Vascular DiseasesRe-written by: Daniel HabashiSeminar by: Dr. Jezewski

Hunt-Hess Grading system for Aneurysmal SAH• I

▫ Asymptomatic or minimal headache and slight neck stiffness

• II ▫ Moderate to severe headache, neck stiffness, no

neurological deficit (except cranial palsy)• III

▫ Drowsiness, confusion, or mild focal deficit• IV

▫ Stupor, moderate to severe hemiparesis, possible early decerebrate rigidity, and vegetative disturbances

• V ▫ Deep coma, decerebrate rigidity, moribund

•SAH – Subarachnoid Hemorrhage•MCA – Middle Cerebral Artery•BAA – Basilar Artery

Complications of SAH

•Re-bleeding▫Can occur in the first hours or first days

after the first bleeding. The bleeding chances of course decrease as time passes.

▫The first hours after a rupture of an aneurysm has a change of re-bleeding up to even 50%

•Vasospasm

•Hydrocephalus

Treatment of Aneurysms• Surgery

▫Depends on clinical state (Very) early operations within 72 hours After 12-14 days of bleeding

▫ Immediate if ICH (Intracerebral hemorrhage) and ICP increase exists

• The most important thing in an aneurysm is to stop the bleeding and close it. The patient has no chance if the aneurysm is open. That’s why the operation should take place as fast as possible. That’s what it’s all about.

Treatment of Aneurysms

•Clipping (surgical clipping of an aneurysm).▫Close the neck of the aneurysm without

closing the vessels•Endoscopic clipping of aneurysms

•Non-surgery – endovascular embolisation

Arteriovenous malformation: Angioma

•Symptoms▫Bleeding or epilepsy▫Epilepsy is very typical. There are patients

that are treated for epilepsy and they don’t even know that they have an Angioma. It’s very typical that such patients have been treated even for 5 years for Epilepsy and there hasn’t been a CT scan performed by a neurologist earlier.

•Diagnostic procedures:▫CT/ MRI and ANG

Treatment

•Surgical▫Excision of AVM

•Non surgical▫Endovascular embolisation

•1+2 (BOTH)