What is the diagnosis of dyscirculatory encephalopathy. Cerebrovascular disorders in the elderly: Dyscirculatory encephalopathy. Photo gallery: medicines used for therapy

Chronic damage to the nervous tissue of the brain, which is constantly progressing, is called vascular (dyscirculatory) encephalopathy. Among all diseases of a neurological profile, it occupies the first place in the world in terms of the frequency of diagnosis. Dyscirculatory encephalopathy, depending on the severity of symptoms, is divided into three degrees, each of which corresponds to certain signs.

What is dyscirculatory encephalopathy

DEP is a syndrome of brain damage that can progress over time. Vascular encephalopathy (ICD-10 code I 67) leads to structural changes in the brain tissue, which affects the quality of the organ's functions. The disease has three degrees, several types and a different prognosis for the recovery of each of the stages. If left untreated, the disease leads a recently healthy person to dementia and an absolute inability to social life.

Causes

Vascular encephalopathy occurs due to deterioration of cerebral circulation, which occurs either in the veins or in the main vessels of the brain. Among the causes of encephalopathy, doctors distinguish the following:

• arterial hypertension;
• atherosclerosis of cerebral vessels;
• vasculitis of cerebral vessels;
• alcoholism;
• chronic ischemia;
• neurocirculatory (vegetovascular) dystonia;
• osteochondrosis of the cervical spine;
• long-term emotional disturbances.

Symptoms

Each of the stages of dyscirculatory (vascular) encephalopathy suggests its own characteristic signs of the disease. However, it is possible to distinguish the general symptoms of DEP, which are present in varying degrees of severity during the progression of the disease:

• dizziness, headaches;
• attention disorder;
• disorder of cognitive activity;
• loss of working capacity;
• depression;
• cognitive disorders;
• refusal of social adaptation;
• gradual loss of autonomy.

MR signs of dyscirculatory encephalopathy

If the above symptoms occur, you should immediately contact a neurologist, who will refer you for additional instrumental studies. During an MRI scan, the doctor may suspect the presence of dyscirculatory changes according to specific MR signs:

• vascular hypotensive inclusions;
• signs of hydrocephalus;
• the presence of calcifications (atherosclerotic plaques);
• narrowing or blockage of the vertebral, basilar, carotid vessels.

CT features

Computed tomography helps to determine the degree of brain damage. Pathological changes in the organ on a CT image look like areas of low density. These may be the consequences of a cerebral infarction (incomplete type), foci of ischemic damage, cysts of post-stroke origin. CT is performed to refute or confirm the diagnosis of DEP. Criteria that confirm the presence of pathology:

• expansion of the ventricles of the brain and subarachnoid space;
• the phenomenon of "leukoareosis" in the subcortical and periventricular layer;
• lesions in the gray and white medulla, which are represented by postischemic cysts and lacunar strokes.

Types of disease

Depending on the cause of the development of the disease, there are several types of cerebral vascular insufficiency:

• venous encephalopathy (impaired venous outflow of blood);
• hypertensive angioencephalopathy (damage to subcortical structures and white matter);
• dyscirculatory leukoencephalopathy of the brain (diffuse vascular damage against the background of persistent arterial hypertension);
• atherosclerotic encephalopathy (impaired patency of the arteries against the background of atherosclerosis);
• mixed encephalopathy.

stages

There are three stages of vascular encephalopathy:

1. DEP grade 1 involves small brain lesions that are easily confused with symptoms of other diseases. If diagnosed at this stage, a stable remission can be achieved. The first degree is expressed by the following symptoms: noises in the head, dizziness, sleep disturbance, the appearance of instability when walking.
2. DEP of the 2nd degree is characterized by the patient's attempts to blame other people for his failures, but this condition is often preceded by a period of strict self-control. The second stage of dyscirculatory changes in the brain is represented by the following symptoms: severe memory loss, impaired control of actions, depression, seizures, increased irritability. Although this degree of dysciculatory condition suggests the presence of a disability, the patient still retains the ability to serve himself.
3. DEP grade 3 (decompensation) is the transition of pathology into the form of vascular dementia, when the patient has severe dementia. The third stage suggests that the patient has urinary incontinence, parkinsonism, disinhibition, and coordination disorders. A person is completely dependent on others, needs constant care and guardianship.

Diagnostics

In addition to CT and MRI of the brain, doctors confirm the diagnosis of DEP using a visual assessment of the neurological manifestations of the disease and studying the patient's neuropsychiatric examination. The degree of dyscirculatory changes detected by REG (examination of cerebral vessels), as well as those recorded by ultrasonic dopplerography and by analyzing the patient's blood, is taken into account. Based on all the data, a general picture of encephalopathy is compiled, its stage is established, and a treatment strategy is determined.

Treatment of dyscirculatory encephalopathy of the brain

Therapy of patients with DEP includes measures aimed at correcting the vascular pathology of the brain, preventing relapses, improving blood circulation and normalizing impaired brain function. Basic principles of complex treatment:

• reduction of excess body weight;
• avoiding the consumption of saturated fats;
• restriction of salt intake to 4 g / day;
• appointment of regular physical activity;
• refusal of alcohol, smoking.

Treatment standards

With the ineffectiveness of lifestyle correction, the standard of treatment in neurology provides for the prescription of medications that reduce blood pressure, suppress the manifestations of atherosclerosis, and drugs that affect brain neurons. When drug therapy does not help to eliminate or slow down the development of encephalopathy, then surgery is performed on the walls of the main cerebral vessels.

Medical treatment

Due to the difficulty of diagnosis, the treatment of vascular encephalopathy often begins with the second stage, when cognitive impairment is no longer in doubt. For the purpose of pathogenetic therapy of dyscirculatory changes in the brain, drugs belonging to different groups are prescribed:

1. Angiotensin-converting enzyme inhibitors. Shown to patients in the presence of hypertension, diabetes mellitus, atherosclerosis of the renal arteries, heart failure.
2. Beta blockers. These drugs lower blood pressure, help restore cardiac function.
3. calcium antagonists. They cause a hypotensive effect, contribute to the normalization of the heart rhythm. In elderly patients, cognitive impairment and movement disorders are eliminated.
4. Diuretics. Designed to lower blood pressure by reducing the volume of circulating blood and removing excess fluid.

Vasodilators

The use of vasodilators helps to improve the function of the nervous tissues of the brain, remove cerebral angiospasm. The best medicines of its kind:

1. Cavinton. Reduces increased blood viscosity, increases mental activity, has an antioxidant effect. With dyscirculatory pathology of the brain, 15-30 mg / day is used. The therapeutic effect develops in 5-7 days. The course of treatment is 1-3 months. If the dosage is exceeded, side effects may occur: tachycardia, lowering blood pressure, dizziness, sleep disturbance.
2. Vazobral. Combined drug that improves cerebral circulation. Assign in the absence of atherosclerosis and vascular spasm due to hypertensive crisis. Tablets are taken orally during meals, 1 piece 2 times / day. The duration of treatment is 2-3 months. With an incorrect dose, nausea, headache, and allergic manifestations may occur.

