Are you concerned about the blood vessels in your brain? Let's talk about Cerebrovascular Disease

Have you ever felt dizzy or lost consciousness on one side of your body? You may even have difficulty speaking. This can be caused by a problem with the blood vessels in your brain. Don't worry, today we'll talk about a condition called cerebrovascular disease, which is a type of brain disease.

What is Cerebrovascular Disease? Let's understand it very simply.

Simply put, this is a general name for a group of diseases that affect the blood vessels in the brain. 'Cerebro' means your brain. 'Vascular' means blood vessels, that is, the arteries and veins that carry blood in our body. So, 'cerebrovascular disease' refers to diseases related to the blood vessels in the brain. Got it?

There are two main things that can happen due to this cerebrovascular disease.

1. Reduced blood flow to the brain: We medically call this 'ischemia'. This happens when a blood vessel becomes blocked.

2. Bleeding inside the brain: This is called 'hemorrhage'. This can happen when a blood vessel bursts.

Both of these conditions are commonly associated with the serious condition we call 'stroke' . Strokes can occur due to diseases of the blood vessels in the brain, as can many other vascular diseases.

It is very important that if you or someone close to you has a stroke, you restore blood flow to the brain as quickly as possible. Otherwise, brain cells can quickly die, leading to permanent disability or death. Therefore, this should be treated as an emergency.

What are these blood vessels that affect the brain?

Both arteries and veins can be affected in cerebrovascular diseases. Several major blood vessels that supply blood to our brain are most susceptible to these diseases:

• Carotid arteries: These blood vessels are located in the front of your neck. Most people have one carotid artery on both the right and left sides.
• Vertebral arteries: These blood vessels are located in the back of your neck. Most people have one on each side of their neck, on the right and left sides.

These are the main blood vessels that carry blood to the brain. So if there is any blockage or problem in these arteries, it will have a major impact on brain function.

Are there different types of this disease?

Yes, there are several types of diseases that fall into the category of 'cerebrovascular disease'. 'Stroke' is the most common of these and the type that almost all of us have heard of. But, this is not the only one. Let's look at a few more examples, shall we?

• Arteriovenous malformation (AVM): This is a condition in which arteries (vessels that carry good blood) and veins (vessels that carry bad blood) are abnormally intertwined within the brain.
• Brain aneurysm: A weakened blood vessel in the brain that bulges like a balloon. This is very dangerous because if it bursts, it can cause bleeding into the brain.
• Brain bleed, hemorrhage / Intracranial hemorrhage: This includes any bleeding that occurs inside the brain.
• Carotid artery disease / Carotid artery stenosis: The carotid artery in the neck, which we discussed earlier, is blocked by deposits of fat and other substances.
• Cervical artery dissection: Blood leaks between the layers of the artery wall in the neck, causing the artery to tear or become blocked.
• Reversible cerebral vasoconstriction syndrome: A condition in which the blood vessels in the brain suddenly constrict and then return to normal. However, this can cause a temporary headache.
• Subarachnoid hemorrhage (SAH): Bleeding into the thin membranes surrounding the brain. This often occurs when an aneurysm ruptures.
• Transient ischemic attack (TIA) or mini-stroke: This is like a small stroke. The blood flow to the brain is temporarily reduced, and symptoms appear and disappear after a while. However, it is not good to ignore it as it can be a precursor to a major stroke.
• Hereditary hemorrhagic telangiectasia (HHT): This is a genetic disease that is passed down through generations. In this, blood vessels develop abnormally in various parts of the body.
• Moyamoya disease: This is a rare condition in which the main artery at the base of the brain gradually becomes blocked, and many small, weak branch veins develop in its place.

There are many more conditions like this. It's not necessary to know about each one in depth, but it's important to understand that various things like these can affect the blood vessels in the brain.

Who is more likely to develop this disease?

In fact, anyone, regardless of age, can develop cerebrovascular disease. However, some people are at a slightly higher risk. For example, this risk increases with age . Also, some genetic factors may play a role.

In countries like the United States, cerebrovascular disease is one of the leading causes of life-threatening brain damage. It is also the fifth leading cause of death. In the United States alone, more than 160,000 deaths have been caused by this disease in 2020. This situation cannot be underestimated in Sri Lanka either.

What are the reasons for this situation?

