Cerebrovascular Disease

Cerebrovascular disease refers to a group of conditions that develop temporarily or permanently as a result of problems with the blood vessels and blood supply to the brain affected by ischemia or bleeding. The term cerebrovascular refers to blood flow in the brain. The cerebrovascular disease occurs with sudden onset due to a burst of cerebral arteries and is one of the major causes of morbidity and mortality in the developed world. Whenever such an event occurs suddenly, medically it is termed as stroke. Occlusion and hemodynamic impairment are mainly responsible for decreasing the cerebral perfusion pressure and eventually leading to cellular death. Carotid and vertebral are the two sets of arteries that supply blood to the brain. Under this condition, one of them gets ruptured therefore, proper blood flow and oxygen are restored to the brain at the earliest. Without the supply of oxygen and proper nutrients on time, brain cells can die and they cannot be regenerated which may result in physical, cognitive, and mental disabilities. A number of important risk factors have been identified with the occurrence of stroke but the mechanism is unclear including high blood pressure, advancing age, high cholesterol, family history of cerebrovascular disease, hypertension, smoking, atrial fibrillation, and diabetes mellitus. Cerebrovascular disease is caused by the following conditions-

• Stroke
• Carotid stenosis
• Vertebral stenosis
• Intracranial stenosis
• Aneurysms
• Vascular malformations

Stroke is subdivided into ischemic events and cerebral hemorrhages. An ischemic stroke is the most common and is caused by blockage due to degenerative vessel wall disease. A hemorrhagic stroke is occurred by the rupturing of a blood vessel into the subarachnoid space which prevents blood from getting to the part of the brain. The pathogenesis of cerebrovascular disease can be categorized into occlusive pathology intrinsic to blood vessels, occlusive pathology due to extrinsic causes, cerebral hypoperfusion, and cerebral hemorrhage. Intrinsix processes include arterial stenosis and damage to the arterial wall. Extrinsic factors include cerebral venous thrombosis and cerebral emboli. Cerebral edema is one of the major complications of stroke which can be further divided into vasogenic and cytotoxic edema. Cerebral angiography, carotid ultrasound, CT or CAT scan, doppler ultrasound, electroencephalogram, lumbar puncture, MRI, and magnetic resonance angiogram is some of the diagnostic imaging tests to identify cerebrovascular problems. Warning signs of cerebrovascular disease includes-

• Dizziness, nausea, or vomiting
• Disorientation and difficulty with comprehension
• Memory loss
• Facial weakness or droop
• Abnormal or slurred speech
• Confusion
• Difficulty communicating including slurred speech
• Losing vision on one side
• Becoming unconscious
• Difficulty walking
• Dizziness
• Loss of balance and coordination
• Numbness or paralysis
• Blurred or darkened vision
• A sudden headache

The specific treatment depends on the type and severity of cerebrovascular diseases such as blood pressure medications, changes in lifestyle, blood thinners, and cholesterol-lowering medications. Carotid endarterectomy, carotid angioplasty, and stenting show some promise in patients suffering from this condition. Post-stroke rehabilitation is helpful to overcome the skills you lost because of the damage caused by the stroke.

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