Nootropics and neuroprotectors

It is impossible to treat a patient with vascular encephalopathy without drugs that improve metabolism in nerve tissues. These include:

1. Piracetam. It enhances the synthesis of dopamine in the brain, increases the content of norepinephrine. Tablets are used orally in a daily dose of 800 mg 3 times before meals until the condition improves or other indications of the attending physician. Piracetam is not prescribed for acute renal failure, diabetes mellitus, or in the presence of allergic reactions indicated in the anamnesis.
2. Nootropil. It has a positive effect on the metabolic processes of the brain, improves its integrative activity. The dosage regimen for adults is 30-60 mg / kg of body weight in 2-4 doses / day. The duration of therapy is 6-8 weeks. The drug is contraindicated in severe renal failure, hemorrhagic stroke, hypersensitivity to the components.

Surgery

When the degree of vasoconstriction of the brain reaches more than 70% or the patient has already suffered acute forms of dysciculatory (vascular) encephalopathy, surgical treatment is prescribed. There are several types of surgery:

1. Endarterectomy. Reconstructive surgery, the purpose of which is to restore blood flow through the affected vessel.
2. Stenting. The intervention is carried out in order to install a special frame (stent) to restore the lumen of the artery.
3. The imposition of anastomoses. The essence of the operation is the implantation of the temporal artery into the cortical branch of the cerebral vessel.

Folk remedies

At the initial stage of development of dyscirculatory changes in the brain, the following folk recipes can be effective:

1. Rosehip infusion. Reduces capillary permeability, improves cerebral circulation. Dry fruits (2 tablespoons) should be crushed, pour boiling water (500 ml), leave for 20-30 minutes. Next, you need to drink instead of tea 2-3 times / day throughout the course of treatment.
2. Infusion of clover flowers. Get rid of the noise in your head. For cooking, you need 2 tbsp. l. raw materials pour 300 ml of boiling water, leave for 1 hour. Take throughout the day 3-4 times half an hour before meals. The infusion should be drunk during an exacerbation of symptoms.

Forecast

With a slowly current disease, the prognosis is more favorable than with a rapidly progressing one. The older the patient, the more pronounced the symptoms of vascular encephalopathy. It is possible to stop the course of the disease for a long time only at the first stage of development of dyscirculatory changes in the brain. The second degree of the disease also often allows you to achieve remission. The most unfavorable prognosis is the third stage of encephalopathy. The patient no longer fully recovers, and therapy is aimed at symptomatic treatment.

Prevention

In order to prevent the development of dyscirculatory pathology of the brain to the last stage, it is necessary to take measures to cure it immediately after diagnosis. Prevention includes:

• maintaining a healthy lifestyle;
• following the recommendations of the attending physician;
• adherence to proper nutrition;
• regular physical activity;
• escape from stressful situations;
• medical examination once every six months.

Video

Attention! The information presented in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can make a diagnosis and give recommendations for treatment based on the individual characteristics of a particular patient.

Did you find an error in the text? Select it, press Ctrl + Enter and we'll fix it! brain damage resulting from insufficiency of cerebral circulation. This disease is called dyscirculatory encephalopathy (DEP).

DEP is a chronic cerebrovascular disease (CVD). Basically, the progression of the disease is due to prolonged chronic impoverishment of the blood flow of cerebral structures. However, the disease can also be provoked by changes in repeated episodes of acute discirculation. Often, chronic vascular pathology occurs when these factors are combined.

There is no code for this disease in the international classification of diseases ICD 10. The closest in clinical and pathogenetic significance are "cerebral atherosclerosis", "hypertensive encephalopathy", "cerebral ischemia (chronic)". However, the diagnosis of dyscirculatory encephalopathy is widely used in clinical practice due to the convenience of understanding the essence of the pathology - morpho-functional damage to the brain due to circulatory disorders.

The definition of dyscirculatory encephalopathy as an independent nosological entity was proposed in 1958 by Russian neurologists G.A. Maksudov and V. M. Kogan.

Causes of pathology

Brain damage as a result of discirculation is a polyetiological process. Cerebrovascular insufficiency can be triggered by one or more initiating factors. The main ones are:

• atherosclerosis;
• hypertension;
• diabetes;
• vasculitis;
• disorders of blood rheology;
• vertebrogenic diseases of the cervical spine;
• head injury;
• neuroinfections.

The diagnosis of dyscirculatory encephalopathy involves clarifying the genesis of the disease. However, this classification is considered rather vague, since more often several factors are involved in the formation of the disease. In this case, the disease is defined as a complex, mixed or combined genesis.

The mechanism of the development of the disease

DEP is pathogenetically a chronic cerebral ischemia. The main changes are based on the pathology of the vascular wall due to the influence of provoking factors on it. As a result, there is a violation of autoregulation of cerebral circulation. This process is the basis of a complex mechanism for the development of stable hypoxia. These symptoms are supplemented by periodic episodes of acute circulatory decompensation. With the initial manifestations of cerebrovascular insufficiency, the phenomenon of autoregulation is partially switched off. In addition, compensatory mechanisms for maintaining blood flow due to the development of collaterals additionally work.

The blood flow in the gray matter of the brain is 50-70 milliliters per 100 grams of tissue per minute. For white matter, this indicator is 20-25 ml / 100 g. A decrease in these values ​​by only 20% leads to the development of ischemic processes in cerebral formations.

Aggravates the course of the pathological process of changing the biochemistry and rheological properties of the blood, as well as venous discirculation.

Of particular note is vertebrogenic or spondylogenic encephalopathy. It occurs in the pathology of the cervical spine (trauma, osteochondrosis, intervertebral hernia, displacement) and is caused by mechanical deformation of the vertebral arteries.

Pathological picture of the disease

The histological picture in DEP corresponds to angiopathy, diffuse and focal lesions of the cerebral tissue. In this case, the genesis of angiopathy is determined by the main causes of the disease (atherosclerotic, hypertensive angiopathy or mixed vascular pathology can be distinguished). Ischemic lesions of nerve cells form in the brain tissue the so-called glial scars that occur with incomplete necrosis of neurons. In addition, changes also affect the white matter of the brain (myelin and axonal fibers).

With gross ischemic processes at a late stage of the disease, lacunar infarcts of the brain may occur. As a rule, such small-focal lesions are localized in deep cerebral structures and may be located in clinically silent areas. However, multiple heart attacks over time act as a cause of development:

• pseudobulbar syndrome;
• dysfunction of the pelvic organs;
• dementia;
• extrapyramidal pathology (most often parkinsonism).

The long course of the disease almost always means a decrease in the volume and mass of the brain due to the progressive expansion of the perivascular spaces. The thinned bark of the cerebral hemispheres at the same time takes on a typical picture, which has the name "dried walnut kernel". This phenomenon is considered as a characteristic sign of the development of vascular dementia and as an unfavorable factor in the further development of the disease.

Clinical picture of the disease

Symptoms of the disease are gradually increasing in nature. The first signs of the disease are defined as initial manifestations. At this stage, there are no objective changes in the nervous system, but there are a number of characteristic complaints. The disease initially progresses slowly, is treated quite successfully, and the prognosis of the disease with early initiation of therapy is relatively favorable. A person can live long enough before the time when the condition turns into an underlying disease. However, it is difficult to determine exactly how long this will take. These circumstances depend on the severity of the background and comorbid pathology.

