home Audience 2 Venous discirculation in childhood and adolescence. Venous discirculation of the brain and its risks

Venous discirculation in childhood and adolescence. Venous discirculation of the brain and its risks

Violation venous outflow brain - this diagnosis is now being made more and more often by doctors to their patients. The reason for this, like almost all other diseases, is largely due to an incorrect lifestyle.

Causes

Medical specialists identify the following possible course of the disease - primary and stagnant.

The primary form of obstruction of venous blood flow in the brain is a violation of blood circulation in general due to a violation of the tone of the veins themselves. More often, the primary form of this pathology is provoked by such factors as:

Internal hematomas resulting from traumatic brain injuries of varying severity;
Strokes in which cerebral edema develops;
Reduction or underdevelopment of the venous network in the brain;
Various tumors and neoplasms leading to compression blood vessels;
Intoxication with alcohol or nicotine;
Blood pressure disorders.

The congestive form of the disease, the so-called cerebral venous dysfunction, is formed in cases where the venous outflow of blood encounters mechanical obstacles along its path. In the stagnant form of the disease, the entire mechanism of the course venous blood weakens over time.

Factors leading to the gradual development of venous dysfunction:

Tumors in the cervical spine;
Blockage of blood vessel channels;
Strangulation-type injuries;
Osteochondrosis;
Damage to the walls of the sternum;
Prolapsed intervertebral discs and spinal hernia.

Symptoms

All of the following symptoms are most acute in the morning:

Severe dull headache, most acute in the morning;
Lethargy;
Increasing pain when turning the head;
Rumbling and noise in the ears;
Cyanotic (blue color) of the nasolabial triangle and ears.

A person who has obstructed venous outflow in the brain finds it difficult to get out of bed, he constantly feels exhausted, as if after insomnia. Such people are very sensitive to weather changes, to any excitement, as well as to drinking alcohol even in the smallest doses.

If all these signs of the disease are left unattended, after some time symptoms such as:

Darkness in the eyes;
Fainting;
Dizziness;
Feeling a little dazed;
Lungs epileptic seizures And episodic disorders mental health in the form of unmotivated changes in mood and seizures;
Copper taste;
Swelling of the upper eyelids;
Redness eyeball;
Temporary loss of sensation in the legs.

With pronounced stagnation of venous blood, the patient is unable to lower his head. But even if all of the listed symptoms of the disease are pronounced, blood pressure levels remain normal in more than 80% of cases.

Diagnostics

The most acute symptoms of a disease such as a violation of the venous outflow of the brain are felt in the off-season - in spring and autumn. In summer and winter, the condition of such patients improves somewhat, so many who are diagnosed with a violation of the venous outflow of the brain try to simply endure all the inconveniences associated with it or use various painkillers.

Along with the difficulty in the outflow of venous blood, diseases such as the well-known varicose veins, thrombophlebitis, and thrombosis are very often diagnosed. In this case, blood thinning medications are additionally prescribed.

Treatment

Treatment of blood flow disorders, like all diseases, begins with the installation accurate diagnosis. Investigation of the causes of difficulties in blood outflow is carried out using magnetic resonance imaging.

If the study reveals difficulties in the outflow of blood in the veins, the neurologist prescribes a course of treatment with venotonic drugs. Most often, drugs such as Detralex or Tanakan are used to treat this disease. These medications strengthen and make the walls of blood vessels more elastic, which stimulates the movement of venous blood.

Therapeutic neck massage, which is performed by a professional massage therapist in a medical facility;
Consumption of vegetables and juices (nettle and grape juices are especially useful);
Categorical refusal to smoke, drink alcohol and various energy drinks;
Moderate physical activity, including morning exercises, swimming, and athletics.

Sometimes, depending on the severity of the disease, the patient is treated in parallel with a neurologist and vascular surgeon. In addition, when venous outflow is impaired, there are often signs of significant pathologies in the heart. In this case, additional examinations will be scheduled.

Gymnastics

The only thing a person suffering from difficulty with blood outflow can help themselves with is performing simple physical exercises that help improve venous outflow of blood. It should immediately be noted that not only each such exercise, but also the number of times they are performed should be discussed with a doctor.

Exercise one – throwing your head back.

Sit on a chair and lean your hands on the back of it. Relax, throw your head back. Breathing deeply and evenly, sit in this position for about a minute. Get up and walk around the room for a few minutes. Repeat several times.

Exercise two – elongated neck.

Relax, hang your head on your chest. Inhale – raise your head as high as possible, pull your neck up. Exhale – lower your head to your chest.

You can perform this exercise while sitting on a chair or standing - whichever is more convenient.

Exercise three - eights

The body is relaxed, breathing is free, eyes are closed. Use the top of your head to draw a figure eight in the air. Repeat 6 times.

Exercise four – bending over with resistance

Sit down, clasp the fingers of both hands tightly under your chin. Exhale - tilt your head down, pressing on it with your palm. Inhale – tilt your head back, overcoming the pressure of your palm on the back of your head. Repeat 12 times. Attention - do not hold your breath.

Nutrition

In order to improve your condition due to dysfunction of the venous blood circulation, you need to turn to the principles of a healthy diet. healthy, proper nutrition to improve blood flow in the brain, first of all, means giving up foods that contribute to weight gain, namely: smoked meats, pickles, carbonated drinks, fast food, baked goods, white bread, canned food

The diet must contain foods that help improve blood circulation and the functioning of blood vessels in general. These products include:

Vitamins E and C (found in rose hips and sea buckthorn, cabbage, green tea leaves, berries and sprouts of various legumes and grains):
Fat polyunsaturated acids(nuts, sunflower and flax seeds, unrefined vegetable oils, many types sea fish eg salmon, trout, tuna);
Cellulose ( bran bread, fresh vegetables and fruits).

In addition, spices - rosemary, parsley, dill, oregano (oregano) - help improve blood circulation. To stimulate blood circulation, including venous outflow of blood in the brain, garlic, ginger, cloves, turmeric, cinnamon, pepper - black, red, chili are suitable.

Treatment at home

Disturbances in the outflow of venous blood in the brain are precisely the disease that can be treated using traditional medicine is not only unanimously not welcomed by all physicians, but is also categorically prohibited.

The fact is that a violation of the outflow of blood in the brain is a disease that can lead to very serious irreversible consequences, and its early stage With drug treatment, improvement in vascular function can be achieved in almost 100% of cases. As for drugs that relieve painful sensations and all other unpleasant signs - it is better that the medications are selected by a doctor. In any case, you should not delay your visit to the doctor.

