home Thyroid Causes and treatment of impaired venous outflow of the brain. What is venous discirculation of brain tissue and how to treat it

Causes and treatment of impaired venous outflow of the brain. What is venous discirculation of brain tissue and how to treat it

With venous discirculation, outflow is disrupted venous blood. 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 meets . 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 discirculatory encephalopathy (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 the final 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, unhealthy lifestyle).
Hypertension – due to chronically high blood pressure, blood cannot fully circulate through narrowed vessels.
Hypotonic disease - due to constant low blood pressure blood circulation slows down.
Osteochondrosis cervical region 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 is a disease in which blood vessels in the brain become 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. Much overgrown thyroid may compress the internal jugular vein.
Closed craniocerebral injury. With absence 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.
Arteriovenous malformations. 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.

When increasing 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 relieve the disturbing symptoms, but get rid of 100 percent pathological changes that occurred in the brain is unlikely to succeed.

Characteristic symptoms

Signs of venous discirculation begin to appear at stage 2.

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.

Treatment methods

First of all, doctors will try to rid you of the underlying disease.

For this purpose they can appoint various drugs (ACE inhibitors for hypertension, glycosides for heart failure, etc.) or perform surgery (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 prevent thrombosis, one of the medications based on acetylsalicylic acid: Aspirin, Aspirin Cardio, ThromboASS, Cardiomagnyl.

To strengthen vascular walls, doctors prescribe their patients a course of treatment with Pyridoxine.

To relieve cognitive symptoms, such as poor memory, emotional instability, difficulties in thinking, nootropics are used: 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, this is especially true for cervical osteochondrosis, to which people often do not attach due importance. If your neck hurts, immediately go to a neurologist.
Follow 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 hypotensive disease. 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. Eat 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 the disease is detected on early stage, when it is still hidden (this is precisely why preventive annual visits to a neurologist are needed), then you can prevent even the appearance of the first symptoms.

Venous discirculation of the brain

Physiology of the cerebral venous system this moment still poorly studied. Therefore, only experienced phlebologists and neuropathologists know what venous discirculation is and how to treat it. Although in fact, under such a complex term lies an ordinary violation of venous blood flow. U healthy person, at rest, the average speed of venous blood movement is approximately 220 mm/min, and in those suffering from dyscirculation it decreases to 47 mm/min. Knowledge of anatomy circulatory system brain will help you independently identify the symptoms caused by dyscirculation, as well as take preventive measures in advance.

The mechanism of occurrence of venous discirculation

Cerebral veins can be divided into 2 subtypes: superficial and deep. The veins that are located in the soft membrane (superficial) are intended for the outflow of blood from the cerebral cortex, and those that are located in central departments hemispheres (deep veins), serve for the outflow of blood from the white matter. The above vessels carry blood to the superior and inferior longitudinal sinuses. From these collectors, blood is pumped into the internal jugular vein, and then flows from the brain through the vertebral vein system.

This rather simplified description of the complex route of blood outflow helps to understand why, for such a long time, doctors have been unable to determine real reasons cerebrovascular accidents.

Causes of obstruction of blood flow from the brain

It is quite difficult to determine exactly what exactly provoked the disruption of the normal outflow of blood from the brain, because more than one year may pass after the event that provoked the blockage. The main causes of venous discirculation may be:

pulmonary and heart failure;
compression of extracranial veins;
jugular vein thrombosis;
brain tumors;
traumatic brain injury;
cerebral edema;
systemic diseases (lupus erythematosus, Wegener's granulomatosis, Behcet's syndrome).

Discirculation can be provoked by either one disease or a complex of several unpleasant symptoms. For example, a mutation in the prothrombin protein in combination with the use of contraceptives in the form of pills increases the risk of developing dysgemia (another name for venous discirculation).

Risk factors

In addition to the above diseases, disruption of venous blood flow can provoke an unhealthy lifestyle. If you find yourself with at least one of the risk factors listed below, you need to make an appointment with a neurologist to discuss measures to prevent dysgemia.

High blood pressure and a sedentary lifestyle are the first step to dysgemia

The following deviations should alert you:

Symptoms of pathology

Dysgemia is almost always accompanied by periodic dull headaches, sometimes with nausea and vomiting. Less commonly, a disturbance of consciousness occurs, after which focal symptoms appear:

numbness of the limbs;
severe aphasia;
isolated epileptic seizures;
impaired vascular-platelet hemostasis.

Signs of venous discirculation may appear irregularly and last for several minutes. If the disease is not treated, then unpleasant symptoms may constantly bother the patient.

