The term "hypoplasia" means "underdevelopment". Such defects of intrauterine development are also found in the arteries of the brain. In the arteries of the carotid artery basin, these anomalies exist in approximately 4% of people, and in the arteries of the vertebrobasilar basin - in every tenth person.
Despite the fact that the brain is the most energy-intensive organ and requires massive blood supply, hypoplasia of the arteries that supply it can go unnoticed for a long time. This is due to the characteristics of the cerebral circulatory system.
Most of the hemispheres receive blood from the system of internal carotid arteries, which form the anterior and middle cerebral arteries, as well as the anterior communicating artery. The posterior part of the hemispheres, the brainstem and the cerebellum are fed from the basin of two vertebral arteries, which merge in the cranial cavity into the main artery, from which the posterior cerebral and posterior communicating arteries are formed.
Due to the anterior and posterior communicating arteries, a connection is formed between the arterial basins of the brain, forming a circle. It is called Willis, and within its limits a compensatory flow of blood into areas with reduced arterial blood flow is possible, including due to hypoplasia of any segment of the artery. It is this feature of the brain’s blood circulation that ensures the long-term asymptomatic course of most hypoplasias, which often become an accidental discovery.
Clinical manifestations of hypoplasia of the cerebral arteries occur against the background of another pathology that worsens the conditions for compensation of cerebral circulation. Most often this is atherosclerosis of cerebral vessels or diseases of the cervical spine. As a result, transient ischemic attacks and ischemic strokes may occur.
What is hypoplasia? Causes, signs, treatment of hypoplasia
Hypoplasia is the underdevelopment of any organ or tissue - this is a common and main feature of pathology, be it hypoplasia of the kidneys, brain, or hypoplasia of a segment of the right or left vertebral artery.
In humans, underdevelopment of individual organs most often occurs. So, this pathology can affect the brain, but not the entire central nervous system, or one lung without involving the second and upper respiratory tract.
Pathology occurs due to a malfunction during intrauterine development. The most common causes of hypoplasia development:
- a failure that occurs during the initial formation of germ cells;
- incorrect intrauterine position of the fetus;
- scanty amount of amniotic fluid;
- bad habits of the expectant mother - smoking, drinking alcohol and drugs (most often they cause brain hypoplasia);
- infectious diseases of women during pregnancy;
- abdominal injuries of a pregnant woman;
- exposure to physical factors - elevated temperature, radiation;
- exposure to toxic compounds and harmful metabolic products.
Hypoplasia is not always detected on time. The success of diagnosis depends on the degree of underdevelopment and which organ is affected. Thus, to identify signs of tooth enamel hypoplasia in a child, an examination by an experienced dentist is often sufficient. While diagnosing renal underdevelopment will require additional instrumental examination methods.
Underdevelopment of the entire organism is called dwarfism.
Segments
What is PMA of the brain? ACA stands for anterior cerebral artery in medicine. The blood supply to the brain is quite complex. Blood enters the brain through two internal carotid and two vertebral arteries. The carotid arteries form the carotid basin. They begin in the chest cavity: the right one from the brachiocephalic trunk, the left one from the aortic arch. The vertebral arteries form the vertebrobasilar basin. Through them, blood flows into the vessels that provide nutrition to the medulla oblongata, cervical spinal cord and cerebellum. As a result of fusion, the vertebral arteries form the main basilar artery.
The ACA (anterior cerebral artery) begins at the site where the internal carotid artery divides into its terminal branches. At the beginning of its journey, it gives off a number of small branches that penetrate through the anterior perforated substance to the basal nuclei of the base of the cerebrum. At the level of the optic chiasm, the anterior cerebral artery forms an anastomosis (ostium) with the artery of the same name on the opposite side through the anterior communicating artery.
Underdevelopment of the central nervous system. Brain hypoplasia
Intrauterine underdevelopment of the structures of the central nervous system is one of the most serious defects affecting the functioning of the entire organism.
You can guess about the underdevelopment of the central nervous system structures from the symptoms, which are detected almost from the moment of birth. Thus, with hypoplasia of the cerebellum, which is responsible for the coordination of movements, the child experiences incoordination and deterioration in muscle tone. And when he begins to walk, a balance disorder is revealed. Hypoplasia of the corpus callosum, which is responsible for the coordinated work of both hemispheres, can lead to a variety of consequences. First of all:
- muscle spasms;
- convulsions;
- impaired skin sensitivity and body temperature regulation;
- deterioration of auditory and visual memory.