Clinicians subdivide the main nosological unit into three degrees. However, in many ways, such a classification implies the stages of the disease, depending on how long the dyscirculatory process is observed.

Dyscirculatory encephalopathy of the 1st degree is characterized by the predominance of the patient's subjective complaints about:

• headaches;
• periodic dizziness;
• general fatigue and malaise;
• feeling of heaviness in the head;
• memory loss and distraction;
• instability of mood;
• insomnia.

During a neurological examination, the doctor can detect signs of the disease in the form of anisoreflexia, dysmetria when performing coordinating tests, and mild oculomotor disorders. The symptoms are diffuse but persistent. However, such phenomena do not make it possible to identify the leading clinical syndrome. Quite often, patients with DEP of the 1st degree do not go to the doctor, and try to eliminate the existing symptoms on their own.

Early referral to a neurologist significantly improves the effectiveness of the treatment of dyscirculatory encephalopathy.

Dyscirculatory encephalopathy of the 2nd degree is manifested by aggravation of complaints, and a clear manifestation of neurological deficit. At this stage, the neurologist is able to isolate a certain clinical syndrome complex:

• pyramidal;
• sensitive disturbances;
• vestibulo-atactic;
• cerebellar;
• extrapyramidal.

Patients with grade 2 DEP quite often turn to a neurologist due to an increase in the number of complaints. When a persistent loss of disability is detected, the doctor determines the group of disability.

Grade 3 dyscirculatory encephalopathy is characterized by a decrease in the number of complaints, which is partly due to an increase in cognitive pathology and a decrease in the patient's criticism of his own condition. Assessing the neurological status, the clinical deficit is clearly defined. Gross neurological syndromes are often manifested:

• pseudobulbar (dysphagia, dysarthria, dysphonia, violent crying and laughter, pathological reflexes);
• amyostatic (muscle rigidity, extrapyramidal tremor, muscle hypertonicity of the “gear wheel” type);
• discoordinating (a combination of cerebellar and vestibular disorders);
• cognitive decline (dementia);
• paroxysmal (falls, paroxysmal states of epileptic and non-epileptic genesis).

Such symptoms significantly reduce the patient's domestic and social adaptation. The patient is not able to live without outside help. The prognosis of the disease in such patients is considered unfavorable.

Diagnostics

Instrumental research methods are reduced to the diagnosis of the disease that constitutes the genesis of DEP, and the search for characteristic morphological changes. The volume of diagnostic measures is determined by the severity of the ischemic lesion, the clinical symptoms of the disease and the stages of the pathological process.

The main methods for diagnosing disorders of the blood supply to the brain are:

• neuroimaging (CT and MRI);
• reaencephalography;
• echoencephaloscopy;
• electroencephalography;
• ultrasound dopplerography of the vessels of the head and neck;
• coagulogram;
• blood chemistry;
• 24-hour ECG and blood pressure monitoring;
• neuropsychological testing.

The preferred method for detecting dyscirculatory encephalopathy is MRI.. Compared to CT, the changes characteristic of cerebral ischemia are more clearly visualized with MR diagnostics.

To clarify the level of cerebral blood flow, perfusion computed tomography is used, for which intravenous bolus administration of a contrast agent is performed and scanning is performed at the required levels.

Treatment

Comprehensive treatment of dyscirculatory encephalopathy should include an impact on the disease, against which a chronic ischemic process has formed, and the elimination of a neurological deficit with activation of cerebral blood flow and regulation of neurometabolic processes. Encephalopathy of complex origin and advanced cases of the disease are the most difficult to treat.

The main drugs included in the DEP treatment standards are:

• antihypertensive drugs;
• statins;
• anticoagulants and antithromboxants;
• hypoglycemic drugs;
• antioxidants;
• analgesics;
• nootropics;
• vasoactive agents;
• anticonvulsants;
• antiparkinsonian drugs.

In addition, physiotherapeutic measures, therapeutic exercises, and psychotherapy are effectively used in the treatment of encephalopathy.

DEP of 2 and 1 degrees is most effectively treated. It is at these stages that with the help of therapeutic measures it is possible to slow down the progression of the disease and level its signs. The condition of patients with stage 3 DEP is practically not amenable to curation, especially if the disease is accompanied by developed dementia. Drug therapy for this category involves only the use of symptomatic agents. And the main help comes down to care and the creation of optimal conditions for their stay in society.

Cerebrovascular diseases are one of the most common neurological disorders. Violation of cerebral blood flow is an inevitable process of brain aging. However, at the present time of psycho-emotional and information overload, this pathology can develop even in relatively young people, reducing their quality of life and prematurely leading to disability. The prognosis of the disease directly depends on the timeliness and adequacy of treatment. It is important to remember that cerebral dyscirculation is not a death sentence. With early detection of the disease, the progression of the ischemic process can be slowed down and the functional usefulness of nerve cells can be preserved.

Pathologies of the brain are always fraught with serious complications and consequences, so their treatment must be carried out in the early stages of development. Dyscirculatory encephalopathy (DEP) is just such a disease. It is a brain lesion due to impaired cerebral circulation, characterized by the presence of many foci.

So, DEP occupies almost the first place in terms of frequency of occurrence among all vascular diseases. Moreover, it is diagnosed not only in the elderly.

Due to poor blood circulation, tissue damage occurs over time, leading to irreversible consequences: a change in the patient's behavior, disability already at the age of 40. Often the patient can not cope with the maintenance of himself in everyday life.

There is no DEP code for ICD 10. But this does not prevent the widespread use of the presented diagnosis in medical practice. It's impossible to install it right away. The patient must be under dispensary observation for at least 3 months.

How does the disease develop?

Due to the influence of certain negative factors, a violation of cerebral circulation occurs, leading to oxygen starvation of cells, deterioration of their trophism. This hastens their death. The number of cells in the brain tissue decreases.

You can get useful information about the disease from Doctor of Medical Sciences Alexei Sergeevich Kotov in this video:

Most of all, such a pathological change lends itself to white matter in the deep sections, as well as subcortical structures. In this case, the connection between the subcortical ganglia and the cortex is broken, which leads to the development of cognitive disorders, problems with movements and the emotional sphere.

Reasons for the development of the disease

DEP is a complex disease that can be provoked by the following factors:

• Hypertension. It provokes a spasm of small arteries, due to which the walls of the vessels undergo irreversible changes.
• Atherosclerosis, in which cholesterol plaques interfere with the normal movement of blood through the vessels.
• Diabetes.

• Vasculitis.
• Violation of rheological parameters of blood.
• venous circulation.

• Head injury.
• Neuroinfection.

• Pheochromocytoma.
• Malformation of the vertebral artery.
• Pregnancy. Hormonal changes that occur during this period contribute to the appearance of the presented problem.

To make a correct diagnosis, it is necessary to clarify the genesis of the disease. However, the development of pathology is characterized by a combination of several factors. And the appearance of encephalopathy contributes to smoking, excessive body weight, frequent use of alcoholic beverages, unhealthy diet.

Classification of dyscirculatory encephalopathy

DEP can be divided by etiology, that is, because of its development. The following types of encephalopathy are distinguished:

1. Hypertensive genesis.
2. atherosclerotic genesis.

1. vascular type.
2. Mixed type.

