Property of Prof Dr. Alif Kelaney, Department of NeuroSurgery Department, Faculty of Medicine. University of Zagazig

1. Dr.Atif kelaney
SUBARACHNOID HAEMORRAGE

2. CERBRAL BLOOD
FLOW
Gray matter---75-80 ml-100g
White -matter---20-30 ml-100 g-M
E.E.G become flat line---when blood flow
25ml
Physiological paralysis ----when blood
flow 15ml
Cell death--------------------when blood flow
10ml

4. CERBERAL BLOOD FIOW

9. RISK FACTORS
Hypertension
Smoking
Contraceptive pills
Alcohol drink
Pregnancy and parturition
Cocaine
Old age

11. CEREBERAL ANEURYSM

14. A.V.M

15. A.V.M

16. A.V.M

17. FILM 1

26. C.T

27. C.T

28. C.T

29. C.T

30. C.T

31. M.R.I

32. M.R.I

33. M.R.I

36. ANGIOGRAPHY

42. COURSE OF SUBARACHNOID
HGE
According to amount and
severity of bleeding

44. BLOOD SUPPLY OF THE BRAIN

52. FILM 2

53. MANAGEMENT OF
A.V.M
Open surgery and removal of
A.V.M
Endovascular occlusion of
feeders
Radio surgery

55. COILLING

57. COILING FILM 3
3

58. SPONTANEOUS
INTRACEREBERAL HAEMATOMA
Definition
Blood within the brain matter
Incidence
Usually after 55 years
Age more than 80 years
incidence is 25 times that during
previous decade

61. LOCATION OF
HEMATOMA
Basal ganglia and internal capsule
-50%
Thalamus------15%
Pons-----------10-15%
Cerebellum-----10%
Sub cortical------15-20%
Brain stem-------1-6%

65. ETIOLOGY
Hypertension
Vascular anomalies
Rupture aneurysm
Rupture A.V.M
Arterial atherosclerosis
Coagulation and clotting disorder
Brain tumor-
C.N.S infection
Drug abuse(cocaine and
amphetamine)

66. CLINICAL PICTURE
Acute onset
Headiche,vomiting and
alternation in level of
consciousness
Specific lesion in I.C.H
Internal capsule---hemi paresis
Thalamic-----contra lateral
hemi sensory loss

68. DELAYED DETERIORATION
1-Rebleeding
Cerebral edema
Hydrocephalus
Seizures

69. DIAGNOSIS
C.T
M.R.I

73. C.T

74. C.T

76. M.R.I
Hyperacute—Less than 24 hours-oxy hgb-
TW1---iso
TW2---slight hyper
Acute-------1-3 dayes-Deoxy hgb-TW1slight
hypo
TW2 very hypo
Subacute—early---less than 3 days—Met
hgb(intracellular)TW1---very hyper
TW2—very hypo
Subacute—late—more than 7 dayes—Met
hgb(extracellular)TW1---veryhyper
TW2----VERYHYPER

77. COSERVATIVE
TREAMENT
Control blood pressure and lower
gradually
Dehydrated measurement
Controlling the ICP
Follow up C.T
Physiotherapy
Normalize the coagulaility
Anticonvulsant

78. INDICATIONS OF
SUERGUERY
Symptomatic patient with large
hematoma
Marked mass effect with midline
shift
Persistent high ICT inspire of
medical therapy
Raid deterioration
More than 3 cm cerebellar
hematoma

79. SUERGICAL
PROCDURE
Open surgery
In sub cortical
hematoma
Minimal invasive technique
In small deep hematoma