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