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Chronic cerebral ischemia (CCI)

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What is chronic cerebral ischemia (CCI)?

Chronic cerebral ischemia (CCI) is a type of nervous system damage associated with multifocal or generalized brain lesion caused by the prolonged restriction of the blood supply to the brain tissue and manifested as a set of neurological and intellectual impairment.

What is the cause of the disease?

In patients with CCI, pathological disorders are based on various causes such as essential hypertension and symptomatic arterial hypertension, atherosclerosis and a combination thereof, cardiac pathology, change in the vertebral condition affecting the vertebral arteries, microcirculatory disturbances due to the change in the coagulating and anti-coagulating blood systems. Diabetes mellitus, smoking, drinking alcohol, obesity, low physical activity, improper feeding can also result in progressive atherosclerosis and deterioration in the patient’s condition. Atherosclerotic lesions of head and neck arteries, ischemic heart disease with signs of fibrillation relate to the most common causes of CCI clinical manifestations.

What can be the course of the disease and how is it manifested?

Based on complaints and neurological symptoms, 3 stages of the disease are differentiated:

During the 1 stage, there are subjective disturbances in the form of headaches, dizziness, heaviness in the head, general weakness and high fatigability. Frequent complaints include memory, attention, sleep impairment and mood swings. In rare cases, objective neurological disorders, increased fatigability with a less ability to long physical and mental strain (asthenic syndrome) and without persistent focal neurological deficits are revealed. The patients can usually attend to themselves but increased stress (emotional and physical) make attendance difficult.. Adequate therapy provided at this stage can result in almost complete healing.

Stage 2 has subjective disorders equivalent to those at stage 1 but also includes increased fatigue, impaired attention and memory, and rare cases of headache (as compared with stage 1). Objective disorders are more evident as neurological symptoms. Imbalance, vivid reflexes, mild symptoms of craniocerebral nerve affection are developed. The leading neurological symptom can usually be found at this stage. It can be used to choose a symptomatic therapy.

Stage 3 is characterized by a sharp decrease in the number of complaints as the patients stops treating their conditions in a critical way. However, they still complain of memory impairment, noise and heaviness in the head, sleep loss and instability when walking. Objectively, persistent and pronounced neurological syndromes are recorded. Several syndromes are combined at this stage. Falls and fainting are frequent. The patients are frequently incapacitated as their social and personal adjustment is disturbed.

What is the treatment?

Treatment of CCI must be based on pathogenetic (effect on the principal mechanism of the disease) and symptomatic (effect on certain symptoms of the disease) therapy.

In CCI, the underlying diseases such as arterial hypertension and atherosclerosis are treated. Atherosclerosis is treated using the common schemes, agents reducing the level of cholesterol and management of patients’ nutrition and style of life. Antihypertensive agents are selected and prescribed by a therapist considering the patient’s personality trait.

Complex therapy of CCI uses peptides of multimodal (multiple and useful) effect that launch all internal mechanisms of pathological process compensation and have an antioxidant, neuroprotective and neurometabolic effect; antiplatelet agents (medicines that reduce clot formation), agents optimizing the brain metabolism, and vasoactive agents (medicines that increase blood supply to the brain).

Antidepressant agents are indicated in pronounced astheno-depressive conditions (decreased general mood, anxiety, fear). Antiasthenic agents that improve working capacity, produce a general tonic effect and improve attention focusing are used as well.

In case of vascular cerebral insufficiency, the use of vasoactive agents (medicines that optimize blood supply to the brain) is pathogenetically substantiated.

Neurometabolic therapy aimed at improved compensatory efforts of the brain is widely applied in chronic vascular cerebral insufficiency.



K. R. Badalyan

Department of Neurology, Faculty of Additional Professional Education

of Pirogov Russian National Research Medical University

Follow a doctor’s recommendations related to chronic and course administration of the drug. Course administration of certain agents must be available at least 2–4 times a year.

It’s necessary to control BP. If arterial hypertension develops, antihypertensive therapy must be given on a constant basis. Ask a specialist (therapist or cardiologist) what to do in case of a sudden rise in BP and what agents must be taken in this case.

Constant control of blood sugar and cholesterol levels is necessary. A special diet is prescribed as needed. If no effect is presented, drug management is provided.

It’s very important to stop smoking and drinking and control ones’ weight. Take low-calorie food with a sufficient amount of protein (cereals, pasta, rice, potatoes are sources of plant protein; meat, fish, farmer cheese, eggs, cheese are sources of animal protein), a diet low in fat with the right balance of plant fats to animal fats, many complex carbohydrates (wholewheat bread is preferable), less salt and enough seasonal fruits and vegetables (over 500 g per day), food rich in vitamins and microelements.

Adequate physical activity is of great importance. Do daily gymnastics, special gymnastic exercises supporting the locomotor apparatus (spine, joints), and go for a walk. If needed, consult a specialist to select an optimal set of physical therapy exercises aimed at the management of any complex of syndromes (combination of symptoms).

Intellectual activity must be supported: read, learn texts by heart, do crosswords, listen to music and radio programs), lead an active social activity (communicate with colleagues, relatives, visit cultural events, engage in interesting leisure activities). In case of memory impairment, write down necessary information, keep memoirs, make a daily plan of activities.

Be active as long as possible. If there is a risk of falling, follow certain protective measures: wear comfortable shoes, use additional support if needed, rearrange your furniture, remove objects with sharp angles, take a shower in a sitting position.



K. R. Badalyan

Department of Neurology, Faculty of Additional Professional Education

of Pirogov Russian National Research Medical University

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