Modern approach to the diagnosis and treatment of chronic cerebral ischemia. Signs and treatment of hypertensive encephalopathy Diagnosis according to ICD 10 167.8 transcript

Discirculatory encephalopathy is a slowly progressive brain dysfunction resulting from diffuse and/or small-focal damage to brain tissue in conditions of long-term insufficiency of cerebral blood supply.

Synonyms: dyscirculatory encephalopathy, chronic cerebral ischemia, slowly progressive cerebrovascular accident, chronic ischemic disease brain, cerebrovascular insufficiency, vascular encephalopathy, atherosclerotic encephalopathy, hypertensive encephalopathy, atherosclerotic angioencephalopathy, vascular (atherosclerotic) parkinsonism, vascular (late-onset) epilepsy, vascular dementia.

The most widely used of the above synonyms in domestic neurological practice is the term “dyscirculatory encephalopathy,” which retains its meaning to this day.

ICD-10 codes

Cerebrovascular diseases are coded according to ICD-10 in categories 160-169. The concept " chronic failure cerebral circulation" is absent in ICD-10. Discirculatory encephalopathy (chronic cerebrovascular 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(vessel aneurysm without rupture, cerebral atherosclerosis, Moyamoya disease, etc.), or the development of acute pathology (hypertensive encephalopathy).

An additional code (F01*) can also be used to indicate the presence vascular dementia.

Rubrics 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.

ICD-10 code

G93.4 Encephalopathy, unspecified

I67.4 Hypertensive encephalopathy

Epidemiology of dyscirculatory encephalopathy

Due to the noted difficulties and discrepancies in the definition of discirculatory encephalopathy, the ambiguity in 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 cerebrovascular insufficiency.

To some extent judge the frequency chronic forms cerebrovascular diseases is possible, based on epidemiological indicators of the prevalence of stroke, since acute cerebrovascular accident, as a rule? develops against a background prepared by chronic ischemia, and this process continues to increase in the post-stroke period.

Causes of dyscirculatory encephalopathy

The causes of both acute and chronic cerebrovascular accidents are the same. Among the main etiological factors atherosclerosis and arterial hypertension are considered, and a combination of these 2 conditions is often identified. Other diseases can also lead to chronic cerebrovascular insufficiency of cardio-vascular system, especially accompanied by signs of chronic heart failure, heart rhythm disturbances (both permanent and paroxysmal forms of arrhythmia), often leading to a drop in systemic hemodynamics. Anomalies in the vessels of the brain, neck, shoulder girdle, and aorta, especially its arch, are also important, which may not appear until atherosclerosis develops in these vessels. hypertensive or other acquired process.

Pathogenesis of dyscirculatory encephalopathy

The above diseases and pathological conditions lead to the development of chronic brain hypoperfusion, that is, to a long-term lack of supply by the brain of the main metabolic substrates (oxygen and glucose) delivered by the blood flow. With the slow progression of brain dysfunction developing in patients with chronic cerebrovascular insufficiency, pathological processes develop primarily at the level of small cerebral arteries (cerebral microangiopathy). Extensive small artery disease causes diffuse bilateral ischemic damage, mainly in the white matter, and multiple lacunar infarcts in the deep parts of the brain. This leads to disruption of normal brain function and the development of nonspecific clinical manifestations - encephalopathy.

Symptoms of dyscirculatory encephalopathy

The main symptoms of dyscirculatory encephalopathy: disturbances in emotional sphere, polymorphic movement disorders, deterioration of memory and learning ability, gradually leading to maladjustment of patients. Clinical features chronic ischemia brain - progressive course, staged, syndromic.

In domestic neurology, for quite a long time, the initial manifestations of cerebral circulatory failure were classified as chronic cerebrovascular insufficiency along with dyscirculatory encephalopathy. Currently, it is considered unfounded to identify such a syndrome as “initial manifestations of insufficiency of blood supply to the brain,” given the non-specificity of the complaints of an asthenic nature and the frequent overdiagnosis of the vascular origin of these manifestations. The presence of headache, dizziness (non-systemic), memory loss, sleep disturbances, 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 failure, may indicate other diseases and conditions .

