Intracranial vascular disease

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 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

SAH classification
 Fisher ; brain ct
 Hunt & Hess
 Wfns

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

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

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

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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