Only a doctor can help prevent the development of severe dysgemia

Most severe symptoms occur if the disorder is ignored:

dizziness;
blurred vision;
sudden loss of consciousness;
tingling in the neck, especially on the left;
moderate hypoxia;
sudden reflex movements;
constant drowsiness.

What does ignoring the problem lead to?

Ignoring symptoms for a long time leads to the fact that oxygen and glucose do not reach the brain. This can lead to neurological problems. Lack of treatment can provoke more severe conditions.

Stroke

If any tumor is blocking the flow of blood into the carotid artery, a heart attack or stroke may occur. As a result, some brain tissue may die. The death of even a small amount of tissue can affect speech, coordination, and memory. The severity of the consequences of a stroke depends on how much tissue has died and how quickly the outflow of venous blood has been restored. Some patients are able to fully recover, but most of those affected suffer irreversible changes.

Brain hemorrhage

At chronic problems with cerebral venous circulation, bleeding in the cranial cavity may occur. This occurs when the walls of the arteries weaken and burst. Even minor bleeding puts pressure on the brain, which can lead to loss of consciousness.

Hypoxia

Hypoxia occurs when completely or partially blocked venous drainage prevents oxygen from reaching the brain. Individuals with hypoxia often feel lethargic and dizzy. If the vessels are not promptly unblocked, coma and death may occur.

Dyscirculatory encephalopathy (including atherosclerotic origin)

Discirculatory hypertensive encephalopathy is a painful syndrome that is caused by a violation of venous blood flow. With minor dyscirculation, encephalopathy develops very slowly and is practically asymptomatic. The syndrome quickly disappears when the original causes of dysgemia are eliminated. But with a prolonged lack of oxygen or as a result of a complete blockage of venous outflow, brain death can occur (just 6 minutes after the complete cessation of blood flow).

Diagnostic methods

If the patient complains of several of the above symptoms, then all the doctor’s efforts will be aimed at identifying and treating the cause of the dyscirculation. To do this, a physical examination is performed, as well as studying medical history. To confirm the violation of venous outflow, several studies are prescribed with visualization of veins in the brain and vertebrobasilar region.

Complete blood count

It is prescribed to detect antinuclear antibodies and determine the erythrocyte sedimentation rate. If the test results confirm the presence of antibodies and a decreased ESR indicator, then it is assigned additional research to determine complement components and the level of antibodies to anti-deoxyribonucleic acid. The results of the above tests will reveal that the cause of dysgemia is systemic lupus erythematosus or Wegener's granulomatosis.

Electroencephalogram (EEG)

An electroencephalogram with impaired outflow of venous blood may be normal. But this study is strongly recommended after unilateral thalamic infarction. A slowdown in the basic alpha rhythm indirectly indicates coordination abnormalities and problems with blood outflow.

An EEG can help a doctor identify venous dyscirculation

Computed tomography (CT)

CT is important method visualization, often prescribed for primary diagnosis dysgemia. In the tomograph image, you can see whether any neoplasm or thrombosis is the cause of dyshemia.

CT angiography

CT angiography is also prescribed to visualize the cerebral venous system. Only angiography can indicate the absence of flow in the venous channels.

Contrast magnetic resonance imaging

Contrast magnetic resonance imaging is an excellent method for visualizing blood flow in the great cerebral veins. It is prescribed if angiography does not reveal any disturbances in the outflow of venous blood into the VBB.

How to treat venous discirculation?

stop smoking and drinking alcohol;
do simple things every day physical exercise;
follow a diet to lower cholesterol levels;
Monitor your blood sugar and blood pressure daily.

Concerning drug treatment patients with venous discirculation, then it is prescribed specific therapy, which includes taking anticoagulants or thrombolytics (depending on medical history). But the use of systemic anticoagulation as primary treatment is recommended for all patients without exception (even for a child and in the presence of intracranial hemorrhage).

Drug therapy is the most effective method treatment of dysgemia

Most often, drugs containing heparin are prescribed. At intravenous administration its action begins immediately, which is very important for patients with acute form dysgemia.

Enoxaparin sodium is a low molecular weight heparin and is prescribed if it is necessary to restore venous outflow to patients suffering from allergic reactions, or for prevention. The main advantage of enoxaparin is the possibility of intermittent administration of the drug, which allows the patient not to go to the hospital, but to take advantage of outpatient treatment.

Warfarin is prescribed to patients with bleeding disorders for whom heparin and enoxaparin are strictly contraindicated. The drug has a slight effect on coagulation activity, but also therapeutic effect will be visible only in a few days. Therefore, such treatment is not prescribed for acute stages discirculation. The dose of the administered drug must be carefully monitored by a doctor, so use at home is excluded. More high doses are introduced at the beginning of treatment in order to speed up the time to restore normal outflow, but at the same time, this tactic leads to an increased risk of bleeding. Treatment with warfarin should be continued for 3-6 months to obtain lasting results.