Brain hypoplasia (or microcephaly) is a proportional underdevelopment of all its structures. In early childhood, such a disorder manifests itself as delayed growth and development, and in later childhood – serious intellectual impairment.
How can you help yourself without pills?
There are two simple ways. The first can be used by each person independently without preparation. The second one is a little more difficult, but regular viewers and readers of Dr. Shishonin will master it very quickly.
It is better to use both methods: working on the points on the sides of the front of the neck, and working under the back of the head. This way, you will not only get rid of headaches and other symptoms of impaired venous outflow, but you will also feel more energetic, your mood and memory will improve. The main thing is to regularly devote time to yourself and help your body recover. The capabilities of the human body are almost limitless, but you need to develop them by doing gymnastics and self-massage.
Underdevelopment of the endocrine system organs
Hypoplasia of any organ of the endocrine system, as well as hypoplasia of the central nervous system structures, is of systemic importance, since many body functions depend on the hormones they produce. Thus, underdevelopment of the adrenal glands provokes disruptions in the production of steroid hormones, without which normal metabolism and immunity are impossible. Hypoplasia of the thyroid gland in women and men is fraught with metabolic disorders. And underdevelopment of the pancreas, which produces insulin, can cause diabetes.
Pathogenesis
Currently, hypoplasia of the vertebral arteries is considered as one of the manifestations (during the formation of the fetal vascular system) of undifferentiated connective tissue dysplasia. Also in the pathogenesis of clinical manifestations, the development of vasospastic reflex reactions caused by irritation of the sympathetic plexus of the vertebral arteries is of significant importance. The resulting flow of afferent impulses irritates the overlying centers of vascular-motor regulation, which is manifested by local/diffuse reactions that predominantly affect the vessels of the vertebrobasilar system.
Underdevelopment of the genitourinary system
Underdevelopment of the genitourinary system manifests itself in the form of:
- kidney hypoplasia (possible underdevelopment of one kidney and absence of the second);
- underdevelopment of the testicles in men and the uterus in women, manifested by reproductive dysfunction.
During intrauterine development, a combination of both disorders is possible - from the urinary tract and the reproductive system.
In men, testicular hypoplasia can be accompanied by a reduction in the penis and scrotum. And in women with uterine hypoplasia, the ovaries, fallopian tubes and external genitalia (clitoris, labia) may not undergo such changes.
A woman’s reproductive function depends on the degree of endometrial hypoplasia of the uterus - if the inner layer of the uterus is underdeveloped, a fertilized egg will not be able to attach to the inner surface of this organ.
results
A 19-year-old patient came to the SSMU clinic on the referral of a neurologist from the district clinic for a triplex scan of the brachiocephalic arteries (TS BCA) with complaints of frequent severe dizziness, recurrent headaches, and lack of coordination.
Similar symptoms have been bothering him for 5 years; he denies any connection with the injury. According to the results of TS of the BCA, bilateral narrowing of the diameter of both VAs was revealed. On the left, the diameter in the V1 segment is no more than 1.8 mm, then at the level of the V2 segment it is in the range of 1.5-1.7 mm, in the V3 segment it is 1.5 mm.
On the right, the diameter of the V1 segment does not exceed 1.5 mm, the diameter of the V2 segment is in the range of 1.3-1.6 mm, in the V3 segment the diameter reaches 1.4 mm. During a transcranial study at the level of V4 segments, the VA is located only on the left side.
There is a pronounced decrease in the linear velocity of blood flow (LBV) on both sides - at the level of the 2nd segment of the LSV, no more than 15-18 cm per second. At the level of the V4 segment on the left, the BSC is reduced to 10 cm per second. The basilar artery is not visualized during TS BCA.
When performing a rotation test to the left side, the LSC along the PA decreases to 4-6 cm per second. Both VAs originated from the anterior wall of the subclavian arteries in segment 1. No ultrasound signs of pathological tortuosity were detected on either side.
On both sides, the PA entered the bone canal at the level of the C6 vertebrae. The above-described ultrasound changes were regarded as signs of hypoplasia of both VAs with severe hypoperfusion in the vertebrobasilar region.
For the purpose of additional verification and detailed examination of the intracranial bed, computed tomography (CT) with contrast was performed, which revealed a sharp narrowing of both VAs at the level of the V4 segment with signs of hypoperfusion in the basilar artery. The patient was sent for planned hospitalization to the neurological department of the SSMU clinic.
