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Dr.Atif kelaney
SUBARACHNOID HAEMORRAGE
CERBRAL BLOOD
FLOW
Gray matter---75-80 ml-100g
White -matter---20-30 ml-100 g-M
E.E.G become flat line---when blood flow
2...
CERBERAL BLOOD FIOW
RISK FACTORS
Hypertension
Smoking
Contraceptive pills
Alcohol drink
Pregnancy and parturition
Cocaine
Old age
CEREBERAL ANEURYSM
A.V.M
A.V.M
A.V.M
FILM 1
C.T
C.T
C.T
C.T
C.T
M.R.I
M.R.I
M.R.I
ANGIOGRAPHY
COURSE OF SUBARACHNOID
HGE
According to amount and
severity of bleeding
BLOOD SUPPLY OF THE BRAIN
FILM 2
MANAGEMENT OF
A.V.M
Open surgery and removal of
A.V.M
Endovascular occlusion of
feeders
Radio surgery
COILLING
COILING FILM 3
3
SPONTANEOUS
INTRACEREBERAL HAEMATOMA
Definition
Blood within the brain matter
Incidence
Usually after 55 years
Age mo...
LOCATION OF
HEMATOMA
Basal ganglia and internal capsule
-50%
Thalamus------15%
Pons-----------10-15%
Cerebellum-----10...
ETIOLOGY
Hypertension
Vascular anomalies
Rupture aneurysm
Rupture A.V.M
Arterial atherosclerosis
Coagulation and clo...
CLINICAL PICTURE
Acute onset
Headiche,vomiting and
alternation in level of
consciousness
Specific lesion in I.C.H
Inte...
DELAYED DETERIORATION
1-Rebleeding
Cerebral edema
Hydrocephalus
Seizures
DIAGNOSIS
C.T
M.R.I
C.T
C.T
M.R.I
Hyperacute—Less than 24 hours-oxy hgb-
TW1---iso
TW2---slight hyper
Acute-------1-3 dayes-Deoxy hgb-TW1slight
hyp...
COSERVATIVE
TREAMENT
Control blood pressure and lower
gradually
Dehydrated measurement
Controlling the ICP
Follow up C...
INDICATIONS OF
SUERGUERY
Symptomatic patient with large
hematoma
Marked mass effect with midline
shift
Persistent high ...
SUERGICAL
PROCDURE
Open surgery
In sub cortical
hematoma
Minimal invasive technique
In small deep hematoma
Cerebral Aneursym & Subarachnoid Haemorrhage
Cerebral Aneursym & Subarachnoid Haemorrhage
Cerebral Aneursym & Subarachnoid Haemorrhage
Cerebral Aneursym & Subarachnoid Haemorrhage
Cerebral Aneursym & Subarachnoid Haemorrhage
Cerebral Aneursym & Subarachnoid Haemorrhage
Cerebral Aneursym & Subarachnoid Haemorrhage
Cerebral Aneursym & Subarachnoid Haemorrhage
Cerebral Aneursym & Subarachnoid Haemorrhage
Cerebral Aneursym & Subarachnoid Haemorrhage
Cerebral Aneursym & Subarachnoid Haemorrhage
Cerebral Aneursym & Subarachnoid Haemorrhage
Cerebral Aneursym & Subarachnoid Haemorrhage
Cerebral Aneursym & Subarachnoid Haemorrhage
Cerebral Aneursym & Subarachnoid Haemorrhage
Cerebral Aneursym & Subarachnoid Haemorrhage
Cerebral Aneursym & Subarachnoid Haemorrhage
Cerebral Aneursym & Subarachnoid Haemorrhage
Cerebral Aneursym & Subarachnoid Haemorrhage
Cerebral Aneursym & Subarachnoid Haemorrhage
Cerebral Aneursym & Subarachnoid Haemorrhage
Cerebral Aneursym & Subarachnoid Haemorrhage
Cerebral Aneursym & Subarachnoid Haemorrhage
Cerebral Aneursym & Subarachnoid Haemorrhage
Cerebral Aneursym & Subarachnoid Haemorrhage
Cerebral Aneursym & Subarachnoid Haemorrhage
Cerebral Aneursym & Subarachnoid Haemorrhage
Cerebral Aneursym & Subarachnoid Haemorrhage
Cerebral Aneursym & Subarachnoid Haemorrhage
Cerebral Aneursym & Subarachnoid Haemorrhage
Cerebral Aneursym & Subarachnoid Haemorrhage
Cerebral Aneursym & Subarachnoid Haemorrhage
Cerebral Aneursym & Subarachnoid Haemorrhage
Cerebral Aneursym & Subarachnoid Haemorrhage
Cerebral Aneursym & Subarachnoid Haemorrhage
Cerebral Aneursym & Subarachnoid Haemorrhage
Cerebral Aneursym & Subarachnoid Haemorrhage
Cerebral Aneursym & Subarachnoid Haemorrhage
Cerebral Aneursym & Subarachnoid Haemorrhage
Cerebral Aneursym & Subarachnoid Haemorrhage
Cerebral Aneursym & Subarachnoid Haemorrhage
Cerebral Aneursym & Subarachnoid Haemorrhage
Cerebral Aneursym & Subarachnoid Haemorrhage
Cerebral Aneursym & Subarachnoid Haemorrhage
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Cerebral Aneursym & Subarachnoid Haemorrhage

