The circle of Willis must be closed or not. Circle of Willis in the form of reduced blood flow

The circle of Willis in the cerebral vascular system was described more than three hundred years ago by the English physician T. Willis. The structure of this arterial ring is of great importance in conditions of trouble, when certain parts of the nervous tissue experience insufficient arterial blood flow due to blockage or stenosis of the arteries. Normally, even with abnormally developed vessels of this circle, a person does not feel the existing features due to the full functioning of other arteries.

The norm of the structure of the circle of Willis is defined, but not everyone can boast of it. According to some reports, classical arterial ring only half of the people are developed, other researchers call the figure only 25% of people, and all the rest have some kind of vascular branching anomalies. This, however, does not mean that those whose arterial circle is developed in a peculiar way will have any negative symptoms or disorders, but nevertheless, manifestations of impaired blood flow can periodically make themselves felt by migraines, vascular encephalopathy, or even manifest acute violations cerebral circulation.

There are a lot of options for the development of the circle of Willis. This may be tripling (trifurcation), aplasia, hypoplasia, the complete absence of any arterial elements. Depending on the type of branching of the arteries, it is determined clinical significance and forecast.

To determine the anatomy of the circle of Willis, non-invasive and invasive diagnostic procedures are used, they are carried out according to indications for specific complaints of the patient. In other situations, anomalies are discovered by chance during examination for another pathology.

The structure of the circle of Willis

The classic circle of Willis is formed by:

• The initial sections of the anterior cerebral arteries (ACA);
• Anterior communicating artery (APC);
• Posterior cerebral arteries (PCA);
• Posterior communicating arteries (PCA);
• Supra-sphenoid part of the internal carotid artery (ICA).

The listed vessels form a kind of heptagon. The ICAs bring blood to the brain from the common carotid and at the base of the brain give out the ACA, which communicate with each other through the PSA. The posterior cerebral arteries originate from the main artery, which is formed by the union of two vertebral arteries. There is a connection between the ICA and the PCA - the posterior connecting vessels, which, depending on their diameter, are fed either from the internal carotid system or from the basilar artery.

structure of the circle of Willis

Thus, a ring is formed that connects two arterial flows - from the basin of the internal carotid and basilar arteries, different parts of which can take on the function of providing nutrition to those parts of the brain that lack blood when other components of the brain network are blocked or narrowed.

The circle of Willis is located in the subarachnoid space of the base of the brain, surrounding with its constituent elements the visual chiasm and the formation of the midbrain, behind is the Varolii bridge, on the surface of which the basilar artery is located.

The anterior cerebral and carotid arteries are distinguished by the greatest constancy in structure, the posterior cerebral and connecting branches are very variable in their anatomy and branching features. However, changes in the anterior circle of Willis are of greater clinical significance due to more severe symptoms and worse prognosis.

The anterior cerebral artery, as a rule, is well formed and normally its lumen reaches one and a half - two and a half millimeters. The PSA is the same size and about a centimeter long. The lumen of the left internal carotid artery is normally larger than the right one by 0.5-1 mm. The middle cerebral artery also has some asymmetry in size: it is thicker on the left than on the right.

Video: the structure of the circle of Willis

The role of the circle of Willis

The circle of Willis is a mechanism of protection, compensation for impaired blood circulation, provided by nature to provide blood to the brain in case of damage to specific arteries. If obstruction, rupture, compression occurs, there is a congenital underdevelopment of the branches of the arterial bed, then the vessels of the opposite side will take over the function of blood supply, delivering blood through the collaterals - the connecting arteries.

Considering the functional significance of the arterial network of the base of the brain, it becomes clear why these arteries are so important. It is not only about serious diseases like or aneurysms. The circle of Willis helps to provide the brain with blood as much as possible in case of functional disorders (), some variants of the structure of the arteries, when the vascular ring is still closed, but the diameter of individual vessels does not allow the required amount of blood to be delivered.

The role of the circle of Willis increases sharply when any of the arteries is full. Then both the prognosis, and the rate of increase in symptoms, and the volume of the focus of damage to the nervous tissue will depend on how this ring is formed and how much it is able to redirect blood to those parts of the brain that receive less nutrition. It is clear that a properly formed vascular system will cope with this task better than one where there are anomalies in the development of blood vessels or even the complete absence of specific branches.

Variant anatomy of the arteries of the base of the brain

There are many types of structure of the circle of Willis. They depend on how the process of vessel formation took place even in the prenatal period, and it is impossible to predict this process.

Among the most common anomalies of the arteries of the brain indicate: aplasia, hypoplasia of individual branches, trifurcation, fusion of two arteries into one trunk, and some other varieties. Some people have a combination of different vascular anomalies.

The most common variant of the development of the circle of Willis is the posterior trifurcation of the ICA, which accounts for almost a fifth of all anomalies of the arterial ring. With this type of structure, three cerebral arteries begin at once from the ICA - anterior, middle and posterior, and the PCA will be a continuation of the posterior connecting branch.

A similar structure is characteristic of the circulatory system of the fetal brain at 16 weeks of gestation, but later the size of the vessels changes, the posterior connective decreases, and the remaining branches increase significantly. If such a transformation of the vessels does not occur, then subsequently the child is born with a posterior trifurcation.

Another common variant of the structure of the circle of Willis is aplasia of the PCA, arising under various adverse external conditions and genetic abnormalities during embryogenesis. In the absence of this artery, the circle of Willis does not close on the side where it does not exist, that is, there is no relationship between the system of the internal carotid artery and the basilar basin.

The absence of PSA is also diagnosed, but much less frequently than the back. With this type of structure of the arterial ring, there is no relationship between the branches carotid arteries, therefore it is impossible, if necessary, to "transfer" blood from the vessels of the left half to the right.

Aplasia of the anterior communicating artery does not give a chance to carry out blood flow in the affected part of the brain by delivering blood from the opposite vascular network, since the carotid arteries are disconnected. With an unformed PCA, there is no relationship between the anterior and posterior parts of the circle of Willis, and the anastomoses do not function. This type of branching of the arterial system seems unfavorable in terms of possible decompensation of blood flow disorders.

The rare forms of the structure of the circle of Willis include:

• median artery of the corpus callosum;
• Combining the anterior cerebral arteries into one common trunk or their parietal course, when they are in close contact with each other;
• Anterior trifurcation of the internal carotid artery (two anterior cerebral arteries depart from one carotid at once);
• Split, double anterior communicating artery;
• Bilateral absence of ACD;
• Trifurcation of the carotid arteries on both sides.

