Microangiopathy of the brain: what it is, symptoms, treatment, prognosis

Microangiopathy of the brain is a lesion of the smallest vessels, capillaries localized in cerebral structures. Pathological changes in the walls, narrowing or complete blockage of blood vessels occur.

The disease does not manifest itself as long as the body is able to cope with disturbances in trophism and nutrition of nerve tissue.

In some cases, the approaching catastrophe is not noticeable, which is why the clinical picture is extremely variable. Depends on the individual characteristics of the body and the localization of the process.

As a rule, the pathology affects all capillaries of the brain at once, but not equally. When assessing a person’s condition, individual, largest lesions are detected. This facilitates targeted therapy if surgical treatment is required.

Correction is mainly medicinal. If ineffective, surgery is prescribed.

Development mechanism

There are several provoking factors underlying this. They occur together or separately. It's more a matter of chance. In total there are 4 main ways:

Consistently high blood pressure levels. A change in the nature of blood flow through the main vessels leads to stenosis (narrowing) of the arteries, a decrease in their elasticity and a reflex violation of capillary tone.

In addition, negative factors that provoke an increase in blood pressure (usually hormonal or toxic, from smoking, drinking alcohol) can also affect small vessels in the same way.

Then the process becomes complex. The entire brain is affected. Such a number of negative factors brings stroke closer every day.

Inability to regulate vascular tone, changes in their physical properties due to hormonal instability. A textbook example of such a disorder is diabetes mellitus.

If treatment is not carried out, the body simply cannot provide homeostasis (a state of equilibrium). Hence the change in the tone of the capillaries, also arteries, veins.

Severe complications arise over a short period of time. Patients walk along the edge constantly.

Improper functioning of the immune system. As a result, active synthesis of antigen-antibody complexes develops, followed by the formation of a special protein conglomerate—amyloid.

This substance settles on the walls of blood vessels and provokes degenerative changes over a short period of time. A similar mechanism applies to autoimmune ones. It is considered difficult to correct and dangerous because the prospects are vague.

It is also possible for mineral salts to be deposited on the walls of the capillaries. Mainly calcium. This is a relatively common mechanism and occurs in children under one year of age. It is diagnosed during the same period.

In the initial stages, symptoms are not noticeable, but as they progress, health deteriorates.

Objectively, the clinical picture is presented by manifestations of nonspecific neurological deficit. Headaches, nausea, spatial disorientation and others are observed that cannot be linked to a specific disease.

Attention:

If you don't take control of the situation, the consequences are dire. Further development of deficiency, stroke, disability or death.

The timing of the negative scenario from beginning to end is different. In most patients, as a result of compensation of the body and adaptation of impaired blood flow, collaterals are formed. That is, parallel, additional networks of capillaries that were not there initially.

If they are sufficiently formed, the violations will not be so noticeable and the “X-hour” will come later. No one can say how much.

Medicines

If the cause of the pathology is accurately determined, cerebral microangiopathy will be eliminated after selecting a therapeutic technique. The prognosis of the disease is determined by preventing the subsequent development of arterial damage. In the clinical picture, medications that help improve blood circulation in the head are widely used:

Pentoxifylline in the form of tablets and injections is taken 2 times a day, starting with the minimum dose.
Cinnarizine relaxes the artery wall, reduces the amount of calcium in the formed elements. Used 3 times a day.
Halidor improves blood flow in the arteries of the head, consumed 3 times a day.
Natsergoline affects receptors and vascular walls, stabilizing blood pressure.

The dosage should only be determined by a specialist; choosing the medicine yourself and drawing up a course of treatment is dangerous to health.

Classification

The main method of division is based on the types of pathological process and its origin.

Hypertensive form

As the name suggests, it develops mainly in patients with the same diagnosis. But not always. A symptomatic increase in blood pressure against the background of other diseases gives the same effect.

The longer the violation exists, the higher the tonometer numbers, the more significant the risks.

A latent pathological process is present in most patients, but not the entire array of situations is diagnosed, because doctors are busy assessing the condition of the arteries, and the capillaries are ignored, which is wrong.

Cerebral microangiopathy amyloid type

Associated with the accumulation of this protein substance in the structures of capillaries. Leads to a fairly rapid development of neurological deficit.

