MR microangiopathy. Why does microangiopathy of the brain develop: signs and treatment

03.10.2017

For the normal functioning of systems and organs human body, including cerebral activity, requires oxygen and nutrients supplied with the bloodstream. The main organs of the human body - the heart and brain - need oxygen and nutrients. If for some reason the oxygen supply stops, pathological processes begin to occur. Microangiopathy of the brain is a dangerous pathology. Cerebral microangiopathy - a disease vascular systemwhen small blood vessels (capillaries) are damaged, as a result, their structure and permeability change.

The blood supply to the neurons of the brain is partially cut off. The consequences can be serious, including death. Microangiopathy of the brain is not an independent disease and develops as a result of pathologies. One of the varieties of microangiopathy is the pathological condition of the retinal vessels or renal capillaries. It is impossible to detect and cure the disease, therefore it is recommended to know what microangiopathy of the brain is, why it develops and manifests itself.

Development of cerebral microangiopathy

Microangiopathy of the brain is a common disease characterized by a violation of the tone and structure of the walls of the small vessels of the brain.
This leads to disruption of the metabolic process in the brain tissues. And as the pathology progresses, the elasticity of the capillary wall decreases, and the vascular lumen becomes smaller, therefore, small vessels become unsuitable for intensive blood flow. This leads to the fact that the neurons of the brain do not receive the required amount of oxygen and nutrients, therefore, brain hypoxia begins.

Due to a decrease in the strength of the vascular walls, the capillaries begin to break, which can lead to subarachnoid bleeding, which in half of the cases is fatal.

Prolonged lack of blood flow to the brain provokes local death of neurons and their replacement by gliosis, as well as the formation of scar tissue. Characteristic feature Cerebral microangiopathy is damage to microscopic blood vessels found in the brain.

The factors predisposing to this are hypertension and impaired cerebral blood supply. Microangiopathy of the brain, affecting the small blood vessels of the brain, their branches, is of 2 types:

• the walls of the capillaries of the brain are thickened;
• the walls of the hyaline arteries thicken.

The cause of the development of pathology is a chronic lack of blood in the brain, which leads to damage to the white matter of the brain. Impaired functioning of the brain can provoke the development of lacunar infarction or cerebral stroke and encephalopathy.

Etiology of cerebral microangiopathy

The reason for the development of cerebral microangiopathy is a metabolic disorder, which is accompanied by the development of pathological phenomena:

• oxygen starvation of tissues;
• dysfunction of the vascular endothelium;
• vascular spasms;
• gluing platelets together;
• activation of the renin-angiotensive system.

Microangiopathy develops against the background of independent pathologies, among which are:

• necrosis. The cells and tissues of the body die and die as a result of a violation of the blood supply or under the influence of toxic substances;
• fibrinoid. A dangerous and irreversible condition, during which the permeability of blood vessels significantly increases, as well as connective tissue is destroyed and it is replaced by fibrous tissue. This phenomenon is observed in inflammatory processes;
• thrombosis. Inside blood vessels blood clots form, which close the vascular lumen and impede the flow of blood flow;
• hyaline dystrophy. Hyaline, a protein that arises from metabolic disorders in connective tissues, is deposited on the walls of blood vessels. The inner walls of blood vessels are gradually destroyed and become saturated with fibrin. This pathological condition occurs in atherosclerosis, diabetes mellitus and autoimmune pathologies.

Cerebral microangiopathy develops as a result of diseases:

• hereditary vegetative-vascular dystonia;
• acute infectious diseases;
• acquired immunodeficiency;
• malignant tumors;
• serious head injuries;
• intoxication of the body;
• pathology of the liver and kidneys.

The syndrome of microangiopathy of the brain does not develop in a few hours, this is preceded by a period of time characterized by the presence of predisposing factors:

• abnormal structure of the walls of blood vessels, due to which its tone is disturbed. Pathology is genetic in nature;
• smoking and drinking alcohol;
• problems with blood clotting;
• infectious diseases of the vascular system;
• increased blood pressure and pathology of the cardiovascular and endocrine system;
• various kinds of injuries, work in difficult and harmful conditions;
• the effect on the body of toxic substances;
• advanced age (more than 50 years).

