Vascular neurology is a focused subspecialty within neurology, concentrating specifically on diseases that involve the blood vessels supplying the brain and spinal cord. The practice centers on cerebrovascular diseases, which are conditions that disrupt the normal blood flow to the nervous system. This highly specialized area requires intensive additional training to manage complex and rapidly evolving medical events that threaten brain function.
The Focus of Vascular Neurology
The brain requires a constant and uninterrupted supply of oxygen and glucose delivered through the bloodstream. Even a brief disruption in blood flow can cause permanent damage to brain tissue. Vascular neurology focuses on the intricate network of arteries and veins that constitute the cerebral circulation, from the large vessels in the neck down to the smallest capillaries within the brain tissue.
The arterial supply is divided into the anterior circulation, primarily fed by the internal carotid arteries, and the posterior circulation, supplied by the vertebral arteries that merge to form the basilar artery. These systems connect at the base of the brain in a network known as the Circle of Willis, a potential source of collateral circulation. Vascular neurologists are experts in the anatomy and function of these specific vessels, including their structural integrity and the hemodynamics of blood moving through them. Their scope encompasses any condition that causes narrowing, blockage, or rupture of these vessels, which collectively fall under the umbrella of cerebrovascular disease.
Key Conditions Managed
Vascular neurologists manage a spectrum of conditions, with the most common being stroke. An ischemic stroke occurs when a blood vessel supplying the brain becomes blocked, often by a clot or by plaque buildup within the artery wall itself. This blockage immediately deprives brain tissue of necessary oxygen, leading to rapid cell death. Ischemic strokes account for the majority of all stroke cases.
A hemorrhagic stroke is caused by a blood vessel rupturing and bleeding into or around the brain. This can occur either deep within the brain tissue (intracerebral hemorrhage) or in the space surrounding the brain (subarachnoid hemorrhage). The pooling blood creates pressure on surrounding brain tissue, causing damage and interfering with normal function. Transient Ischemic Attacks (TIAs) are also managed, which involve a temporary blockage that causes stroke-like symptoms that resolve quickly without causing permanent damage.
Vascular neurologists also address structural abnormalities of the blood vessels. Cerebral aneurysms are balloon-like bulges in an artery wall that can rupture, causing a hemorrhagic stroke. Arteriovenous Malformations (AVMs) are abnormal tangles of blood vessels that create direct connections between arteries and veins, bypassing the capillary network. These malformations are prone to rupture and bleeding because high-pressure arterial blood is forced into the thinner-walled veins. Additionally, they treat conditions like cerebral vasculitis, which involves inflammation of the blood vessel walls in the brain.
Role in Diagnosis and Acute Care
The vascular neurologist is crucial in the acute management of stroke, where rapid assessment is paramount due to the principle of “time is brain.” For every minute a large vessel is blocked during an ischemic stroke, an estimated two million brain cells can be lost. The specialist is responsible for the initial triage and interpretation of diagnostic imaging, such as a CT scan, which quickly differentiates between an ischemic stroke and a hemorrhagic stroke.
For eligible patients with an ischemic stroke presenting within a specific time window, the neurologist may administer intravenous thrombolytics to dissolve the blockage. If the blockage is in a large artery, they coordinate with an interventional team to perform an endovascular thrombectomy, a procedure to physically remove the clot using specialized catheters. The vascular neurologist guides the overall treatment plan, using advanced imaging like CT angiography or MRI to pinpoint the exact location and extent of the vascular issue.
The specialist manages long-term recovery and prevention. They identify and modify risk factors such as high blood pressure, diabetes, and high cholesterol to reduce the likelihood of a future event. This post-acute management involves prescribing antiplatelet or anticoagulant medications and developing a comprehensive strategy to optimize the patient’s overall vascular health.