Non-classical types of the circle of Willis are more typical for its anterior part, but since defects in the posterior part are of greater clinical importance due to a worse prognosis, they are diagnosed more often. The conclusions of experts indicate that the vast majority of patients with impaired blood flow in the brain have certain anomalies of the circle of Willis, and this indicates its great importance in providing the brain with blood in pathology.

Anomalies in the branching of the vessels and the openness of the circle of Willis make it unable to perform the role of anastomosis in critical situations.- with thrombosis, spasm,. In addition, some types of branching suggest large areas of necrosis of the nervous tissue with circulatory failure. For example, anterior trifurcation means that most parts of the hemisphere receive blood from the branches of only one artery, so if it is affected, the scale of necrosis or hemorrhage will be significant.

When the arteries of the base of the brain are classically developed, between them there are all the necessary connecting branches and the caliber of each vessel is within normal limits, they say that the circle of Willis is closed. This is the norm, indicating that the anastomosis is consistent, and in case of pathology, the blood flow will be maximally compensated.

fully open VC

The open circle of Willis is considered a serious anomaly, predisposing to various kinds. There is an openness of the anterior part of the arterial ring, which occurs with aplasia of the PSA or anterior trifurcation of the carotid artery, and the openness of the circle of Willis due to anomalies in the posterior part of the vascular bed - aplasia of the posterior communicating, basilar artery, posterior trifurcation of the ICA.

If the connecting branches are completely absent, they speak of the complete openness of the circle of Willis, and when the arteries are preserved, but stenotic, hypoplastic, then the openness is considered incomplete.

Signs and diagnosis of anomalies of the circle of Willis

Clinical signs of branching anomalies of the vessels of the circle of Willis occur when the blood flow through the collaterals becomes insufficient for various reasons. For example, fatty plaques formed in the arteries, a thrombus appeared or migrated from the left half of the heart, an aneurysm ruptured. A healthy person does not feel non-classical vascular branching, since his brain does not feel the need for bypass blood flow paths.

the development of a stroke / disorders associated with insufficient blood supply to a part of the brain

Symptoms of obstructed blood flow can be very different. If we are not talking about a stroke, then patients complain of dizziness, a decrease in intellectual abilities, memory, and attention. Psychological problems are also not uncommon - often abnormal branching of blood vessels is accompanied by neuroses, panic attacks, emotional lability of its owners.

A characteristic manifestation of the non-classical development of the circle of Willis is considered. The issue of the relationship between the structure of the cerebral arteries and migraine has been the subject of many observations that indicate that most patients with migraine have one or another anomaly. Especially often with migraine, deviations in the structure of the posterior arterial system are diagnosed. With the circle of Willis open, hypoplasia or aplasia of the posterior communicating arteries, posterior trifurcation, those parts of the brain that are responsible for vision receive less blood, so an intense headache is preceded by a visual aura in the form of flashes, zigzags, etc.

A decrease in blood flow through the vessels of the arterial ring of the brain can provoke periodic headaches and disorders like apathy or irritability, decreased performance, fatigue, etc. Usually, such a conclusion can be found in the results of MR angiography and it speaks of hypoplasia of certain vessels .

With aplasia of the arterial trunks, when some vessels are absent at all, the study fixes the absence of blood flow. For example, aplasia of the posterior communicating arteries will be accompanied by a lack of blood flow through them, respectively. Such aplasia can also be asymptomatic, but only when a sufficient amount of blood passes through the main arteries. With atherosclerosis or spasm of the arteries, signs of insufficient blood supply to the brain will not keep you waiting.

% distribution of cases of aneurysms in the arteries of the brain

If, against the background of the abnormal structure of the arteries of the base of the brain, an acute circulatory disorder occurs, then the clinic will have obvious symptoms of a stroke - paresis and paralysis, speech disorders, pathological reflexes, impaired consciousness up to coma.

Separately, it is worth mentioning the expansion of the vessels of the brain. According to statistics, it is in the arteries of the circle of Willis that they are found in the greatest number. An aneurysm of the arteries in this area is fraught with rupture and massive subarachnoid hemorrhage with a stroke clinic, coma, and severe neurological manifestations.

Aneurysm is an independent pathology, and not a variant of individual vascular branching, but it is significantly often accompanies non-classical types of the circle of Willis.

The diagnosis of one or another anomaly in the development of the circle of Willis can only be established with the involvement of modern instrumental methods of examination. Opportunities in diagnostics gave specialists a chance to analyze the nature of the prevalence of variants in the structure of cerebral vessels and their varieties, but relatively recently, conclusions could be drawn mainly from the results of autopsies of deceased patients.

The development of Doppler ultrasound and magnetic resonance imaging techniques made it possible to make the study of the nature of the structure of the circle of Willis a public and safe event. The main methods for diagnosing variants of the vascular system of the brain include:

• X-ray contrast - one of the most informative methods, but has contraindications associated with the need for contrast (pathology of the liver, kidneys, allergy to contrast, etc.);
• Transcranial - the procedure is safe, affordable, requires devices with a Doppler sensor, which are available in many medical institutions;
• MR angiography - performed on a magnetic tomograph, has contraindications, a significant drawback is the high cost.

Circle of Willis on a diagnostic x-ray

Selective angiography cerebral vessels refers to invasive procedures, when femoral artery a catheter is inserted, advancing to the area of ​​interest of the cerebral arteries. When the required area is reached, a contrast agent is applied. The method is used most often during surgical treatment (stenting, angioplasty).

Instead of selective angiography can be applied CT angiography, when a contrast agent is injected intravenously, and then pictures of the head are taken in different projections and sections. Subsequently, a three-dimensional image of the vascular structures of the brain can be recreated.

Transcranial dopplerography allows you to determine the nature of blood flow in the vessels of the brain (reduced, absent), but it does not provide enough data on the anatomical structure of the arteries. An important advantage of it is considered the almost complete absence of contraindications and low cost.

MR angiography- one of the most expensive, but at the same time, quite informative way of diagnosing the structure of the circle of Willis. It is carried out in a magnetic tomograph and contraindications to it are the same as for conventional MRI ( high degree obesity, claustrophobia, the presence in the body of metal implants that conduct a magnetic field).

The MRI picture shows the structure of the vessels of the circle of Willis, the presence or absence of connections between them, aplasia or hypoplasia of the arteries. When evaluating the result, a specialist can determine the diameter of each artery and the features of its branching.

