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Dyscirculatory encephalopathy of the brain is a common pathological condition that develops as a result of progressive circulatory disorders. Until recently, this disease was diagnosed mainly in people over 50 years of age, but now it is rapidly becoming younger and is not uncommon in those who have only recently crossed the 40-year age limit. According to statistics, approximately 12% of the adult population suffer from this pathological condition.

Brain tissue is extremely sensitive to decreased levels of oxygen and nutrient saturation. As the deficit gradually increases, neurons begin to die. Compensatory phenomena that are triggered make up for lost functions, so severe symptoms may long time absent. Subsequently, poor circulation leads to the fact that the damaged areas of the brain can no longer perform their functions.

Etiology of dyscirculatory encephalopathy

The causes of gradual impairment of cerebral circulation are already well known. The main predisposing factor in the appearance of such a pathological condition is considered. The formation of cholesterol plaques not only mechanically contributes to the narrowing of the lumen of arteries and veins, but also leads to disruption of the structure of the walls.

In the presence of atherosclerosis, blood flow gradually slows down, which contributes to the appearance of severe symptoms.

Another common cause of the development of dyscirculatory encephalopathy of the brain is. A sharp increase in pressure leads to rupture of a blood vessel, which provokes saturation of brain tissue with plasma. At the same time, arterial hypertension causes a decrease in the elasticity of the blood walls of the arteries and veins located in the brain. This helps to increase their permeability. Certain areas are saturated with plasma, which negatively affects the functioning of neurons and contributes to their damage. A change in the structure of the blood and an increase in its viscosity also provokes the development of dyscirculatory encephalopathy. In this case, platelets stick together, forming small clots that can further block the blood flow in certain areas. If the patient's condition does not return to normal, this leads to the formation of extensive areas of tissue ischemia.

Low blood pressure can trigger the development of this disease. The blood vessels are not filled with blood properly, so the brain does not receive the required amount of oxygen.

circulatory disorders are often associated with osteochondrosis. With this disease of the musculoskeletal system, a gradual decrease in the height of the intervertebral discs is observed. This process leads not only to pinching of nerve endings, but also to the vertebral artery. If blood does not circulate normally in a large vessel, signs of encephalopathy increase very rapidly. In some cases, cerebrovascular accident is a consequence of injury to the skull or spine.

The development of dyscirculatory encephalopathy is often associated with congenital anatomical features of the structure of cerebral vessels. Sometimes a hereditary predisposition to the occurrence of such a problem is clearly visible. There are many described cases where members of the same family experienced the development of this dangerous condition.

In addition, it is necessary to highlight a number of predisposing factors that significantly contribute to the occurrence of such a disease. Such a violation of cerebral circulation may be a consequence of malfunctions of the endocrine system. Often it is hormonal disorders, diabetes and other diseases that become the springboard for the onset of damage to the blood vessels that feed brain tissue.

Autoimmune and neurological diseases can largely provoke the development of dyscirculatory encephalopathy.

Bad habits also do not help improve the condition of blood vessels. In people who suffer from drug addiction or who also have a certain history of smoking, this pathology is much more common.

Pathogenesis of disease development

The mechanism of deterioration of cerebral circulation is still being studied. It is known that this process can occur at different speeds depending on the complexity of the anamnesis of a particular person. It is believed that under the influence of a combination of primary diseases and unfavorable factors, there is a rapid decrease in oxygen saturation of brain tissue. For a long time, trophic disturbances can be compensated for by the remaining healthy cells. However, in the future, hypoxia of brain tissue becomes pronounced. In places where neurons do not receive the required amount of oxygen, softening areas appear. Such areas gradually acquire a spongy structure. The number of lesions can increase significantly. Such areas are called “silent” strokes.

As practice shows, the most vulnerable are the white matter and subcortical structures. The ischemic process in the deep parts of the brain leads to disruption of connections between neurons. Thus, after a short time, a disruption of the connection between the cortex and the subcortical ganglia can be observed. It is the “disconnection phenomenon” that causes the increase in symptoms of dyscirculatory encephalopathy.

In approximately 50% of cases, this pathological condition is accompanied by the appearance of neurodegenerative processes in brain tissue. This combination can be explained by the common etiological factors leading to the development of both types of disorders.

The main symptoms of dyscirculatory encephalopathy

Symptoms of increasing disruption of intracerebral circulation with subsequent damage to white matter tissue largely depend on the stage of development of the pathological process. This greatly complicates the process of early diagnosis. As a rule, at stage 1 of the development of dyscirculatory encephalopathy, the signs of pathology are very weakly expressed. Memory is usually the first to suffer. A person is forced to write down his plans because he forgets about what he needs to do in the near future. The patient remembers well what happened many years ago. Among other things, characteristic manifestations of stage 1 dyscirculatory encephalopathy include:

• fast fatiguability;
• decreased mental performance;
• recurrent headaches;
• frequent insomnia;
• decreased libido;
• emotional lability;
• slight lack of coordination of movements.

In stage 2 encephalopathy, the signs of pathology are very pronounced. The previously present symptomatic manifestations intensify significantly, so they can no longer be attributed to ordinary fatigue. Most patients experience a significant increase in focal symptoms. Impaired coordination of movements becomes more pronounced. Headaches get worse. A common occurrence insomnia occurs, and intellectual abilities are significantly reduced. A person stops critically assessing his appearance and actions. At the same time, irritability and quarrelsomeness increase significantly. Memory is severely impaired, and attacks of spatial orientation loss may occur.

At stage 3, the signs of pathology are already so clearly expressed that the patient cannot lead a full life. In addition to the intensified manifestations of the disease, the symptoms of damage to large areas of brain tissue are significantly worsened. TO characteristic features Stage 3 of dyscirculatory encephalopathy includes epileptic seizures and frequent fainting. Given that coordination of movements is impaired, the patient often falls. This can cause serious injury, especially in older people.

In addition to severe pain, there is a constant heaviness in the head. There are significant personality changes, decreased mental performance, insomnia and other manifestations of brain dysfunction. Gradually, a person loses the ability to self-care and requires constant supervision from others. At stage 3 of pathology development, disability occurs in 95% of cases.

Methods for diagnosing pathology

The process of making a correct diagnosis in the early stages of development of discirculatory encephalopathy is significant. People suffering from this pathology may not pay attention to the existing manifestations for a long time, attributing them to age, fatigue or other reasons. In the vast majority of cases, patients see a doctor at stages 2 or 3 of the disease. Only a neurologist can make a diagnosis. In addition to the medical history, to confirm the diagnosis, studies such as:

• Ultrasound of the neck;
• MRA of cerebral vessels;
• duplex scanning;
• Doppler ultrasound;
• ECHO-KG;
• general blood and urine analysis;

Often, consultation with other specialized specialists is required, for example, a visit to an ophthalmologist. It is advisable to consult a cardiologist, psychiatrist, nephrologist and some other specialists to identify not only the degree of damage to brain structures, but also the root cause of the problem.

Treatment of the disease

Treatment of dyscirculatory encephalopathy is difficult, since it is impossible to restore dead areas of the brain. Therapy should first be aimed at eliminating the root cause of the circulatory disorder. Most patients are prescribed drugs that lower cholesterol levels, as well as drugs to normalize blood pressure. To control blood pressure the following may be prescribed:

• angiotensin inhibitors;
• beta blockers;
• diuretics;
• adrenergic blockers, etc.