The list of causes and factors provoking the development of cerebral microangiopathy is large. It is recommended that each person know the symptoms that manifest pathology in order to identify it and prevent the development of consequences.

Symptoms of cerebral microangiopathy

The insidiousness of brain microangiopathy lies in the fact that on initial stages development, it manifests itself and the person does not know about the problem. Small single areas with damaged vessels are supplied with oxygen and nutrients from neighboring capillaries. Due to this, the symptomatology of pathology is absent at first.

After a time, when a large volume of the microvasculature is affected and the blood supply from neighboring vessels cannot replace damaged capillaries, many neurons of the brain die, signs of microangiopathy appear.

The first symptom that all patients complain about is pain in the head, which cannot be eliminated with the help of painkillers. Patients note the presence of a pronounced astheno-neurotic syndrome, which is expressed in the following:

• being in a bad mood;
• irritability and depression;
• fast fatiguability;
• sleep problems;
• feeling overwhelmed and empty;
• significant decrease in performance;
• fatigue.

Microangiopathy of the brain is manifested by symptoms:

• dizziness, confusion;
• impaired coordination of movement;
• sleepiness during the day and sleeplessness at night;
• memory problems;
• absent-mindedness, forgetfulness;
• pupils of different diameters;
• violation of temperature and pain sensitivity on some parts of the body;
• bruising, subcutaneous bruising;
• nosebleed;
• dry and flaky skin on the legs;
• visual impairment.

Basically, the symptomatology of microangiopathy depends on the location of the pathological process. But in any case, cerebral microangiopathy of the brain causes encephalopathy of varying severity. You may also experience internal bleeding into the space between the hemispheres or directly into the medulla.

Microangiopathy of the brain must be started to be treated faster, otherwise, as it progresses, the patient's condition will only get worse, and ultimately lead to disability and death.

Diagnostics and treatment of pathology

Microangiopathy of the brain: what is it and how to treat the disease? Doctors often hear this question, and cases of pathology detection occur quite often. First of all, the doctor assesses the patient's history; similar symptoms may apply to other diseases. After interviewing and examining the patient, diagnostic measures are prescribed:

• blood and urine tests;
• encephalogram;
• CT and MRI of the brain;
• examination by an ophthalmologist and ultrasound of the fundus;
• ultrasound dopplerography.

After an accurate diagnosis is made, a complex treatment is prescribed, which consists of drug therapy, adherence to a special diet, lifestyle changes. Your doctor may recommend physical therapy. If a conservative treatment is not suitable and it is necessary to restore vascular patency, then surgical intervention is used.

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Microangiopathy of the brain is a disease in which there is a violation of cerebral circulation. A pathological process develops in the vascular wall of the capillaries that provide neurons with oxygen and nutrients. As a result, the lumen of the blood flow narrows, the brain cells stop receiving glucose, and oxygen starvation develops. Neurons begin to die off, they are replaced by glial cells. Focuses of gliosis form adhesions or scars over time, which is fatal if left untreated.

Causes

Microangiopathy syndrome can occur for 4 main reasons:

• Fibrosis. An irreversible pathology characterized by the destruction of vascular endothelial cells. Inflammatory processes provoke the replacement of capillaries with fibrous tissue.
• Thrombosis. Ischemia develops due to blockage of the vascular lumen by a blood clot.
• Necrosis. Irreversible cell death.
• Hyalinosis. The pathology is characterized by the deposition of hyaline protein on the walls of the capillaries of the brain. According to a similar scheme, due to the accumulation of amyloid on the endothelium, cerebral microangiopathy develops. Protein deposition is typical for people with hypertension and atherosclerosis.

The following conditions can provoke the development of a pathological process or worsen an existing disease:

• severe infections;
• blood clotting disorder;
• bad habits;
• age after 50 years;
• cardiovascular pathology;
• genetic diseases in which there is a violation of vascular tone;
• head trauma;
• stress, constant physical strain;
• endocrine system damage.

Ischemia progresses slowly over several years. Therefore, when a symptomatic picture of the disease appears, you should consult with your doctor. The specialist will explain what microangiopathy of the brain is and prescribe treatment depending on the type of pathology.

