Cerebrovascular Disease

Cerebrovascular disease is a term that describes disorders in which an area of the brain may be temporarily or permanently deprived of blood and oxygen (ischemia) or bleeding (hemorrhage), and involves one or more of the blood vessels that feed the brain or are located in the brain.

Types of cerebrovascular disease include:

Arterial stenosis. Arterial stenosis is the narrowing or blockage of the arteries that supply oxygen-rich blood to the brain.
Aneurysms. An aneurysm is an enlargement of a weak area in a blood vessel. When an aneurysm occurs in a blood vessel in the brain, it is called a cerebral aneurysm.
Arteriovenous malformations (AVMs). AVMs are abnormal connections in which capillaries are absent, so blood is diverted directly from arteries to veins. The high pressure of blood flow in an AVM can cause it to burst and spill blood into the brain.

WHAT ARE THE SYMPTOMS?

Many people with cerebrovascular disease experience no symptoms. For example, people with aneurysms or AVMs may experience no symptoms until a vessel ruptures, and people with arterial stenosis may not experience symptoms until the arteries become severely narrowed or blocked.

CAUSES AND RISK FACTORS

Arterial stenosis is most commonly caused by atherosclerosis.

The possible causes of aneurysms include:

Atherosclerosis;
Hypertension (high blood pressure);
Coarctation (narrowing) of the aorta;
Fibromuscular dysplasia (FMD), an arterial disease;
Connective tissue disorders such as Marfan syndrome; and
Polycystic kidney disease.

Scientists don't know why AVMs occur, but they are believed to be congenital (present at birth).

DIAGNOSIS

To diagnose cerebrovascular disease, a physician may recommend one or more of the following tests:

Angiography;
Blood tests;
Carotid duplex scanning;
Cerebral angiogram or intra-arterial catheterization angiography;
Cranial magnetic resonance imaging (MRI);
Computed tomographic angiography (CTA);
Electroencephalogram (EEG);
Evoked response test;
Head CT scan;
Magnetic resonance angiography;
Radionuclide single-photon emission computed tomography (SPECT) scanning;
Transesophageal echocardiography;
Transcranial doppler; and
Xenon CT scanning.

TREATMENT OPTIONS

Treatment for cerebrovascular disease depends on many factors and whether or not a stroke has occurred. Treatment for unruptured aneurysms or AVMs is decided based on the aneurysm's or malformation's size, the patient's health, and other factors. Nonsurgical treatment for cerebrovascular disease includes medications and lifestyle modifications.

Procedures for cerebrovascular disease include:

Surgical aneurysm repair;
Endovascular aneurysm repair;
Carotid endarterectomy;
Carotid angioplasty and stenting;
Open surgery/surgical resection;
Stereotactic radiosurgery;
Interventional neuroradiology/neuroendovascular surgery; and
Endovascular embolization/occlusion.

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