What is Cerebrovascular Disease?

Cerebrovascular disease refers to a variety of conditions that affect the supply of blood to the brain.

These can include several types of stenosis, aneurysms and vascular malformations, and can lead to transient ischemic attacks, hemorrhaging and strokes.

Cerebrovascular diseases include:

Cerebrovascular stenosis, which involves plaque buildup in the arteries that supply blood to the brain. This causes them to harden and narrow and increases the risk of clots.

Cerebral aneurysm, which occurs when the wall of an artery that supplies blood to the brain becomes weak and begins to bulge, increasing the risk of hemorrhaging.

Cerebrovascular malformations, which are conditions present at birth affecting the blood vessels in the brain.

Baptist Health is known for advanced, superior care in the diagnosis, management and treatment of cerebrovascular disease. You will appreciate timely appointments and a professional, friendly atmosphere where we take time to listen to your concerns. At Baptist Health, you have access to the region’s most comprehensive, multidisciplinary team of specialists and innovative therapies, including many available only through specialized clinical trials. In every way, we work to demonstrate the utmost in excellent care to those who trust us with their health.

Cerebrovascular Disease Signs and Symptoms

The signs and symptoms of cerebrovascular disease depend on which blood vessels in the brain are affected and how much blood flow is impacted.

Signs and symptoms of cerebrovascular stenosis do not usually become apparent until a trans ischemic attack or stroke occurs. Warning signs of a trans ischemic attack or stroke may include the sudden onset of some or all the following symptoms:

• Dizziness, nausea, or vomiting
• Unusually severe headache
• Confusion, disorientation, difficulty with comprehension, memory loss
• Numbness or weakness of an arm or leg
• Facial weakness or droop, especially on one side
• Abnormal or slurred speech
• Loss of vision or difficulty seeing
• Loss of balance, coordination, or the ability to walk 

Small aneurysms do not usually have any symptoms, but larger ones may cause localized pain or headaches, and very large aneurysms can exert pressure on adjacent brain tissue or nerves, causing sensitivity to light, vision problems, numbness or weakness of an arm or leg, difficulty with memory or speech, fainting, or seizures. If an aneurysm ruptures, it may cause:

• Head and neck pain
• Cold, clammy skin
• Dizziness, nausea or vomiting
• Rapid heart rate
• Low blood pressure
• Shock

Some cerebrovascular malformations may present as blood-filled bulges visible under the skin and are sometimes painful but rarely have other symptoms. When symptoms do occur, they can include:

• Headache
• Seizure

Cerebrovascular Disease Diagnosis

To determine if you have cerebrovascular disease, the physician will start by reviewing your symptoms, risk factors, and family and medical histories, and performing a physical exam. In most cases, the physician will also order one or more diagnostic imaging tests that allow vascular specialists to view the brain and the arteries and vessels around it. These tests may include:

Angiogram:A thin tube (catheter) is inserted into a blood vessel and dye is injected to make the blood vessel visible during an X-ray. This can show any blood clots or other blood vessel issues.

Ultrasound: An ultrasound device can measure blood pressure on various points of your arm or leg, which will help the physician determine if you have any blockages and how quickly blood flows through your arteries.

Computed tomographic angiography (CT):This non-invasive test can show the arteries in the abdomen, pelvis and legs. This test is particularly useful in patients with pacemakers or stents.

Electroencephalogram (EEG):During this test, special electrodes that are attached to different spots on your scalp send electrical impulse data from your brain to a special recording machine. This machine converts the impulses to a visual pattern that is saved to a computer.

Lumbar puncture (spinal tap):This diagnostic test uses a needle to remove a sample of cerebrospinal fluid from the space surrounding the spinal cord. This test can be helpful in detecting bleeding caused by a cerebral hemorrhage.

Magnetic resonance imaging (MRI):A large magnet, radio waves and a computer are used to produce pictures of the heart and blood vessels.

Cerebrovascular Disease Causes

Cerebrovascular malformations have no known causes. Cerebrovascular stenosis and aneurysms may be caused by:

• Diabetes
• High blood cholesterol
• High blood pressure
• Physical inactivity and obesity
• Smoking

Risk Factors

In addition to the causes of cerebrovascular disease that can be controlled, risk factors include: Family history:Those who have a family history of cerebrovascular disease and related conditions are at greater risk. Gender: Women are more likely to develop a brain aneurysm and cerebrovascular hemorrhaging. Ethnicity:African-Americans are more likely to develop cerebrovascular disease due to a greater risk of high blood pressure. Prevention

Cerebrovascular malformations cannot be prevented, but there are things you can do to help prevent cerebrovascular stenosis and aneurysms:

Watch what you eat: Eat healthy, and avoid foods that are high in trans and saturated fats.

