Volume 13| October 2022 ISSN: 2795-7624

Dyscirculatory encephalopathy:
principles of treatment

P.F. Boymamatova Teacher of the department of Pathological

physiology of Samarkand state medical university.
+998972850595
This article discusses about how a person ages, his or her body ages, the capacity of the
cardiovascular system diminishes, hormones are disrupted, the function of all the
sensitive analyzers is impaired, digestion of food becomes difficult, age-related changes
ABSTRACT

in the joints and spine make movement difficult. In people over 70 years of age, gross
metabolic disorders are observed in 70%, locomotor system disorders in 85%, reduced
functionality of the brain (memory, thinking, depression, sleep disturbance) in over 90%.
The sharp increase in vascular disease among the younger generation and the consequent
development of vascular discirculatory encephalopathy should be taken into account.
Dyscirculatory encephalopathy, dysmnesic, haemodynamics,
Keywords: actovegin and antihypoxant, paroxysmal states, subarachnoid
expansion, neurological symptoms

Currently, cerebral vascular disease is a problem of aging as a natural process that does
major medical and social problem. This not require the intervention of specialists.
pathology has become the cause of temporary A study of the combined use of
disability and the main cause of primary neuroprotective therapy with Ceraxon and
disability. Acute and chronic forms of Actovegin in the treatment of dyscirculatory
cerebrovascular disease are conventionally encephalopathy. Twenty patients aged 40-65
divided, although in many cases it is impossible years were examined. The complex therapy was
to draw a clear line between them and stroke is more effective compared to monoprotection
usually only a certain stage of the development due to the restoration of neurological deficits,
of chronic cerebrovascular disease. restoration of the functional activity of the brain
The consequences of these diseases have a and improvement of cognitive functions. For the
negative impact on the country's economy and clinical characterization of brain dysfunction
society in general, and reduce the quality of life developing as a result of vascular disorders, the
of patients and their families. At the same time, concept of "discirculatory encephalopathy"
the economic losses due to stroke are (DE) is widely used in our country.
significant. Most costs (up to 80%) are Dyscirculatory encephalopathy is a
associated with the cost of hospital treatment slowly progressing disorder of blood supply to
and subsequent early and late rehabilitation the brain, developing most often against the
after stroke. All this points to the importance of background of atherosclerosis, hypertension,
systematic analysis and planning of a set of sometimes - against the background of diabetes,
therapeutic and preventive measures for this syphilis and other diseases affecting the blood
category of patients. An increasing proportion vessels of the brain. It is important to note that
of the population consists of older people, the DE is the result of diffuse multifocal brain
"elderly". It is unfair and unjustified to treat the damage. In most cases, DE can be confirmed by

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various neuroimaging modalities. In CT, DE is restoration of microcirculation and application
characterised by subarachnoid expansion of the principles of metabolic therapy.
("atrophy"), periventricular luminescence, and The subjects of my study were 20
ventricular dilatation, while MRI in T2-weighted patients aged 40-65 years (13 men and 7
images usually shows fine-point multiple foci women). The criteria for the analysis of the
localised in the white matter. The main conducted treatment were the degree of
etiological causes are atherosclerotic, recovery of neurological deficit, regression of
hypertensive, mixed and venous DE. There are the general cerebral symptoms, improvement of
three stages of DE based on clinical signs. Stage the mental status. Additional methods of
I is dominated by subjective disorders such as investigation were used: general laboratory
headaches, sensations of heaviness in the head, tests, ocular fundus examinations, EEG, CT, MRI
general weakness, fatigue, emotional lability, of the brain.
impaired memory and attention, dizziness Successful treatment of dyscirculatory
(more often of a non-systemic nature), encephalopathy involves a comprehensive
unsteadiness when walking, and sleep approach to the problem, taking into account
disturbances. Focal neurological symptoms in compensation of cardiovascular abnormalities,
this stage are manifested by reflexes of oral restoration of microcirculation and application
automatism, weak convergence of the eyeballs, of the principles of metabolic therapy. Influence
and sometimes anisoreflexia. Stage II of DE on the metabolic processes of ischemic brain
differs from the first in the more persistent and tissue is one of the leading directions of
pronounced symptoms and the appearance of therapeutic tactics in DE. The possibility of
signs of pyramidal and extrapyramidal influencing such important processes as
insufficiency. The dominant neurological oxidative damage of the cell, membrane
syndrome - discoordination, pyramidal, permeability, restoration of energy capabilities
dysmnesic, etc. - is characteristic. At stage III, looks extremely attractive. It is only necessary
against a background of clear focal neurological to remember that the implementation of
manifestations, intellectual and mental therapeutic efforts aimed at restoring the
disorders become clinically significant and metabolism of nervous tissue is possible only
sometimes reach the degree of psychoorganic with the restoration of central hemodynamics
syndrome. and elimination of microcirculatory
More often paroxysmal states - falls, disturbances. Metabolic therapy in DE can have
fainting, epileptic seizures are observed. different points of application. Widely used in
Movement and cognitive disorders are practice are antioxidants: vitamins A, E, C in
considered to be the core of the clinical picture various combinations or in complex, actovegin,
of DE and its distinctive feature. Severe etc. The inclusion of phospholipid complexes in
movement disorders are usually associated treatment programs should be considered an
with an acute cerebral circulation disorder. indispensable condition for the successful
Progressive extrapyramidal syndrome is treatment of DE. Phospholipids are necessary
another cause of severe movement disorders. for the construction of cell membranes imielin.
Sometimes the patient's motor activities are Traditional "activators" of neural tissue
impeded by an increasing lack of coordination of metabolism such as piracetam and others
movements. Along with the progression of focal demonstrate high efficacy. In recent years,
neurological symptoms as DE progresses, the combined drugs, which form an optimal
destruction of higher brain functions occurs. combination of components influencing the
Dementia is a frequent outcome of progressive metabolism of neurons, have been actively used,
cerebral blood supply disorders. Successful such as Fezam. It is a combined preparation
treatment of DE involves a comprehensive containing 400 mg of piracetam and 25 mg of
approach to the problem, taking into account cinnarizine. The combination of the two
compensation for cardiovascular abnormalities, components increases the antihypoxic effect
and decreases the tone of the smooth muscle of

