Expansion vascular blood-brain
Brain aneurysm
This topic has been prepared by Physicians Specialty Center for medical advice, in the case of quotation, please refer to our official website www.medicalcom.net
Is widening or expansion in a part of the wall of a blood vessel within the brain due to a lack of ethics, in patients Onatj shocks.This usually occurs at the point of confluence of great arteries, or at the base of the brain in the basal arterial circle (Circle of Willis).In the case of weak blood vessel grows in part out of the result of blood pressure and the greater the size of the expansion, the higher rates exploded, and bleeding within the brain, there is a way to predict the occurrence of the explosion and bleeding, not all cerebral vascular expansion and is subject to explosion.
Statistics show that:
Expansion of less than 10 mm in size are less likely to explode than others (the Great)
40% of those who suffer from explosion to dilate cerebral blood vessel and die during the first year after infection, and about one-third of them will suffer from severe central nervous disorder.
Age is the most vulnerable 40 to 60 years for the onset of symptoms, and rarely occurs in children who are affected by those males more than females Baltmdeddat vascular and are also larger than females.
Patients who survived the explosion of vascular blood-brain more than twice as likely than others to recurrence of aneurysms of cerebral blood and this new expansion vascular six times more likely to flare who did not suffer from it.
Women are more likely than men to Tmdeddat vascular brain.
10% of patients with renal sacculation more vulnerable to cerebral vascular Tmdeddat than others.
15-20% of cases of aneurysms Eugdldém more than one.
75% of cases of expansion have two of those to Tmdeddat vascular
15% have three to Manalhalat Tmdeddat vascular.
Manalhalat 10% have more than three.
Explosion of vascular expansion resulting in the death of 10-20% of cases.
50% of the deaths occur during the first month after hemorrhage.
Higher frequency of bleeding in the first day of the explosion of vascular expansion.
Consists of any wall of a blood vessel of three layers, the middle of them responsible for the muscle flexibility of the blood vessel in response to changes in blood pressure.In case of any weakness (putrefactive) in this class, whatever the cause, arises the so-called lying down vascular blood. Generally thought in the past that the cause of these aneurysms is birth defects in the walls of blood vessels, but now sees some evidence little for other reasons such as:Weakness of the walls of arteries, genetic - Defects formative during growth - and most likely defects Tvskhih mural in the blood vessels, which arise from an imbalance in the dynamics of blood, which is believed to do now as a major cause directly to the occurrence and development of any expansion and vascular, and clots from forming or Tfjrh in the end.
Months of the causes of cerebral vascular aneurysms:1. Dynamic disturbances in blood circulation.2. Vascular disintegration.3. Hardening of the arteries.4. Odguet cases increase the speed of blood flow.5. Congenital vascular malformations.6. Vascular fistula.7. There are other reasons are less frequent, such as: HIV infections - infections that lead to weak blood vessels - Diseases cancer - the misuse of drugs, including heroin, cocaine and ephedrine.
Types of vascular aneurysms Alddmagah:Expansion can be real or false.1. Expansion vascular blood-brain false: for Hoabarh cavity in the wall of the blood vessel, filled blocked by a blood clot.2. Expansion vascular blood-brain real: It is our topic be in the form of three forms:Casey (Saccular), fusiform (Fusiform) and lobar (Dissecting).
Here we will discuss three types Blaadah each separately.First stretch the blood-brain vascular fibrosis: (Dissecting)Is a real breadth of Casey all layers constituting the vessel wall, mostly at the points of branching arteries.In most cases, no symptoms occur until the flare-up of the blood-brain vascular expansion, and then show case of the worst headaches brain of the patient symptomatic membrane of the brain.There are several ways to assess the severity of symptoms, from headaches, stiff neck muscles and the background, and ending with comatose and sclerosis year, and many symptoms, including Aatmadaaly place and vascular blood volume expansion and condition of the explosion or not.
There are several reasons for the expansion of the blood-brain vascular fibrosis:
Expansion of the blood-brain vascular fibrosis due to injury: and be due to either penetrating head injury, such as firearms, or non-penetrating injury of the head and are rare, such as trauma and fractures of the skull.
