Cerebral ischemia: symptoms, causes and treatment

One of the most feared brain phenomena and problems in the world is the onset of stroke or stroke, which is one of the most common causes of death in the world.

The reason is that their presence leads to the death of part of the brain cells, which can lead to different consequences more or less disabling and compromise survival depending on the injured areas.

But the truth is, when we talk about stroke, we are actually talking about two main types of stroke: we may be dealing with cerebral hemorrhage or cerebral ischemia.

It is on the latter type that we will focus on throughout this article, in order to discuss what it is, for what reasons it can occur and what type of intervention can be performed in those they have suffered from. .

    What is cerebral ischemia?

    It is called cerebral ischemia to one of the main types of stroke that exists, which is characterized by the appearance of neuronal degeneration or death in the brain resulting from the existence of a kind of blockage in one of the blood vessels that supply the brain.

    This blockage prevents the blood from reaching the nerve cells that the blood vessel needs to supply, so that it does not receive sufficient levels of oxygen and nutrients, and the affected cells degenerate and die quickly. So, technically we are talking about 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 wide variety and diversity of symptoms, Since the obstruction can occur in any of the blood vessels that supply blood to one of the areas of the brain. So, the specific symptoms will largely depend on the affected area.

      However, some symptoms are common both in ischemia and in other strokes: sudden onset of paralysis or numbness of part of the face or half of the body, sudden changes in speech (including aphasias in which the ability to understand and / or produce speech is lost) and sudden hypotonia or lack of muscle tone in any part of the body.

      In addition to this, other types of changes may occur such as dizziness, headache, 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, with a large number of factors and situations in which 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 less areas of the brain. Among the different types, the following stand out.

      1. Thrombotic ischemia

      These types of ischemia occur inside the blood vessels of the brain a blockage appears that prevents the passage of blood. This obstruction is called a thrombus and is usually caused by the presence of cholesterol plaques in the vein or artery or the existence of a clot forming in the cerebrovascular system itself.

      2. Embolic ischemia

      Ischemia or embolic embolism differs from the previous one because the element that causes the blockage of the cerebral blood vessel, in this case called the piston, occurs somewhere in the body other than the brain and travels along the blood flow through the body until it finally reaches the cerebrovascular system, at some point causing a blockage if it meets a glass smaller than it. This can happen for example with some blood clots.

      3. Transient ischemic attack

      Transient ischemic attack is a type of cerebral ischemia in which, like others, there is a sudden appearance of an element that blocks the vessels of the brain, but which nevertheless the very functioning of the body manages to unblock by itself quickly (for example because the blood flow manages to push or fragment the plunger or thrombus).

      In these cases, the symptoms are usually short-lived and the subject can fully recover, although the fact that it has occurred means that the subject is likely to appear more serious.

      4. Lacunar stroke

      It is understood as such a type of cerebral ischemia in which the affected blood vessel is an arteriole, i.e. one of the the small branches of the arteries that are introduced into the depths of different areas of the brain.

      The fact that ischemia passes to this level implies that the affected areas will generally be small and its effects less than in other types of stroke, but they can also have serious repercussions and even lead to death depending on the region in which occurs.

        5. Focal cerebral ischemia

        It is called as such a type of ischemia in which the interruption of blood flow it occurs in a blood vessel that will irrigate 1 specific area of ​​the brain, So that the effect at the neural 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 passes to a more globalized level, being all or almost all of the brain that does not receive enough oxygen or nutrients. In this case, the problem is global and has the potential to generate much more repercussions on the subject suffering from it.

        7. Hemodynamic ischemia

        In this little-known type of ischemia, there is no blockage as such, but it is an interruption in the flow of oxygen or nutrients to the brain. The cause of this type of stroke is the absence of blood pressure deficit which causes the blood to circulate at the speed necessary to nourish the cells.

        the causes

        Technically, the presence of ischemia implies the existence of some kind 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 plaques of cholesterol and lipids that clog the arteries. But beyond that, there are many possible causes that can lead to this type of stroke.

        Among the many risk factors for its occurrence are the presence of hypertension, diabetes mellitus, cholesterol, previous brain damage (for example due to healing of a vascular injury), heart problems (as in the case of hemodynamic cerebral ischemia), malformations, trauma (which can cause blood clots), lack of sufficient nutrients, tumors, smoking or taking certain medications.

        Assignment in the subject’s life

        Suffering from cerebral ischemia usually has a major impact on the life of the patient, who can suffer significant sequelae for a period of time or even his entire life.

        At the direct level, the patient can suffer from a wide variety of problems arising from the death of his tissues, which can range from aphasia to paralysis of a part of the body, including tingling, cognitive difficulties ( such as concentration or memory), sensory deficits, problems with sleep, movement, sexuality or eating. And unfortunately, these problems cannot always be fixed or compensated, which can cause the patient to have different degrees of disability.

        It should also be borne in mind that at the social and professional level the consequences of ischemia can have consequences: for example, if the patient suffers from aphasia derived from ischemia, he has difficulty in communicating effectively, which can be very frustrating for the subject and generate misunderstandings vis-à-vis 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 lived a situation of great risk to his life and it is not uncommon for problems of anxiety or depression to appear, as well as a great fear of the possibility that he may return to pass.

        treatment

        With cerebral ischemia, rushing to a medical center is essential and can save the lives of those who suffer from it, as well as reduce the possible effects of cell destruction.

        Once the problem has been identified, medically, it is possible to inject substances that allow the clots to dissolve or even resort to surgery to remove the clot (which can reach the arteries in the brain with procedures such as angioplasty. from other parts of the cos).

        After the problem has been treated and the blood supply has returned to normal, and after a period in which the patient remains under observation and during which it is possible that the part of the area affected by the absence risk is reduced penumbra in which an area of ​​the brain has been partially affected but not entirely dead and which, in some cases, may partially or completely recover its functionality), the patient’s neuropsychological condition should be assessed.

        To do this, it will be necessary to evaluate its functionality in the different domains, both motor and cognitive, in order to identify any deficits and alterations caused by the death of nerve cells. Once this is 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 like memory, executive functions or attention can be worked on), speech therapy and / or physiotherapy.

        It is a question of carrying out a neuropsychological rehabilitation of the patient, by encouraging him to recover or to compensate the affected functions.

        Psychological therapy can also be helpful to the affected person, as the sequelae of ischemia can be felt with panic and pain and cause (either directly as a result of ischemia or indirectly derived from the perception of deficits) emotional disturbances. , anxiety, distortions psychosocial adjustment problems.

        Bibliographical references:

        • Kuźma, Elżbieta; Lourida, Ilianna; Moore, Sarah F .; Levine, Deborah A .; Ukoumunne, Obioha C .; Llewellyn, David J. (2018-08). “Risk of stroke and dementia: a systematic review and meta-analysis.” Alzheimer’s and dementia. 0 (0)
        • Lewis. SL (2008). Medico-surgical nursing care. Vascular disorder.

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