It occurs mainly in patients over 60, which is associated with lifestyle and past illnesses. But the deviation does not have gender and age characteristics.

The pathology is autoimmune and requires correction of the functional activity of the body's defenses.

Lenticulostriate type

It is associated with the deposition of calcium salts on the walls of blood vessels, which does not occur normally. The process progresses extremely slowly, which is why symptoms appear late.

The disease is diagnosed mainly in children. According to research, the disorder occurs in every sixth birth. In Russia - the fourth.

This condition is not always considered a disease. There is an opinion that we are talking about a variant of the physiological norm.

If there are no symptoms and the nature of the trophism of nerve tissue is not changed, this is a feature of the body, not a pathology.

Diabetic form

One of the most common. Occurs as a complication of the named endocrine disorder. Diabetic angiopathy is severe and provokes critical disturbances in cerebral blood flow, since the arteries are also affected.

If the correct course of treatment is chosen, the condition is partially controlled, the likelihood of negative consequences is not so high. A complete correction is also possible.

But the effectiveness of the measures and the final result depend on the patient himself, his willingness to follow the specialist’s recommendations and discipline.

There are also classifications according to the course of the pathological process. Thus, angiopathy can be with or without the presence of foci of gliosis (scars, scars). The first option is one and a half to two times less common.

It is possible to subdivide the pathology according to the volume of the lesion. The extensive type is accompanied by the formation of many areas of impaired vascular function.

Attention:

Single lesions give mild symptoms and are much better treated. Because localization is clear, and you can clearly monitor the dynamics of the process.

Typifications are used to describe pathology in documentation and develop treatment methods.

Healing procedures

Microangiopathy of the brain is treated with complex methods. All stages must be controlled by specialists. First of all, the degree of vascular damage is determined, after which medications are prescribed. Elderly patients require increased attention because their disease progresses more quickly.

If microangiopathy is detected, the pressure should be reduced. Hypertension in patients contributes to rapid deterioration of health. In pharmacies there is a small selection of drugs that can lower blood pressure. If the disease develops, the patient should consult a doctor and not act at his own discretion .

Additional provision of the brain with useful substances is required. Nootropic drugs are used for this. A positive effect can be achieved from drugs containing nicotinic acid. Picammilion is the most effective.

Reducing the amount of lipids is also practiced in the treatment of microagniopathy. Fibrates and statins can achieve this effect. Doctors often prescribe Simvastatin.

A decrease in the amount of oxygen in neurons will affect the intensity of the development of pathology. In order for blood composition to have a beneficial effect, you need to consume antioxidants. The treatment regimen includes blood thinning medications. Physiotherapy, regular massage and swimming in the pool have a beneficial effect on the body.

Rare situations arise when drug treatment does not restore the patency of veins and arteries or compensate for circulatory deficiency. In such situations, the patient's condition requires surgical intervention.

A positive result can be achieved if you use traditional medicine in the initial stages of the disease.

Traditional medicine:

Herbal decoctions that stimulate metabolic processes and improve blood circulation. The list of useful plants includes: clover, hemlock, herbal preparations from the pharmacy.
Fasting, raw food diet. Losing weight to improve your well-being.

The use of medications eliminates negative symptoms; tissues damaged by gliosis are not treated. If the causes of these formations are not dealt with, the pathology cannot be eliminated. The benefits of such traditional medicine are long-lasting, but not too noticeable . Therefore, you should not rely on self-medication; you will have to consult a doctor as soon as possible.

Surgical procedures are performed in rare situations. Indications for the procedure include: difficulties in restoring vascular patency, problems with blood supply. Hirudotherapy refers to alternative methods of eliminating the disease. Non-traditional treatment methods have been used for a long time. Today it is successfully used to eliminate many ailments.

Leech has the following effects on the body: thrombolytic, regenerative, analgesic, hypotensive. This method of treatment gives a positive result, there are no contraindications, and it is safe.

The active components contained in leech saliva have a general effect on the body, stabilize blood circulation and metabolism, glucose levels decrease, and stabilize microcirculation in the capillaries. Patients with vascular pathology need to undergo herudotherapy twice a year.

Symptoms

The clinical picture at the initial and even advanced stages is blurry. Because microangiopathy does not always lead to severe blood flow disturbances. This takes time.

