Cerebrovascular disease of Brain CT

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

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

9. Middle cerebral A (MCA)

10. Posterior communicating A Acom. Pcom. ICA

11. PCA

12. PCA • 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 cerebrovasculardz • Transient ischemic attack : TIA • Reversible ischemic neurologic deficit : RIND • Progressing stroke • Completed stroke

15. Ischemic Cerebrovasculardz • 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. IntracranialAneurysm

33. IntracranialAneurysm

34. IntracranialAneurysm SizeSmall < 10mm Large : 10-24mmGiant > 25mm

35. IntracranialAneurysm • 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. IntracranialAneurysm Aneurysm at the Lt. anterior cerebral area.

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

38. IntracranialAneurysm Aneurysm at the middle cerebral bifurcation area.

39. Intracranial Aneurysm P-com area에 posterior direction의 aneurysmal sac이 보이고 size는 8mm 으로 측정됨. 25%

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. Moyamoya disease

45. Moyamoya disease

46. 감사합니다.