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Volume 13| October 2022 ISSN: 2795-7624
cerebral vessels. The drug has moderate anti- Effective treatment of DE can be only
aggregant activity, stimulates metabolic with long-term use of complex regimens, taking
processes in CNS and increases integrative into account the data of additional studies,
capacity of the brain. Fezam has significantly including indicators of central and cerebral
fewer side effects than its individual hemodynamics, laboratory tests reflecting the
components and is ideal in those cases where process of metabolism and hemostasis.
the use of piracetam alone causes tenseness and Cognitive function and motivation must be
insomnia, and cinnarizine - drowsiness. In this maintained in order to carry out active
regard, it can be recommended for the working rehabilitation measures. Numerous studies
group of patients, as driving and operating have demonstrated the positive effect of
machinery is allowed during treatment with actovegin and ceraxon on these processes. In
Fezam. addition, actovegin is known to stimulate the
A promising direction of metabolic energy processes of functional metabolism and
therapy is associated with the use of anabolism with increased energy expenditure,
neurospecific peptides. Low molecular weight which takes place in restorative kinesitherapy
peptides (cerebrolysine, cytamines) derived sessions.
from brain tissue have multidirectional effects Given that the post-stroke period is
in chronic cerebral ischaemia. They contribute usually accompanied by progression of
to the restoration of inter-neuronal cerebrovascular disease, administration of
connections, exhibit a stimulating effect, actovegin to stroke survivors is indicated for
contribute to the restoration of lost functions, both therapeutic and prophylactic purposes. It
activation of disturbed inter-neuronal has been observed that basic therapy
connections. The use of regulatory peptides in (antihypertensive and antiaggregant) is not
DE should be considered quite reasonable. Of sufficient to prevent the progression of vascular
the regulatory peptides already used in clinical encephalopathy. Additional administration of
practice, melatonin should be mentioned. Actovegin and Ceraxon changed the situation
Melatonin is a low molecular weight - Asgenic syndrome, vestibular ataxia,
peptide, a product of pineal gland secretion. Its motivation, anxiety, pseudobulbar and
biological effect goes far beyond the regulation amiostatic syndromes were significantly
of the day-night cycle. It influences the circadian reduced. A statistically significant decrease in
rhythms of BP and takes part in the adaptation the signs of venous dyscirculation was detected.
of the neuroendocrine system to changing It should be noted that it is the venous vascular
environmental conditions. Thus, the analysis of component that is of great importance in the
modern possibilities of DE treatment shows that development of chronic ischaemia. The
in most cases these possibilities are not used to presence of a therapeutic "trace" effect by the
the full extent. Simplified and standardized 3rd month of observation is especially
prescription of "vasodilators" and nootropics in emphasized, which allowed to recommend
most cases does not lead to sustainable taking Actovegin by courses of 25 days 2 times a
improvement of patients' condition. At the same year in a dose of 160 mg (4 ml). The analysis of
time, the abundance of drugs of different groups the literature shows that actovegin and ceraxon
that are potentially useful in the treatment of DE can be used at different stages of stroke
should not lead the physician to polypragmasy. treatment. Thus, the use of actovegin and
It is reasonable to divide the entire treatment ceraxon, influencing such important
cycle into three periods: pathological links of stroke as hypoxia, oxidative
1) stabilisation of central, cerebral stress and energy deficit, is pathogenetically
haemodynamics and microcirculation; justified and clinically proven at different stages
2) application of antioxidants, neuroprotective of stroke treatment.
vitamins, phospholipid and peptide complexes; Actovegin as an antihypoxant affects the
3) application of regulatory peptides and first stage of the pathological cascade initiated
nootropics. by ischemic cerebral process (promotes cell

