neurovascular cases in nsv

8/4/2019 Neurovascular Cases in Nsv

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NEUROVASCULAR CASES

IN NSVProf.Subbiah MCh


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CASE 1

Harikrishnan 26 M

C/O Benumbed sensation of entire Rt

UL for 1-2 mts and recovery . 1-2episodes a week in last 3 months.

O/E HMF,Cr Nerves,SMS,Cerebellum-

Normal Pt came with CT Angio which shows

AVM 1.8X1 cm Lt Frontoparietal

region.Feeding from MCA.Drains intoSu r sa ittal sinus.


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CASE 1

Spletzer Martin grading:

Size:1 Eloquency:1 Draining

Vein:0Score : 2


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CASE 1

Preop pictureshowing the

Ltfrontoparietalregion AVM


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CASE 1

Preop picture showing the Ltfrontoparietal region AVM


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CASE 1

Pt undergone Lt frontoparietalcraniotomy and excision of AVM.

Postoperatively pt had Dysphasiaand Rt UL monoparesis whichrecovered gradually.


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CASE 1

Postop picture showing theexcision of the AVM


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CASE 2

Surya 10 MCh

C/O Severe headache and vomiting

for which he was admitted in a pvthospital.Pt referred to GGH with CTBrain.

O/E HMF,Cr Nerves,SMS,Cerebellum-Normal

CT Brain shows ICH in Rt Temporal

region with thin SDH with mass effectand minimal midline shift


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CASE 2

Pt initially managed conservativelyfor ICH and evaluated.

CT Angio shows 1X1 cm AVM in RtTemporal lobe withhemorrhage.Feeding Artery RtMCA.Draining vein Superficial

cortical vein. Spletzer Martin grading:

Size:1 Eloquency:1 DrainingVein:0


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CASE 2

Preop picture showingthe temporal ICH


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CASE 2

Preop picture showingthe Rt temporal AVM


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CASE 2

Pt undergone Rt temporalcraniotomy and excision of AVM.

Postoperatively pt had noneurological deficit but had CSFcollection underneath the flap whichwas managed by LP drain.

Pt improved and discharged.


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CASE 2

Postop picture showing theexcision of Rt temporal AVM


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CASE 3

Dhanalakshmi 54 F

C/O Giddiness and fall followed by

severe headache, vomiting andaltered sensorium.

Not a known HTN,DM or IHD.

O/E Drowsy,obeys simplecommands,Lt 6th nervepalsy,PERL,no weakness of limbs.

CT shows SAH in both the sylvian


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CASE 3

Pt conservatively managed for SAHand evaluated.

CT Angio shows Acom Aneurysm

Spletzer Martin grading:

Size:1 Eloquency:1 Draining

Vein:0Score : 2


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CASE 3

Preop picture showing theSAH


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CASE 3

Preop picture showing the RtAcom Aneurysm


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CASE 3

Preop picture showing the RtAcom Aneurysm


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CASE 3

Pt undergone Rt pterional craniotomyand clipping of Acom aneurysm.

Postoperatively pt had no significantneurological deficit.


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CASE 3

Postop picture after theclipping of Rt Acom Aneurysm


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CASE 4

Masthan 23 M

Alleged H/O RTA 2 wheeler vs 2wheeler and patient admitted in

Trauma ward.

O/E E3V2M5 PERL no weakness oflimbs.

CT shows Lt temporoparietal ICH withmass effect . Rt temporal small EDH.


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CASE 4

Pt undergone Emergency LtTemporoparietal craniotomy andevacuation of ICH.

Pt improved postoperatively andevaluated for ICH.

CT angio shows posttraumaticaneurysm of size 6.3X8 mm from Rtmiddle meningeal artery.


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CASE 4

Preop picture showing Lttemporal and parietal ICH


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CASE 4

Postop picture showingevacuation of ICH


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CASE 4

Picture showing Rt temporalMiddle meningeal arteryaneurysm


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CASE 4



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CASE 4



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CASE 4

Pt undergone Rt temporalcraniotomy and clipping andcauterization of aneurysm.

Postoperatively pt had no significantneurological deficit.


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DISCUSSION

Traumatic intracranial aneurysmsrarely occur and can develop as theresult of either blunt or penetrating

head trauma. Traumatic intracranialaneurysms can present in a varietyof ways such as subarachnoid

hemorrhage, intracranialhemorrhage, and subduralhematoma.

The mortality rate for patients with


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DISCUSSION

Traumatic aneurysms comprise lessthan 1% of all intracranialaneurysms. Most of these aneurysms

are actually false aneurysms,orpseudoaneurysms, which are causedby the rupture of entire vessel wall

layers, with the wall of the aneurysmbeing formed by thesurroundingcerebral structures.


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DISCUSSION

The natural history of traumaticaneurysms is not well known, butprogressive growth of traumatic

aneurysms has been demonstratedon repeated angiograms .

Traumatic MMA may regress,thrombose, enlarge, or rupture.


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DISCUSSION

Therefore, preventive therapy isrequired for this vascular lesions .

Because rupture of a

pseudoaneurysm of the middlemeningeal artery can be lethal, likethis case, we emphasize earlydiagnosis and early preventivetreatment.


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THANK YOU

neurovascular cases in nsv

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