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Intracranial vascular disease

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Dr. javadi amir hossein

Dr. javadi amir hossein

Published in: Education, Health & Medicine

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  • 1. Intracranial vascular disease
  • 2. 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
  • 4. Aneurysm Presentation :  Hemorrhage ; SAH, ICH ,IVH  Stroke  Mass effect Location : A.com , P.com , Mca  POST. : PICA , Vertebral
  • 5. Aneurysm Risk of rupture: Size >1cm Location: Post. , Pcom , A.com Multiple: large, prox., irregular Symptomatic HTN Age Female
  • 6. Subarachnoid hemorrhage Sudden severe headache Neck rigidity Low grade fever No neurologic deficit except ;  ptosis : Post. communicating Art.( PCOM)
  • 7. SAH
  • 8. SAH diagnosis BCT Lumbar puncture : xantochromia  Traumatic : serial CSF , clotting , xantochromia  12 hours  Contraindication : papilledema, coagulopathy  Fresh CSF: low glucose
  • 9. Complications : Rebleeding , Hydrocephalus , Seizure , Vasospasm ICH Electrolyte imbalance
  • 10. Vasospasm
  • 11. Risk factors for vasospasm
  • 12. Process of vasospasm
  • 13. Electrolyte imbalance
  • 14. SAH classification Fisher ; brain ct Hunt & Hess Wfns
  • 15. SAH & Traumatic CSF
  • 16. SAH etiology Trauma : most common Vascular Infection Blood disease Neoplasm Toxins : cocaine, amphetamine
  • 17. Treatmaent Medical :  Nimodipin = Ca blocker vasospasm, metabolism  Barbiturates  Stool softener  Dextromtorphane  3 H therapy: HTN, hemodilution , heypervolermia Surgery Endovascular : coil , stent ,…
  • 18. Aneurysm ICH ICH: A.com , MCA Interhemispheric Temporal lobe and sylvian fissure Hematoma evacuation and clipping Simultaneous Size ; predictor of clinical grade
  • 19. Aneurysm Management
  • 20. ICH Diff.Dx Child : AVM, metastasis , Adult : aneurysm , avm , cocaine Old : amyloid angiopathy
  • 21. 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
  • 22. Cavernoma presentation Headache Seizure : hemosiderin ring Hemorrhage : capsular not overt Focal deficit Pregnancy : growth Cummulative Risk of hemorrhage : more in young
  • 23. Imaging
  • 24. Treatment Surgery ; young , hemarrhage seizure ; hemosiderin ring focal deficit
  • 25. 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
  • 26. AVM High flow , low pressure Arterialization of veins Smooth muscle proliferation Gliotic nonfunctional brain Perilesional ischemia Wegde shape lesion
  • 27. Presentation Headache Focal deficit : steal phenomenon Hemorrhage : Risk of rupture : 2-4% Sizure
  • 28. AVM grading Spetzler – martin: Size : 0-3 , 3-6 , >6 Drainage : deep or superficial Eloquent area
  • 29. AVM imaging
  • 30. AVM
  • 31. Capillary telangiectasis 2nd most common Capillary malformation Dilatation MRI; demyelination , infarct , lymphoma GRE Asymptomatic
  • 32. Venous anomalies Most common Thick hyalinized veins Star cluster ; Imaging : caput medusa Low flow , low resistance Hemorrhage: cavernoma associated