Cerebral vascular pathology or cerebrovascular disease is that which affects the intracranial blood vessels. We have a sufficiently well-developed vascular network that, from the cranial base, reaches to the far cerebral cortex. This is done through multiple bifurcations that give rise to smaller and smaller vessels that end in the sulci of the cerebral convolutions, with a size of a few millimeters. In addition, there are communicating arteries that join the arterial networks of both cerebral hemispheres, forming the polygon of Willis at the cranial base.
Pathologies included in cerebrovascular diseases
The most frequent cerebral arterial pathologies are:
1) Malformative. These are aneurysms and arteriovenous malformations. In this type of cerebral vascular pathologies, the arterial wall is affected in the middle and outer layer.
2) Degenerative. This is arteriosclerosis. The involvement of the arterial wall occurs in the inner layer, with partial or complete obstruction of the arterial lumen, by deposition of arteriosclerotic material.
Symptoms of cerebral vascular pathology or cerebrovascular disease
Malformative vascular pathologies become evident in middle age with cerebral hemorrhages of varying intensity. The symptoms caused are acute and intense headache accompanied by varying degrees of altered consciousness, and may even lead to sudden death. The most common is subarachnoid hemorrhage, which usually presents without serious accompanying neuralgic signs, allowing the patient to be transferred to a hospital for urgent radiological examinations and appropriate treatment.
Degenerative vascular pathologies are more typical of the elderly, and are manifested by ischemic phenomena. The symptoms are headache associated with signs of transient neurological deficit (hemiparesis, dysphasia, etc.). If an intracerebral hematoma occurs, the neurological deficit will be more severe and the alteration of consciousness may lead to coma.
Specialists involved in the treatment of cerebrovascular diseases
Currently, the treatment of cerebral vascular pathology in large centers is carried out by an interdisciplinary unit made up of a neurologist, neuroradiologist, neurosurgeon and neurosurgeon, as well as ICU and rehabilitation.
The consensus among the specialists determines the type of treatment to be administered. The neurosurgery expert is essential in those cases in which there has been a hematoma that produces a significant displacement of the nerve structures through the midline, which is synonymous with death within a few hours.
Aneurysms fall within the field of interventional neuroradiologists, who use endovascular treatments by means of coils or stents to exclude the aneurysm from blood circulation. In contrast, neurosurgeons perform this exclusion through a craniectomy, closing the neck of the aneurysm outside the artery, using clips. Cerebral arteriovenous malformations fall within the field of the neurosurgeon who often needs the help of the neuroradiologist and/or radiosurgeon for the most complicated cases.
Are the results favorable?
Cerebral vascular pathology is the first cause of mortality in women and the second in men. In addition, survivors are left with varying degrees of disability, which is a major problem for their families and a huge health care expense.
The results of the treatment of aneurysms and arteriovenous malformations have improved in recent years due to the perfection of microscopic surgery techniques, anesthetic advances and ICU care.
Patients with degenerative vascular pathology have benefited from the creation of stroke units in large hospitals. These units centralize such patients with symptoms of cerebral alteration and, within a few hours, they undergo radiological examinations that lead to a diagnosis and, as a matter of urgency, medical or endovascular treatment is applied. This speed of treatment has not only reduced mortality but also the severity of possible sequelae, reducing the group of patients who, after a stroke, are left in a situation of permanent dependence.