Video: an example of MR angiography of the brain

(The circle of Willis is closed; a tortuous S-shaped course of the intracranial section of the left vertebral artery is determined; a C-shaped course of the basilar artery; otherwise, in the segments of the ICA and paired arteries of the annulus of the brain base, data for the presence of hemodynamically significant stenoses, pathological tortuosity were not obtained).

As you can see, each of the methods has both advantages and disadvantages, so they are combined to obtain accurate conclusions regarding the arteries of the brain. An integrated approach makes it possible to determine both the anatomy of the vessels and the nature and direction of blood flow through them, which is very important in assessing the risk of vascular accidents and possible prognosis.

Many people who have found any variant of the structure of the circle of Willis are immediately interested in methods of treatment. Since deviations in vascular branching are not considered an independent disease, treatment as such is not required. Moreover, in the absence of a clinic of blood flow insufficiency, it does not make sense.

In cases where there are specific complaints (migraines, mental disability, etc.), you need to seek help from a neurologist who will prescribe (nootropil, phezam, actovegin) to improve brain metabolism (mildronate, B vitamins), if necessary - sedatives, tranquilizers, antidepressants, in case of migraine - analgesics, anti-inflammatory, specific anti-migraine drugs (ketorol, ibuprofen, paracetamol, askofen, drugs of the triptan group).

Surgical treatment indicated for severe circulatory disorders with progression of vascular encephalopathy, diagnosed aneurysm, sometimes after a stroke. It consists in stenting, clipping or exclusion of an aneurysm from the bloodstream, balloon angioplasty for narrowing of the arteries.

Video: lecture on the blood supply to the brain and the circle of Willis

The circle of Willis (VC) is a system of associations of vessels of the circulatory system in the brain (anastomoses).

These compounds are located at the very base of the organ. Circulus arteriosus translated from Latin means arterial circle - this is a connection between the system of carotid vessels, as well as arterial system vertebrobasilar basin.

The formation of a system of anastomoses in the body is important for non-standard situations in the body. This is when the body feels a shortage of oxygen-rich blood due to damage to the blood flow system by a thrombus.

A person does not feel the function of this ring of vessels, because the functionality of the vascular system is not impaired. A variant of the development of a circle of organ anastomoses was described 3 hundred years ago by the medical scientist Willis.

Norms in the formation of the circle of Willis

There is a clear definition of the regulatory structure of this body. These are anastomoses that are collected in a ring and have the shape of a circle. Less than half of the people have such a structure of this organ. In other people, the anastomoses of the circle of Willis are formed with anomalies in the branch of various vessels.

The circle can be:

• Closed;
• Open.

An anomaly of the arterial ring does not lead to widespread diseases of the organ, although the lack of blood supply to organs periodically manifests itself in such diseases:

• Migraine headaches with circle of Willis;
• Arterial encephalopathy - the vessels of the organ are affected;
• Deviation in the blood supply to the head in an acute form, which is a dangerously complicated form - a stroke.

Variants of the structure and formation of types of the circle of Willis:

• Type of formation - trifurcation;
• Type of organ structure - aplasia;
• Type of hypoplasia;
• An anomaly in the structure in the complete absence of vascular branches and elements.

Pathologies that develop in the circle of Willis depend on the type of branching of this organ. Clinical manifestations and therapy of diseases are also in accordance with the structure of the arterial type of the ring.

To study the anatomy of the VC, the following are used:

• Non-invasive diagnostic procedures;
• Invasive diagnostic research checks.

The structure of the circle of Willis

The classical formation of the ring of Willis is formed by the following arterial beds:

• Anterior cerebral artery (ACA);
• Connecting bed of the anterior section (PSA);
• The bed of the posterior part of the organ (ZMA);
• Connecting artery of the posterior organ (PCA);
• Above the wedge-shaped section of the internal type of the carotid channel (ICA).

All these rivers of blood flow form a heptagonal figure at the base of the organ - the brain. The bed of the carotid vessels (ICA) delivers blood to the organ from the general circulation of the carotid basin and is transferred to the anterior section (ACA) at the base of the organ.

The right-sided side of the anterior bed and the left-sided anterior artery are connected by means of the connecting vessels of the anterior part of the organ (PSA).

The posterior right internal carotid artery originates from the union of the vertebral vessels.

You can learn more about the location of the internal carotid artery by.

The union of the left ICA and the right ICA, as well as the PCA, occurs through the posterior communicating artery. The PCA receives its blood supply either from the carotid basin system or from the basilar basin.

Functions

The circle of Willis forms in itself two streams of arterial blood supply from the basilar pool and blood supply to the head from the pool of the carotid vascular system. The supply of those parts of the body that do not receive additional nutrition is carried out due to the functioning of one of the efficient channels.

The ring of Willis is located in the subarachnoid region of the base of the organ of the brain and is surrounded by arterial elements (formed by branches) that create the chiasm of the visual type and the base of the midbrain.

Behind the VC is the pons Varolii, which connects the ring with the basilar vessel.

Vessels of the anterior part of the brain are well formed (in most cases) and, according to standard indicators, they have a lumen diameter of up to 2.5 mm. PSA has an identical diameter and length - up to 10.0 millimeters.

The diameter of the left-sided internal carotid vessel is up to 1.0 mm according to the standard.

The midbrain vessel has an asymmetric shape - its left side is wider in diameter, and the right side has a narrowing of the lumen.

The vessels of the anterior section are distinguished by high constancy in formation - these are sleepy, as well as cerebral. The vessels of the posterior section are more variable and have a certain physiological individuality in the scheme of the anatomy of the structure and branches in the ring of Willis.

With pathology of the channel of the anterior cerebral region clinical manifestations much stronger and have a worse prognosis for the development of this pathology.

Role of VK

The circle of Willis is a protective mechanism that compensates for disturbances in the blood flow system. This brain structure is formed by nature in order to avoid the irreversible consequences of a slight shortage nutrients in the brain.

If one of the vessels is damaged, then it functional responsibilities takes over the ring of Willis and supplies blood to all parts of the head, receiving it from the second working artery.

Through the connecting vessels, the necessary volume of blood is delivered to all parts of the organ.

The role of the ring of Willis in the blood flow system is very important, and not only during a period of serious diseases, such as an aneurysm of the arteries, or a stroke, but even when a vascular spasm occurs.

