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    Vazospazam

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    scepan
    This document discusses cerebral vasospasm, which is a prolonged contraction of cerebral arteries caused by blood products released after subarachnoid hemorrhage. Ultrasound criteria are used to diagnose and monitor cerebral vasospasm. Transcranial Doppler ultrasonography can detect increased blood flow velocities and other signs that indicate vasospasm. Vasospasm is treated initially with medical therapies like calcium channel blockers, hypervolemia, and hypertension. More severe cases may require angioplasty or intra-arterial papaverine injections, and response to treatment can be assessed with follow-up ultrasound exams.

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    Vazospazam

    Uploaded by

    scepan
    316 views16 pages
    This document discusses cerebral vasospasm, which is a prolonged contraction of cerebral arteries caused by blood products released after subarachnoid hemorrhage. Ultrasound criteria are used to diagnose and monitor cerebral vasospasm. Transcranial Doppler ultrasonography can detect increased blood flow velocities and other signs that indicate vasospasm. Vasospasm is treated initially with medical therapies like calcium channel blockers, hypervolemia, and hypertension. More severe cases may require angioplasty or intra-arterial papaverine injections, and response to treatment can be assessed with follow-up ultrasound exams.

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    vasospasam, angiology, neurology, radiology

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    vazospazam

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    This document discusses cerebral vasospasm, which is a prolonged contraction of cerebral arteries caused by blood products released after subarachnoid hemorrhage. Ultrasound criteria are used to diagnose and monitor cerebral vasospasm. Transcranial Doppler ultrasonography can detect increased blood flow velocities and other signs that indicate vasospasm. Vasospasm is treated initially with medical therapies like calcium channel blockers, hypervolemia, and hypertension. More severe cases may require angioplasty or intra-arterial papaverine injections, and response to treatment can be assessed with follow-up ultrasound exams.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    316 views16 pages

    Vazospazam

    Uploaded by

    scepan
    This document discusses cerebral vasospasm, which is a prolonged contraction of cerebral arteries caused by blood products released after subarachnoid hemorrhage. Ultrasound criteria are used to diagnose and monitor cerebral vasospasm. Transcranial Doppler ultrasonography can detect increased blood flow velocities and other signs that indicate vasospasm. Vasospasm is treated initially with medical therapies like calcium channel blockers, hypervolemia, and hypertension. More severe cases may require angioplasty or intra-arterial papaverine injections, and response to treatment can be assessed with follow-up ultrasound exams.

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    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 16

    ULTRAZVUNI KRITERIJUMI CEREBRALNOG VAZOSPAZMA

    Doc. Dr sci med Zagorka Jovanovi Institut za neurologiju Kliniki centar Srbije, Beograd

    CEREBRALNI VAZOSPAZAM

    CEREBRALNI VAZOSPAZAM JE PRODUENA KONTRAKCIJA CEREBRALNIH ARTERIJA KOJA NASTAJE POD UTICAJEM PRODUKATA IZLIVENE KRVI NA CEREBRALNE ARTERIJE. CEREBRALNI VAZOSPAZAM je najee komplikacija SUBARAHNOIDNE HEMORAGIJE (SAH), koji je esto odgovoran za nastanak ODLOENOG ISHEMIKOG DEFICITA MOZGA. Moe biti posledica i TRAUME GLAVE ili NEUROHIRURKE INTERVENCIJE (angiografije, vazoplastike, operacije drugih razloga).

    uinjene

    iz

    FISHER-ova gradacija SAH na osnovu CT-a

    1. Krv nije detektovana 2. Difuzni ili linijski sloj krvi <1 mm debljine 3. Lokalizovani subarahnoidni izliv krvi ili sloj 1 mm debljine 4. Intracerebralna ili intraventrikularna krv sa difuznom SAH

    Newell W.D, Alexandrov V.A. Cerebrovascular Ultrasound in Stroke Prevention and Treatment, 2004, 181-191.

    CEREBRALNI VAZOSPAZAM KOD SUBARAHNOIDNE HEMORAGIJE

    HEMOGLOBIN I DRUGI PRODUKTI IZLIVENE KRVI (biohemijske promene u zidu arterija) MUSKULARNA KONTRAKCIJA I DEPOZICIJA KOLAGENA SUAVANJE CEREBRALNIH ARTERIJA REDUKCIJA PROTOKA

    TCD KRITERIJUMI u dijagnostici i praenju SAH

    DIJAGNOSTIKE PROCEDURE CT mozga bez kontrasta TCD (transkranijalni dopler) MONITORING VAZOSPAZMA DSA (digitalna subtrakciona angiografija)

    MRA (magnetna rezonantna angiografija SPECT (singl foton emition computed tomography) PET (positron emition tomography)