The body also compensates for the disorder by increasing the amount of nutrition due to the formation of new capillary networks. The so-called collaterals.

They cannot replace functional structures completely, but they are enough.

You also need to take into account the number of lesions, their size, and the type of microangiopathy itself. Individual characteristics of the body. Such an array of factors makes bringing the clinic to a common denominator a difficult task.

The following symptoms occur, with varying intensity and severity and at different times:

Headache. The strength of discomfort varies. By nature it is pressing, shooting, burning. Located in the frontal and temporal lobes. A different location is possible. The intensity increases after physical activity, stress, and smoking. Consumption of coffee, alcohol, changes in climate zone and when exposed to other negative factors.

The pain is paroxysmal. They go away on their own within a few minutes or hours. The drugs help eliminate discomfort faster.

Dizziness. Inability to properly navigate in space. Usually low intensity.
Due to insufficient blood flow, the patient becomes more sensitive to aggressive environmental factors. Changes in weather, vegetative-vascular crises, surges in blood pressure against the background of a new temperature regime, for example, when moving to another region or climate zone. Women have a much more difficult time with premenstrual syndrome, etc.
Nausea. Rarely vomiting. Single episodes and not always.
There is also an inability to control one’s own body normally. Weakness in the limbs, clumsiness, unsteadiness of gait, muscle discomfort, feeling of leaden heaviness. All these are parts of one whole.
Asthenic phenomena. A person constantly feels tired. Weakness, fatigue, drowsiness, regardless of the time of day. All these are signs of insufficient trophism of cerebral tissues. The brain goes into an “economy” mode and does not spend energy as actively.
Behavioral disorders. Aggressiveness, tearfulness, irritability for no apparent reason.
Problems with thinking and cognitive sphere. Decreased speed and productivity, absent-mindedness, forgetfulness, attention deficit, inability to concentrate on a subject.
Focal neurological signs. Disorders of the sensory organs and higher nervous activity. In severe cases, speech disorders are observed, the patient cannot perform arithmetic operations, write, read, etc.

This is not as pronounced as with a stroke, but attracts enough attention. Such signs are possible only with brain damage. What kind of plan - vascular, tumor, toxic or other - needs to be quickly clarified.

In rare cases, fainting and syncope are possible. They indicate a progressive disturbance of cerebral blood flow and indicate the severity of the process. A stroke is likely in the near future.

Symptoms are an unreliable diagnostic criterion. However, they must be taken into account.

Possible consequences

Capillary pathology belongs to the list of serious diseases and requires the use of complex therapy. If the necessary therapy is not used, the patient's condition worsens. Results of poor quality treatment: disability, death.

Delayed contact with a specialist leads to the following results: stroke, heart attack, blindness, kidney problems.

Preliminary diagnosis of the disorder, the site of inflammation, and vascular deformation can reduce the consequences of the disease. It is impossible to completely eliminate the symptoms of the disease ; adequate treatment makes it possible to slow down the development of the disease and avoid possible complications.

Causes

Development factors are different. Among the possible:

Past severe infectious processes. Especially affecting the brain. It is this disorder that often becomes a trigger, a trigger for amyloidosis. The immune system begins to react inadequately to imaginary stimuli.
Cardiovascular pathologies. Already named hypertension or symptomatic increase in blood pressure.
Diabetes. The real scourge of patients with this diagnosis is problems with vessels of various sizes throughout the body. In addition, it may be influenced by other hormonal diseases. Like pathologies of the thyroid gland, adrenal glands.
Smoking, alcoholism. Bad habits.
Also excessive physical activity.
Genetic disorders.
Malfunctions of the immune system. Against the background of other disorders or as a primary deviation, which rarely happens.

Microangiopathy of cerebral vessels can be polyetiological, that is, due to a group of reasons. All of them are taken into account to determine the path of fundamental treatment.

Diabetic form of the disease

Diabetic microangiopathy is a complex manifestation of diabetes. The danger is that the disease affects the strength of tissues and the removal of toxic substances from the body. If the disease is not detected in a timely manner and the patient is not treated, the arteries and veins will become even thinner. This promotes tissue hypoxia.

