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Cerebrovascular disease of Brain CT. SIM HO YONG 2008 , 03 , 15 Masan samsung medical center. CT Angio , Colonography. Percentage of smc Brain CT ,2007. Percentage of cerebrovascular dz ,2007. ANATOMY.
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Cerebrovascular disease of Brain CT SIM HO YONG 2008 , 03 , 15 Masan samsung medical center
ANATOMY • Intracranial vascular anatomy • Basal ganglia anatomy
Anterior communicating artery Perforating artery Hypothalamic artery Anterior cerebral artery Recurrent artery Ophthalmic artery Lenculostriate artery Internal carotid artery Middle cerebral artery Posterior communicating artery Posterior cerebral artery Anterior choroidal artery Superior cerebellar artery Perforating artery Basilar artery Long and short pontine artery Perforating artery Anterior inferior cerebellar artery Vertebral artery
Basal ganglia Corpus callosum Head of caudate nucleus lateral ventricle Putamen Interthalamic adhesion Globus pallidus 3rd ventricle Thalamus Pineal body
Callosomarginal A Anterior cerebral A (ACA) Pericallosal A Frontopolar A Orbital A
Posterior communicating A Acom. Pcom. ICA
PCA • Branches of the VBA • Posterior cerebral A (PCA) • Superior cerebellar A (SCA) • Anterior inferior cerebellar A (AICA) • Posterio inferior cerebellar A (PICA) SCA AICA
뇌혈관질환의 병리학적 분류 • Occlusive cerebrovascular diseases • Hemorrhagic cerebrovascular diseases
Ischemic cerebrovasculardz • Transient ischemic attack : TIA • Reversible ischemic neurologic deficit : RIND • Progressing stroke • Completed stroke
Ischemic Cerebrovasculardz • 50~55ml/100g/min • Ischemic threshold Threshold of electrical failure; 15~18ml/100g/min Threshold of ionic failure; 10~12ml/100g/min Ischemic penumbra;10~20ml/100g/min
Intracerebral Hemorrhage(ICH) • Cause 1, Hypertension: 70% 2, Aneurysm: 20% 3, AVM: 5.6% 4, Other(CCF, Moyamoya dz, etc): 4.4% • SMC(2007) Brain CT 1, Hypertension: 64.9% 2, Aneurysm: 31.3% 3, AVM: 1.6% 4, Other: 2.2%
Hypertensive Intracerebral Hemorrhage < Spontaneous Intracerebral Hemorrhage > Aneurysm AVM Moyamoya disease Hemorrhagic brain tumor
Hypertensive Intracerebral Hemorrhage • Putaminal hemorrhage : 55% • Thalamic hemorrhage : 10% • Subcortical hemorrhage : 15% = Lobal hemorrhage • Pontine hemorrhage • Cerebellar hemorrhage : 20%
Hypertensive Intracerebral Hemorrhage Putaminal hemorrhage
Hypertensive Intracerebral Hemorrhage Thalamic hemorrhage
Hypertensive Intracerebral Hemorrhage Thalamic hemorrhage
Hypertensive Intracerebral Hemorrhage Subcortical hemorrhage = Lobal hemorrhage
Hypertensive Intracerebral Hemorrhage Subcortical hemorrhage = Lobal hemorrhage
Hypertensive Intracerebral Hemorrhage Pontine hemorrhage
Hypertensive Intracerebral Hemorrhage Cerebellar hemorrhage
IntracranialAneurysm SizeSmall < 10mm Large : 10-24mmGiant > 25mm
IntracranialAneurysm • Anterior circulation • :92% • Internal carotid A:34% • Anterior cerebral A:36% • Middle cerebral A:19% • Posterior circulation • : 8% • Basilar A • Posterior cerebral A • Cerebellar A • Vertebral A
IntracranialAneurysm Aneurysm at the Lt. anterior cerebral area.
IntracranialAneurysm Aneurysm at the Lt. anterior cerebral area.
IntracranialAneurysm Aneurysm at the middle cerebral bifurcation area.
Intracranial Aneurysm P-com area에 posterior direction의 aneurysmal sac이 보이고 size는 8mm 으로 측정됨. 25%
Intracranial Aneurysm P-com area에 posterior direction의 aneurysmal sac. – post clipping -
Intracranial Aneurysm RT vertebral artery aneurysm
Carotid Cavernous Fistula(CCF) Enlarged enhancing Rt. cavernous sinus with engorged Rt. superior ophthalmic vein.