Venous dysfunction is a serious pathology that requires proper treatment. Otherwise, such a condition leads to irreversible consequences. Self-medication in this case is life-threatening. When the first symptoms of the disease appear, you should consult a doctor. The features of venous blood stagnation, causes and treatment methods will be discussed in detail below.

General information about pathology

Venous dysfunction is serious illness, which, if incorrect or untimely treatment can lead to the most sad consequences. Central nervous system human is a multifunctional system that has a complex structure. It cannot work properly without good nutrition. It is provided by blood. Many reasons can affect the deterioration of blood circulation. As a result, venous outflow becomes slower. This condition is called venous outflow dysfunction.

The blood supply system in the brain consists of veins and arteries, which differ in diameter. Vessels can be superficial or deep. The first category of veins runs in the pia mater of the brain. Through them there is an outflow of blood from the cortex and some part white matter. Blood is taken from the remaining parts of the brain by deep veins.

Such vessels also pass through the dura mater of the brain. Blood from the veins is discharged into the space between the venous sinuses. This hard shells, which are called longitudinal (upper and lower), circulating and transverse sinuses. From the cranial cavity, venous blood moves through the internal jugular vein.

Dysfunction of blood outflow through the veins is a fairly common disease not only in the elderly, but also at a young age. After 30 years, every second person suffers from this disease. It may be less or more pronounced. Unpleasant symptoms diseases are aggravated by an unhealthy lifestyle, bad habits, unbalanced diet and overweight etc. Some people have a genetic predisposition to this disease.

Dysfunction of the outflow of venous blood develops more actively if a person has hypertension, atherosclerosis, as well as osteochondrosis in the cervical spine.

Classification

There are two forms of cerebral venous dysfunction. This is a primary and congestive type of disease. They have a number of differences. The primary form manifests itself due to impaired venous tone. This leads to various tissue nutritional disorders. This situation is often observed after a traumatic brain injury, in a state of alcohol or drug intoxication.

The primary form of pathology is also caused by hyperinsolation, hypertension and hypotension, diseases endocrine system etc.

In the stagnant form of the disease, difficulties in the outflow of blood of a mechanical type are observed. Blood circulation in this case is very difficult. This leads to a gradual decay of the mechanical flow of the process. A person requires external intervention. Otherwise, the outcome will be sad.

Venous dysfunction in a child is often caused by head injuries. In adults similar reasons also lead to poor circulation. Various hematomas and tumors are also causes of this condition. Deterioration in older people cerebral circulation and venous outflow may be explained by a stroke. As a result, the brain swells. This entails compression of the veins and arteries.

A genetic predisposition is determined in people who naturally have underdeveloped veins.

TO external factors A similar condition is vascular blockage. This group of causes also includes tumors, osteochondrosis in the cervical spine, injuries to the abdomen or sternum and other ailments.

The causes of obstructed outflow may vary. They occur both in the skull itself and in other parts of the body. Often, disorders in the spine lead to global disorders and pathologies. Malfunctions of organs can be the most unexpected.

Stages

Treatment of venous dysfunction depends on the stage and characteristics of the disease. The doctor must also determine what causes the obstructed blood flow. Only in this case the effect on the body can be effective. The disease can develop due to various malfunctions in the body. Moreover, this problem does not depend on gender. Many people do not even realize that they have problems with the flow of blood to the brain. This is explained by the peculiarities of the development of the disease.

In medicine, there are three stages of dysfunction of the outflow of venous blood. On initial stage the disease is practically asymptomatic. Nothing bothers the person yet. However pathological processes in it are already gradually developing. called latent. The quality of human life does not change in any way.

In the second stage, the first symptoms appear. However, changes in general condition and well-being are still insignificant. However, the symptoms already affect the quality of life. At this stage, the doctor diagnoses cerebral venous dysfunction.

The third stage is the most serious. It is called venous encephalopathy. Symptoms become obvious. The disease is actively progressing. The veins do not cope well with the function assigned to them. During the diagnosis, violations are determined at the micro and macro levels. In this case, immediate treatment is required. It is prescribed by a doctor after a complete diagnosis.

In order to identify such a disease in time, you need to know its main symptoms. If you suspect the development of dysfunction of the venous outflow of blood, you should go to the hospital. The sooner treatment begins, the less consequences will bring disease.

Symptoms

Venous dysfunction in the vertebral is manifested by a number of symptoms. If a person notices such phenomena, he should consult a doctor. By the way, such a disease is also called dysfunction of the outflow of venous blood. Modern therapy is effective, especially in the early stages of the disease. Therefore, the sooner treatment is started, the better for the patient.

There are certain signs of venous dysfunction. First and foremost on this list is headache. It is also called cephalgia. With slight turns of the head it intensifies. Also, a violation of the venous outflow of blood may be indicated by intense headaches that appear after stress or while intoxicated.

The pain is often concentrated in the ear area. There may be noise and unpleasant sounds in the head. The veins in the eyeball dilate and a vascular network appears.

Another sign of venous dysfunction is a headache that appears for no reason. Most often, such attacks occur before lunch. At the same time, the person’s face acquires a bluish tint. Swelling of the legs may also be present. Sometimes fainting may occur.

Patients with similar disorders in the cerebral circulation complain of numbness in the arms and legs. They lose their sensitivity. May happen mental disorders. These symptoms progress over time. Their manifestations in different people are not the same. All people's bodies are different. Therefore, even if one symptom appears, which recurs periodically, you need to consult a specialist for advice. Such a violation can lead to ischemia of brain tissue and other serious pathologies.

Consequences of circulatory disorders

Dysfunctions in the venous systems of the brain can lead to serious consequences. Without proper treatment, a number of other diseases appear. When venous circulation is disrupted, oxygen and glucose do not enter the brain in the required quantities. This leads to neurological pathologies.

Stroke is one of the diseases that is caused by disturbances in the venous circulation. In this case, part of the brain tissue dies. This can affect speech, motor coordination, and memory. The consequences of a stroke can vary. This depends on the amount of brain tissue that has died as a result of hemorrhage, as well as the speed of restoration of venous blood flow. In some cases, the patient's health is completely restored. However, in most cases the changes are irreversible. Sometimes this leads to death.