With occlusion of one channel, the circle of Willis performs the functions of pumping arterial blood.

The symptoms of occlusion and the development of pathology, its speed and the area of ​​the focus of destruction, directly depend on the correct structure of the ring and how effectively it can redirect blood flow to those organs that suffer from blood deficiency.

With the normal structure of the system, this circle copes with the task assigned to it.

If the circle is closed, is it good or bad?

With a closed VC, the coordinated work of all the vessels of this organ occurs. Blood circulation occurs in all branches of the arterial system. The transit of the blood flow occurs instantly to the place where its deficiency is felt.

Blood sampling takes place from two pools:

• Vertebrobasilar basin type;
• The great circle basin type of the carotid arteries.

A vicious circle is a normative indicator and means that in the event of a pathology in the organ, the blood supply will be maximally available and compensated.

A closed VC is good, as it guarantees that in the event of damage to one of the arteries, the brain will work normally and hypoxia will not develop, with all the ensuing complications.

The circle of Willis of an open type is an anomaly of a pathological nature that provokes disturbances in the blood supply to the medulla.

The system supplies blood only to the part to which it has access, but the organ does not fully perform its function.

Types of abnormal deviations during formation:

• Aplasia of the posterior as well as anterior connective vessels;
• The posterior communicating vessels are divided into three arteries (trifurcation);
• Aplasia of the basilar vessel in the circle of Willis.

Physiological anomaly of the ring of Willis

The type of formation of the circle of Willis depends on the intrauterine formation of the future person. It is impossible to predict how this auxiliary system of the brain will be formed.

The most common anomaly in the circle of Willis is trifurcation of the posterior ICA. More than 5 of all anomalous manifestations in the head section are due to trifurcation.

With this type of formation of this pathology, 3 arteries immediately leave the ICA:

• Anterior vessel of the brain;
• Middle cerebral vessel;
• Posterior cerebral vessel (PMA).

The posterior cerebral vessel is a continuous branch of the connecting vessel.

Such a structure of the departments and systems of the brain is typical for 16-17 weeks of intrauterine development of the fetus, but with the further formation of the baby, the priority vessels are re-formed.

The connecting vessels decrease in size, while the main posterior vessels increase in diameter.

Circle of Willis anomaly - aplasia

Aplasia of the posterior communicating arteries of the brain is also a common anomaly in the structure of the circle of Willis.

This anomaly has an intrauterine etiology and is associated with genetic hereditary abnormalities, as well as the influence of external risk factors during the period of intrauterine laying of the fetal organs.

With anomaly of aplasia, from the edge where there is no posterior communicating artery, the annulus of the annulus of Willis does not close. In the absence of a posterior connection, the circle of Willis is an open type between the pools - the basilar type and the blood flow pool of the carotid vessels.

The lack of blood flow in both posterior communicating arteries makes it impossible to carry out a normal supply of nutrients to the affected organs.

If there is no anterior cerebral communicating artery, or ACA segment, this is also diagnosed on examination, but this anomaly is much less common.

With this anomaly, there is no possibility in the circle of Willis to redirect the blood flow from the left-sided vessels to the right-sided vessels of this organ.

With the incomplete absence of an artery, and with its hypoplasia, it occurs in the form of a decrease in the pressure of the blood flow in the a1 segment.

This aplasia does not make it possible to transport the required amount of nutrients to the other side of the arterial network.

With the pathology of the absence of ACA, it is not possible to connect both parts of the circle of Willis - its front side, as well as the posterior edge.

An open circle does not fulfill the tasks assigned to it, there is no delivery from the vertebral artery to the damaged areas of the brain through the intracranial pas.

Rare anomalies

Rare anomalies in the formation of the Circle of Willis include :

• Absence of the artery of the middle corpus callosum;
• The left-sided anterior cerebral vessel and the right-sided anterior cerebral vessel are connected into one artery, or their location is so close to each other that they are in contact with their walls;
• Trifurcation of the carotid artery of the internal type of the anterior part of the organ - a pathology occurs in the circle, when from one internal vessel it bifurcates with the exit of the anterior two cerebral vessels in the circle of Willis;
• The connecting artery of the anterior part of the organ has a bifurcation pathology with the circle of Willis;
• Complete absence of connecting vessels on both sides of the circle of Willis in the back of the circle;
• Bilateral trifurcation of carotid types of vessels in the posterior part of the circle in the circle of Willis.

Atypical anomalies most often develop in the anterior part of the organ, but, as we already know, pathologies in the posterior part of the organ are the most dangerous, because they most often become provocateurs of serious disorders in the cerebral blood flow system, which lead to death.

Pathologies of the posterior circle are more often diagnosed. Most patients who have developed brain pathologies of varying severity have anomalies in the structure of the circle of Willis.

Anomalies in the formation of the circle of Willis do not save blood flow to the brain in such pathologies:

• Hypertensive crisis with a sharp increase in the index blood pressure;
• With spasm of large arteries;
• With thrombosis;
• Pathology atherosclerosis;
• With the development of arterial stenosis;
• aneurysm pathology.

Pathologies

The anatomy of the human body implies the coherence of all organs and systems, but quite often, during the formation of the body, developmental failures occur and the organs are not deformed, as a result of which their functionality decreases.

This also happens with the organ of the cerebral circulation system - the circle of Willis. More than 50.0% of the population have various anomalies of this circle.

An underdeveloped organ leads to migraine pain, and also provokes a number of pathologies.

Signs of an open circle:

• Brain hypoplasia. This defect is a narrowing of the arteries. Hypoplasia occurs in the body without pronounced symptoms, and is most often diagnosed due to a study of the brain due to other diseases. Hypoplasia is well defined in the study of the brain by MRI (magnetic resonance imaging);
• Small vessel aneurysm. The principle of this pathology is the protrusion of a part of the vessel on the outer wall. There are no signs of the development of the disease, and the course of the pathology is mostly asymptomatic. Symptoms appear only during the period of rupture of the wall of the affected vessel. Signs of an aneurysm are: strong pain in the head, nausea, which provokes severe vomiting, the reaction of the optic nerve to bright light. With an aneurysm attack, you must immediately call an ambulance team and begin treatment, because lost time can cost the patient his life. An aneurysm develops very quickly and a person falls into a coma with subsequent death;
• This condition leads to the fact that the efficiency of the circle of Willis is reduced (if there is a connecting vessel, but it has incomplete development). This means that the closure of this circle is not complete. The absence of connecting vessels most often occurs in the posterior region. Openness is diagnosed by the method of magnetic resonance imaging (MRI).