Screening

To identify discirculatory encephalopathy, it is advisable to carry out, if not a mass screening examination, then at least an examination of people with major risk factors (arterial hypertension, atherosclerosis, diabetes mellitus, heart and peripheral vascular diseases). Screening examination should include auscultation of the carotid arteries, ultrasound examination of the great arteries of the head, neuroimaging (MRI) and neuropsychological testing. It is believed that discirculatory encephalopathy 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 (layered atherosclerotic lesion of the brain), leading to to the progression of cerebrovascular pathology.

Diagnosis of dyscirculatory encephalopathy

To diagnose chronic cerebral circulatory failure, it is necessary to establish a connection between clinical manifestations and pathology of cerebral vessels. For the correct interpretation of the identified changes, careful collection of anamnesis with an assessment of the previous course of the disease and dynamic monitoring of patients are 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 signs with 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).

Dyscirculatory encephalopathy is an extremely common disease that affects almost every person with arterial hypertension.

Decoding scary words is quite simple. The word “dyscirculatory” means disorders of blood circulation through the vessels of the brain, while the word “encephalopathy” literally means suffering from the head. Thus, discirculatory encephalopathy is a term that refers to any problems and disturbances of any functions due to impaired blood circulation through the vessels.

Information for doctors: the code for dyscirculatory encephalopathy according to ICD 10 is most often code I 67.8.

Causes

There are not many reasons for the development of dyscirculatory encephalopathy. The main ones are hypertension and atherosclerosis. Discirculatory encephalopathy is less often spoken of when there is a tendency to lower blood pressure.

Constant swings blood pressure, the presence of a mechanical barrier to blood flow in the form of atherosclerotic plaques creates the prerequisites for chronic insufficiency of blood flow to various structures of the brain. Lack of blood flow means insufficient nutrition, untimely elimination of metabolic products of brain cells, which gradually leads to disruption of various functions.

It should be said that frequent changes in pressure lead to encephalopathy most quickly, while constantly high or constantly low pressure levels will lead to encephalopathy over a longer period of time.

A synonym for discirculatory encephalopathy is chronic cerebral circulatory failure, which, in turn, means the long-term formation of persistent disorders of the brain. Thus, the presence of the disease should be discussed only if vascular diseases are reliably present for many months and even years. Otherwise, you should look for another reason for the existing violations.

Symptoms

What should you pay attention to in order to suspect the presence of dyscirculatory encephalopathy? All symptoms of the disease are quite nonspecific and usually include “ordinary” symptoms that can also occur in healthy person. This is why patients seek medical care not immediately, only when the severity of the symptoms begins to interfere with a normal life.

According to the classification of dyscirculatory encephalopathy, several syndromes that combine the main symptoms should be distinguished. When making a diagnosis, the doctor also determines the presence of all syndromes, indicating their severity.

• Cephalgic syndrome. Includes complaints such as headaches (mainly in the occipital and temporal regions), pressure on the eyes, nausea with headaches, and tinnitus. Any discomfort associated with the head should also be included in this syndrome.
• Vestibulo-coordinating disorders. They include dizziness, throwing up when walking, a feeling of instability when changing body position, blurred vision with sudden movements.
• Astheno-neurotic syndrome. Includes mood swings, persistently low mood, tearfulness, and feelings of distress. In case of pronounced changes, it should be differentiated from more serious psychiatric diseases.
• Dissomnia syndrome, including any sleep disorders (including light sleep, “insomnia”, etc.).
• Cognitive impairment. They combine memory impairment, decreased concentration, absent-mindedness, etc. If the impairment is severe and there are no other symptoms, dementia should be excluded various etiologies(including, ).

