Cerebral Ischemia Symptoms and Treatment

Cerebral ischemia , known as cerebrovascular ischemia or brain ischemia, occurs when there is an insufficient amount of blood flow to the brain. This prevents oxygen and vital nutrients from reaching the brain.

Cerebral ischemia is a medical emergency. Even a temporary drop in oxygen supply can impair the brain. In fact, if brain cells are deprived of oxygen for more than a few minutes, severe damage can occur, which may result in the death of the brain tissue. This type of brain tissue death is also known as a cerebral infarction or ischemic stroke.

This article explains the signs of cerebral ischemia, causes, and treatment options.

Symptoms of Cerebral Ischemia

The symptoms of brain ischemia can range from mild to severe. They can last from a few seconds to a few minutes. If the ischemia is brief and resolves before permanent damage (infarction) can occur, then the event is often referred to as a transient ischemic attack (TIA).

If the brain becomes damaged as a result of ischemia, the symptoms may become permanent. Symptoms of brain ischemia include the following:

• Body weakness on one or both sides of the body ( hemiparesis )
• Loss of sensation on one or both sides of the body
• Confusion or disorientation
• Changes in vision of one or both eyes
• Dizziness, vertigo
• Double vision
• Slurred speech
• Loss of consciousness or decreased consciousness
• Balance problems and problems with coordination

Causes of Cerebral Ischemia

Brain ischemia is linked to many different diseases or irregularities. They may include the following:

• Sickle cell anemia or other blood diseases
• Heart disease and damaged blood vessels
• Certain genetic health conditions
• Congenital heart defects
• Low blood pressure
• Traumatic brain injury

Heart attack, and heart arrhythmias like ventricular tachycardia , can make the heart unable to pump blood to the brain. An atrial fibrillation arrhythmia (A-Fib) can cause blood clots to form and travel to the brain. Medication to treat A-Fib also may cause small bleeds in the brain.

Types of Cerebral Ischemia

Brain ischemia can be categorized into a few different types. These include:

• Thrombotic: This type of ischemia is caused by blockage of a blood vessel, usually due to a blood clot or a sudden spasm of an artery.
• Embolic: This type of ischemia is typically caused by a blood clot that may have formed in the heart or an artery that then travels to another (often smaller) artery, causing a blockage in the destination artery.
• Hypoperfusion: This type is caused by an overall lack of blood supply. A heart attack, severe blood loss from trauma, or surgery can cause a decrease in overall blood flow to the brain.

The ischemia can affect a small region of the brain, or it may affect a large region or even the entire brain:

• Focal ischemia is confined to a specific area of the brain. It usually occurs when a blood clot has blocked an artery in the brain. Focal ischemia can be the result of a thrombus or embolus.
• Global ischemia affects a wider area of the brain and usually occurs when the blood supply to the brain has been drastically reduced or stops. This is typically caused by a cardiac arrest.

Diagnosing Cerebral Ischemia

The diagnosis of cerebral ischemia may depend on the cause, such as the differences between a stroke that follows a traumatic brain injury and ischemia associated with age or an underlying condition like heart disease.

The symptoms of cerebral ischemia can be strongly associated with ischemia, but a "silent stroke" episode may not lead to symptoms that your healthcare provider can evaluate. Tests used to diagnose the condition can include:

• Neurological exam to test your responses and reflexes
• Imaging, including magnetic resonance imaging (MRI) or computed tomography (CT) scans, as well as ultrasounds of your carotid arteries
• Cerebral angiography, which uses dye to help visualize blood flow to the brain

Blood tests to evaluate other conditions, like heart attack or high cholesterol, are used to identify risk factors or rule out other causes of symptoms, like dementia or multiple sclerosis.

Preventing Cerebral Ischemia

Brain ischemia can be prevented. The treatment of brain ischemia includes a number of medications that are used for the treatment and prevention of ischemic stroke.

Prevention of brain ischemia includes medications that can help you achieve your ideal blood pressure, as well as medications for lowering levels of cholesterol and fat in the blood. Dietary modification can also help in achieving ideal cholesterol levels.

Cerebral Ischemia and Stroke

Some risk factors for cerebral ischemia can't be changed, like age or race. (Black people have higher risk of dying from stroke than White people.) Other risk factors for ischemic stroke include:

• High blood pressure
• Heart disease
• Smoking tobacco
• Certain birth control products
• High cholesterol
• Diabetes
• Previous TIA
• Atrial fibrillation
• Obesity
• Lack of exercise

Extreme temperature exposure, and even the region you live in, can contribute to your risk profile.

Treating of Cerebral Ischemia

Medications and surgeries can be needed to treat cerebral ischemia.

Medication

Treatment for sudden ischemia includes the intravenous medication alteplase (tPA). When administered quickly, this emergency treatment has been shown to improve the medical outcome after a stroke. The American Stroke Association calls for tPA to be given up to four-and-a-half hours after stroke symptoms start.

This drug restores blood flow by dissolving the blood clot causing the stroke. There are also emergency procedures (like thrombectomy) to directly treat the blocked blood vessel.

Sometimes, after a stroke, survivors are at higher risk of developing post-stroke seizures. Anti-seizure medications can help prevent some post-stroke seizures and can also control post-stroke seizures if they do develop.

Surgery

Surgeries to treat cerebral ischemia depend on the specific cause. They can include:

• Embolectomy (removal of an embolus blocking a vessel)
• Balloon angioplasty, used to open a blood vessel that's blocked or has spasms
• Carotid endarterectomy , to treat carotid artery problems like stenosis

Procedures to restore blood flow (cerebral revascularization) can be performed to treat cerebral ischemia, as well as conditions like inoperable aneurysms in which endovascular neurosurgery can't be done.

Silent Stroke

Damage to blood vessels in the brain is a common condition affecting older adults. It is a risk factor for "silent strokes." Since the silent brain ischemia doesn't cause common stroke symptoms, guidelines from the American Heart Association and American Stroke Association call for the use of imaging tests to evaluate the risk for silent cerebrovascular disease.

Summary

Cerebral ischemia occurs when blood flow to the brain is disrupted. This is a serious and potentially life-threatening condition, so it's important to have any symptoms assessed immediately. There also may be a benefit to immediate treatments like tPA, which can lead to improved outcomes.

The causes and risks of cerebral ischemia include factors that you can control (like not smoking, or always taking your medication for high blood pressure) and some that you can't, like underlying diseases, your age, or congenital problems. Talk to your healthcare provider about screening and treatment for cerebral ischemia.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

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By Jose Vega MD, PhD
Jose Vega MD, PhD, is a board-certified neurologist and published researcher specializing in stroke.

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