Cerebrovascular Disease: Types, Symptoms, Causes and Treatment Options

Cerebrovascular disease refers to disorders affecting brain blood vessels, impairing blood supply and oxygen delivery. It encompasses conditions such as stroke, transient ischemic attack, aneurysms, and vascular malformations.

The most common form is ischemic stroke, caused by arterial blockage. It results in sudden neurological deficits, including weakness, speech difficulties, and vision loss, requiring immediate medical intervention.

Hemorrhagic stroke occurs when weakened brain vessels rupture, leading to bleeding and increased intracranial pressure. This type often has more severe outcomes and requires urgent surgical or medical management.

Prevention of cerebrovascular disease focuses on controlling hypertension, diabetes, and high cholesterol, alongside smoking cessation and healthy lifestyle habits. Early detection and risk management are key to reducing incidence.

Prof. Dr. Özgür KILIÇKESMEZ
Interventional Radiology / Interventional Neuroradiology

Prof. Dr. Kılıçkesmez holds the Turkish Radiology Competency Certificate, the Turkish Interventional Radiology Competency Certificate, Stroke Treatment Certification, and the European Board of Interventional Radiology (EBIR). In his academic career, he won the Siemens Radiology First Prize in 2008.

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What Is Cerebrovascular Disease?

Cerebrovascular disease encompasses various health issues that occur as a result of inadequate blood flow to brain tissue. This disease develops due to blockage or bleeding of the vessels that carry oxygen and nutrients to the brain. Once known simply as “stroke,” this condition has been examined in greater detail through years of medical research and classified into various subtypes. Anatomical studies from the Renaissance era contributed to a better understanding of the underlying causes and effects of this disease. With medical advances in the 19th century, the pathophysiology of cerebrovascular events was more clearly defined, leading to the development of today’s modern medical approaches. Reducing risk factors is important for prevention and early diagnosis of these diseases.

What Are the Causes of Cerebrovascular Disease?

Cerebrovascular diseases are associated with various disorders affecting the brain’s blood vessels. There are many causes of these diseases, which are often characterized by problems such as vascular blockage or bleeding. The main causes that increase the risk of cerebrovascular disease lead to brain damage by disrupting the structure of the vessels or blocking blood flow.

Main causes:

• Atherosclerosis
• Hypertension
• Embolism
• Aneurysm
• Arteriovenous Malformations (AVMs)
• CADASIL (hereditary arterial disease)
• Arterial Dissections
• Inflammatory Conditions
• Coagulopathies
• Lifestyle Factors

The most common causes among cerebrovascular diseases, such as atherosclerosis, high blood pressure, and embolism, directly impair the function of blood vessels and cause damage in the brain. In addition, conditions such as hereditary diseases or arteriovenous malformations are associated with genetic factors and may result in individuals being at risk from birth. Adopting healthy lifestyle habits and having regular health check-ups are important for reducing the impact of risk factors.

How Common Is Cerebrovascular Disease?

Cerebrovascular diseases pose a significant burden on health worldwide with high morbidity and mortality rates. Every year, millions of new stroke cases occur, and the number continues to increase each year. In addition to millions of people living after stroke, deaths from these diseases are at serious levels worldwide. Especially with the aging population and negative changes in lifestyle, the incidence of cerebrovascular diseases is increasing even further:

• More than 101 million people worldwide live after stroke
• There are 12.2 million new stroke cases annually
• 56% of stroke survivors are women, 44% are men
• 53% of new stroke cases occur in women, 47% in men
• 87% of all strokes are ischemic, the remainder are hemorrhagic strokes
• 3.3 million deaths in 2020 due to intracranial hemorrhage
• 0.4 million deaths in 2020 due to subarachnoid hemorrhage

In the United States, stroke holds a significant place among deaths caused by cardiovascular diseases. In 2022, the stroke mortality rate was recorded as 39.5 per 100,000 people, and it was determined that someone had a stroke every 40 seconds. Similarly, in Australia in 2018, deaths from cerebrovascular diseases constituted 6.29% of all deaths, making it the third most common cause of death in the country. The increasing incidence of cerebrovascular diseases in low- and middle-income countries demonstrates the unequal distribution of disease burden and the need for more targeted interventions in these regions.

How Does Cerebrovascular Disease Develop?

The development of cerebrovascular diseases involves a complex chain of pathophysiological events resulting from damage to the brain’s blood vessels for various reasons. The main factors leading to brain vascular diseases include atherosclerosis, hypertension, embolism formation, small vessel disease, inflammatory processes, and genetic factors.

