Neurovascular diseases are defined by doctors as various diseases of the blood vessel system in the spinal cord and brain. Some of these differ greatly from one another in terms of their severity, treatment and symptoms.
Find out everything you need to know about this group of diseases here and find selected specialists for the treatment of neurovascular diseases.
Neurovascular diseases are complex diseases of the vascular system of the brain and spinal cord. In this medical term, neuro stands for brain and spinal cord, vascular for the blood vessel system.
There are both acute and chronic forms. As the brain is very sensitive to all damage mechanisms, these are often illnesses with time constraints. These usually require swift action.
In general, the group of neurovascular diseases includes
What is special about vascular protrusions (aneurysms)?
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Aneurysms that occur in the arteries of the brain (cerebral arteries) are called brain aneurysms or cerebral aneurysms @ p6m5 /AdobeStock
Aneurysms are vesicle- or ball-like dilations of the vessels that cause life-threatening bleeding when they burst.
Rupture is the medical term for the bursting of hollow organs and vessels. Elevated blood pressure, especially blood pressure crises, are risk factors for a rupture.
In principle,aneurysms can affect any vessel, but the arteries are most frequently affected. When arteries of the brain are involved, these are also called cerebral aneurysms. Venous aneurysms are much rarer and rupture is an exception.
What are cavernomas?
A cavernoma is a spongy vascular formation that can occur in the brain and spinal cord. Strictly speaking, it is a benign tumor disease of the blood vessels. It leads to the formation of numerous nodular structures and chambers.
This is how the medical terms cavernoma (cavern = chamber) or cavernous hemangioma (heme = blood; angioma = benign vascular tumor) can be understood.
The rupture of cavernomas is a rare complication. Cavernomas are much rarer than aneurysms and belong to the group of arteriovenous malformations (AVM). This is an umbrella term for all vascular malformations in which structures known as "arterial-venous clusters" are formed.
Cavernomas are vascular malformations that are often first noticed through seizures @ Naeblys /AdobeStock
What are dural arteriovenous fistulas?
Arteriovenous fistulas (AVF) are generally understood to be short-circuit connections between the high- and low-pressure systems.
The arteries belong to the high-pressure system, the veins to the low-pressure system . The fistula causes blood to flow from the arteries directly into the veins.
This leads to circulatory disorders in the downstream tissue. Dural AVFs are special vascular malformations in the brain and spinal cord, but they are very rare.
What are vascular occlusions in the brain?
Vascular occlusions in the brain can be caused by constrictions or clots that have been carried over. The main cause is usually an event such as a stroke. Depending on the size of the blocked vessel, this can have little effect or cause serious complications.
Clots are caused in particular by cardiac arrhythmia, while constrictions are usually caused by calcification of the vessel wall (medical term: atherosclerosis).
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Comparison of healthy artery, artery with impaired blood flow and artery with impaired blood flow @ Axel Kock /AdobeStock
The different diseases of the neurological system are accompanied by different symptoms. An aneurysm, for example, is primarily characterized by a severe headache.
The following symptoms are typical of a stroke:
An arteriovenous malformation (AVM) manifests itself through
When cavernomas cause symptoms, they often involve bleeding and seizures.
The most common type of neurovascular disease is a stroke, also known as a cerebral infarction. A stroke causes poor blood flow to the tissue in the brain. This can be caused by a blockage or narrowing of the blood vessels.
The risk of stroke increases due to:
Aneurysms usually occur sporadically. The opposite of sporadic is the familial aneurysm, although this occurs less frequently.
Approximately 5 percent of people suffer from an aneurysm in the brain. Of these, 30 percent of patients have aneurysms in several places.
These include the large aorta and the popliteal artery in particular. Occasionally, aneurysms occur as a concomitant symptom of polycystic kidney disease.
In many neurovascular diseases, the symptoms described provide important clues as to the nature of the disease. These are obtained during the anamnesis interview by asking specific questions. Doctors must also take into account a family history of the disease in order to confirm suspicions.
An aneurysm can be detected in a special screening and is therefore in some cases a chance diagnosis. This aneurysm screening is recommended if two direct relatives have this disease.
MR angiography (magnetic resonance angiography) is a special form of magnetic resonance imaging (MRI). This imaging procedure shows the blood vessels and draws attention to neurovascular diseases.
Cavernomas can also be visualized well and reliably in MRI examinations. If the suspicion is confirmed, MR angiography is usually the diagnostic tool of choice.
Magnetic resonance imaging is also used for strokes and the associated vascular occlusions. An important alternative to magnetic resonance imaging is computed tomography (CT), which also provides the best results when using a contrast agent.
When contrast medium is used, doctors refer to this as CT angiography (CTA). However, the contrast agent used in CTA has more side effects than that used in MRA. It can lead to kidney problems and allergic reactions.
Who carries out the treatment of neurovascular diseases?
Many neurovascular diseases require a surgical procedure to remove the interfering factor or eliminate the vascular changes. However, there are numerous different treatment options depending on the severity of the disease.
The specialty for diseases of the vascular system in the brain is vascular neurosurgery. As this involves the treatment of highly complex clinical pictures, several specialist areas should work together.
These include
If children suffer from neurovascular diseases, pediatric neurosurgery (paediatric neurosurgery) should be involved. This is the point of contact for surgical treatment and psychological care.
Constricted vessels (stenoses) can be kept open with a stent, which is a metal or plastic vascular support. This is a widely used method, especially for strokes.
If a patient has an aneurysm, doctors decide on an individual basis depending on the size and speed of growth.
Endovascular coiling is a widely used method of treatment. Doctors insert metal coils via a catheter and place them there. The aim is to prevent the aneurysm from receiving any more blood. The risk of a life-threatening rupture is then lower.
In some cases, coiling is not successful and is not suitable. For this reason, open surgical removal of the aneurysm is sometimes used. However, this requires a general anesthetic and the opening of the skull. Endovascular therapy, on the other hand, is performed under local anesthesia.
In the case of an AVM, microsurgery is an option, whereby the surgical intervention is as minimal as possible.
Microsurgical procedures are preferred for AV fistulas in particular. The skull or spinal canal is opened via small incisions so that the surgical access trauma is as minimal as possible.
Endovascular methods are also available and have similarly good results.
The most serious complication of neurovascular surgery is injury to nerve tissue. A good view of the surgical area of the brain or spinal canal is therefore immensely important. This is why special surgical microscopes are used.
Neuromonitoring, for example, makes it possible to safely monitor nerves using acoustic and optical stimuli. This minimizes the risk of injury to the nervous system during surgery.
The success of treatment for neurovascular diseases depends on many factors, such as
In the case of strokes, aneurysms and similar diseases, the timing of the start of treatment is very important.
These diseases are emergencies where every second counts. Do not hesitate to call an ambulance if you have symptoms so that the prognosis is as favorable as possible.
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