Explore the mysteries of cerebral blood vessels and unlock cerebrovascular diseases

Author: Cai Xiao, Peking University Third Hospital

Guo Xiaoxian, Chief Physician, Peking University Third Hospital Yan'an Branch

Reviewer: Fan Dongsheng, Chief Physician, Peking University Third Hospital

Cerebrovascular vessels are the life channels of the brain, silently providing a steady stream of energy for our thinking, emotions and behaviors every day. Only when the cerebrovascular vessels are healthy can our thinking be clear, our emotions be rich, our actions be powerful, and our lives be full of vitality. Let us unveil the mystery of cerebrovascular vessels and explore the mysteries of cerebrovascular diseases.

1. Breaking through the brain’s “smog”

Moyamoya disease is a rare vascular malformation disease, named because the patient's cerebral angiography shows that the cerebral blood vessels look like "a cloud of smoke".

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Because vascular stenosis or occlusion can easily cause cerebral ischemia, and rupture of collateral vessels or aneurysms can easily cause cerebral hemorrhage, once moyamoya disease occurs, the mortality rate or disability rate is high.

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Cerebrovascular malformation is an uncommon cerebrovascular disease with a high probability of congenital developmental abnormalities. Most patients are difficult to detect before the disease occurs and are relatively hidden. Cerebral angiography can detect cerebrovascular malformations, but because the contrast agent needs to be excreted from the body through the kidneys, people with poor renal function should not undergo repeated angiography examinations.

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Normal people can be screened for moyamoya disease through non-invasive and convenient transcranial Doppler ultrasound examination. If multiple new blood vessels/blood flow are found in the bilateral main vessels, accompanied by distal vascular stenosis or occlusion, moyamoya disease can be preliminarily confirmed; transcranial Doppler ultrasound examination can also evaluate the patency of collateral vessels, further determine whether there are vascular malformations, and can be repeated to monitor the progression of the disease. Early detection of moyamoya disease can allow for early intervention and treatment, which will greatly help and improve the patient's quality of life in the future.

2. Can cerebral blood vessels also become inflamed?

Arteritic cerebrovascular disease is mainly manifested by inflammatory cell infiltration, necrosis, exudation and thrombosis of the vascular wall. In the later stage, vascular fibrosis and aneurysm formation may occur, which is mainly caused by autoimmune abnormalities.

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Patients with arteritic cerebrovascular disease usually experience migraine or severe headache in the early stages. The onset is acute or chronic, with varying severity and may resolve on its own. Some patients will experience sudden loss of consciousness, convulsions, and progressive intellectual impairment. These patients may be considered to have epilepsy or dementia and are easily missed.

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Transcranial Doppler ultrasound can detect specific blood flow spectra in all detectable cerebral vessels. Accelerated blood flow velocity, narrowing of the lumen due to inflammatory changes in the vessel wall, poor vascular elasticity, and decreased vascular pulsatility index all indicate the possibility of occlusion of distal vessels. Regular examinations of patients during treatment can reveal that blood flow velocity partially returns to normal after treatment.

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The non-invasive, convenient and repeatable characteristics of transcranial Doppler ultrasound examination provide a good basis for disease diagnosis and prognosis monitoring.

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3. Does crooked mouth corners indicate cerebrovascular disease?

Does crooked mouth mean cerebrovascular disease? Don't panic, remember the "1+2+3" formula to help you determine whether you have cerebrovascular disease.

(1) Simple mouth corner deviation

It is clinically called "central facial palsy", which indicates that the patient may have cerebrovascular disease. Patients are advised to go to the hospital as soon as possible.

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(2) Deviation of mouth corners + incomplete eyelid closure

It is clinically called "peripheral facial paralysis" and is not a cerebrovascular disease. Patients will not experience serious conditions such as limb paralysis and the condition is relatively mild.

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(3) Deviation of the corners of the mouth + incomplete eyelid closure + any other symptom (such as dizziness, seeing things in double, numbness of the face/limbs, limb weakness, unsteady gait, slurred speech, and coughing when drinking water, etc.) indicates that the patient may have cerebrovascular disease, and the lesion may be in the brain stem. The condition is serious and it is recommended to go to the hospital for treatment as soon as possible.

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Summary: If you have crooked corners of your mouth, remember the “1+2+3” formula, where “1” and “3” may indicate cerebrovascular disease.