You are on page 1of 33

NEUROVASCULAR CASES IN NSV

Prof.Subbiah MCh Click to edit Master subtitle style

4/15/12

CASE 1
• •

Harikrishnan

26

M

C/O Benumbed sensation of entire Rt UL for 1-2 mts and recovery . 1-2 episodes a week in last 3 months. O/E HMF,Cr Nerves,SMS,CerebellumNormal Pt came with CT Angio which shows AVM 1.8X1 cm Lt Frontoparietal region.Feeding from MCA.Drains into 4/15/12 Supr sagittal sinus.

CASE 1

Spletzer Martin grading:

Size:1 Eloquency:1 Draining Vein:0 Score : 2

4/15/12

CASE 1 • Preop picture showing the Lt frontoparietal region AVM 4/15/12 .

CASE 1 • Preop picture showing the Lt frontoparietal region AVM 4/15/12 .

Postoperatively pt had Dysphasia and Rt UL monoparesis which recovered gradually.CASE 1 • Pt undergone Lt frontoparietal craniotomy and excision of AVM. • 4/15/12 .

CASE 1 • Postop picture showing the excision of the AVM 4/15/12 .

SMS.Pt referred to GGH with CT Brain.CerebellumNormal CT Brain shows ICH in Rt Temporal region with thin SDH with mass effect 4/15/12 and minimal midline shift • • . O/E HMF.CASE 2 • • Surya 10 MCh C/O Severe headache and vomiting for which he was admitted in a pvt hospital.Cr Nerves.

CT Angio shows 1X1 cm AVM in Rt Temporal lobe with hemorrhage.Draining vein – Superficial cortical vein. Spletzer Martin grading: • • Size:1 Eloquency:1 Draining 4/15/12 Vein:0 .CASE 2 • Pt initially managed conservatively for ICH and evaluated.Feeding Artery – Rt MCA.

CASE 2 • Preop picture showing the temporal ICH 4/15/12 .

CASE 2 • Preop picture showing the Rt temporal AVM 4/15/12 .

Postoperatively pt had no neurological deficit but had CSF collection underneath the flap which was managed by LP drain.CASE 2 • Pt undergone Rt temporal craniotomy and excision of AVM. • • 4/15/12 . Pt improved and discharged.

CASE 2 • Postop picture showing the excision of Rt temporal AVM 4/15/12 .

no weakness of limbs.DM or IHD.obeys simple commands. Not a known HTN.Lt 6th nerve palsy. O/E Drowsy.CASE 3 • • Dhanalakshmi 54 F C/O Giddiness and fall followed by severe headache. 4/15/12 • • • CT shows SAH in both the sylvian . vomiting and altered sensorium.PERL.

CASE 3 • Pt conservatively managed for SAH and evaluated. CT Angio shows Acom Aneurysm Spletzer Martin grading: • • Size:1 Eloquency:1 Draining Vein:0 Score : 2 4/15/12 .

CASE 3 • Preop picture showing the SAH 4/15/12 .

CASE 3 • Preop picture showing the Rt Acom Aneurysm 4/15/12 .

CASE 3 • Preop picture showing the Rt Acom Aneurysm 4/15/12 .

CASE 3 • Pt undergone Rt pterional craniotomy and clipping of Acom aneurysm. Postoperatively pt had no significant neurological deficit. • 4/15/12 .

CASE 3 Postop picture after the clipping of Rt Acom Aneurysm • 4/15/12 .

4/15/12 • • .CASE 4 • • Masthan 23 M Alleged H/O RTA 2 wheeler vs 2 wheeler and patient admitted in Trauma ward. CT shows Lt temporoparietal ICH with mass effect . O/E E3V2M5 PERL no weakness of limbs. Rt temporal small EDH.

CT angio shows posttraumatic aneurysm of size 6. Pt improved postoperatively and evaluated for ICH. 4/15/12 • • .CASE 4 • Pt undergone Emergency Lt Temporoparietal craniotomy and evacuation of ICH.3X8 mm from Rt middle meningeal artery.

CASE 4 • Preop picture showing Lt temporal and parietal ICH 4/15/12 .

CASE 4 • Postop picture showing evacuation of ICH 4/15/12 .

CASE 4 • Picture showing Rt temporal Middle meningeal artery aneurysm 4/15/12 .

CASE 4 • Picture showing Rt temporal Middle meningeal artery aneurysm 4/15/12 .

CASE 4 • Picture showing Rt temporal Middle meningeal artery aneurysm 4/15/12 .

CASE 4 • Pt undergone Rt temporal craniotomy and clipping and cauterization of aneurysm. Postoperatively pt had no significant neurological deficit. • 4/15/12 .

intracranial hemorrhage. 4/15/12 • The mortality rate for patients with . Traumatic intracranial aneurysms can present in a variety of ways such as subarachnoid hemorrhage. and subdural hematoma.DISCUSSION • Traumatic intracranial aneurysms rarely occur and can develop as the result of either blunt or penetrating head trauma.

Most of these aneurysms are actually false aneurysms.DISCUSSION • Traumatic aneurysms comprise less than 1% of all intracranial aneurysms. with the wall of the aneurysm being formed by thesurrounding cerebral structures. 4/15/12 . which are caused by the rupture of entire vessel wall layers.or pseudoaneurysms.