Forms of microangiopathy

There are 4 main types of pathology:

• Hypertensive macroangiopathy. Increased arterial pressure can provoke atherosclerotic changes in the cerebral arteries.
• Lenticulostriatal form. It is characteristic only for newborns and infants.
• Cerebral microangiopathy of the brain. In most cases, it occurs in the elderly. Degradation changes against the background of natural aging of the body cause the deposition of proteins inside the capillaries.
• Diabetic form of the disease.

What it is? The human body is designed in such a way that oxygen and nutrients are required for the normal functioning of all organs and systems. All this is delivered to the tissues along with the blood through small and large vessels. The largest number metabolic processes occurs in the brain, it is this organ that is characterized by the most developed network of blood vessels.

For some reason, changes occur in small vessels that lead to blockage of their lumens. This condition is called microangiopathy.

This pathological process can develop in any organ, but its cerebral form is considered the most dangerous. The normal functioning of the brain tissue is impossible without the supply of oxygen and glucose. With microangiopathy, there is a pronounced deficiency of these substances, which contributes to the appearance of signs of hypoxia. Violation of the patency of small vessels leads to a decrease in the volume of blood entering the cells of the brain or a complete cessation of blood supply. As a result, areas of gliosis are formed, where adhesions are formed from rapidly dividing glial cells. In the later stages, this condition becomes life-threatening.

The causes of microangiopathy

It takes a lot of time for the development of foci of gliosis and the complete overlap of the vascular lumens, so we can assume that the disease is characterized by slow development. The following factors contribute to the start of the pathological process:

• alcoholism and smoking;
• traumatic brain injury;
• diseases circulatory systemleading to increased blood clotting;
• chronic infections;
• endocrine disorders, especially diabetes;
• impaired liver and kidney function;
• oncological diseases;
• genetic anomalies in the structure of the walls of blood vessels;
• elderly age;
• depletion of the body.

Lesion of small vessels can occur with tissue necrosis, protein deficiency, increased permeability of vascular walls, violation of the integrity of the protective membranes of blood vessels. Ischemic microangiopathy develops when the lumen of blood vessels is blocked by blood clots. The disease is classified into 4 types. The amyloid cerebral form occurs when protein is deposited on the walls of blood vessels. It is typical for the elderly. The lenticulostriatal species, on the other hand, most often affects children. Experts consider this condition to be a variant of the norm, but the child should be under constant supervision of the attending physician.

Diabetic microangiopathy develops in the decompensated form of diabetes mellitus. The symptoms of the disease are progressive. The hypertensive type is typical for patients long time suffering from arterial hypertension. Any form of the disease is characterized by the production of increased amounts of glycoproteins and collagen, which leads to thickening of the capillary walls. This helps to reduce the rate of metabolic processes, cessation of tissue nutrition in certain areas of the brain, and the formation of foci of gliosis.

The clinical picture of the disease

The main signs of microangiopathy are headaches, memory impairment, general weakness and clouding of consciousness.

The appearance of such symptoms is associated with impaired blood circulation in small vessels, due to which substances that destroy brain tissue are produced. Due to the slow development of microangiopathy, the patient is not aware of the presence of the disease for a long time. Therefore, doctors most often face advanced forms of pathology. In the early stages, a person begins to tire quickly while doing the usual work. This symptom is accompanied by a severe headache that cannot be controlled with standard pain relievers.

Over time, astheno-neurotic syndrome develops, characterized by frequent mood swings, insomnia, chronic fatigue, decreased performance. The disease often leads to the formation of depressive disorders. In the later stages of microangiopathy, a person becomes forgetful, absent-minded, and intellectual abilities suffer. Character accompanying symptoms depends on the localization of the lesions. This may be a violation of coordination of movement, decreased visual acuity, change in the size of the pupils. A syndrome of vegetative polyneuritis may develop, in which thermoregulation is impaired, there is no reaction to pain.

Microangiopathy is accompanied by blood clotting disorders, which is why nose and gastrointestinal bleeding, hematuria and subcutaneous hemorrhages often occur in the later stages of the disease. The most dangerous condition is considered - hemorrhage in the brain tissue.

Diagnosis and treatment of the disease

Before making a definitive diagnosis, it is necessary to exclude other diseases with similar symptoms.

