What is vasospasm? What are the identification and treatment of vasospasm?

What is vasospasm? What are the identification and treatment of vasospasm?

What is vasospasm? What are the identification and treatment of vasospasm?

Vasospasm
Vasospasm is caused by a strong contraction of the smooth muscle of the vessel wall and a narrow lumen, resulting in a decrease in blood flow. In severe cases, the lumen can be completely occluded. Excessive time can cause blood vessel embolism. It is divided into two types: neurogenic and myogenic. There are many causes of vasospasm. Common symptoms are systemic factors such as excessive mental stress, painful stimulation, hypovolemia, hypotension, inflammation or misuse of vasoconstrictors, and local factors such as cold, mechanical irritation, Surgical stimulation, dryness, extravascular exposure to fresh blood, etc. can induce local vasospasm.

Introduction
Arteriosclerotic plaques of the internal carotid artery or vertebral-basal artery system narrow the vascular lumen and eddy currents. When the eddy current accelerates, the blood vessel wall is stimulated to cause vasospasm and a transient ischemic attack occurs, and the symptoms disappear when the vortex decelerates. However, some scholars believe that due to the special nature of the cerebral vascular structure, it is not easy to occur. However, most scholars believe that vasospasm can undoubtedly occur in the internal carotid artery and the cerebral artery ring, cerebral angiography can be seen in the aortic stenosis; subarachnoid hemorrhage can cause extensive and focal cerebral vasospasm; brain surgery on the brain When the aorta is operated, the diameter of the artery is significantly thinned. Therefore, cerebral arterial spasm can also be caused by persistent hypertension, local injury or microparticle stimulation, and cause transient ischemic attack.


Identification
Need to be differentiated from the following diseases:

1. Focal epilepsy The performance of various types of focal seizures is similar to that of TIA. For example, seizures or seizures of epilepsy are easily confused with TIA. Tension-free seizures are similar to those of a trip. It is more convenient to perform 24-hour EEG Holter monitoring. If there is focal epileptic discharge, it can be diagnosed as epilepsy. If there is no abnormality, it is considered as TIA. CT or MRI findings have focal non-infarct lesions in the brain and may also be considered epilepsy.

2. Meniere's disease has a long duration of vertigo (up to 2-3 days), accompanied by tinnitus, hearing loss after multiple episodes, and no other signs of nervous system localization.

3. Before the syncope, there are many black eyes, dizziness and unstable standing, accompanied by pale, cold sweat, fine pulse and blood pressure drop, and transient disturbance of consciousness but quickly recovered after falling to the ground, and no nerve positioning. Signs. More than the upright position occurs.

4. Migraine often begins in adolescence, often with a family history. The episodes are mainly autonomic symptoms such as unilateral headache and vomiting, with less loss of focal neurological function and longer onset. Regardless of the factors, TIA should be considered as an important risk factor for complete stroke, especially in repeated short-term authors. The disease can be relieved by itself, and treatment focuses on preventing recurrence.

Treatment

1.Etiology treatment

Find the cause and carry out active treatment, especially to strengthen the prevention and treatment of atherosclerosis.

2. Drug treatment

• Early use of cerebral vasodilators and expanders can significantly reduce and terminate the clinical onset of TIA. It is possible to use 20 mg of betahidine or 500 ml of 5% glucose, or 500 ml of low molecular weight dextran or 706 generation plasma. Wei Nao Lu Tong, Xi Biling, etc. may also have a certain effect.
• Antiplatelet aggregation agents can reduce the occurrence of microemboli. If there is no ulcer disease or bleeding disease, aspirin is usually used to treat 50mg--300mg daily. Most people think that it is better to take a smaller dose, and if the long-term dose can be reduced. Dipyridamole (25 mg 3 times daily) in combination with aspirin works synergistically and reduces the dose of aspirin. If the patient is not suitable for aspirin or aspirin is not ideal, you can use ticlopidine (Ticlopidine 200--250mg 1-1-2 times a day) or ticlid 250mg, once a day), during treatment, Need to pay attention to strengthen the prevention and treatment of toxic side effects such as bleeding.
• Anticoagulant therapy for frequent seizures, severe and progressive aggravation, and no obvious anticoagulant treatment contraindications, early anticoagulant therapy has a positive significance for reducing seizures and preventing cerebral infarction. Commonly used heparin 12500U was added to 5% glucose physiological saline to slowly instill, while the first day can be taken orally with new dicoumarin 300mg or dicoumarin 100--200mg or warfarin 4--6mg. The time and activity of thrombin were checked daily, and were measured once a week after stabilization to adjust the oral dose. The time of intravenous clotting was maintained at 20-30 minutes, and the activity of thrombin was 15-25%. The amount of maintenance in the future is 150--225 mg of new coumarin, 2-75 mg of dicoumarin or 2-4 mg of warfarin. During the treatment, attention should be paid to prevention and treatment of bleeding complications. The withdrawal should be gradually reduced to avoid the "rebound effect". Because of this treatment, it is difficult to control the dose and there are many bleeding complications.
• Calcium antagonist can selectively act on the calcium channel of cerebral vascular smooth muscle, prevent calcium ions from flowing into the cell from outside the cell, and has the functions of preventing cerebral artery spasm, dilating blood vessels, increasing cerebral blood flow and maintaining red blood cell deformability. Generally, more than 5-10mg of sibelium is used once a day.
• Other methods such as in vitro anti-bo, ultraviolet light quantum therapy and blood thinning, as well as activating blood circulation to remove blood stasis and passing through active Chinese medicine can also be used.

3. Surgical treatment

Angiography confirmed that there is obvious stenosis or occlusion of the large aorta in the neck. The drug efficacy is poor. The patient's general condition allows, and those with conditions may consider carotid endarterectomy, stent placement or intracranial extracranial anastomosis. It has certain curative effect on eliminating microembolism, improving cerebral blood flow and establishing collateral circulation. Because it is not a cure, and the indications and effects of surgery are not yet certain.