Surgical intervention to get rid of dyscirculation is prescribed in extreme cases

If the disturbances in the venous system are too severe, the doctor may recommend surgery to quickly improve the flow of blood from the brain. But it is appointed surgery only if medicinal methods didn't work.

endarterectomy (removal inner shell affected artery);
bypass surgery: a new blood vessel is placed near the narrowing of the vein to create a new route for blood flow;
angioplasty: a balloon catheter is inserted into a narrow section of the artery to widen the walls and improve blood flow.

Forecasts for venous discirculation

The prognosis and speed of recovery will depend on several factors.

Success in treating the underlying disease that caused dysgemia

For example, the survival prognosis for dysgemia may be quite negative if the patient has had a stroke or thrombosis. But if the cause of the disease is hypertension or diabetes, the prognosis will be much better.

Presence of hypoxia

The prognosis will be poor if venous discirculation previously led to hypoxia. Even after eliminating dysgemia, sudden losses consciousness or problems with the musculoskeletal system.

Age and general health

Most of all, the result of treatment will depend on the age and general health of the patient. Young people with good immunity have the most best predictions for a full recovery.

Causes and treatment of venous circulation disorders

If you explain accessible language, then venous discirculation is impaired blood circulation in the human brain. This disease is quite common, and there are many reasons for its occurrence. As for short-term blood flow disturbances, a person encounters them regularly: this normal cough, daily sneezing, excessive physical activity, sudden turns of the head. If we consider permanent violations, they are due to more serious reasons.

Obstructed blood flow from the brain

Here it is worth identifying the main reasons for the occurrence of an undesirable effect:

Serious head injuries, impairment of activities vertebral region, manifestation of osteochondrosis.
Cardiovascular dysfunction vascular system, which manifests itself in the form of atherosclerosis, arterial hypertension.
Strokes and their consequences.
Endocrine system disorders.
Diseases that lead to thrombosis in blood vessels.
Uncontrollable and excessive long-term use medicines, these can be nitrates, hormonal or vasodilators.
Abnormal congenital development.
Emergency condition in the form of heat or sunstroke.

Among the provoking and unsafe factors it is worth highlighting excess weight, bad habits in the form of smoking and alcoholism, physical activity, regular stressful situations etc.

Symptoms and diagnosis

Venous discirculation in a child or adult is manifested by a muted headache, which is especially activated in morning time. A person, not having time to get up, feels lethargic, severe weakness, numbness of the limbs. During movement, the pain present in the head may intensify.

Headache manifests itself under the influence of various factors, in particular:

drinking alcohol in excessive quantities;
constant anxiety;
stressful situations.

Against the background of the above, dilation of the fundus veins, bright swelling of the lower eyelid, noise in the head, cyanotic cheeks and lips are observed. These signs in most cases appear in the morning after waking up.

As for disturbances in the outflow of venous blood, they are characterized by blurred vision, regular dizziness, and fainting. IN in rare cases mental disorders and even seizures of epilepsy are observed.

Vertebro-basilar insufficiency is diagnosed by performing an X-ray of the human skull, in which the diploic veins and their development, veins related to the dura mater, are clearly visible. Specialists must pay attention to the general condition of a person’s fundus. Blood stagnation in this case is manifested by an unnatural enlargement of veins.

An expanded picture of the disease is revealed during magnetic resonance imaging. In this situation, changes appear in the jugular veins, which make it possible to identify the causes of constant and unwanted headaches in a person. Difficulty of diagnosis of this disease The point is that with other disorders of cerebral circulation, similar symptoms appear.

Treatment

First of all, treatment of diseases of the head and cervical region is aimed at improving the general condition of the patient. At the same time, it is necessary to correct image life without bad habits. Drinking alcohol and smoking cigarettes is unacceptable. Usually the patient is prescribed therapeutic diet, which contains a large amount of fiber and microelements. Consumption restrictions include fats and heavy carbohydrates. The constant rule is to sharply reduce the amount of salt consumed.

If there is discirculation in the basilar basin, it is recommended to increase physical activity. A professional trainer must create the most effective training method that will lead to speedy recovery patient. The most accurately selected program will improve the outflow of blood in a short time, thereby normalizing its redistribution.

The collar zone is usually called the cervical region of the spine. It is in this area that a huge number of active points are concentrated, enriched nerve plexuses, blood vessels, endings. If such points are massaged incorrectly, the patient’s health can be harmed, which is why this work should be performed by real professionals.