The examination begins with taking an anamnesis and conducting laboratory research: general and biochemical analysis blood, determination of its lipid composition, coagulogram. Doppler ultrasonography allows you to assess the state of blood vessels, detect the presence of blood clots and other abnormalities. Electroencephalography is used to detect abnormalities in the brain. An ophthalmological examination reveals changes in the state of the fundus. Microangiopathy of the brain is an indication for MRI and CT. These diagnostic procedures allow you to study the degree of pathological changes in the brain tissue and vascular walls, to detect foci of gliosis and enlargement of large arteries. They are also used to detect hemorrhagic stroke.

Treatment of the disease involves a complex approach, conservative therapy is aimed at eliminating the cause of microangiopathy and removing its main symptoms. In diabetes mellitus, drugs are prescribed to normalize blood glucose levels. Must take medicineshelping to lower blood pressure and keeping it within normal limits. Antihypoxants are prescribed in the presence of pronounced signs of oxygen starvation.

The course of treatment includes the use of drugs that lower the level of lipids, improve the blood supply to the brain tissues, and strengthen the walls of blood vessels. Antiplatelet agents and antioxidants are also prescribed. Drug treatment can be combined with physiotherapy, acupuncture, special exercises, massage and swimming. Comprehensive treatment contributes to the improvement general condition organism, increasing conductivity in the affected areas of the brain, eliminating the symptoms of the disease.

Advanced forms of the disease are treated surgically... Self-medication for microangiopathy of the brain is strictly prohibited. Selection of types and dosages of drugs is possible only on the basis of test results. This disease is considered dangerous to human health and life. If untreated, it can lead to disability and death. Early diagnosis pathological changes in the vessels of the brain and the detection of foci of gliosis allows you to avoid the development of severe complications. Full recovery from microangiopathy does not occur, however, it is quite possible to suspend the development of the disease. It is necessary to take all the medications prescribed by the doctor, follow all his recommendations, undergo regular examinations and treat chronic diseases.

Microangiopathy of the brain is a pathological condition that is characterized by a violation of cerebral blood supply due to irreversible changes in the vessels. The predisposing factors for the occurrence of microangiopathy are old age, malnutrition, hereditary predisposition.

Causes of microangiopathy

In the development of this disease, metabolic disorders and metabolic diseases play a significant role:

• atherosclerosis;
• obesity;
• type II diabetes mellitus;
• alcohol abuse;
• smoking;
• thrombosis;
• chronic liver and kidney disease;
• traumatic brain injury;
• anomalies of the vascular wall;
• a blood clotting disorder;
• vegetative-vascular dystonia.

Development of microangiopathy

In endocrine microangiopathy, the proteins of the vascular wall undergo glycosylation. Due to the increased concentration of glucose in the bloodstream, the configuration of the vessels is disrupted, and they cannot fully perform their functions.

The thickening of the walls leads to disruption of metabolic processes through the capillary membranes between substances dissolved in the blood, the intercellular space and cells. Therefore, such formidable complications of diabetes mellitus develop:

• signs of microangiopathy of the brain;
• retinopathy - a violation of the blood supply to the retina, disc optic nerve, lens;
• nephropathy - interruptions in the blood supply to the renal parenchyma, due to which the excretory function of the kidneys suffers;
• neuropathy - a disorder of the supply of nutrients to the neurovascular bundles;
• vascular angiopathy lower limbs, which is why the "diabetic foot" develops - necrosis of the soft tissues of the foot.

When atherosclerosis occurs, cholesterol is deposited on the walls of blood vessels in the form of plaques that block the lumen. This condition leads not only to disruption of the blood supply to organs and systems, but also to the development of blood clots. Complicating this pathological condition is the sudden death of the patient from blockage of pulmonary vessels, heart attacks, etc.

With malignant arterial hypertension the tone of the veins changes in a pathological rhythm, the mechanisms of its regulation are disrupted, as a result of which the diffusion of oxygen and nutrients into certain brain areas is disturbed. Processes occurring with the vascular wall:

• fibrinous swelling - impregnation of the vessel shell with fibrin fibers;
• hyalinosis - deposition of pathological hyaline protein in the capillary wall.

