Dyscirculatory encephalopathy of the brain (DEP) is a disease when the brain tissue chronically suffers from a deficiency in blood circulation and oxygen supply.
It does not occur in the ICD, the term DEP is more used to denote characteristic pathological phenomena from the side of the brain. Pathology is always secondary, because it arises as a reaction to existing problems with blood vessels. It is considered chronic; it is impossible to restore the functions of the cerebral cortex to its original state.
To understand what discirculatory encephalopathy of the brain is, the picture displayed during the passage of an MRI will help. The technique shows the lesions of the brain substance, the speed of their development.
Development reasons and stages
The reasons for the development of chronic CVD discirculatory encephalopathy, with signs visible on MRI, as a rule, are:
- atherosclerosis of cerebral vessels, due to cholesterol plaques, vascular patency worsens;
- arterial hypertension, which can be caused by both cardiac pathology and the more rare polycystic kidney disease, Itsenko-Cushing’s disease;
- diabetic changes;
- traumatic brain injury;
- pathology of the cervical arteries, congenital or acquired as a result of physical injuries, diseases.
Each of the reasons contributes to the fact that the blood flow in the vessels of the brain is reduced, leads to oxygen starvation and the formation of foci of necrosis. Unfortunately, one patient may have two or more of the above factors. This aggravates the course of the disease.
DEP degrees
With the defeat of individual branches of the vessels, the foci will be concentrated in one or another part of the brain (lacunar, focal form of DEP). When the lumen of a large artery is blocked, a larger volume of the brain substance suffers. This option is called diffuse, widespread. And it is more common.
The following stages of discirculatory encephalopathy are distinguished based on the rate of progression and the symptoms manifested:
- First stage. The predominance of subjective symptoms over objective ones. Examination by a neurologist shows minor deviations from the norm. It is characterized as “something is wrong with the head.”
- Second stage. Cognitive impairments (memory, logic) are increasing, patients become less critical of their condition. When they are told they need help, pathology is denied.
- Third step. Memory and intelligence are weakened to the level of dementia. There are problems with the coordination of movements. Simple self-service tasks become overwhelming.
Varieties
Dyscirculatory encephalopathy is also divided into types. The criteria are the manifestations of the lesion of the corresponding part of the brain. For example, in case of imbalance, there is a vestibular type of DEP. Disorders of a psychogenic nature are referred to as neurocirculatory. Headaches due to impaired blood outflow – venous type.
This division is of clinical importance, since the dynamics of symptoms can track the progression of pathology. And vice versa – to assess the adequacy of the treatment.
Medicine is taking the problem of diffuse cerebral discirculatory encephalopathy seriously, trying to figure out how to treat it with subcompensation and supportive therapy.
Symptoms
Complaints with discirculatory encephalopathy (DEP) of the brain, even at the initial stage, indicate signs of dysfunction of the brain and circulatory system. Initially, due to mild severity, they are mistaken for a slight malaise. One that does not require diagnosis and treatment. This feature leads to the fact that pathology is found in advanced stages.
Typical symptoms of DEP are:
- the appearance of speech viscosity;
- violations in the coordination of movements, maintaining balance;
- dizziness and headaches;
- nausea;
- sleep problems, in which a person is sleepy during the day and suffers from insomnia at night;
- memory deteriorates;
- thinking slows down, logic suffers, the ability to process new information worsens;
- character changes, irritability, unmotivated aggression occurs.
In an exacerbation, with gross brain lesions, apathetic state and depression occur. Patients lose interest in their appearance and contacts with the outside world.
Depending on the stage and characteristics of manifestations, the doctor can answer the question “Is it possible to stop the development of discirculatory encephalopathy due to chronic anemia or atherosclerosis, diabetes” in different ways. The prognosis is based on the results of diagnostics and the characteristics of the dynamics of the disease in a particular patient.
Diagnostics
First – a survey and inspection. It is obligatory to undergo diagnostic tests and procedures. Based on the results, the neurologist diagnoses moderate or progressive circulatory encephalopathy of the brain, determines how to treat it, explains what the MRI results mean, determines by signs whether the disease is in its initial stage or has a long history.
Reasonable conclusions are made after passing the necessary diagnostic procedures:
- examination and questioning with the collection of anamnesis, allowing to identify a possible root cause of poor health;
- basic blood and urine tests;
- MRI of the brain, neck vessels.
The last study on the list shows a picture of the development of the disease. With its help, changes in the state of the cortex, necrotic foci become visible.
If the root cause of the vascular problems is not established, additional research is done to determine why the circulatory system of the head is not getting enough oxygen.
This is necessary, since the treatment is based on neutralizing the root cause and after that on stabilizing the patient’s condition.
Treatment
After the stage of diagnosis and identification of the cause of the development of the disease, a comprehensive treatment of discirculatory vascular encephalopathy of the brain in adults is selected.
Treatment of crises, exacerbations is carried out in the Department of Neurology, since the symptoms of cerebral discirculatory encephalopathy can be expressed both in physiological problems and in psychiatric ones. In the phase of remission, minimal manifestations, it is treated on an outpatient basis.
Complex therapy, combining medication and non-medication methods and techniques, was recognized as effective.
Effective physiotherapeutic methods of dealing with DEP, depending on the root cause, are:
- physiotherapy exercises, a set of exercises for which is prescribed by a doctor;
- transcranial magnetic stimulation;
- collar massage;
- acupuncture;
- electromyostimulation;
- vortex fields.
In parallel, treatment with medicines is carried out:
- diuretics;
- beta blockers;
- vascular funds;
- neurometabolites;
- vestibulo-correctors;
- antidepressants.
When destructive encephalopathy affects large areas of the brain due to the overlap of large vessels, surgery is allowed.
Two types of operations have become widespread:
- Carotid endarterectomy, cleaning the inner walls of the carotid artery in atherosclerosis.
- Stenting, in this case, a special expander is inserted into the vessel, which improves blood flow in the narrowed part of the artery.
It is necessary to understand that the treatment of symptoms and signs of cerebral discirculatory encephalopathy in adults is a slowdown in the development of the disease, an arrest of pathological processes. It is no longer possible to restore the affected foci. As well as to be cured forever, without the danger of again facing a worsening of the condition.
DEP is a chronic disease that requires regular maintenance therapy and lifestyle changes.
Prevention and prognosis
Any type: vestibular, neurocirculatory, circular, venous, dysfunctional, destructive radicular – DEP (discirculatory encephalopathy) develops quickly without treatment, signs progress in the eyes. Already after 2 years, a noticeable worsening of symptoms is expected, a transition to the next stage.
Many factors influence the process. Pathology will slow down if you regularly undergo treatment courses, change your lifestyle according to the advice of a neurologist, and carefully monitor the symptoms that appear. A person who has been diagnosed with such a diagnosis, having no other serious health problems, is able to live for 10 years and even more without serious deterioration.