Ισχαιμική Μικροαγγειοπάθεια του εγκεφάλου

Ισχαιμική Μικροαγγειοπάθεια του εγκεφάλου.

Μετά τον πρώτο ενθουσιασμό για τις απεικονιστικές δυνατότητες της Μαγνητικής Τομογραφίας Εγκεφάλου και τους νέους δρόμους που άνοιξε, μιά καινοφανής ομάδα ευρημάτων δημιούργησε τεράστια διαγνωστική αμηχανία στους νευρολόγους και τους νευροακτινολόγους. Τα ευρήματα αυτά ήταν οι στικτές “διαυγαστικές περιοχές” -γνωστές στη βιβιλιογραφία και ώς White Matter Hyperintensities (WMH)– άλλοτε μεμονομένες και άλλοτε συρρέουσες, στη λευκή ουσία του εγκεφάλου. Σαν πρόβλημα αυτό πήρε σημαντικές διαστάσεις με την ευρεία χρήση της Μαγνητικής Τομογραφίας Εγκεφάλου για τη διερεύνηση διαφόρων παθήσεων από την Πολλαπλή Σκλήρυνση, μέχρι τη ζάλη και την κεφαλαλγία.

Στον πίνακα φαίνονται τα πολλά ονόματα  με τα οποία αναφέρεται αυτή η διάγνωση στο “Συμπέρασμα”  που συνοδεύει μια εξέταση Μαγνητικού Συντονισμού (Μαγνητικής Τομογραφίας) Εγκεφάλου.

Είναι νόσος, κατάσταση, ή παθολογικό εύρημα;

Τα 1000+1 ονόματα της 'νόσου'
  • Μικροαγγειακή Ισχαιμική Νόσος του Εγκεφάλου
  • Μικροαγγειοπάθεια της Λευκής Ουσίας
  • Περικοιλιακές βλάβες της Λευκής Ουσίας
  • Νοσος των μικρών αγγείων του εγκεφάλου

και κάθε δυνατή παραλλαγή και συνδυασμός αυτών.

Η μορφολογία των βλαβών, οι εικονες δηλαδή που βλέπουμε στη Μαγνητική Τομογραφία (και κυρίως στις ακολουθίες FLAIR), είναι εικόνες που υποδηλώνουν εγκεφαλική βλάβη.  Τί είδους όμως βλάβη, τί αιτιολογίας; Ποιές είναι οι συνέπειες αυτών των βλαβών, δηλαδή ποιά είναι η κλινική εικόνα, τα συμπτώματα που έχει ο ασθενής;  Οποιος εμφανίζει τέτοιου είδους βλάβες στη Μαγνητική του Τομογραφία πρέπει να θεωρείται οπωσδήποτε ασθενής;

Πρέπει να πούμε ότι ένα ποσοστό 95% των ανθρώπων πάνω από τα 60, εμφανίζουν τέτοιου είδους βλάβες στη μαγνητική τομογραφία. Είναι όλοι ασθενείς; Και βέβαια όχι. Θα μπορούσαμε να χωρίσουμε τους ανθρώπους που εμφανίζουν αυτού του είδους τις βλάβες σε τρείς κατηγορίες:

  • αυτοί που είναι τελείως υγιείς δεν έχουν δηλαδή κανένα ενόχλημα, κανένα συμπτωμα.
  • αυτοί που έχουν γενικής φύσεως ενοχλήματα μικρής έντασης, όπως μια απλή ζάλη, πονοκεφάλους, καταθλιπτικό συναίσθημα κλπ.
  • αυτοί που έχουν σοβαρότερα προβλήματα όπως γνωστικές διαταραχές (μνήμης κλπ), διαταραχές ισορροπίας / βάδισης, εγκεφαλικά επεισόδια, αγγειακή άνοια.

Στην πραγματικότητα η Ισχαιμική Μικροαγγειοπάθεια του Εγκεφάλου είναι μία κατάσταση η οποία συνδέεται με την ηλικία και επιδεινώνεται μέ όλους τους παράγοντες που επηρεάζουν την κατάσταση των αγγείων. 

 

TI ΠΡΕΠΕΙ ΝΑ ΕΛΕΓΞΟΥΜΕ ΚΑΙ ΝΑ ΔΙΟΡΘΩΣΟΥΜΕ Σ’ ΑΥΤΟΥΣ ΠΟΥ ΕΜΦΑΝΙΖΟΥΝ ΙΣΧΑΙΜΙΚΗ ΜΙΚΡΟΑΓΓΕΙΟΠΑΘΕΙΑ ΤΟΥ ΕΓΚΕΦΑΛΟΥ

  • σωστή ρύθμισή της αρτηριακής πίεσης
  • ρύθμιση των επιπέδων χοληστερίνης, τριγλυκεριδίων κλπ
  • ρύθμιση των επιπέδων σακχάρου
  • παχυσαρκία
  • κάπνισμα
  • άπνοια ύπνου
  • ψυχολογικοί παράγοντες (χρόνιο άγχος, κατάθλιψη)
  • καθιστική ζωή
  • σωστές διαιτητικές συνήθειες (μειωμένη γλυκόζη και λίπος, άφθονα λαχανικά, φρούτα)

Παραπομπή

Ιστοπαθολογικά, άν άνοιγε δηλαδή κανείς τον εγκέφαλο και έβλεπε “με γυμνό μάτι” τις περιοχές αυτές αυτό που θα παρατηρούσε είναι μικρές ή μεγαλύτερες βλάβες της λευκής ουσίας και ίσως ακόμη και απώλεια-νεκρωση νευρικών ινών (νευραξόνων).

Φαίνεται ότι οι βλάβες αυτές είναι αποτέλεσμα χρόνιας ισχαιμίας στη μικρή περιοχή γύρω από την ισχαιμική περιοχή. Η ισχαιμία – δηλαδή το γεγονός ότι δεν φτάνουν αρκετές από τις ουσίες που τρέφουν τον εγκέφαλο στην περιοχή, οφείλεται στη σκλήρυνση των μικρών αυτών αγγείων. Οταν η ισχαιμία είναι μεγάλη, ή όταν είναι μακροχρόνια, οι βλάβες στη λευκή ουσία του εγκεφάλου είναι διαφορετικές, μικρότερες ή μεγαλύτερες και είναι δυνατόν να φτάνουν μέχρι τη νέκρωση -τοπικά- νευρικών ή νευραξόνων.

 

 

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