DISCUSSION • The natural history of traumatic aneurysms is not well known. or rupture. enlarge. Traumatic MMA may regress. but progressive growth of traumatic aneurysms has been demonstrated on repeated angiograms . thrombose. 4/15/12 • .

• . like this case. we emphasize early diagnosis and early preventive 4/15/12 treatment. preventive therapy is required for this vascular lesions . Because rupture of a pseudoaneurysm of the middle meningeal artery can be lethal.DISCUSSION • Therefore.

THANK YOU 4/15/12 .

° @ ¯½f   ¯f–  °–    .@°– ¾¾On¯I.

 f°°–  ° ½ €nfnnf ° W ½   .f°–f °–   °n f°°–I °  n   .

.

 9 ½ ½n ¾°–  ¯½f.

 .

.

. 9 ½ ½n ¾°–   ¯½fI.

.

 W 9° –°   ¯½fnf°¯f°  n¾°€I. W 9¾½ f ½f °° –nf €n f .

n n°° ° f €f½ nf¾¯f°f–  9 f° W 9¯½ f°  ¾nf– .

.

. 9¾½ ½n ¾°–  n¾°€  ¯½fI.

.

 W f°ff¾¯  W .

 W $¾  ¾ ¾¯½ n¯¯f° ¾   °  ½f¾ 9 °  f° ¾¾€¯ ¾ W ..$ ° ¾¾f° €f€  ¾     f fn ¯°–f° f  ¾ °¾¯ W -f°°@.

@¾¾°  ¾f° €¾¾ ¾ ¯ °  €°  ¯¾½ n  .

.

 W 9n°¾ f ¯f°f– €f°  ff W .

@°– ¾¾n¯ ° ¾¯ W ½   .f°–f °–   °n f°°–I °  n   .

.

 9 ½ ½n ¾°–  .

.

 9 ½ ½n ¾°–  n¯ ° ¾¯ .

.

 9 ½ ½n ¾°–  n¯ ° ¾¯ .

.

 W 9° –°  ½ °f nf°¯f°  n½½°–€n¯ f° ¾¯ W 9¾½ f ½f °¾–°€nf° ° –nf €n .

.

 9¾½ ½n f€  n½½°–€ n¯ ° ¾¯ .

.

W  – $@  ¾   f°  ½f °f ¯ °@f¯ff W $I.f¾f° . W .9° f° ¾¾€¯ ¾ W .

@¾¾ ¯½½f f .

¯f¾¾ €€ n   ¯½f¾¯f .

.

 W 9° –° ¯ – °n@ ¯½½f f nf°¯f°  fnf°€.

 W 9¯½ ½¾½ f f°  ff € .

 W .

@f°– ¾¾½¾f¯fnf° ¾¯€ ¾  O¯¯€¯ ¯  ¯ °°– f f  .

.

 9 ½ ½n ¾°– ¯½ff° ½f f.

 .

.

 9¾½ ½n ¾°– fnf°€.

 .

.

 9n ¾°–  ¯½f.  ¯ °°– f f  f° ¾¯ .

.

 9n ¾°–  ¯½f.  ¯ °°– f f  f° ¾¯ .

.

 9n ¾°–  ¯½f.  ¯ °°– f f  f° ¾¯ .

.

 W 9° –°   ¯½fnf°¯f°  n½½°–f° nf f°€f° ¾¯ W 9¾½ f ½f °¾–°€nf° ° –nf €n .

.

DW @f¯fn°fnf°ff° ¾¯¾f nnf° nf°  ½f¾  ¾€   °½ ° f°–  f f¯f @f¯fn°fnf°ff° ¾¯¾nf° ½ ¾ °°ff €f¾¾nf¾¾ ffn°   ¯f– °fnf°f ¯f– f° ¾ f  ¯f¯f W @ ¯ff €½f °¾f¯fn °fnf°ff° ¾¯¾¾–½ W @  € ½¯½ f–°¾¾n  ff°––f½ f° ¾€€n °¾–nf f¯ °f ° n ¾¾f  W €ffnf¾ ¾€f¯fn¯  ¯ °°– f f f° ¾¯   ½   .

.

¾€ ¾ f° ¾¯¾ f fnf€f¾ f° ¾¯¾  ½¾  f° ¾¯¾ nf nf¾    ½ € °  ¾¾ ff ¾  f € f° ¾¯ °–€¯   ¾° °– n  f¾n ¾  W @f¯fn½¾  f° ¾¯¾ € ¯   ¯ °°– f f f f¾f  .DW @f¯fnf° ¾¯¾n¯½¾  ¾¾f° €f °fnf°ff° ¾¯¾ .

.

DW @ °ff¾€f¯fnf° ¾¯¾¾°  °°  ½– ¾¾ –€f¯fnf° ¾¯¾ f¾ ° ¯°¾f ° ½ f f°––f¯¾ W @f¯fn..¯f – ¾¾ ¯ ¾  °f–  ½ W 9¾  f° ¾¯ € ¯  ¯ °°– f f  nf ¾f –¾€½ ½ n°–f°f ½ ° –nf  f°  °fnf°f  ¯f¯ff€ f  f° f n¾ f¾¾nf f¯f€   .

.

DW @  € ½  °  f½¾  € ¾f¾nf ¾°¾ W nf¾ ½ €f½¾  f° ¾¯ €  ¯  ¯ °°– f f nf°  f   ¾nf¾   ¯½f¾  f f–°¾¾f°  f½  °  f¯ ° .

@-D .