cerebro-vascular disease dr. raid jastania. cerebrovascular disease – congenital/developmental –...

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Cerebro-Vascular Disease Dr. Raid Jastania

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Page 1: Cerebro-Vascular Disease Dr. Raid Jastania. Cerebrovascular disease – Congenital/Developmental – Acquired – Localized lesion: Blockage – Thrombosis

Cerebro-Vascular Disease

Dr. Raid Jastania

Page 2: Cerebro-Vascular Disease Dr. Raid Jastania. Cerebrovascular disease – Congenital/Developmental – Acquired – Localized lesion: Blockage – Thrombosis
Page 3: Cerebro-Vascular Disease Dr. Raid Jastania. Cerebrovascular disease – Congenital/Developmental – Acquired – Localized lesion: Blockage – Thrombosis

• Cerebrovascular disease– Congenital/Developmental– Acquired

– Localized lesion:• Blockage

– Thrombosis– Emboli

• Hemorrhage

– Global ischemia

Page 4: Cerebro-Vascular Disease Dr. Raid Jastania. Cerebrovascular disease – Congenital/Developmental – Acquired – Localized lesion: Blockage – Thrombosis

Cerebrovascular Disease

• 3rd leading cause of death• Vascular diseases:– Congenital/Developmental, Acquired– Acquired:• Localized

– Thrombosis– Embolism– Hemorrhage

• Global ischemia

Page 5: Cerebro-Vascular Disease Dr. Raid Jastania. Cerebrovascular disease – Congenital/Developmental – Acquired – Localized lesion: Blockage – Thrombosis

Hypoxia, Ischemia, Infarction

• Hypoxia: reduction in oxygen supply• Ischemia: reduction in tissue perfusion• Infarction: necrosis due to hypoxia/ischemia

• Brain receives 15% of cardiac output• Brain consumes 20% of oxygen • Autoregulation of vascular resistance• Functional/Structural hypoxia

Page 6: Cerebro-Vascular Disease Dr. Raid Jastania. Cerebrovascular disease – Congenital/Developmental – Acquired – Localized lesion: Blockage – Thrombosis

• Cerebrovascular disease– Congenital/Developmental– Acquired

– Localized lesion:• Blockage

– Thrombosis– Emboli

• Hemorrhage

– Global ischemia

Page 7: Cerebro-Vascular Disease Dr. Raid Jastania. Cerebrovascular disease – Congenital/Developmental – Acquired – Localized lesion: Blockage – Thrombosis

Global Cerebral Ischemia• Generalized reduction in perfusion• Systolic pressure <50mmHg• Mild: transient injury• Moderate/Severe: permanent damage• Persistent Vegetative state• Brain Death• Changes:– Swelling, necrosis, neutrophils, macrophages, giolosis,

repair– Border zone (watershed) infarct

Page 8: Cerebro-Vascular Disease Dr. Raid Jastania. Cerebrovascular disease – Congenital/Developmental – Acquired – Localized lesion: Blockage – Thrombosis

• Cerebrovascular disease– Congenital/Developmental– Acquired

– Localized lesion:• Blockage

– Thrombosis– Emboli

• Hemorrhage

– Global ischemia

Page 9: Cerebro-Vascular Disease Dr. Raid Jastania. Cerebrovascular disease – Congenital/Developmental – Acquired – Localized lesion: Blockage – Thrombosis

Localized (Focal) Cerebral Ischemia• Occlusion of artery• Presence of collateral flow• Circle of Willis• Cortical-leptomeningeal anastomosis

• Thrombosis: in carotid athrosclerosis• Emboli: – MI, valve disease, atrial fibrillation, cardiac thrombi,

paradoxical emboli– Middle cerebral artery is the most frequent

Page 10: Cerebro-Vascular Disease Dr. Raid Jastania. Cerebrovascular disease – Congenital/Developmental – Acquired – Localized lesion: Blockage – Thrombosis
Page 11: Cerebro-Vascular Disease Dr. Raid Jastania. Cerebrovascular disease – Congenital/Developmental – Acquired – Localized lesion: Blockage – Thrombosis
Page 12: Cerebro-Vascular Disease Dr. Raid Jastania. Cerebrovascular disease – Congenital/Developmental – Acquired – Localized lesion: Blockage – Thrombosis
Page 13: Cerebro-Vascular Disease Dr. Raid Jastania. Cerebrovascular disease – Congenital/Developmental – Acquired – Localized lesion: Blockage – Thrombosis

Focal Cerebral Ischemia

• Infarction:– Non hemorrhagic– Hemorrhagic– Changes:• <6 hours: normal• 24 hours: necrosis, neutrophils, edema• 48 hours: pale, soft, swollen• 2-10 days: gelatinous, friable, macrophages• 10days-3weeks: liquifaction• >3 weeks: Gliosis, repair

Page 14: Cerebro-Vascular Disease Dr. Raid Jastania. Cerebrovascular disease – Congenital/Developmental – Acquired – Localized lesion: Blockage – Thrombosis

• Cerebrovascular disease– Congenital/Developmental– Acquired

– Localized lesion:• Blockage

– Thrombosis– Emboli

• Hemorrhage

– Global ischemia

Page 15: Cerebro-Vascular Disease Dr. Raid Jastania. Cerebrovascular disease – Congenital/Developmental – Acquired – Localized lesion: Blockage – Thrombosis