If we talk about drug treatment of the described disease, it involves the use of venotonics, these are drugs that improve blood flow in a short time. It is also mandatory to take antiplatelet agents; these are drugs that affect the rheological characteristics of the patient’s blood.

Against the background of harmful life habits, received injuries, serious illnesses a person may develop this disease. Timely access to a medical facility and proper treatment will help each patient to stop the disease in a timely manner and get rid of its symptoms.

The information on the site is provided for informational purposes only and does not constitute a guide to action. Do not self-medicate. Consult your healthcare provider.

Venous discirculation of the brain

To put it more in simple language– then venous discirculation of the brain is a violation of blood circulation in the veins of the head. This problem is quite common and can occur for a number of reasons. Short-term disturbances in blood flow can occur during normal physiological processes: sneezing, coughing, turning the head or physical activity. There are deeper reasons for persistent violations.

Classification

Experts distinguish three stages of this disease:

Latent. The disease goes on latently and clinical symptoms practically absent. The patient lives his ordinary life, unaware of the disease.
Cerebral venous dystonia. At this stage, some symptoms are already noticeable, but the patient does not always pay due attention to them.
Venous encephalopathy, accompanied by organic microsymptoms. This disease requires medical care, as it poses a threat to the patient’s life.

There is a classification of this disease according to Berdichevsky. In 1989, he defined two stages of the disease according to the forms of manifestation:

primary, when the tone of the veins changes and venous circulation in the brain is disrupted;
stagnant, when there are mechanical obstacles to the outflow of blood: venous outflow is very difficult, which causes the extinction of the process itself.

Causes of the disease

The primary form may be a consequence of traumatic brain injury, accompanied by bone fractures, as well as hematomas, alcohol or smoking intoxication, hyperinsolation, hypertension, endocrine diseases. Also, strokes with cerebral edema, tumors that compress brain structures and blood vessels, underdevelopment of the venous network or its reduction lead to venous discirculation.

The causes of this disease can also be external factors: blockage of veins, strangulation injuries and chest injuries, tumors of the cervical spine, osteochondrosis, prolapse of spinal discs.

Symptoms and diagnosis

The main symptom of venous discirculation is a dull headache that gets worse in the morning. After waking up, you feel weak, lethargic, it is very difficult to get out of bed, the body does not obey. When moving the head, the pain intensifies, and severe weather dependence appears. Headache caused by many factors: stress, alcohol intake, anxiety. Swelling of the lower eyelid appears, the nose, lips, cheeks become cyanotic, the fundus veins dilate, and a buzzing sensation appears in the head. The maximum severity of symptoms is observed in the morning, after waking up.

Disturbances in the outflow of venous blood manifest themselves in the form of dizziness, blurred vision, stupor, fainting and numbness of the extremities. It's even possible mental disorders And epileptic seizures. With pronounced venous stagnation, a person is unable to take horizontal position or lower your head.

Big diagnostic value have research methods such as skull radiography, where you can see overdevelopment diploic veins, veins of the dura mater, graduates, as well as phlebography and blood pressure measurement. You should pay attention to the condition of the fundus of the eye: there you can see enlarged veins and other manifestations of blood stagnation. Magnetic resonance imaging provides the most complete picture of the condition of blood vessels. Most often, it detects changes in the jugular veins, and from them one can judge the causes of persistent headaches and other symptoms.

In principle, signs of venous discirculation can be found in most adults, especially in mild form, when the patient himself does not yet know about the disorder. In the autumn-winter period, this disease manifests itself most strongly. Many people suffer inconvenience and try to cope with painful manifestations on their own.

Treatment

If the disease was noticed at an early stage, then do not worry: correcting the functioning of the blood vessels is quite simple. Sometimes it’s enough just to change your lifestyle, habits that worsen your health, and the disease goes away. To do this, you should contact a specialist as soon as you notice suspicious symptoms.

Mostly, drug treatment is used. Often patients suffering from venous discirculation also have varicose veins veins In this case, specialists prescribe blood thinners. To treat obstructed blood flow from the head, the drug Detralex is used. It improves the condition of the veins, makes them more elastic, and also improves blood flow.

In principle, drugs that stimulate venous outflow are sufficient. Modern venotonics normalize blood flow, vascular function, and can be used for preventive purposes. They give veins elasticity, strengthen the vascular wall, improve its permeability, and relieve swelling. Also, these drugs prevent and fight inflammatory processes, increase the tone of the body. The most popular venotonics now are drugs based on plant based: Aescusan, Venoplant, Venen-gel, Ginkor-gel, Anavenol, Doctor Theiss, Ginkor-fort, Getralex.