Exercise and maintain a healthy weight: Staying active increases your heart health.

Avoid smoking: If you are currently a smoker, there are many programs available to help you quit.

Take your medications as prescribed: if you have high blood pressure, high cholesterol or diabetes, make sure you take your prescribed medications as directed.

Get regular check-ups: if you are experiencing chest pain, fatigue, shortness of breath or other symptoms, get checked out right away. The earlier you’re diagnosed and treated, the better the outcome.

Cerebrovascular Disease Prognosis

The prognosis for cerebrovascular disease depends on the size and location of the aneurysm or cerebrovascular malformation, or severity of the stenosis. Those experiencing more serious symptoms should seek emergency medical help immediately, as brain damage caused by complications from cerebrovascular disease is irreversible.

Cerebrovascular Disease Treatment and Recovery

Depending on the type and severity of cerebrovascular disease, the physician may recommend a variety of different treatments including lifestyle changes, medications, careful monitoring and surgery.

Lifestyle Changes

If you have cerebrovascular disease or are at high risk, your doctor may recommend a healthier diet, more exercise, quitting smoking, and reducing your stress.

Medications

Medications that can help reduce the risk of serious complications from cerebrovascular disease include

• Anticoagulants: Your doctor may prescribe a blood thinner such as aspirin to reduce the risk of blood clots.
• Blood pressure medications: Diuretics, ACE inhibitors, beta blockers and other medications that are used to lower blood pressure reduces the risk of hemorrhaging.
• Cholesterol- lowering medications: Statins, or cholesterol-lowering medications, can help prevent further buildup of arterial plaque that causes stenosis and clotting.

Careful Monitoring

Those with small aneurysms (10mm or less) are generally at low risk for a rupture, so your doctor may recommend careful monitoring to make sure that the aneurysm does not grow or show signs of leakage. Similarly, most cerebrovascular malformations do not pose a major risk, are difficult to remove, and will grow back if not removed completely. Therefore, surgery may only be recommended if the risk from the malformation is serious or the symptoms are debilitating and cannot be otherwise treated.

Cerebral Angiography

Depending on the location of the aneurysm, malformation or narrowing caused by stenosis, minimally invasive treatment options, also known as neurointerventional or neuroradiological procedures, may be available. First, a catheter is threaded into the artery, and the aneurysm, malformation, or stenosis is located by injecting a special dye that helps create a clear picture of the cerebrovascular system on an X-ray. For cases of cerebrovascular stenosis, a balloon may be used to widen a narrowed artery, followed by the placement of a stent to keep the artery open and prevent clotting. For aneurysms and malformations, tiny platinum coils or beads are used to fill the problem area, preventing blood from circulating or pooling in that area, and reducing the risk of clots, leaks, or hemorrhages.

Neurosurgery

Because any surgery on the brain and surrounding blood vessels is inherently risky, open neurosurgery is generally only recommended in cases where there is already leakage or hemorrhaging, or more serious symptoms begin to occur and cannot be treated with a cerebral angiography. Most aneurysms and malformations that require surgery are treated with a process known as surgical clipping, which cuts off the blood supply to the affected area. In cases where clipping is not possible or there is damage to the artery itself, bypass surgery may be required. If the artery being bypassed is a major artery, it may require harvesting a vessel graft from the arm or leg. For minor arteries, a donor artery that normally supplies blood to the face and scalp can be rerouted to supply blood to the brain.

Recovery After Surgery

Depending on how your body heals, you will be in the hospital for four to six days to several weeks, depending upon the surgical procedure. Recover may take weeks or months.

For those who have experienced a stroke or permanent damage related to complications from cerebrovascular disease, physical and cognitive rehabilitation programs can help restore or improve some speech, motor skills and cognitive functions. While damaged brain tissue cannot be repaired, skills can be re-learned as other parts of the brain are trained to take on some of the functions of the damaged area.

Complications

When a cerebral blood vessel becomes partially or totally blocked, or a blood vessel or aneurysm ruptures, it can cause serious complications such as:

Stroke: A stroke occurs when part of the brain loses its blood supply due to a blockage or rupture in one of the arteries, causing permanent damage.

Trans ischemic attack: A trans ischemic attack occurs when the blood supply to part of the brain is temporarily cut off by a clot, but the clot quickly dislodges itself and does not result in lasting brain damage.

Vascular dementia: Damage to the brain cells caused by a shortage of blood supply can result in a widespread and persistent loss of mental ability known as vascular dementia.