If a person has chronic disorders in the area of venous circulation in the brain, hemorrhage may appear in the cranial cavity. The walls of blood vessels weaken. This leads to their breakup. Hemorrhage leads to loss of consciousness and more serious consequences.

Hypoxia can also be caused by venous stagnation of blood. For example, venous dysfunction of the vertebral veins can lead to a partial or complete cessation of oxygen supply to the brain. The person feels weak and dizzy. If the vessels are not unblocked promptly, coma occurs and then death.

Disturbances in the area of venous circulation provoke the appearance of dyscirculatory hypertensive encephalopathy. This syndrome usually develops slowly. The brain does not receive the amount of oxygen required for normal functioning. If the process develops rapidly, the venous outflow is completely blocked. 6 minutes after similar phenomenon death comes.

Diagnostics

Venous dysfunction in both areas or in only one part of the brain can be diagnosed using modern techniques. Without this, the doctor will not be able to prescribe adequate treatment.

When visiting a neurologist, a person describes his condition. He names the symptoms that appear to him periodically. The doctor also examines the patient. He prescribes a number of diagnostic procedures. One of the most informative methods is the use of MRI. With a contrast examination, you can obtain a three-dimensional image of all the vessels of the brain. This is one of the most modern precise methods diagnostics

Ultrasonography also used if a similar pathology is suspected. In some cases, a person is prescribed a vascular computed tomography scan. In this case, he is injected with a special contrast agent. CT is a fairly informative technique. However, the radiation dose during the procedure is quite high. Therefore, CT has a number of contraindications.

Venous dysfunction in the VBB can also be diagnosed after vascular angiography. Almost all of the methods listed above identify the root cause of this condition. The examination may show abnormalities in the jugular vein area. Also, the doctor who performs the procedure examines the patient’s eyeball. There may also be signs of venous stagnation of blood.

The disease often presents is also manifested by swelling of the veins in the legs. The treatment prescribed by the doctor must be comprehensive. It includes a number of medications, as well as special exercises.

Drug treatment

Venous dysfunction of the brain requires proper, comprehensive treatment. After conducting an examination and making a diagnosis, the doctor prescribes a number of medications. They affect the entire body, including blood vessels. Drug treatment is the main approach in the process of eliminating problems in the outflow of venous blood from the brain.

The doctor individually selects the necessary antiplatelet agents and anticoagulants. These can be Plavix, Warfarin, etc. They prevent the formation of blood clots in circulatory system. This reduces the likelihood of complications.

The patient must also take diuretics (for example, Furadonin). They remove from the body excess liquid. As a result, the load on the veins is reduced. In combination with these drugs, medications that have a tonic effect on the veins are necessarily prescribed. These include Fazoket, Escusan, Troxevasin, etc. The listed drugs act on the walls of blood vessels. They improve their elasticity. This has a positive effect on blood outflow processes.

If necessary, the doctor prescribes caffeine-based medications. This substance increases muscle tone, which has a positive effect on the veins performing their functions. To improve brain performance, Strugeron is prescribed. The drug also normalizes blood circulation in these tissues.

The dosage of drugs depends on the characteristics of the patient’s body. It is selected individually. The stage of the disease and symptoms are also taken into account.

Folk recipes

Venous dysfunction of the brain is treated with complex methods. In combination with the main drug treatment You can use traditional medicine recipes. To choose the right remedy, you need to consult your doctor.

It is also worth considering that folk remedies It is advisable to use only at the initial or second stage of the disease. In case of serious disturbances in the outflow of venous blood, such recipes are ineffective.

To improve the patient's condition, various herbs are used. It could be nettle. During treatment, both the plant itself and its juice are used. A decoction is made from 100 g of nettle. To do this, pour boiling water over the plant and heat it in a water bath for 15 minutes. Next, remove the product from the heat and cool. Take the infusion daily before meals. You can also drink it between meals. Nettle helps thin the blood. It becomes less thick, so it is easier for it to circulate inside the vessels.

You can also take grape juice internally. It is pressed from dark varieties of the plant. Take 200 g of juice half an hour before meals. Grapes contain many minerals and vitamins that strengthen the walls of blood vessels. Also, the juice of this plant improves venous blood circulation.

Exercises

During the treatment of cerebral venous dysfunction, the doctor may prescribe a complex special exercises. They are performed daily. You need to tilt your head back. In this case, the person sits calmly on a chair. He is relaxed, breathing deeply. You need to stay in this position for a minute. Then rest and repeat the exercise several times.

After these exercises, you need to cross your fingers under your chin. At the moment of exhalation, the head is tilted and pressed on the hands. As you inhale, raise your head and throw it back. This exercise is performed several times.

If a person is diagnosed with venous dysfunction, there is a predisposition to a similar condition, or for the purpose of prevention, a number of measures must be taken simple actions. You must follow your doctor's recommendations exactly. This will require you to reconsider your lifestyle. Need to give up bad habits. Smoking, alcohol, and taking drugs are prohibited. This leads to rapid progression of the disease. You need to play sports. Moreover, the exercises should not be strength exercises. It is better to give preference to fitness, gymnastics, and swimming.

You need to reconsider your diet. With a balanced diet, blood flow improves. Vessels become stronger and more elastic. It is necessary to exclude smoked, fatty, salty foods from the diet. You should also avoid drinking carbonated drinks. Fast food in this case it is also unacceptable. Baked goods, canned food and other unhealthy foods should be eliminated from the daily diet.

The body must receive sufficient amounts of vitamins C, E and P. It also needs amino acids and fiber. A healthy diet will help you get rid of not only this, but also other pathologies, and prevent the development of serious illnesses.

Having considered the features of venous dysfunction, as well as the symptoms, causes and consequences of this disease, one can understand the importance of timely treatment. Following the recommendations of the attending physician and a healthy lifestyle can restore a person’s health.

The brain receives nutrients (glucose, fatty acid, amino acids) and oxygen, thanks to a well-developed system of blood vessels: arteries and veins. There are special mechanisms for regulating work that prevent the development of blood flow disorders. However, sometimes a similar situation does occur, leading to the development of various vascular diseases, among which special place occupies venous discirculation, characterized by a violation of the outflow of blood from the brain.

