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Dyscirculatory encephalopathy - Information Review
Last reviewed: 12.07.2025
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Dyscirculatory encephalopathy is a slowly progressive dysfunction of the brain that occurs as a result of diffuse and/or small focal damage to brain tissue in conditions of long-term insufficiency of cerebral blood supply.
Synonyms: cerebrovascular insufficiency, chronic cerebral ischemia, slowly progressive cerebrovascular accident, chronic ischemic disease of the brain, cerebrovascular insufficiency, vascular encephalopathy, atherosclerotic encephalopathy, hypertensive encephalopathy, atherosclerotic angioencephalopathy, vascular (atherosclerotic) parkinsonism, vascular (late) epilepsy, vascular dementia.
Of the above-mentioned synonyms, the term “dyscirculatory encephalopathy” has entered into domestic neurological practice most widely, and retains its meaning to this day.
ICD-10 codes
Cerebrovascular diseases are coded according to ICD-10 in sections 160-169. The concept of "chronic cerebral circulatory insufficiency" is not included in ICD-10. Dyscirculatory encephalopathy (chronic cerebral circulatory insufficiency) can be coded in section 167. Other cerebrovascular diseases: 167.3. Progressive vascular leukoencephalopathy (Binswanger's disease) and 167.8. Other specified cerebrovascular diseases, subsection "Cerebral ischemia (chronic)". The remaining codes from this section reflect either only the presence of vascular pathology without clinical manifestations (aneurysm of a vessel without rupture, cerebral atherosclerosis, Moyamoya disease, etc.), or the development of acute pathology (hypertensive encephalopathy).
To indicate the cause of cerebrovascular insufficiency, you can use additional codes marked with an asterisk: arterial hypertension (110*, 115*), arterial hypotension (195*), heart disease (121*, 147*), cerebral atherosclerosis (167.2*), cerebral amyloid angiopathy (168.0*), cerebral arteritis in infectious, parasitic and other diseases classified in other categories (168.1*, 168.2*).
An additional code (F01*) can also be used to indicate the presence of vascular dementia.
Sections 165-166 (according to ICD-10) “Occlusions or stenosis of precerebral (cerebral) arteries that do not lead to cerebral infarction” are used to code patients with an asymptomatic course of this pathology.
Epidemiology of cerebrovascular insufficiency
Due to the noted difficulties and discrepancies in the definition of cerebrovascular insufficiency, the ambiguity of the interpretation of complaints, the non-specificity of both clinical manifestations and changes detected by MRI, there are no adequate data on the prevalence of chronic cerebral circulatory insufficiency.
To some extent, it is possible to judge the frequency of chronic forms of cerebrovascular diseases based on epidemiological indicators of the prevalence of stroke, since acute cerebrovascular accident, as a rule, develops on a background prepared by chronic ischemia, and this process continues to increase in the post-stroke period.
[ Causes of cerebrovascular insufficiency
The causes of both acute and chronic cerebrovascular accidents are the same. Atherosclerosis and arterial hypertension are considered among the main etiologic factors; a combination of these two conditions is often detected. Other cardiovascular diseases, especially those accompanied by signs of chronic heart failure, heart rhythm disturbances (both constant and paroxysmal forms of arrhythmia), which often lead to a drop in systemic hemodynamics, can also lead to chronic cerebrovascular insufficiency. Anomalies of the vessels of the brain, neck, shoulder girdle, aorta, especially its arch, are also important; they may not manifest themselves until an atherosclerotic, hypertensive or other acquired process develops in these vessels.
Pathogenesis of cerebrovascular insufficiency
The above diseases and pathological conditions lead to the development of chronic cerebral hypoperfusion, i.e. to a long-term under-receipt of the brain of the main metabolic substrates (oxygen and glucose) delivered by the blood flow. With slow progression of brain dysfunction developing in patients with chronic cerebral circulatory insufficiency, pathological processes unfold primarily at the level of small cerebral arteries (cerebral microangiopathy). Widespread damage to small arteries causes diffuse bilateral ischemic damage, mainly of the white matter, and multiple lacunar infarctions in the deep parts of the brain. This leads to disruption of normal brain function and the development of non-specific clinical manifestations - encephalopathy.