Dyscirculatory damage to the brain is classified according to the nature of the course: slowly progressive, rapidly developing. In the first case, the disease can be formed for many years. If development occurs quickly, then each stage lasts no more than two years.

It is also possible to single out a remitting type of encephalography, in which the patient has a periodic decrease and increase in symptoms. At the same time, the intellect continues to degrade.

The main signs and symptoms of the disease

Dyscirculatory encephalopathy develops rather slowly, that is, its symptoms appear and increase gradually. The patient for a long time does not even suspect the seriousness of his condition.

Symptoms of pathology depend on the degree of its development:

• First stage. Dyscirculatory encephalopathy of the 1st degree is characterized by a subjective manifestation of disorders. Cognitive problems are not very pronounced. There are no changes in the neurological status.
• Second degree. DEP in this case already manifests itself quite clearly. Movement disorders, disturbances in the emotional sphere are noted.
• Third degree. Mental and physical disorders are very pronounced. The manifestation of vascular dementia begins.

Treatment of the disease is carried out only after a thorough diagnosis of the patient.

Features of the manifestation of DEP 1 degree

The patient has the following symptoms:

1. Minor disorders of the emotional sphere of a person.
2. Most patients experience depression, and they themselves rarely complain of depression or lack of mood.
3. Most often, DEP is characterized by the presence of spinal and headaches, noise in the ears, head. Depression in this case is very difficult to treat with pills and occurs as a result of the most insignificant psychotraumatic situation.

1. A person's irritability increases, mood swings become more frequent, attacks of aggression directed at others appear.
2. Also, the patient has a memory impairment, a decrease in the speed of thinking, and rapid mental fatigue.

With regard to motor problems, a sign of dyscirculatory damage to the brain in this case is unsteadiness when walking, as well as dizziness, malaise and general fatigue.

Features of the manifestation of DEP 2 degrees

The presented disease is progressive. Encephalopathy of the second degree is characterized by an increase in the intensity of symptoms. The patient has a decrease in intelligence, memory disorders become more pronounced. The patient is unable to perform his work duties.

A person begins to experience difficulties in everyday life. He spends a long time in a sitting or lying position, doing nothing. Interest in any activities gradually disappears. Instead of mood swings, he develops apathy. A feature of this stage is that it is quite difficult to distinguish it from the 3rd degree.

Features of the manifestation of DEP 3 degrees

Dyscirculatory encephalopathy of the 3rd degree is characterized by the fact that its signs become as pronounced as possible. Memory deteriorates significantly, there is a lack of attention, intellectual abilities decrease. With DEP of this degree, the patient is not able to independently adequately assess his own condition.

The third degree of dyscirculatory encephalopathy is also characterized by the fact that the patient begins to get lost in time, cannot orient himself in space. He has a loss of personality, he cannot work, and in some cases even serve himself. The patient becomes apathetic, he is not interested in previous hobbies. He does practically nothing.

At the last stage of the development of DEP, motor disorders are clearly visible: movement in small steps, and the patient practically cannot tear the foot off the floor. Once he starts moving, it is very difficult for him to stop. However, the hands usually function normally.

For dyscirculatory encephalopathy of the 3rd degree, the following symptoms are also characteristic: tremor, paresis and paralysis, a serious speech disorder, pseudobulbar syndrome manifests itself. If the patient walks independently, then he can fall and be seriously injured even during a normal stop or turn.

In addition to the disease under study, the causes of tremor are different.

The presence of such an ailment requires an attentive and patient attitude towards the patient. He needs constant care. All duties for the implementation of hygiene procedures, feeding, as well as maintaining other vital functions, fall on the shoulders of the relatives and friends of the patient. The patient is disabled.

What syndromes are typical for the last stage of the disease development?

In this case, the patient has a reduced number of complaints, since he cannot correctly assess his condition. For this period of development of DEP, the following pathological syndromes are characteristic:

• Pseudobulbar. There are pathological reflexes, speech disorders, a sharp appearance of causeless crying or laughter.
• Amyostatic. With it, hardening and increased muscle tone, the appearance of a tremor are observed.

• discoordinator syndrome. In this case, there is a loss of coordination of movements and a sense of time and space.
• Cognitive, which is characterized by the degradation of human mental functions.
• Paroxysmal.

As you can see, the symptoms of dyscirculatory brain damage become very severe over time. That is why it is very important to make the correct diagnosis even at the initial stage of the development of pathology.

Features of the diagnosis of the disease

The classification of dyscirculatory encephalopathy makes it possible to understand that each type of disease requires its own treatment. However, diagnostics involves the use of the same methods. For a thorough examination of the patient is used:

1. MRI or CT. These procedures make it possible to visualize the brain, which allows you to carefully examine the condition of the tissues.
2. Reencephalography.
3. Electroencephalography.

1. echoencephaloscopy.
2. Ultrasound of the blood vessels of the brain and neck with the use of a contrast agent.
3. Laboratory biochemical blood test.
4. Determination of arterial pressure by means of daily monitoring of the cardiogram.
5. Neuropsychological tests.

The most accurate and reliable method of diagnosis is still MRI. This tomography is more clear. In addition to instrumental diagnostics, the patient will also need consultations with an ophthalmologist, vertebrologist, phlebologist and neurologist, endocrinologist, cardiologist.

Treatment of dyscirculatory encephalopathy

DEP therapy should be complex, and depends on its genesis, degree of development, as well as the manifestation of disorders. First of all, treatment should be aimed at eliminating those factors that provoked the pathological condition. In parallel with this, the symptoms are being treated. DEP of mixed genesis, as well as advanced forms of pathology, are very difficult to treat. The prognosis for these patients is poor in most cases.

Learn a lot of interesting things about the approaches to the diagnosis and treatment of the disease from the lecture of Andrey Petrovich Rachin, MD, prof., head. Department of Neurology and Dept. honey. rehabilitation of patients with disorders of the nervous system function of the Russian National Center for Medical and Rehabilitation of the Ministry of Health of the Russian Federation:

So, for the treatment of DEP, the following drugs are used:

• To lower blood pressure: Capropril, Lisinopril, Atenolol, Anaprilin, Verapamil. These funds belong to different groups, but they are intended to reduce pressure, reduce cardiac hypertrophy, improve blood circulation and blood microcirculation. The dosage of each of the presented drugs is determined only by the attending physician. Diuretic drugs are also used to lower blood pressure: Furosemide, Hypothiazid. It is necessary to prescribe these drugs very carefully during pregnancy.
• Sugar-reducing drugs, as well as drugs to lower cholesterol levels: Acipimox, Simvastatin, Cholestyramine. Medicines based on vitamin E are considered useful.
• Antioxidants.

• To prevent the formation of blood clots: "Cardiomagnyl". These drugs help reduce blood viscosity.
• Analgesics.
• Sedatives: valerian extract, motherwort tincture, Phenazepam.
• Anticonvulsants.
• Nootropics that improve the functionality of the nervous tissue: Piracetam, Nootropil, Mildronate. These funds contribute to the improvement of metabolic processes in brain tissues. In addition, nootropics can improve the cognitive functions of the body, increase resistance to stress. It will take a long time to take such drugs. The effect can be felt only after 2-3 weeks.

