Ischemic cerebrovascular disease occurs when the brain’s blood supply is compromised. This disruption prevents oxygen and nutrients from reaching brain tissue, leading to potential damage.
Understanding Ischemic Cerebrovascular Disease
When blood flow to a specific part of the brain is interrupted or significantly reduced, brain cells are deprived of oxygen and glucose. This quickly leads to cellular damage and, if prolonged, cell death. The most severely affected brain tissue forms an “infarct core,” where cells die within minutes.
Surrounding this core is an area known as the “ischemic penumbra,” which receives some residual blood flow through collateral circulation, meaning it is still salvageable. There are two primary types of ischemic stroke. A thrombotic stroke happens when a blood clot forms directly within an artery in the brain, often in areas where blood vessels are already narrowed by plaque buildup. An embolic stroke occurs when a blood clot or a piece of plaque breaks away from another part of the body, such as the heart or a carotid artery, and travels to the brain, blocking a smaller artery.
Recognizing the Signs
Recognizing the signs swiftly is important for improving outcomes. The acronym FAST serves as a simple and effective tool for identifying common symptoms: Face drooping, Arm weakness, Speech difficulty, and Time to call emergency services. If one side of the face droops or feels numb, or if a person’s smile appears uneven, this indicates facial drooping.
Arm weakness is evident if one arm feels weak or numb, or if a person struggles to raise both arms equally, with one arm drifting downward. Speech difficulty can manifest as slurred speech, an inability to speak clearly, or trouble understanding simple sentences. If any of these signs are observed, call emergency services immediately. Other potential symptoms include sudden weakness or numbness in a leg, hand, or foot, sudden blurred or lost vision in one or both eyes, unexpected memory loss or confusion, and sudden dizziness or unsteadiness.
Causes and Risk Factors
Many medical conditions and lifestyle choices increase the likelihood of developing ischemic cerebrovascular disease. High blood pressure (hypertension) damages blood vessel structures and leads to atherosclerosis, a condition where plaque narrows arteries. High cholesterol also contributes to plaque buildup in arteries, further restricting blood flow. Diabetes is another risk factor, as persistently high blood sugar levels can promote plaque formation and independently double the risk of stroke.
Atrial fibrillation, an irregular heart rhythm, increases stroke risk because it can lead to blood clot formation in the heart, which can then travel to the brain. Lifestyle choices also play a role; smoking doubles the risk by damaging blood vessel linings, increasing clot likelihood, and narrowing vessels. Obesity and physical inactivity contribute to conditions like high blood pressure, high cholesterol, and diabetes, all of which elevate stroke risk. Advanced age, a prior history of stroke, and a family history of stroke or cardiovascular disease are also recognized risk factors.
Emergency Care and Treatment
When ischemic cerebrovascular disease is suspected, call emergency services immediately. Upon arrival at a hospital, diagnostic procedures such as a computed tomography (CT) scan or magnetic resonance imaging (MRI) are performed to confirm the diagnosis and distinguish it from other conditions, such as a hemorrhagic stroke. These scans help identify the location and extent of brain tissue affected by the lack of blood flow.
Acute treatments aim to restore blood flow to the brain as quickly as possible. Thrombolytic therapy, such as intravenous tissue plasminogen activator (tPA), is a clot-dissolving medication administered to eligible patients, ideally within 4.5 hours of symptom onset. For large vessel occlusions, mechanical thrombectomy is a procedure where a catheter is used to physically remove the blood clot from the blocked artery. This intervention can be effective for a longer time window, sometimes up to 12 to 24 hours in selected patients, especially when advanced imaging indicates salvageable brain tissue. Following acute treatment, post-acute care and rehabilitation are important to help patients recover and manage any lingering neurological deficits.