To break down lipids in the blood, drugs belonging to the statin group are used, for example Atorvastatin, Rosuvastatin, Simvastatin, etc. If cerebrovascular accident has a different etiology, drugs are selected to correct the primary disease. The treatment regimen should be prescribed by a doctor, taking into account the age and severity of the patient’s medical history.

Should be aimed at improving the functioning of brain tissue.

To restore normal metabolic processes, drugs belonging to the group of noootropics are usually prescribed. The treatment regimen may include Nootropil, Encephabol, Cerebrolysin, Piracetam. To improve cerebral circulation, medications based on nicotinic acid are prescribed. If there are pronounced signs of tissue hypoxia, glutamic acid, Emoxipine, etc. are usually prescribed. A necessary measure is the use of drugs that have a neuroprotective and antioxidant effect.

Physiotherapy, including galvanotherapy of the collar zone, UHF, magnetic therapy, and laser exposure, can be of significant benefit. A positive effect is observed when using lymphatic drainage and acupressure massage and acupuncture. The attending physician prescribes a gentle diet and a course of exercise therapy for the patient. This allows you to improve brain metabolism. In addition, the patient is advised to refuse bad habits. Some herbal medicine may be added to the treatment regimen on the recommendation of a doctor.

Prevention of the development of dyscirculatory encephalopathy

A healthy lifestyle is the most the best prevention many diseases.

To prevent the development of dyscirculatory encephalopathy in old age, it is necessary to give up smoking and alcohol. The most important point are daily physical activity. A sedentary lifestyle contributes to the development of stagnant processes, which negatively affects the state of the cardiovascular system.

The combination of low physical activity and addiction to junk food high in cholesterol causes the rapid development of atherosclerosis. A necessary measure is timely completion of scheduled examinations. This makes it possible to diagnose certain diseases at an early stage, preventing them from becoming chronic. These main areas of prevention help prevent the development of many life-threatening pathologies. If you have chronic diseases, you must take medications according to the regimen prescribed by your doctor.

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If the disease is detected at an early stage and medical instructions are followed, a person can live for many more years. happy life.

Description

Apathy, headache, Bad mood usually attributed to fatigue, a hard day at work, troubles or weather conditions. The same phenomena can also be symptoms of a complex pathology - discirculatory encephalopathy.

The disease is officially recognized and included in ICD-10 under code G93.4. It is believed that in Russia 6% of the population is sick with it.

Causes and mechanism of development

The main cause of the disease is. There is a disturbance in the flow of blood into the brain and its various parts, as well as its outflow from the cavity of the cranium. Diseases such as arterial hypertension, atherosclerosis, vasculitis, thrombosis, thrombophlebitis, and diabetes mellitus lead to pathology.

Discirculatory encephalopathy can occur due to genetic pathology, as a result of birth trauma, or prolonged hypoxia in the prenatal period. Factors that worsen the course are traumatic brain injuries, osteochondrosis, alcoholism, obesity, physical inactivity. Mental and mental stress, lack of sleep, and overwork also contribute to the development of the disease.

Drug therapy

Drug treatment of dyscirculatory encephalopathy of the brain depends on the causes that caused it. To normalize blood pressure, the following groups of drugs are used:

1. Sartans. Medicines in this group block the interaction of neuroreceptors with hormones that cause vasoconstriction and increased blood pressure. Sartans include Losartan, Hipotel, Valz.
2. Diuretics. Their action is aimed at removing fluid from the body and reducing swelling, including vascular walls. Diuretics: Hypothiazide, Indapamide, Veroshpiron, Furosemide, Torasemide.
3. Beta and alpha blockers. Medicines suppress adenoceptors, leading to vasodilation and decreased contraction of the heart muscles. Drugs in this group: Conco ram, Methanoprolol, Gedralazine, Doxazosin.
4. ACE inhibitors. They act on the enzyme that converts angiotensin I into angiotensin II. Medicines in this group: Enalapril, Captopril.
5. Calcium antagonists. Medicines inhibit the penetration of calcium into the cells of the muscular tissue of the heart and blood vessels, reduce arrhythmia, and improve blood circulation. This group includes Diltiazem and Lacidipine.

Atherosclerosis should be treated with drugs that improve lipid metabolism, accelerate fat metabolism, absorb cholesterol from the intestines, and inhibit its production. Sermion, Vinpocetine, Piracetam are prescribed. Some of the medications lead to a decrease in blood pressure, so they must be taken carefully with antihypertensive drugs in the treatment of a disease of mixed origin.

For any form of dyscirculatory encephalopathy, neuroprotectors are prescribed. Drugs in this group improve metabolic processes in the brain. Actovegin and Gliatilin are often used. Cerebrolysin is used for intramuscular injections.

Aspirin and Tenecteplase will help prevent the formation of blood clots.

Non-drug therapy

For the treatment of dyscirculatory encephalopathy of the 1st degree, therapeutic massage and physical exercise are prescribed. To improve blood circulation and dilate blood vessels, radon and oxygen baths are indicated.

Electrosleep therapy improves brain metabolism and stimulates the establishment of new connections between neurons.

During galvanotherapy, weak currents are applied to the collar area. This improves blood circulation and metabolism.

Much attention pay attention to a healthy lifestyle.

Surgical intervention

A severe form of the disease with severe narrowing of blood vessels is an indication for surgical intervention. Stenting, endarterectomy, and bypass surgery are performed.

Stenting involves placing a stent where the artery is narrowed. It acts as a vascular wall, dilates and supports the vessel.

During endarterectomy, atherosclerotic plaque is removed from the affected vessel.

Bypass surgery involves creating a bypass for blood flow. To do this, a piece of an artery or vein is taken from another part of the body and sewn into the vessel before and after the obstruction. Another way is to suture the affected artery to another brain vessel.

Traditional medicine methods

It is impossible to cure the disease with folk remedies. However, they will help improve blood circulation, memory, and relieve headaches.

To prepare the Crimean collection, take 1 tablespoon of a mixture of flowers and fruits of rose hips, linden, oregano, horsetail, birch leaves, sweet clover, plantain, coltsfoot, raspberry fruits and dill seeds. Steam in a glass of water and leave for 20 minutes. Drink 3 times a day before meals for 3 months. The product stimulates brain function and tones.

A drink made from hawthorn will relieve headaches. A glass of berries is steamed in a water bath for 10 minutes. The resulting decoction is infused for 12 hours and drunk a glass 3 times a day before meals.

Prevention

To treat DEP, prevent its occurrence and transition to more severe stages, it is recommended to lead a healthy lifestyle. The patient is advised to give up alcohol and smoking. It is necessary to exclude semi-finished products and fried foods from the diet, replace fatty meat with lean meat, eat more vegetables, fruits, and lean sea fish. It is recommended to control your weight, walk, play sports, taking into account your general condition and age.

It is important to provide yourself with normal rest, sleep at least eight hours a day. Take vitamins as needed.

Disability

Patients who are diagnosed with DEP of the 2nd degree receive the 3rd disability group. With significantly reduced vital activity at the second stage, as well as with dyscirculatory encephalopathy of the 3rd degree, group 2 is prescribed. Patients with impaired memory and signs of deep impairment of motor functions are assigned a group 1 disability.

Forecast

With DEP 1, the prognosis is favorable. The progression of the disease is unlikely to be stopped, but it is possible to reduce the severity of symptoms and lead a full life. To do this, it is important to maintain a healthy lifestyle and adhere to medical recommendations.