To reduce the risk of blood clots, use antiplatelet drugs. The most popular among them is aspirin, it is taken in the morning, once 0.125 mg. The resistance of the vascular wall is improved by courses of injections of Pyridoxine or nicotinic acid. If they appear brain symptoms, improve the condition well nootropic drugs, among which the most famous are Phenotropil and Glycine. They must be taken in long courses.

Sometimes good results gives a massage. It is performed for the neck area. However, the procedure should be carried out by a specialist only after a doctor’s recommendation, otherwise the disease may not be cured, but rather harm the body. Your doctor may recommend increasing your exercise to improve blood flow. However, when following this recommendation, you should not overdo it: excessive loads can be harmful.

To quickly heal and maintain the body in good shape, it is necessary to perform a complex therapeutic measures, which, in addition to medications, includes: herbal medicine, massage, good rest and sleep, relaxation, regular exercise, cold and hot shower, walks on fresh air. Sometimes you can improve venous blood flow with the help of a complex special exercises. They are done several times a day, spending 10 minutes. Working with the cervical spine in a few weeks will improve the condition and eliminate the main symptoms. Yoga is the best way to improve venous blood flow. It contains many asanas that help strengthen blood vessels. Increases blood flow and special breathing through the larynx that accompanies exercise. Running is also great for blood flow, but it's not for everyone. Therefore, if you have some difficulties with this, you can start by simply walking at a fast pace for long distances. Special effect will result from such walking if it takes place in places with clean air, away from the roadway.

Since bad habits, drinking alcohol and smoking, addiction to fast food, often contribute to the occurrence of this disease, they must be abandoned forever. Introduce fresh vegetables, fruits, herbs, and juices into your diet.

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.

The most common occurrence in medical practice is cerebral venous circulation. 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 will talk about impaired blood 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.

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 of the coronary arteries, congenital and acquired heart defects, arrhythmias, and 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 becomes clogged with 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, and contribute to inflammatory processes in the 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 a 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 a very late and advanced stage of 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, one of the medications based on acetylsalicylic acid will be prescribed: Aspirin, Aspirin Cardio,.
To strengthen the vascular walls, doctors prescribe a course of treatment with Pyridoxine to their patients.
To relieve cognitive symptoms, such as poor memory, emotional instability, difficulties in thinking, nootropics are used: 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 subject your body to excessive physical activity, but also do not lead a sedentary lifestyle.
Treat chronic diseases in a timely manner, especially for 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 treatment of cerebral venous circulation, you 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.

The physiology of the cerebral venous system is currently still poorly understood. Therefore, only experienced phlebologists and neuropathologists know what venous discirculation is and how to treat it. Although in fact, under such a complex term lies an ordinary violation of venous blood flow. In a healthy person at rest, the average speed of venous blood movement is approximately 220 mm/min, and in those suffering from dyscirculation it decreases to 47 mm/min. Knowledge of the anatomy of the circulatory system of the brain will help you independently determine the symptoms caused by dyscirculation, as well as take preventive measures in advance.

The mechanism of occurrence of venous discirculation

Cerebral veins can be divided into 2 subtypes: superficial and deep. The veins that are located in the soft membrane (superficial) are designed to drain blood from the cerebral cortex, and those that are located in the central parts of the hemispheres (deep veins) serve to drain blood from the white matter. The above vessels carry blood to the superior and inferior longitudinal sinuses. From these collectors, blood is pumped into the internal jugular vein, and then flows from the brain through the vertebral vein system.

This rather simplified description of the complex route of blood outflow allows us to understand why for such a long time doctors cannot determine the true causes of cerebrovascular accidents.

At the moment, doctors have learned that cerebral venous discirculation occurs due to pathological processes in the cavity between the membranes of the brain or in the cervical and spinal plexus. In 75% of cases these pathological processes are cervical osteochondrosis or atherosclerotic plaques.

Causes of obstruction of blood flow from the brain

pulmonary and heart failure;
compression of extracranial veins;
jugular vein thrombosis;
brain tumors;
traumatic brain injury;
cerebral edema;
systemic diseases (lupus erythematosus, Behcet's syndrome).

Risk factors

High blood pressure and a sedentary lifestyle are the first step to dysgemia

The following deviations should alert you:

Symptoms of pathology

Dysgemia is almost always accompanied by periodic dull headaches, sometimes with nausea and vomiting. Less commonly, a disturbance of consciousness occurs, after which focal symptoms appear:

numbness of the limbs;
severe aphasia;
isolated epileptic seizures;
impaired vascular-platelet hemostasis.

