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