• Vasoactive drugs that promote the expansion of blood vessels: Trental, Cinnarizine. They can be taken in the form of tablets or intravenous injections. If, against the background of dyscirculatory encephalopathy, there is a difficulty in the outflow of venous blood, then Redergin is considered the most effective drug.
• Means for the prevention and treatment of Parkinson's disease.

Additional methods of DEP therapy are physiotherapeutic procedures, psychotherapy, therapeutic exercises. Do not forget about proper nutrition, as well as the rejection of bad habits

Effective treatment will be only in the first and second degree of the development of the disease. Since there is still an opportunity to stop or slow down the progression of encephalopathy, as well as eliminate the symptoms.

At the last stage of the development of the disease, drug therapy is no longer effective. Drugs are used only to relieve symptoms.

If the degree of vasoconstriction is 70%, a decision can be made about surgical intervention. There are such types of operations: stenting, endarterectomy, anastomoses.

Is it possible to use traditional medicine?

The standard for the treatment of dyscirculatory encephalopathy provides for the use of non-traditional methods as an addition to the main therapy. It is not recommended to take them on your own. Folk remedies will be effective only in the presence of dyscirculatory encephalopathy of the brain of the 1st degree. The following tools will be useful:

1. Alcohol tincture of red clover.
2. Decoction of hawthorn. It is necessary to pour 2 tablespoons of chopped fruits with half a liter of boiling water. Further, on low heat, the mixture languishes for no more than 10 minutes. It will take another 2 hours to insist. Now the medicine needs to be filtered, mixed with 2 tablespoons of honey and drunk the whole amount in 3 doses.

Folk remedies often help improve blood circulation, memory, and sleep. But they are unable to stop the disease. Women should be especially careful when using these drugs during pregnancy.

Forecast and methods of prevention of pathology

A correct diagnosis, as well as adequate treatment, can stop the progression of discirculatory encephalopathy. The combination of the presented disease with degenerative changes in the brain is considered extremely negative.

Alexey Sergeevich Borisov, a neurologist, will tell about prevention:

As for the prevention of dyscirculatory disease, then it is necessary to correct lipid metabolism, effectively fight atherosclerosis, as well as other violations of vascular functionality. It is important to control a person's blood pressure

Despite the fact that cerebral circulation is disturbed due to the aging of this organ, now such a problem manifests itself even in young people.

Cerebrovascular pathologies of various origins are very dangerous for human health and life. Only timely and correctly diagnosed can prolong a person's life and improve its quality. So you should not regard dyscirculatory encephalopathy as a sentence.

Problems with blood supply, narrowing of the veins and arteries in the cervical area causes diffuse damage to areas of the brain.

Dyscirculatory encephalopathy (DEP) of the brain adversely affects the general condition, negatively affects health and psycho-emotional state.

The disease proceeds with a complex of negative signs. Only timely treatment prevents disability.

Lack of oxygen, nutrients against the background of stenosis of the main arteries and veins after a certain period provokes a disruption in the functioning of brain cells. Diffuse damage to tissues adversely affects the speed of reactions, psycho-emotional state, motor, mental, physical activity.

You need to contact a neurologist with frequent headaches, memory impairment, insomnia, vestibular disorders. Consultation with a specialist is needed if there are problems with the perception and processing of information, emotional instability develops, coordination is reduced, gait has changed, dizziness and nausea are disturbing when walking.

Encephalopathy on MRI

Early diagnosis, timely initiation of therapy for dyscirculatory encephalopathy (DEP) prevents severe neurological disorders, reduces the risk of impaired mental and cognitive functions.

Inattention to the manifestations of pathology against the background of diffuse brain damage leads to increased disorders of the emotional-volitional sphere, problems with motor activity, working capacity, memory, vision, and hearing.

Causes of dyscirculatory encephalopathy

Diffuse disorders in the vessels and tissues of the brain develop under conditions and diseases, against which the blood flow in the arteries and veins is disturbed.

The condition with DEP in many ways resembles a stroke, but the narrowing of the lumen of the vessels going to the brain does not occur abruptly, but gradually.

Dyscirculatory encephalopathy, unlike apoplexy, progresses at a low rate.

With the development of DEP, a negative effect on the vessels supplying the brain with oxygen and nutrients provokes hypoxia, certain areas of the sensitive tissue die, and leukoaraiosis zones appear. Foci of tissue rarefaction are located in different parts of the brain.

In the initial stage of dyscirculatory encephalopathy, the zones near the affected areas take on the function of dead cells, but gradually the connection between them weakens. Oxygen deficiency, disruption of tissue trophism adversely affects the functioning of the brain. In the absence of competent therapy for DEP, a person with a high degree of probability can become disabled.

The main reasons for the development of dyscirculatory encephalopathy:

1. Periodic increase in blood pressure. The constancy of perfusion pressure ensures proper nutrition of brain cells. Violation of blood supply, restriction of the amount of oxygen negatively affects brain activity.
2. Atherosclerosis of cerebral vessels. Excessive accumulation of lipoproteins on the inner wall of arteries and veins narrows the lumen of blood vessels, increases the risk of thrombosis, and provokes a deficiency of oxygen and nutrients.

Atherosclerosis of cerebral vessels

Dyscirculatory encephalopathy often develops in negative conditions and pathologies of various kinds:

• diabetes;
• thrombosis of cerebral arteries and veins;
• endocrine diseases, against which the vessels of the brain are noticeably narrowed or dilated;
• smoking, excessive alcohol consumption;
• permanent forms of arrhythmias, in which the brain receives critically small amounts of nutrients and oxygen;
• hereditary pathologies of blood vessels;
• inflammation of the arteries, veins of a systemic nature;
• decrease in perfusion pressure against the background of hypotension as a consequence of vegetative-vascular dystonia and other pathologies.

Risk factors:

• obesity;
• smoking;
• low physical activity;
• thrombosis of arteries and veins;
• diabetes;
• frequent stress;
• chronic fatigue;
• diseases of the heart, blood vessels;
• addiction to alcohol.

The prognosis of each stage of encephalopathy is different. can lead to disability in the absence of adequate treatment.

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Read about the treatment of dyscirculatory encephalopathy with medications.

Symptoms

Manifestations of dyscirculatory encephalopathy depend on the type and stage of the disease. You need to know the main signs of diffuse brain damage, the appearance of which requires an urgent consultation with a neurologist.

Classical symptoms in dyscirculatory encephalopathy:

• headache in the temporal and occipital zone;
• often there is pain, a feeling of pressure in the eye area, sometimes there is nausea, vomiting;
• sleep problems appear, irritability increases;
• the quality of vision and smell changes for the worse, the person hears less;
• concerned about fluctuations in blood pressure;
• memory worsens, interest in knowing the world disappears, it is difficult to reproduce and evaluate the information received;
• there are sharp mood swings, possible nervous tics: vocal, motor;
• negative personality changes occur: a person becomes suspicious, aggressive, irritated more often than before;
• causes discomfort increased sweating, nausea, dry mouth.

Classification

According to the speed of development, doctors distinguish the following types of dyscirculatory encephalopathy:

• Rapidly progressive. The stages of the disease alternate more often than after 24 months.
• Remitting. This type of DEP is characterized by periods of relapse and remission.
• Slowly progressive. The stages of pathology alternate every 5 years or less.

