1. Cerebrovascular disease of Brain CT
SIM HO YONG
2008 , 03 , 15
Masan samsung medical center

2. CT Angio, Colonography

3. Percentage of smc Brain CT ,2007

4. Percentage of cerebrovascular dz ,2007

5. ANATOMY
Intracranial vascular anatomy
Basal ganglia anatomy

6. 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

7. Head of caudate nucleus Interthalamic adhesion
Basal ganglia
Corpus callosum
Head of caudate nucleus
lateral ventricle
Putamen
Interthalamic adhesion
Globus pallidus
3rd ventricle
Thalamus
Pineal body

8. Anterior cerebral A (ACA)
Callosomarginal A
Pericallosal A
Frontopolar A
Orbital A

9. Middle cerebral A (MCA)

10. Posterior communicating A
Acom.
Pcom.
ICA

11. PCA

12. Posterior cerebral A (PCA) Superior cerebellar A (SCA)
Branches of the VBA
Posterior cerebral A (PCA)
Superior cerebellar A (SCA)
Anterior inferior cerebellar A (AICA)
Posterio inferior cerebellar A (PICA)
SCA
AICA

13. 뇌혈관질환의 병리학적 분류 Occlusive cerebrovascular diseases
Hemorrhagic cerebrovascular diseases

14. Ischemic cerebrovascular dz
Transient ischemic attack : TIA
Reversible ischemic neurologic deficit
: RIND
Progressing stroke
Completed stroke

15. Ischemic Cerebrovascular dz
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

16. Cerebral Infarction(CI)

17. Transient Ischemic Attack(TIA)

18. Transient Ischemic Attack(TIA) ( CI )

19. Cerebral Infarction(CI)

20. Cerebral Infarction(CI)

21. 대표적 뇌혈관질환 별 발생 빈도

22. 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%

23. Hypertensive Intracerebral Hemorrhage
< Spontaneous Intracerebral Hemorrhage > Aneurysm AVM Moyamoya disease Hemorrhagic brain tumor

24. Hypertensive Intracerebral Hemorrhage
Putaminal hemorrhage : 55%
Thalamic hemorrhage : 10%
Subcortical hemorrhage : 15%
= Lobal hemorrhage
Pontine hemorrhage
Cerebellar hemorrhage : 20%

25. Hypertensive Intracerebral Hemorrhage
Putaminal hemorrhage

26. Hypertensive Intracerebral Hemorrhage
Thalamic hemorrhage

27. Hypertensive Intracerebral Hemorrhage
Thalamic hemorrhage

28. Hypertensive Intracerebral Hemorrhage
Subcortical hemorrhage
= Lobal hemorrhage

29. Hypertensive Intracerebral Hemorrhage
Subcortical hemorrhage
= Lobal hemorrhage

30. Hypertensive Intracerebral Hemorrhage
Pontine hemorrhage

31. Hypertensive Intracerebral Hemorrhage
Cerebellar hemorrhage

32. Intracranial Aneurysm

33. Intracranial Aneurysm

34. Size Small < 10mm Large : 10-24mm Giant > 25mm
Intracranial Aneurysm
Size Small < 10mm Large : 10-24mm Giant > 25mm

35. Intracranial Aneurysm
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

36. Intracranial Aneurysm
Aneurysm at the Lt. anterior cerebral area.

37. Intracranial Aneurysm
Aneurysm at the Lt. anterior cerebral area.

38. Intracranial Aneurysm
Aneurysm at the middle cerebral bifurcation area.

39. Intracranial Aneurysm
P-com area에 posterior direction의 aneurysmal sac이 보이고 size는 8mm 으로 측정됨 %

40. Intracranial Aneurysm
P-com area에 posterior direction의 aneurysmal sac. – post clipping -

41. Intracranial Aneurysm
RT vertebral artery aneurysm

42. Arteriovenous Malformation

43. Carotid Cavernous Fistula(CCF)
Enlarged enhancing Rt. cavernous sinus with engorged Rt. superior ophthalmic vein.

44. Moya moya disease

45. Moya moya disease

46. 감사합니다.