Discirculatory encephalopathy grades 1, 2 and 3 (description)

Also, in addition to syndromic classification, there is a gradation according to the degree of encephalopathy. So, there are three degrees. Discirculatory encephalopathy of the 1st degree means the most initial, transient changes in brain function. Discirculatory encephalopathy of the 2nd degree indicates persistent disorders, which, however, only affect the quality of life, usually not leading to a severe decrease in ability to work and self-care. Discirculatory encephalopathy of the 3rd degree means persistent gross disorders, often leading to disability of a person.

According to statistical data, the diagnosis of grade 2 dyscirculatory encephalopathy is one of the most common neurological diagnoses.

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Diagnostics

Only a neurologist can diagnose the disease. To make a diagnosis, an examination of the neurological status requires the presence of revitalized reflexes, the presence of pathological reflexes, changes in performance, and signs of disturbance of the vestibular apparatus. You should also pay attention to the presence of nystagmus, deviation of the tongue away from the midline and some other specific signs that indicate the suffering of the cerebral cortex and a decrease in its inhibitory effect on spinal cord and the reflex sphere.

Just in addition to neurological examination serve additional methods research – , and others. Rheoencephalography can reveal disturbances in vascular tone and asymmetry of blood flow. MRI signs of encephalopathy include the presence of calcifications (atherosclerotic plaques), hydrocephalus, and scattered vascular hypodense inclusions. Typically, MRI signs are detected in the presence of grade 2 or 3 dyscirculatory encephalopathy.

Treatment

Treatment must be comprehensive. The main factor in successful therapy is the normalization of the causes that caused the development of the disease. It is necessary to normalize blood pressure and stabilize lipid metabolism. Standards for the treatment of dyscirculatory encephalopathy also include the use of drugs that normalize the metabolism of brain cells and vascular tone. The drugs in this group include sermion.

Selecting the rest medicines depends on the presence and severity of certain syndromes:

• In case of severe cephalgic syndrome and existing hydrocephalus, they resort to specific diuretics (diacarb, glycerin mixture), venotonics (detralex, phlebodia).
• Vestibular-coordinating disorders should be eliminated with drugs that normalize blood flow in the vestibular structures (cerebellum, inner ear). The most commonly used are betahistine (, vestibo, tagista), vinpocetine ().
• Astheno-neurotic syndrome, as well as sleep disorders, are eliminated by prescribing mild sedatives (glycine, tenoten, etc.). In case of severe manifestations, antidepressants are prescribed. You should also adhere to proper sleep hygiene, normalize the work-rest regime, and limit psycho-emotional stress.
• For cognitive impairment, nootropic drugs are used. The most commonly used drugs are piracetam, including in combination with a vascular component (fezam), as well as more modern drugs such as phenotropil, pantogam. In case of existing severe concomitant diseases, preference should be given to safe herbal-based drugs (for example, tanakan).

Treatment with folk remedies for dyscirculatory encephalopathy usually does not pay off, although it can lead to a subjective improvement in well-being. This is especially true for patients who are distrustful of receiving medicines. In advanced cases, such patients should be oriented at least to taking constant antihypertensive therapy, and during treatment, use parenteral methods of treatment, which, in the opinion of such patients, have a more good effect than tablet forms of drugs.

Prevention

There are not many methods for preventing the disease, but standard treatment cannot do without prevention. To prevent the development of dyscirculatory encephalopathy, as well as to reduce its manifestations, you should constantly monitor the level of blood pressure, the content of cholesterol and its fractions. Psycho-emotional overload should also be avoided.

If you have dyscirculatory encephalopathy, you should also regularly (1-2 times a year) undergo a full course of vasoactive, neuroprotective, nootropic therapy in a day or round-the-clock hospital to prevent progression of the disease. Be healthy!