Expansion vascular blood-brain fibrosis caused by microbial infection: it is the result of transmission to the vessel wall through the blood Vtdafh and lead to an expansion, this type has disappeared because of the presence of antibiotics Alehiobh, but he re-emerged after the spread of diseases, lack of immunity and Poor use of antibiotics vital. The expansion of this type so you Mahtria treated first with antibiotics, to begin to shrink in size before surgery of 4-6 weeks.
Expansion of the blood-brain vascular fibrosis-associated tumors: the concomitant expansion and type of tumor that invades the vessel wall, and either the tumor from the brain or from outside it is transferred through the blood.
Second expansion vascular blood-brain spin: (Fusiform)
Also known as sclerotherapy Baltmdeddat resulting from hardening of the very unusual in the vascular wall, often made up stroke cushion in the cavity of the blood vessel.
This happens usually fusiform type of vascular expansion in older patients, and stroke often occur resulting in a dam in the brain stem, and may put pressure on the part of the brain adjacent to it, or may lead to the emergence of symptoms of cerebral palsy nerves.
Third expansion vascular blood-brain Alvsa: (Dissconnecting)
And it accumulates in the blood vessel wall resulting in a narrow cavity in the blood vessel or even Onsdadeh to the large volume expansion. The expansion extends outside the blood vessel component Tkisa the outside wall.
May arise from the expansion of this type because of trauma or because of defects formative walls of blood vessels.
Does not consist of this type of extensibility but rarely inside the skull in cases of severe brain trauma.
Diagnosis:
The blood-brain vascular expansion is evaluated and diagnosed only symptoms of bleeding phenomenon that results from it if it has not been discovered before Tfjrh, and is usually fatal if not severe and rapid intervention to contain it.
In the case of checks to make sure of its existence or lack thereof can do the following:
MRI: despite promising interest of it except that it is difficult to evaluate so that it does not depend upon the whole in the diagnosis.
Vascular radiation telescope (Angiography): is one of the best ways and Aqovernma in cases of non-blood-vascular expansion due to trauma, and it can be evaluated over a narrow blood vessel and its relationship with him from the tissue and vessels and a major subset.
Computerized tomography: help in the diagnosis of 95% of cases of bleeding inside my brain at the beginning, and some types of cerebrovascular aneurysms.
Telescope vascular magnetic resonance: a kind of perspectives that uses MRI as a type of radiation to create images of the cerebral vessels and are surrounded by tissues, and is the best way for the diagnosis of cerebrovascular aneurysms.
How is the treatment of cerebrovascular aneurysms?After confirming the presence of expansion and vascular cerebral hematoma should be to determine how and when the dam will be removed and extensibility.In the past, be delayed intervention for two or three weeks after bleeding in principle to avoid the difficulty of the surgery with swelling of the brain caused by bleeding, but now opinion is preferred to deal surgically with bleeding during the first 48 hours, especially in patients who do not suffer from the symptoms of disadvantages neurological large.
Therapeutic drugs:1. The patient should be given drug prevents constriction of blood vessels such as Nimodipine immediately for a period not less than 21 days, very decisively.2. Must give the patient a suitable property to prevent high blood pressure.3. Reduce the blood must be prevented.4. Prevention of hydrocephalus may be a savior for the life of the patient and the miraculous improvement in his condition.
Surgical intervention:And be either surgical excision or vascular surgical perspectives, the goal of surgery is to isolate the expansion of the blood circulation to the public without the patient's blood vessel bridging the injured lying down.In the case of the inability to do so surgically for any reason (the type of expansion - Place expansion - the age of the patient - the poor condition of the patient's health) may resort to surgery using binoculars blood vessels.
Surgical removal:1. Wrapping any stretch of the winding outside with plastic (or Bolesaria and are chemical compounds) are better than other alternatives such as cotton or muscle tissue from the patient, this procedure does not give very satisfactory results.2. Trapping of any dam the blood vessel before and after stretch and reached the vessel side of the compass to maintain blood flow.3. To link the pre-expansion vessel cerebral mass.