Signs of venous discirculation may appear irregularly and last for several minutes. If the disease is not treated, then unpleasant symptoms can constantly bother the patient.

Only a doctor can help prevent the development of severe dysgemia

The most serious symptoms that occur if the disorder is ignored are:

dizziness;
blurred vision;
sudden loss of consciousness;
tingling in the neck, especially on the left;
moderate hypoxia;
sudden reflex movements;
constant drowsiness.

What does ignoring the problem lead to?

Ignoring symptoms for a long time leads to the fact that oxygen and glucose do not reach the brain. This can lead to neurological problems. Lack of treatment can provoke more severe conditions.

Stroke

If any tumor blocks the flow of blood in the carotid artery, a heart attack or stroke may occur. As a result, some brain tissue may die. The death of even a small amount of tissue can affect speech, coordination, and memory. The severity of the consequences of a stroke depends on how much tissue has died and how quickly the outflow of venous blood has been restored. Some patients are able to fully recover, but most of those affected suffer irreversible changes.

Brain hemorrhage

With chronic problems with cerebral venous circulation, bleeding in the cranial cavity may occur. This occurs when the walls of the arteries weaken and burst. Even minor bleeding puts pressure on the brain, which can lead to loss of consciousness.

Hypoxia

Dyscirculatory encephalopathy (including atherosclerotic origin)

Discirculatory syndrome is a painful syndrome that is caused by a violation of venous blood flow. With minor dyscirculation, encephalopathy develops very slowly and is practically asymptomatic. The syndrome quickly disappears when the original causes of dysgemia are eliminated. But with a prolonged lack of oxygen or as a result of a complete blockage of venous outflow, brain death can occur (just 6 minutes after the complete cessation of blood flow).

Diagnostic methods

If the patient complains of several of the above symptoms, then all the doctor’s efforts will be aimed at identifying and treating the cause of the dyscirculation. This involves a physical examination and a medical history. To confirm the violation of venous outflow, several studies are prescribed with visualization of veins in the brain and vertebrobasilar region.

Complete blood count

It is prescribed to detect antinuclear antibodies and determine the erythrocyte sedimentation rate. If the test results confirm the presence of antibodies and reduced rate ESR, then an additional study is prescribed to determine complement components and the level of antibodies to anti-deoxyribonucleic acid. The results of the above tests will reveal that the cause of dysgemia is systemic lupus erythematosus or Wegener's granulomatosis.

Electroencephalogram (EEG)

An EEG can help a doctor identify venous dyscirculation

Computed tomography (CT)

CT is an important imaging modality and is often indicated for the initial diagnosis of dysgemia. In the tomograph image, you can see whether any neoplasm or thrombosis is the cause of dyshemia.

CT angiography

CT angiography is also prescribed to visualize the cerebral venous system. Only angiography can indicate the absence of flow in the venous channels.

Contrast magnetic resonance imaging

Contrast magnetic resonance imaging is an excellent method for visualizing blood flow in the great cerebral veins. It is prescribed if angiography does not reveal any disturbances in the outflow of venous blood into the VBB.

How to treat venous discirculation?

stop smoking and drinking alcohol;
perform simple physical exercises daily;
follow a diet to lower cholesterol levels;
Monitor your blood sugar and blood pressure daily.

As for the drug treatment of patients with venous discirculation, specific therapy is prescribed, which includes taking anticoagulants or thrombolytics (depending on the medical history). But the use of systemic anticoagulation as primary treatment is recommended for all patients without exception (even for a child and in the presence of intracranial hemorrhage).

Drug therapy is the most effective method of treating dysgemia

Most often, drugs containing heparin are prescribed. When administered intravenously, its action begins immediately, which is very important for patients with acute dyshemia.

Enoxaparin sodium is a low molecular weight heparin and is prescribed if it is necessary to restore venous outflow to patients suffering from allergic reactions, or for prophylaxis. The main advantage of enoxaparin is the possibility of intermittent administration of the drug, which allows the patient not to go to the hospital, but to take advantage of outpatient treatment.

Warfarin is prescribed to patients with bleeding disorders for whom heparin and enoxaparin are strictly contraindicated. The drug has a slight effect on coagulation activity, but the therapeutic effect can only be seen after a few days. Therefore, such treatment is not prescribed in the acute stages of dyscirculation. The dose of the administered drug must be carefully monitored by a doctor, so use at home is excluded. Higher doses are administered at the beginning of treatment in order to speed up the time to restore normal outflow, but at the same time, this tactic leads to an increased risk of bleeding. Treatment with warfarin should be continued for 3-6 months to obtain lasting results.