Atherosclerotic lesion can affect all vessels of the human body. However, cerebral atherosclerosis of the brain is considered as a separate subtype of this disease. This is due to the fact that this pathology has characteristic features that distinguish it from damage to other arteries. It plays a significant role in the development of specific disorders of the central nervous system. nervous system and leads to the appearance characteristic symptoms, which allows us to distinguish it from other forms of atherosclerosis. She was assigned ICD 10 code 167.2.

For modern medicine the issue of atherosclerosis remains extremely relevant, because it is one of the factors leading to the development of other diseases, for example:

• Arterial hypertension.
• Coronary heart disease.
• Renal failure.
• Acute cerebrovascular accident.
• Discirculatory encephalopathy.

This is interesting! Regardless of which arteries are affected, the underlying mechanism behind the disease is the same.

Unfortunately, like many other diseases of the cardiovascular system, cerebral atherosclerosis cannot be completely cured.

Pathogenesis of atherosclerotic lesions

Unfortunately, the exact causes of this pathology still remain unknown. At the early stages of atherogenesis, the protective function of the vascular endothelium is disrupted, which leads to the penetration of lipid molecules into the arterial intima. Following them, leukocytes begin to migrate into the vascular wall, and a local inflammatory reaction develops, which entails more severe consequences.

Endothelial cell death, proliferation and migration of new leukocytes occur. The restructuring of the intercellular substance begins. First, lipid stains appear in the arteries, which over time grow and turn into plaques. They are a collection of lipid molecules and leukocytes that are surrounded connective tissue. The plaque is separated from the lumen of the vessels by a connective tissue covering.

At a later stage, the arteries narrow and allow less blood to pass per unit of time. This leads to the fact that the tissues that are supplied with blood do not receive the amount of oxygen and nutrients they need. As a result, chronic organ ischemia develops, which leads to the appearance of symptoms. This is called stenotic atherosclerosis.

It is important! An atherosclerotic plaque differs in structure from the vascular wall, so over time, blood clots begin to form around it.

Their appearance is also facilitated by disruption of laminar blood flow in the plaque area. Over time, blood clots can almost completely block the lumen of the artery. However, a much more dangerous situation is when a blood clot forms near a plaque with a thin, unstable “cover.” Such a plaque can easily rupture, as a result of which the blood clot breaks away from the wall and, together with the contents of the plaque, moves through the vessel until it completely clogs it.

As a result, acute ischemia develops, leading to the death of those tissues that were previously supplied with blood by the affected vessel.

In case of damage to the vascular bed of the brain, a stroke develops.

Clinical picture

The peculiarity of cerebrosclerosis is that it develops gradually, and the first stages pass without symptoms, so many patients do not even suspect that they are sick. Clinicians distinguish several stages of pathology development:

• Silent stage. Arterial sclerosis is minimally expressed, there are no symptoms.
• First stage. The stenosis is not critical, rarely exceeding 30-35% of the lumen. Manifested functional disorders, symptoms are inconsistent.
• Stenosis 2 degrees. The plaque covers about half of the vessel. At this stage, there are both functional and organic changes in the nervous tissue. Symptoms stabilize, some of them become permanent.
• 3rd degree stenosis. Subtotal occlusion of the artery occurs, resulting in severe ischemia of the nervous tissue. Symptoms progress, most are constantly present.

In the early stages, the main signs are neurasthenia, increased irritability, and weakness. Patients report problems with concentration, perseverance and performance. Their thoughts are confused, they cannot concentrate on one task for a long time, and sometimes even their memory is impaired. Patients may also experience tinnitus, frequent dizziness, and sometimes headaches.

As the disease progresses, patients develop more severe impairments. They experience depressed mood, depression, and possible anxiety and delusional disorders and even hallucinations. At this stage, there are already organic signs of damage to the nervous tissue.

It is important! Already at this stage, some patients experience initial manifestations of dementia and encephalopathy.

