorders, sleep disorders, anxiety, irritability or depressive symptoms.

4, dizziness is persistent: cerebral vasospasm patients with dizziness is persistent, can also be paroxysmal, mainly manifested as rotatory vertigo, dizziness attacks do not dare to move, bedridden, especially can not move the head, with severe nausea Severe vomiting, or accompanied by tinnitus, head sounds, continuous low-pitched tinnitus or head squeak, mood irritability, anxiety, or chest tightness, palpitation, shortness of breath, breathing urgency, unclear mind, thinking and memory are affected.

5, persistent headache: cerebral vasospasm patients with severe headache symptoms, often have persistent headaches, head nausea, pressure, heavy feeling, and some patients complained that the head has a "tight" feeling. Headaches are often exacerbated by factors such as excitement, anger, insomnia, anxiety or depression.

Symptom

Cerebral vasospasm symptoms common symptoms cerebral palsy dizziness vasospasm chronic headache headache and vomiting

Dizziness and headache are prominent features. If dizziness occurs frequently, you should be alert to the occurrence of cerebral vasospasm. Headache is the initial symptom of cerebral vasospasm, especially persistent headache, faint, but continuous.

1, dizziness: dizziness is persistent, can also be seizure, mainly manifested as vertigo, dizziness, when the attack does not dare to move, bedridden, especially can not move the head, with severe nausea, severe vomiting, or accompany Tinnitus, head sounds, tinnitus or head sounds with persistent low-pitched tone, irritability and anxiety, or chest tightness, palpitation, shortness of breath, feeling of breathing urgency, unclear mind, and thought and memory are affected.

2, headache: persistent headache, head stuffiness, pressure, heavy feeling, and some patients complained that the head has a "tight" feeling. Most patients have bilateral headaches, mostly two sides, the posterior occipital and the top of the head or the entire head. The nature of headache is dull pain, pain, pressure, numbness and bandage. The intensity of headache is mild to moderate. Some patients may have persistent headaches for many years. Patients can have headaches all day long and have more headaches than they do not. Headaches are often exacerbated by factors such as excitement, anger, insomnia, anxiety or depression. There are also some patients complaining of pulsating headaches. Patients are often accompanied by irritability, anxiety, anxiety, flusteredness, shortness of breath, fear, tinnitus, insomnia, back pain, neck stiffness and other symptoms.

3, other symptoms: in the early stage of cerebral vasospasm may also be accompanied by nausea, vomiting and other symptoms, or there may be symptoms such as tinnitus, palpitation and shortness of breath. These are the precursors of cerebral vasospasm. If you have multiple symptoms at the same time, you should go to the hospital in time, especially young people under various pressures.

The headache caused by cerebral vasospasm may be in the form of severe pain, tenderness, etc. It may also be caused by swelling, heavy feeling, pressure, etc. of the head. The abnormality of the head indicates that cerebral vasospasm may occur.

Examine

Cerebral vasospasm examination

Common diagnostic methods for cerebral vasospasm include CT, digital subtraction angiography (DSA), and transcranial Doppler flow analysis (TCD).

CT scans a certain thickness of a certain part of the human body with X-ray beam. The detector receives the X-ray passing through the layer and converts it into visible light. It is converted into an electrical signal by photoelectric conversion, and then passed through an analog/digital converter (analog). /digitalconverter) converts to a number and enters the computer for processing. It is a kind of modern advanced medical scanning examination, mainly for scanning the human brain.

Diagnosis

Diagnosis and identification of cerebral

Diagnose based on

CT diagnosis found that SAH accuracy rate of more than 99%, but the detection rate of aneurysm and cerebrovascular malformation is only 34%, so it can not be the only means of etiological diagnosis.

Clinically, the severity of cerebral vasospasm can be estimated based on the amount of bleeding displayed by CT, ie Fischer grading. According to the standard, grade 0 is no bleeding, the incidence of cerebral vasospasm is about 3%, grade 1 is only see basal cell hemorrhage, vasospasm incidence is 14%, grade 2 is peripheral cerebral pool or lateral fissure pool hemorrhage, vasospasm The incidence rate was 38%. Grade 3 was extensive SAH with intracerebral hematoma. Grade 4 was thicker in the basal and peripheral cerebral pools and lateral fissure pools. The corresponding incidence of vasospasm was more than 50%.

Whole cerebral angiography has a high positive rate of aneurysm and cerebral vascular malformation, which can clearly show the branches of the cerebral vessels, the size of the aneurysm or the shape distribution of the deformed blood vessels, providing a reliable and objective basis for treatment. It is used as a gold standard for judging cerebral vasospa However, there are certain disadvantages, such as being an invasive examination, and the price is relatively expensive, the operation is complicated, and sometimes it is not accepted by the patient.

TCD is also a good method to monitor cerebral vasospasm after SAH. In particular, it can be monitored multiple times in one day. Dynamic observation of cerebral hemodynamic changes after SAH is of great value in the diagnosis and prognosis of cerebral vasospasm. The basic principle is to estimate the degree of lumen stenosis by changes in blood flow velocity. The most important detection site is usually bilateral MCA, and the blood flow of the internal carotid artery of the extracranial segment can also be monitored.

The normal MCA blood flow velocity is 30~80 cm/s. The diagnostic criteria for general cerebral vasospasm is blood flow velocity over 120 cm/s. The advantages of TCD are simple operation, low price, no trauma to patients, but indirect diagnosis of cerebral vasospasm by blood flow velocity, high specificity and relatively low sensitivity. Therefore, it has been proposed that the standard for diagnosis of vasospasm from TCD is 120. The cm/s is reduced to 80 cm/s. If vasospasm is suspected, TCD is continuously performed during the entire treatment period.

For microvascular spasm, a new detection method, orthogonal polarization spectrum imaging, has emerged. This method can qualitatively and quantitatively analyze the microcirculation of the cerebral cortex. The related literature reports that the capillary density can be significantly reduced in the early stage of SAH, and vasospasm occurs in the cerebral cortex arterioles and arterioles.

In the early stage of SAH, 55% of patients develop segmental microvascular spasm, and the diameter of the blood vessels can be reduced by up to 75%, which can cause clinical symptoms and ultimately affect clinical outcomes. Based on the above findings, the authors believe that early SAH, even if cerebral angiography or TCD has not found vasospasm, should start treatment as soon as possible.

Differential diagnosis

1. Focal epilepsy The performance of various types of focal seizures is similar to that of TIA. For example, epileptic seizures or motor seizures are easily confused with TIA. Tension-free seizures are similar to those of a trip. It is more convenient to perform 24-hour EEG Holter monitoring. If there is focal epileptic discharge, it can be diagnosed as epilepsy. If there is no abnormality, it is considered as TIA. CT or MRI findings have focal non-infarct lesions in the brain and may also be considered epilepsy.

2, Meniere's disease vertigo episodes last longer (up to 2-3 days), accompanied by tinnitus, hearing loss after multiple episodes, and no other signs of nervous system positioning.

3, before the syncope, there are many eyes black, dizziness and unstable standing, accompanied by pale, cold sweat, fine pulse and blood pressure drop, and transient disturbance of consciousness but quickly recovered after falling to the ground, and no nerve positioning Signs. More than an upright position occurs.

4, migraine multiple onset in adolescence, often family history, episodes of unilateral headache, vomiting and other autonomic symptoms, less focal neurological loss, seizure time is longer. Regardless of the factors, TIA should be considered as an important risk factor for complete stroke, especially in the short-term repeated authors. The disease can be relieved by itself, and treatment focuses on preventing recurrence.

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