• Atherosclerosis: Accumulation of lipids and inflammatory cells in the vessel wall
• Hypertension: Changes in vessel structure due to increased blood pressure
• Embolism: Blockage of brain vessels by clots from other parts of the body
• Small vessel disease: Weakening and blockage of small vessels in the brain
• Inflammation: Damage to vessel structure as a result of activation of immune cells
• Genetic factors: Genetic mutations affecting vessel structure

Each of these factors causes irregularities in brain blood flow and can trigger ischemic or hemorrhagic strokes. Especially conditions like hypertension, atherosclerosis, and embolism reduce the vessels’ capacity to carry blood, preventing enough oxygen and nutrients from reaching brain tissue. This can lead to death of brain cells and irreversible losses in neural functions. Genetic factors and inflammatory processes also increase susceptibility to these diseases.

What Are the Symptoms of Cerebrovascular Disease?

Cerebrovascular disease may cause various neurological symptoms by interrupting blood flow to the brain. These symptoms differ according to the type of disease and the area of the brain affected:

• Hemiplegia
• Hemiparesis
• Facial droop
• Ataxia
• Numbness
• Paresthesia
• Aphasia
• Dysarthria
• Hemianopsia
• Diplopia
• Transient vision loss
• Confusion
• Memory loss
• Executive dysfunction
• Sudden and severe headache
• Vertigo
• Loss of balance
• Fainting
• Coma
• Clonic seizures
• Absence seizures
• Incontinence
• Fluctuations in heart rate or blood pressure

These symptoms indicate the severity of cerebrovascular diseases, and the sudden onset of any of them requires emergency intervention. Rapid medical support is vital to prevent brain damage.

How Is Cerebrovascular Disease Diagnosed?

The diagnosis of cerebrovascular diseases is vital for early intervention. This process involves detailed clinical evaluation, advanced imaging techniques, and various laboratory tests. Each stage is carefully assessed for accurate diagnosis:

• Medical History: Past illnesses
• Neurological Examination: Cognitive functions
• CT Scan: Diagnosis of hemorrhagic stroke
• MRI: Detailed brain imaging
• MRA: Vascular abnormalities
• Carotid Ultrasound: Atherosclerotic plaques
• Cerebral Angiography: Detailed images of vessels
• Blood Tests: Coagulation, glucose levels
• Cardiac Evaluation: ECG and echocardiography

Each of these diagnostic techniques contributes to a precise diagnosis and treatment planning. Especially advanced imaging methods help determine the extent and characteristics of damage in brain tissue.

How Is Cerebrovascular Disease Treated?

The treatment of cerebral vascular diseases is performed through various endovascular and surgical methods. These treatment options address conditions such as vascular obstructions, aneurysms, and arteriovenous malformations. Compared to traditional surgeries, these methods are less invasive, shorten recovery times, and improve patients’ quality of life.

Main treatment methods:

• For intracranial aneurysms: Endovascular coiling
• For arteriovenous malformations: Endovascular embolization
• For acute ischemic stroke: Mechanical thrombectomy
• For carotid artery stenosis: Carotid artery stenting
• For intracranial atherosclerotic disease: Angioplasty and stenting
• For dural arteriovenous fistulas: Endovascular embolization
• For traumatic vascular injuries: Stent placement and embolization

Endovascular procedures are a primary preference in the treatment of cerebral vascular diseases as they offer minimally invasive methods. Different devices and embolic agents are used according to the type and degree of the disease to be treated. Determining the most suitable treatment for high-risk cases is critical for patient health.

What Are the Complications of Cerebrovascular Disease?

Complications of cerebrovascular disease occur as various brain functions are adversely affected by disruptions in blood flow to the brain. These complications seriously reduce the quality of life and make it difficult for patients to continue their daily lives.

Main complications:

• Stroke
• Transient ischemic attack (TIA)
• Memory loss
• Balance and coordination problems
• Speech difficulty
• Swallowing problems
• Partial or complete paralysis
• Visual disturbances
• Fatigue and low energy
• Depression and anxiety
• Urinary or fecal incontinence

In addition, people who have experienced cerebrovascular disease often have cognitive slowing, difficulty with logical thinking, and mood changes. Such complications can lead to problems in social relationships and reduced independence. In severe cases, the individual may require care.

The severity of complications of cerebrovascular disease varies depending on the type of disease and the areas of the brain affected. In some patients, complications may regress over time, while in others, they may become permanent. Therefore, early diagnosis and regular medical monitoring are crucial for the management of complications.

When Can Cerebrovascular Disease Be Treated?

