医学优质课件精选——《脑动静脉畸形》.ppt
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1、,脑动静脉畸形,执教教师:XXX,CEREBRALARTERIOVENOUS MALFORMATIONS,AVM: a TLA for the CNS,Incidence,0.52% at autopsySlight male preponderance (1.09 to 1.94)Congenital lesions (although rarely familial),Embryology,First half of third week of gestationepiblastic cells migrate to form mesodermmesodermal cells differ
2、entiate to arterial and venous vessels on the surface of the embryonic nervous system,Embryology,First half of third week of gestationepiblastic cells migrate to form mesodermmesodermal cells differentaite to arterial and venous vessels on the surface of the embryonic nervous systemSeventh gestation
3、al weekvessels sprout branches & penetrate developing brainreach the gray-white interface, either loop back to pial surface or traverse entire neural tube, thus epicerebral & transcerebral circneventually connect arterial and venous systems by around the twelfth week,Pathology & Pathophysiology,abse
4、nce of normal capillary system,Pathology & Pathophysiology,absence of normal capillary systemusual function displaced,Pathology & Pathophysiology,absence of normal capillary systemusual function displacedasymptomatic at birth,Pathology & Pathophysiology,absence of normal capillary systemusual functi
5、on displacedasymptomatic at birthvessels change with timemay develop aneurysms,parenchymal changes within and around the lesion,Pathology & Pathophysiology,absence of normal capillary systemusual function displacedasymptomatic at birthvessels change with timemay develop aneurysms,parenchymal changes
6、 within and around the lesionsite frequency is proportional to brain volume,Pathology & Pathophysiology,absence of normal capillary systemusual function displacedasymptomatic at birthvessels change with timemay develop aneurysms,Clinical presentation,95% have symptoms by age of 70 years,Clinical pre
7、sentation,95% have symptoms by age of 70 yearspeak presentation second to fourth decade,Clinical presentation,95% have symptoms by age of 70 yearspeak presentation second to fourth decadehigh output failure, neonate, vein of Galenhydrocephalus, first decadeheadache, hemorrhage, seizures, 2nd & 3rd,C
8、linical presentation,factors contributing to symptomsvessel walls, flow and pressures,Clinical presentation,factors contributing to symptomsvessel walls, flow and pressuresenlargement and encroachment,Clinical presentation,factors contributing to symptomsvessel walls, flow and pressuresenlargement a
9、nd encroachmentdural sinuses,Clinical presentation,factors contributing to symptomsvessel walls, flow and pressuresenlargement and encroachmentdural sinusesischaemia,Clinical presentation,factors contributing to symptomsvessel walls, flow and pressuresenlargement and encroachmentdural sinusesischaem
10、iacardiac output,Clinical presentation,Hemorrhage,AVMrupture not a function of size,Aneurysmrupture related to aneurysm size,Hemorrhage,AVMrupture not a function of sizeno marked increase with exercise, pregnancy, trauma,Aneurysmrupture related to aneurysm sizeincrease with trauma exercise, end preg
11、nancy,Hemorrhage,AVMrupture not a function of sizeno marked increase with exercise, pregnancy, traumaarteriovenous, therefore less severe,Aneurysmrupture related to aneurysm sizeincrease with trauma exercise, end pregnancyarterial, therefore more severe,Hemorrhage,AVMrupture not a function of sizeno
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