OVERVIEW

What is cerebral arterial insufficiency?

Cerebral arterial insufficiency refers to a series of diseases characterized by cerebral dysfunction due to insufficient blood supply to the brain caused by various factors. Symptoms may include headache, dizziness, blurred vision, sleep disorders, memory decline, facial deviation, limb paralysis, speech impairment, etc.^[1].

Treatment involves preventing recurrence, early intervention of risk factors (such as hypertension, diabetes, dyslipidemia, smoking, and excessive alcohol consumption). However, the most crucial aspect is identifying and addressing the underlying cause. Early and effective intervention can slow disease progression and reduce the incidence of stroke^[2].

Cerebral arterial insufficiency significantly impacts patients' physical health and daily quality of life. Therefore, active treatment should be pursued after onset to prevent recurrence or worsening of the condition.

What are the types of cerebral arterial insufficiency?

Based on the onset speed, it can be divided into two types:

1. Chronic cerebral arterial insufficiency: Commonly occurs in middle-aged and elderly individuals (generally aged 50 and above). Symptoms often include recurrent dizziness, headache, insomnia, excessive dreaming, and memory decline^[3].
2. Acute cerebral arterial insufficiency: Usually caused by arterial stenosis, vascular spasm, increased blood viscosity, or microthrombus formation. In severe cases, it may lead to brain tissue necrosis, resulting in cerebral infarction or transient ischemic attack. Common manifestations include sudden facial deviation, drooling, speech difficulties, slurred speech, limb weakness, or numbness^[4].

Is cerebral arterial insufficiency common?

Yes. Cerebral arterial insufficiency is a prevalent ischemic cerebrovascular disease among middle-aged and elderly individuals aged 50 and above. National epidemiological surveys indicate that approximately two-thirds of middle-aged and elderly people suffer from chronic cerebral arterial insufficiency^[5].

SYMPTOMS

What are the manifestations of insufficient cerebral artery blood supply?

1. Motor dysfunction: Common clinical manifestations include crooked mouth, drooling, slurred speech or aphasia, difficulty swallowing, unsteady walking, numbness or weakness in one limb, inability to move normally, and unexplained falls or fainting.
2. Sensory dysfunction: Often manifests as numbness in the face or tongue, tingling or foreign body sensation in one limb, blurred vision, sudden blindness, dizziness, tinnitus, or spontaneous pain.
3. Abnormal mental state: Drowsiness and low spirits are also signs of insufficient cerebral artery blood supply. Some patients may experience insomnia. Cognitive dysfunction may also occur, mainly manifested as declines in memory, orientation, and calculation abilities, such as difficulty recalling recent events, getting lost on the way home, or frequent calculation errors^[6].

What are the consequences of insufficient cerebral artery blood supply?

Acute cerebral artery insufficiency can lead to acute ischemic stroke, which has high rates of disability, mortality, and recurrence^[7]. Long-term chronic cerebral insufficiency can result in cerebral infarction and dementia^[6]. Therefore, insufficient cerebral blood supply is referred to as a "silent killer."

CAUSES

What are the common causes of insufficient cerebral artery blood supply?

1. Vascular factors:
   • Atherosclerosis: Conditions such as hypertension, hyperlipidemia, diabetes, and obesity are risk factors for atherosclerosis. When cerebral or carotid arteries develop atherosclerosis, the blood pathways narrow, impairing normal blood supply to the brain.
   • Cervical spondylosis: Misalignment of cervical vertebrae can compress the vertebral artery, causing stenosis or spasms, thereby hindering normal blood supply to the brain.
2. Hemodynamic factors: When systolic blood pressure exceeds 160 mmHg or diastolic blood pressure falls below 80 mmHg, cerebral blood flow decreases, leading to insufficient blood supply to brain tissue.
3. Changes in blood composition: Hyperlipidemia, diabetes, polycythemia, smoking, etc., increase blood viscosity and slow blood flow, which may result in insufficient cerebral blood supply^[2].
4. Embolism formation: Atherosclerotic plaques or atrial thrombi can detach and travel with the bloodstream to block cerebral vessels, causing insufficient blood supply.

Who is commonly affected by insufficient cerebral artery blood supply?