When the disease moves to the second stage, recovery can only be said if the cause that caused it can be eliminated surgically. Otherwise, the disease progresses. Gradually the patient's condition will worsen and lead to disability. Timely comprehensive treatment of DEP 2 allows you to delay the appearance of signs of the third stage for up to 10 years.

Discirculatory encephalopathy is a complex disease that destroys the emotional, cognitive and motor spheres of human life. The prognosis can be favorable with early detection of pathology, its treatment and prevention. Pronounced symptoms indicate an organic lesion and are difficult to treat.

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Dyscirculatory encephalopathy (DEP) is damage to brain tissue as a result of disruption of its blood vessels. This is a progressive disease of a non-inflammatory nature, which in most cases develops slowly. Due to persistent oxygen starvation, the brain matter degrades and atrophies, which leads to a decrease in the functionality of the organ. At the end of the last century, grade 1 - the initial stage of the disease - was diagnosed mainly in older people. Unfavourable conditions external environment, refusal of physical activity, consumption of junk food and chronic stress have led to the fact that the disease has become noticeably “younger”. Today, it is increasingly being detected in middle-aged people, and some forms of the disease are characteristic even of adolescents.

What is dyscirculatory encephalopathy of the 1st degree?

Degree 1 DEP is a stage of chronic brain disease when disturbances in the functioning of the organ have already occurred and are gradually increasing, and the clinical picture is not yet obvious. Due to the non-inflammatory nature, the signs of the disease are blurred. Persistent circulatory failure, leading to oxygen starvation, can lead to complete dysfunction of the central nervous system organ due to atrophy of its tissues.

According to statistics, DEP is present in half of the people inhabiting the planet. Many people ignore its development and manifestations, mistaking warning signs for the consequences of fatigue or stress. In most cases, people seek help only when typical symptoms that are characteristic of stage 2 of the pathology occur.

Causes of DEP 1st degree

Dyscirculatory can be congenital or acquired. In the first case, the cause of vascular disorders is genetic pathology, the use of antibiotics during pregnancy, fetal hypoxia, and birth trauma.

The risk of developing DEP is many times higher in children of women who used drugs, alcohol or smoked while pregnant. The acquired form of the disease in most cases turns out to be the result of the conscious actions of the person himself.

The main causes of DEP 1st degree:

• vascular atherosclerosis;
• high blood pressure;
• the effect of toxins on the body;
• a number of features of the course of diseases of internal organs;
• radioactive radiation;
• inflammatory vascular diseases;
• diseases of the cervical spine.

A separate group of reasons is the management of non- healthy image life. Stage 1 DEP can be caused by poor diet, smoking, alcohol and drug use. The risks of cerebral vascular dysfunction increase with chronic lack of sleep, stress, refusal of physical activity, and drug abuse. The condition of the blood channels can be negatively affected by unfavorable environmental conditions.

Symptoms of the disease

At stage 1 of the disease, minor damage to brain tissue occurs. Alarming signs are already obvious, but they can easily be mistaken for manifestations of weather dependence, overwork or seasonal depression. The symptoms are not specific; they are also common to other brain diseases, which complicates the diagnosis.

Manifestations of grade 1 DEP:

• decreased memory quality;
• disruption of sleep rhythm, changes in its depth and duration;
• dizziness, loss of coordination of movements;
• tinnitus or buzzing in the head;
• deterioration of intellectual abilities;
• chronic fatigue and decreased performance;
• tearfulness, moodiness, depression;
• irritability, mood swings;
• difficulties with the perception of new information.

These symptoms can disappear completely after a long rest and worsen against the background of psycho-emotional stress. Timely detection of dyscirculatory disease in a person and initiation of specialized treatment allows achieving stable remission. In this case, the person’s quality of life will not decrease, there will be no exacerbations or their frequency will become minimal. Otherwise, disability is almost inevitable.

How is stage 1 DEP diagnosed?

Even one of the above symptoms is an indication for a visit to the doctor. When 3 of the listed signs appear, a suspicion of dyscirculatory encephalopathy arises. But based on medical history alone, a diagnosis of grade 1 DEP is not made. To confirm the preliminary version, a number of laboratory and hardware examinations are carried out.

Diagnostic methods for identifying stage 1 DEP:

• CT or – the density of brain tissue is assessed, which may change due to the appearance of lesions in it;
• Ultrasound of the vessels of the brain and cervical spine - helps to identify problems with the blood supply to the organ and its parts, to detect congenital or acquired defects in the structure of the vascular network;
• X-ray of the cervical spine - necessary if there is a suspicion of anatomical pathologies that interfere with the normal blood supply to the skull;
• – effective when it is necessary to assess the electrical activity of the brain matter;
• REG is another method for assessing the quality of blood flow within the brain;
• blood biochemistry - cholesterol levels and biomass clotting rates are checked.

The patient must also be examined by a neurologist. The specialist assesses the tone of muscles and tendons, checks reflexes, tries to identify signs of impaired motor activity and coordination, disruptions in the functioning of the autonomic system. nervous systems s.

Treatment of DEP 1st degree

Therapy for dyscirculatory encephalopathy should be comprehensive. Its action is aimed at eliminating the causes of the problem, combating symptoms, generally strengthening the body and preventing complications. The main goals of treatment are to normalize blood flow in the brain, restore the functionality of the vascular network, and protect nerve tissue from atrophy.

Lifestyle and bad habits

Making changes to the usual regimen is a mandatory condition for the treatment of DEP of the 1st degree. Often this alone is enough to achieve lasting positive results. Within a few weeks after the start of such therapy, a noticeable improvement in the patient’s condition is noted. If you neglect the rules, then even taking medications will not give the desired effect.

When treating DEP and preventing its progression, lifestyle should be as follows:

• giving up bad habits - smoking and drinking alcohol poison the entire body, and the brain suffers first;
• diet – exclusion from the diet of semi-finished products, fatty and fried foods, simple carbohydrates. Replacing red meat with white or lean meat sea ​​fish. Eating plenty of vegetables and fruits;
• introduction to a regime of physical activity - their intensity should be selected in accordance with the age, gender and general condition of the patient;
• body weight control – if necessary, it is necessary to get rid of excess weight and ensure that it does not return;
• vitamin therapy - a course of vitamin-mineral complexes is agreed with the doctor;
• proper sleep - night rest should be at least 8 hours, it is better to avoid daytime sleep altogether.

The listed rules must be followed not until positive dynamics appear, but throughout your life. Only in this case will the risks of worsening the situation or regular exacerbation of the problem be minimized.

Drug treatment

Medicines must be taken strictly according to the regimen drawn up by the attending physician. It is individual in each case and provides for work in all problem areas. In some cases it becomes a temporary measure, in others it represents a lifelong necessity.

Depending on the causes of the disease and the patient’s condition, the following groups of drugs can be used:

• antihypertensives – to normalize high blood pressure;
• venotonic – strengthen the walls of blood channels and prevent their ruptures;
• diuretics - prevent swelling, remove unnecessary fluid from the body, retain valuable potassium in brain cells;
• beta-blockers - have a positive effect on the functioning of the heart, blood vessels, and respiratory organs;
• nootropics – stimulate brain activity;
• drugs that normalize blood composition and cleanse blood vessels from cholesterol plaques.

Additionally, you may need to take sedatives or tranquilizers. They are prescribed by neurologists or psychotherapists if there are obvious changes in the patient’s psycho-emotional state. It is strictly prohibited to independently supplement or adjust the regimen chosen by the doctor.

