Pharmaca ad systema nervosum centrale et circulationem cerebri
For medical students2 min readUpdated 2026-10-10
Cerebrovascular disorders are divided into acute and chronic forms requiring targeted pharmacotherapy. The primary goal of medications is to improve cerebral perfusion with minimal impact on systemic blood pressure.
Types of disordersAcute (strokes) and chronic (dyscirculatory encephalopathies)
Types of strokesIschemic (tissue necrosis) and hemorrhagic (bleeding)
Main objectiveCerebral vasodilation without reducing systemic blood pressure
Drug classesCalcium channel blockers, periwinkle and ergot alkaloids, GABA and nicotinic acid derivatives
Classification and Causes of Cerebrovascular Disorders
In medical practice, vascular pathology of the brain is divided into two main categories:
Acute disorders — include ischemic stroke (develops when blood flow stops due to spasm, thrombosis, or embolism against the background of master artery atherosclerosis, leading to necrosis) and hemorrhagic stroke (bleeding into brain tissue due to arterial hypertension or aneurysm rupture).
Chronic disorders — dyscirculatory encephalopathies. They develop gradually due to age-related changes in the vessel wall, atherosclerosis, arterial hypertension, and metabolic dysfunctions in neurons. Clinical manifestations include memory loss, cognitive decline, psychiatric alterations, and motor deficits.
Principles of Pharmacotherapy for Ischemic Disorders
Therapy and prevention of chronic ischemia, as well as rehabilitation after acute ischemic states, rely on the following principles:
Main goal: Widening of cerebral blood vessels, i.e., cerebral vasodilation.
Requirement for drugs: High selectivity of action. Medications must increase cerebral blood flow without disrupting general hemodynamics. An excessive drop in systemic pressure is unacceptable because it worsens perfusion of the brain tissue.
Indications: Prevention and management of chronic disorders, as well as elimination of residual effects after ischemic strokes.
Classification of Applied Vasodilators
Pharmacological agents that improve cerebral circulation are divided into the following pharmaceutical groups:
Vasodilator classes can be easily remembered by their key chemical and herbal sources: CCBs (Nimo), Periwinkle (Vinpocetine), GABA, Ergot (Nicergoline), and Nicotinic acid (Xanthinol).
Frequently asked questions
What is the mechanism of the vasodilating action of vinpocetine?
Vinpocetine is a periwinkle alkaloid derivative; literature indicates it is used to improve cerebral circulation and possesses neuroprotective properties, although the exact mechanism of its vasodilating action is not fully specified.
What is the mechanism of action of cinnarizine on vascular smooth muscle cells?
Cinnarizine is a calcium channel blocker with selective action on cerebral arterioles. The drug reduces the reactivity and sensitivity of vascular smooth muscle cells in response to endogenous vasoconstrictors such as catecholamines, angiotensin, bradykinin, and vasopressin.
What are the two main clinical forms of cerebrovascular disorders?
Acute disorders (strokes) and chronic disorders (dyscirculatory encephalopathies).
What is the difference in mechanisms between ischemic and hemorrhagic strokes?
Ischemic stroke occurs due to cessation of blood flow (spasm, thrombosis, embolism) resulting in necrosis, whereas hemorrhagic stroke represents bleeding into the brain tissue.
What is the main requirement for vasodilators in cerebral blood flow?
Drugs must possess selectivity of action: increase blood flow in the brain and have a minimal effect on systemic hemodynamics to avoid hypotension.
Go deeper
Pathogenetic differences between thrombosis and embolism in ischemic stroke
Impact of arterial hypertension on the development of hemorrhagic strokes
Metabolic disorders in neurons during chronic ischemia
Pharmacodynamics of calcium channel blockers in cerebral vessels
Features of the pharmacological action of periwinkle and ergot derivatives