Más contenido relacionado La actualidad más candente (20) Similar a Intracranial vascular disease (20) Intracranial vascular disease2. Pathology
Aneurysm
Arteral Venous malformation (AVM)
Cavernoma
Venous angioma
3. Aneurysm
Irreversible dilatation of arterial wall
3 layers ; tunica media
Pseudoaneurysm ; traumatic, rupture wall, clot
Dissecting aneurysm ; intima
Fusiform aneurysm
5. Aneurysm
Presentation :
Hemorrhage ; SAH, ICH ,IVH
Stroke
Mass effect
Location : A.com , P.com , Mca
POST. : PICA , Vertebral
6. Aneurysm
Risk of rupture:
Size >1cm
Location: Post. , Pcom , A.com
Multiple: large, prox., irregular
Symptomatic
HTN
Age
Female
7. Subarachnoid hemorrhage
Sudden severe headache
Neck rigidity
Low grade fever
No neurologic deficit except ;
ptosis : Post. communicating Art.( PCOM)
9. SAH diagnosis
BCT
Lumbar puncture : xantochromia
Traumatic : serial CSF , clotting , xantochromia
12 hours
Contraindication : papilledema, coagulopathy
Fresh CSF: low glucose
10. Complications :
Rebleeding ,
Hydrocephalus ,
Seizure ,
Vasospasm
ICH
Electrolyte imbalance
17. SAH etiology
Trauma : most common
Vascular
Infection
Blood disease
Neoplasm
Toxins : cocaine, amphetamine
18. Treatmaent
Medical :
Nimodipin = Ca blocker vasospasm, metabolism
Barbiturates
Stool softener
Dextromtorphane
3 H therapy: HTN, hemodilution , heypervolermia
Surgery
Endovascular : coil , stent ,…
20. Aneurysm ICH
ICH: A.com , MCA
Interhemispheric
Temporal lobe and sylvian fissure
Hematoma evacuation and clipping
Simultaneous
Size ; predictor of clinical grade
22. ICH Diff.Dx
Child : AVM, metastasis ,
Adult : aneurysm , avm , cocaine
Old : amyloid angiopathy
23. Cavernoma
Venous Sinusoidal , thin-walled, and dilated and
have a single-cell endothelial layer
absence of any parenchyma within the lesion
Low flow: pressure more than cvp.
Growth : thrombosis , endothelial proliferation
hemorrhage ( diapedesis )
angiogenic factors
24. Cavernoma presentation
Headache
Seizure : hemosiderin ring
Hemorrhage : capsular not overt
Focal deficit
Pregnancy : growth
Cummulative Risk of hemorrhage :
more in young
26. Treatment
Surgery ;
young ,
hemarrhage
seizure ; hemosiderin ring
focal deficit
27. AVM
Abnormalities of the intracranial vessels that
constitute a connection between the arterial and
venous systems and that lack an intervening
capillary bed.
Nidus , art.Feeder & venous drainage
28. AVM
High flow , low pressure
Arterialization of veins
Smooth muscle proliferation
Gliotic nonfunctional brain
Perilesional ischemia
Wegde shape lesion
30. Presentation
Headache
Focal deficit : steal phenomenon
Hemorrhage : Risk of rupture : 2-4%
Sizure
31. AVM grading
Spetzler – martin:
Size : 0-3 , 3-6 , >6
Drainage : deep or superficial
Eloquent area
34. Capillary telangiectasis
2nd most common
Capillary malformation
Dilatation
MRI; demyelination , infarct , lymphoma
GRE
Asymptomatic
35. Venous anomalies
Most common
Thick hyalinized veins
Star cluster ;
Imaging : caput medusa
Low flow , low resistance
Hemorrhage: cavernoma
associated