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Property of Prof Dr. Alif Kelaney, Department of NeuroSurgery Department, Faculty of Medicine. University of Zagazig

Publicada em: Saúde e medicina
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Cerebral Aneursym & Subarachnoid Haemorrhage

  1. 1. Dr.Atif kelaney SUBARACHNOID HAEMORRAGE
  2. 2. CERBRAL BLOOD FLOW Gray matter---75-80 ml-100g White -matter---20-30 ml-100 g-M E.E.G become flat line---when blood flow 25ml Physiological paralysis ----when blood flow 15ml Cell death--------------------when blood flow 10ml
  3. 3. CERBERAL BLOOD FIOW
  4. 4. RISK FACTORS Hypertension Smoking Contraceptive pills Alcohol drink Pregnancy and parturition Cocaine Old age
  5. 5. CEREBERAL ANEURYSM
  6. 6. A.V.M
  7. 7. A.V.M
  8. 8. A.V.M
  9. 9. FILM 1
  10. 10. C.T
  11. 11. C.T
  12. 12. C.T
  13. 13. C.T
  14. 14. C.T
  15. 15. M.R.I
  16. 16. M.R.I
  17. 17. M.R.I
  18. 18. ANGIOGRAPHY
  19. 19. COURSE OF SUBARACHNOID HGE According to amount and severity of bleeding
  20. 20. BLOOD SUPPLY OF THE BRAIN
  21. 21. FILM 2
  22. 22. MANAGEMENT OF A.V.M Open surgery and removal of A.V.M Endovascular occlusion of feeders Radio surgery
  23. 23. COILLING
  24. 24. COILING FILM 3 3
  25. 25. SPONTANEOUS INTRACEREBERAL HAEMATOMA Definition Blood within the brain matter Incidence Usually after 55 years Age more than 80 years incidence is 25 times that during previous decade
  26. 26. LOCATION OF HEMATOMA Basal ganglia and internal capsule -50% Thalamus------15% Pons-----------10-15% Cerebellum-----10% Sub cortical------15-20% Brain stem-------1-6%
  27. 27. ETIOLOGY Hypertension Vascular anomalies Rupture aneurysm Rupture A.V.M Arterial atherosclerosis Coagulation and clotting disorder Brain tumor- C.N.S infection Drug abuse(cocaine and amphetamine)
  28. 28. CLINICAL PICTURE Acute onset Headiche,vomiting and alternation in level of consciousness Specific lesion in I.C.H Internal capsule---hemi paresis Thalamic-----contra lateral hemi sensory loss
  29. 29. DELAYED DETERIORATION 1-Rebleeding Cerebral edema Hydrocephalus Seizures
  30. 30. DIAGNOSIS C.T M.R.I
  31. 31. C.T
  32. 32. C.T
  33. 33. M.R.I Hyperacute—Less than 24 hours-oxy hgb- TW1---iso TW2---slight hyper Acute-------1-3 dayes-Deoxy hgb-TW1slight hypo TW2 very hypo Subacute—early---less than 3 days—Met hgb(intracellular)TW1---very hyper TW2—very hypo Subacute—late—more than 7 dayes—Met hgb(extracellular)TW1---veryhyper TW2----VERYHYPER
  34. 34. COSERVATIVE TREAMENT Control blood pressure and lower gradually Dehydrated measurement Controlling the ICP Follow up C.T Physiotherapy Normalize the coagulaility Anticonvulsant
  35. 35. INDICATIONS OF SUERGUERY Symptomatic patient with large hematoma Marked mass effect with midline shift Persistent high ICT inspire of medical therapy Raid deterioration More than 3 cm cerebellar hematoma
  36. 36. SUERGICAL PROCDURE Open surgery In sub cortical hematoma Minimal invasive technique In small deep hematoma

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