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survival in ischemic conditions), as an normal aging, as well as in degenerative
antioxidant reduces pathological effects of processes leading to cognitive impairment, such
primary and repeated wave (after reperfusion) as Alzheimer's disease.
oxidative stress, fills the energy deficit, The pathogenesis of the clinical manifestations
providing recovery processes, prevents of encephalopathy is determined by two main
development and reduces severity of cognitive factors. The first one is the focal damage of
disorders in long-term sequelae of stroke. certain cortical and subcortical areas, which is
Continuity in the treatment of patients at accompanied by the appearance in the clinical
different stages of cerebral vascular disease is picture of a number of rather well-studied
facilitated by the availability of different syndromes. The second factor is the
medication forms and doses of the drug. phenomenon of cortical-subcortical
Dyscirculatory encephalopathy is a syndrome of dissociation, which is caused by disruption of
focal or diffuse brain damage, manifesting as a the connections of both cortical areas with each
range of disorders: clinical neurological, non- other and the cortex with the subcortical
neuropsychological, in some cases psychiatric, structures. There are a number of clinical
and is associated with chronic cerebral vascular syndromes that can occur in patients with this
insufficiency and/or acute cerebral circulation phenomenon. Among these, pseudobulbar and
disorders. The occurrence of acute episodes of postural disorders as well as cognitive
cerebral dyshemia can exacerbate the course of dysfunction should be mentioned. Disruption of
DE. The term 'dyscirculatory encephalopathy' anterior (frontal) brain connectivity plays an
reflects both the pathogenetic and important role in the occurrence of
morphological features of cerebral damage disassociation phenomenon. The main clinical
caused by cerebrovascular disease. The signs of encephalopathy are as diverse as the
pathogenetic mechanisms that can lead to the variants of cerebral lesions of vascular genesis.
occurrence of DE are very diverse. But still, among them it is possible to distinguish
are manifold. These include chronic vascular two main types of disorders, often underlying
cerebral insufficiency, acute cerebrovascular the disability of patients. These are movement
events, and so-called "uncompleted strokes". disorders and cognitive disorders. Movement
The term 'incomplete stroke' refers to the area disorders are polymorphic in their
surrounding the infarction zone that has phenomenology. In particular, there may be
different characteristics (morphological and pyramidal disorders, not necessarily paresis, as
pathogenetic) from the necrosis. It is the zone of well as extrapyramidal disorders, often in the
incomplete stroke that is often associated with form of hypokinesia in the lower extremities
hopes for effective therapy, both acute and (trembling is not common in this category of
chronic cerebrovascular disorders. patients). Atactic disorders of complex genesis
The second part of the term DE, and pseudobulbar syndrome can also be
'encephalopathy', reflects a number of changes detected in patients. The undoubted advantage
that used to be identified mainly on autopsy. of actovegin and ceraxon is good tolerability, the
Nowadays, with the introduction of possibility of long-term use even in relatively
neuroimaging techniques, these changes can be high doses. Side effects in the form of allergic
assessed in vitro. They are postischemic cysts of reactions (urticaria, oedema, fever), nausea,
different localization, diffuse changes in white fever and fatigue are rare.
matter (leukoareosis), as well as cerebral
Conclusion
atrophy. Leukoareosis is often visualized in
Thus, the complex application of
patients with DE by computed tomography, or
Actovegin and Ceraxon in the treatment of
better yet, by magnetic resonance imaging.
dyscirculatory encephalopathy produced a
Cerebral atrophy is manifested by enlargement
positive therapeutic effect in terms of recovery
of the ventricular system and subarachnoid
of haemodynamic disturbances, stabilisation of
spaces. It should be noted that cerebral atrophic
microcirculation, improvement of cognitive
changes and leukoareosis can also occur in

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functions and restoration of disturbed functions
of the central nervous system.
Literature
1. Chukanova E. I. "Actovegin in the treatment of
patients with dyscirculatory encephalopathy"
2005.
2. Kamchatnov P. R., Chugunov A. В. "Combined
therapy of dyscirculatory encephalopathy"
2005.
3. Jansen W., Bruckner G.W. "Treatment of
discirculatory encephalopathy" Med. Journal
2002.
4. Fedin A. I., Rumyantseva S.A. "Treatment of
nervous diseases" 2001
5. Skoromets. A. A., Kovalchuk V.V. "Actovegin in
neurology" 2002.

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