A multimodal approach in the treatment of chronic cerebral ischemia: what should a doctor know?
The article discusses one of the leading problems of modern angioneurology - chronic cerebral ischemia. The main etiological factors playing a significant role in the development of chronic cerebral ischemia, among which atherosclerosis, hypertension, myocardial diseases, diabetes mellitus, etc. play a major role. The main clinical manifestations of this disease are described. The emphasis is on the fact that the main nucleus of the clinical picture of chronic cerebral ischemia is cognitive impairment, which in most cases determines the severity of patients. The development of cognitive impairment is associated with focal or diffuse brain lesions, resulting in the impairment of one or more cognitive functions. Vascular cognitive deficits are the result of acute or chronic cerebrovascular processes. The main causes and mechanisms of vascular cognitive impairment development are presented. It is shown that depending on the mechanism and the cause, the rate of cognitive impairment development may vary. The clinical picture of cognitive impairments developing as a result of the lesion of small brain vessels is described. The peculiarities of vascular cognitive disorders occurring against the background of cerebral hypoperfusion are described. The modern criteria of diagnosis are given. The main diagnostic methods are listed. The main approaches in treatment of patients with chronic cerebral ischemia depending on the disease stage are described. In-depth attention is given to neuroprotection with a more detailed description of the mechanisms of action and clinical efficacy of drugs with active substances - citicoline and ethylmethylhydroxypyridine succinate.