One of the manifestations of advancing dementia is emotional lability. Patients have an unstable mood that easily changes under the influence of minor factors. People begin to panic, cry or, conversely, rejoice and laugh because of insignificant reasons. Negative emotions usually predominate - patients are afraid, easily become depressed, and feel anxious for unknown reasons. This is often associated with age-related personality changes, but the reason is not always due to old age.

Doctors also note that people suffering from atherosclerosis of the cerebral arteries often complain of sleep disturbances. Insomnia may bother them already from the initial stages of the disease, but rarely does anyone attach any importance to this. Others also blame it on insomnia. unpleasant symptoms, thinking that bad dream- this is their cause, and not one of the consequences.

Remember! In later stages, severe dementia and personality changes with changes in behavior, preferences and habits are observed.

Patients may complain of senestopathy - unusual, often pretentious sensations. If the arteries supplying the cerebellum are affected, patients develop ataxia, unsteady gait, dizziness and other vestibular disorders.

Diagnostic search for cerebral atherosclerosis

Unfortunately, this disease does not have pronounced specific symptoms. Therefore, the diagnosis of cerebral atherosclerosis can be multi-stage. Often, consultation with several specialists is required:

1. Cardiologist.
2. Neurologist.
3. Vascular surgeon.
4. Neurosurgeon.
5. Endocrinologist.

The main specialist who makes the diagnosis in this case is, of course, a neurologist. However, it is the cardiologist who must give his assessment of the state of the cardiovascular system.

Important! Treatment should be prescribed based on the general conclusion of these specialists.

In order to verify the diagnosis, a number of instrumental techniques are used. Patients are prescribed ultrasonography heart and neck vessels. If necessary, it is supplemented with Doppler scanning - it allows you to assess the level and speed of blood flow in the extracranial vessels.

Thanks to this, doctors are able to assess the size of atherosclerotic plaques, identify their location, and assess the degree of narrowing of the arterial lumen. In order to study the state of the vascular basin inside the cranium, a specially modified ultrasound technique is used - transcranial Dopplerography.

Angiography provides the most complete information about the condition of blood vessels and their patency. This is an x-ray method in which a contrast agent is injected into the patient's blood, after which an image is taken. This method is especially useful when there is non-stenotic atherosclerosis, which is particularly difficult to diagnose.

Computed tomography is used to study the state of nervous tissue and clarify the affected area after strokes.

This is interesting! Magnetic resonance imaging is considered the most accurate, but this method is rarely used due to its high cost and long waiting time.

Also carried out laboratory diagnostics. Patients undergo a general and biochemical blood test to determine their lipid profile. Doctors look at the level of cholesterol in the blood of patients, and how exactly it is distributed among fractions. The results of this examination determine the prescription of certain medications in the future.

Treatment tactics

Cerebral atherosclerosis is a chronic disease that cannot be cured completely. The main goal of treatment is to reduce blood cholesterol levels and stop the progression of atherosclerosis. Well-chosen drugs can even achieve some regression of atherosclerosis, but it is very important that the patient fully understands the importance of these measures and fully assists the doctors. After all, it is impossible to treat a patient if he himself does not want it.

Lifestyle modification plays a very important role. Patients are recommended a special diet. Patients should avoid eating fatty and fried foods. Also, you should not use a lot of seasonings when cooking, especially salt. You should eat more fruits and vegetables. It is advisable to cook dishes steamed or stewed. It is undesirable to overuse fatty meat; preference should be given to turkey, chicken, and simple types of fish. It is also important to give up alcohol and smoking. These bad habits have an extremely negative impact on the health of people with atherosclerosis.

Atherosclerosis itself is not the cause of death. However, the appearance of plaques increases the risk of developing blood clots and subsequent strokes, which can lead to death several years after the onset of the disease. Therefore, patients suffering from cerebral atherosclerosis can also be prescribed antiplatelet drugs.

