Vascular Malformations

Question 1

popcorn MRI

Answer 1

multiple cavernomas. intractable seizures. bright on CT bc of pooling blood. blood product of dif age= characteristic. hyper intensity is methemoglobin. hypo intense ring-hemosiderin on T2. Predisposing gene -CCM1/2/3. most in superficial in cortex ad jot subarachnoid space. can be anywhere

Question 2

Fischer scale

Answer 2

1) no blood. 2) diffuse blood 3) clot 4) intraventricular or intraparenchymal blood. for SAH.

Question 3

pupil/CN3 involved severe sudden HA

Answer 3

think PCA aneurysm

Question 4

SAH management

Answer 4

all admitted to ICU for monitor for signs of respiratory distress of neuro deterioration.

Question 5

SAH complciations

Answer 5

1) rebleeding 2) vasosplasm 3) hyponatremia 4) cardiac dysfunction 5)hydrocephalus

Question 6

rebleeding v SAH

Answer 6

rerupture rate of untreated aneurysm is 30%. highest risk is 1st week. 50% of pt with 2nd aneurysm die.

Question 7

hyponatremia SAH

Answer 7

due to inappropriate secretion of vasopressin- “cerebral salt wasting.” occurs btw 3-7d. should not be treated with free water restriction bc that can cause cerebral ischemia. tx with intravenous normal saline, sodium tablets or hypertonic saline

Question 8

cardiac dysfunc SAH

Answer 8

often dev T wave inversion or ST elevation ~ MI. SHF from myocardial damage due to catecholamine surge. normalizes over 3-4wks.

Question 9

aneurysm RF

Answer 9

drug use (cocaine, amphetamine, cigarettes, alcohol). fx, HTN, polycystic kidney disease, marina’s, ehlers-danlos syndrome, fibromuscular dysplasia.

Question 10

aneurysm size v rupture rate

Answer 10

10mm-1%. >25mm-6%

Question 11

fusiform aneurysm

Answer 11

uniform dilation of an entire artery

Question 12

hydrocephalus v SAH

Answer 12

occur wks to mo post aneurysm rupture due to obstruction of CSF reabsorption within arachnoid granulations and presents with classic triad of gait, apraxia, dementia and urinary incontinence. ventricular shunting is needed. may be acute-obtundation or coma. = need emergent ventricle drainage

Question 13

vasospasm v SAH

Answer 13

dx by doppler US(show incr flow due to narrowing) or CT angio. prevent with triple H therapy (HTN, hypervolemia, hemodilution)

Question 14

AVM T2

Answer 14

apear as multiple flow voids

Question 15

capillary telaniectasia

Answer 15

seen in MS. rarely of clinical sig. formed by network of dialed capillaries. surround brain tissue is normal. most commonly in pons

Question 16

developmental venous anomalies (DVA)

Answer 16

most common vascular malformation. composed of enlarged collection of veins. rarely bleed. no surgical resection bc can cause venous infarction

Question 17

kissing carotids

Answer 17

carotids deviate medially in sella. can compress pituitary gland or stalk. relevant in pt who need transphenoidal surgery

Question 18

dolichoectasia

Answer 18

elongation and distention of artery due to deterioration of tunica intimate and weakening of vessel wall usually due to HTN. indivi present with cranial N dysfunction. most likely effect basilar- present with multi CN dysfunc due to mass effect.

Question 19

paraganglioma

Answer 19

rare neuroendocrine neoplasm. most are benign. arise from carotid body- painless mass in neck or mass effect on vagus/hypoglossal. surgical removal. rarely secrete hormone

Question 20

congenital absence of ICA

Answer 20

rare. collateral flow through circle of wills from persistent embryonic vessel or transcranial collateral from external carotid artery.

Question 21

embryonic cxn btw ICA and vertebrobasilar system

Answer 21

trigeminal, otic and hypoglossal artery. persistence in adult associated with higher rate of vascular malformation like aneurysm and AVM. can dev CN def or trigeminal neuralgia

Question 22

posterior reversible encephalopathy syndrome (PRES)

Answer 22

rated incr in BP or due to ummunosuppresant use like tacrolimus or cyclosporin. path- disordered cerebral auto regulation of vasculature in posterior regions of brain.
present: visual sx, seizure, HA, altered mental status. reversible with normalization of BP or discontinue med. some left with permanent visual deficit

Question 23

moyamoya disease

Answer 23

occlusive arteriopathy that affect terminal ICA + proximal ACA and MCA. in asia. look like puff of smoke

Question 24

vasculitis labs

Answer 24

incr CRP. confirm with mining’s biopsy