1 degree

Flow features:

• character changes, anxiety, tearfulness appear;
• periodically headache, decreased performance;
• after a mental load, a person quickly gets tired;
• it is difficult to memorize new data, the sharpness of thinking decreases;
• a person confuses events;
• when walking there is dizziness, slight nausea.

2 degree

Characteristic signs:

• persistent headache;
• lethargy, chronic fatigue;
• bad memory;
• insomnia;
• depression, anxiety, irritability, panic attacks;
• a strange noise is felt in the head;
• difficult to reproduce speech;
• there is a convulsive syndrome;
• facial expressions become poorer;
• periodically flashes of light appear before the eyes;
• there is a trembling of the hands, head;
• impaired fine motor skills;
• sometimes difficult to swallow;
• the level of hearing is reduced;
• movements are slow, awkward;
• it is difficult to fulfill production tasks: at this stage of the DEP, most people receive a disability group.

3 degree

Symptoms and signs:

• neurological and cognitive impairments are pronounced, others notice how a person’s character and attitude to life have changed dramatically against the background of a severe form of DEP;
• apathy appears, difficulty with orientation in space;
• the functions of the sense organs are noticeably reduced, motor activity is impaired;
• a person cannot concentrate, is engaged in insignificant or useless affairs;
• a characteristic feature - unwillingness to do something even at the request of loved ones;
• a shuffling gait appears, hands tremble, paralysis is possible;
• often there is incontinence of feces, urine;
• at this stage, DEP is often disturbed by painful cramps.

Doctors distinguish several types of dyscirculatory encephalopathy:

• Venous. The negative process is a consequence of the pressure of tumors on extra- and intracranial veins. This type of DEP occurs with pulmonary and heart failure.
• Hypertensive. Most cases of diffuse damage to brain tissue are diagnosed by doctors in young people. The rate of progression of DEP depends on the number of hypertensive crises: the more sudden jumps in blood pressure, the higher the risk of cerebrovascular accident.
• Mixed. This type of DEP develops with a combination of factors that cause hypertensive and venous pathology.
• Atherosclerotic. A common type of DEP against the background of diffuse lesions of brain regions. The walls of arteries and veins thicken, lose their elasticity due to the deposition of harmful cholesterol and other lipid complexes. Plaque, plaques on the walls of blood vessels narrow the lumen for blood flow, dysfunction and inflammation of the vessels develop.

Diagnosis of dyscirculatory encephalopathy

If diffuse brain damage is suspected, the doctor conducts an examination, finds out complaints, and clarifies the clinical picture. Next, the neurologist prescribes a comprehensive examination, if there are indications, he sends him for a consultation with other specialists.

Stages of dyscirculatory encephalopathy

The doctor's task is to identify neuropsychological and neurological signs that signal stenosis of arteries and veins, diffuse damage to brain tissues, and the development of DEP. After a conversation, studying the clinical manifestations, you need to figure out how quickly the pathology progresses.

An important point in the diagnosis is the detection of atherosclerosis, the presence of harmful cholesterol deposits and the inflammatory process in the arteries and veins.

If MRI or CT does not confirm the development of other pathologies, then the neurologist diagnoses "dyscirculatory encephalopathy", develops a therapy regimen.

Treatment and prevention of discirculatory encephalopathy

After confirmation of diffuse damage to brain tissues, detection of stenosis of the great vessels, DEP therapy is carried out under the guidance of a neurologist.

It is necessary to get advice from an endocrinologist, cardiologist, psychotherapist, vertebrologist, if pathologies of other organs are detected, against the background of which DEP develops.

In a severe stage of brain tissue damage, you will need the help of a vascular surgeon to determine the method of surgical intervention.

Treatment of dyscirculatory encephalopathy includes several elements:

• drug therapy;
• physiotherapy;
• psychotherapy sessions, relaxation;
• a complex of exercise therapy to normalize blood pressure, reduce the clinical manifestations of DEP;
• Spa treatment;
• special gymnastics for training the vestibular apparatus;
• correction of the regime of work and rest to reduce the risk of recurrence of DEP;
• giving up alcohol and smoking.

Preparations

The doctor selects a set of medications depending on the stage of DEP, the presence of background pathologies:

• To stabilize and lower blood pressure: Nimodipine, Enalapril, Corvitol, Ampril.
• Drugs that reduce the rate of platelet deposition on the walls of arteries and veins: Curantil, Clopidogrel.
• To stabilize neuronal membranes in DEP: Cereton.
• Diuretics to stabilize blood pressure, prevent the accumulation of excess fluid. The type of diuretic is selected by the doctor: Furosemide, Aquaphor, Amiloride, Clopamid, Hydrochlorothiazide.
• Antioxidants to reduce the negative effect on brain cells: Actovegin, Tocopherol, Mexidol.
• To improve the condition of arteries and veins in the development of DEP: Stugeron, Vinpocetine.
• To lower cholesterol: Mevacor, Fitostatin, Lipodemin, Questran, Gemfibrozil, Leskol.
• To activate metabolism in brain cells, reduce the degree of cognitive impairment: Nootropil, Cerebrolysin, Aminalon, Gingko biloba extract.
• To eliminate signs of vertebrobasilar insufficiency. A good effect is given by vegetotropic and vasoactive drugs: Sermion, Cinnarizine, Belloid, Vasobral, Cavinton, Betaserc, Tanakan.
• Drugs to reduce high blood pressure in DEP. Medicines must be taken strictly as prescribed by the doctor. Tablets stop the dangerous manifestations of a hypertensive crisis: Reserpine, Clonidine, Moxonidine, Methyldopa.
• Antidepressants with sedative and analeptic action. If a person can perform professional duties (at the first stage of DEP), then doctors prescribe injections of Prozac without the effect of drowsiness 1 time per day. With dyscirculatory encephalopathy, the neurologist selects the names on an individual basis: it is advisable to prescribe a lower daily rate of antidepressants than with endogenous depressions.

Additional therapies

To eliminate the negative symptoms of DEP, restore the optimal lumen in the arteries and veins that deliver blood to the brain, the doctor selects a complex of diverse procedures. It is important to adhere to the scheme indicated by the specialist, to attend all sessions.

If negative sensations appear during therapy or if you feel worse, you should promptly report the discomfort to the physiotherapist and the attending physician.

To eliminate cognitive impairment, cerebral complications, restore blood supply to the brain, the following methods of physiotherapy are prescribed:

• physiotherapy procedures: laser therapy, electrosleep, UHF heating in the neck area, galvanic currents on the collar zone, therapeutic baths;
• acupuncture, reflexology, the use of the Lyapko applicator;
• conversations with a psychotherapist.

Operation

Indications for surgical treatment:

• severe lesions of important main arteries in the head;
• occlusion or narrowing of more than 2/3 of the vessel lumen;
• active increase in cognitive impairment, neurological signs;
• critical narrowing of the arteries against the background of a microstroke.

Types of surgery in the internal carotid artery:

• extra-intracranial microanastomosis is performed with complete occlusion;
• endarterectomy is prescribed for severe stenosis.

The last degree of brain encephalopathy is the most severe. In some cases, a fatal outcome is observed, but supportive treatment is possible.

You can read more about dyscirculatory encephalopathy and its symptoms.