There can be a variety of causes for cerebrovascular disease. Here are some of the main causes:

• A blood clot forms inside a blood vessel in the brain: This is called 'thrombosis'. This often happens in a place where the blood vessel is already somewhat narrowed or irregular.
• A blood clot that forms elsewhere in the body travels to the brain: This is called an 'embolism'. It most commonly occurs when a blood clot that forms in the heart travels to the brain.
• Hemorrhage: This often occurs with uncontrolled high blood pressure.
• Atherosclerosis: Like rust forming in water pipes, fatty deposits build up inside the blood vessels, clogging them.
• Structural problems in the blood vessels of the brain: It can also be caused by some congenital defects.
• Traumatic brain injury (TBI): Severe head injury from an accident can also cause problems with blood vessels.

What are the symptoms? How do we recognize them?

The symptoms of cerebrovascular disease can vary depending on which part of the brain is affected. However, there are some common, sudden symptoms that can occur:

• Balance problems: Suddenly unable to walk, stumbling.
• Delirium: Loss of consciousness, loss of place.
• Fainting.
• Visual impairment: Sudden loss of vision, double vision, or partial or complete blindness.
• Paralysis or weakness on one side of the body or face.
• Sudden, severe headache: This is not like a normal headache, it can be a severe headache like you have never experienced in your life.
• Difficulty speaking or understanding what is said (Aphasia).
• Slurred speech / Dysarthria.
• Change in sensation on one side of the body or face: numbness or loss of feeling.

The American Stroke Association has developed a short method called FAST to help you recognize these symptoms quickly. It's important to remember this:

* F – Face drooping: See if one side of the face droops when the person is asked to smile.

* A – Arm weakness: When asked to raise both arms, see if one arm drops down.

* S – Speech difficulty: See if the words are slurred or if there is difficulty speaking when asked to say a simple sentence.

* T – Time to call 1990: If you have any of these symptoms, don't waste time and get to the hospital immediately. Because every second counts!

How do doctors figure this out exactly?

Cerebrovascular disease is a medical emergency. Therefore, it is important to get a diagnosis quickly. A doctor will first ask you about your medical history. Then they will do a physical exam. They will look for the following things in particular:

• Mental state: Are you conscious and aware of your surroundings?
• Eye movement and vision: Abnormal eye movements, changes in vision.
• Weakness or paralysis.
• Decreases or abnormalities in sensation.
• Different aspects of speaking: word order, comprehension, naming.
• Loss of balance and coordination.
• Dizziness or a feeling like the room is spinning (Vertigo).

After these tests, if the doctor suspects cerebrovascular disease, more specific tests may be performed. Some examples:

• Cerebral angiography: An X-ray examination of the blood vessels in the brain.
• Coronary computed tomography angiogram (CT Angiogram): A CT scan to look at the blood vessels.
• Electrocardiogram (EKG): Checks the functioning of the heart.
• MRI (Magnetic Resonance Imaging): Obtain detailed images of the brain.
• Spinal tap/Lumbar puncture: In some special cases.

These tests can help your doctor pinpoint the cause of your cerebrovascular disease. Depending on your condition, you may need to do more tests.

How to treat it? Don't worry, there are ways!

The treatment for cerebrovascular disease varies depending on your specific condition. The most important thing is to start treatment as soon as possible after symptoms begin. This is when you can minimize brain damage.

Doctors often treat you with medications. These work by improving blood flow to the brain. These medications may include:

• Blood pressure medications.
• Blood thinners / Anticoagulants.
• Cholesterol-lowering drugs.
• Blood sugar medications: For people with diabetes.

If you have severe blockage in your blood vessels, you may need surgery. Some types of surgery include:

• Carotid angioplasty: The surgeon inserts a balloon-like device into your artery and inflates it to widen the blocked artery.
• Carotid endarterectomy: The surgeon cuts your carotid artery and removes the fatty deposits (plaque) that have built up inside.
• Carotid stenting: The surgeon inserts a small metal mesh tube (stent) into your carotid artery to improve blood flow.
• Catheter-directed mechanical thrombectomy: The surgeon inserts a catheter (a thin tube) into the artery and inserts a device through it to pull out the blood clot.

How can we avoid this? How can we reduce the risk?