Physiotherapy

In most cases, the basic treatment plan is supplemented with physiotherapy methods. They do not cause discomfort to patients, enhance the effectiveness of taking medications, and have a positive overall effect. This can be therapeutic massage, acupuncture, exercise therapy. In special rooms and sanatoriums, patients are given oxygen and radon baths, electrosleep, phono- and electrophoresis, and laser therapy techniques are used.

Treatment with folk remedies

The use of alternative therapy methods is previously agreed with the doctor. If the approach is used as an auxiliary one, it can bring a lot of benefit to the patient. Traditional medicine cannot be used as the only treatment option - their effectiveness is insufficient. will not be able to cope with changes in the structure of brain tissue.

Folk ways to combat the manifestations of dyscirculatory encephalopathy:

• stabilization of blood pressure and strengthening of the heart - alcohol or water tinctures of propolis, hawthorn fruits, clover, bear ears;
• strengthening the nervous system - decoctions and teas of chamomile, lemon balm, valerian or mint;
• lowering cholesterol levels, increasing vascular tone - a decoction of rose hips or alfalfa, alcohol tincture of garlic.

The listed products are used in courses of 1-3 weeks, depending on the type of product. After this, a break is taken for 2-4 weeks and another cycle is performed. If the chosen remedy does not produce negative consequences, you can resort to it several times a year.

Prognosis at the stage of DEP stage 1

At the first stage of the disease, the patient’s chances of maintaining a high quality of life are high. The main thing is not to delay diagnosis and start of therapy, follow the doctor’s recommendations and adhere to the rules of a healthy lifestyle. The progression of the disease can only be stopped by in rare cases, but at the right approach the development of the disease slows down significantly. People with the initial stage of DEP can lead a full life and not even notice signs of pathology.

How long you can live with stage 1 DEP depends on the patient’s age, his general condition, the presence of concomitant problems and the quality of therapy. In many cases, this figure is calculated in years and even tens of years. True, provided that the therapy does not stop, and the patient regularly visits specialists to diagnose and assess his condition.

Encephalopathy– a disease of the brain that occurs as a result of the fact that its different parts “starve”, not receiving oxygen and nutrients. The nervous tissue in this place swells, ceases to perform its functions and is destroyed. The cause of changes in the brain is disruption of small and large blood vessels.

At first, the disease manifests itself as headache, weakness and decreased performance. Over time, other changes become noticeable: attention decreases, thinking and memory deteriorate, apathy and depression appear.

Who risks more?

With age, the risk of developing discirculatory encephalopathy increases several times. This disease is one of the main causes of senile dementia. Its most dangerous consequence is ischemic stroke.

Discirculatory encephalopathy is considered throughout the world to be one of the main causes of disability and death. Over the past ten years, the number of patients has doubled. It is believed that the number of people who have this disease is more than 6% of the total population of the planet.

The main reasons that the disease has become so common are poor diet, excess weight, smoking, alcohol consumption, hormonal disorders, high blood pressure and diabetes. The disease can be caused by unsuccessful treatment by massage therapists and chiropractors, injuries to the spine and head.

Who can make a diagnosis?

In addition, it is necessary to conduct an examination using special psychological tests, which reveal disturbances in memory, thinking and emotions. The diagnosis of dyscirculatory encephalopathy is made only when the changes last more than 6 months and the condition gradually worsens.

Without the results of a thorough examination, one cannot say that a person has dyscirculatory encephalopathy. If you notice signs of this disease, do not rush to get upset. Because its symptoms are in many ways similar to the results of overwork, chronic lack of sleep, cervical osteochondrosis or other diseases.

How to live further?

How does dyscirculatory encephalopathy develop?

The brain needs a constant flow of blood to bring it oxygen and nutrients. Nutrition for each nerve cell (neuron) is provided by many large vessels and small capillaries. When they work well, there are no problems. But as soon as the vessels narrow or completely block, trouble begins.

The capillary does not bring enough blood to some part of the brain. At this point the vessel wall begins to work poorly. It allows excess fluid to enter the brain tissue. Edema develops. Neurons receive little oxygen. They starve and die. The destruction of nerve cells is called a cerebral microinfarction.

The disease has such a feature that the first blow is taken by the white matter, which is located under the bark. Its destruction leads to the fact that the signal from parts of the body and organs does not reach the cerebral cortex - our “control center”. Therefore, it becomes difficult to coordinate your movements.

The second attack of the disease is aimed at the gray matter - the cerebral cortex. On it, each section is responsible for its function. The death of cells on the surface of the cortex leads to thinking disorders. With dyscirculatory encephalopathy, areas of necrosis (death) more often occur in the frontal and temporal lobes. Here up to 40% of nerve cells die. As a result, a person loses motivation and does not see a goal in life.

Also in the cortex there are centers that provide attention. The patient becomes unable to concentrate on anything. It is even more difficult to switch your attention to another subject.

Where brain damage occurs, cells are no longer restored. Over time, other vessels become blocked and new foci of necrosis appear. In this case, the person experiences weakness and headache.

Unlike a stroke, when only one part of the brain is destroyed, with dyscirculatory encephalopathy there are many micro-strokes. This leads to the fact that several functions are disrupted at the same time. Therefore, with this disease, disorders in coordination of movements, memory, and thinking are simultaneously noticeable; behavior also changes and the person is constantly in a depressed mood.

Causes of dyscirculatory encephalopathy

1. Atherosclerosis– a disease in which a blood vessel is blocked by cholesterol plaques. Metabolic disorders cause fats to attach to the lining of the arteries. The lumen of blood vessels decreases or is completely blocked. As a result, the blood does not deliver oxygen and nutrients to a specific part of the brain.


2. High blood pressure(arterial hypertension) leads to the fact that the vessel closes or bursts. In this case, brain tissue is saturated with blood or plasma. It also happens that the walls of the vessel lose their elasticity and become like a sieve. In this case, substances that can harm it enter the brain.


3. Increased blood viscosity and it circulates poorly through narrow capillaries and stagnates in them. Platelets stick together and form blood clots. These clots clog the vessel. The part of the brain that it supplied dies without nutrition.


4. Low pressure(hypotension). With this disease, the vessels are not sufficiently filled with blood; it moves slowly through the capillaries.


5. Osteocondritis of the spine. With this disease, the vertebral artery is compressed by bone processes and spasmed muscles. As a result, the brain does not receive enough blood volume.


6. Spinal and brain injuries. Their result can be hematomas - areas filled with stagnant blood. They compress blood vessels and disrupt the nutrition of nerve cells.


7. Congenital characteristics of the body(angiodysplasia, abnormal development of arteries and veins) can cause the vessels to not work well enough.


8. Smoking causes constriction of capillaries. Especially in the brain. In long-term smokers, the blood vessels become spasmodic and no longer expand to their normal size.


9. Diseases of the endocrine glands(hormonal disorders). The main task of the glands is to produce hormones. These substances regulate all processes in our body, including the narrowing and expansion of the lumen of blood vessels in the brain. Often, due to hormonal imbalance, dyscirculatory encephalopathy occurs in women during menopause.


10. Diseases of the blood and blood vessels: vegetative-vascular dystonia, thrombophlebitis. These diseases impair the movement of blood throughout the body. First of all, the brain suffers from this.

Signs and manifestations of dyscirculatory encephalopathy

1. Headache. There are no pain receptors in the brain itself, but there are many of them in the meninges and capillaries. Therefore, when the capillaries suffer, we experience discomfort, pain and a feeling of fullness.


