Professional Documents
Culture Documents
(CVD:Neurosurgical aspect)
3 (Time is brain)
accident or stroke) , (CVD = conbrovascular disease or CVA = cerebrovascular (Neurological deficit) 24 (vascular origin)
1.) , (Ischemic stroke, cerebral infarction) 2.) (Hemorrhagic stroke, cerebral hemorrhage) (Cerebral hemorrhage), Subarachnoid(subarachnoid hemorrhage,SAH), (Intraventricular hemorrhage)
1.
Carotid (Anterior circulation) 2. Vertevral circulation) infarction) infarction) (Large vessel) (Small vessel)
1.)
(Emboli)
24 . (Amaurosis fugax) Retinal artery 1.2)Reverse Ischemic Neurological Deficit 24 . (Major stroke)
(Infarction) 2.1)Progressive stroke 2.2)Complete stroke 100-200 (Ischemic stroke) subarachanoid 10-15% 5% 1 30%-40% 30%
(Hemorrhagic stroke) ,
(Risk factor)
(Arrythmia) , , Polycytemia ,
1.)
(Clinical manifestation)
2.) 3.) 4.) 5.) 6.) infarction 7.) , ation) 1.) 2.) 3.)
(Consciousness change)
(Investig
1.)
(Investigation)
CT,MRI
Gold
(Non invasive technic) CT.Angiography(CTA),MRAngiography(MRA) (MRV) 2.) DUPLEX ultrasound Carotid Transcranial Doppler ultrasound(TCD) velocity) 3.) 4.) , (Flow (Vasospasm), ,Evoke potential
1.) 1.
(EKG)
, (Aerobic (Modified ,
2.)
3 .
1.
2. 3.
1.
(Antiplatelet aggregration):Aspirin,Ticlopidine,Placidogrel,Cilastazol
: arin), 2. 3.
Recombinant factor 7 ,
Diuretic drug Dichlortide,Beta blocker Propanolol,Calcium channel blocker Nifedipine,Nicardipine,Angiotencin receptor blocker Valsartan,Angiotensin converting enzyme inhibitor Enarapril,Vasodilator Nitroglycerine,Nitroprusside Neuroprotection:
1. 2. 3. 3.)
(Ischemic stroke)
Carotid Carotid
2/3
1.Carotid endartherectomy
(Hemorrhagic stroke)
1.Craniotomy remove blood clot 2.Craniotomy aneurysm clipping 3. Vascular bypass(Revascularization) Fusiform aneurysm Giant aneurysm 4.Craniotomy resection of AVM,AVF 5.CSF Diversion (Ventriculostomy), 6.Decompressive craniectomy
(Sacrifice)
(VP.shunt)
4.)
technic)
, 1.Endovascular angioplasty& stent Fusiform aneurysm 2.Embolization , AVM,AVF, ( Coiling) Giant aneurysm,Posterior circulation aneurysm, Balloon fistular(CC fistular) 5.)
Carotid-Carvernous sinus
23 / 1.) 1.) disease), cc. 2.)
(Ischemic stroke)
/100 / , 15 /100 , 10 /100 (Cerebral infarction) 3 (Necrosis), 2.) Penumbra zone (Idling neurone) (Ischemia) 3.) (Thrombosis) , (Carotid) (Arrythmia,valvular heart (Air embolism) 50
/100
/ /
(Artheriosclerosis,Thrombosis) , , (Thrombosis)
Plaque
(Clinical manifestation)
1.)Large vessel disease (Cerebral infarction) 2.)Small vessel disease (Lacunar infarction) (Lacunar syndrome) sensory loss of sensation 20
(Teritory)
Pure
, ,
(Intracerebral hemorrhage)
, (cocain, amphetamine)
(Clinical Manifestation)
, , Cushing
CT scan
(Conservative)
, , manitol, steroid
Subarachnoid ((brain herniation) Subarachnoid Hemorrhage) SAH (Decompressive Craniectomy) (Remove Clot) 5% ,
1. 2. 3. 4. 5.
AVM
5%
30-50% 10%
(Cerebral Aneurysm)
10,
Aneurysm
(Clinical manifestation)
(Stiff Neck) (Alteration of consciousness) (Neurological deficit) (hemiplegia), , Hunt & Hess 5 Grade I , Grade II , / palsy) Grade III , , Focal deficit Grade IV , rigidity) Grade V , Decerebrate rigidity , CT scan Aneurysm (Clip) ,
( CN III (Decerebrate
(Cerebral Angiography)
1. 2. 1.
Aneurysm
(Neck)
Aneurysm
Arterio
Middle Cerebral
AVM
AVM
AVM AVM
(Clinical Manifestation)
SAH : , , (Generalical Seizure) ,
1-2%
3-4%
(Ischemia)
(Neurological Deficit)
Cerebral Angiography
1. 2. 3.Embolization
AVM ,
3 cm.
(Prognosis of CVA)
(GCS <5) , , , (Large
1. 2. 3. infarct,hematoma) 4.
5. incontinence) 6. 7.
(Urinary
(TIA) (Major stroke :Progressive,complete stroke) 20 % 1 10% (Hemorrhagic stroke45%) (Ischemic stroke20%) 1.) (Brain herniation), (Infection), (Myocardial infarction) 50%( 100: 1 ) 45% (Independent) 1 (Bed ridden 20%), 3% 23%, (Independent) 48%, 6 ( 2/3) ,60%
26%,
(Nursing home)