Surgical intervention to get rid of dyscirculation is prescribed in extreme cases

If the disturbances in the venous system are too severe, the doctor may recommend surgery to quickly improve the flow of blood from the brain. But surgery is prescribed only if medical methods do not work.

endarterectomy (removal of the inner lining of the affected artery);
bypass surgery: a new blood vessel is placed near the narrowing of the vein to create a new route for blood flow;
angioplasty: a balloon catheter is inserted into a narrow section of the artery to widen the walls and improve blood flow.

Forecasts for venous discirculation

The prognosis and speed of recovery will depend on several factors.

Success in treating the underlying disease that caused dysgemia

Presence of hypoxia

The prognosis will be poor if venous discirculation previously led to hypoxia. Even after eliminating dysgemia, sudden loss of consciousness or problems with the musculoskeletal system are possible.

Age and general health

Most of all, the result of treatment will depend on the age and general health of the patient. Young people with good immunity have the best prognosis for a full recovery.

The brain receives nutrients(glucose, fatty acid, amino acids) and oxygen, thanks to a well-developed system 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, including 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?” It's complex pathological condition which occurs as a result of a number of reasons:

Systemic diseases with vascular damage, such as atherosclerosis or. Such conditions lead to changes in the walls of arteries and veins, and disrupt normal blood flow.
Traumatic injuries of 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 a number of medications (nitrates, oral contraceptives, drugs that dilate blood vessels) 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 prescribing 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 when large quantities 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.), as well as disturbances in consciousness, are possible varying degrees expressiveness.

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 it dangerous? this state? 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.
Disruption of blood flow in the brain - main reason the appearance of dyscirculatory 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. Of great importance in making a diagnosis is 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 medical history and data on concomitant diseases ( hypertonic disease, traumatic brain injury) help identify the cause of impaired 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. As a rule, recommendations for lifestyle changes have a positive effect:

give up alcoholic beverages and smoking, which will improve blood supply to organs;
support motor activity during 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 severe complications, such as stroke. Therefore, if any symptoms appear, you should seek medical help.

For the brain to work correctly, without overstrain and failures, blood circulation must be ideal. Moreover vital role plays not only the flow of oxygen and nutrients, but also the timely outflow of blood. Recently, doctors are increasingly diagnosing a violation of the venous outflow of the brain - a dangerous pathology that in most cases develops due to an incorrect lifestyle. Whatever form of dyscirculation is identified (congenital or acquired), it in any case indicates the presence dangerous diseases and in the future may cause pathological changes in brain tissue. That is why, at the first symptoms of a disorder, you should immediately contact the clinic, because at an early stage it is much easier to get rid of the disease and prevent complications.

If a person is healthy, blood circulates freely throughout the body, delivering necessary substances and components: glucose, protein, oxygen. When the transfer process is completed and the nutrients are absorbed, the outflow of blood begins. In the body, the vertebral and jugular vein, emissaries.

With certain pathologies, venous dysfunction appears - deterioration and slowing of blood outflow from the brain. Today in international medicine there are three stages of this disease:

latent stage. Dysfunction of the cerebral venous outflow is minimal, symptoms are completely absent;
standard violations(II stage). Signs of the disease begin to appear and become more pronounced. Most often, patients ignore the symptoms and continue to lead their previous lifestyle;
encephalopathy. The state of health deteriorates significantly. Organic changes become so severe that professional help is required.

Depending on the symptoms and nature, the pathology can also be:

primary. Usually develops with serious head injuries, alcohol abuse and blood pressure problems;
stagnant. Venous outflow is difficult due to mechanical compression of the vessels.

Experts assure that latest form pathology is more dangerous because it can lead to serious consequences, including thrombosis portal vein and dysfunction of certain parts of the brain.

Causes

To assign effective treatment, doctors need to find the origins of the disease. Experts assure that the primary form most often develops due to a deterioration in the tone of the veins in general. Pathology can also be caused by factors such as:

severe traumatic brain injury with the formation of internal hematomas;
the formation of benign and malignant tumors, leading to compression of capillaries;
receiving ischemic or hemorrhagic strokes with further swelling brain;
alcohol abuse and constant smoking;
long-term intoxication with chemicals;
blood pressure problems;
underdevelopment of the vascular network in brain tissue.