Symptoms of cerebrovascular insufficiency
The main symptoms of discirculatory encephalopathy are: disturbances in the emotional sphere, polymorphic movement disorders, deterioration of memory and learning ability, gradually leading to maladaptation of patients. Clinical features of chronic cerebral ischemia are progressive course, staging, syndromicity.
In domestic neurology, for quite a long time, initial manifestations of cerebral circulatory insufficiency were classified as chronic cerebral circulatory insufficiency along with discirculatory encephalopathy. Currently, it is considered unfounded to distinguish such a syndrome as "initial manifestations of insufficient cerebral blood supply", given the non-specificity of the presented complaints of an asthenic nature and the frequent overdiagnosis of the vascular genesis of these manifestations. The presence of headache, dizziness (non-systemic), memory loss, sleep disturbance, noise in the head, ringing in the ears, blurred vision, general weakness, increased fatigue, decreased performance and emotional lability in addition to chronic cerebral circulatory insufficiency may indicate other diseases and conditions.
Where does it hurt?
Screening
To detect cerebrovascular insufficiency, it is advisable to conduct, if not a mass screening examination, then at least an examination of individuals with the main risk factors (arterial hypertension, atherosclerosis, diabetes mellitus, heart disease and peripheral vascular disease). Screening examination should include auscultation of the carotid arteries, ultrasound examination of the main arteries of the head, neuroimaging (MRI) and neuropsychological testing. It is believed that cerebrovascular insufficiency is present in 80% of patients with stenotic lesions of the main arteries of the head, and stenoses are often asymptomatic up to a certain point, but they are capable of causing hemodynamic restructuring of the arteries in the area located distal to atherosclerotic stenoses (echeloned atherosclerotic brain damage), leading to the progression of cerebrovascular pathology.
Diagnosis of cerebrovascular insufficiency
To diagnose chronic cerebral circulatory insufficiency, it is necessary to establish a connection between clinical manifestations and pathology of cerebral vessels. For the correct interpretation of the detected changes, careful collection of anamnesis with an assessment of the previous course of the disease and dynamic observation of patients are very important. It is necessary to keep in mind the inverse relationship between the severity of complaints and neurological symptoms and the parallelism of clinical and paraclinical signs during the progression of cerebral vascular insufficiency.
It is advisable to use clinical tests and scales taking into account the most common clinical manifestations of this pathology (assessment of balance and gait, identification of emotional and personality disorders, neuropsychological testing).
What do need to examine?
What tests are needed?
Who to contact?
Treatment of cerebrovascular insufficiency
The goal of treating cerebrovascular insufficiency is stabilization, stopping the destructive process of cerebral ischemia, slowing the rate of progression, activating sanogenetic mechanisms of compensation of functions, preventing both primary and recurrent stroke, treating underlying underlying diseases and concomitant somatic processes.
Treatment of acutely developed (or exacerbated) chronic somatic disease is considered mandatory, since against this background, the phenomena of chronic cerebral circulatory failure significantly increase. They, in combination with dysmetabolic and hypoxic encephalopathy, begin to dominate the clinical picture, leading to incorrect diagnosis, non-specialized hospitalization and inadequate treatment.
Drugs
Forecast
The prognosis depends on the stage of discirculatory encephalopathy. The same stages can be used to assess the rate of disease progression and the effectiveness of treatment. The main unfavorable factors are severe cognitive disorders, often occurring in parallel with an increase in episodes of falls and the risk of injury, such as craniocerebral trauma and fractures of the extremities (primarily the femoral neck), which create additional medical and social problems.