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CEREBRAL ANEURYSMS

CEREBRAL ANEURYSMS . why do we need mathematical models? edoardo boccardi Neuroradiologia Ospedale Niguarda-Ca’Granda Milano. the answer is obvious and very simple we (medical doctors) are very ignorant. the answer is obvious and very simple we (medical doctors) are very ignorant

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CEREBRAL ANEURYSMS

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  1. CEREBRAL ANEURYSMS why do we need mathematical models? edoardo boccardi Neuroradiologia Ospedale Niguarda-Ca’Granda Milano

  2. the answer is obvious and very simple we (medical doctors) are very ignorant

  3. the answer is obvious and very simple we (medical doctors) are very ignorant we know very little about vascular diseases and their causes

  4. the answer is obvious and very simple we (medical doctors) are very ignorant we know very little about vascular diseases and their causes we hope to find answers in modelization

  5. why cerebral aneurysms? because cerebral aneurysms represent a possible and not uncommon cause of death. When they rupture in the brain they cause a very severe disease: subarachnoid hemorrhage (SAH)

  6. SAH subarachnoid hemorrhage is a very severe disease:

  7. SAH • subarachnoid hemorrhage is a very severe disease: • one third of patients dies before arriving to the hospital

  8. SAH • subarachnoid hemorrhage is a very severe disease: • one third of patients dies before arriving to the hospital • one third of those who are hospitalized will die later on

  9. SAH • subarachnoid hemorrhage is a very severe disease: • one third of patients dies before arriving to the hospital • one third of those who are hospitalized will die later on • less than half of the survivors will go back to normal (around 20% of the initial population)

  10. AIMS the goal of modern medicine is to cure in the best possible way SAH patients, but more than that it would be better to prevent the occurence of SAH

  11. aneurysm: localized dilatation of an artery

  12. aneurysm: localized dilatation of an artery artery: blood vessel (tube) where blood flows in a centrifugal direction (i.e. from the heart towards the tissues)

  13. aneurysm: localized dilatation of an artery artery: blood vessel (tube) where blood flows in a centrifugal direction (i.e. from the heart towards the tissues) the vessels which bring blood back to the heart are the veins

  14. arteries

  15. angiography (arteriography) is the technique we use in order to visualize cerebral vessels and to find the aneurysm(s)

  16. catheter arteriography

  17. brain arteries

  18. anterior circulation

  19. posterior circulation

  20. when a vessel ruptures there is a hemorrhage when an artery ruptures the hemorrhage is more rapid and more intense

  21. when a vessel ruptures there is a hemorrhage when an artery ruptures the hemorrhage is more rapid and more intense a hemorrhage in the subarachnoid space is a SAH

  22. subarachnoid space ventricles

  23. CT scan of a subarachnoid hemorrhage (SAH)

  24. a SAH is (almost) always due to the rupture of a cerebral aneurysm : because these arterial dilatation of the cerebral arteries are usually to be found in the subarachnoid space

  25. a person with an acute SAH must be immediately taken care of to help him/her overcome this terrible trauma and to avoid possible complications

  26. one of the most dreaded complication is a second rupture of the aneurysm or rebleeding often more severe than the first, with less chances of survival to avoid the rebleeding we must exclude the aneurysm from the circulation. This is what we call aneurysm treatment

  27. the aim of the treatment is to prevent a new rupture of the aneurysm options: surgical clip endovascular coils

  28. clip open surgery

  29. where is the aneurysm? SAH

  30. where is the aneurysm?

  31. surgical clip

  32. before after

  33. clips

  34. coils endovascular treatment

  35. SAH rupture of an aneurysm at the tip of the basilar artery

  36. before after

  37. is it possibile to recognize an aneurysm before it ruptures?

  38. is it possibile to recognize an aneurysm before it ruptures? . symptoms due to compression of nervous structures

  39. is it possibile to recognize an aneurysm before it ruptures? . symptoms due to compression of nervous structures . incidental finding in exams for other reasons

  40. is it possibile to recognize an aneurysm before it ruptures? . symptoms due to compression of nervous structures . incidental finding in exams for other reasons . in cases where a ruptured aneurysm is also present

  41. biology • unruptured aneurysms • may not be all the same • incidental (discovered by chance) • coincidental (with a ruptured aneurysm) • large mass effect

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