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Doctor News (Rong Media Reporter Huang Jing) Some people's physical examination report will read: lacunar infarction
.
Many people will wonder: "I didn't have a stroke, why did I have a cerebral infarction?" ”
Others are told on examination that white matter is demyelination or ischemic lesions
.
Many elderly people are puzzled, what is this?
"These are the two most common imaging findings
of cerebral small vessel disease.
" Professor Peng Dantao, director of the Department of Neurology of China-Japan Friendship Hospital, pointed out
.
The onset of cerebral small vessel disease is insidious and the etiology is complex, which seriously affects the quality of life of patients and needs attention
.
Professor Peng Dantao
all elderly people will suffer from cerebral small vessel disease
In cerebrovascular disease, the well-known stroke is also known as stroke and cerebrovascular disease, which is a group of diseases that cause brain tissue damage caused by cerebral thrombosis or cerebral hemorrhage caused by blood vessel rupture caused by cerebral blood vessel blockage, which can involve large and small blood vessels
in the brain.
The extremely high prevalence of cerebral small vessel lesions is not recognized by the public because of its insidious onset and slow
progression.
Large blood vessels are the channels that transport blood, and small blood vessels are the places where glucose, oxygen and other nutrients in the blood are diffused and exchanged, and play the role of
nourishing brain tissue.
Therefore, if the small blood vessels of the brain are damaged, it will lead to the inability of nutrients in the blood vessels to diffuse, and then lead to the loss and damage of neurons in the brain, resulting in a series of symptoms
such as cognitive decline, unsteady walking, drinking cough, emotional disorders and so on.
"Lacunar infarction and white matter demyelination are the two most common types of cerebral small vessel disease, with incidence also increasing from 50% to 90%
from 45 to 80 years of age.
" Professor Peng Dantao emphasized, "With the increase of age, most elderly people will suffer from cerebral small vessel disease
to a greater or lesser extent.
”
In addition to lacunar infarction and white matter demyelination, there are also vascular amyloidosis, perivascular space enlargement, small infarction, microinfarction and other injury manifestations, vascular amyloidosis imaging is often manifested as microbleeding, the proportion of microbleeding accounts for 20%~30%.
Because the pathogenesis of cerebral small vessel disease is different and the diagnostic criteria are different, the epidemiological data obtained by different international and domestic studies are also very
different.
However, the academic community agrees that cerebral small vessel disease is extremely common, and can account for 1/2~2/3
in people with cerebrovascular disease.
"The country manages cerebrovascular disease as a chronic disease, and cerebral small vessel disease is the main disease that needs to be managed, the pathogenesis of cerebral small vessel disease is complex, the prevalence is high, and the international research on cerebral small vessel disease is paying more and more attention
.
" Professor Peng Dantao emphasized, "Cerebral small vessel disease affects cognition, disability, and lifespan, and must be paid attention to and well managed
.
" ”
Cerebral small vessel disease progresses slowly, like boiled frogs in warm water, early diagnosis and early treatment are the key
Stroke caused by macrovascular lesions will suddenly appear aphasia, limb movement disorders, limb numbness, sensory disorders and other symptoms, the disease is menacing, like a violent storm, causing great damage
to the patient's body.
And cerebral small vessel disease is hidden, the course of the disease is slow, it is not easy to be identified, and it progresses quietly unconsciously, more like a boiled frog in warm water, making people mistakenly think that it is just the natural process
of aging.
In daily life, if the following symptoms occur, it is necessary to start paying attention to whether cerebral small vessel disease is responsible
.
First, cognitive dysfunction and memory loss
.
Housework that used to be completely self-careful, such as buying vegetables and cooking, going to the bank to deal with money, taking medicine, and even finding your own clothes to wear have become very difficult, and in severe cases, they need to be taken care of
.
Second, walking is easy to fall and even fracture, bringing a series of disabling hazards and increasing the burden of family and medical care
.
Third, there are emotional disorders, such as senile depression, anxiety, insomnia, and even pneumonia caused by swallowing, drinking water, and
coughing.
Although the early symptoms of cerebral small vessel disease are not obvious and the clinical progress is slow, in fact, in the early stage of the disease, there have been lacunar cerebral infarction, white matter lesions, perivascular enlargement or microhemorrhage and other imaging changes in the brain structure
.
"Cerebral small vessel disease will develop faster and faster without intervention, and it is not characterized
by emergencies.
" Professor Peng Dantao said
.
Unconsciously and slowly progressively, it causes from cognition to motor to eating disorders, and ultimately leads to the decline of the patient's own quality of life
.
More importantly, disability also leads to an increase in the burden on the entire family and medical system, so early diagnosis and early treatment are the key to
the prevention and treatment of cerebral small blood diseases.
diagnosis and early treatment of cerebral small vessel disease requires "multi-pronged"
diagnosis
"No matter how insidious the onset of cerebral small vessel disease is, there are always clues to follow
.
