Defining Cerebrovascular Disease:
Cerebrovascular disease, also referred to as stroke, affects about 1.2 to 2.5 out of every one-hundred thousand children every year. The Centers for Disease Control (CDC) states the over one-hundred and sixty-two thousand cerebrovascular-related deaths occurred in America in 2003 alone; the majority of them among persons age sixty-five and older. A stroke may happen to persons of any age, although children who experience a stroke commonly have one between the ages of one and five. Cerebrovascular disease is any disorder that affects the blood vessels that provide oxygen rich blood to a person's brain and face. The term is commonly used to describe a hardening of the person's carotid arteries which supply their brain with blood.
The form of cerebrovascular disease that is commonly referred to us similar to coronary artery disease, also called, 'Ischemic disease,' one which causes a lack of blood flow. Because the disease occurs in blood vessels located outside of a person's heart, the condition is also considered to be a form of peripheral artery disease. Ischaemic cerebrovascular disease is a particularly dangerous disease because many times there are no symptoms associated with it. The disease may cause stroke due to plaque rupture or pieces of plaque which have blocked a narrowed artery, or when the person's carotid artery has become completely blocked by plaque buildup.
Hemorrhagic cerebrovascular disease, unlike ischemic cerebrovascular disease, happens when a person's brain receives too much blood. Hemorrhagic cerebrovascular disease happens when a blood vessel in the person's brain ruptures. Symptoms could take from hours up to days to present themselves, or could become apparent rather abruptly and cause the person to experience a coma.
While it may be difficult to detect a form of cerebrovascular disease, there are some known risk factors that can alert a doctor. Risk factors that cannot be controlled include a person's age, ethnicity, gender, and family history. There are risk factors that can be controlled; these include diet, smoking, obesity, exercise, and uncontrolled diabetes. Additional risk factors that can be controlled include high blood pressure, emotional factors, and unhealthy cholesterol levels.
A stroke may occur when a person's blood supply to their brain is cut off. The cause may be a blockage of the blood vessel, referred to as an, 'Ischemic Stroke,' or due to a blood vessel which has burst, referred to as a, 'Hemorrhagic Stroke.' When a person's blood vessel that supplies blood to their brain bursts, it prevents normal blood flow to their brain and permits blood to leak into an area of their brain, destroying tissue. In children, the most common cause of stroke is congenital cyanotic heart disease and sickle cell disease. Drugs; such as amphetamines and cocaine, may narrow a person's blood vessels, causing a stroke.
Symptoms of Cerebrovascular Disease
The symptoms of a stroke in children can vary depending upon where the supply of blood has been cut off from their brain, or where the bleeding has happened. A number of conditions can lead to a stroke that results in emboli, or clots which form in a person's heart, that then break free and travel through their arteries to their brain. There are several symptoms that a person may experience; these symptoms include:
Vision impairment, particularly blindness or vision field problems in one eye
Depression, mood and behavioral disturbances
Impaired speech and verbal comprehension
Paralysis affecting only one side of the body
Drooling or difficulty eating or swallowing
Coma or lower level of consciousness
Partial loss of vision or hearing
Loss of balance
Symptoms of a stroke always involve neurological functions. The fact that stroke causes damage to a person's brain tissues means that the neurological damages done are more likely to be permanent. While some of the brain cells in a person's brain die with resulting permanent damage, other cells may only be injured and eventually recover.