Consequences of the VK anomaly

Pathologies of the circle of Willis, which have a congenital or genetic etiology, lead to the fact that the entire blood flow system inside the brain is disrupted. Signs of this deviation can appear from early childhood.

There is no blood pressure in the abnormal circle, which is the reason for the lack of isolation in this organ, and it does not fulfill its functional abilities to balance the blood pressure drop in various cerebral vessels.

This deviation leads to the following consequences:

• Frequent circling of the head, which is sometimes severe;
• Dizziness leads to severe nausea, which turns into vomiting;
• Dizziness when changing the position of the head, especially with a sharp turn;
• Severe pain in the head, which is not stopped by painkillers;
• Migraine attacks, in which nausea, vomiting, an unpleasant reaction to bright lights and loud sounds are manifested.

The most dangerous consequences of the abnormal structure of the organ of the cerebral circulation system of the circle of Willis are:

• Aneurysm of the arteries with a large diameter;
• Ischemic stroke.

With an aneurysm, a sudden rupture of the affected area of ​​the artery occurs, which, if time is lost, leads to death.

With an abnormal structure of the circle of Willis, the area of ​​damage during a stroke increases significantly, and also with untimely assistance, a fatal outcome occurs.

Signs of an abnormal structure

Clinical signs of an underdeveloped VC occur only when a serious pathology in the bloodstream system has manifested in the body, which led to insufficient blood flow to the brain cells:

• Atherosclerotic plaques formed on the arteries;
• Thrombosis of arteries of various diameters;
• An embolus entering the artery, which transported the blood flow from the left ventricle, or the left atrium;
• Coronary insufficiency, which leads to impaired blood flow;
• Pulmonary artery insufficiency also disrupts blood flow, and the brain does not receive the required amount of nutrients;
• Aneurysm of the arteries of the brain.

Symptoms of impaired blood flow in anomalies of the circle of Willis

The symptomatology of impaired blood circulation corresponds to the cause of the pathology in the blood circulation system, as well as in the organs of the brain. With a developing stroke, the symptoms are characteristic of this pathology, with encephalopathy, there will be a completely different symptomatology.

Generalized symptoms in violation of blood supply to the brain:

• Severe circling of the head;
• Severe pain in the head, which increases with a change in the position of the head;
• Inability to think rightly - difficulty in the intellect;
• Reduced concentration on objects and situations;
• A sharp decrease in memory;
• inattention;
• Cardiopalmus;
• Dyspnea;
• panic attack;
• Photophobia:
• Irritability;
• Drowsiness;
• Fatigue of the body;
• Deviations in the visual organ - fuzziness and blurring of objects;
• Clogging of the eyeball bifurcation of objects;
• Noise in the ears, which sometimes increases with the reaction of the auditory nerve to increased sounds;
• Constant feeling of tiredness.

Diagnostics

Most people have anomalies of the circle of Willis, and this deviation occurs only when examining the cerebral vessels.

If there is a pronounced symptomatology of the development of an aneurysm of the arteries, then the following diagnostic check of the condition of the cerebral arteries is performed:

• Non-invasive technique for examining an organ — CT scan- angiography (CT). This is an x-ray technique in which a special contrast agent is injected into the bloodstream of the brain to identify the affected areas of all branches of the cerebral vessels with an anomaly of the circle of Willis;
• Non-invasive MRI (magnetic resonance imaging) for an anomaly of the ring of Willis- this is the most versatile method for a comprehensive study and for obtaining an image of the entire vascular system in detail;
• Invasive organ check - angiography. This technique is based on catheterization of the arterial system of the head, in which a contrast composition is introduced into the arterial system. And an X-ray of the vascular system is performed.

Medical treatment of anomalies

How to treat? If an anomaly is detected in the circle of Willis, drug treatment is aimed at preventing complications of pathologies that can make this organ function:

• To improve blood circulation in the head with the pathology of the circle of Willis - nootropic drugs (Piracetam, as well as Nootropil);
• A group of vasodilators - the drug Cinnarizine, Vestibo;
• A group of antispasmodic drugs - Papaverine;
• Medicines that improve oxygen consumption in the anomaly of the circle of Willis - Cerebrolysin, the drug Solcoseryl;
• Sedative group medicines— Valerian;
• Statins for the anomaly of the circle of Willis - the drug Atomax.

The circle of Willis is the brain blood flow system, the functions of which are reserve, therefore, when pathologies such as aneurysm, arterial thrombosis are detected, a surgical technique is used to treat the pathology.

Prevention

Prevention of this body is based on the prevention of all possible pathologies the body's blood flow system with an anomaly of the circle of Willis, and activities are as follows:

• Constant control of the coagulation system;
• Control of the cholesterol index in the blood with VC anomalies;
• Normalize the BP index;
• Proper nutrition with an anomaly of the ring of Willis;
• Treatment of all pathologies of the cardiac organ and vascular system;
• Timely cure vegetative-vascular dystonia with anomalies of the circle of Willis;
• Engage in hardening of the vascular system from childhood;
• Avoid stressful situations that can trigger spasms.

Prognosis for life with anomalies

If a timely diagnostic study is carried out to identify pathologies of the head and, if an anomaly of the Willis ring is detected, the prevention of the vascular system is carried out, then the prognosis of the circle of Willis is favorable.

With a missed opportunity to timely eliminate disturbances in the blood flow system in the head and with a complicated form of pathologies with an aneurysm, as well as a stroke, the prognosis for the life of the circle of Willis is unfavorable.

The vascular system of the brain has a complex structure. One of its most important components is the circle of Willis. It is a complex of arteries that are located at the base of the brain.

Thanks to him, the correct distribution of blood flow occurs in case of impaired functioning of the carotid arteries. Therefore, any pathology in its development can provoke the appearance of negative consequences. In order to identify them in a timely manner, it is necessary to know the structure and features of the circle of Willis.

What is the circle of Willis made of?

First of all, you need to figure out what it is - the circle of Willis. This is an anastomosis of the arteries of the brain, which has the shape of an oval crown. This formation received its name in honor of its discoverer, Thomas Willis.

The circle is formed by such arteries as:

1. Back connecting.
2. Posterior cerebral.
3. Anterior cerebral.
4. Internal sleepy.

This structure of the circle allows you to connect two systems: the spinal-basic and carotid.