Causes

Many people ask the question: “What is cerebral venous circulation?” This is a complex pathological condition that occurs as a result of a number of reasons:

Systemic diseases with vascular damage, such as atherosclerosis or. Similar conditions lead to changes in the walls of arteries and veins, and disrupt normal blood flow.
Traumatic injuries to the skull and their early or long-term consequences (see).
Consequences of hemorrhagic or.
Infectious lesion brain with inflammatory or thrombotic changes in the walls of blood vessels.
Long-term use of the series medicines(nitrates, oral contraceptives, vasodilators) without proper medical supervision.
In some cases, venous discirculation may occur as acute condition- at .

It is important to note that the mere presence causative factor does not always lead to the onset of disease. The presence of risk factors is also necessary:

chronic alcohol abuse;
obesity of the second and third degree;
smoking;
prolonged stress;
frequent physical or mental stress.

Types of disease

Clarification of the type of venous discirculation is important for additional diagnostic methods and appointments adequate treatment. Cases of venous discirculation in the VBB (vertebrobasilar basin) are divided into two large groups:

The primary form is associated with direct brain disease and changes in tone venous vessels. A similar situation occurs as a result of traumatic brain injury, pathology of the cardiac system and a number of intoxications.
The secondary form, or congestive form, appears as a result of long-term damage to the blood vessels of the brain.

Main manifestations

Signs of venous discirculation are not specific and occur with a large number various diseases. As a rule, the leading symptom is periodic dull headaches, often accompanied by nausea and vomiting. With the development of decompensation of the outflow of venous blood, disturbances in cognitive functions (memory, thinking, attention, etc.) are possible, as well as disturbances of consciousness of varying degrees of severity.

If the patient does not receive treatment, the disease continues to progress and the symptoms expand:

attacks of dizziness with impaired orientation in space;
transient visual impairment;
sudden fainting with or without exposure to external provoking factors;
tics and other involuntary muscle movements;
drowsiness during the day, which is associated with the development of hypoxia.

Possible complications

After the patient finds out what venous discirculation in the VBB is, the question often arises: why is this condition dangerous? Violation of the outflow of venous blood causes disturbances in the blood supply to the brain and, as a result, a hypoxic state, which leads to a number of serious consequences:

Ischemic or hemorrhagic stroke are the most serious complications of the disease and lead to disability and decreased quality of life.
Chronic hypoxia leads to impairment in the cognitive sphere, which is manifested by a decrease in a person’s ability to remember and reproduce information, make decisions, and concentrate on assigned tasks.
Impaired blood flow in the brain is the main cause of discirculatory encephalopathy, caused by impaired blood supply to the central nervous system.

Diagnosis of the disease

The appointment of additional methods makes it possible to identify the main cause of venous discirculation and identify treatment tactics. Great importance in making a diagnosis has clinical examination patient and careful collection and analysis of complaints: time of onset of symptoms, provoking factors, methods of independent and previous treatment, etc. In most cases, a survey of the medical history and data on concomitant diseases (hypertension, traumatic brain injury) help to identify the cause of the violation of venous outflow.

In some cases it is necessary to carry out additional methods with imaging, such as computed tomography and magnetic resonance imaging. During the examination, doctors assess the condition of anatomical formations and identify disorders, localization of pathological areas and structures. X-ray or CT angiography is used to visualize the vascular system.

Treatment of venous discirculation

The main method of treatment is to remove the cause of the development of disturbances in the outflow of venous blood. Usually, positive effect provide recommendations for lifestyle changes:

give up alcoholic beverages and smoking, which will improve blood supply to organs;
maintain physical activity throughout the day;
exclude fatty, salty and sweet foods from food to normalize metabolism;
treat concomitant diseases after consultation with your doctor.

Among medications, patients with venous dyscirculation are prescribed drugs that reduce blood viscosity (anticoagulants - Fraxiparin, Heparin, and anticoagulants - Aspirin, Clopidogrel, Aspirin Cardio). Medicines prevent the development of thrombotic complications.

Venous discirculation is manifested by periodic headaches, to which many people do not pay attention. However, the disease can lead to serious complications such as stroke. Therefore, if any symptoms appear, you should seek medical help.

MATERIAL FROM THE ARCHIVE

The role of venous circulation disorders in the origin, course and clinical definition of cerebrovascular diseases long time underestimated. This is explained by the complexity of intravital assessment of cerebral venous hemodynamics when using low-resolution traditional methods registration of venous blood flow in the vessels of the brain and insufficient attention from researchers to this section of angiology.

Let's begin our consideration of this problem by outlining the features of blood circulation in the brain. The blood supply to the brain is provided by two interconnected systems - the carotid, from the carotid artery basin, and the vertebral, from the subclavian artery basin.

Features of arterial blood supply to the brain:

Large arterial branches run only along the surface of the brain, while small ones extend from them at an angle of 90 degrees into the brain tissue.

Large arteries are located between the parietal and visceral layers of the arachnoid membrane of the brain and are immovably fixed by them.

Doesn't exist in the brain lymph nodes and lymphatic vessels

Capillaries are thin, inextensible vessels (do not contain muscle fibers). Exudation, transudation and absorption occur in pre- and post-capillaries.

Features of venous outflow from the brain:

There are no valves in the veins that provide venous outflow from the brain tissue, but between them there is a very a large number of anastomoses.

Venous pressure in the cranial cavity corresponds to intracranial pressure.

The cerebral sinuses, formed by the layers of the dura mater, take part in ensuring venous outflow from the brain. There are eight paired and five unpaired cerebral sinuses. The sinuses connect to the external veins of the skull using diploic veins.

The veins of the brain are divided into: superficial - located in the pia mater, they collect blood from the cortex and white matter; deep - collect blood from the white matter of the hemispheres, subcortical nodes, walls of the ventricles and choroid plexuses. The veins of the dura mater pass together with the arteries in the thickness of the shell and form a significant venous network. All veins carry blood to the venous blood collectors - the venous sinuses of the dura mater, located between its two leaves. The main ones:

superior longitudinal sinus- runs along the upper edge of the large falciform process;

inferior longitudinal sinus- located along the lower free edge of the large falciform process with the tentorium of the cerebellum;

transverse sinus- the widest of all, located on the sides of the internal occipital bone thickening

cavernous sinus- located on the sides of the sella turcica;

anterior and posterior intercavernous sinuses- pass between the left and right cavernous sinuses, thus forming a circular sinus around the pituitary gland;

Venous drainage from the brain occurs through: superficial and deep cerebral veins (see above). The superior superficial cerebral veins open into the superior sagittal sinus; The inferior superficial cerebral veins open into the transverse sinus of the brain. The deep cerebral veins open into the vein of Galen (v.cerebri magna Galeni) and further into the straight sinus cerebral cord. From the sinuses, blood enters the internal ducts jumbo and vertebral veins and further, through v. brachiocephalica, into the superior vena cava. Part of the venous blood is drained through emissaries - venous graduates located inside the flat bones of the skull and connecting the venous sinuses of the dura mater with the diploic veins and with the external veins of the head

DISORDERS OF VENOUS CIRCULATION OF THE BRAIN

The following variants of venous circulation in the brain are distinguished: chronic - venous congestion and venous encephalopathy; acute - venous hemorrhages, thrombosis of the veins and venous sinuses, thrombophlebitis.