Insufficient cerebral artery blood supply often occurs in middle-aged and elderly individuals over 50 years old^[5]. It is also prevalent among people with cardiovascular risk factors, such as hypertension, diabetes, hyperlipidemia, smoking, and excessive alcohol consumption.

DIAGNOSIS

What tests are needed to diagnose insufficient cerebral artery blood supply?

1. Transcranial Doppler ultrasound: It can directly reflect changes in cerebral blood flow, the degree and extent of cerebral ischemia, helping doctors infer the cause and predict subsequent developments. Although it is a non-invasive and convenient examination, it cannot measure vascular diameter or blood flow and is subject to human error, making it only a rough screening method^[1].
2. Carotid color Doppler ultrasound: It can assess whether there is significant atherosclerosis in extracranial cerebral vessels, display vascular diameter, determine the presence of stenosis, and evaluate blood flow conditions^[2]. It is suitable as one of the screening methods for diagnosing insufficient cerebral artery blood supply, but it cannot examine intracranial vessels in detail, and results may vary depending on the operator. Similarly, it is a non-invasive test that does not cause discomfort to patients.
3. Magnetic resonance angiography (MRA): It allows direct observation of the three-dimensional course of blood vessels, accurate measurement of vascular diameter, and clear visualization of vascular lesions and malformations. It is a non-invasive examination, requiring the patient to lie still on the examination table.
4. Multislice spiral CT angiography: It is the only method that can detect vascular wall calcification. It is simple, fast, safe, and more accurate in determining the cause, location, and degree of stenosis. During the examination, a contrast agent may be intravenously administered based on the patient's condition.

What diseases should insufficient cerebral artery blood supply be differentiated from?

1. Focal motor epilepsy: More common in young people, it involves a series of repetitive convulsions in one limb or a specific body part, such as one side of the mouth, eyelid, finger, or toe, or may affect one side of the face or the distal part of a limb. Patients usually have a history of epilepsy.
2. Meniere's disease: More common in middle-aged and young individuals with tinnitus. Symptoms include sudden, unexplained vertigo and high-pitched tinnitus. The episodes last longer, often several days, before gradually subsiding.
3. Syncope: More common in young women. It includes neurally mediated reflex syncope, orthostatic syncope, and syncope caused by arrhythmia or structural cardiopulmonary diseases. The duration of syncope is usually short.
4. Transient global amnesia: Mostly occurs in people aged 50–80. It manifests as an inability to form new memories, with memory loss lasting from hours to days, weeks, or occasionally years, but neurological examination results are normal^[8,9].

TREATMENT

How to treat cerebral artery insufficiency?

1. First, control personal risk factors, such as lowering blood pressure (daily monitoring, antihypertensive medications), managing blood sugar (monitoring glucose levels, taking hypoglycemic drugs), controlling blood lipids (regular lipid tests, a light diet), and quitting smoking and alcohol.
2. When clinical symptoms or tests indicate cerebral ischemia or hypoxia, doctors may recommend treatments to improve circulation, inhibit platelet aggregation, nourish nerves, or activate brain cells^[2]. Common medications include:
   • Betahistine: Helps relieve dizziness and tinnitus. Side effects mainly include gastrointestinal symptoms (e.g., nausea, vomiting, loss of appetite) and headaches. Contraindicated in patients allergic to the drug, with pheochromocytoma, or children. Use cautiously in those with a history of peptic ulcers^[9].
   • Flunarizine (Sibelium): Regulates cerebrovascular tone and improves cerebral circulation. Follow the doctor's dosage strictly. Report worsening fatigue promptly. Contraindicated in patients with depression or Parkinson’s disease. Caution advised for drivers and machinery operators^[10].
   • Citicoline: Aids brain function recovery and improves blood supply when combined with flunarizine. Administered via IV drip. Discontinue if hypotension, chest tightness, or breathing difficulties occur^[11].
   • Alprostadil: Dilates blood vessels, inhibits platelet aggregation, and protects endothelial cells. Administered via IV drip. Contraindicated in severe heart failure, pregnancy, or allergy^[12].
3. Surgery: Recommended for symptomatic carotid stenosis >50% or asymptomatic stenosis >70%, possibly requiring carotid endarterectomy or stenting^[2].

The treatment plan should be determined by a doctor based on the patient's condition.