Cerebral atherosclerosis of cerebral vessels is an insidious disease. It begins gradually, without manifesting significant symptoms in the early stages. Most often, patients have nonspecific complaints, so a thorough examination and accurate diagnosis are necessary. Treatment requires not only a correct diagnosis, but also the patient’s interest in his own well-being.

A disease called cerebral atherosclerosis affects the arteries located in the brain area.

The pathology occurs in people over the age of 20, however, most often it occurs in older people over 60 years of age.

The disease is a type of vascular dementia, or dementia, and is sometimes called “senile sclerosis.”

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Risk factors

The following factors contribute to this disease:

• the presence in the patient’s diet of harmful animal fats and products that have a negative effect on the structure of vascular walls (fried, spicy and salty foods);
• long-term bad habits (nicotine and alcohol addiction);
• hypodynamic lifestyle and excess weight;
• tendency to hypertension, diabetes, chronic anxiety and stress - which affects the membranes of blood vessels;
• age-related factor, for example, menopause in females.

Diagnostics

In order to make a diagnosis of cerebral atherosclerosis, it is necessary to conduct a series of examinations. First of all, they examine the brain, then find out the symptoms when interviewing the patient.

Next mandatory step- this is listening to systolic murmurs in the aorta, palpation of all arteries that are accessible to. If there are problems with the blood vessels of the brain, do not resort to the presented method.

It is also necessary to:

• immunological blood test and test for cholesterol ratio in the blood;
• angiography, which makes it possible to identify narrowing of blood vessels in the brain;
• Doppler examination of extracranial arteries;
• MRI, which, together with angiography, allows you to obtain the maximum amount of information and is characterized by a high degree of accuracy.

Treatment of cerebral atherosclerosis

In the initial stages, pathology can be treated with medications that normalize blood pressure and reduce the ratio of cholesterol in the blood.

The main thing at this stage should be considered to be maintaining a healthy lifestyle, a balanced diet with a reduced ratio of cholesterol and fats of animal origin. Optimal physical activity and avoidance of alcohol and cigarettes are recommended.

At the stage when there are already serious changes in the brain and the general state health, they prescribe drugs that improve hemodynamics and increase the speed of blood flow.

It is also necessary to take medications that stop the formation of blood clots and make the blood more fluid. Shown:

• antioxidant agents;
• lecithin;
• iodine in minimal quantities.

At the stage when an atherosclerotic plaque, as well as a blood clot, covers the lumen of the vessel by 70% or more (and, moreover, begins to collapse), it will not be possible to limit yourself to drug therapy alone.

At this stage, patients need surgical intervention, in which resection of a blood clot or plaque, as well as a section of a damaged vessel, occurs. The operation involves subsequent prosthetics of the affected vessel.

Folk remedies

Application folk remedies for cerebral atherosclerosis, it is permissible only after consultation with a specialist and a significant improvement in the condition.

Significant help for atherosclerotic patients with mental disorders is provided by the introduction of grain sprouts into the menu for 4 or even 6 months; garlic will be no less useful.

The latter can be consumed in its pure form, as well as cooked medicinal tinctures, mixtures. One of them is prepared as follows:

• 50g of garlic is crushed and poured with 200 ml of vodka;
• insist for 7 days in a darkened and insulated place;
• use 10 drops in 1 tsp. water three times a day until the mixture is complete.

Bee bread is also useful for cerebral sclerosis. It, like pollen, is characterized by an antiatherosclerotic effect and helps reduce the cholesterol ratio in the blood.

Both presented components have membrane-stabilizing, antioxidant and adaptogenic effects, and are ideal sources of nutritional components and vitamin complexes.

In order to avoid complications, it is necessary to begin recovery of the body as early as possible and do not forget about carrying out correct diagnostics

Complications

For any vascular diseases of the brain, a critical consequence should be considered a disruption of the blood supply. With the long-term development of the pathology, when the lumen of the blood vessels is significantly reduced, there is a starvation of the brain cells for oxygen, which complicates its work and destroys the organ.