VENOUS STAGNESS

The most common form of venous circulation disorder.

Venous congestion of the brain can be due to various reasons:

heart and cardiopulmonary failure;

respiratory diseases - bronchitis, bronchiectasis, bronchial asthma, emphysema, etc.;

compression of extracranial veins (internal jugular, innominate, superior cava) by struma, arterial aneurysm, tumor in the neck;

neoplasms of the brain, membranes and skull;

traumatic brain injury;

thrombosis of the veins and sinuses of the dura mater;

compression of veins with cerebral hydrocele and craniostenosis.

At venous stagnation: metabolic changes and brain hypoxia occur, venous and intracranial pressure increases, and cerebral edema develops. More often, milder disorders occur in the form of changes in the tone of the cerebral veins, which is detected using orbital plethysmography and rheography.

Clinical manifestations:

dull headache, more pronounced in the morning;

headache increases when moving the head to the sides, changing atmospheric pressure, temperature change environment, after excitement, drinking alcohol, etc.;

there is a hum or noise in the head, cyanotic lips, cheeks, ears, nose, mucous membranes of the oral cavity, swelling of the lower eyelids, especially in the morning;

dilatation of veins in the fundus;

venous pressure ranges from 55 to 80 mmH2O, arterial pressure is usually within normal limits;

stupor, dizziness, darkening of the eyes, fainting, numbness of the extremities are observed;

possible epileptic seizures, mental disorders;

with severe venous stagnation, patients are unable to lower their heads and remain in a horizontal position.

They have diagnostic value for venous pathology measuring pressure in the cubital vein, radiography of the skull (increased development of diploic veins, graduates and veins of the dura mater), phlebography.

VENOUS ENCEPHALOPATHY

With venous encephalopathy, the following syndromes are distinguished:

hypertensive(pseudotumorous);

diffuse small-focal brain damage;

bettolepsy;

asthenic.

Bettolepsy (cough epilepsy) develops with: chronic bronchitis, emphysema, pneumosclerosis, bronchial asthma, cardiopulmonary failure. Persistent cough may end sudden loss consciousness (syncope form).

VENOUS HEMORRHAGES

Capillary-venous hemorrhages in the brain and capillary-venous stasis are observed in hypertension.

Venous stroke occurs in patients with:

heart failure;

traumatic brain injury;

brain tumor;

infectious and toxic brain lesions.

Clinical manifestations develop slowly: confusion, speech disorders, diplopia, pyramidal reflexes, hemiparesis, hemihypesthesia, damage to cranial nerves.

CEREBRAL VEIN THROMBOSIS

Occurs as a complication:

various inflammatory processes;

infectious diseases;

operations;

abortions;

pregnancy;

childbirth;

skull injuries;

“blue” heart defects, etc.

The following factors play a role in pathogenesis and promote aggregation: shaped elements blood: changes in the walls of the veins, slowing down the speed of blood flow, increased blood clotting, change colloidal properties endothelial cells. Often, thrombosis of the cerebral veins is combined with thrombosis of the sinuses of the brain, as well as the veins of the lower extremities.

Clinical manifestations of cerebral vein thrombosis:

symptoms usually develop gradually;

headache, nausea, vomiting, meningeal symptoms appear, stagnant discs optic nerves, increased body temperature, increased ESR;

V cerebrospinal fluid mild pleocytosis and an increase in protein content, sometimes blood, are detected;

characterized by confusion, partial motor-type seizures, and less commonly generalized convulsions;

depending on the location of the vein lesions occur focal symptoms: aphasia, alexia, hemianopsia, flaccid or spastic paresis or paralysis, sensory disturbances.

Exodus:often favorable - focal symptoms often undergo significant or even complete regression; relapses of the disease are possible; perhaps slow chronic course for many months and even years; sometimes there are consequences in the form of mental disorders, aphasia, convulsions x seizures and paresis of the limbs.

Thrombophlebitis of the brain veins

Clinical manifestations:

the temperature rises to subfebrile levels with periodic rises to 38 - 39 ° C;

patients complain of headache, nausea, vomiting;

stupor is observed, soporous state, epileptic seizures, paresis of limbs

in the fundus - swelling and dilation of veins;

in the blood - leukocytosis;

in the cerebrospinal fluid - slight pleocytosis, an increase in the amount of protein and positive protein reactions, sometimes an admixture of erythrocytes.

VENOUS SINE THROMBOSIS (sinus - thrombosis)

Thrombosis of the cerebral venous sinuses is an uncommon diagnosis due to the difficulty of diagnosing it. But within last decade Due to the development of modern neuroimaging technology, the possibilities of intravital diagnosis of this disease. Depending on the location and collateral blood flow, as well as the age of the patient, the clinical manifestations of cerebral venous thrombosis are extremely variable and nonspecific.

The most common initial symptoms are:

G tin pain, which is present in 75 - 95% of patients in combination with swelling of the optic discs as a manifestation of intracranial hypertension syndrome;

seizures, focal neurological deficit, flickering disturbances of consciousness appear gradually in the future in case of damage to the brain substance against the background of a developing infarction or hemorrhage and progressive cerebral edema.

When the sinuses are affected, general cerebral symptoms depend on the massiveness and rate of growth of thrombosis, and focal neurological symptoms correspond to the location of the affected sinus. Focal migrating symptoms appear when the brain substance is involved in the process, i.e. An extensive cortical venous infarction develops - cortical motor deficits, cortical symptoms and seizures appear.

Etiology of dural sinus thrombosis:

injuries;

compression of the sinus by a tumor;

dural malformation;

septic lesions;

systemic connective tissue lesions;

may occur against the background of thrombophlebitis of the extremities or inflammatory foci in the body, for example, in postpartum period, after abortion, for diseases of the ears and paranasal sinuses, for infectious diseases.