A distinctive feature of the congestive form of the disease is that venous outflow is disrupted due to mechanical obstacles. With absence timely treatment the pathology will begin to progress and in the future may lead to a weakening of blood flow in general, which will negatively affect human health. The main reasons for the development of this form of the disease are:

Violation of venous outflow can be caused not only by pathologies, but also by exposure to external factors. In this case, discirculation usually does not last long and goes away on its own, the person is not bothered by any consequences. It can be called:

constant physical stress and fatigue;
being upside down for a long time;
holding your breath for several minutes (impaired venous outflow - occupational disease divers and singers);
strong cry (especially in a child);
coughing attack.

Symptoms

If venous outflow is obstructed, the first signs will not appear immediately. Problems such as:

severe headaches in the morning. You may feel dizzy when trying to get out of bed or turn your head after lying for a long time. The sensations may intensify after emotional stress or a hard day at work;
faintness, tinnitus;
darkening and double vision;
general weakness muscles;
sleep disturbance;
the appearance of bradycardia;
swelling facial tissues;
redness of the eyes;
memory impairment, loss of concentration, mental disorders;
anemia of the limbs;
cyanotic(cyanosis) nasolabial area;
appearance of minor asymmetry in facial features.

Symptoms of impaired venous outflow are especially severe in the morning. Even after a long sleep, a person may have the feeling that he did not sleep at all. In addition, sensitivity to weather changes and emotional stress increases sharply.

Diagnostic methods

To assign the right medications, the doctor must draw up a general clinical picture and discover the main factor obstructing the outflow of blood. To do this, the patient is prescribed the following procedures:

X-ray of the skull. This study is considered basic and gives doctors the opportunity to assess the condition of the vessels visually;
CT scan. To obtain complete information, CT is best performed simultaneously with capillary angiography. This way you can identify the consequences of a stroke and hematoma;
MRI. This will detect early tumors and cysts, deformation of capillaries;
examination of the eyeball;
Ultrasound. It is prescribed to determine the speed of blood flow.

All these examinations must be carried out regardless of the general condition and age of the patient. This is the only way to objectively assess the problem and select the optimal therapy.

Basic treatment methods

To get rid of blood dyscirculation, an integrated approach is needed. Most often, doctors prescribe venotonics when there is a violation of the venous outflow of the brain. Similar drugs delivered to capillaries essential vitamins and microelements, the walls of blood vessels become stronger and more elastic. But for a speedy recovery, you need to follow a diet and exercise.

Drug treatment

Pharmacies have a good choice drugs that improve the condition of blood vessels. These medications not only help strengthen the arteries, but also normalize lymphatic drainage and are an excellent prevention of this disease. The most common and effective venotonics:

Detralex. The drug is produced on the basis of natural flavonoids. The product has a beneficial effect on cardiovascular system in general and helps to avoid pain and cramps. The big plus is that it prevents varicose veins.
Vaso collected. Most often prescribed for chronic vascular diseases brain. Regulates metabolism and fights hypertension intracranial pressure. Doctors also claim that Vasobral eliminates insomnia and promotes overall well-being.
Phlebodia 600. The medicine has a complex effect on the walls of capillaries and is an excellent prophylactic agent.
Troxevasin. A drug combined action. Available in the form of capsules and gel for external use.

The list of medications is huge, but you need to select them together with your doctor.

Physiotherapy

Numerous studies have confirmed that regular exercise also helps normalize venous outflow. But you can do therapeutic exercises only after consulting a doctor, and even better - under his supervision. If you choose a complex yourself or immediately start complex exercises, the effect on the capillaries will be even more intense, and their bending will increase.

Diet

If you review your diet, venous circulation in the vertebrobasilar and carotid basins will normalize on its own, and the intracranial outflow of cerebrospinal fluid into the transverse sinuses will also decrease. To achieve positive effect, the patient needs to refuse:

flour products. Buns, cakes and other baked goods are strictly contraindicated;
smoked meats;
pickling;
canned food;
soda;
fast food.

The basis of the diet should be foods rich in fiber and polyunsaturated acids. Largest quantity these substances are contained in:

fresh vegetables;
nuts;
linseed oil;
berries;
sea fish.

Possible complications

Venous discirculation is extremely dangerous because, if not treated promptly, it can cause various complications. The likelihood of their occurrence increases if the disease is diagnosed in an infant. Since the newborn's body is too weak, dysfunction of the venous outflow can lead to underdevelopment of some organs, as a result of which there is a high probability of becoming disabled. Other common complications include:

development of heart attack;
hypoxia;
discircular encephalopathy.

Completion

If the venous outflow of the brain is impaired, the prognosis largely depends on the stage at which the disease was diagnosed and on the general condition of the patient. Experts warn that it is impossible to cure it using folk remedies. The only chance to prevent complications and save life is timely contact with an experienced doctor.