1. Vascular Diseases Re-written by: Daniel Habashi Seminar by: Dr. Jezewski

2. 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

3. SAH – Subarachnoid Hemorrhage MCA – Middle Cerebral Artery BAA – Basilar Artery

4. 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

5. 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.

6. 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

7. 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

8. Treatment Surgical ▫Excision of AVM Non surgical ▫Endovascular embolisation 1+2 (BOTH)