Diagnosis
The diagnosis of circulatory disorders in the brain is usually based on a typical picture of the symptoms. In the case of newly occurring neurological deficits such as impaired vision and speech, a stroke may be suspected, while a migraine attack may be the cause in the case of severe paroxysmal headaches. Proof of the diagnosis can often be provided by an imaging procedure such as computed tomography of the head (cCT) or magnetic resonance imaging of the head (MRI of the head).
This allows the blood flow in the brain and any circulatory disorders to be measured and analyzed. In addition, if circulatory disorders of the brain are suspected, ultrasound examinations, examinations of the heart for possible underlying diseases and the examination of the blood for coagulation disorders can also be considered. MRI, short for magnetic resonance tomography, is a detailed and radiation-free diagnostic method that can provide accurate diagnoses, especially in the case of structural damage to the brain and after circulatory disorders.
On the one hand, other diseases such as a brain tumor can be ruled out, and on the other hand, a circulatory disorder can be detected and localized even at the smallest degree if a stroke is suspected. In addition, the MRI examination is important for monitoring progress. Circulatory disorders of the brain often originate in the neck or brain vessels, which can be diagnosed particularly well with special procedures known as MR angiography.
The symptoms of a stroke depend on the location of the undersupply of nerve cells. In the acute phase, imaging of the head, usually in the form of computer tomography, is used for diagnosis. A bleeding can be seen immediately, an ischemia (undersupply of a brain area by a blood clot from a cerebral artery) is often only visible after several hours.
Therapy
The treatment of circulatory disorders in the brain depends on the cause. A distinction is made between acute treatment in the acute stage of a circulatory problem (e.g. stroke), preventive treatment and rehabilitation treatment. In the case of an acute circulatory disorder in the brain, the cause of the symptoms must be eliminated as quickly as possible.
In the case of a stroke, this is usually done with the help of drug treatment. Prevention of circulatory disorders in the brain or rehabilitation after a stroke usually involves other measures. In this case, risk factors should be reduced by regular exercise, good blood sugar control, stopping smoking and losing excess weight.
In addition, blood-thinning medication and physiotherapy are often used. Diseases of the cardiovascular system must be treated as a possible cause of circulatory disorders of the brain and narrowed neck vessels may require surgery. The circulatory disturbance in the brain can have numerous causes and can be accompanied by many secondary diseases, which is why treatment should also be carried out by physicians from many disciplines.
For diseases of the nerve cells in the brain, the neurologist is primarily the first point of contact. Also in the case of strokes, TIAs or vascular dementia, treatment is guided by a neurologist. Other disciplines, however, are also assigned important tasks in the treatment of neurological clinical pictures.For the prognosis of many neurological diseases, the first treatment by a general practitioner or emergency physician is crucial.
Emergency medical treatment is often crucial, especially in the detection of stroke. The radiologist fulfills an important function in the diagnostic recognition of the clinical picture. Radiologists can also carry out important acute treatment themselves with the help of so-called “interventions”.
In the long-term treatment and follow-up care of neurological clinical pictures, treatments by the family doctor and an internist are important, which minimize risk factors, influence the patient’s lifestyle and provide medical treatment for underlying diseases. If a circulatory disorder in the brain is a stroke caused by a blood clot, various therapeutic options can be used Depending on the type of stroke and the amount of time since the onset of symptoms, thrombolysis may be a therapeutic option The aim is to dissolve the blood clot that has blocked the blood vessel or at least prevent it from growing any larger. The drug that is supposed to help dissolve the clot is injected via a vein access.
A more recent procedure is the so-called neurothrombectomy, which attempts to remove the clot from the vessel with a catheter. This procedure is mainly used in patients in whom a large blood vessel is blocked. In patients who have already suffered a circulatory disorder of the brain, various drugs are administered to reduce the likelihood of recurrence.
A circulatory disorder can manifest itself, for example, as a stroke with disorders of speech, motor skills, sensory perception or optics, but also as a transient ischemic attack (TIA). A TIA is, so to speak, a harbinger of a stroke and symptoms similar to those of a stroke occur, but they are completely reversible relatively quickly. If a circulatory disorder of the brain has occurred, the affected patients usually receive acetylsalicylic acid (see: Aspirin) once a day, provided there are no contraindications or the patient is taking medication that forbids this.
Acetylsalicylic acid is a drug that belongs to the group of antiplatelet drugs, commonly known as “blood thinners”. A statin is also usually prescribed. This is a drug that is supposed to lower the cholesterol levels in the blood.
Typical representatives are e.g. simvastatin, pravastatin or atorvastatin. If the affected patient has high blood pressure, it is treated. Often, a previously undetected atrial fibrillation of the patient is responsible for the circulatory disorder.
In atrial fibrillation, the heart beats irregularly and the risk of blood clots forming is increased. These can then be flushed out of the heart by the pumping action of the heart into the bloodstream and transported to the brain, where they block a blood vessel. This leads to an acute stroke.
If there are no contraindications, patients with atrial fibrillation are therefore given a blood thinner such as phenprocoumon (Marcumar® or Falithrom®) or one of the newer blood thinning drugs such as Apixaban or Rivaroxaban. In the acute case of a circulatory disorder of the brain, depending on the length of time between the onset of symptoms and presentation at a hospital, a drug is used to prevent the blood clot from further increasing in size. This is called “lysis therapy”.
Among other things, rtPA (Tissue Plasminogen Activator) is used here, which is administered via a vein access. Tebonin® is a purely plant-based drug containing ginkgo extract as a potential active ingredient. This ginkgo extract is said to help with dizziness, tinnitus as well as concentration disorders and forgetfulness.
Studies investigating whether Ginkgo actually has positive effects on cognitive abilities vary, but there is no reliable proof of its efficacy to date. The preparation can be purchased over the counter in pharmacies and is available in different strengths. Tebonin konzent® 240 mg costs just under 76 euros for 60 tablets. Tebonin intens® for ringing in the ears costs just under 40 euros for a pack of 60 tablets.