Infectious thrombosis of the cerebral veins and sinuses can be complicated by purulent meningitis, encephalitis, and brain abscess.

The causes of aseptic cerebral venous thrombosis also include:

severe dehydration;

heart disease - birth defects heart failure, arrhythmias);

malignant neoplasms - a variant of paraneoplastic syndrome;

diabetes;

pregnancy, androgen intake, oral contraceptives, that is, conditions that change the background of sex hormones;

nephrotic syndrome;

blood diseases, coagulopathy - polycythemia, essential thrombocytosis, DIC syndrome;

systemic diseases, vasculitis;

inflammatory bowel diseases;

cirrhosis of the liver.

In addition to the listed processes of damage to the vascular wall as a result of autoimmune and toxic processes of increased thrombus formation, cerebral venous thrombosis can occur with: brain tumors, traumatic brain injuries. In these cases, the factor of local traumatization is important.

Venous sinus thrombosis usually develops:

in case of penetration of infection from a nearby focus through the cerebral and diploic veins- boils or carbuncles of the scalp, face, erysipelas, etc., purulent osteomyelitis of the skull bones, purulent acute and chronic otitis media, mastoiditis, purulent processes in the eye socket, paranasal sinuses nose;

with hematogenous introduction of infection against the background of thrombophlebitis of the veins of the extremities or pelvis and during septic processes;

for chronic infections(tuberculosis), malignant tumors and other diseases occurring with cachexia, in debilitated patients and in old age.

Thrombosis of the cerebral sinuses is sometimes accompanied byrhombophlebitisretinal veins, purulent meningitis, abscessesbrain and etc.

Clinical manifestations:

low-grade or sometimes very high, stable or fluctuating body temperature;

headache, vomiting, leukocytosis in the blood, increased intracranial pressure;

with thrombosis of the sinuses of the convexital surface of the brain, general cerebral symptoms predominate;

with thrombosis of the sinuses at the base of the brain, signs of damage to the cranial nerves predominate;

drowsiness develops, sometimes, on the contrary, motor restlessness, insomnia, delirium, epileptic seizures, rigidity neck muscles, Kernig's sign, hyperesthesia to visual, auditory and skin stimuli, sometimes trismus;

focal symptoms of brain damage correspond to the localization of the sinus;

swelling, cyanosis of the face or mastoid area are noted;

dilated veins and swelling of the optic discs are detected in the fundus;

cerebrospinal fluid is clear or xanthochromic, sometimes with an admixture of red blood cells; moderate pleocytosis is noted;

septic thrombosis of the dural sinuses is manifested by chills, very high remitting temperature;

with thrombosis of the superior sagittal sinus, epileptic seizures of the motor type, hemi- and paraplegia or paresis occur.

It is very important for the doctor to know the main characteristics of headache with central venous thrombosis:

subacute headache with increasing frequency and intensity: usually headache with central venous thrombosis begins subacutely, increasing over several days (initially inconsistent, gradually becoming constant and increasing in intensity);

over time, the headache becomes resistant to the effects of any analgesics and is especially disturbing at night;

less often, headache occurs suddenly like a “thunderclap” and develops in less than 24 hours, which is sometimes indistinguishable from subarachnoid hemorrhage;

headache with this pathology always intensifies with physical activity and increases in a lying position;

headache is accompanied by persistent symptoms - fever, nausea;

headache is often accompanied by neurological symptoms.

Other features of headache with central venous thrombosis:

patient age: occurs less frequently in the elderly than in the young (probably due to the lower incidence of intracranial hypertension in the elderly due to atrophic processes and decreased reactivity of the pain system);

nature of the headache: may be migraine-like or tension-type headache-like, but usually the headache is progressive, long-lasting and resistant to treatment;

localization of headache: often diffuse, but can also be local, one-sided;

headache intensity: medium or strong;

type of headache: increasing or pulsating;

characterized by a decrease in headaches after a few days during treatment with heparin;

lumbar puncture improves the condition of headaches caused by intracranial hypertension, and is especially indicated for visual disorders;

Symptoms of thrombosis of the transverse or sigmoid sinus:

often occurs as a result of complications purulent otitis or mastoiditis;

local symptoms: swelling of the soft tissues of the mastoid area, pain when turning the head to the healthy side, forced tilt of the head to the painful side (anti-pain position of the head) - due to tension ligamentous apparatus the working sternocleidomastoid muscle (m. sternocleidomastoideus);

early neurological symptom - headache on the affected side, aggravated by percussion of the skull;

bradycardia, sometimes double vision;

septic temperature, chills, stupor, turning into stuporous and even coma, sometimes delirium and agitation;

meningeal phenomena, leukocytosis in the blood;

the jugular vein may be involved in the process, with swelling of the tissue surrounding the vein and signs of damage to the glossopharyngeal, vagus, accessory and hypoglossal nerves;

Thrombosis of the sigmoid sinus with extension to the jugular vein:

local symptoms: swelling and tenderness at the site of the jugular vein projection in the neck;

possible signs of damage to the caudal group of cranial nerves, dysphonia, dysphagia, paresis of the sternocleidomastoid and upper portion of the trapezius muscle.

Symptoms of cavernous sinus thrombosis:

exophthalmos, swelling and venous hyperemia of the eyelids, eye sockets, forehead, root of the nose, dilatation of the veins of the fundus (congestion);

pain and hyperesthesia in the area of innervation upper branch trigeminal nerve, conjunctival chemosis;

ophthalmoplegia - paralysis or paresis of muscles innervated by the III, IV, VI cranial nerves;

stupor, delirium, sometimes coma;

metabolic and endocrine dysfunctions;

complications: purulent meningitis, metastatic abscesses in the lungs, septic pneumonia.

Thrombosis of the superior sagittal sinus:

local symptoms: tortuosity and swelling of the veins of the eyelids, root of the nose, skin, temporo-parietal and frontal areas; swelling of the soft tissues of these areas;

pain on percussion midline heads.

Thrombosis of the superior petrosal sinus:

local symptoms: damage to the trigeminal nerve - pain, paresthesia and hypoesthesia along all its branches, weakness of the masticatory muscle on the affected side.

Thrombosis of the inferior petrosal sinus:

local symptoms: damage to the abducens nerve - the inability to abduct the eyeball outward.

