CEREBRAL ANEURSM
Dr.Atif kelaneySUBARACHNOID HAEMORRAGE
CERBRAL BLOOD FLOWGray matter---75-80 ml-100gWhite -matter---20-30 ml-100 g-ME.E.G become flat line---when blood flow 25mlPhysiological paralysis ----when blood flow 15mlCell death--------------------when blood flow 10ml
CERBERAL BLOOD FIOW
RISK FACTORSHypertensionSmokingContraceptive pillsAlcohol drinkPregnancy and parturitionCocaineOld age
CEREBERAL ANEURYSM
A.V.M
A.V.M
A.V.M
FILM 1
C.T
C.T
27
C.T
C.T
C.T
M.R.I
M.R.I
M.R.I
ANGIOGRAPHY
COURSE OF SUBARACHNOID HGEAccording to amount and severity of bleeding
BLOOD SUPPLY OF THE BRAIN
FILM 2
MANAGEMENT OF A.V.MOpen surgery and removal of A.V.M
Endovascular occlusion of feeders
Radio surgery
COILLING
COILING FILM 33
SPONTANEOUS INTRACEREBERAL HAEMATOMADefinition Blood within the brain matterIncidence Usually after 55 years Age more than 80 years incidence is 25 times that during previous decade
LOCATION OF HEMATOMABasal ganglia and internal capsule -50%Thalamus------15%Pons-----------10-15%Cerebellum-----10%Sub cortical------15-20%Brain stem-------1-6%
ETIOLOGYHypertensionVascular anomalies Rupture aneurysm Rupture A.V.M Arterial atherosclerosisCoagulation and clotting disorderBrain tumor-C.N.S infectionDrug abuse(cocaine and amphetamine)
CLINICAL PICTUREAcute onsetHeadiche,vomiting and alternation in level of consciousnessSpecific lesion in I.C.H Internal capsule---hemi paresis Thalamic-----contra lateral hemi sensory loss
DELAYED DETERIORATION1-Rebleeding
Cerebral edema
Hydrocephalus
Seizures
DIAGNOSISC.T
M.R.I
C.T
C.T
M.R.IHyperacuteLess than 24 hours-oxy hgb-TW1---iso TW2---slight hyperAcute-------1-3 dayes-Deoxy hgb-TW1slight hypo TW2 very hypoSubacuteearly---less than 3 daysMet hgb(intracellular)TW1---very hyper TW2very hypoSubacutelatemore than 7 dayesMet hgb(extracellular)TW1---veryhyper TW2----VERYHYPER
COSERVATIVE TREAMENTControl blood pressure and lower graduallyDehydrated measurementControlling the ICPFollow up C.TPhysiotherapyNormalize the coagulailityAnticonvulsant
77
INDICATIONS OF SUERGUERYSymptomatic patient with large hematomaMarked mass effect with midline shiftPersistent high ICT inspire of medical therapyRaid deteriorationMore than 3 cm cerebellar hematoma
SUERGICAL PROCDUREOpen surgery In sub cortical hematomaMinimal invasive technique In small deep hematoma
URE79