Treatment of hypoplasia: general principles
There is no pathognomonic treatment (directed against provoking factors and slowing down the development of the disease) - medicine is taking the first steps in curing fetal diseases during intrauterine development. Rather, it is necessary to take preventive measures (in particular during pregnancy), which will help prevent failure in the formation of organs and systems, leading to disruption of tissue formation.
In the treatment of hypoplasia after the birth of a child and in adulthood, replacement therapy is practiced. So, with hypoplasia of the thyroid gland, accompanied by its hypofunction, the patient is injected with gland hormones.
You can read more about the tactics and methods of treating hypoplasia on our clinic’s website https://dobrobut.com.
Related services: Ultrasound examination Consultation with an obstetrician-gynecologist during pregnancy
Self-massage in the collarbone area
Working out certain points improves blood flow through the jugular veins. This will help immediately reduce or completely eliminate headaches caused by blood stagnation. If you do this self-massage regularly, the veins will become more elastic, resilient and begin to work like pumps, draining blood from the head in time. Accordingly, headaches will stop without taking medications. This is important because any drugs have side effects, including those delayed over time. It is imperative to use the body’s natural ability to heal itself.
Self-massage technique step by step:
- Place two fingers in the middle of the collarbone - just above the jugular fossa.
- Lightly press on the point - the pressure should not be strong, but should feel pleasant.
- Start working the point with circular rotations clockwise or counterclockwise - whichever is more comfortable for you.
- Do 20-30 rotations.
- Move to the other side of the neck and repeat steps 1-4.
Important! Please note again that you cannot put pressure on the point. Throughout the self-massage there should be pleasant sensations, and after its completion - a feeling of vigor or pleasant relaxation (depending on the time of day). This is a marker that you are doing everything right.
How often to perform
Everything is individual here. For some, it will help the first time and the headache will subside for a long time, for others, several sessions in a row are needed, and then maintain the condition of the veins with preventive self-massage.
If you have a diagnosed migraine, you need to start working on the point as soon as the first signs of pain appear. As soon as there is the slightest hint of imminent pain, we immediately do it. This will certainly reduce the intensity of pain and will most likely stop its further development. That is, a terrible migraine attack, for which even pills don’t help, simply won’t happen, your head will hurt a little, but it will go away after working on the clavicular point.
To prevent migraines, if they happen several times a month or a year, it is useful to do self-massage every week. This will help maintain the elasticity of the veins and blood vessels, so the blood will circulate correctly, without stagnation. The risk of not only headaches, but also increased intracranial pressure will be reduced.
Consequences and complications
In general, VA hypoplasia significantly impairs quality of life. The most serious complications of VA hypoplasia primarily include a high risk of cerebrovascular accident/ stroke , which is caused by a decrease in blood supply to brain structures. In addition, frequent complications of the pathology of the vertebral arteries include neurological symptoms: headaches ( migraine ), irritability, depression, severe fatigue, disorders of the autonomic nervous system, impaired auditory/visual function, weakened cognitive abilities, dementia, decreased ability to work, arterial thrombosis
Right vertebral artery
According to statistics, hypoplasia of the right vertebral artery occurs once in every tenth person, that is, it affects 10 people out of 100.
Narrowing of the right VA in most cases is also a congenital pathology. This form of the pathological process is also accompanied by impaired blood supply, however, ischemia and blood stagnation in this case occur less frequently.
Doctors call concomitant diseases of the circulatory system and blood vessels the main danger factor for PPA hypoplasia. If hypoplasia of the vertebral artery on the right is accompanied, for example, by vascular atherosclerosis, the development of the second disease and associated degenerative changes in the head will proceed many times faster than if the disease developed independently.
The severity of the pathological process largely depends on how extensive it is. The disease can affect the posterior communicating artery, cover all 4 segments (segments of the artery are not involved in the pathological process immediately, but one at a time), etc. In cases where the pathology takes on a severe course, is complicated by other diseases, affects the vertebrobasilar system and concerns vertebral artery, the patient may experience decreased sensitivity in certain areas of the body. This is a clear sign of circulatory problems in the corresponding area of the brain; in such situations, immediately consult a doctor and undergo an examination.
Forecast
The prognosis is determined by many factors, in particular, unilateral/bilateral VA pathology, since with unilateral VA hypoplasia, blood flow compensation mechanisms develop, the functional state of the arterial-venous system of the brain, and the condition of the vascular wall (in particular, the presence of atherosclerotic plaques). After surgical treatment and drug rehabilitation, in most cases the lumen of the vertebral arteries can be normalized, and neurological symptoms regress.