This is the most important part. Following a healthy lifestyle can greatly reduce your risk of developing cerebrovascular disease. Consider these things:

• Control high blood pressure (hypertension): If you have high blood pressure, take the medication your doctor prescribes. Check your blood pressure regularly.
• Eat a healthy diet low in salt, oil, and calories: Eat more vegetables, fruits, legumes, and foods high in fiber.
• Exercise regularly: Do something like walking or running for at least 30 minutes a day.
• Limit or completely stop alcohol use.
• Avoid smoking completely: This is very important.
• Do not use other drugs.
• Maintain a healthy body weight.
• Control your blood sugar and cholesterol levels.
• Reduce stress: Meditation, yoga, and hobbies are good ways to reduce stress.
• Get medical checkups at regular intervals.
• If you have conditions such as heart arrhythmia, take blood-thinning medication as directed by your doctor.
• If you are taking hormone replacement therapy (HRT) after menopause, talk to your doctor about the risks and benefits of blood clots.

Are there other risk factors?

In general, you are at higher risk of developing cerebrovascular disease if you have these conditions:

• Diabetes.
• High blood pressure.
• High cholesterol.

In addition, the following factors may increase the risk of developing certain types of cerebrovascular disease:

• If you are pregnant: The risk of blood clots in the veins of the brain (cerebral venous thrombosis) is higher during pregnancy.
• If you have a hereditary (congenital) condition: This may increase your risk of developing vascular diseases such as brain aneurysms.
• If you have suffered a severe head injury (traumatic brain injury).
• If you are taking Hormone Replacement Therapy (HRT): If you already have atherosclerosis or carotid artery disease, HRT may increase your risk of stroke.

What can you expect if you develop this disease?

People who have managed cerebrovascular disease often make a full recovery and lead normal lives. However, in some cases, the disease can lead to death or permanent disability. Some of the complications that can occur include:

• Difficulty finding words (Aphasia).
• Gait disorders.
• Memory loss.
• Paralysis or weakness in the face, arms, or legs.
• Temporary or permanent mental disabilities.
• Difficulty thinking and reasoning (Cognitive impairment).

What are the prospects for recovery?

As mentioned earlier, some people make a full recovery, while others may have ongoing disabilities. If you have cerebrovascular disease, your chances of recovery depend on:

• How quickly you received treatment.
• The severity of the disease or the size of the stroke.
• Which area of ​​the brain was affected?
• Type of cerebrovascular disease.

Therefore, it is very important to seek medical advice as soon as you notice symptoms.

How do I take care of myself?

As a person with cerebrovascular disease, you can continue to take care of yourself by doing the following:

• Following a healthy lifestyle (as mentioned earlier, things like eating well, exercising, and not smoking).
• Taking the correct medication for underlying medical conditions (e.g., blood pressure, diabetes, cholesterol).

If your brain function has been affected by cerebrovascular disease, you may need rehabilitative therapies to help you:

• Occupational therapy: Training to regain skills to perform daily tasks.
• Physical therapy: Helps restore movement, strength, and balance in the body.
• Psychological therapy: Helps with the stress and sadness that come with this condition.
• Speech therapy: Helps overcome speech and swallowing difficulties.

When should you see a doctor? How do you recognize an emergency?

Call 1990 immediately! If you experience any symptoms of a cerebrovascular accident (especially a stroke), call 1990 (ambulance) or go to the nearest hospital without delay. Remember the FAST method we discussed earlier.

Also, if you are having side effects from your treatments or if you are not seeing results after a certain amount of time, talk to your doctor about that as well. He or she can suggest other treatments that may help you.

Remember as a summary (Take-Home Message)

Cerebrovascular disease is a general term for conditions that affect the blood vessels that supply blood to your brain. This can lead to damage to the brain by reducing the amount of oxygen it receives. The most common of these conditions is stroke. It also includes other conditions such as brain aneurysms, brain bleeds, carotid artery disease, and transient ischemic attacks (TIAs), also known as mini strokes.

Symptoms can include loss of balance, vision loss, severe headaches, and difficulty speaking . Doctors can treat the condition with medication and surgery. You can also reduce your risk by making lifestyle changes, such as exercising and reducing stress.

Although cerebrovascular disease can cause disability and even death, with prompt treatment and proper management, most people recover and live normal, full lives. Therefore, it is important to be aware of the symptoms and seek treatment promptly.

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