Patient care after surgery:Patient stays in the intensive care unit for critical cases for a period not less than 7-10 days, to prevent constriction of vascular hematoma or edema in the head or bleeding again, They are more complications frequent and dangerous for this type of surgery, and deal with them soon to happen to keep the the patient's life.Most surgeons agree that the restoration of an X-ray of the blood vessels is very useful to ensure the success of the surgery and no complications.
Surgery, surgical perspectives from within the blood vessel:And the expansion of vascular dam is by using binoculars.New in this issue is the use of surgical wire coiled and very small (Micro coil).This surgical wire of platinum ((Platinum Guglielmi detachable coilsThe device is used during surgery to monitor the flow of blood in the arteries (Doppler).Essential to give the patient the doses of heparin to prevent blood clots during surgery and for a period thereafter.Disadvantage of this method is the high rate of recurrence of aneurysms and vascular Tfjradtha.
Date of surgical intervention:
Doctors split on the appropriate time for surgical intervention:
1. Department recognized early surgical intervention within 2-4 days of the start of bleeding.2. And the Department approved the surgical intervention after 10-14 days of the start of bleeding.And agreed that sections boiled abused at the time of the intervention is between 4-10 days from start of bleeding to the presence of a state of contraction vascular blood that prevent surgical intervention and increase the chance of complications.In the end, we find that setting a date surgical intervention needs to the wisdom and experience and patience, and depends on several factors including: the existence of extended vascular or more - the shape and size of the expansion - Place expansion - age of the patient - his illness - the size of the symptoms the patient - rupture vascular and bleeding or not - the presence of concomitant medical conditions such as high blood pressure, kidney disease, lung or heart attack, and the presence of cancer.In the event of discovery and expansion of vascular cerebral hematoma without symptoms is the opinion of the patient and his family a central role in setting a date and the extent and type of intervention.
References:
Pathology Illustrated (ADT Govan / PS Macfarlane / R.Callander) Second Edition
Hutchison's Clinical Methods (Michael Swash) 19th Edition
Brain aneurysm
This topic has been prepared by Physicians Specialty Center for medical advice, in the case of quotation, please refer to our official website www.medicalcom.net
Is widening or expansion in a part of the wall of a blood vessel within the brain due to a lack of ethics, in patients Onatj shocks.This usually occurs at the point of confluence of great arteries, or at the base of the brain in the basal arterial circle (Circle of Willis).In the case of weak blood vessel grows in part out of the result of blood pressure and the greater the size of the expansion, the higher rates exploded, and bleeding within the brain, there is a way to predict the occurrence of the explosion and bleeding, not all cerebral vascular expansion and is subject to explosion.
Statistics show that:
Expansion of less than 10 mm in size are less likely to explode than others (the Great)
40% of those who suffer from explosion to dilate cerebral blood vessel and die during the first year after infection, and about one-third of them will suffer from severe central nervous disorder.
Age is the most vulnerable 40 to 60 years for the onset of symptoms, and rarely occurs in children who are affected by those males more than females Baltmdeddat vascular and are also larger than females.
Patients who survived the explosion of vascular blood-brain more than twice as likely than others to recurrence of aneurysms of cerebral blood and this new expansion vascular six times more likely to flare who did not suffer from it.
Women are more likely than men to Tmdeddat vascular brain.
10% of patients with renal sacculation more vulnerable to cerebral vascular Tmdeddat than others.
15-20% of cases of aneurysms Eugdldém more than one.
75% of cases of expansion have two of those to Tmdeddat vascular
15% have three to Manalhalat Tmdeddat vascular.
Manalhalat 10% have more than three.
Explosion of vascular expansion resulting in the death of 10-20% of cases.
50% of the deaths occur during the first month after hemorrhage.
Higher frequency of bleeding in the first day of the explosion of vascular expansion.