" Professor Peng Dantao pointed out that in addition to the above clinical symptoms, imaging examination can find generalized white matter demyelination, lacunar status, microbleeding foci, new small infarction, perivascular space enlargement and other characteristics, suggesting that patients may
suffer from cerebral small vessel disease.
In addition, there are also some patients with cerebral small vessel disease for gene mutation family hereditary diseases, if someone in the family has cerebral small vessel disease, then should actively go to the hospital for examination, the use of cognitive scale for testing and head MRI imaging can detect cerebral small vessel disease
as soon as possible.
treat
Different from macrovascular lesions, the etiological mechanism of cerebral small vessel lesions is heterogeneous, mainly manifested as vascular vitreous lesions, vascular amyloidosis, fibrinoid necrosis, atherosclerosis proportion is not high, these all cause vascular endothelial damage, there is currently no non-invasive detection method that can directly detect cerebral small blood vessels, because of its diverse pathogenesis, the current detection methods can not be accurately determined, so in the treatment of mostly symptomatic treatment
.
Endothelial damage, decreased cerebral blood perfusion, immunoinflammatory damage, and expansion of perivascular space are the common damage characteristics of cerebral small vessel disease caused by different etiologies, around the protection and repair of endothelium, strengthen blood perfusion, anti-immunoinflammatory response, reduce endothelial injury exudate caused by the expansion of perivascular space, can well control and delay the further damage of cerebral small blood vessels, while the application of anti-dementia, antidepressant, improve cerebral blood flow perfusion, anti-cerebral small vessel disease drugs can improve clinical symptoms and delay the development of the disease
。
Professor Peng Dantao said that the primary prevention of cerebral small vessel disease can not be ignored, and it is necessary to strengthen publicity, improve the population's awareness of cerebral small vessel disease, and control risk factors such as high or low blood pressure, high blood lipids and high or low blood sugar; Let patients have the awareness of cerebral microblood disease examination at the beginning of symptoms, rather than mistaking the process of natural aging and delaying early diagnosis and early treatment
.
Treatment of cerebral small vessel disease Expect breakthroughs in traditional Chinese medicine
China's traditional Chinese medicine is broad and profound, self-contained and theoretical, and there are many studies on cerebral small vessel disease, and there are many drug literature reports that have the effect
of treating cerebral small vessel disease.
It has shown certain curative effects
in improving cerebral microcirculation, alleviating hypoperfusion injury, protecting vascular endothelium, repairing blood-brain barrier, strengthening cellular nutrition, and protecting cranial nerves.
Professor Han Jingyan of Peking University Health Science Center found through the pharmacological study of nursing serum brain particles that nursing serum brain particles have a protective effect on the vascular endothelium because of their multi-component and multi-target characteristics, and they can prevent the expansion of perivascular space by reducing endothelial damage and blocking endothelial leakage, which is an important target for the treatment of cerebral small vessel disease
.
The contraction and relaxation elasticity of small blood vessels affects cerebral blood perfusion, and ensuring the elasticity of small blood vessels in the brain can ensure blood perfusion
.
Professor Han Jingyan found that nursing serum brain particles protect endothelial cells and retain vascular elasticity, thereby improving blood flow perfusion and improving cerebral microcirculation
.
In addition, the immunoinflammatory response produced after vascular endothelial injury will damage neurons around the lesion, destroy the blood-brain barrier, and the antioxidant and anti-aging effects of nursing serum brain particles can protect the blood-brain barrier
.
Nursing serum brain particles through endothelial protection, cerebral blood flow perfusion, blood-brain barrier protection, microcirculation improvement, thereby improving the damage of cerebral small vessel disease to neurons, clinical research data show that it can also improve cognitive dysfunction, anxiety and depression, thereby improving the quality of life of
patients.
Serum nourishing brain granules are modern Chinese medicine developed based on the classic famous Fang Siwu soup of traditional Chinese medicine to nourish blood and regulate blood, which has the effect of
nourishing blood and leveling the liver and activating blood circulation.
After more than 20 years on the market, evidence-based medical research evidence has become more and more abundant, and it has been included in the "Chinese Guidelines for the Diagnosis and Treatment of Cognitive Dysfunction Related to Cerebral Small Vessel Disease (2019)", and is recommended for application
as II.
b evidence.
Professor Peng Dantao emphasized that cerebral small vessel disease requires comprehensive treatment of traditional Chinese and Western medicine, and expects more evidence-based evidence, more drugs, and better treatment options
.
Typesetting: Huang Jing
Editor: Huang Jing
Reviewed: Hsu Bongyan
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