Diagnosis of cerebral venous thrombosis is based on: clinical picture of the disease and paraclinical study data. Clinical manifestations can be divided into the following groups:

1 - intracranial hypertension:

patients complain of diffuse headaches of a bursting nature, more often in the morning;

in the neurological status, a decrease in corneal reflexes, soreness of Greenstein’s points, mild paresis of the abducens nerves, as a consequence of hypertension, may be observed;

the fundus reveals congestion and tortuosity of the veins;

echo-encephalography reveals additional strong lateral echoes.

2. Symptoms of diseases leading to septic and aseptic cerebral venous thrombosis.
Mandatory examination of the blood coagulation system.

3. “Dyscirculatory” symptoms associated with local disturbances of venous blood flow, allowing the evaluation of topical diagnostics (see previously described syndromes of damage to the sinuses of the brain).

4. Analysis of conduction disorders in cerebral venous thrombosis.

thrombosis of the sigmoid and transverse sinuses- accompanied (often) by paresis on the side opposite to the lesion, sometimes by aphasia;

thrombosis of the superior sagittal sinus- accompanied (often) by lower spastic paraplegia with pelvic disorders, motor Jacksonian paroxysms in lower limbs, cramps in the feet.

This is explained by the involvement of the superficial veins of the brain in the process with the development of thrombosis or thrombophlebitis in them.

Neuroimaging (paraclinical study data). In cases of a clinical picture of cerebral venous thrombosis along the veins and sinuses, a CT or MRI of the brain reveals an area of ischemia and hemorrhage. However, neuroimaging often fails to detect changes in the brain parenchyma.

Magnetic resonance imaging. The method of choice is magnetic resonance imaging (MRI) of the brain with magnetic resonance venography, but, unfortunately, these methods are not always available, especially in acute period diseases. An MRI reveals:

replacement of the MR signal of normal blood flow in the sinus with pathological ones: in the first days (acute stage) T1-isointense to T2-hypointense; after a few days (subacute stage) T1-hyperintense, T2-hypo- or isointense;

zones of ischemia or infarction along the thrombosed sinus;

vasogenic edema: hypointense in DW and hyperintense in T2 mode.

CT scan. Computed tomography (CT; axial slices) is usually the first test performed in patients with suspected cerebral venous thrombosis. CT scan may reveal signs of venous cerebral infarction and intracerebral hemorrhage. But CT scans often fail to detect thrombosis, especially if the study is performed without contrast injection. Using spiral CT with bolus injection contrast agent(SCT in angio- and venography mode), MRI and MR-venography are indicated in these cases. When performing a native CT scan (without contrast), the following results are possible: no changes and/or nonspecific symptoms: hyperdensity of the venous system nous, narrowing of the cisterns and/or ventricles due to increased intracranial pressure. When performing a CT scan with intravenous enhancement, the following results are possible:

symptom of “empty delta” - absence of accumulation of contrast agent in the thrombosed area of the venous sinus;

localized subcortical infarcts near the thrombosed sinus.

If necessary, cerebral angiography and venography are used to definitively determine the location and extent of thrombosis. MR venography is a defect of current hyperintensity (loss of MR signal) in one or more sinuses. Role ultrasonic methods(TCD, TCDS) in the diagnosis of cerebral sinus thrombosis remains poorly studied. Almost all known ultrasound studies are devoted to changes in the LSC in the basal veins during thrombosis of the superior sagittal sinus. A few studies describe observations of thrombosis of the direct and transverse sinuses. When conducting transcranial ultrasound diagnostics of cerebral venous thrombosis, it is possible to detect retrograde blood flow through the basal veins, which may indicate obstruction of the straight sinus. This allows one to suspect pathology in the venous system of the brain even before use. cerebral angiography or MRI venography.

Treatment Septic cerebral venous thrombosis poses a challenge for the physician. In these cases it is necessary:

surgical removal of the source of infection;

early appointment systemic antibacterial drugs (cultures are necessary to clarify sensitivity); until culture results are obtained, antibiotics are prescribed that are effective for infections of the face, ear, and neck;

cephalosporins III generation(ceftriaxone or cefotaxime 2 g 2 times a day alone intravenously or in combination with penicillinase-resistant penicillins;

patients with suspected nosocomial infections are prescribed meropenem (2 g 3 times a day intravenously), ceftazidine (2 g 3 times a day intravenously), vancomycin (0.5 g 4 times a day intravenously).

The advisability of prescribing anticoagulants in this case has not been proven, but, according to a number of authors, their inclusion in complex treatment is effective.

Even during the last 20 years, despite the development modern methods neuroimaging, the etiology of 20-35% of venous thrombosis remains unclear and in some cases it is not possible to establish the exact cause of central venous thrombosis. However, patients with complaints of increasing headaches that get worse at night, pain in the eye, the mastoid area, patients with congestion in the fundus (especially in combination with swelling of the eyelids and conjunctiva) of unknown origin require a thorough examination to exclude venous brain pathologies.

Treatment aseptic cerebral thrombosis. The fight against blood clots comes first. It is recommended to use heparin in a dose of 2.5 - 5 thousand. ED intravenously or subcutaneously, which is then increased to 70 thousand units/day. The dose is selected under the control of APTT, which should double. Heparin is used until the patient's symptoms of cerebral venous thrombosis improve. Then oral anticoagulants are added to treatment for a period of at least 3 months. to prevent relapses. Currently, warfarin is widely used for this purpose under the control of the results of the prothrombin test - INR. There are three levels of hypocoagulation based on INR values:

high - INR = 2.5 - 3.5;

average - INR = 2.0 - 2.5;

low - INR = 1.6 - 2.0.

Article publication date: 06/07/2017

Article updated date: 12/21/2018

From this article you will learn: what is venous discirculation. Why does it appear, what complications can it lead to. Symptoms, diagnosis, treatment and prognosis of pathology.

With venous discirculation, the outflow of venous blood is disrupted. Because of it, blood stagnation occurs and associated disruptions in the functioning of the organ that has suffered from the disease.

The term “dyscirculation” itself means a circulatory disorder.

Most often in medical practice venous discirculation of the brain occurs. Among other circulatory disorders in the brain, discirculation in the VBB (vertebrobasilar basin), discirculation in the carotid sinus, and in the circle of Willis are distinguished. These 3 components of the brain's circulatory system are made up of arteries. And in this article we'll talk about impaired circulation in the veins of the head and neck, which leads to brain disorders associated with blood stagnation.

This is a very dangerous phenomenon as it progresses over the years and can lead to a stroke or severe (brain damage due to lack of blood circulation). In both cases, the patient essentially becomes disabled.

