enge 1: Vascular dementia
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74-year-old male with
unknown hypertension and hypercholesterolemia.
Smoker, 20 cigarettes a day.
No usual treatment.
Comes for outpatient consultation
due to progressive alteration
of memory and behaviour during
the past year.
Mental status mini-exam 15 points
(normal 28-30) indicating moderate
degree of affectation.
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Vascular dementia is the second most
widespread type of dementia after
Alzheimer’s disease, clearly
related to cardiovascular risk factors:
hypertension, dyslipemia, diabetes
and smoking.
Control of these factors is basic
for its prevention.
The bases for the treatment of vascular
dementia once the diagnosis has been
made are strict control of cardiovascular
risk factors along with specific treatment:
acetylcholinesterase inhibitors.
enge 2: Carotid stenosis
and cerebral infarction
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Carotid stenosis and
cerebral infarction
74-year-old male with history
of hypertension, diabetes mellitus
and acute myocardial infarction.
Referred to our centre owing
to an abrupt loss of strength
in the right arm and leg.
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Cerebral NMR:
Findings compatible with acute
ischemic infarction, predominantly
in the frontal and parietal
left cerebral hemisphere.
Presence of lesions compatible
with previous infarctions on
the level of the right cerebellar
hemisphere and parietal lobe.
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AngioNMR of supra-aortic trunks:
Obstruction of left internal carotid
artery.
Cerebral infarctions occur as a result
of the partial or total obstruction
of the carotid arteries (arteries
carrying the blood to the brain).
Atheromatosis in these arteries accounts
for the most frequent cause.
Vascular risk factors (hypertension,
hypercholesterolemia, diabetes and
smoking) are in turn the main cause
for atheromatosis in the arteries.
Thus, a strict control of these factors
contributes to the maintenance of
healthy arteries, with the consequent
decline of cerebral circulatory problems
(infarctions).
enge 3: Hypertension and
cerebral haemorrhage
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65-year-old woman with
a long history of badly-controlled
hypertension, diabetes mellitus
and hyperlipemia.
She was brought by ambulance
to Emergency due to “sleeping
limbs” and sudden loss
of strength in the left arm
and leg, provoking a fall with
facial traumatism.
Blood pressure of 220/110 is
recorded. |
Cerebral MNR:
intraparenchymatous haematoma in the
right thalamus region and striatum.
Small left frontal subdural haematoma
Chronic hypertension, as well as other
vascular risk factors such as diabetes,
hypercholesterolemia or smoking, contribute
to the hardening of the arteries.
In badly-controlled situations, the
cerebral arteries become fragile,
with less capacity to respond to sudden
pressure increases, with the consequent
risk of rupture and intracerebral
haemorrhage.
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