Consists of any wall of a blood vessel of three layers, the middle of them responsible for the muscle flexibility of the blood vessel in response to changes in blood pressure.In case of any weakness (putrefactive) in this class, whatever the cause, arises the so-called lying down vascular blood. Generally thought in the past that the cause of these aneurysms is birth defects in the walls of blood vessels, but now sees some evidence little for other reasons such as:Weakness of the walls of arteries, genetic - Defects formative during growth - and most likely defects Tvskhih mural in the blood vessels, which arise from an imbalance in the dynamics of blood, which is believed to do now as a major cause directly to the occurrence and development of any expansion and vascular, and clots from forming or Tfjrh in the end.
Months of the causes of cerebral vascular aneurysms:1. Dynamic disturbances in blood circulation.2. Vascular disintegration.3. Hardening of the arteries.4. Odguet cases increase the speed of blood flow.5. Congenital vascular malformations.6. Vascular fistula.7. There are other reasons are less frequent, such as: HIV infections - infections that lead to weak blood vessels - Diseases cancer - the misuse of drugs, including heroin, cocaine and ephedrine.
Types of vascular aneurysms Alddmagah:Expansion can be real or false.1. Expansion vascular blood-brain false: for Hoabarh cavity in the wall of the blood vessel, filled blocked by a blood clot.2. Expansion vascular blood-brain real: It is our topic be in the form of three forms:Casey (Saccular), fusiform (Fusiform) and lobar (Dissecting).
Here we will discuss three types Blaadah each separately.First stretch the blood-brain vascular fibrosis: (Dissecting)Is a real breadth of Casey all layers constituting the vessel wall, mostly at the points of branching arteries.In most cases, no symptoms occur until the flare-up of the blood-brain vascular expansion, and then show case of the worst headaches brain of the patient symptomatic membrane of the brain.There are several ways to assess the severity of symptoms, from headaches, stiff neck muscles and the background, and ending with comatose and sclerosis year, and many symptoms, including Aatmadaaly place and vascular blood volume expansion and condition of the explosion or not.
There are several reasons for the expansion of the blood-brain vascular fibrosis:
Expansion of the blood-brain vascular fibrosis due to injury: and be due to either penetrating head injury, such as firearms, or non-penetrating injury of the head and are rare, such as trauma and fractures of the skull.
Expansion vascular blood-brain fibrosis caused by microbial infection: it is the result of transmission to the vessel wall through the blood Vtdafh and lead to an expansion, this type has disappeared because of the presence of antibiotics Alehiobh, but he re-emerged after the spread of diseases, lack of immunity and Poor use of antibiotics vital. The expansion of this type so you Mahtria treated first with antibiotics, to begin to shrink in size before surgery of 4-6 weeks.
Expansion of the blood-brain vascular fibrosis-associated tumors: the concomitant expansion and type of tumor that invades the vessel wall, and either the tumor from the brain or from outside it is transferred through the blood.
Second expansion vascular blood-brain spin: (Fusiform)
Also known as sclerotherapy Baltmdeddat resulting from hardening of the very unusual in the vascular wall, often made up stroke cushion in the cavity of the blood vessel.
This happens usually fusiform type of vascular expansion in older patients, and stroke often occur resulting in a dam in the brain stem, and may put pressure on the part of the brain adjacent to it, or may lead to the emergence of symptoms of cerebral palsy nerves.
Third expansion vascular blood-brain Alvsa: (Dissconnecting)
And it accumulates in the blood vessel wall resulting in a narrow cavity in the blood vessel or even Onsdadeh to the large volume expansion. The expansion extends outside the blood vessel component Tkisa the outside wall.
May arise from the expansion of this type because of trauma or because of defects formative walls of blood vessels.
Does not consist of this type of extensibility but rarely inside the skull in cases of severe brain trauma.
Diagnosis:
The blood-brain vascular expansion is evaluated and diagnosed only symptoms of bleeding phenomenon that results from it if it has not been discovered before Tfjrh, and is usually fatal if not severe and rapid intervention to contain it.
In the case of checks to make sure of its existence or lack thereof can do the following:
MRI: despite promising interest of it except that it is difficult to evaluate so that it does not depend upon the whole in the diagnosis.