A neurologist deals with the problem of venous circulation of the brain.

To get rid of pathology, you will need to eliminate its cause (the underlying disease). However, reversing the changes that have occurred in the brain is almost impossible. Therefore, the main task of doctors is to prevent the progression of the disease and its transition to last stage. Treatment will help you get rid of symptoms that are preventing you from living a full life and significantly prolong your ability to work.

The location of the veins on the human head and neck. Impaired circulation of these veins poses a great danger to health

Causes of venous discirculation

A factor that provokes insufficient outflow of venous blood can be:

Heart failure (it occurs due to atherosclerosis coronary arteries, congenital and acquired heart defects, arrhythmias, poor lifestyle).
Hypertension – due to chronically high blood pressure, blood cannot fully circulate through narrowed vessels.
Hypotonic disease – due to constantly low blood pressure, blood circulation slows down.
Osteochondrosis of the cervical spine. Osteophytes that form during this disease or prolapsed intervertebral discs can compress large vessels coming from the brain, which provokes a violation of the outflow of venous blood.
Cerebral atherosclerosis. This brain gets clogged cholesterol plaques, which makes proper blood circulation impossible.
Endocrine diseases: hyperthyroidism, hypothyroidism, diabetes and others. Hormonal disorders often cause complications on blood vessels: they increase or decrease blood pressure, contribute to inflammatory processes in arteries and veins.
Goiter. A heavily enlarged thyroid gland can compress the internal jugular vein.
Closed craniocerebral injury. In the absence of adequate treatment, the tone of cerebral vessels changes, which leads to circulatory disorders.
Neck tumors. They compress the veins that carry blood away from the brain.
Vein thrombosis. The blood clot clogs the vessel, and blood cannot pass through it normally.
Brain tumors. This compresses the veins located directly in the brain.
. This is a pathology in which there are pathological vessels connecting arteries and veins. This provokes a mixing of arterial and venous blood and disrupts venous outflow.

With an enlarged thyroid gland (goiter), venous discirculation may develop due to compression of nearby veins

Three stages of pathology

Venous discirculation develops in 3 stages:

The first is that symptoms do not appear.
Secondly, the signs are present, but although they worsen the quality of life, they do not exclude the ability to work and the ability to self-care.
Third, the symptoms are so strong that they provoke severe complications in the brain and throughout the body. The patient can no longer work. Over time, he cannot take care of himself; he requires constant care from other people.

The disease is insidious in that it does not manifest itself at the first stage, and when the symptoms begin to make themselves felt, the changes are sometimes irreversible. And at the second stage, you can only prevent the disease from moving into the third – the most severe phase. You can also completely alleviate the disturbing symptoms, but it is unlikely that you will be able to get rid of the pathological changes that have occurred in the brain 100 percent.

Characteristic symptoms

Signs of venous discirculation begin to appear at stage 2.

Pathology can be recognized by the following symptoms	When the headache gets worse
Headache (dull, bursting)	In the morning, especially if you haven't gotten enough sleep
Weakness, fatigue, difficulty getting up in the morning	When you take horizontal position or tilt your head down
Swelling of the lower eyelid, bags under the eyes	When you turn your head many times
Noise, ringing in the ears	When performing complex movements that require good coordination
Dizziness, fainting	When you exercise
Periodic numbness of the limbs	When there is a sudden change in weather
Blue tint to the tip of the nose, lips, cheeks	When you're nervous

Closer to the third stage, the following signs are added to the listed characteristics:

Disorders of coordination, memory, speech, thinking, psyche.
The patient's gait is disturbed and he cannot perform precise movements, for example, touching his nose with his eyes closed.
He becomes forgetful, whiny, irritable.
May begin to speak less clearly.
Intellectual abilities decrease.
The frequency of numbness in the extremities also increases. This can eventually lead to paralysis.
Epileptic seizures may also develop.

Ultimately, all this leads to a condition similar to the consequences of a stroke. At very late and advanced stage Due to venous discirculation, the patient becomes disabled. Also, the disease at the third stage can lead to a stroke, which will further aggravate the severity of the patient’s condition.

Diagnostics

The disease can be detected using three procedures:

Doppler scanning of the vessels of the head and neck.
Phlebography of the brain (examination of veins).
MRI of the brain.

Doppler scanning of blood vessels - using the example of the carotid artery

Treatment methods

First of all, doctors will try to rid you of the underlying disease.
For this, various drugs may be prescribed (ACE inhibitors for hypertension, glycosides for heart failure, etc.) or surgery may be performed (for example, to remove a tumor compressing a vein).
To improve the outflow of venous blood, you will be prescribed a venotonic. Examples of drugs in this group: Venoplant, Detralex, Aescusan, Anavenol.
To thin the blood and prescribe one of the medications based on acetylsalicylic acid: Aspirin, Aspirin Cardio, .
To strengthen vascular walls, doctors prescribe their patients a course of treatment with Pyridoxine.
To relieve cognitive symptoms such as bad memory, emotional instability, difficulties in thinking, use nootropics: Glycine, Phenibut, Phenotropil.

Prevention

To prevent circulatory problems in the brain:

Get rid of bad habits.
Avoid stress, overexertion, and overtime.
Eat right.
Do not expose your body to excessive physical activity, but also don’t lead a sedentary lifestyle.
Treat on time chronic diseases, especially it concerns cervical osteochondrosis, which people often do not give due importance. If your neck hurts, immediately go to a neurologist.
Monitor your blood pressure, especially if you are over 40. Buy an automatic electronic blood pressure monitor and measure your blood pressure 2 times a day. This will take at most 5 minutes a day, but in this way you will eliminate hypertension and hypotension. If you notice that your blood pressure changes, immediately go to a therapist, and then to a cardiologist.
Once every six months to a year, undergo a preventive examination with a therapist, cardiologist, or neurologist.

Forecast

If the symptoms of venous discirculation pathology are already pronounced, the prognosis is not very favorable. There is a high probability that the disease will progress further. The risk of stroke is also increased.

However, if you follow all the doctor’s recommendations regarding the treatment of the underlying disease and symptomatic therapy venous discirculation of the brain can almost completely get rid of unpleasant manifestations and delay the progression of the disease until old age.

If you identify the disease at an early stage, when it is still hidden (this is why preventive annual visits to a neurologist are needed), then you can prevent even the appearance of the first symptoms.