The treatment of cerebrovascular disease is determined by the type, severity, and overall health status of the patient. Timely and appropriate intervention is essential in the treatment of diseases affecting blood flow to the brain. In conditions such as stroke, aneurysm, and vascular malformations, surgical or minimally invasive methods can be used to improve patients’ quality of life. Preferred treatment methods for specific cerebrovascular diseases include:

• Acute ischemic stroke: Mechanical thrombectomy
• Intracranial aneurysms: Endovascular coiling
• Intracranial atherosclerotic disease (ICAD): Angioplasty and stenting
• Cerebral arteriovenous malformations (AVMs): Endovascular embolization
• Carotid artery stenosis: Carotid artery stenting (CAS)
• Dural arteriovenous fistulas (dAVF): Endovascular embolization
• Intracranial venous sinus stenosis: Venous sinus stenting
• Tumor embolization: Primary embolization

These treatment options are individualized according to the patient’s specific needs and the characteristics of the disease. For example, in acute ischemic stroke, mechanical thrombectomy is only effective if performed shortly after the onset of symptoms. In some cases, this period can be extended up to 24 hours for patients identified with special imaging methods. In aneurysm treatment, endovascular coiling is preferred based on features such as the location, size, and age of the patient. For vascular malformations, embolization is performed in AVMs or dAVFs with high risk of bleeding. For patients with carotid artery stenosis and high surgical risk, stenting is an important alternative.

When Is Cerebrovascular Disease Treatment Not Possible?

Interventional methods used in the treatment of cerebrovascular diseases cannot be applied under certain conditions. Procedures such as endovascular coiling, carotid endarterectomy, and thrombolysis may carry high risks for some patients and should be evaluated carefully.

Endovascular Coiling: Endovascular coiling, which aims to prevent rupture in intracranial aneurysms by creating a clot, is contraindicated in some aneurysm and patient characteristics.

• Wide-necked aneurysms
• Large luminal diameter
• Uncontrolled hypertension
• Coagulopathy
• Anatomically difficult to access structures

Carotid Endarterectomy (CEA): The surgical procedure aiming to remove atherosclerotic plaques from the carotid artery to reduce stroke risk should not be performed in certain cases.

• Complete carotid occlusion
• Previous complete hemispheric stroke and severe neurological deficit
• Age 80 and over, severe heart failure, or recent myocardial infarction
• High cervical or intrathoracic lesions
• History of previous neck surgery or radiotherapy

Thrombolysis: Thrombolytic therapy used to dissolve blood clots in acute ischemic stroke cannot be administered to some patients due to certain bleeding tendencies and medical histories.

• Active internal bleeding or history of hemorrhagic stroke
• Major surgery or significant trauma within the past 14 days
• Platelet count <100,000/µL or INR >1.7
• Uncontrolled hypertension
• Seizure at stroke onset, blood glucose <50 mg/dL or >400 mg/dL
• Recent gastrointestinal or urinary tract bleeding

What Is the Recovery Process of Cerebrovascular Disease?

The postoperative recovery process aims to improve patients’ health and reduce the risk of complications after treatment of cerebrovascular diseases. This process is managed by monitoring cognitive functions, assessing neurological outcomes, and taking precautions against possible complications. Changes in cognitive functions after the treatment of unruptured intracranial aneurysms in elderly patients are of particular concern:

• Postoperative cognitive dysfunction (POCD)
• MMSE and FAB tests for cognitive function assessment
• Risks of neurological complications
• Cerebral hyperperfusion syndrome (CHS)
• Intraoperative monitoring of cerebrovascular autoregulation
• Perioperative stroke risk

Recovery of cognitive function loss during treatment may take time, and full recovery may not be achieved, especially in elderly patients. Monitoring cerebrovascular autoregulation during surgery is important to reduce the risk of postoperative complications. Early diagnosis and intervention play a vital role in reducing perioperative stroke risk.

How Can Cerebrovascular Disease Be Prevented?

Prevention of cerebrovascular diseases is possible through the implementation of certain strategies, especially to reduce stroke risk. Managing the risk factors that contribute to these diseases and adopting healthy lifestyle changes form the basis of this process.

