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Dr. javadi amir hossein
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Intracranial Intracranial vascular diseasevascular disease
Pathology Pathology
AneurysmAneurysm Arteral Venous malformation (AVM)Arteral Venous malformation (AVM) Cavernoma Cavernoma Venous angiomaVenous angioma
AneurysmAneurysm
Irreversible dilatation of arterial wallIrreversible dilatation of arterial wall 3 layers ; tunica media3 layers ; tunica media Pseudoaneurysm ; traumatic, Pseudoaneurysm ; traumatic,
rupture wall, clotrupture wall, clot Dissecting aneurysm ; intima Dissecting aneurysm ; intima Fusiform aneurysmFusiform aneurysm
Aneurysm Aneurysm
Presentation :Presentation :
Hemorrhage ; SAH, ICH ,IVHHemorrhage ; SAH, ICH ,IVH StrokeStroke Mass effectMass effect
Location : A.com , P.com , McaLocation : A.com , P.com , Mca POST. : PICA , VertebralPOST. : PICA , Vertebral
Aneurysm Aneurysm
Risk of rupture:Risk of rupture: Size >1cmSize >1cm Location: Post. , Pcom , A.com Location: Post. , Pcom , A.com Multiple: large, prox., irregularMultiple: large, prox., irregular SymptomaticSymptomatic HTNHTN Age Age Female Female
Subarachnoid Subarachnoid hemorrhagehemorrhage
Sudden severe headacheSudden severe headache Neck rigidityNeck rigidity Low grade feverLow grade fever No neurologic deficit except ;No neurologic deficit except ;
ptosis : Post. communicating Art.ptosis : Post. communicating Art.( PCOM)( PCOM)
SAHSAH
SAH diagnosisSAH diagnosis
BCTBCT Lumbar puncture : xantochromia Lumbar puncture : xantochromia
Traumatic : serial CSF , clotting , Traumatic : serial CSF , clotting , xantochromiaxantochromia
12 hours12 hours Contraindication : papilledema, Contraindication : papilledema,
coagulopathycoagulopathy Fresh CSF: low glucoseFresh CSF: low glucose
Complications :Complications :
Rebleeding , Rebleeding , Hydrocephalus ,Hydrocephalus , Seizure ,Seizure , Vasospasm Vasospasm ICHICH Electrolyte imbalanceElectrolyte imbalance
Vasospasm Vasospasm
Risk factors for Risk factors for vasospasmvasospasm
Process of vasospasmProcess of vasospasm
Electrolyte imbalanceElectrolyte imbalance
SAH classificationSAH classification
Fisher ; brain ctFisher ; brain ct Hunt & Hess Hunt & Hess Wfns Wfns
SAH & Traumatic CSFSAH & Traumatic CSF
SAH etiologySAH etiology
Trauma : most commonTrauma : most common VascularVascular InfectionInfection Blood diseaseBlood disease NeoplasmNeoplasm Toxins : cocaine, amphetamine Toxins : cocaine, amphetamine
Treatmaent Treatmaent
Medical : Medical : Nimodipin = Ca blocker vasospasm, Nimodipin = Ca blocker vasospasm,
metabolismmetabolism BarbituratesBarbiturates Stool softenerStool softener DextromtorphaneDextromtorphane 3 H therapy: HTN, hemodilution , 3 H therapy: HTN, hemodilution ,
heypervolermiaheypervolermia Surgery Surgery Endovascular : coil , stent ,…Endovascular : coil , stent ,…
Aneurysm ICHAneurysm ICH
ICH: A.com , MCAICH: A.com , MCA InterhemisphericInterhemispheric Temporal lobe and sylvian fissureTemporal lobe and sylvian fissure Hematoma evacuation and clipping Hematoma evacuation and clipping Simultaneous Simultaneous Size ; predictor of clinical gradeSize ; predictor of clinical grade
Aneurysm Management Aneurysm Management
ICH Diff.DxICH Diff.Dx
Child : AVM, metastasis , Child : AVM, metastasis , Adult : aneurysm , avm , cocaineAdult : aneurysm , avm , cocaine Old : amyloid angiopathy Old : amyloid angiopathy
CavernomaCavernoma
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 Cavernoma presentation
Headache Headache Seizure : hemosiderin ringSeizure : hemosiderin ring Hemorrhage : capsular not overtHemorrhage : capsular not overt Focal deficitFocal deficit Pregnancy : growthPregnancy : growth Cummulative Risk of hemorrhage : Cummulative Risk of hemorrhage :
more in young more in young
Imaging Imaging
Treatment Treatment
Surgery ; Surgery ;
young , young ,
hemarrhagehemarrhage
seizure ; hemosiderin ringseizure ; hemosiderin ring
focal deficitfocal deficit
AVMAVM
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
AVMAVM
High flow , low pressureHigh flow , low pressure Arterialization of veinsArterialization of veins Smooth muscle proliferationSmooth muscle proliferation Gliotic nonfunctional brain Gliotic nonfunctional brain Perilesional ischemiaPerilesional ischemia Wegde shape lesionWegde shape lesion
Presentation Presentation
Headache Headache Focal deficit : steal phenomenonFocal deficit : steal phenomenon Hemorrhage : Risk of rupture : 2-4%Hemorrhage : Risk of rupture : 2-4% Sizure Sizure
AVM grading AVM grading
Spetzler – martin: Spetzler – martin: Size : 0-3 , 3-6 , >6Size : 0-3 , 3-6 , >6 Drainage : deep or superficialDrainage : deep or superficial Eloquent areaEloquent area
AVM imagingAVM imaging
AVMAVM
Capillary telangiectasisCapillary telangiectasis
22ndnd most common most common Capillary malformationCapillary malformation DilatationDilatation MRI; demyelination , infarct , MRI; demyelination , infarct ,
lymphomalymphoma GRE GRE Asymptomatic Asymptomatic
Venous anomaliesVenous anomalies
Most common Most common Thick hyalinized veinsThick hyalinized veins Star cluster ; Star cluster ; Imaging : caput medusaImaging : caput medusa Low flow , low resistanceLow flow , low resistance Hemorrhage: cavernomaHemorrhage: cavernoma
associatedassociated