. .

(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)

Internal carotid Vertebral (Posterior (Large (Lacunar

1.)

(TIA): (RIND): 2.)

(Collateral circulation) 1.1)Transient ischemic attack

(Minor stroke) (Ischemia)

(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) ,

1.) 2.) 3.) 4.) 5.)

(Risk factor)

(Arrythmia) , , Polycytemia ,

1.)

(Clinical manifestation)

(Focal neurological deficit) ,

2.) 3.) 4.) 5.) 6.) infarction 7.) , ation) 1.) 2.) 3.)

(Consciousness change)

, (Vascular dementia,Bingswanger disease) Hemiballismus Subthalamic hemorrhage or (Meningismus) , Arachnoid(SAH) ,

(Investig

1.)

(Investigation)

CT,MRI

(DWI) MR Spectroscopy,PET,SPECT Cerebral angiography standard

MR Diffusion weight image

3 ., (Functional imaging) CT MRI ,MRVenography

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)

exercise), 2 2. Risk factor) exercise), , ,

, (Modified Risk factor) , , (Aerobic , , ,

, (Aerobic (Modified ,

2.)

3 .

1.
2. 3.

(Ischemic stroke) (Thrombolytic agent) :Tissue plasminogen activator(rTPA)

(Anticoagulant) :Coumadin,Warfarin (Valvalar heart disease,Arrythmia) (Thrombosis)

1.

(Antiplatelet aggregration):Aspirin,Ticlopidine,Placidogrel,Cilastazol

(Hemorrhagic stroke) (Coagulopathy)

: arin), 2. 3.

Recombinant factor 7 ,

(Coumadin,Warf (Consumptive coagulopathy) (Antifibrinolytic drug) : Transamine (Antihypertensive drug)

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.)

(Diuretic drug) Lasix,Acetazolanide (Osmotherapy) Mannitol Barbiturate

(Ischemic stroke)
Carotid Carotid

2/3

,Plaque 90% , 70% 2.Vascular bypass(Revascularization) 3. Decompressive craniectomy 4.Craniotomy Thrombectomy

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.)

(Neurointervention : Endovascular technic)

technic)

(Cerebral angiography (Non invasive endovascular

, 1.Endovascular angioplasty& stent Fusiform aneurysm 2.Embolization , AVM,AVF, ( Coiling) Giant aneurysm,Posterior circulation aneurysm, Balloon fistular(CC fistular) 5.)

Carotid-Carvernous sinus

(Gamma knife,Linac radiotherapy) AVM 3 .

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

/ /

(Ebolism) (Fat embolism) (>200 ) Thrombosis ,

(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

TIA,Vertebrobasilar insufficiency 20% Major stroke

, ,

(Hemorrhagic stroke) (arteriosclerosis) ,

(Intracerebral hemorrhage)
, (cocain, amphetamine)

(anticongulant , heparin, coumadin), AVM, ,

(Clinical Manifestation)
, , Cushing

1. : response , , 2. (Alteration of Consciousness) 3. (Neurological deficit) (Hemiplegia), ,

CT scan

(Conservative)
, , manitol, steroid

Subarachnoid ((brain herniation) Subarachnoid Hemorrhage) SAH (Decompressive Craniectomy) (Remove Clot) 5% ,

1. 2. 3. 4. 5.

AVM

5%

(Ruptured Aneurysm) (Ruptured AVM) 10% ,

30-50% 10%

(Idiopathic) 20% Aneurysm, AVM

(Cerebral Aneurysm)

SAH 15% posterior circulation 3:2 , 2-4%

Saccular (berry) Aneurysm Anterior Circulation 85-90%, 40-60 (Rebleed) 50%

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

(Coil) (Endovascular Technic)

2. (Vasospasm) Nimodipine (Calcium Blocker)

Arterio

Venous Malformation (AVM)

(Cerebral Hemisphere) 10-40 (Pathophysiology) SAH (Ischemic) AVM

Middle Cerebral

AVM

AVM

AVM AVM

(Clinical Manifestation)
SAH : , , (Generalical Seizure) ,

1-2%

3-4%

(Ischemia)

(Neurological Deficit)

, CT scan AVM Radiosurgery AVM

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)