• Blood pressure control: Regular monitoring and management of blood pressure
• Cholesterol control: Helps reduce the risk of atherosclerosis
• Antithrombotic therapy: Effective in reducing the risk of embolic stroke in conditions such as atrial fibrillation
• Healthy nutrition: A diet rich in fruits, vegetables, and whole grains, such as the Mediterranean diet
• Regular exercise: At least 150 minutes of moderate-intensity aerobic activity per week
• Smoking cessation: A critical step in reducing stroke risk
• Diabetes management: Requires regular monitoring of blood sugar levels
• Obesity management: Includes dietary and exercise plans with healthy weight goals
• Sleep regulation: Positively affects cardiovascular health
• Limiting exposure to artificial light at night: Maintains biological rhythms

New treatment approaches are also promising in preventing cerebrovascular diseases. Especially methods such as remote ischemic conditioning (RIC) aim to reduce the risk of recurrent stroke. New pharmacological options, such as the combination of low-dose rivaroxaban and aspirin, are also being investigated. The regular and individualized application of these strategies with medical evaluation can significantly reduce the incidence of cerebrovascular diseases.

Frequently Asked Questions

What are the symptoms of cerebrovascular diseases?

Symptoms of cerebrovascular diseases include sudden numbness or weakness on one side of the body, difficulty speaking or understanding, sudden loss or blurring of vision, loss of balance or coordination, and severe headache. In the United States, about 160,264 people died from stroke in 2020, making it the fifth leading cause of death in the country. Worldwide, there are 12.2 million new stroke cases each year, and one in four people over the age of 25 will experience at least one stroke in their lifetime. The F.A.S.T. rule is important for recognizing stroke symptoms: Face drooping, Arm weakness, Speech disturbance, and Time to call for emergency help. Early medical intervention significantly improves outcomes and reduces the risk of long-term disability.

How are cerebral vascular diseases diagnosed?

Cerebrovascular diseases are diagnosed by combining clinical evaluations with imaging techniques. Computed tomography (CT) scans are often the first imaging method used to detect hemorrhages, tumors, and other structural abnormalities. Magnetic resonance imaging (MRI) provides detailed images of brain tissue and is especially used to detect ischemic stroke and vascular malformations. Digital subtraction angiography (DSA) is considered the gold standard for visualizing blood vessels and detecting conditions such as aneurysm or arteriovenous malformations. Additional methods such as Doppler ultrasound assess blood flow in major arteries, while advanced techniques such as perfusion imaging and diffusion tensor imaging (DTI) provide information on tissue viability and white matter integrity. Combining multiple imaging methods allows for more comprehensive assessment of cerebrovascular diseases, enabling the detection of vascular and metabolic changes, tissue damage, and functional disorders. Early and accurate diagnosis is critical for effective treatment management and improved patient outcomes.

What is the role of nutrition in preventing cerebrovascular diseases?

A healthy diet plays an important role in preventing cerebrovascular diseases such as stroke. Adopting eating habits that include healthy fats such as fruits, vegetables, whole grains, legumes, nuts, and olive oil, like the Mediterranean diet, has been proven to significantly reduce the risk of stroke. For example, the PREDIMED study showed that individuals following a Mediterranean diet with nut supplementation reduced the incidence of stroke by 47% over five years. In contrast, high consumption of red and processed meats is associated with an increased risk of stroke. A review found that diets containing processed meat increase the risk of stroke by 17%. In addition, low consumption of whole grains, nuts, seeds, and fruits contributes significantly to cardiovascular deaths. In the WHO European Region, low whole grain consumption caused approximately 429,000 deaths, while low nut and seed consumption caused 341,000 deaths. Therefore, increasing the intake of plant-based foods and healthy fats and reducing red and processed meat consumption can significantly reduce the risk of cerebrovascular disease.

What treatment methods are used for patients at risk of stroke?

To reduce the risk of stroke, patients are treated with antihypertensive drugs to control high blood pressure, statins to lower cholesterol levels, and antiplatelet or anticoagulant therapies to prevent blood clots. Adopting a healthy diet, regular physical activity, quitting smoking, and limiting alcohol consumption are also important. Anticoagulant therapy is recommended for individuals with atrial fibrillation to reduce stroke risk. In some cases, surgical interventions such as carotid endarterectomy or angioplasty may be required to address significant arterial obstructions. Regular monitoring and management of conditions such as diabetes and high cholesterol are essential components of a comprehensive stroke prevention strategy.

What are the long-term effects of cerebrovascular diseases?

Cerebrovascular diseases, such as stroke, can result in long-term physical disabilities, cognitive impairments, and increased mortality. In 2021, stroke-related deaths worldwide exceeded 7 million, a 44% increase since 1990, making stroke the third most common cause of death globally. In the US, there are about 795,000 new or recurrent stroke cases annually, with direct medical costs calculated at $17.9 billion. In a study of 5,123 patients, 14% died within six months after discharge, and 52.6% died within five years. Long-term exposure to air pollution has also been found to increase the risk of cerebrovascular diseases.