Cerebral ischemia and driving
The cerebral vascular disease is the most frequent cause of neurological disability. Most vascular lesions of the brain are secondary to atherosclerosis and hypertension.
The main types of cerebral vascular disease are:
- Brain insufficiency due to transient blood flow disorders.
- Brain infarction caused by an embolism or a thrombosis of the intracranial or extracranial arteries.
- Hypertensive parenchymal cerebral bleeding and the subarachnoid bleeding by a congenital aneurism.
- Arteriovenous malformation, that can cause symptoms by an effect of mass, infarction or bleeding.
The neurological signs and symptoms of cerebrovascular disease reflect the area of the brain that has been injured.
Both ischemic stroke and brain bleeding usually appear suddenly, with bleeding having a more catastrophic acute onset.
According to the last data available to the Spanish Society of Neurology in our country more than 100,000 new cases occur per year, leaving 33,000 dependents.
Furthermore, the rate of stroke increases with age, so, based on the current life expectancy, an important increase is expected for a near future.
Stroke is currently the leading cause of death among Spanish women and the second one in men being, in addition, the leading cause of serious disability in adults and the second of dementia.
A third of the patients who suffer stroke develop dementia in the next three months.
Specifically, of every three people suffering a stroke, one dies in the first six months, another survives with a serious disability that leads him to be entirely depend on someone, and another, though not requiring permanent assistance, can suffer sequels.
This problem appears suddenly and in most cases without previous symptoms, so it is essential to control lifestyle.
The population should know the symptoms of the disease that allow them for promptly going to their physician, such as loss of strength in half of the body, difficulty to speak or understand, sharp loss of vision, double vision, dizziness and imbalance or severe, unusual headache.
- Etiology: Intracerebral thrombosis or the embolus derived from a plaque of atheroma, arteritis, rheumatic valve insufficiency, endocarditis, or atrial fibrillation, frequently cause an ischemic arterial obstruction.
Sympathicomimetic agents such as cocaine and amphetamine can cause ischemic stroke.
Vertebral osteophytes enhance arterial compression with risk of brain ischemia, in addition, the artery can have a stenosis due to a plaque of atheroma. HT, atherosclerosis, heart disease, diabetes mellitus, and polycythemia all contribute to it.
In both situations, thrombosis or embolism, if oxygen and nutrient deprivation in the brain is prolonged, an infarction occurs that will cause brain damages and neurological injuries that can be permanent, and even, death.
Western diet, containing processed red meat, grains, cereals, and refined sugar, can be related to a greater risk of cerebral infarction. People who suffer migraine with aura are four times more susceptible to suffer a cerebral infarction or heart disease before 45 years of age.
According to recent studies, there must be a shared susceptibility to migraine and heart disease, regardless of risk factors such as alcohol, smoking, or use of oral contraceptives.
The intake of three or more alcohol beverages a day increases by 45% the possibilities of suffering brain ischemia, most frequently for embolism, as compared to non-drinkers.
Over 20% of the adult population suffer apnea during sleep time and there is some relationship between these repeated interruptions of breathing at night, and the probability of dying from a brain infarction.
In fact, the frequency of apnea is directly proportional to the risk of death after a cerebral infarction.
- Treatment: The treatment of stroke depends on the cause and type of disorder. In cerebral infarction, that is the most common form, drugs making blood clotting difficult and enhancing blood flow are indicated only in selected cases.
Statins have been shown to be effective in the significant reduction of myocardial infarction and stroke in diabetic patients. Patients with diabetes II and patients treated with atorvastatin reduce by near 48% the risk of suffering stroke.
Other alternatives are aimed at removing in the first three hours and in selected cases, the intraarterial thrombi with tissue plasminogen activating thrombolytic agents, such as rt-BP.
Surgery is limited to very specific situations, such as the intervention in the carotid arteries, provided it is shown that they have some degree of obstruction and significant sequels have not remained.