Microangiopathy of the brain with the presence of foci of hyalinosis is a serious disease, since the deposition of the pathological protein hyaline occurs not only in the cerebral vessels, but also in the renal glomeruli, which leads to shrinkage of the kidney.

Symptoms

Patients with cerebral microangiopathy syndrome of the brain are often worried about the following symptoms:

• weakness;
• decreased performance;
• headaches;
• noise in ears;
• convulsions;
• , visual impairment;
• dizziness;
• disorder of the process of falling asleep, insomnia, nightmares;
• decreased memory;
• violation of precise coordination of movements - a wobbly gait, deterioration of fine motor skills;
• numbness of the hands;
• nosebleeds.

Patients often associate symptoms with age-related changes, therefore, the disease is diagnosed in the late stages, when the treatment cannot bring sufficient effect.

Important! Consult a doctor at the first signs of deterioration in health, manifestation of neurological symptoms.

Diagnosis of cerebral microangiopathy

Before starting treatment for cerebral microangiopathy of the brain, an examination is prescribed:

1. General blood analysis.
2. Biochemical blood test - determination of cholesterol, high and low density lipoproteins, glucose, glycosylated hemoglobin.
3. Coagulogram - indicators of coagulation and anticoagulation systems, prothrombin index.
4. ... During the procedure, the alleged place of blood supply disturbance is visualized - foci of microangiopathy, ischemic lesions, the state of the brain tissues, the vascular wall is assessed.
5. Angiography - visualization of cerebral blood flow.
6. Electroencephalography - recording the electrical activity of the brain.

Treatment

Treatment of vascular microangiopathy of the brain should be complex and long-term. Patients are shown:

1. Restricted diet simple carbohydrates, fatty foods, salt.
2. Correction of blood sugar levels: taking tablets of sugar-lowering drugs.
3. Correction of cholesterol levels with drugs Rosuvastatin, Atorvastatin.
4. Normalization of blood pressure levels: Enalapril, Captopril, Metoprolol, Bisprolol.
5. Appointment of nootropov - substances that improve metabolism in the brain (Piracetam, Cerebrolysin, Nootropil).
6. Correction of conditions frolicking due to microangiopathy - drugs that affect liver function - hapatoprotectors.

Kinesitherapy is recommended for patients with manifestation of cerebral microangiopathy - treatment with moderate, dosed physical activity... With thrombosis, agents are shown that affect the rheological properties of the blood (Clopidogrel, Aspirin, Aspecard). In severe forms of pathology, specialized help from vascular surgeons may be required.

Angiopathy of the brain is a vascular disease that various reasons causes their tone, as a result of which the brain cells cease to be supplied with blood. This is a very serious pathology that can lead to hemorrhage and even death. In some cases, we can talk about a disease such as microangiopathy of the brain. What it is? In this case, the work of microscopic capillaries is disrupted. Let's consider this disease in more detail.

Characteristics of pathology

Many have heard, and some have even encountered such a disease as cerebral microangiopathy. What is it? This is a pathological process that affects the capillaries and small vessels, acquiring a chronic form. The blood circulation in the brain is disturbed. Since oxygen and glucose are responsible for normal blood flow, a long-term shortage of these substances leads to disruption of the small vessels of the brain.

Forms of microangiopathy

Such a pathology of the brain occurs as a result of disruption of the work of the smallest vessels. This does not appear immediately, so on early stage it is very difficult to diagnose such a disease.

Cerebral microangiopathy occurs mainly in the elderly. Special group at risk are those with Alzheimer's disease. With such a disease, amyloid (glycoprotein) begins to accumulate on the walls of the veins. It is also worth noting that the pathology is difficult to diagnose and treat.

Lenticulostriatal microangiopathy often affects children and is not a disease, but a feature of the circulatory system. Constant supervision is necessary.

Diabetic microangiopathy is caused by a circulatory disorder in the brain that causes diabetes.

Hypertensive microangiopathy is caused by a malfunction of the circulatory system arising from hypertension... It is necessary to keep blood pressure under control and avoid sudden surges.

Causes of the disease

The development of microangiopathy occurs against the background of other diseases. It can be diabetes mellitus, oncology, liver pathology, hemolysis.

