Cerebrovascular diseases are a large group of diseases characterized by the interruption of blood flow to brain tissue as a result of deterioration, blockage or rupture of the blood vessels feeding the brain.
These conditions, also known as “stroke” or “paralysis” among the people, are emergency medical conditions that cause the central nervous system to temporarily or permanently lose its functions.
What are Cerebrovascular Diseases?
Cerebrovascular diseases are the inability to transport the oxygen and glucose needed by the brain tissue to survive due to a vascular problem.
Although the brain makes up only 2% of body weight, it uses 15% of total blood flow and 20% of oxygen consumption.
When this delicate balance is disrupted, the vessel becomes blocked (ischemia) or the vessel bursts and blood leaks into the brain tissue (bleeding).
In both cases, brain cells begin to be damaged within minutes; For this reason, the basic rule in this disease group is the principle of “time equals brain”.
According to Assoc. Prof. Dr. Erdinç Özek; “Cerebrovascular diseases are not just a disease of old age. Today, we frequently encounter vascular ruptures or occlusions at a young age due to stress, inactivity and genetic predisposition. For us, success is not only to keep the patient alive, but also to restore him to his social life by preserving his neurological functions.”
What are the Symptoms of Cerebrovascular Diseases?
Symptoms appear suddenly, depending on which area of the brain the vascular damage affects. The “FAST” (Face, Arm, Speech, and Time) rule is vital for early diagnosis.
- Percentage Slippage: One side of the face sagging or appearing asymmetrical when smiling.
- Weakness in Arms and Legs: Sudden numbness, loss of strength or lack of control only on the right or left side of the body.
- Speech Disorder: Rolling words in the mouth, incomprehension of what is being spoken, or complete inability to speak.
- Sudden Vision Loss: Darkening of one or both eyes, double vision, or loss of part of the visual field.
- Severe Headache: Sudden explosive pain, which is described by patients as “the most severe pain I have ever felt in my life”, especially in aneurysm bleeding.
- Loss of Balance: Sudden tossing to one side while walking, severe dizziness and nausea.
Causes and Risk Factors of Cerebrovascular Diseases
The deterioration of the vascular structure is not due to a single cause; It is usually caused by a combination of genetic background and lifestyle.
- Hypertension: High blood pressure is the biggest risk factor that weakens the vessel walls over time, paving the way for both occlusion and bleeding.
- Diabetes: High blood sugar accelerates calcification (atherosclerosis) by disrupting the internal structure of the vessel (endothelium).
- Hyperlipidemia: High levels of cholesterol and fat in the blood form plaques in the vessel, narrowing blood flow.
- Smoking and Alcohol Use: It directly triggers arteriosclerosis and increases the tendency of blood to clot.
- Heart Diseases: Especially Atrial Fibrillation (arrhythmia) causes a clot to form in the heart and this clot to jump to the brain.
- Aneurysm and AVM: Congenital or acquired weak spots (bubbles) in the vessel wall are a risk of sudden bleeding.
Clinical Experience Note (Anonymous Case): A 54-year-old patient with uncontrolled hypertension suddenly dropped a spoon from his hand during dinner and his speech was impaired. Thanks to the fact that his relatives noticed the symptoms early and delivered him to the emergency room within 30 minutes, the patient was treated with vasodilating treatment (thrombolytic) and his functions returned to normal within 24 hours without permanent damage to the brain.
Types of Cerebrovascular Diseases
Cerebrovascular diseases are divided into two main categories and structural disorders according to their mechanisms. Each type has its own urgency and method of intervention.
Cerebral Vascular Occlusion (Ischemic Stroke)
It accounts for about 80-85% of all strokes. It occurs when a vessel feeding the brain becomes blocked due to a clot or plaque.
The clot either forms in the area of arteriosclerosis or breaks away from another organ, such as the heart, and reaches the brain. Cells in the area where blood flow stops turn into a risk zone called “penumbra”; Minutes are raced to save this region.