2. The white matter (subcortical layer of the brain) contains centers for processing information that comes from the environment and from the senses, centers for sleep and daytime activity, and emotions. Areas of necrosis of nerve cells in the subcortical centers cause:
   • weakness and fatigue;
   • mood swings;
   • sleep disturbances, daytime sleepiness.


3. In the cortex there are centers responsible for higher mental activity, which only humans have. Microstrokes in the gray matter cause thinking disorders:
   • memory impairment;
   • it becomes difficult for a person to concentrate on what he is doing;
   • it's getting hard to imagine final result actions;
   • problems arise with drawing up an action plan.


4. The death of neurons in the cerebral cortex and disruption of connections between nerve cells leads to impulsive behavior. A person develops excessive emotionality that was not there before: bouts of causeless laughter, hysterics.


5. The appearance of foci of necrosis in the subcortex of the frontal lobe causes disturbances in mood. The patient develops apathy, indifference, reluctance to do anything, and depression. The situation becomes worse due to the fact that a person is not able to do his job and take care of himself in everyday life.


6. Damage to the deep pyramidal systems of the brain leads to movement disorders. The signal that the cerebral cortex transmits to the limbs reaches them in a distorted version. It seems that the body is not listening. The gait changes. She becomes shaky and unstable. Pyramidal disorders cause muscle paralysis on one side of the body, muscle spasms, and tendon tension.


7. The cerebral cortex and its deep subcortical structures can no longer work coherently. The cortical-nuclear pathways through which the signal passes from the brain to the muscles of the head and neck are disrupted. As a result, symptoms of oral automatism appear. These are involuntary movements of the mouth that occur in response to irritation of different areas of the skin. The voice also becomes dull and nasal, and swallowing becomes difficult.


8. Vision decreases when cell damage occurs in the occipital cortex or along the transmission path of the visual signal in the deep layers. Moreover, this does not happen evenly. For example, the right eye may see normally, but the left eye may see in a fog. May appear before your eyes dark spots.

Degrees of dyscirculatory encephalopathy

First stage. Manifests itself as a minor headache. The person feels that he does not have enough energy to perform ordinary tasks. Insomnia appears. The mood changes often. In women this is manifested by tearfulness, and in men by increased aggression.

There are periods when a person feels dizzy and has temporary impairment of vision, hearing and speech. Weakness and numbness occur on one side of the body. These attacks are caused by damage to a new area of ​​the brain and resolve in less than 24 hours. At this stage, the brain manages to compensate for the disturbances.

Second stage. The condition is getting worse. Tinnitus appears, dizziness and headaches occur more often. Daytime sleepiness and severe weakness interfere with work. All types of memory gradually deteriorate. A person does not always understand what is said to him. Changes in character appear: self-doubt, causeless anxiety, irritability, depression. Sometimes involuntary twitching of the mouth is observed, the voice becomes nasal, and speech slows down.

Third stage. The patient becomes significantly worse. But he does not feel this and does not complain about his condition. This behavior is associated with impaired thinking. A person becomes aggressive and conflict-ridden, gets rid of all complexes and feelings of shame. Hearing and vision deteriorate. Dark spots or fog appear before the eyes. The gait becomes unsteady. The patient feels very depressed and loses all interest in life. At this stage, dementia develops. The person needs constant help. He can't even do the most simple steps to serve yourself.

Treatment of discirculatory encephalopathy with medications

Treatment of dyscirculatory encephalopathy with physiotherapy

Electroson . This method helps stimulate the brain using currents of low frequency and strength. Electrodes are applied to the eyelids, and through bundles of blood vessels the current penetrates deep into the brain. It improves metabolic processes in white and gray matter, helps establish new connections between nerve cells. Often during the procedure a person falls asleep, the nervous system calms down.

Galvanotherapy . Impact on the collar area (neck, shoulders) with weak currents. Helps expand capillaries and improve blood movement in them. Relieves pain and spasm, improves metabolic processes and cell nutrition. To enhance the effect, you can simultaneously take medications: iodine, bromine, potassium orotate.

UHF therapy – treatment with high frequency electromagnetic field. As a result, an ionic current appears in the blood. It begins to move better through small capillaries and brings more oxygen to the cells. This has a healing effect on the blood vessels and neurons of the brain. Nervous tissue absorbs radiation and this leads to its functioning improving and inflammation disappearing.

Laser therapy. Magnetic laser and magnetic infrared laser radiation are used. Special devices are used to treat the cervical-collar area. This improves the functioning of nerve cells and increases the volume of blood flowing to the brain. The blood becomes more liquid, and the speed at which it moves through the capillaries increases.

Baths . Oxygen, carbon dioxide and radon baths are best suited for the treatment of dyscirculatory encephalopathy. They normalize blood circulation and dilate blood vessels. As a result, your mood improves, sleep problems and noise in your head disappear.

Massage. Various types of techniques are used. Acupuncture massage affects special reflex points on the body, which improve brain function. It goes well with acupuncture. Unlike other varieties, it is allowed even for people with high blood pressure. A regular massage of the collar area helps relieve muscle spasms that can compress the arteries leading to the brain. Lymphatic drainage massage improves the outflow of lymph and relieves swelling of the affected areas of the brain.

Treatment with folk remedies

Caucasian balsam

An excellent remedy for improving blood circulation is a herbal balm, popularly called “Caucasian”. To prepare this natural remedy, you will need three ingredients: propolis, tinctures of Dioscorea Caucasica and red clover.

Let's first prepare propolis. 100 g of the substance must be dissolved in 1 liter of vodka. Let sit for 10 days. 2 tbsp. crushed pink clover flowers pour 500 g of vodka. Let it brew in a dark place for 5-7 days. 3 tbsp. crushed dioscorea root pour 400 g of 70% medical alcohol. Then let it brew in a cool place for 3-5 days.

Last step: strain all ingredients through cheesecloth and mix in equal proportions. The medicine is drunk 1 tsp. after every meal. The duration of treatment is 10 weeks. After which, a break of 2 weeks and the course is repeated.
The first results will be noticeable after the first two weeks of treatment. Caucasian balsam normalizes blood circulation in the brain and stimulates its performance.

Healing hawthorn

Hawthorn in folk medicine has always been considered an effective remedy for stimulating the circulatory and cardiovascular systems. Fresh hawthorn fruits are recommended for use during dyscirculatory encephalopathy throughout the entire fruiting season. But it's worth remembering that daily norm should not exceed 1 cup of berries.

The beneficial medicinal properties of hawthorn increase many times over if you prepare a decoction from the fruit. We will need 1 cup of dried hawthorn berries. The fruits must be washed with warm water and pour 1 liter of boiling water into an enamel bowl and heat in a water bath for 10 minutes. Infuse the decoction for 8-12 hours. The drink should be drunk 200 mg half an hour before meals three times a day. The prepared decoction must be drunk within 24 hours. Don't prepare it ahead of time.

The course of treatment is 2-3 months. After 1-2 weeks, the headache disappears. There is an improvement in brain performance.

Herbal infusions

Crimean herbal collection. Back at the beginning of the twentieth century, the famous Russian poet M. Voloshin drank tea twice a day from a collection of herbs according to an ancient Crimean recipe for “clarity of mind.” The secret of this tea was revealed to him by Tatar shepherds.

To make tea you will need: dried rosehip petals, sweet clover herb, white birch leaves, licorice herb, linden inflorescences, horsetail, oregano, leaves of coltsfoot and plantain. You also need crushed dry raspberries, rose hips and fried dill seeds. All of the listed ingredients are ground in a clay mortar in equal proportions.

