Professional Documents
Culture Documents
Cerebral Aneurysm IBN Ok
Cerebral Aneurysm IBN Ok
CEREBRAL ANEURYSM
Presenter : dr.Muhamad Ibnu Sina
Pembimbing: dr.Iskandar Nasution Sp.S FINS
Departemen Neurologi FK USU/RSUP H.Adam Malik
MODUL NEUROVASKULAR 1
INTRODUCTION
A cerebrovascular disorder in which weakness in the wall of
a cerebral artery or vein causes a localized dilation or
ballooning of the blood vessel.
MODUL NEUROVASKULAR 2
ANATOMY
MODUL NEUROVASKULAR 3
MODUL NEUROVASKULAR 4
MODUL NEUROVASKULAR 5
MODUL NEUROVASKULAR 6
PATHOGENESIS
Risk Factors
MODUL NEUROVASKULAR 7
CLASSIFICATIONS
• Size
• The neck of the aneurysm plays also an important role to further separate aneurysms with small neck (less than
4mm) or with large neck (greater than 4mm)
• The ratio between aneurismal sac size and neck size is also an important parameter to be considered in
planning an endovascular approach
MODUL NEUROVASKULAR 8
MODUL NEUROVASKULAR 9
CLASSIFICATIONS
• Location
MODUL NEUROVASKULAR 10
CLASSIFICATIONS
• Shape and site of origin
MODUL NEUROVASKULAR 11
Saccular Aneurysm
• Most common
• have a neck that separates the
aneurysm from the parent
artery
• Lobulation was divided into
unilobular, multilobular,
daughter sac
MODUL NEUROVASKULAR 12
Saccular Aneurysm
MODUL NEUROVASKULAR 13
Fusiform Aneurysm
• as a circumferential arterial
dilatation resulting from
pathological involvement of
the entire artery
• fusiform aneurysms have
circumferential arterial
dilation without any ostium
or neck
MODUL NEUROVASKULAR 14
Giant Aneurysm
MODUL NEUROVASKULAR 15
Dissecting Aneurysm
• A dissecting aneurysm
is when blood from the
vessel lumen tracks
between the two inner
layers, the intima and
the tunica media.
• This can cause
blockage of the flow
MODUL NEUROVASKULAR 16
• A pseudoaneurysm, also known as a false aneurysm, collection of blood that forms
between the two outer layers of an artery, the tunica media and the tunica adventitia.
• It is usually caused by a penetrating injury to the vessel
• It may be pulsatile and can resemble a true aneurysm.
MODUL NEUROVASKULAR 17
SYMPTOMS
Only 10-15% of intracranial aneurysms are
symptomatic
• Wagner M, Stenger K. Unruptured intracranial aneurysms: using evidence and outcomes to guide patient teaching. Crit Care Nurs Q 2005; 28: 341-54.
• Friedman JA, Piepgras DG, Pichelmann MA, et al. Small cerebral aneurysms presenting with symptoms other than rupture. Neurology 2001; 57: 1212-6 .
MODUL NEUROVASKULAR 18
MODUL NEUROVASKULAR 19
MODUL NEUROVASKULAR 20
Anterior communicating artery: Usually, ACoA aneurysms are silent until they
rupture. Suprachiasmatic pressure may cause altitudinal visual field deficits, aboulia or
akinetic mutism, amnestic syndromes and hypothalamic dysfunction
Anterior cerebral artery: Most are asymptomatic until they rupture, although frontal
lobe syndromes, anosmia and motor deficits may be noted.
Middle cerebral artery: This typically affects the first or second division in the sylvan
fissure. Aphasia, hemiparesis, hemisensory loss, anosognosia and visual field defects
may be noted.
MODUL NEUROVASKULAR 21
Internal carotid artery: Supraclinoid aneurysms may cause ophthalmoplegia due to the compression
of the cranial nerve (CN) III or variable visual defects and optic atrophy due to the compression of the
optic nerve. Chiasmal compression may produce bilateral temporal hemianopsia. Hypopituitarism or
anosmia may be seen with giant aneurysms. Cavernous-carotid aneurysms exert mass effects within
the cavernous sinus, producing ophthalmoplegia and facial sensory loss.
Basilar artery: The clinical findings are usually those associated with SAH, although bitemporal
hemianopsia or an oculomotor palsy may occur. Dolichoectatic aneurysms may cause bulbar
dysfunction, respiratory difficulties and neurogenic pulmonary oedema.
Vertebral artery or posterior inferior cerebellar artery : Aneurysms at these arterial segments
typically result in ataxia, bulbar dysfunction or spinal involvement.
MODUL NEUROVASKULAR 22
DIAGNOSTIC
the gold-standard for diagnosis of cerebral aneurysms is DSA because it
remains the test with the highest spatial resolution
• Wagner M, Stenger K. Unruptured intracranial aneurysms: using evidence and outcomes to guide patient teaching. Crit Care Nurs Q 2005; 28: 341-54.
MODUL NEUROVASKULAR 23
ASPECT RATIO
MODUL NEUROVASKULAR 24
AR is a reliable
predictor of aneurysmal
pathophysiology,evolution
, and rupture.
MODUL NEUROVASKULAR 25
MODUL NEUROVASKULAR 26
• Pasien laki-laki , 45 tahun, dengan riwayat suka konsumsi alcohol, merasakan nyeri
kepala yang sangat hebat selama hidupnya. Pasien juga merasakan mual dan
pandangan kabur. Pada pemeriksaan didapatkan diplopia, ptosis pada mata kanan, dan
pupil dilatasi. Penyebab terjadinya kasus di atas adalah:
MODUL NEUROVASKULAR 27
MODUL NEUROVASKULAR 28
• Laki-laki 43 tahun masuk ruang gawat darurat setelah mengalami gejala nyeri kepala dan
kelemahan tubuh sebelah kiri secara tiba-tiba. Pada penilaian NIHSS didapatkan 12 poin.
Pada pemeriksaan CT didapatkan gambaran hipodens sesuai teruitori MCA D. Pada
pemeriksaaan duplek didapatkan gambaran seperti di bawah, diagnosis:
Moya-moya
Fibrumuscular displasia
AVM
Diseksi carotis
MODUL NEUROVASKULAR 29
• Seorang laki-laki menderita nyeri kepala mendadak dan paling berat dirasakan sepanjang
hidupnya. Hasil CT scan normal dan LP 4 tabung didapatkan darah. Pemeriksaan
penunjang terbaik selanjutnya adalah: (MCQ UNDIP XXIII)
DSA.
MRA.
MODUL NEUROVASKULAR 30