Among the main reasons are the following:

• viral infections (measles, rubella);
• pathologies that contribute to blood damage;
• diabetes;
• hypertension;
• elderly age;
• hereditary pathologies that cause vascular tone;
• various injuries;
• severe intoxication;
• abuse of bad habits.

Most often, pathology develops as a result of the following processes:

• Necrosis is the death of body tissues and cells.
• Hyalinosis is a lack of protein against the background of hyaline deposition.
• Increased vascular permeability. The resulting fibers and structural elements connective tissue are undergoing irreversible changes.
• Thrombosis, characterized by the formation of a blood clot in the lumen of a vessel, resulting in impaired blood flow.
• Dysfunction of the vascular endothelium, which leads to their spasm. In this condition, the production of antithrombin, prostacyclin decreases, and the concentration of thromboxane increases.

Characteristic signs of microangiopathy

The clinical manifestations of the disease depend on the specifics of organs and tissues, the damage of which occurred under the influence of certain external factors... Patients most often complain of pain and burning in the legs, decreased vision, bleeding from the stomach and nose, the development of intermittent claudication, dry skin of the feet, hemoptysis.

Thus, the following signs of microangiopathy are distinguished:

• the integrity of small vessels is disturbed;
• renal failure develops;
• red blood cells are damaged;
• the process of blood clotting is disrupted;
• high probability of occurrence

Symptoms of the disease

Microangiopathy of the brain has the following symptoms: the patient begins to complain of memory impairment, clouding of consciousness, causeless weakness and headaches. They appear due to the fact that blood circulation is disturbed in the capillaries of the brain. The resulting damage to the walls of small vessels activates the oxidative processes of lipids, free radicals are formed, which have a destructive effect on brain cells.

As the patient progresses, he becomes inattentive and forgetful. He develops a convergence disorder, the diameter of the pupils becomes different, and visual functions deteriorate. In addition, there are frequent nose and stomach bleeding, discomfort in the legs at rest, dryness and peeling of the skin of the feet, blood clots in the urine.

Diagnostics

If there is a suspicion of brain pathology, it is important to diagnose where the foci of microangiopathy are located and what is the degree of damage to the vascular walls. For this, the following diagnostic methods are used:

• MRI of the brain;
• nuclear magnetic resonance;
• ultrasound dopplerography.

To get as much information as possible, they use such a rather safe procedure for the human body as an MRI of the brain, the price of which bites a little. This diagnostic method is considered the most popular. It allows you to identify such signs of the disease as cerebral atrophy, leukoaraiosis, microscopic hemorrhages, lacunar infarctions. MRI of the brain, the price of which depends on the amount of contrast agent, allows you to make the correct diagnosis. If the patient weighs less than 69 kg, this figure is 2700 rubles, from 70 to 99 kg - 3200 rubles, from 100 kg and more - 4400 rubles.

The method of magnetic nuclear resonance allows you to study the brain tissue itself and the vascular network. In this case, signs of arterial hypoplasia are clearly visible. The foci of heart attacks that arise due to vascular occlusion, hypoperfusion of the brain, microscopic hemorrhages are easily visible.

Method ultrasound doppler allows you to identify abnormalities in blood vessels, blockages or narrowing of the lumen.

Treatment

When they are diagnosed with cerebral microangiopathy, patients do not always understand what it is and whether it can be cured. The doctor usually prescribes complex therapy.

First of all, the patient should take medications that normalize blood pressure. To eliminate the lack of oxygen in the brain, antihypoxants are used, for example "Emoxipin". It is also important to adjust lipid levels by using statins, fibrates, bile acid sequestrants. It can be the following drugs: "Atorvastatin", "Simvastatin", "Rosuvastatin".

Also, if microangiopathy is diagnosed, treatment should be carried out using nootropics that improve brain nutrition. These are Piracetam, Nootropil, Cerebrozilin, Encephabol. To normalize blood circulation, drugs are used nicotinic acid: "Picammilon", "Xantilone nicotinate".

Output

Thus, we have examined such a disease as cerebral microangiopathy. You now know what it is. This is a serious pathology that requires immediate intervention. The sooner it is clarified in what place the disease is localized and what is the degree of vascular damage, the easier it will be to minimize the consequences of such a disease.