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Dyscirculatory encephalopathy: a review of information
Last reviewed: 23.04.2024
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Dyscirculatory encephalopathy is a slowly progressive brain dysfunction that has arisen as a result of diffuse and / or small-focal damage to the brain tissue in conditions of long-term insufficiency of the cerebral blood supply.
Synonyms: dyscirculatory encephalopathy, chronic cerebral ischemia, slow progressive cerebral circulation, chronic ischemic brain disease, cerebrovascular insufficiency, vascular encephalopathy, atherosclerotic encephalopathy, hypertensive encephalopathy, atherosclerotic angioencephalopathy, vascular (atherosclerotic) parkinsonism, vascular (late) epilepsy, vascular dementia.
The most widely used of the above synonyms in domestic neurological practice is the term "dyscirculatory encephalopathy", which retains its importance for today.
ICD-10 codes
Cerebrovascular diseases are coded according to ICD-10 in the headings 160-169. The concept of "chronic cerebral circulatory failure" in ICD-10 is absent. Coding discirculatory encephalopathy (chronic cerebral circulatory failure) can be found in heading 167. Other cerebrovascular diseases: 167.3. Progressing vascular leukoencephalopathy (Binswanger's disease) and 167.8. Other specified cerebrovascular diseases, subheading "Ischemia of the brain (chronic)". The rest of the codes in this section reflect only the presence of vascular pathology without clinical manifestations (aneurysm of the vessel without rupture, cerebral atherosclerosis, Moyamoy's disease, etc.) or the development of acute pathology (hypertensive encephalopathy).
To indicate the cause of dyscirculatory encephalopathy, additional codes marked with an asterisk may be used: arterial hypertension (1101, 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 elsewhere (168.1 *, 168.2 *).
An additional code (F01 *) can also be used to indicate the presence of vascular dementia.
Headings 165-166 (on ICD-10) "Occlusion or stenosis of precerebral (cerebral) arteries that do not lead to cerebral infarction" is used to coding patients with asymptomatic course of this pathology.
Epidemiology of dyscirculatory encephalopathy
Due to the noted difficulties and differences in the definition of discirculatory encephalopathy, the ambiguity in the treatment of complaints, the non-specificity of both clinical manifestations and the changes detected in MRI, there are no adequate data on the prevalence of chronic cerebral circulatory insufficiency.
To some extent, judging the frequency of chronic forms of cerebrovascular disease can be based on epidemiological indicators of the prevalence of stroke, because acute disturbance of cerebral circulation, as a rule? Develops on a prepared chronic ischemia background, and this process continues to grow in the post-sultan period.
[Causes of discirculatory encephalopathy
The causes of both acute and chronic disorders of cerebral circulation are one. Among the main etiological factors, atherosclerosis and arterial hypertension are considered, a combination of these two conditions is often revealed. Other cardiovascular diseases can lead to chronic cerebral circulatory insufficiency, especially accompanied by signs of chronic heart failure, cardiac rhythm disturbances (both permanent and paroxysmal forms of arrhythmia), often leading to a drop in systemic hemodynamics. The anomaly of the vessels of the brain, neck, shoulder girdle, aorta, especially its arches, which may not manifest before the development of atherosclerotic vessels, is also important. Hypertensive or other acquired process.
Pathogenesis of discirculatory encephalopathy
The above-mentioned diseases and pathological conditions lead to the development of chronic brain hypoperfusion, that is, to prolonged failure of the brain to receive the main metabolic substrates (oxygen and glucose) delivered by the bloodstream. With the 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). The widespread defeat of small arteries causes diffuse bilateral ischemic lesions, mostly white matter, and multiple lacunar infarctions in the deep regions of the brain. This leads to disruption of normal brain functioning and development of nonspecific clinical manifestations - encephalopathy.
Symptoms of dyscirculatory encephalopathy
The main symptoms of discirculatory encephalopathy: emotional disorders, polymorphic motor disorders, memory impairment and learning ability, gradually leading to maladaptation of patients. Clinical features of chronic cerebral ischemia - progressive course, staging, syndromic.
In domestic neurology for a long time to chronic insufficiency of cerebral circulation, along with discirculatory encephalopathy, the initial manifestations of cerebral circulatory insufficiency were also included. At present, it is considered unfounded to isolate such a syndrome as "initial manifestations of cerebral blood supply deficiency," given the non-specific nature of the asthenic complaints presented and the frequent overdiagnosis of the vascular genesis of these manifestations. The presence of headache, dizziness (non-systemic nature), memory loss, sleep disturbance, head noise, ringing in the ears, blurred vision, general weakness, increased fatigue, decreased efficiency and emotional lability, in addition to chronic cerebral circulatory failure, may indicate other diseases and conditions .
Where does it hurt?
Screening
To identify dyscirculatory encephalopathy, it is advisable to carry out, if not a mass screening survey, then at least a survey of people who have major risk factors (arterial hypertension, atherosclerosis, diabetes, heart and peripheral vascular disease). The 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 discirculatory encephalopathy is present in 80% of patients with stenosing lesions of the main arteries of the head, and stenoses are often asymptomatic until a certain point, but they are able to cause hemodynamic restructuring of the arteries at a site distal to atherosclerotic stenoses (echeloned atherosclerotic brain damage) to the progression of cerebrovascular pathology.
Diagnosis of dyscirculatory encephalopathy
To diagnose chronic cerebral circulatory insufficiency, it is necessary to establish a connection between clinical manifestations and the pathology of cerebral vessels. For a correct interpretation of the revealed changes, careful collection of an anamnesis with an assessment of the previous course of the disease and dynamic observation of the patients is very important. It should be borne in mind the inverse relationship between the severity of complaints and neurological symptoms and the parallelism of clinical and paraclinical features in the progression of vascular cerebral insufficiency.
It is advisable to use clinical tests and scales taking into account the most common clinical manifestations in this pathology (balance and walking assessment, emotional and personality disorders, neuropsychological testing).
What do need to examine?
What tests are needed?
Who to contact?
Treatment of dyscirculatory encephalopathy
The goal of treatment of discirculatory encephalopathy is stabilization, suspension of the destructive process of brain ischemia, slowing down of progression, activation of sanogenetic mechanisms of compensation of functions, prevention of both primary and repeated stroke, therapy of basic background diseases and concomitant somatic processes.
Obligatory treatment is considered to be acute (or exacerbated) chronic medical illness, since on this background the phenomena of chronic cerebral circulatory insufficiency increase significantly. They, in combination with dismetabolic and hypoxic encephalopathy, begin to dominate the clinical picture, leading to incorrect diagnosis, non-core hospitalization and inadequate treatment.
Drugs
Forecast
The prognosis depends on the stage of dyscirculatory encephalopathy. At the same stages, it is possible to assess the rate of progression of the disease and the effectiveness of the treatment. The main adverse factors are pronounced cognitive disorders, often accompanied by an increase in episodes of falling and the risk of injury, such as craniocerebral trauma, and fractures of the limbs (primarily the femoral neck), which create additional medical and social problems.