Brain Hemorrhages (Hemorrhagic Stroke)
It is the rupture of a weakened vessel and the leakage of blood into the brain tissue or between the meninges. Blood not only directly damages brain tissue, but also crushes healthy areas by increasing intracranial pressure. Often uncontrolled high blood pressure is the biggest trigger.
Brain Aneurysm (Bubble)
It is the balloon-like inflation of a weak spot in the vessel wall with blood pressure. Aneurysms usually do not cause symptoms unless they rupture. However, when they burst, they cause a life-threatening, sudden onset of severe condition called “Subarachnoid Hemorrhage”.
Arteriovenous Malformation (AVM)
It is an abnormal ball of veins that forms between arteries and veins without a capillary bed. These tangles can be congenital and can tire the vessel wall as high-pressure blood passes directly into the vein, leading to bleeding or seizures.
Diagnostic Methods
Modern diagnostic methods determine the exact location of vascular occlusion or bleeding, clarifying the treatment strategy within seconds.
- Computed Tomography (CT): It is the first-step examination that shows whether there is bleeding within seconds.
- CT Angiography: It scans the structure of the vessels in detail with the help of contrast material.
- MRI and MR Angiography: It shows damage to brain tissue and vascular occlusions more precisely.
- Digital Subtraction Angiography (DSA): It is an advanced imaging method that is performed by entering through the inguinal vein and is considered the “gold standard” of diagnosis in vascular diseases.
Cerebrovascular Diseases Treatment Methods
Treatment is carried out in three main branches according to the type of disease and the patient’s clinic:
Medication
In ischemic strokes (occlusion), it is aimed to open the vessel by administering intravenous clot-dissolving (thrombolytic) drugs within the first 4.5 hours. In cases of bleeding, drugs that lower blood pressure and reduce intracranial pressure are used.
Interventional Neuroradiological Procedures (Angiography)
They are non-surgical, closed procedures performed by entering through the groin. The clot in the blocked vessel can be removed mechanically (thrombectomy) or the aneurysms can be filled with special wires (coiling).
Surgical Treatment (Microsurgery)
It is used for draining large bleeding, closing aneurysms with metal clipping, or removing AVMs. These procedures, performed under high-resolution microscopes, aim to cause minimal damage to brain tissue.
| Type of Treatment | Applies | Advantage |
| Clot-Dissolving Drug | Early occlusion | Fast implementation |
| Thrombectomy (Angiography) | Large vessel occlusion | Opening the vein with the closed method |
| Microsurgical Clipping | Ruptured aneurysms | Permanent and definitive solution |
According to Assoc. Prof. Dr. Erdinç Özek; “Success in cerebrovascular surgery comes not only with technical equipment, but also with knowing that each patient’s vascular structure is as special as a fingerprint. Especially in risky cases such as aneurysms and AVMs, microsurgery should be performed with robotic precision and the blood supply to the brain should be monitored instantly throughout the operation.”
Ways to Prevent Cerebrovascular Diseases
- Blood pressure and sugar monitoring should be done regularly.
- Cholesterol should be kept under control with a Mediterranean diet.
- Anti-vascular habits such as smoking and alcohol should be stopped.
- Regular exercise maintains vascular flexibility.
Frequently Asked Questions
Does someone with an aneurysm necessarily need surgery?
The size, shape, and location of the aneurysm are analyzed. Small aneurysms with a low risk of bursting can only be followed closely.
What is Transient Stroke (TIA)?
It is a condition in which symptoms last less than 24 hours and resolve spontaneously. This is the most important harbinger of a major stroke in the future.
How long does it take to recover after a stroke?
The healing process varies depending on the extent of the damage. The first 6 months are the period when brain plasticity is highest and intensive physical therapy is critical in this process.
Resource and Expert Knowledge
This article has been prepared in the light of Assoc. Prof. Dr. Erdinç Özek’s academic studies and clinical experience on microneurosurgery and cerebrovascular diseases. Assoc. Prof. Dr. Erdinç Özek is a neurosurgeon who adopts advanced technology and safe margin principles in cerebrovascular surgery.