To prepare tea, you need to steam 1 tbsp. ready mixture per 200 mg of water. Let it brew for 20 minutes. Drink half a glass three times a day on an empty stomach. Duration of treatment is 3 months.

Crimean herbal mixture stimulates basic brain functions, strengthens memory, and has tonic properties. The improvement will be noticeable after 2-3 weeks of regular use of the collection.

Sedative herbal mixture. This herbal collection is one of the most common in folk medicine in the treatment of brain disorders. Its properties are aimed at stimulating the functioning of the circulatory and central nervous systems. It has a pronounced calming effect.

The collection included: dried chamomile inflorescences, mint leaves, lemon balm, valerian root and lemon zest.

To prepare the collection you need to take 1 tsp. each ingredient and steam 1 liter of boiling water in an enamel pan. Cover with a lid and let steep for 4 hours.

Drink 200 mg of decoction every 8 hours daily for 2-3 months. In a week the first results will be noticeable. First of all, sleep will normalize, fatigue and headaches will disappear. After 5-7 days, tinnitus goes away, mood improves, and performance increases.

Diet for dyscirculatory encephalopathy

Many Western and domestic doctors agreed that for patients with dyscirculatory encephalopathy, Mediterranean and low-calorie diets will be the most effective.

Mediterranean diet

It is imperative to include as many fresh fruits and vegetables in your daily diet. An integral part of the diet should be: seafood, rice (brown), rye, corn, low-fat cheese, fermented milk products, hazelnuts. Turkish peas occupy a special place. It contains a lot of vitamin B12 and helps brain cell membranes repair.

Low calorie diet

This diet involves limiting calorie intake to 2500 kcal/day. In this case, it is necessary to completely abandon fatty animal products.

On a low-calorie diet, it is recommended to eat more grated carrots seasoned with olive oil (300 g/day). It is also necessary to include foods rich in potassium in the diet: dried apricots, figs, raisins, potatoes, avocados. Especially if you are taking diuretics.

To increase attention and improve memory, shrimp and onions will be useful. They need to be eaten 100g daily. Bananas, strawberries and cumin will help overcome depression.

In addition to all this, any patient’s diet should include foods that lower blood cholesterol levels, stimulate metabolic processes and have antioxidant properties. This includes cereals (rice, oatmeal), sprouted wheat grains, virgin vegetable oils, cod liver and green vegetables. In addition, it is necessary to include products that stimulate the circulatory system. These are onions, garlic, potatoes, peppers, tomatoes, parsley, citrus fruits, grapes, raspberries.

It is also very important to limit the amount of salt. It should not exceed half a teaspoon per day. This will help get rid of swelling and reduce blood pressure.

Do a diagnosis of dyscirculatory encephalopathy give you disability?

III group: The patient has stage 2 dyscirculatory encephalopathy. Disturbances in life activity are not very pronounced, but difficulties arise in work activities. The person is capable of self-care, but requires selective assistance from others.

Group II: The patient has stage 2 or 3 of the disease. He has a severe limitation of his life activity. There is significant memory impairment, neurological abnormalities, and repeated strokes occur. The person is unable to fully perform his or her job. In everyday life requires outside control and assistance.

Group I: Progressive dyscirculatory encephalopathy stage 3. Severe impairment of musculoskeletal functions, dementia, circulatory disorders, memory loss, aggressiveness. The person has completely lost his ability to work and is incapable of self-care.

Recognition of a patient as a disabled person in the Russian Federation is carried out in accordance with the Federal Law “On Social Protection of Disabled Persons”. The same law determines the procedure for examining disability and assigning a group.

How long do people live with dyscirculatory encephalopathy?

The length and quality of life depends on the stage at which the disease is detected, whether the treatment is prescribed correctly and how accurately the patient follows the doctor’s advice.

Death most often occurs from complications of discirculatory encephalopathy: cardiovascular collapse, heart attack, ischemic stroke.

What is the prognosis for dyscirculatory encephalopathy?

Even stage 2 discirculatory encephalopathy can be slowed down for 5 years, or even decades. Unfortunately, stage 3 progresses quickly, so it is difficult to fight. But an integrated approach to treatment will help significantly prolong life.

The prognosis can be worsened by: acute circulatory disorders and degenerative changes in the brain, increased blood sugar.

It is worth remembering that if you ignore treatment and prevention of new attacks of the disease, each subsequent stage develops with an interval of 2 years.

Leading WHO experts say that even with the help modern medicine in the next 10 years it will be difficult to completely overcome the disease, especially in the last stages of development. But it will be possible to significantly improve the quality of life of sick people.

It is quite easy to prevent the development of dyscirculatory encephalopathy. You need to eat right and don’t forget about physical activity. 15 minutes of gymnastics a day will protect you from developing this disease.

The goal of treatment of chronic cerebrovascular insufficiency is stabilization, suspension of the destructive process of cerebral ischemia, slowing down the rate of progression, activation of sanogenetic mechanisms of function compensation, prevention of both primary and recurrent stroke, therapy of major background diseases and accompanying somatic processes.

Treatment of an acutely occurring (or exacerbation of) chronic somatic disease is considered mandatory, since against this background the phenomena of chronic cerebral circulatory failure are significantly increasing. They, in combination with dysmetabolic and hypoxic encephalopathy, begin to dominate in clinical picture, leading to incorrect diagnosis, non-core hospitalization and inadequate treatment.

Indications for hospitalization

Chronic cerebral circulatory failure is not considered an indication for hospitalization if its course is not complicated by the development of a stroke or severe somatic pathology. Moreover, hospitalization of patients with cognitive disorders and removal from their usual environment can only worsen the course of the disease. Treatment of patients with chronic cerebrovascular insufficiency is assigned to the outpatient clinic service; if cerebrovascular disease has reached stage III of discirculatory encephalopathy, home patronage is necessary.

Drug treatment of dyscirculatory encephalopathy

The choice of medications is determined by the main areas of therapy noted above.

The main ones in the treatment of chronic cerebral circulatory failure are considered to be 2 areas of basic therapy - normalization of brain perfusion by influencing different levels of the cardiovascular system (systemic, regional, microcirculatory) and influencing the platelet component of hemostasis. Both of these directions, optimizing cerebral blood flow, simultaneously perform a neuroprotective function.

Basic etiopathogenetic therapy, affecting the underlying pathological process, primarily implies adequate treatment of arterial hypertension and atherosclerosis.

Antihypertensive therapy

A major role in preventing and stabilizing the manifestations of chronic cerebrovascular insufficiency is assigned to maintaining adequate blood pressure. There is information in the literature about the positive effect of normalizing blood pressure on the resumption of an adequate response of the vascular wall to the gas composition of the blood, hyper- and hypocapnia (metabolic regulation of blood vessels), which affects the optimization of cerebral blood flow. Maintain blood pressure at 150-140/80 mm Hg. prevents the increase in mental and movement disorders in patients with chronic cerebrovascular insufficiency. In recent years, it has been shown that antihypertensive drugs have a neuroprotective property, that is, they protect surviving neurons from secondary degenerative damage after a stroke and/or chronic cerebral ischemia. In addition, adequate antihypertensive therapy helps prevent the development of primary and repeated acute cerebrovascular accidents, the background of which is often chronic cerebral circulatory failure.