With prolonged fasting due to oxygen deficiency, a critical moment comes when the discrepancy between blood flow and tissue need for oxygen reaches its limit. In this case, an acute ischemic stroke is formed.

Besides:

• due to the rupture of a vessel that was affected by an atherosclerotic plaque or thrombus, a hemorrhage forms inside the brain, or a hemorrhagic stroke;
• with constant destabilization of blood circulation inside the brain, discirculatory encephalopathy, which was mentioned earlier, can occur. It is characterized by a deterioration in the functioning of brain tissue.

Prevention

Primary and secondary prevention of the presented form of pathology is possible:

Diet

Nutrition for the described disease should be aimed at optimizing fat metabolism and improving the condition of the walls of blood vessels.

The beneficial components that come with food should have a positive effect on getting rid of cholesterol. The diet should create obstacles to the accumulation of any harmful components.

It is necessary to reduce the calorie content of dishes and the calorie content per day, which should be from 2000 to 2500 calories.

It is necessary to significantly reduce the salt ratio, so dishes should be prepared without the use of salt, and seasoned food should be seasoned. It should also:

• consume as much vegetable fat as possible;
• use lean meats and sea fish for food;
• consume fermented milk products with a low fat content;
• eat as many seasonal vegetables and fruits as possible.

In order for the diet to be complete, you should add legumes and eggplants to your diet. They make it possible to reduce the ratio of cholesterol in the blood and optimize metabolism. Drinking 1 – 1.5 liters of fluid per day is also an important element of the diet.

FAQ

How long does it take for death to occur upon diagnosis?

In this case, we are talking about a pathology of a chronic type, which is characterized by a long course. In case of circulatory disorders in the brain area and active damage to brain tissue, the prognosis is unfavorable - even death.

There is no statistical data on how quickly death occurs. It depends on such nuances as the general health condition, age and social status of the patient.

What mental disorders are there?

Cerebral atherosclerosis, ICD code 10 167.2, occurs when accompanied by disorders associated with mental activity.

When aggravated, it can provoke intellectual and mnestic changes in personality, as well as the formation of severe dementia.

Mental disorders can be divided into 2 classes:

Speaking about non-mental disorders, it should be noted that they are manifested by neurosis-like symptomatic complexes and their aggravated, depressive variants.

Other combined forms are possible, as well as obsessive states (doubts, fears, phobias). In the most difficult situations, psychopathic personality changes appear.

Cerebral atherosclerosis is a disease that can last for years. Its treatment involves a symptomatic and comprehensive approach.

Nowadays, the diagnosis of dyscirculatory encephalopathy of the 2nd degree is made, one might say, everywhere. Young people and old people on all continents suffer equally from this disease, and it is the Caucasian race that is more prone to developing the highest stage of the disease. With prolonged neglect, if left untreated, chronic encephalopathy will lead to the risk of developing ischemic or even hemorrhagic stroke.

What kind of disease is this?

The manifestations of such a disease are associated with several factors, some of which are considered congenital abnormalities of the blood supply to the brain, and some acquired as a result of the action of a combination of factors.

According to statistics, after the age of 70, the risk of developing dyscirculatory encephalopathy in the second or third degree increases approximately threefold, and the chance of becoming disabled increases by 5-6 times.

Atherosclerotic (arising as a result of atherosclerosis) or generally dyscirculatory encephalopathy is considered a diffuse focal disorder of the blood supply to the brain. As a result, the functioning of nerve cells is disrupted. Responsible for the functioning of certain body systems. And if a person is not helped in time by providing treatment at the first stage or suppressing symptoms at an early stage of development, the prognosis is disappointing: disability of group 1-2.