The development of the circle of Willis often occurs according to the classical version. In this case, the formation will be symmetrical with respect to vertical axis. Often there are pathologies of the structure.

What functions is responsible

The main task of this system is to ensure sufficient blood supply to certain areas of the brain. This is especially important in case of impaired blood flow in the arteries of the neck. Difficulty in the flow of blood through the cervical arteries threatens with oxygen starvation of the brain, which provokes various deviations. In order to prevent this from happening, the circle of Willis is provided.

Ensuring the functionality of the circle is achieved due to the fact that the carotid arteries are connected not only to each other, but also to the vertebral arterial system. This scheme allows you to constantly supply the brain with nutrients.

According to statistics, the classic variant of the development of the circle of Willis is observed only in 50% of cases. In many people, its symmetry is broken.

Possible pathologies

Human anatomy provides for the complex structure of internal systems, which ensures the full functioning of the body. Unfortunately, developmental deviations are often observed due to certain reasons. This is also the case with the Circle of Willis. Its normal structure is observed only in half of the people.

Most often, deviations from the classical variant of development are manifested in the asymmetry of outgoing branches or the absence of certain sections of the circle. Often there is a difference in the diameters of the vertebral arteries in the posterior and anterior parts. Research results show that the violation of the symmetry of the circle sometimes causes frequent migraine attacks.

Among the most significant pathologies:

1. Hypoplasia. It is a malformation in which the arteries have greatly reduced parameters. If there are no blood flow disturbances in other basins of the brain, then hypoplasia will be asymptomatic. Such a pathology can be detected in the course of a comprehensive diagnosis of the state of the brain. It is clearly visible in the images obtained with magnetic resonance imaging.
2. Aneurysm. This is a protrusion of the wall of the artery outward. The deviation is asymptomatic until the aneurysm ruptures. This leads to bleeding in the brain. In this case, unbearable headaches, bouts of nausea and vomiting, acute reactions to bright light appear. If measures are not taken in time, a person may fall into a coma and die.
3. Aplasia. This is a condition in which the circle of Willis is not closed due to the absence of a communicating artery. It can be observed both in the anterior and in the posterior. If the artery is still present, but extremely poorly developed, then an incomplete openness of the circle is diagnosed. Pathology in the anterior part of the circle is extremely rare, only in 4% of cases. Most often, the deviation is found behind. An open circle is examined using MRI. The reason for this phenomenon is a stop in development at the stage of fetal formation.
4. Trifurcation of the carotid artery. This is the splitting of the artery into three components. Such a deviation is observed in 28% of cases. It is not dangerous until occlusive changes in the arteries are observed. Distinguish between anterior and posterior trifurcation. This deviation is associated with a delay in the reduction of the connecting arteries during embryonic development.

Pathologies that are extremely rare include Geibner's artery, splitting of the anterior communicating artery, plexus-like appearance of the basilar arteries, and some others.

What are the consequences of the incorrect development of the circle of Willis?

In the normal state, the circle of Willis is closed. It acts as a backup system. If no deviations in the work of the cervical arteries are observed, then it is not activated. Therefore, even if deviations from normal development are present in it, they do not manifest themselves in any way.

When there is a problem with the supply of nutrients to the brain, the circle of Willis is activated. It helps to pump blood from other departments. In this case, his pathology can have negative consequences for health.

Congenital pathologies of the circle of Willis in certain situations lead to difficulty in cerebral circulation. It can appear at an early age and increase over time.

Unlike the rest of the arteries of the brain, there is no difference in pressure in the areas of the circle. This is due to the lack of balancing pressure of the brain tissue. This can lead to the following negative consequences:

1. Frequent dizziness.
2. Unpleasant sensations with a sharp change in the position of the head.
3. Severe headaches that are not always possible to stop even with painkillers.
4. Migraine attacks, which are accompanied by photophobia, nausea, reaction to sounds.

One of the most dangerous pathologies is an aneurysm. It appears due to thinning and increased elasticity of the artery wall. Moreover, this process is completely asymptomatic. Any impact on the head area leads to an instant rupture of the aneurysm. If timely action is not taken, the person will simply die.

How are deviations detected?

Most often, pathologies of the development of the circle of Willis are detected during a comprehensive examination of a patient who complained of a headache. First of all, in such a situation, specialists check for the presence of circulatory disorders of the brain.

MRI

MRI remains the most accurate modern diagnostic method. The examination is carried out on a special magnetic resonance tomograph. Its principle of action is based on fixing the reactions of body cells in response to exposure to a strong magnetic field.

Such a survey helps to get a complete picture of the structure of any internal organs, including the vascular system. MRI is considered completely safe, as it is a non-invasive examination and does not involve the use of radioactive irradiation.

Angiography

One of the most popular methods of examination of the vascular system is angiography. This technique involves the introduction of a special contrast agent into the patient's blood. After it is evenly distributed throughout all the arteries, an x-ray is taken. All pathologies are clearly visible on it.

Such an examination can be carried out using a conventional radiograph or under the control of computed tomography. The contrast agent is completely harmless to humans. After a certain time, it is completely excreted from the body naturally.

CT

Computed tomography is also used to determine the exact location and condition of the arteries. This examination is carried out using X-ray irradiation. And although the dose of investment is extremely small, this diagnostic method cannot be called completely safe for health.

How are they treated

If the examination revealed non-life-threatening pathologies, for example, trifurcation, then no special treatment is required in this case. But it is worth remembering that the state of health can deteriorate sharply with the appearance of complications, for example, vascular thrombosis. Therefore, the patient is recommended measures aimed at preventing complications.

It is necessary to adhere to proper nutrition, to exclude the use of excessively fatty foods, fried, smoked foods. To refuse from bad habits. Try to eat as many fresh vegetables and fruits as possible. Lead an active lifestyle, walk more in the fresh air. All this has a positive effect on the health of the cardiovascular system as a whole.

Operation

If an aneurysm is diagnosed, urgent surgery is required. There is no other way to deal with this problem. The operation is performed under general anesthesia.

The surgeon makes a burr hole in the patient's skull. After that, he pushes the tissue apart to get to the damaged artery. Using special tools, the doctor removes the aneurysm and bandages the vessel.

Then it remains only to restore the meninges and sutures. Most often, after such an operation, medical treatment is necessary, which is aimed at preventing possible complications.