Intracarnial Hemorrhage

• Anatomical site:– Intraparenchymal– subarachnoid– Subdural– Epidural

• Cause:– Bleeding disorder– Primary vessel disease:

• Developmental: berry aneurysm

• Acquired: Vasculitis– Secondary vessel

disease: • Hypertension• Amyloid angiopathy

– Trauma, tumor, inflammtion

Page 16: Cerebro-Vascular Disease Dr. Raid Jastania. Cerebrovascular disease – Congenital/Developmental – Acquired – Localized lesion: Blockage – Thrombosis

Subarachnoid Hemorrhage

• Causes:– Saccular (berry) aneurysm– A-V malformation– Trauma– Tumors

Page 17: Cerebro-Vascular Disease Dr. Raid Jastania. Cerebrovascular disease – Congenital/Developmental – Acquired – Localized lesion: Blockage – Thrombosis

• Cerebrovascular disease– Congenital/Developmental– Acquired

– Localized lesion:• Blockage

– Thrombosis– Emboli

• Hemorrhage

– Global ischemia

Page 18: Cerebro-Vascular Disease Dr. Raid Jastania. Cerebrovascular disease – Congenital/Developmental – Acquired – Localized lesion: Blockage – Thrombosis

Berry Aneurysm

Page 19: Cerebro-Vascular Disease Dr. Raid Jastania. Cerebrovascular disease – Congenital/Developmental – Acquired – Localized lesion: Blockage – Thrombosis

Berry Aneurysm

• Can be congenital• Most appear later in life• Risk of bleeding: if 10mm size, risk 50% bleed• 20-30% have multiple aneurysms• 90% in the anterior circulation at the circle of

Willis• 25-50% risk of death if rupture• Headache, increase ICP, loss of consciousness

Page 20: Cerebro-Vascular Disease Dr. Raid Jastania. Cerebrovascular disease – Congenital/Developmental – Acquired – Localized lesion: Blockage – Thrombosis

Vascular Malformation

• Arterio Venous Malformation (A-V malforamtion)

• Cavernous angioma• Capillary telangeictasia• Venous angioma

Page 21: Cerebro-Vascular Disease Dr. Raid Jastania. Cerebrovascular disease – Congenital/Developmental – Acquired – Localized lesion: Blockage – Thrombosis

A-V malformation

• male > female• 10-30 years of age• Seizure, hemorrhage, sometimes CHF

Page 22: Cerebro-Vascular Disease Dr. Raid Jastania. Cerebrovascular disease – Congenital/Developmental – Acquired – Localized lesion: Blockage – Thrombosis

Intraparenchymal Hemorrhage

• Peak: 60 years of age• Rupture of intraparenchymal vessels• Hypertension: basal ganglia, thalamus, pons,

cerebellum• Cerebral Amyloid Angiopathy: leptomeningeal

and cortical vessles

Page 23: Cerebro-Vascular Disease Dr. Raid Jastania. Cerebrovascular disease – Congenital/Developmental – Acquired – Localized lesion: Blockage – Thrombosis

Hypertensive cerebrovascular disease

• Slit hemorrhage• Lacunar infarct• Intracerebral hemorrhage• Hypertesive encephalopathy

Page 24: Cerebro-Vascular Disease Dr. Raid Jastania. Cerebrovascular disease – Congenital/Developmental – Acquired – Localized lesion: Blockage – Thrombosis
Page 25: Cerebro-Vascular Disease Dr. Raid Jastania. Cerebrovascular disease – Congenital/Developmental – Acquired – Localized lesion: Blockage – Thrombosis

Hypertensive cerebrovascular disease

• Changes:– Hyaline arteriolar sclerosis– Weak arteriols– Aneurysm (Charcot-Bouchard microaneurysm– Lacunar infarct: small cavity in basal ganglia,

thalamus, pons– Encephalopathy: headache, confusion, vomiting,

convulsions, coma

Page 26: Cerebro-Vascular Disease Dr. Raid Jastania. Cerebrovascular disease – Congenital/Developmental – Acquired – Localized lesion: Blockage – Thrombosis

Vasculitis

Page 27: Cerebro-Vascular Disease Dr. Raid Jastania. Cerebrovascular disease – Congenital/Developmental – Acquired – Localized lesion: Blockage – Thrombosis

Summary

• Cerebrovascular disease– Congenital/Developmental– Acquired

– Localized lesion:• Blockage

– Thrombosis– Emboli

• Hemorrhage– Global ischemia

Page 28: Cerebro-Vascular Disease Dr. Raid Jastania. Cerebrovascular disease – Congenital/Developmental – Acquired – Localized lesion: Blockage – Thrombosis

Intracarnial Hemorrhage

• Anatomical site:– Intraparenchymal– subarachnoid– Subdural– Epidural

• Cause:– Bleeding disorder– Primary vessel disease:

• Developmental: berry aneurysm

• Acquired: Vasculitis– Secondary vessel

disease: • Hypertension• Amyloid angiopathy

– Trauma, tumor, inflammtion