    ULTRAZVUNE KARAKTERISTIKE VAZOSPAZMA


    1- POVEANJE BRZINA Na ACM, vazospazam poinje sa brzinom iznad 120 sm/sec; 200 sm/sec kroz ACM predstavlja izraen vazospazam, lumen ACM je redukovan na 1 mm) 2- KRATKO VREME AKCELERACIJE 3- POVEAN INDEKS PULSATILNOSTI (iznad 1.17) na proksimalnim arterijama 4- POVEAN HILDEGARDOV ODNOS Hildegardov odnos= sred. brzina ACM = 1.7 sred. brzina ACI Hildegardov odos 3 ozbiljan vazospazam

    MONITORING VAZOSPAZMA
    PRVI TCD PREGLD BILATERALNI MONITORING prvi dan: neurooki pregled, CT, TCD, DSA-pre poetka ili posle prekida vazospazma

    SVAKODNEVNO PRAENJE (BILATERALNI MONITORING) vazospazma Utvrivanje vremena pojave vazospazma Tok vazopazma Efekat leenja (HHH, antagonisti Ca, papaverin, angioplastika) Zavretak vazospazma

    VAZOSPAZAM PROKSIMALNOG DELA a. Cerebri mediae

    LEVO, gore- Angiogram levog karotidnog stabla, ACM bez vazospazma (prvi dan SAH) Levo dole odgovarajui TCD ACM (97 sm/sec) DESNO, gore vazospazam proksimalnog dela ACM Desno dole- odgovarajui TCD -visoke brzine u proksimalom delu ACM (239 sm/sec)

    Newell W.D, Alexandrov V.A. Cerebrovascular Ultrasound in Stroke Prevention and Treatment, 2004, 181-191.

    VAZOSPAZAM M2 ACM

    ISTI BOLESNIK, posle angioplastike ANGIOGRAM - Leva ACI, kao i M1 ACM pokazuje poboljanje dijametra, posle balonangioplastike, M2 vazospazam. TCD M1 ACM (gore desno) Saniran spazam M1 ACM TCD pokazuje ponoljanu sred. brzinu 97 sm/sec). TCD M2 ACM (dole levo)veliko poveanje brzina, srednja 258 sm/sec

    Newell W.D, Alexandrov V.A. Cerebrovascular Ultrasound in Stroke Prevention and Treatment, 2004, 181-191.

    TCD U PACIJENTA SA BILATERALNIM VAZOSPAZMOM ACA

    Newell W.D, Alexandrov V.A. Cerebrovascular Ultrasound in Stroke Prevention and Treatment, 2004, 181-191.

    MULTIPLI VAZOSPAZAM POSLE SAH Ruptura aneurizme a.cerebelli post. inf. desno
    CT difuzna kolekcija u subarahnoidnom prostoru i bazalnoj cisterni

    55 god, Prvi dan, NEMA VAZOSPAZMA Hipoplastina AV desno, sa sindromom krae (nie amplitude, bifazni protok) Leva AV irokog lumena, dobrog protoka

    MULTIPLI VAZOSPAZAM

    55 god,

    Drugog dana posle SAH klipovanje aneurizme


    Petog dana (slika) NE REGISTRUJE SE VAZOSPAZAM (brzine protoka u svim arterijama dobre )

    MULTIPLI VAZOSPAZAM

    55 god, GLAVOBOLJE I DALJE, POJAVA SOMNOLENCIJE

    Od 5. do 16 dana: TCD- -STALNO POVEANJE BRZINA u AB, ACP obostrano, ACA obostrano, posebno desno(222 sm/sec) MULTIPLI VAZOSPAZAM (slika)
    PREPORUENA DSA

    MULTIPLI VAZOSPAZAM

    55 god, ; DSA- 16 dana od poetka SAH uraena DSA Levo: AB prvog dana, normalnog dijametra, i 16. danavazospazam. Desno: ACA prvog dana, bez vazospazma, i 16-og dana, sa vazospazmom.

    LEENJE BOLESNICE SA MULTIPLIM VAZOSPAZMOM CEREBRALNIH ARTERIJA

    BOLESNICA LEENA BALON ANGIOPLASTIKOM DILATACIJOM A. Basilaris i INTRAARTERIJSKIM UBRIZGAVANJEM PAPAVERINA u A. Cerebri posterior levo i A. Cerebri anterior desno OPORAVLJENA u potpunosti. TCD pokazao normalne brzine cerebralnih arterija i Hildegardove indekse.

    LEENJE VAZOSPAZMA I PRAENJE EFEKTA LEENJA TCD-OM

    3 H (HHH): Hipertenzija (vazopresori) Hipervolemija, Hemodilucija (kristaloidne i koloidne solucije)


    BLOKATORI KALCIJUMOVIH KANALA (nimodipin) BALON ANGIOPLASTIKA-balon kateter PAPAVERIN i.a. (preko katetera) TCD smanjivanje brzina i Hildegardovog odnosa (do normalnih granica)- znak prestanka vazospazma

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