There is a variant of the operation, in which the aneurysm is not removed, therefore, there is no rupture of the vessels. This procedure is performed under local anesthesia. The surgeon makes a small puncture in the vessel and inserts a special tool into it. With its help, the specialist fills the cavity of the aneurysm with a certain material in the form of microscopic spirals.

These spirals contribute to the formation of a dense thrombus in the cavity of the aneurysm. Thus, pathology is completely excluded from the process of blood circulation.

During the operation, the surgeon must act very carefully, since the slightest inaccuracy will lead to rupture of the aneurysm and hemorrhage. Three months after such treatment, a follow-up examination is mandatory.

The circle of Willis is the reserve blood supply to the brain. If a pathology is detected, regular examinations are necessary to determine the likelihood of developing an aneurysm.

At the base of the human brain is a special oval-shaped arterial network called the circle of Willis. The arteries that make up the circle have a minimal cross section, but the blood supply to the human brain directly depends on them. About what other functions the circle of Willis performs in the body, what diseases can affect it and how to diagnose them correctly - further. The diagram of the structure of the circle is shown in the picture below.

Functional load

In the body of an absolutely healthy person, the circle of Willis is an organ that connects the carotid arteries with each other, as well as with a complex system of vertebral arteries.

But as soon as in the human body there is a blockage of the vessels that feed the brain, the main function turns on: the circle of Willis begins to provide a full blood supply to individual parts of the brain.

It happens something like this: at the moment of reducing blood flow in one or more cervical arteries, the brain begins to experience a sharp lack of oxygen and nutrients to compensate for this problem and there is an additional arterial circle.

Possible problems

According to studies, the normal development of the circle of Willis is observed in only half of the people. Considering that this area is studied quite rarely, the proportion of patients with a normally developed organ may be even smaller.

For what reason the circle is underdeveloped, it is not known for certain.

So the main problems are:

• Hypoplasia of the communicating arteries. As long as the other arteries that feed the brain are functioning properly, this problem does not manifest itself in any way, remaining unnoticed for many years.
• Disparity in the size of arteries from different sides, asymmetry of an extensive network. It is not recognized as a pathology threatening life and health, since the circle is closed, and in case of urgent need it will be able to perform its functions. According to recent studies, a similar problem can provoke frequent migraine attacks.

The circle of Willis is open. The most serious situation, which is conditionally divided into two groups:

• complete (in case of underdevelopment or narrowing) and incomplete (in the absence of connecting arteries). The variant of the development of the circle of Willis in the form of a lack of blood flow is considered the most dangerous.
• Another common problem is aneurysm, more on that later.

About the aneurysm

Often, cerebral aneurysms choose the circle of Willis as the site of localization. At a young age, an aneurysm is usually the result of an abnormal structure of the circle.

In adults, aneurysms of the circle of Willis in most cases are caused by one of the following pathologies:

• atherosclerosis;
• infectious vasculitis;
• syphilitic endarteritis.

The main cause of all these problems is a pathological vascular process that causes destruction of the vascular wall.

For a long time, an aneurysm does not manifest itself in any way, as a rule, a person learns about problems at the moment when the aneurysm ruptures.

Symptoms of this severe lesion: neck stiffness, nausea, vomiting, unbearable headache, sensitivity to bright light.

The sooner a person gets to the hospital, the better the chances of survival, because a ruptured aneurysm causes a large release of blood, which can lead to a quick death.

The gap is sewn up, after the necessary therapeutic measures, the person lives a full life.

About treatment

In fact, it is not possible to treat the circle of Willis. Congenital or acquired developmental anomalies are not recognized as a reason for the operation.

If the patient suffers from migraines caused by anomalies in the structure of the arterial network of the circle, doctors limit themselves only to prescribing strong painkillers.

Problems with the organ are easy to identify and diagnose using magnetic resonance imaging. In most cases, structural anomalies are discovered by chance during the diagnosis of other organs and systems.

As a rule, surgical intervention is applied at the moment when the aneurysm ruptures. Sometimes the operation is performed before the aneurysm ruptures, but in most cases, doctors try to get by with a conservative treatment option.

The circle of Willis, which is almost never treated, is an important and complex organ of the human body.

Be aware of the symptoms of a ruptured aneurysm: it could save your life.

To ensure its metabolism, the brain must be provided with a high-intensity blood supply, the main source of which is the circle of Willis.

Let's figure out what it is, how it functions, what options for its development exist, how pathologies are diagnosed and treated, if they are detected.

The brain has a complex structure of the vascular system.

The main component of the arterial network is the circle of Willis (abbreviated as VC), thanks to which a reliable blood supply to this organ is carried out.

In fact, the Willis (or arterial) circle is an anastomosis (connection) of blood vessels in the form of an oval located at the base of the brain.

Arterial blood enters the VC through the following main vessels:

• The right and left internal carotid arteries form the anterior cerebral vessels in both hemispheres, connected by a vascular bridge.
• Vertebral arteries - after merging, they create an unpaired basilar vessel, from which two posterior cerebral arteries depart. The posterior cerebral arteries are connected, in turn, to the internal carotid arteries - a closed system is obtained.

Features of the anatomy of the VC are usually called variants.

Classic variant arterial circle closed, has a symmetrical shape, which is formed by the following arteries:

• ACA - anterior cerebral.
• ZMA - posterior cerebral.
• PSA - anterior connective.
• ZSA - rear connecting.
• ICA - internal carotid (supra-sphenoid part).

What role does he play?

The circle of Willis is a compensatory mechanism for hemodynamic disorders due to anatomical structure person.

Its purpose is to protect the brain from interruptions in blood supply when blood flow is disturbed in any area.

For example, in one side of the brain there is a risk of impaired blood delivery associated with congenital vascular underdevelopment or vessel compression, obstruction, etc.

In such a situation, the circle of Willis helps. That is, the arteries of the other half take over the supply, supplying blood through the connecting vessels (collaterals).

Taking into account the compensatory features of the VC located at the base of the brain, it is difficult to underestimate its role in the process of blood circulation. Its value increases several times when occlusive changes (closing of the lumen) occur in the vessels. In this case, the further prognosis, the amount of neuronal damage and the rate of manifestation of symptoms depend precisely on the quality of the arterial ring.

A properly formed classical circle will be easier to cope with the delivery of blood to injured areas than a circle with destruction or complete absence of blood vessels (or branches).

Options for its development

The anatomical structure of the circle of Willis has various patterns of the structure of blood vessels. The formation of the vessels of the circle occurs even in the womb.

