Stroke

BRAIN DAMAGE IN CARDIOVASCULAR DISEASES: HOW TO DETECT AND CAN I AVOID?
The frequency of cerebral strokes in people older than 50-55 years increases by 1.8-2 times in each subsequent decade of life. The development of acute disorders of cerebral circulation is preceded by long and complex changes in the cardiovascular system and the system of cerebral circulation associated with the emergence and progression of various risk factors.

The risk of recurrent strokes or transient ischemic attacks (TIA) in survivors of an acute cerebral event is significantly increased: the frequency of recurrent ischemic strokes is about 15 times higher than that of those who first occurred in people of the same age. The most important direction in neurology is the secondary prevention of ischemic stroke, aimed at reducing the risk of recurrent acute cerebral ischemic events.

The patient should be aware of the risk of stroke

Practice shows that each patient has a “own” mechanism that leads to a sudden disruption of the blood supply to a certain area of ​​the brain tissue, however, there is one general pattern: a stroke develops suddenly against the background of a long-term existence of pathological conditions for decompensation of cerebral circulation.[11]

Between a pathological process that creates conditions for acute cerebrovascular accident and a vascular accident, an event always occurs that decompensates hemodynamic and hemostatic reserves. The immediate cause of a stroke is always a hemodynamic crisis – an acute disturbance of systemic or local hemodynamics, leading to impaired function or damage to the brain. But what creates the conditions for this phenomenon?

Arterial hypertension (AH) is the most significant risk factor for the development of not only acute disorders of cerebral circulation, but also chronic cerebral ischemia, the symptoms of which are memory disorders and other cognitive (cognitive) functions. There is a positive relationship between blood pressure (BP) levels and the incidence of stroke, with the risk increasing as blood pressure is exceeded across the entire range. In addition, the attention of patients should be paid to the presence of other factors that increase the risk of stroke.

The first symptoms of cerebrovascular insufficiency reveal themselves during intense mental work, especially in conditions of fatigue. Over time, such disorders are observed more and more often, and it is no longer a disorder, but the disease will progress and pass into subsequent stages of cerebrovascular insufficiency. Therefore, in such patients, the treatment of the first signs of cerebrovascular insufficiency is the most important step in the prevention of stroke. First of all, it is necessary to treat the underlying disease, against which the insufficiency of cerebral circulation has developed: vegetative-vascular dystonia, hypertension, atherosclerosis. But already at the precursor stage, it is possible to restore the disturbed microcirculation of the brain, as well as to protect and restore the tissue of the brain itself, which has suffered from malnutrition. This is the main task of neuroprotection.

The patient is at risk of developing a cerebral stroke if

• Patient over 55 years of age
• Is overweight
• Leads an inactive lifestyle
• Often experiences excessive physical activity
• Have problems with alcohol and smoking
• In the diet – a lot of harmful products (for example, containing large amounts of animal fats)
• Suffers from diseases of the cardiovascular system (atrial fibrillation, atherosclerosis)
• Suffering from diabetes
• Frequent headaches and dizziness, sensitive to weather changes
• Has a history of stroke or transient ischemic attacks

Hypertension is the main risk factor for vascular accidents

Hypertensive encephalopathy (HE) is a slowly progressive focal and diffuse lesion of brain tissues caused by chronic cerebrovascular accident against the background of long-term uncontrolled hypertension.
Attachment of atherosclerosis of the cerebral vessels (with hypertension, this process occurs early and at an accelerated pace) and a violation of the rheological properties of the blood contributes to a further deterioration in the blood supply to the brain, which leads to the progression of HE; in this case, they speak of dyscirculatory encephalopathy of mixed genesis. Often combined with hypertension, diabetes mellitus, lipid metabolism disorders and smoking also have a damaging effect on the circulatory system of the brain.
Hypertensive encephalopathy is a variant of dyscirculatory encephalopathy that forms a variety of neurological syndromes, threatens the development of a stroke and leads to vascular dementia.
The consequences of dyscirculatory encephalopathy (DE) are very diverse in terms of clinic and course features: cerebrovascular crises, transient ischemic attacks (TIA), strokes, combined

these disorders of cerebral and coronary circulation, which are difficult and not always effective to treat. Therefore, more and more attention has recently been paid to their prevention, that is, early diagnosis and treatment of chronic cerebrovascular insufficiency [1,2,3,4,5,6,7,9].

Prevention of the development and progression of DE consists of several areas:

• Treatment of arterial hypertension
• Impact on factors that aggravate the course of DE: hypercholesterolemia, increased platelet aggregation and blood viscosity, diabetes mellitus, atrial fibrillation (if these diseases are associated), smoking cessation and excessive alcohol consumption
• Improvement of blood supply to the brain
• Improving the metabolism of nerve cells under conditions
ischemia and hypoxia
• Impact on structural changes in brain tissue is a promising direction.

Based on the results of clinical studies, the possibility of preventing stroke has been established by correcting high blood pressure, using antiplatelet agents, and normalizing carbohydrate and lipid metabolism. And what if we use the influence on the pathogenetic mechanisms of the development of cerebral ischemia? At the current level of knowledge about them, this is possible.

From dyscirculatory encephalopathy to stroke, the path is short

Structural changes in the brain during circulation disorders can range from changes in individual neurons, gliocytes and white matter fibers to cerebral infarcts of various sizes and localizations [1,8]. Under conditions of chronic disturbance of the blood supply to the brain, compensation mechanisms are gradually depleted, the energy supply of the brain becomes insufficient, as a result, disorders of brain functions first develop, and then irreversible diffuse morphological changes that prepare the brain tissue for the development of a stroke.

What happens in the focus of ischemic damage?

When a focus of ischemic injury is formed, various signaling molecules are activated in it, regulatory mediators-peptides (cytokines) are synthesized, and inflammatory cells are concentrated. At the same time, a deficiency of anti-inflammatory interleukins and trophic factors occurs in the ischemic zone, which usually protect neurons from traumatic, hypoxic, ischemic damage, and regulate the growth and differentiation of neurons [10]. Thus, the protection of the brain is weakened.
First of all, it is necessary to treat the underlying disease, against which the insufficiency of cerebral circulation has developed. But even effective therapy of the underlying disease does not allow regression of the already formed cognitive deficit in conditions of vascular brain damage. Therefore, in complex therapy, the use of drugs that protect and restore the tissue of the brain itself, which has suffered from malnutrition, is justified.