It is very important to start antihypertensive therapy early, before the development of a pronounced “lacunar state”, which determines the disconnection of cerebral structures and the development of the main neurological syndromes of dyscirculatory encephalopathy. When prescribing antihypertensive therapy, sharp fluctuations in blood pressure should be avoided, since with the development of chronic cerebral circulatory failure, the mechanisms of autoregulation of cerebral blood flow are reduced, which is already in to a greater extent will depend on systemic hemodynamics. In this case, the autoregulation curve will shift towards higher systolic blood pressure, and arterial hypotension (

Currently, a large number of antihypertensive drugs from different pharmacological groups have been developed and introduced into clinical practice to provide blood pressure control. However, the data obtained on the important role of the renin-angiotensin-aldosterone system in the development of cardiovascular diseases, as well as on the connection between the content of angiotensin II in the central nervous system and the volume of ischemia of brain tissue, allow today in the treatment of arterial hypertension in patients with cerebrovascular pathology to give preference to drugs influencing the renin-angiotensin-aldosterone system. These include 2 pharmacological groups - angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists.

Both angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists have not only antihypertensive, but also organoprotective effects, protecting all target organs affected by arterial hypertension, including the brain. The PROGRESS (prescription of the angiotensin-converting enzyme inhibitor perindopril), MOSES and OSCAR (prescription of the angiotensin II receptor antagonist eprosartan) studies have proven the cerebroprotective role of antihypertensive therapy. It is especially worth emphasizing the improvement in cognitive functions while taking these drugs, given that cognitive disorders are present to one degree or another in all patients with chronic cerebrovascular insufficiency and are the dominant and most dramatic disabling factors in severe stages of dyscirculatory encephalopathy.

According to the literature, it is possible that angiotensin II receptor antagonists influence degenerative processes occurring in the brain, in particular in Alzheimer’s disease, which significantly expands the neuroprotective role of these drugs. It is known that in Lately Most types of dementia, especially in old age, are considered as combined vascular-degenerative cognitive disorders. It should also be noted the putative antidepressant effect of angiotensin II receptor antagonists, which is of great importance in the treatment of patients with chronic cerebrovascular insufficiency, who often develop affective disorders.

In addition, it is very important that angiotensin-converting enzyme inhibitors are indicated for patients with signs of heart failure, nephritic complications of diabetes mellitus, and angiotensin II receptor antagonists can provide angioprotective, cardioprotective, and renoprotective effects.

The antihypertensive effectiveness of these groups of drugs increases when they are combined with other antihypertensive drugs, often with diuretics (hydrochlorothiazide, indapamide). The addition of diuretics is especially indicated in the treatment of elderly women.

Lipid-lowering therapy (treatment of atherosclerosis)

For patients with atherosclerotic lesions of cerebral vessels and dyslipidemia, in addition to a diet with limited animals and the predominant use of vegetable fats, it is advisable to prescribe lipid-lowering drugs, in particular statins (atorvastatin, simvastatin, etc.), which have a therapeutic and preventive effect. Taking these drugs in the early stages of dyscirculatory encephalopathy is more effective. Their ability to reduce cholesterol levels, improve endothelial function, reduce blood viscosity, stop the progression of the atherosclerotic process in the main arteries of the head and coronary vessels of the heart, have an antioxidant effect, and slow down the accumulation of beta-amyloid in the brain has been shown.

Antiplatelet therapy

It is known that ischemic disorders are accompanied by activation of the platelet-vascular hemostasis, which determines the mandatory prescription of antiplatelet drugs in the treatment of chronic cerebrovascular insufficiency. Currently, the effectiveness of acetylsalicylic acid is most well studied and proven. Enteric-soluble forms are used predominantly at a dose of 75-100 mg (1 mg/kg) daily. If necessary, other antiplatelet agents (dipyridamole, clopidogrel, ticlopidine) are added to treatment. Prescribing drugs in this group also has a preventive effect: it reduces the risk of developing myocardial infarction, ischemic stroke, and peripheral vascular thrombosis by 20-25%.

A number of studies have shown that only basic therapy (antihypertensive, antiplatelet) is not always sufficient to prevent the progression of vascular encephalopathy. In this regard, in addition to the constant intake of the above groups of drugs, patients are prescribed a course of treatment with agents that have antioxidant, metabolic, nootropic, and vasoactive effects.

Antioxidant therapy

As chronic cerebrovascular insufficiency progresses, there is an increasing decrease in protective sanogenetic mechanisms, including the antioxidant properties of plasma. In this regard, the use of antioxidants such as vitamin E, ascorbic acid, ethylmethylhydroxypyridine succinate, and Actovegin is considered pathogenetically justified. Ethylmethylhydroxypyridine succinate (Mexidol) can be used in tablet form for chronic cerebral ischemia. The initial dose is 125 mg (one tablet) 2 times a day with a gradual increase in dose to 5-10 mg/kg per day (maximum daily dose - 600-800 mg). The drug is used for 4-6 weeks, the dose is reduced gradually over 2-3 days.

Use of combination drugs

Considering the variety of pathogenetic mechanisms underlying chronic cerebral circulatory failure, in addition to the above-mentioned basic therapy, patients are prescribed drugs that normalize the rheological properties of blood, microcirculation, venous outflow, and have antioxidant, angioprotective, neuroprotective and neurotrophic effects. To exclude polypharmacy, preference is given to drugs that have a combined effect, a balanced combination of medicinal substances in which eliminates the possibility of drug incompatibility. Currently, quite a large number of such drugs have been developed.

Below are the most common drugs with a combined effect, their doses and frequency of use:

• ginkgo biloba leaf extract (40-80 mg 3 times a day);
• vinpocetine (5-10 mg 3 times a day);
• dihydroergocriptine + caffeine (4 mg 2 times a day);
• hexobendine + etamivan + etophylline (1 tablet contains 20 mg hexobendine, 50 mg etamivan, 60 mg etophylline) or 1 tablet forte, which contains 2 times more content of the first 2 drugs (taken 3 times a day);
• piracetam + cinnarizine (400 mg niracetam and 25 mg cinnarizine, 1-2 capsules 3 times a day);
• vinpocetine + piracetam (5 mg of vinpocetine and 400 mg of piracetam, one capsule 3 times a day);
• pentoxifylline (100 mg 3 times a day or 400 mg 1 to 3 times a day);
• trimethylhydrazinium propionate (500-1000 mg 1 time per day);
• nicergoline (5-10 mg 3 times a day).

These drugs are prescribed in courses of 2-3 months, 2 times a year, alternating them for individual selection.

The effectiveness of most drugs that affect blood flow and brain metabolism is manifested in patients with early, that is, stages I and II of dyscirculatory encephalopathy. Their use in more severe stages of chronic cerebrovascular insufficiency (in stage III discirculatory encephalopathy) can give a positive effect, but it is much weaker.

Despite the fact that they all have the above-described set of properties, one can focus on some selectivity of their action, which may be important in the choice of drug, taking into account the identified clinical manifestations.

• Ginkgo biloba leaf extract accelerates vestibular compensation processes, improves short-term memory, spatial orientation, eliminates behavioral disorders, and also has a moderate antidepressant effect.
• Dihydroergocryptine + caffeine acts primarily at the level of microcirculation, improving blood flow, tissue trophism and their resistance to hypoxia and ischemia. The drug helps improve vision, hearing, normalize peripheral (arterial and venous) circulation, reduce dizziness and tinnitus.
• Hexobendine + etamivan + etophylline improves concentration, integrative brain activity, normalizes psychomotor and cognitive functions, including memory, thinking and performance. It is advisable to slowly increase the dose of this drug, especially in elderly patients: treatment begins with 1/2 tablet per day, increasing the dose by 1/2 tablet every 2 days, bringing it up to 1 tablet 3 times a day. The drug is contraindicated in epileptic syndrome and increased intracranial pressure.

