CARDIOCEREBRAL SYNDROMES

From Big Medical Encyclopedia

CARDIOCEREBRAL SYNDROMES (grech, kardia heart + lat. cerebrum brain; a syndrome[s]) — the disturbances of functions of a brain caused by cardiac pathology.

Normal functioning of a brain is possible only at the full-fledged cardiac performance providing the level of blood supply adequate to requirement of a brain. Disturbances of cordial activity often lead to disturbances of cerebral circulation with emergence various To. pages which character depends on degree and localization of these disturbances. Mechanisms of cardiogenic disturbances of cerebral circulation following: a) a thromboembolism from heart, b) the insufficiency of blood supply of a brain caused by cordial weakness, leading to ischemia and a hypoxia of a brain, c) the disturbances of blood circulation in a brain caused by reflex influences from receptors of a muscle of heart and its vessels.

Most often To. pages arise at myocardial infarction (see). This combination was designated by Kini (V. Chini, 1957) as «the associated koronarotserebralny syndrome» (i.e. «koronarotserebralny syndromes» — a concept narrower, than To. page). Nevrol, symptoms develop along with a myocardial infarction or is consecutive. Focal brain symptoms are observed approximately in 10% of cases of a myocardial infarction, and all-brain symptoms (a headache, dizziness, disturbance of consciousness, etc.) different expressiveness — more than in 30% of cases. At a myocardial infarction all three mentioned mechanisms can be the cornerstone of brain complications. In the acute period of a heart attack the main role is played by hemodynamic factors while danger of an embolism arises in several days when in heart pristenochny blood clots are formed. Emergence of the cerebral symptoms connected directly with development of a myocardial infarction is caused by falling of the ABP, reduction of stroke and minute output of cordial emission with reduction of volume of the circulating blood. All this can lead to ischemia and a hypoxia of a brain (see. Hypoxia ), especially in the presence of atherosclerosis of brain vessels. In a zone of the most affected vessels local acidosis develops, cellular metabolism is broken, as leads to emergence of focal symptoms — passing if ischemia was not too long and deep and blood circulation was recovered, or resistant if death of fabric managed to occur.

Disturbances of cerebral circulation can arise and without falling of the ABP — is reflex as a result patol, the impulsation from receptors of heart conducting to spasms and staza in brain vessels. This mechanism takes place more often at heart attacks of a front wall of a left ventricle since the irritation in the descending coronal artery of heart causes reflexes from vessels of a brain, generally brain trunk. In similar cases can arise cardiogenic shock (see) and the cerebral symptomatology develops apoplektiformno. A metastasis ad nervos of cerebral circulation is more often observed at young people, and at elderly into the forefront insufficiency of blood supply of a brain acts.

The cerebral symptomatology at a myocardial infarction is shown by the following all-brain symptoms: headache, dizziness, shaky gait, nausea, vomiting, blackout; excitement with motive concern, disturbance of consciousness, a disorientation in the place and time is quite often observed. Focal symptoms in the form of paresis are noted (see. Paralyses, paresis ), frustration speeches (see), hemianopsias (see), epileptiform attacks of the general or focal type. Most often within several hours the hemiparesis develops (with dominance of weakness in a hand); if suffers dominant (left at right-handed persons) the parencephalon, then can join an alalia. The focal brain symptoms existing to a heart attack usually amplify. In most cases nevrol, symptoms have passing character. However in 10% of cases focal symptoms remain resistant. They are observed at elderly people with the expressed atherosclerosis of brain vessels. The lethality in such cases is higher, than at the myocardial infarctions which are not complicated by focal brain symptomatology. In cases when into the forefront the brain phenomena act, the myocardial infarction can proceed latentno, without subjective symptoms inherent in it (to pain, asthmas, fear of death) and without falling of the ABP, and diagnose it only with the help electrocardiography (see). At a myocardial infarction usually corticosubcortical softenings are the cornerstone of brain symptoms, hemorrhages are found less often. The venous hemorrhages resulting from thromboses of small veins prevail; merge of small diapedetic hemorrhages leads to formation of the large hemorrhagic center. If death comes quickly, then even in the presence of focal symptoms can not be macroscopic changes in a brain, except for hypostasis, however signs of a distsirkulyation — a staza, a plasmorrhagia etc. microscopically are found.

The embolism in vessels of a brain at a myocardial infarction arises more often on 3 — the 7th day and leads to formation of a hemorrhagic heart attack of a brain in bark and the subject white matter; it is clinically shown by acute emergence of focal symptoms which character depends on what vessel was corked (see. Embolism, vessels of a brain ).

The embolism can arise also at postinfarction hems, and at a diffusion atherosclerotic cardiosclerosis, especially in the presence of a ciliary arrhythmia. The embolism in a brain is observed also at an endocarditis and heart operations.

Cerebral paroxysms in the form of faints, generalized epileptiform attacks, and sometimes and focal symptoms are observed at Adams's syndrome — Stokes — Morganyi (see. Morganyi — Adams — Stokes a syndrome ) and at other disturbances of conductivity of a cardiac muscle. They arise at psychological or physical more often. overstrain.

At the heart diseases and other forms of cardiac pathology leading to heart and cardiopulmonary failure in a brain there is a venous stagnation with the phenomena of hypostasis therefore intracranial pressure increases. Such state is shown by the headache (amplifying at cough, sneezing, a ducking), not rotatory vertigo, apathy, sleeplessness (see); nausea, vomiting, developments of stagnation at the bottom of an eye, Meningeal symptoms appear in more hard cases (see. Gipertenzionny syndrome ).

Along with To. pages are described tserebrokardialny syndromes at which pathology of heart is caused by primary damage of a brain.

Treatment — see St. Crises .

The forecast depends on a basic disease.



Bibliography: Bogolepov N. K. Cerebral crises and stroke, page 254, M., 1971; Disturbances of cerebral circulation, under the editorship of N. V. Konovalov and R. A. Tkachyov, page 197, M., 1968, bibliogr.; Vascular diseases of a nervous system, under the editorship of E. V. Schmidt, page 348, M., 1975; With h in i V. Sindrome associata coronarica e cerebrale, Minerva med. (Torino), v. 48, p. 3157, 1957; De’Thomatis M.La sindrome associata coronarica e cerebrale, contributo clinico, Arch. E. Maragliano Pat. Clin., v. 26, p. 47, 1970; Friedman G. D., Loveland D. B. a. E h r 1 i with h S. P. Relationship of stroke to other cardiovascular disease, Circulation, v. 38, p. 553, 1968.

E. V. Schmidt.

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