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Neurology diagnoses and treats disorders of the nervous system, including the brain, spinal cord, and nerves, as well as thought and memory.
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Cerebrovascular disease is an umbrella term encompassing a wide range of medical conditions that affect the blood vessels of the brain and the cerebral circulation. While stroke is the most prominent manifestation, the field includes aneurysms, vascular malformations, carotid artery stenosis, and vascular dementia. The brain is an organ of immense metabolic demand, requiring a continuous, high volume supply of oxygen and glucose. Cerebrovascular disease represents the failure of this delivery system, leading to temporary or permanent brain dysfunction.
The pathology typically involves one of two mechanisms: occlusion or rupture. Occlusive diseases involve the narrowing (stenosis) or blockage (thrombosis/embolism) of the arteries, starving the brain tissue of fuel. Rupture involves the breaking of a vessel wall, causing blood to leak into the brain tissue or the surrounding spaces, causing physical damage via pressure and chemical toxicity.
To manage cerebrovascular disease, one must master the anatomy of the brain’s blood supply. Four major arteries feed the brain: two internal carotid arteries in the front (anterior circulation) and two vertebral arteries in the back (posterior circulation). These arteries ascend the neck and meet at the base of the brain to form a vital anastomotic ring known as the Circle of Willis.
The Circle of Willis allows for collateral flow—if one artery is slowly blocked, blood can theoretically flow across the circle from the other side to keep the brain alive. The major cerebral arteries (Anterior, Middle, and Posterior) branch off this circle to irrigate specific territories of the brain. Understanding which artery supplies which area allows neurologists to pinpoint the location of a lesion based solely on the patient’s symptoms.
The most common driver of cerebrovascular disease is atherosclerosis. This is a systemic inflammatory process where lipids, cholesterol, and calcium accumulate within the inner lining of the artery walls, forming plaques. Over time, these plaques grow, hardening the arteries and narrowing the lumen (stenosis).
Plaques can cause damage in two ways. First, they can grow large enough to significantly reduce blood flow (hemodynamic failure). Second, and more commonly, a plaque can rupture. When the cap of a plaque breaks, the body forms a clot (thrombus) on the rough surface. This clot can block the vessel instantly or break off (embolize) and travel downstream to block a smaller artery in the brain.
Not all cerebrovascular diseases are acquired; some are structural defects. A cerebral aneurysm is a weakening in the wall of an artery that causes it to balloon out. These typically form at the branching points of the Circle of Willis where hemodynamic stress is highest. While often asymptomatic, they carry a risk of rupture, leading to subarachnoid hemorrhage.
Arteriovenous Malformations (AVMs) are tangles of abnormal vessels connecting arteries directly to veins, bypassing the capillary bed. This high pressure flow can cause the veins to dilate and rupture. Cavernous malformations are clusters of thin walled capillaries that leak blood slowly. These structural anomalies represent “ticking clocks” within the brain’s vascular tree.
While arterial disease dominates the field, the venous system is also susceptible to pathology. Cerebral Venous Sinus Thrombosis (CVST) is a rare but dangerous condition where a blood clot forms in the brain’s draining veins (sinuses). This prevents blood from leaving the brain, causing congestion, swelling, and eventually hemorrhage.
CVST is often linked to hypercoagulable states rather than traditional stroke risk factors. Pregnancy, oral contraceptive use, dehydration, and genetic clotting disorders are common triggers. The symptoms are often distinct from arterial stroke, presenting with severe headaches, seizures, and increased intracranial pressure rather than sudden weakness.
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Cerebrovascular disease is the broad category of all conditions affecting brain blood vessels (like “heart disease”), while a stroke is a specific event that happens when blood flow is blocked or a vessel bursts.
Most aneurysms are sporadic, but having two or more first degree relatives with an aneurysm suggests a familial risk, and screening may be recommended.
Yes, atherosclerosis in the carotid arteries (neck) is a major cause of stroke; pieces of plaque or clot can break off and travel up into the brain.
An Arteriovenous Malformation (AVM) is a knot of abnormal blood vessels where blood flows directly from high pressure arteries to low pressure veins, skipping the capillaries, which creates a risk of bleeding.
Hypertension is the single biggest risk factor; it damages the artery walls promoting plaque (atherosclerosis) and weakens vessel walls promoting rupture (hemorrhage/aneurysm).
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