Should medication continue after improvement in cerebral artery insufficiency?

Yes. Continued medication is crucial for consolidation therapy, similar to initial treatment. Follow the doctor's prescription to maintain stable cerebral blood supply, often requiring long-term use.

Is follow-up necessary after discharge for cerebral artery insufficiency?

Yes. Follow-up intervals vary but are typically every 1–2 months. Routine checks include blood pressure, heart rate, lipids, blood sugar, and liver/kidney function. Imaging (e.g., CT/MRI, CTA, MRA) may be repeated if needed.

Can cerebral artery insufficiency recur?

Yes, if underlying causes persist, medication/compliance is irregular, or lifestyle habits remain poor^[13].

Which department treats cerebral artery insufficiency?

Neurology or neurosurgery. Emergency care is needed for sudden facial paralysis, speech difficulties, or vision loss.

DIET & LIFESTYLE

What should patients with cerebral arterial insufficiency pay attention to in their diet?

1. Low-fat diet: Reduce intake of animal fats, fried foods, animal skin, and organ meats. Replace animal fats with vegetable oils and use less oil when cooking.
2. Low-salt diet: Use less salt and high-sodium seasonings when cooking, and avoid pickled vegetables and meats.
3. Low-sugar diet: Limit sugary drinks, pastries, biscuits, and other processed foods high in sugar. If overweight, reduce staple food intake appropriately.
4. High-fiber diet: Eat more foods rich in vitamins and fiber, such as fresh fruits, vegetables, and whole grains.
5. High-quality protein diet: Choose foods rich in high-quality protein, such as eggs, milk, fish, and shrimp.
6. Avoid alcohol.
7. Regular meals: Maintain consistent meal times and portion sizes^[13].

What should patients with cerebral arterial insufficiency pay attention to in daily life?

1. Quit smoking and limit alcohol.
2. Follow the doctor's instructions strictly, take medications on time and in the prescribed dosage, and do not stop medication without permission.
3. Schedule regular follow-ups as advised to monitor the condition and potential side effects of medications.
4. Patients should educate themselves about cerebral arterial insufficiency, including its causes, symptoms, and risks^[13]. Seek immediate medical attention if symptoms worsen.
5. Keep the living environment free of obstacles and ensure floors are slip-resistant to prevent falls.

Can patients with cerebral arterial insufficiency exercise?

If physically capable, moderate exercise is recommended. Patients can create a suitable exercise plan based on their preferences and physical condition^[13]. Aim for 3–5 sessions per week, about 30 minutes each, combining aerobic exercises (e.g., jogging, cycling, tai chi) and strength training (e.g., sit-ups, weightlifting). Proceed gradually and according to individual ability.

What should family members of patients with cerebral arterial insufficiency pay attention to?

1. Ensure the patient takes medications regularly and attends follow-up appointments.
2. Maintain a clean and comfortable living environment with proper ventilation (open windows daily; in winter, ventilate 3 times a day for about 15 minutes each).
3. Provide a nutritious diet rich in high-quality protein and vitamins, with a variety of foods.
4. Monitor the patient's mood. If signs of excessive worry, anxiety, or depression appear, offer support to maintain a positive and optimistic mindset.
5. Accompany the patient when using the bathroom, bathing, or going out to prevent falls.
6. Avoid prolonged bed rest. If necessary, provide limb massages to prevent blood clots.
7. If symptoms like dizziness, weakness, headache, limb numbness, or double vision recur, accompany the patient to seek medical attention promptly.

PREVENTION

How to Prevent Insufficient Cerebral Artery Blood Supply?

1. Control risk factors related to cerebrovascular diseases and actively treat conditions that may lead to insufficient cerebral artery blood supply, including cervical spondylosis and heart failure.
2. Undergo regular health check-ups to screen and monitor cerebrovascular risk factors such as blood pressure, blood sugar, blood lipids, and electrocardiograms.
3. Quit smoking and limit alcohol consumption.
4. Avoid prolonged sitting and engage in regular physical exercise.
5. Maintain a healthy diet. Distribute meals reasonably, balance meat and vegetables, and ensure dietary diversity.
6. Keep a positive mindset, avoid prolonged exposure to high-stress work environments, and participate in recreational activities such as watching movies or listening to music.