Intracranial vascular disease

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Dr. javadi amir hossein

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Intracranial vascular disease

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

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