Cerebrovascular Disease

Cerebrovascular disease is a group of brain dysfunctions related to disease of the blood vessels supplying the brain. Hypertension is the most important cause; it damages the blood vessel lining, endothelium, exposing the underlying collagen where platelets aggregate to initiate a repairing process which is not always complete and perfect. Sustained hypertension permanently changes the architecture of the blood vessels making them narrow, stiff, deformed, uneven and more vulnerable to fluctuations in blood pressure.

A fall in blood pressure during sleep can then lead to a marked reduction in blood flow in the narrowed blood vessels causing ischemic stroke in the morning. Conversely, a sudden rise in blood pressure due to excitation during the daytime can cause tearing of the blood vessels resulting in intracranial hemorrhage. Cerebrovascular disease primarily affects people who are elderly or have a history of diabetes, smoking, or ischemic heart disease. The results of cerebrovascular disease can include a stroke, or occasionally a hemorrhagic stroke. Ischemia or other blood vessel dysfunctions can affect the person during a cerebrovascular accident.

Every year, an estimated 158,000 people in the United States die from cerebrovascular disease. An estimated 30,000 people in the United States experience a ruptured cerebral aneurysm, and up to 6 percent of the population may be living with unruptured aneurysms. Aneurysms occur in all age groups, but the incidence increases steadily for individuals age 25 and older. Aneurysm rupture is most prevalent in people age 50 to 60 and is about three times more prevalent in women. Ruptured brain aneurysms are fatal about 50 percent of the time.

A cerebral aneurysm forms from a weakened part of a wall of a blood vessel, producing a bulging or ballooning out of part of the vessel wall. Usually, aneurysms develop at the point where a blood vessel branches, because the 'fork' is structurally more vulnerable. The disorder may result from congenital defects or from other conditions such as high blood pressure, atherosclerosis (the build-up of fatty deposits in the arteries), or head trauma. People who suffer a ruptured brain aneurysm (subarachnoid hemorrhage) may have warning signs such as a severe headache; nausea or vomiting; stiff neck; blurred or double vision; sensitivity to light (photophobia); and loss of sensation. Unruptured aneurysms, however, may be asymptomatic.

Actress Sharon Stone underwent treatment in October 2001, at age 43, for a subarachnoid hemorrhage. In Stone's case, the bleeding was actually caused by a vertebral artery dissection (VAD) at the base of her skull, rather than a ruptured aneurysm. The symptoms and results were nearly identical to those of a ruptured aneurysm—an excruciating headache and bleeding into the brain. Occurring in only about one in 10,000 people, VADs are 10 times rarer than brain aneurysms. VADs are caused by tears in the layers of the vertebral artery.

Further Reading



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