This form is characterized by:

Nephropathy. The syndrome resolves in 1/3 of patients with diabetes. It is characterized by impaired renal function and swelling.
Diabetic angioretinopathy occurs when the blood vessels that help supply blood to the retina are damaged.
Microangiopathy on the legs contributes to problems with blood supply and tissue nutrition deteriorates. More damage is done to the feet. Sometimes the problem spreads to the legs, knee joints, and hips.

At first, patients experience leg pain and fatigue. Initially, the pain occurs moderately, but as the disease progresses, it becomes more difficult to tolerate. Feeling burning or numbness in the legs. The dimensions of the ankle are expanding. In complex clinical disorders, ulcers form on the skin that do not heal for a long time.

Diagnostics

The examination is the task of neurologists. If necessary, a specialist in vascular surgery is involved.

The list of activities is always identical, with minor deviations:

Oral questioning of the patient. It is necessary to identify complaints and make a list of symptoms. This will allow you to determine the direction of further diagnostics.
Anamnesis collection. In particular: infectious processes suffered in the recent past, current and chronic pathologies, family history of diseases, bad habits.
General and biochemical blood tests.
Electroencephalography. To determine the functional activity of cerebral structures.
MRI or CT scan of the brain. It is possible to conduct two studies at once. Used to identify the location, number of lesions, and severity of the disorder.

Dopplerography and duplex scanning are also possible. To determine the quality of trophism of nerve tissue.

Preventive actions

The following preventive measures are recommended for patients:

Make more frequent visits to the doctor and carry out procedures.
Follow dietary recommendations.
Don't smoke, don't drink.
Regularly measure your blood pressure, do a blood test, and check your glucose levels.
Exercise. Spend time outdoors as often as possible.

Gradually worsening symptoms of the disease influence changes in the patient’s lifestyle. Destroyed brain tissue cannot be restored.

Treatment

Therapy involves solving three problems. Eliminating the root cause, relieving symptoms, preventing complications.

There are two methods: conservative or surgical. In the vast majority of cases, the use of medications and, if necessary, lifestyle adjustments are sufficient. What medications are prescribed?

For hypertension and symptomatic increase in blood pressure:

Means for lowering blood pressure. Beta blockers (Propranolol, Anaprilin, Metoprolol), ACE inhibitors (perindopril in different variations), calcium antagonists (Diltiazem or Verapamil), diuretics (Veroshpron, Hypothiazide), also diuretics, also centrally acting medications (Moxonidine).
Statins. To adjust the concentration of cholesterol and other lipids in the bloodstream.

In addition, patients are advised to correct their diet (minimum fat and up to 7 grams of salt per day), adequate drinking regimen (1.3-1.8 liters or more, as needed, taking into account the recommendations of a specialist).

Diabetes:

Antihyperglycemic agents, insulin as needed.
Statins.

It is also possible to use medications to lower blood pressure levels.

Lenticulostriate type:

The deposition of calcium salts does not always require correction. There is no specialized treatment. Symptomatic drugs are used.

As for the amyloid form:

A nicotinic acid. The main means of combating violations.
Immunosuppressants, glucocorticoids (Prednisolone and analogues), cytostatics as needed. But this occurs extremely rarely. The purpose of these drugs is to reduce the activity of the body's defenses.

Systematic administration of vitamin-mineral complexes is indicated for all categories of patients.

Physiotherapy and acupuncture have proven themselves well.

Surgical correction is rarely needed. If there are clear foci of microangiopathy and there is a critical disturbance in the nutrition of nerve tissue in this particular area of the brain. With an additional condition: the drugs do not help.

Attention:

None of these methods can completely eliminate the disorder in the later stages. Foci of gliosis and scars do not disappear anywhere.

However, there is every chance of bringing the disorder under control. Moreover, the body, through the development of collaterals, can cope quite well on its own. You just need to support him.

Possible complications

Consequences are relatively rare. Years pass from the development of microangiopathy to the final outcome. However, you cannot relax.

Possible problems include:

Stroke. Acute cerebrovascular accident. Provokes the death of nerve tissue. Severe disability with neurological deficit. The death of a person is possible and even probable.
Encephalopathy. The process is similar, but there is no destruction of cerebral structures yet.
Vascular dementia. Dementia due to insufficient brain nutrition.

Complications develop spontaneously. Treatment is the only way to prevent them.