Cerebral vascular abnormalities are extremely dangerous and can be fatal if not treated promptly. This condition can lead to a stroke (blockage or bleeding), which can lead to permanent brain tissue damage and even death.
What is Cerebral Vascular Disorder?
The most common cerebral vascular disorder is stroke, which occurs when the blood flow carrying oxygen and nutrients to brain cells is interrupted. This disruption can be caused by a blockage (ischemic stroke) or a ruptured blood vessel (hemorrhagic stroke). If not treated promptly, the oxygen-deprived brain tissue will experience cell death.
Symptoms of Cerebral Vascular Disorders
Symptoms of cerebral blood vessel disorders can be numerous, ranging from:
- Severe headaches that suddenly appear for no apparent reason
- Weakness on one side of the body , especially in the face, arm, or leg
- Sudden cramps and numbness
- Sudden visual disturbances in one or both eyes, blurred vision, or double vision
- Slurred speech (dysarthria) or difficulty understanding what others are saying
- Numbness around the mouth
- Wandering like on a ship, unbalanced, staggering
- Vertigo that doesn't go away
In addition, symptoms to watch out for include an asymmetrical face, a crooked mouth when smiling, and even decreased consciousness (which can lead to coma).
Cerebral Vascular Disorder Examination Methods
Various technologies can be used to detect disorders of the brain's blood vessels, including:
- MRA (Magnetic Resonance Angiography) : uses magnetic fields and radio waves to produce three-dimensional images of blood vessels.
- TCD (Transcranial Doppler) : a non-invasive examination to assess blood flow in the brain.
- TCCD (Transcranial Color-Coded Doppler) : a development of TCD equipped with color imaging.
- CTA (Computed Tomography Angiography) : uses CT scans and contrast agents to view blood vessel structures in detail.
- DSA (Digital Subtraction Angiography) : a minimally invasive procedure using a catheter and contrast agent to obtain highly accurate images.
DSA: The Gold Standard of Screening
To date, brain DSA (Digital Subtraction Angiography) remains the gold standard for evaluating cerebral blood vessel conditions. This examination is highly effective in detecting various abnormalities, such as narrowing of blood vessels (stenosis), arteriovenous malformations (AVMs), fistulas, and even brain aneurysms.
The fluoroscopy technology used allows structures such as bones to be digitally removed from the image, allowing the condition of the blood vessels to be seen more clearly and in more detail.
How is the DSA Procedure Performed?
Digital Subtraction Angiography (DSA) is an imaging procedure used to view blood vessel conditions in great detail. This examination is performed by specialists trained in neurology specializing in neurointervention, neurosurgery specializing in endovascular surgery, or radiology specializing in radiointervention. It is often used to evaluate various brain blood vessel disorders that cannot be optimally seen through other examinations.
Before the procedure begins, the patient will undergo a comprehensive health evaluation, including kidney function testing and a history of allergies to contrast agents. The area where the catheter will be inserted, usually in the groin (sometimes through the wrist), will be cleaned and a local anesthetic administered to minimize discomfort.
Next, the doctor inserts a thin catheter into the blood vessel and carefully guides it toward the blood vessels supplying the brain. The catheter's movement is monitored in real time using fluoroscopy technology so that its position can be precisely controlled.
Once the catheter reaches the target site, a contrast agent is injected into the blood vessel. This agent makes blood flow visible on X-ray imaging. The "subtraction" technology in DSA then digitally removes the shadows of surrounding bone and tissue, allowing the doctor to obtain a clearer, sharper, and more detailed image of the blood vessels.
Through this examination, the doctor can assess:
- Narrowing or blockage of blood vessels (stenosis)
- Brain aneurysm or abnormal widening of the blood vessel wall
- Arteriovenous malformation (AVM)
- Congenital vascular malformations
- Blood flow disorders associated with stroke
- Other blood vessel disorders that can potentially cause brain hemorrhage
The DSA procedure generally takes about 30 minutes, depending on the complexity of the case and whether any additional measures need to be taken during the examination.
The Role of DSA in Patient Management
One of the main advantages of DSA is its ability to function not only as a diagnostic tool, but also as a means of determining future therapy or intervention measures.
If an abnormality is discovered during the examination, the doctor can immediately administer treatment through the same catheter without the need for open surgery. For example, in the case of a brain aneurysm, the doctor can perform a coiling procedure to close the aneurysm and reduce the risk of blood vessel rupture. In cases of certain narrowing of the blood vessels, the doctor can also insert a balloon or stent to help improve blood flow.
This ability to diagnose and treat in one procedure is what makes DSA have an important role in the treatment of modern cerebrovascular diseases.
What are the advantages of DSA compared to other examinations?
Various vascular imaging methods are currently available, such as TCD-TCCD, MRA, and CTA, which are simpler and non-invasive. However, DSA is still considered the gold standard due to its high level of accuracy and image detail.
Some of the advantages of DSA include:
- Provides very high resolution visualization of blood vessels.
- Capable of displaying even very small blood vessel structures.
- Can evaluate the direction and velocity of blood flow in real-time.
- Helps determine the size, shape, and location of the aneurysm more accurately.
- Very useful in planning surgical procedures and interventions.
Due to its capabilities, DSA is often used as a follow-up examination when the results of previous examinations still require more detailed evaluation or when the doctor needs very specific information before determining therapy.
Is DSA Safe?
In general, DSA is a relatively safe procedure when performed by experienced medical personnel and with proper preparation. However, like any medical procedure, DSA carries some risks that should be considered, such as minor bleeding at the catheter insertion site, reactions to contrast agents, impaired kidney function in certain patients, and rare complications such as stroke.
However, the benefits of this examination often far outweigh the risks, especially in patients suspected of having cerebral blood vessel abnormalities that could potentially cause stroke or brain hemorrhage.
Before carrying out the procedure, the doctor will first evaluate the patient's condition and explain the possible complications that may occur during the procedure.
Risk Factors to Watch Out For
Some factors that increase the risk of cerebrovascular disorders include:
- Hypertension or uncontrolled high blood pressure.
- High cholesterol
- Diabetes .
- High uric acid
- Smoking habit
- Overweight or obesity
Keeping blood pressure, blood sugar levels, and body weight within normal limits can help reduce the risk of serious complications.
Recognize the Symptoms with BEFAST
Early detection is crucial. Remember the following BEFAST code :
- B (Balance) : loss of balance, dizziness, or spinning sensation.
- E (Eyes) : blurred, double or sudden loss of vision.
- F (Face) : the face looks crooked or it is difficult to smile symmetrically.
- A (Arms) : one arm or leg feels weak.
- S (Speech) : slurred speech, unclear speech, or difficulty speaking.
- T (Time) : seek medical help immediately because every minute is precious.
Conclusion
Cerebrovascular disorders are serious conditions that require prompt treatment. Symptoms can include severe headaches, visual disturbances, weakness on one side of the body, vertigo, difficulty swallowing, difficulty speaking, and even unconsciousness. Various testing methods are available to aid diagnosis, with DSA remaining the gold standard in evaluating cerebrovascular disorders.
At EMC Pulomas Hospital, various examination options are available such as MRA, CTA, TCD, TCCD, and DSA to help detect brain blood vessel disorders more accurately.
The sooner this condition is recognized and treated, the greater the chance of preventing serious complications, disability, and death. Don't ignore any symptoms and consult a doctor immediately if you notice any suspicious signs.
The article was written by Dr. Andika Surya Atmadja, Sp.N-FINA, AIFO-K (Neurology Specialist Doctor at EMC Pulomas Hospital).