Metabolic therapy

Currently, there are a large number of drugs that can influence the metabolism of neurons. These are drugs of both animal and chemical origin that have a neurotrophic effect, chemical analogues of endogenous biologically active substances, agents affecting cerebral neurotransmitter systems, nootropics, etc.

Drugs such as Cerebrolysin and polypeptides of the cerebral cortex of livestock (polypeptide cocktails of animal origin) have a neurotrophic effect. It must be taken into account that in order to improve memory and attention in patients with cognitive disorders caused by cerebral vascular pathology, fairly large doses should be administered:

• Cerebrolysin - 10-30 ml intravenously, 20-30 infusions per course;
• polypeptides of the cerebral cortex of livestock (cortexin) - 10 mg intramuscularly, per course - 10-30 injections.

Domestic drugs glycine and Semax are chemical analogues of endogenous biologically active substances. In addition to their main effect (improving metabolism), glycine can produce a slight sedative effect, and Semax can produce an stimulating effect, which should be taken into account when choosing a drug for a particular patient. Glycine is a non-essential amino acid that affects the glutamatergic system. The drug is prescribed at a dose of 200 mg (2 tablets) 3 times a day, the course is 2-3 months. Semax is a synthetic analogue of adrenocorticotropic hormone, its 0.1% solution is administered 2-3 drops into each nasal passage 3 times a day, the course is 1-2 weeks.

The concept of “nootropic drugs” combines various drugs that can cause an improvement in the integrative activity of the brain, having positive influence on memory and learning processes. Piracetam, one of the main representatives of this group, has the noted effects only when given in large doses (12-36 g / day). It should be borne in mind that the use of such doses by elderly people may be accompanied by psychomotor agitation, irritability, sleep disturbance, as well as provoke an exacerbation of coronary insufficiency and the development of epileptic paroxysm.

Symptomatic treatment of dyscirculatory encephalopathy

With the development of vascular or mixed dementia syndrome, background therapy is enhanced with agents that affect the exchange of the main neurotransmitter systems of the brain (cholinergic, glutamatergic, dopaminergic). Cholinesterase inhibitors are used - galantamine 8-24 mg/day, rivastigmine 6-12 mg/day, glutamate NMDA receptor modulators (memantine 10-30 mg/day), D2/D3 dopamine receptor agonist with α2-noradrenergic activity piribedil 50-100 mg/day. The last of these drugs is more effective in the early stages of dyscirculatory encephalopathy. It is important that, along with improving cognitive functions, all of the above drugs are able to slow down the development of affective disorders, which may be resistant to traditional antidepressants, and also reduce the severity of behavioral disorders. To achieve the effect, the drugs should be taken for at least 3 months. You can combine these means, replace one with another. At positive result technique shown effective drug or long-term medications.

Dizziness significantly impairs the quality of life of patients. Some of the above drugs, such as vinpocetine, dihydroergocriptine + caffeine, ginkgo biloba leaf extract, can eliminate or reduce the severity of vertigo. If they are ineffective, otoneurologists recommend taking betahistine 8-16 mg 3 times a day for 2 weeks. The drug, along with reducing the duration and intensity of dizziness, reduces the severity of autonomic disorders and noise, and also improves motor coordination and balance.

Special treatment may be required if affective disorders (neurotic, anxiety, depressive) occur in patients. In such situations, antidepressants that do not have an anticholinergic effect (amitriptyline and its analogues), as well as intermittent courses of sedatives or small doses of benzodiazepines, are used.

It should be noted that the division of treatment into groups according to the main pathogenetic mechanism of the drug is very arbitrary. For broader acquaintance with a specific pharmacological agent, there are specialized reference books; the task of this guide is to determine directions in treatment.

Surgical treatment of dyscirculatory encephalopathy

In case of occlusive-stenotic lesions of the main arteries of the head, it is advisable to raise the question of surgical elimination of the obstruction of vascular patency. Reconstructive operations are often performed on the internal carotid arteries. This is carotid endarterectomy, agency of the carotid arteries. The indication for their implementation is the presence of hemodynamically significant stenosis (overlapping more than 70% of the vessel diameter) or a loose atherosclerotic plaque, from which microthrombi can break off, causing thromboembolism of small vessels of the brain.

Approximate periods of incapacity for work

The disability of patients depends on the stage of dyscirculatory encephalopathy.

• At stage I, patients are able to work. If temporary disability occurs, it is usually due to intercurrent illnesses.
• Stage II of dyscirculatory encephalopathy corresponds to disability group II-III. Nevertheless, many patients continue to work, their temporary disability can be caused by both a concomitant disease and an increase in the phenomena of chronic cerebral circulatory failure (the process often occurs in stages).
• Patients who have III stage discirculatory encephalopathy, disabled (this stage corresponds to Group I-II disability).

Further management

Patients with chronic cerebrovascular insufficiency require constant background therapy. The basis of this treatment is blood pressure correcting drugs and antiplatelet drugs. If necessary, substances are prescribed that eliminate other risk factors for the development and progression of chronic cerebral ischemia.

Non-drug methods of influence are also of great importance. These include adequate intellectual and physical activity, feasible participation in social life. For frontal dysbasia with disorders of gait initiation, freezing, and the threat of falls, special gymnastics are effective. Stabilometric training based on the principle of biofeedback helps reduce ataxia, dizziness, and postural instability. At affective disorders use rational psychotherapy.

Patient Information

Patients should follow the doctor’s recommendations for both continuous and course use of medications, control blood pressure and body weight, quit smoking, follow a low-calorie diet, and eat foods rich in vitamins.

It is necessary to carry out health-improving exercises, use special gymnastic exercises aimed at maintaining the functions of the musculoskeletal system (spine, joints), and take walks.

It is recommended to use compensatory techniques to eliminate memory disorders, write down the necessary information, and draw up a daily plan. Intellectual activity should be maintained (reading, memorizing poems, talking on the phone with friends and family, watching television, listening to music or radio programs of interest).

It is necessary to perform feasible household duties, try to lead an independent lifestyle for as long as possible, maintain physical activity while taking precautions to avoid falling, and, if necessary, use additional means of support.

It should be remembered that in older people, after a fall, the severity of cognitive impairment increases significantly, reaching the severity of dementia. To prevent falls, it is necessary to eliminate risk factors for their occurrence:

• remove carpets that could cause the patient to trip;
• use comfortable non-slip shoes;
• if necessary, rearrange the furniture;
• attach handrails and special handles, especially in the toilet and bathroom;
• Showers should be taken in a sitting position.

Forecast

The prognosis depends on the stage of dyscirculatory encephalopathy. Using these same stages, it is possible to evaluate the rate of disease progression and the effectiveness of treatment. The main unfavorable factors are severe cognitive disorders, often paralleled by an increase in episodes of falls and the risk of injury, both traumatic brain injury and limb fractures (primarily the femoral neck), which create additional medical and social problems.

It is important to know!

Hemorrhagic stroke is any spontaneous (non-traumatic) hemorrhage into the cranial cavity. However, the term “hemorrhagic stroke” in clinical practice is used, as a rule, to refer to intracerebral hemorrhage caused by the most common vascular diseases brain: hypertension, atherosclerosis and amyloid angiopathy.