Vascular radiation telescope (Angiography): is one of the best ways and Aqovernma in cases of non-blood-vascular expansion due to trauma, and it can be evaluated over a narrow blood vessel and its relationship with him from the tissue and vessels and a major subset.
Computerized tomography: help in the diagnosis of 95% of cases of bleeding inside my brain at the beginning, and some types of cerebrovascular aneurysms.
Telescope vascular magnetic resonance: a kind of perspectives that uses MRI as a type of radiation to create images of the cerebral vessels and are surrounded by tissues, and is the best way for the diagnosis of cerebrovascular aneurysms.
How is the treatment of cerebrovascular aneurysms?After confirming the presence of expansion and vascular cerebral hematoma should be to determine how and when the dam will be removed and extensibility.In the past, be delayed intervention for two or three weeks after bleeding in principle to avoid the difficulty of the surgery with swelling of the brain caused by bleeding, but now opinion is preferred to deal surgically with bleeding during the first 48 hours, especially in patients who do not suffer from the symptoms of disadvantages neurological large.
Therapeutic drugs:1. The patient should be given drug prevents constriction of blood vessels such as Nimodipine immediately for a period not less than 21 days, very decisively.2. Must give the patient a suitable property to prevent high blood pressure.3. Reduce the blood must be prevented.4. Prevention of hydrocephalus may be a savior for the life of the patient and the miraculous improvement in his condition.
Surgical intervention:And be either surgical excision or vascular surgical perspectives, the goal of surgery is to isolate the expansion of the blood circulation to the public without the patient's blood vessel bridging the injured lying down.In the case of the inability to do so surgically for any reason (the type of expansion - Place expansion - the age of the patient - the poor condition of the patient's health) may resort to surgery using binoculars blood vessels.
Surgical removal:1. Wrapping any stretch of the winding outside with plastic (or Bolesaria and are chemical compounds) are better than other alternatives such as cotton or muscle tissue from the patient, this procedure does not give very satisfactory results.2. Trapping of any dam the blood vessel before and after stretch and reached the vessel side of the compass to maintain blood flow.3. To link the pre-expansion vessel cerebral mass.
Patient care after surgery:Patient stays in the intensive care unit for critical cases for a period not less than 7-10 days, to prevent constriction of vascular hematoma or edema in the head or bleeding again, They are more complications frequent and dangerous for this type of surgery, and deal with them soon to happen to keep the the patient's life.Most surgeons agree that the restoration of an X-ray of the blood vessels is very useful to ensure the success of the surgery and no complications.
Surgery, surgical perspectives from within the blood vessel:And the expansion of vascular dam is by using binoculars.New in this issue is the use of surgical wire coiled and very small (Micro coil).This surgical wire of platinum ((Platinum Guglielmi detachable coilsThe device is used during surgery to monitor the flow of blood in the arteries (Doppler).Essential to give the patient the doses of heparin to prevent blood clots during surgery and for a period thereafter.Disadvantage of this method is the high rate of recurrence of aneurysms and vascular Tfjradtha.
Date of surgical intervention:
Doctors split on the appropriate time for surgical intervention:
1. Department recognized early surgical intervention within 2-4 days of the start of bleeding.2. And the Department approved the surgical intervention after 10-14 days of the start of bleeding.And agreed that sections boiled abused at the time of the intervention is between 4-10 days from start of bleeding to the presence of a state of contraction vascular blood that prevent surgical intervention and increase the chance of complications.In the end, we find that setting a date surgical intervention needs to the wisdom and experience and patience, and depends on several factors including: the existence of extended vascular or more - the shape and size of the expansion - Place expansion - age of the patient - his illness - the size of the symptoms the patient - rupture vascular and bleeding or not - the presence of concomitant medical conditions such as high blood pressure, kidney disease, lung or heart attack, and the presence of cancer.In the event of discovery and expansion of vascular cerebral hematoma without symptoms is the opinion of the patient and his family a central role in setting a date and the extent and type of intervention.
References:
Pathology Illustrated (ADT Govan / PS Macfarlane / R.Callander) Second Edition
Hutchison's Clinical Methods (Michael Swash) 19th Edition
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