This document discusses various pathologies of intra-cranial vascular disease including aneurysms, arteriovenous malformations, cavernous hemangiomas, and Moyamoya disease. It provides details on the prevalence, types, clinical presentation, imaging findings, and treatment of different conditions. In particular, it notes that brain aneurysms are abnormal bulges in brain arteries that can rupture and cause life-threatening bleeding. Imaging tools like CT, MRI, and DSA are used to detect aneurysms and other vascular abnormalities. Moyamoya disease involves progressive stenosis of carotid arteries and formation of collateral vessels visible on angiography.

1. Imaging of intra-cranial
vascular disease.
Dr/ ABD ALLAH NAZEER. MD.

18. Pathology.
Aneurysm.
Arterial venous malformation.(AVMs).
. Parenchymal(pial)
. Dural
. Mixed pial-dural
Cavernous hemangioma(Cavernoma).
Capillary telangiectasias.
Venous angioma.
Vein of Galen aneurysm.
Venous varix.
Moyamoya disease.

19. A brain aneurysm is an abnormal bulge in a
brain artery wall or irreversible dilatation of
the arterial that develops where the blood
vessel wall is weakened.
Lifestyle changes that may be beneficial in
preventing a brain aneurysm include:
Not smoking
Exercising regularly
Eating a balanced, low-fat diet
Getting help for alcohol and/or drug abuse
Controlling high blood pressure
Aneurysm

20. The prevalence of intracranial saccular aneurysms by
radiographic and autopsy series is 5 percent in the United
States.
Approximately 20 to 30 percent of patients have
multiple aneurysms and 70-75% is solitary.
Aneurysmal SAH occurs at an estimated rate of 6 to 16
per 100,000 population.
Most aneurysms, particularly small aneurysms, do not
rupture.
Approximately 10 percent of patients die prior to
reaching the hospital, and only one-third have a "good
result" after treatment.
Rupture of an intracranial aneurysm is believed to
account for 0.4 to 0.6 percent of all deaths.

21. Types:
Congenital or acquired.
True or false.
Acquired (Saccular) with or without systemic
disease (ADPKD).
Non-saccular-
fusiform, dissecting, traumatic, infective
, neoplastic and mycotic aneurysm
Saccular is the most, occurring at vessel
bifurcations.
Size varies from a few millimeters to several
centimeters.

22. By size-
. Small aneurysm diameter <1.5 cm.
. Large aneurysm(1.5to 2.5 cm).
. Giant (2.5to 5 cm).
. Super giant (over 5 cm).
By Shape-
. Saccular, most common: berry aneurysms,
necks or stems resembling a berry.
. Fusiform- without stem.
. Dissecting- blood follows a false lumen.

25. Clinical presentation:
Most intracranial aneurysms are
asymptomatic unless they rupture, and so
they are usually found either incidentally or
when a patient presents with SAH.
The clinical presentation include:
1. rupture(90%)
2. compression from aneurysm sac (7%)
3. Incidental finding (3%)

26. Rupture of aneurysm:
Headache (97 percent of cases)
sudden onset, severe worst headache
of my life.
Lateralized in 30 percent of
patients, predominantly to the side of the
aneurysm
associated with a brief loss of consciousness,
seizure, nausea, vomiting, or meningismus
warning leak.

27. Incidence:
Female: Male = 3:2
But the ratio varies with age:
< 40 years: males > females
> 40 years: females > males
The sites different from gender:
female supraclinoid segment of the internal
carotid artery.
male anterior communicating complex
Age: rupture is most common between 40 and 60
years but can occur in any age, even in old age.

28. Hereditary syndromes
Heritable disorders associated with the
presence of intracranial aneurysm include:
Connective tissue diseases such as Ehlers-Danlos
syndrome and pseudoxanthoma elasticum
Autosomal dominant polycystic kidney disease
Glucocorticoid-remediable aldosteronism (familial
aldosteronism type I).
Familial aneurysms
Familial aneurysms tend to rupture at a smaller
size and younger age than sporadic aneurysms.
Siblings often experience rupture in the same
decade of life.

29. CT:
An unenhanced CT scan is the preferred procedure
for detection of SAH is positive in more than 90% of
patients in the first 24 hours more than 50% in the
first week the sensitivity drops off dramatically
after the first week SAH appears as areas of
increased density in the subarachnoid spaces along
the base of the skull and within the sylvian fissure.
The location of the SAH may frequently suggest the
site of the aneurysm, and, rarely, the aneurysm
itself might be visible.

30. Right MCA aneurysm with subarachnoid hemorrhage.

31. 2 cases with subarachnoid hemorrhage
from rupture of an aneurysm.

32. Computed tomographic (CT) angiography of the head showed
a partially thrombosed giant paraclinoid aneurysm of the
left internal carotid artery, measuring 5 cm in diameter.

33. CTA with MIP and aneurysms of the
anterior communicating artery.

34. MRI:
MRI is not recommended in the acute
management of patients with SAH, difficult to
manage acutely sick patients within the
environment of an MRI suite
SAH is poorly seen on MRI, However, for patients
with un-ruptured aneurysms MRI and MRA are
excellent screening procedures to detect and
follow intracranial aneurysms as small as 3 mm
have been identified in high-quality MRI studies.

35. Right para-sellar aneurysm.

36. Giant right
middle
cerebral. A.A,

37. MCA aneurysm.

38. Giant partially thrombosed ICA aneurysm with some calcification at the ventral rim.

39. Giant vertebral aneurysm in the vertebral artery with
nausea and vomiting due to brain stem compression.

40. DSA with small aneurysm at PCA.

41. </body
Cavernous angioma with left middle cerebral artery aneurysm.

63. Cavernoma with signs of recent hemorrhage.

64. Familial cavernomatosis.

74. Vein of Galen malformation.

77. Moyamoya syndrome is characterized by progressive
stenosis of the internal carotid arteries and formation
of collateral vessels that give a "puff of smoke"
appearance on angiography.
Moyamoya disease occurs mainly in Japanese and
other Asian populations and may have a genetic basis
and first described at 1957.
Secondary moyamoya syndrome is seen in
association with neurofibromatosis, Down syndrome,
Williams syndrome, sickle cell disease, and as a
sequale of cranial irradiation. Intracranial
hemorrhage is common in young adults.
Dissection — Arterial dissection is the most common
vascular abnormality in some young adult series
Moyamoya

78. Clinical features.
Ischemic events more frequent in children.
Hemorrhagic stroke
Epilepsy.
In children: 77%-ischemic events
59%-TIA
5%-ICH
In adults: 69%-ICH
27%-TIA +ischemic stroke
Epilepsy: 25%- children , 5% -adults.

79. Moyamoya disease.

82. Moyamoya disease.

83. Moyamoya disease.