Cerebral Ischemia: Symptoms, Causes And Treatment

Cerebral ischemia

One of the most feared brain phenomena and problems worldwide is the appearance of a stroke, which is one of the most frequent causes of death worldwide.

The reason is the fact that its presence generates the death of part of the brain cells, something that can generate different more or less disabling consequences and compromise survival depending on the areas that are damaged.

But the truth is that when we talk about stroke we are actually talking about two main types of stroke: we could be facing a cerebral hemorrhage or a cerebral ischemia

It is on this last type that we are going to focus throughout this article, in order to discuss what it is, for what reasons it can occur and what type of intervention can be carried out in those who have suffered from it.

What is cerebral ischemia?

The name cerebral ischemia is given to one of the major types of stroke that exists, which is characterized by the appearance of neuronal degeneration or death in the brain derived from the existence of some type of blockage in one of the blood vessels that supply the brain

This blockage prevents blood from reaching the nerve cells that the blood vessel should supply, so that by not receiving a sufficient level of oxygen and nutrients, the affected cells degenerate and die quickly. Thus, technically we speak of ischemia when for some reason the supply of nutrients and oxygen that brain cells need to survive is interrupted.

Symptoms

Cerebral ischemia is an alteration that can generate a great variety and diversity of symptoms, since the obstruction can occur in any of the blood vessels that supply any of the areas of the brain. Thus, the specific symptoms will depend largely on the affected area.

However, there are some symptoms that are common both in ischemia and in other strokes: the sudden appearance of paralysis or numbness of a part of the face or half of the body, sudden speech alterations (including aphasias in which the the ability to understand and/or produce speech) and sudden hypotonia or lack of muscle tone in a part of the body.

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In addition, other types of alterations may arise, such as dizziness, headaches, hallucinations, personality changes, tremors and/or seizures blurred vision or loss of specific sensory abilities.

Between ischemia and cerebral hemorrhage, ischemia is much more common, there are a large number of factors and situations in which a blockage of the cerebral vessels can appear.

Its main types

Within ischemias we can also find different typologies, depending on how and why the blockage in question appears and even to what extent it affects more or fewer brain regions. Among the different types, the following stand out.

1. Thrombotic ischemia

This type of ischemia occurs when within the blood vessels of the brain An obstruction appears that prevents the passage of blood This obstruction is called a thrombus, and usually comes from the presence of cholesterol plaques in the vein or artery or from the existence of a clot that forms within the cerebrovascular system itself.

2. Embolic ischemia

Embolic ischemia or embolism differs from the previous one because the element that causes the blockage of the cerebral blood vessel, in this case called an embolus, arises in some part of the body other than the brain and travels together with the bloodstream throughout the body until which finally reaches the cerebrovascular system, causing tamponade at some point if it encounters a vessel smaller than it. This is what can happen, for example, with some blood clots

3. Transient ischemic attack

The transient ischemic attack is a type of cerebral ischemia in which, as in the rest, some element suddenly appears that blocks the cerebral vessels, but nevertheless the body’s own functioning manages to unblock it by itself quickly (for example because the blood flow manages to push or fragment the embolus or thrombus).

In these cases, the symptoms usually last a short time and the subject can fully recover, although the fact that they have appeared means that the subject is at risk of more severe ones appearing.

4. Lacunar stroke

This is understood as a type of cerebral ischemia in which the affected blood vessel is an arteriole, that is, one of the small branches of the arteries that enter the depths of the different areas of the brain

That ischemia occurs at this level implies that the affected areas will generally be small and its effects less than in other types of stroke, but it can also have serious repercussions and even cause death depending on the region in which it occurs.

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5. Focal cerebral ischemia

This is called a type of ischemia in which the interruption of blood flow It is produced in a blood vessel that will supply a specific brain area in such a way that the effect at the neuronal level is specific to the specific area that is damaged or dies.

6. Global cerebral ischemia

In this case, ischemia does not occur in a specific vessel but occurs at a more global level, with all or almost the entire brain not receiving sufficient oxygen or nutrients. In this case the problem is global and has the potential to generate many more repercussions on the subject who suffers from it.

7. Hemodynamic ischemia

In this little-known type of ischemia there is no blockage as such, but there is a disruption in the delivery of oxygen or nutrients to the brain The cause of this type of stroke is the absence of a deficit in blood pressure that leads the blood to circulate at the speed necessary to nourish the cells.

Causes

Technically, the presence of ischemia implies the existence of some type of blockage or difficulty in the arrival of blood with oxygen and nutrients to the brain cells. In this sense, the most common causes are usually blood clots or cholesterol and lipid plaques that clog the arteries But beyond that, there are many possible causes that can lead to this type of stroke.

Among the numerous risk factors for its appearance we find the presence of high blood pressure, diabetes mellitus, cholesterol, previous brain injuries (for example due to healing of a vascular lesion), cardiac problems (as in the case of hemodynamic cerebral ischemia), malformations, trauma (which can cause blood clots), lack of sufficient nutrients, tumors, smoking or consumption of certain drugs

Impact on the subject’s life

Suffering from cerebral ischemia generally has a major impact on the life of the patient, who may suffer significant consequences for a time or even throughout their life.

At a direct level, the patient can suffer from a great variety of problems derived from the death of their tissues, which can range from aphasia to paralysis of part of the body, passing through, among others, tingling, cognitive difficulties (such as concentration or memory), sensory deficits, sleep, movement, sexuality or eating problems. And unfortunately these problems will not always be able to be solved or compensated, something that can lead to the patient presenting different degrees of disability

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Furthermore, it must be taken into account that at a social and work level the consequences of ischemia can have consequences: for example, if the patient suffers from aphasia derived from ischemia, they will find it difficult to communicate effectively, something that can be very difficult. frustrating for the subject and generating misunderstandings towards the environment.

Finally and beyond the direct consequences of ischemia, We cannot ignore the great emotional impact of suffering from this type of disorder The subject has experienced a situation of great risk to his life and it is not uncommon for anxiety or depressive problems to appear, as well as a great fear of the possibility that it could happen again.

Treatment

In cases of cerebral ischemia, rushing to the medical center is essential and can save the life of the person suffering from it, as well as reduce the possible effects of cell destruction

Once the problem has been identified, at a medical level it is possible to inject substances that allow the dissolution of clots or even use surgery to remove the clot (being able to reach the cerebral arteries with procedures such as angioplasty from other parts of the body).

Once the problem has been treated and the blood flow has returned to normal, and after a period in which the patient is under observation and in which it is possible that part of the area affected will be reduced due to the lack of risk (the so-called ischemic penumbra in which a brain area has been partially affected but has not completely died, and in some cases it can partially or totally recover functionality), It will be necessary to assess the patient’s neuropsychological status

To do this, it will be necessary to assess its functionality in various areas, both at a motor and cognitive level, in order to identify possible deficits and alterations that have caused the death of nerve cells. Once this is done, it will be necessary to develop an individualized treatment, in which depending on the case it may be necessary to use occupational therapy, cognitive stimulation (in which aspects such as memory, executive functions or attention can be worked on), speech therapy and/or physiotherapy.

It involves carrying out neuropsychological rehabilitation of the patient, helping them recover or compensate for the affected functions.

Psychological therapy may also be useful for the affected person, given that the consequences of ischemia can be experienced with panic and suffering and cause (either directly as a consequence of the ischemia or indirectly as a result of the perception of deficits) emotional disturbances, anxiety, cognitive distortions and psychosocial adjustment problems.