Causes of encephalopathy

As far as doctors have been able to identify to date, grade 2 discirculatory encephalopathy occurs and develops when there is insufficient blood supply to areas of the brain. This may be due to the following reasons:

• Atherosclerosis of blood vessels, arteries.
• Arterial hypertension, a sharp spasm of blood vessels due to a jump in blood pressure.
• Venous thrombosis.
• The presence of high levels of cholesterol on the walls of blood vessels - often the reasons lie in poor diet and excess weight.
• Toxins entering the blood - bacterial type as with measles or botulism, disease internal organs, or chemical/organic. For example, improper treatment, alcoholism, poisoning, smoking.
• Osteochondrosis of the cervical spine, pinching the vessel and symptomatic of this brain disease.
• Vegetative-vascular dystonia also significantly influences the appearance of dyscirculatory encephalopathy.
• Vasculitis is inflammation of blood vessels.

In addition, one of the most negative factors that can be attributed to the causes of the disease already at its first stage is stress.

Frequent psycho-emotional stress and disorders lead to the fact that our brain and the vessels in it experience excessive shock and wear out prematurely.

Of all the above, atherosclerosis is the most common factor in the development of dyscirculatory encephalopathy. Often 2-3 more reasons are added to it.

Symptoms of encephalopathy

It is difficult to say unambiguously how exactly grade 2 encephalopathy manifests itself, because many symptoms initial stage identical to the manifestations of other brain diseases. Therefore, it is difficult to build a prognosis for the disease.

Thus, the following manifestations are distinguished, requiring treatment to varying degrees:

1. Disorders of an emotional and mental nature are characteristic of stage 2 and do not appear earlier.
2. Memory problems - in particular, amnesia for recently occurring events.
3. Lethargy, apathy, complete lack of interest in hobbies.
4. Severe headaches are symptoms of a focal nature.
5. Absent-mindedness, sclerosis.
6. Inability to perceive large amounts of information.
7. Nausea and weakness, dizziness.

It is worth noting that symptoms begin to manifest themselves to a greater extent at night, after a long day or after tiring exercise. And if the duration of these symptoms lasts about six months or more, they speak of stage 2 of the development of dyscirculatory encephalopathy, and after diagnosis, adequate treatment is prescribed.

Already during outpatient or inpatient treatment, doctors recommend registering a disability. Since the brain is severely atrophied, the patient will not be able to return to his previous job.

Treatment of encephalopathy

This brain disorder is treated in the same way as similar diseases. Hypertensive, hypertonic, venous encephalopathy, and dyscirculatory encephalopathy require that a complex treatment be prescribed, mixed with drug treatment. In order to diagnose and confirm the condition of the brain, assess the size of encephalopathy lesions, a number of examinations are carried out:

• Positron emission tomography.
• Electroencephalography.
• Magnetic resonance imaging.
• CT scan.
• X-ray of the cervical spine (to exclude osteochondrosis).
• Biochemical analysis blood, etc.

Based on the results of the examination, it becomes clear what size the brain area is and what stage of the lesion it is in, therefore, how long the treatment will take and what degree of disability will be assigned (usually not lower than group II).

In addition to eliminating the brain pathology itself, an integrated approach is required to eliminating the symptoms arising from dyscirculatory encephalopathy. A detailed examination is carried out by a neurologist, as well as a cardiologist, therapist and, if necessary, a psychiatrist.

Treatment includes:

1. Restoring blood circulation in brain tissue. Nootropic drugs are usually used in combination with blood pressure normalizers - Cavinton, Nootropil, Tanakan, etc.
2. Drugs that reduce platelet counts and lower blood viscosity, such as Tiklid or Instenon.
3. Tablets and injections that reduce vascular hypertension using potassium antagonists and beta-blockers. For example, Finoptin or Nimopidine.
4. Therapy aimed at achieving a hypolipidemic effect.

Along with medicinal methods Physiotherapy based on magnesium sulfate electrophoresis, galvanic collars, and hyperbaric oxygen therapy is widely recommended. In the rarest cases, when it comes to a transient ischemic attack or hemorrhage (hemorrhage), as well as severe swelling brain, surgery is required.