The symptoms a person may experience in association with hemorrhagic disease depends on the extent of the bleeding involved. For the most part, there are two causes of hemorrhagic disease - intra-cerebral hemorrhage, and sub-arachnoid hemorrhage. Intra-cerebral hemorrhage happens when the small arteries in the person's brain bleed directly into their brain, causing an accumulation of blood over a period of minutes to hours, during which the person's symptoms increasingly worsen. Symptoms the person can experience include lethargy, headaches, nausea, and vomiting. A sub-arachnoid hemorrhage happens when a blood vessel bursts, commonly due to an aneurysm or a defect in the blood vessel itself. Blood from the ruptured blood vessel spreads throughout the person's cranial cavity, potentially resulting in either coma or even death. Symptoms the person may experience include:
Difficulty speaking or understanding
Severe onset of headache
Loss of memory
Pain in the neck
Diagnosing Cerebrovascular Disease
A doctor commonly diagnoses a stroke through a physical examination of the person affected as well as a description of the symptoms they are experiencing. A doctor attempts to find the location in the person's brain that has experienced damage through testing involving a CT or MRI scans, which may also help to rule out brain hemorrhage or tumors. A doctor considers the person's age, as well as any vascular, cardiac, or brain conditions the person may have. The doctor will attempt to determine whether the stroke was either hemorrhagic or ischemic. Ischemic strokes are often followed by additional strokes unless the problem is treated. A doctor may order an EEG if the person has experienced seizure activity, or an echocardiogram if they have a pre-existing heart condition. A doctor will attempt to rule out things such as encephalitis, meningitis, bleeding inside the person's skull, neurodegenerative disorders, brain abscess, or migraines as causes of the stroke symptoms the person is experiencing.
There are a number of tests that a doctor can use to assist in reaching a diagnosis of cerebrovascular disease. The majority of the tests involved are designed to detect carotid artery disease (CAD) before the person experiences a stroke. CAD, unlike hemorrhagic cerebrovascular disease, often progresses for many years while presenting no symptoms at all, accounting for approximately ninety-five percent of all cases of cerebrovascular disease.
Treating Cerebrovascular Disease
Treatment for cerebrovascular disease depends on the individual, the nature of the disease, and the severity of the disease. For example; the goals for treating hemorrhagic disease is to stop the bleeding associated with it while preventing a recurrence of the bleeding. The goals can be achieved through surgery, catheters, and wire mesh stents. Prompt treatment of hemorrhagic disease may prevent more serious damage to the person affected.
The goal in treating carotid artery disease (CAD) is prevention of an embolism, which is a piece of plaque or a blood clot that has the potential to break away from the wall of the person's artery and travel along with their blood, possibly becoming lodged in a smaller artery. Persons with CAD have the risk of an embolism that may block an artery inside their brain, causing a stroke. A doctor can treat CAD with medication and promotion of lifestyle changes, or through techniques that are more invasive such as catheters and surgery. Antiplatelet medications can help prevent embolisms in persons with CAD through inhibition of the blood clotting process, reducing the person's risk of blood clot formation and stroke. Common Aspirin is an antiplatelet drug, as well as the first line of therapy for CAD.
Medical research continues to show the value of cholesterol controlling medications in reducing the risk of cerebrovascular and cardiovascular diseases. The Food and Drug Administration, in 2005, approved a simple blood test called the, 'PLAC test,' that screens for risk of ischemic stroke. The PLAC test is available through a doctor's office today. A doctor may suggest that persons with CAD make some different lifestyle changes:
Improving blood cholesterol levels (lowering LDL and raising HDL)
Eating a heart-healthy diet, low in trans and saturated fat
Avoiding chronic stress or anger
Maintaining a healthy weight
Controlling blood pressure
Getting regular exercise
Controlling blood sugar
Persons who do not respond to medical treatment or have significant narrowing in their arteries may receive procedures to treat their carotid artery disease that includes either carotid artery stenting, or carotid endarterectomy. Carotid endarterectomy involves an open surgical procedure where the person's carotid artery is exposed through an incision on the side of their neck. The person's artery is then clamped, and the atherosclerotic material is surgically removed. Greater than ninety-five percent of persons who experience this surgery are discharged the day after undergoing the procedure.
Carotid artery stenting is a fairly recent approach to preventing stroke in persons with carotid artery disease. The procedure involves insertion of a catheter into the person's carotid artery. A balloon is used to crush the plaque deposit that is blocking the person's carotid artery, after which a, 'stent,' or wire mesh tube, is implanted in the person's artery in order to keep it open. Some stents are coated in medications to prevent clotting and keep the person's artery open. A stent reduces the risk of a piece of plaque breaking off and traveling to the person's brain. A number of person's who experience this procedure go home the day after undergoing it, although some stay in an intensive care unit due to a resulting loss of blood pressure and instability in their heart rate.