The most common types of development options are:

• Posterior trifurcation of the ICA - splitting of the carotid artery into three branches. It is observed most often, up to 30% of all possible anomalies. The condition is not dangerous if there is no narrowing (occlusion) of the vessels, which can manifest itself in the form of a lack of blood flow to certain parts of the brain.
• Hypoplasia (or underdevelopment) of one or two ASA, PSA or ACA segment - occurs when the diameter or parameters of the vessels decrease, manifests itself in the form of a decrease in blood flow and nutrition of the brain. If there are no violations in other departments, then compensation will occur fully, without the appearance of symptoms.
• PCA aplasia is the absence or extremely weak development of the communicating artery. It is most often observed in the back of the ring. Either complete or incomplete openness of the circle is diagnosed. People with this anomaly are automatically at risk of developing serious vascular pathologies.
• Aplasia of the anterior section (PSA) is the most unfavorable, there is no possibility of compensating for the blood supply from the vessels on the opposite side, since the carotid arteries are disconnected.
• The absence of PSA or PSA is more often diagnosed in the posterior VC, there is a loss of interaction between the branches of the carotid arteries and, as a result, the loss of compensatory functions. That is, if necessary, it is impossible to supply from the left to the right department.
• The merger of two arteries into one highway (vessel) - a deviation can provoke the development of ischemic diseases.

Some people may have a combination of different variants of the development of VC.

What is dangerous wrong development?

Congenital abnormalities can gradually create difficulty in blood supply or signs of decompensation with excessive stress on the arteries.

The consequences can be completely catastrophic - the development of aneurysms, hemorrhagic or ischemic strokes.

Even young people can experience occasional migraine attacks.

In the older age category, aneurysms are more likely to occur, provoked by acquired pathologies (, vasculitis infections, syphilis).

Aneurysm - a protrusion on the wall of the artery, the development of the pathology proceeds without visible symptoms. It is most often localized within the circle of Willis (in the ACA or PCA, on the bifurcation of the ICA and BA) against the background of the asymmetric structure of the arterial ring.

With the formation of an aneurysm, there is a risk of rupture of the vessel and, as a result, hemorrhage in the brain.

Clinical syndromes caused by ring arterial aneurysms:

• pseudotumorous - nerve tissues and medulla are compressed;
• hemorrhagic extracerebral basal - after rupture of a vessel with subarachnoid hemorrhage;
• discirculatory - with slow growth or with the development of a dissecting aneurysm.

Branching variant anomalies and shape distortion (broken circle) weaken or lead to loss of compensation in complex cases ( hypertensive crisis, thrombophlebitis, spasm, etc.).

Symptoms of the onset of diseases

The open circle of Willis, unlike other GM arteries, is not balanced by the pressure of the brain tissue.

This can cause the following symptoms:

• often dizzy;
• with a sharp turn of the body, unpleasant sensations arise;
• severe headache that does not help painkillers;
• migraine attacks, accompanied by nausea, sometimes vomiting, photo and phonophobia.

The symptomatology of aneurysms of an open arterial ring depends on the location, size and nature of the pathology, which in most cases affect the nervous system.

When the aneurysm compresses the surrounding nerve tissue clinical picture are the following signs:

• double vision;
• pupils are dilated;
• soreness in the inner part of the orbit of the eyeballs;
• headache.

With aneurysms of the PSA (anterior communicating artery), impaired vision and smell are added.

If the arterial circle is not closed, then spontaneous sensations appear when the aneurysm ruptures:

• heaviness in the head;
• nausea accompanied by vomiting;
• stiffness in the cervical region;
• temporary loss of vision or unconsciousness.

Anomalies of the open arterial circle increase the risk of ischemic stroke, which is accompanied by sudden manifestations:

• weakness or numbness of the muscles on one side of the body;
• confusion;
• impaired speech and vision;
• staggering gait;
• dizziness;
• uncoordination of movements;
• cephalgia.

Diagnostic methods

As a rule, anomalies of the arterial circle are detected unexpectedly. This usually happens during a detailed examination for the presence of concomitant symptoms (constant dizziness or headache).

The exact diagnosis of deviations in the development of the circle of Willis is established exclusively by the methods of instrumental studies:

• MRI, CT;
• angiography;
• dopplerography.

MRI and CT

MRI (magnetic resonance imaging) is one of the most accurate diagnostic methods. This is the safest way to obtain a detailed image that captures the structure of the vascular system of the brain.

The essence of the method is the use of a magnetic field and radio waves to fix the reaction of GM cells to their impact.

CT (computed tomography) is a method using X-ray irradiation. This study allows you to get more three-dimensional images that are fixed at different angles. This method has contraindications.

Angiography

This is the most common method used to evaluate cerebral circulatory disorders.

Cerebral angiography allows you to study any vessels in as much detail as possible, which makes it an indispensable procedure in the diagnosis of cardiovascular diseases.

The principle of its operation is similar to a conventional x-ray, with the only difference that the vessels are not visible on the x-ray image, so they need to be contrasted. To do this, during angiography, a vessel is punctured, then a catheter is inserted into it, through which a radiopaque preparation is injected, which will reflect the radiation.

Thanks to this, it is possible not only to obtain a picture of the vessel under study, but even to reproduce its three-dimensional image.

dopplerography

Doppler ultrasound of the cerebral vessels (USDG) is also one of the main diagnostic methods.

The principle of its operation is the impact of ultrasonic waves on blood cells, reflecting from them, the waves allow you to get a complete picture of the vessels and blood flow inside them.

With the help of ultrasound, it is possible to obtain a comprehensive picture of the structure of blood vessels and arteries, the presence of pathologies in them and the speed of blood flow.

Methods for the treatment of pathologies

Treatment of anomalies of variants of the development of the circle of Willis is not required. The vast majority of people don't even know they exist.

It is necessary to treat the diseases to which they can lead. Pathologies of the arterial circle belong to the field of neurology. Therefore, a course of therapy with drugs to normalize blood circulation is prescribed by a neurologist.

The therapeutic course for pathologies of the circle of Willis includes:

• Ingestion or in the form of intravenous injections of drugs to improve blood circulation (Cavinton, Pentoxifylline).
• Appointment of nootropics to improve brain metabolism (Phezam, Vinpotropil, Nootropil).
• A course of antioxidants (Mexidol, Cytoflavin).
• A course of metabolic drugs (Actovegin).
• Vitamin therapy, especially B vitamins are useful.