Preventive measures

To reduce the risk of recurrence of DEP, you need to follow the recommendations of a neurologist:

• properly organize the mode of work and rest, do not overwork mentally and physically;
• avoid stress, attend psychotherapy sessions or conduct autogenic training at home, master relaxation techniques;
• periodically donate blood to clarify the level of cholesterol, adjust the diet, take medications with an increase in indicators;
• refuse smoked meats, pickled vegetables, spices, pickles;
• reduce the consumption of foods containing bad cholesterol: pork, eggs, offal, refractory fats;
• avoid excess body weight: excess weight increases the risk of damage to the arteries and veins;
• engage in physical education according to the method proposed by the doctor. Moderate physical activity is necessary for the good condition of the vessels;
• maintain blood sugar levels at an optimal level;
• limit table salt - consume no more than 5 g of bulk product per day;
• give up smoking, alcohol;
• adhere to a low-calorie diet, get more plant foods, fresh fruits and vegetables, nuts, greens, low-fat cottage cheese, kefir;
• do not overeat, especially at night, to reduce the load on the heart;
• for prophylactic purposes, take long-term courses of medication according to the scheme developed by the doctor. You should not wait until the next hypertensive crisis is coming: modern antihypertensive drugs in a small dose stabilize the pressure, side effects are rare. To achieve a positive result, you need to take half (third, quarter) tablets in the morning and evening, or 1 time throughout the day (the scheme depends on the type of drug).

Unbearable physical labor, negative factors in hazardous production (vibration, high temperature, gas pollution), nervous strain, night shifts are factors that increase the risk of exacerbations in DEP.

It is necessary to choose an occupation in which the likelihood of conflicts, stressful situations, overloads will be minimal. It is important to create a pleasant psychological microclimate at home and in the team, enough rest, otherwise relapses of dyscirculatory encephalopathy cannot be avoided.

If signs appear that indicate problems with cerebral circulation, you should immediately visit a neurologist and be examined. Early diagnosis of dyscirculatory encephalopathy (DEP), complex therapy to restore the patency and functions of arteries and veins prevents ischemic disorders of the brain.

Related video

Dyscirculatory encephalopathy is a slowly progressive disease of the brain. With insufficient blood supply, small vessels are destroyed in it. Due to the accumulation of proteins, salts or fatty molecules, the integrity of the walls of arterioles is disrupted. With a diagnosis of cerebral dyscirculatory encephalopathy, treatment is aimed at preventing multiple microbleeds in the brain.

Dyscirculatory encephalopathy (DEP) is diagnosed mainly in the elderly. Recently, there have been cases when the diagnosis was made to patients of working age from 40 years.

In the presence of the disease, a person suffers from quite serious neurological disorders and slowly progressive dementia. Pathological processes are irreversible. Without appropriate treatment, dyscirculatory encephalopathy, the patient becomes disabled, loses the adequacy of thinking. In most cases, he cannot do without outside help. And the earlier the diagnosis is made, the more likely it is to stop the progression of the disease.

Development mechanism

Healthy blood vessels and normal blood circulation are necessary for the full functioning of the brain. Against the background of developing atherosclerosis, the blood flow weakens. In areas where the vessels are broken, the brain is not enriched with a sufficient amount of oxygen, it is not supplied with food, it is noted.

If oxygen starvation has reached a critical point, brain cells die, the tissue undergoes leukoaraiosis (rarefaction). This process leads to the disease of dyscirculatory encephalopathy.

The lesions are mostly small in size, they do not have a specific location. Being close to pathological foci, healthy ones take on their functions. But with the course of the disease, they lose contact with them and are also exposed to hypoxia. Therefore, with dyscirculatory encephalopathy, treatment is primarily aimed at stopping the destructive process.

Etiology

Dyscirculatory encephalopathy of the brain in the elderly and people of working age does not develop as an independent disease, but against the background of a number of pathological changes in the body. These include diseases:

• persistently high blood pressure (hypertension);
• tendency to a sharp decrease in blood pressure;
• violation of the walls of blood vessels (atherosclerosis);
• presence or rheumatism;
• osteochondrosis of the cervical region;
• pheochromocytoma (tumor of the adrenal glands);
• hypocoagulation (blood clotting disorder);
• thrombosis;
• diabetes.

In addition to the listed diseases, dyscirculatory encephalopathy can occur against the background of domestic causes:

• malnutrition (settlement of cholesterol plaques on the vessels);
• the use of alcoholic beverages;
• physical exercise;
• inadequate sleep;
• nervous strain, stress.

But, the most common cause, when diagnosing dyscirculatory encephalopathy, is an advanced form of atherosclerosis in one patient.

Signs and classification of the disease

Dyscirculatory encephalopathy is classified depending on the reasons that provoked it:

• atherosclerotic dyscirculatory encephalopathy caused by negative changes in the vessels of the brain;
• hypertensive form of dyscirculatory encephalopathy, caused by instability of blood pressure;
• venous dyscirculatory encephalopathy, the cause may be swollen compressing the walls of blood vessels (cardiac pathology, pulmonary insufficiency);
• mixed encephalopathy, the cause of atherosclerotic and hypertensive disorders;

The rate of development of the disease is determined by:

• slowly progressive (period for 5 years);
• remitting (instability is characterized by a frequent change of exacerbation and remission);
• rapidly progressive (stage change within 2 years).

Symptoms of dyscirculatory encephalopathy will depend on the zone of greater localization of lesions and on the severity.

The main features include:

• Change in personality due to new behavioral norms, change in character, manifestation of unreasonable aggression, suspiciousness in relation to others, mood swings.
• Speech disorders in dyscirculatory encephalopathy are characterized by incoherent speech, fuzzy pronunciation.
• Mental deviations, when the patient loses the ability to meaningfully perceive information, to adequately participate in the dialogue. Loses the ability to learn, cannot apply existing knowledge, memory deteriorates.
• Hearing is impaired, the sense of smell and vision are lost.
• Frequent headaches in dyscirculatory encephalopathy are accompanied by nausea, a feeling of pressure in the occipital part, giving off a "knock" in the temporal lobes.
• Violation of the vestibular apparatus in the form of coordination of movement, dizziness and fuzzy gait.
• Symptoms of a vegetative nature (vomiting, sweating, dryness of the oral mucosa).

A patient with dyscirculatory encephalopathy has sleep problems in the form of insomnia or light sleep. Against the background of fatigue, neurotic symptoms develop, this is emotional lability with frequent depressive moods. According to the severity of symptoms, dyscirculatory encephalopathy is divided into three stages.

Symptoms of the first degree

This is the initial stage of the disease, encephalopathy can be determined by human behavior. This degree is characterized by emotional symptoms, they appear brighter than others and are the reason for going to the doctor.

People around notice an unusual change in behavior, attributing them to the person's age or excessive fatigue. A patient with dyscirculatory encephalopathy has a tendency to depression, but the person is not aware of it, attributing a bad mood, sometimes to non-existent diseases. The pronounced signs characteristic of stage I of dyscirculatory encephalopathy include:

• neurasthenia (difficulty in contact with loved ones);
• aggression, laughter turning into crying and vice versa;
• causeless joy, brightly grown emotionally;
• cognitive impairment is noted in nine out of ten patients.

