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Intracranial vascular
       disease
Pathology
   Aneurysm
   Arteral Venous malformation (AVM)
   Cavernoma
   Venous angioma
Aneurysm
   Irreversible dilatation of arterial wall
   3 layers ; tunica media
   Pseudoaneurysm ; traumatic, rupture wall, clot
   Dissecting aneurysm ; intima
   Fusiform aneurysm
Aneurysm

   Presentation :
      Hemorrhage ; SAH, ICH ,IVH
     Stroke

     Mass effect

   Location : A.com , P.com , Mca
       POST. : PICA , Vertebral
Aneurysm
   Risk of rupture:
   Size >1cm
   Location: Post. , Pcom , A.com
   Multiple: large, prox., irregular
   Symptomatic
   HTN
   Age
   Female
Subarachnoid hemorrhage
   Sudden severe headache
   Neck rigidity
   Low grade fever
   No neurologic deficit except ;
       ptosis : Post. communicating Art.( PCOM)
SAH
SAH diagnosis
   BCT
   Lumbar puncture : xantochromia
     Traumatic : serial CSF , clotting , xantochromia
     12 hours

     Contraindication : papilledema, coagulopathy

     Fresh CSF: low glucose
Complications :
   Rebleeding ,
   Hydrocephalus ,
   Seizure ,
   Vasospasm
   ICH
   Electrolyte imbalance
Vasospasm
Risk factors for vasospasm
Process of vasospasm
Electrolyte imbalance
SAH classification
   Fisher ; brain ct
   Hunt & Hess
   Wfns
SAH & Traumatic CSF
SAH etiology
   Trauma : most common
   Vascular
   Infection
   Blood disease
   Neoplasm
   Toxins : cocaine, amphetamine
Treatmaent
   Medical :
     Nimodipin = Ca blocker vasospasm, metabolism
     Barbiturates

     Stool softener

     Dextromtorphane

     3 H therapy: HTN, hemodilution , heypervolermia

   Surgery
   Endovascular : coil , stent ,…
Aneurysm ICH
   ICH: A.com , MCA
   Interhemispheric
   Temporal lobe and sylvian fissure
   Hematoma evacuation and clipping
   Simultaneous
   Size ; predictor of clinical grade
Aneurysm Management
ICH Diff.Dx
   Child : AVM, metastasis ,
   Adult : aneurysm , avm , cocaine
   Old : amyloid angiopathy
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
Cavernoma presentation
   Headache
   Seizure : hemosiderin ring
   Hemorrhage : capsular not overt
   Focal deficit
   Pregnancy : growth
   Cummulative Risk of hemorrhage :
    more in young
Imaging
Treatment
   Surgery ;
    young ,
    hemarrhage
    seizure ; hemosiderin ring
    focal deficit
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
AVM
   High flow , low pressure
   Arterialization of veins
   Smooth muscle proliferation
   Gliotic nonfunctional brain
   Perilesional ischemia
   Wegde shape lesion
Presentation
   Headache
   Focal deficit : steal phenomenon
   Hemorrhage : Risk of rupture : 2-4%
   Sizure
AVM grading
   Spetzler – martin:
   Size : 0-3 , 3-6 , >6
   Drainage : deep or superficial
   Eloquent area
AVM imaging
AVM
Capillary telangiectasis
   2nd most common
   Capillary malformation
   Dilatation
   MRI; demyelination , infarct , lymphoma
   GRE
   Asymptomatic
Venous anomalies
   Most common
   Thick hyalinized veins
   Star cluster ;
   Imaging : caput medusa
   Low flow , low resistance
   Hemorrhage: cavernoma
                   associated
Intracranial vascular disease

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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.
  • 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)
  • 8. SAH
  • 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
  • 12. Risk factors for vasospasm
  • 15. SAH classification  Fisher ; brain ct  Hunt & Hess  Wfns
  • 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 ,…
  • 19.
  • 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
  • 29.
  • 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
  • 33. AVM
  • 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