At stage I of dyscirculatory encephalopathy, slight disturbances in the patient's motor ability are noticeable.

Signs of the second degree

It is characterized by dyscirculatory encephalopathy of the second degree, progression of signs of the first, against the background of a decrease in mental abilities, attention and memory disorders. The patient's condition is aggravated by his rejection of the disease. He is not able to assess the environment due to the degradation of intelligence. The behavior is different:

• inability to cope with the usual household duties;
• indifference to a previously favorite pastime;
• complete detachment from the environment, which lasts for hours;
• disorientation in time and space.

Loss of ability to work and impossibility of existence alone. A patient with dyscirculatory encephalopathy needs care and control. The second degree of the disease makes it difficult to contact the attending physician, the patient cannot answer questions related to his condition.

Dyscirculatory encephalopathy of the second stage is characterized by a change in depressive mood to complete indifference. A person is in a state of apathy almost constantly. Movement disorders are visually noticeable, the gait becomes shaky, shuffling.

Third (severe) degree of the disease

In a severe degree, dyscirculatory encephalopathy is manifested by a complete loss of ability to work. A person loses the ability to think by 80% and cannot perform elementary actions. Completely exists outside of time and space. Violations are clearly pronounced neurological in nature:

• incoherent or completely absent speech;
• inability to eat on their own, complete lack of appetite and thirst;
• uncontrolled urination and stool.

The patient is in a state of dementia (dementia), if motor skills are not lost, they are chaotic and unpredictable. The patient needs constant care.

Treatment Methods

At the first stage of the disease, when the first symptoms of dyscirculatory encephalopathy of the brain have just appeared, no treatment is required. It is enough to reconsider your habitual lifestyle, excluding bad habits from it, resort to preventive measures, sometimes it is enough to adjust the diet. Thus, to prevent dyscirculatory encephalopathy from progressing.

If time has been lost, and the pathology has affected brain activity, it is necessary to resort to traditional therapy, in especially severe cases, a decision is made for surgical intervention.

Drug treatment of dyscirculatory encephalopathy is prescribed for the purpose of stopping the disease and eliminating the causes that led to it. With the help of traditional therapy, the pressure in the arteries is normalized, the fat and carbohydrate balance is regulated, and atherosclerotic changes are eliminated. Pathogenetic drug therapy for dyscirculatory encephalopathy is usually carried out in a complex manner, with drugs from various groups.

Elimination of hypertension

To normalize blood pressure in dyscirculatory encephalopathy, the attending physician prescribes the following drugs:

• ACE inhibitors Capropril, Lisinopril, Losartan, these drugs and their analogues reduce the degree of hypertrophy of the muscular layer of arterioles. Thus, an improvement in blood circulation and microcirculation is achieved in dyscirculatory encephalopathy.
• Pindolol, Atenolol, Anaprelin (Beta-blockers), their function is to reduce pressure and strengthen the heart muscle. They are prescribed in tandem with ACE inhibitors for people with ischemic disease,.
• To improve blood flow in the brain, eliminate arrhythmia and vasospasm, calcium antagonists Nifedipine, Verapamil, Diltiazem are used. They effectively relieve severe headaches in dyscirculatory encephalopathy of the brain and eliminate cognitive impairment in older people with this diagnosis.
• Drugs with a diuretic effect Furosemide, Veroshpiron, Hypothiazide are also included in the complex for normalizing pressure. Reduce blood volume and remove excess fluid from the body.

Lowering blood pressure in dyscirculatory encephalopathy is carried out along with the normalization of fat metabolism.

Elimination of hypercholesterolemia

To prevent the formation of cholesterol plaques on the walls of cerebral vessels and to treat existing ones, it is prescribed:

• Enduracin, Acipimox (active substance nicotinic acid);
• gemfibrozil, clofibrate, fenofibrate (fibrates);
• stabilize existing cholesterol plaques statins Simvastatin, Lescol, Lovastatin;

Cholestyramine is a fatty acid sequestrant that prevents the absorption of cholesterol and fatty acids in the intestines.

The use of vasodilators

For the treatment of dyscirculatory encephalopathy, the need to use vasodilators and improve the function of nerve tissues:

• In case of violation of blood flow in the carotid artery, with VBN (vertebrobasilar insufficiency) of the brain, a decrease in mental activity, a violation of the vestibular apparatus, Cavinton, Cinnarizine, Stugeron or Sermion are used.
• With difficulty in the outflow of blood from the brain, Redergin is used intravenously or its analogues.
• To prevent the aggregation of elements in atherosclerosis and relieve spasm against the background of hypertension, Vasobral is prescribed.

Treatment of dyscirculatory encephalopathy is impossible without the use of drugs that improve metabolic processes in the nervous tissue under conditions of hypoxia.

Appointment of nootropics and neuroprotectors

Nootropic drugs, to improve memory, the resistance of the nervous system to stressful situations, the perception of new information, are prescribed Semax, Cerebrolysin and Cortexin.

Piracetam, Encephabol, Nootropil have a vasodilating effect in dyscirculatory encephalopathy, they also improve brain function by normalizing metabolic processes. Block the formation of free radicals, eliminate vasospasm.

The use of antiplatelet agents, anticoagulants in dyscirculatory encephalopathy is necessary to prevent the occurrence of thrombosis. Acetylsalicylic acid, Cardiomagnyl are used to reduce blood viscosity. Warfarin, Clopidogrel are prescribed - the drugs are quite effective, but periodic testing for blood clotting is necessary. If the patient has atherosclerosis, Curantyl, Pentoxifylline is prescribed.

Symptomatic and alternative treatment

Therapy for the treatment of dyscirculatory encephalopathy, aimed at eliminating the symptoms of the disease, is designed to eliminate the pathology of an emotional nature. In the treatment of depression, tranquilizers Relanium and Phenazipam are taken. Antidepressants Melipramine and Prozac. Drugs are prescribed by a psychotherapist with an individual dosage. Available in pharmacies with a prescription.

For the prevention and treatment of dyscirculatory encephalopathy, nutritionists have developed a variety of diets that prevent the formation of cholesterol plaques. Traditional medicine offers many recipes for how to treat the disease. Examples of several infusions and decoctions:

• For a decoction, you will need leaves of lemon balm, mint and strawberries. The ingredients are taken in equal parts (1 tablespoon) per 200 grams of boiling water. Pour and infuse for six hours. The remedy is drunk one spoonful before meals.
• For tincture, you will need fresh or frozen cranberries and honey. The berry is interrupted with a mixer or passed through a meat grinder, mixed with honey in equal parts. The mixture is infused for a day in a dark place. It is taken with discirculatory encephalopathy before meals.
• Dandelion roots are taken, during the flowering of the plant, crushed. In the ratio of a tablespoon of the root and 200 grams of water, it is cooked in a pore bath for 10-15 minutes. It is recommended both for prevention and for the treatment of dyscirculatory encephalopathy, a tablespoon four times.

Treatment of dyscirculatory encephalopathy of the brain by surgery is carried out in the case when drug therapy did not give a positive result and the degree of vasoconstriction reached a critical level (more than 75%). And if the patient had cases of acute violation of cerebral blood flow.

Given that the processes in dyscirculatory encephalopathy are irreversible, much attention is paid to preventing the disease through preventive measures and timely access to a doctor.