Neurovascular Disorders Diagnoses
ANEURYSM
An abnormal balloon-like bulging of an artery’s wall. As the artery bulges, it is weakened and its chances of rupturing increase. Aneurysms can form in any part of the body, but only those affecting the arteries supplying the brain can cause a stroke. The condition is worsened by hypertension, aging and atherosclerosis. If an aneurysm ruptures, blood flows into the brain, or a protective membrane surrounding the brain called the subarachnoid space. Aneurysmal subarachnoid hemorrhage is a medical emergency. Aneurysm treatment options.
ARTERIOVENOUS MALFORMATION (AVM)
A complex tangle of thin-walled blood vessels that can break more easily than normal, healthy vessels. AVM’s are commonly associated with strokes at younger ages (20 – 40 years old), but the onset of symptoms is usually not as fast as the ones produced by an aneurysm rupture. Arteriovenous Malformation (AVM) treatment options.
CAROTID ARTERY DISEASE
Carotid Artery Disease is the blockage or narrowing of the carotid arteries, the main source of blood flow from the heart to the brain. The carotid arteries can become blocked (occluded) or narrowed (stenosis) due to several different types of disease. The most common cause is atherosclerosis, a hardening or thickening of artery walls caused by plaque or fatty deposits. These deposits may prevent adequate blood flow into the brain, causing a variety of complications including stroke. Carotid Artery Disease treatment options.
CAROTID-CAVERNOUS FISTULA (CCF)
An uncommon and unique subgroup of AVMs. They can be separated into two categories direct and indirect. A direct CCF has connections between the carotid artery and the veins of the cavernous sinus (usually due to trauma or ruptured aneurysm). An indirect CCF usually occurs spontaneously. It is an abnormal connection in which small arterial branches supply the veins. Both types threaten vision as well as eye movement and both conditions can result in major stroke. Carotid-Cavernous Fistula (CCF) treatment options.
CEREBROVASCULAR ISCHEMIA
See Stroke. Stroke treatment options.
INTRACRANIAL ATHLEROSCLEROTIC DISEASE (ICAD)
Intracranial atherosclerotic disease accounts for 8-10% of all ischemic strokes in the United States. Approximately 70,000 Americans suffer an ICAD related stroke each year. Until recently, the only approved treatment option was medical management. The WASID (Warfarin vs. Aspirin for Symptomatic Intracranial Disease) study, published in the New England Journal of Medicine in 2005, showed that statistically, warfarin was no more effective in preventing stroke than aspirin, and warfarin can cause more hemorrhages. In addition, patients with a 70% stenosis and who are on meds are at high risk (23%) for a recurrent stroke after one year.
There is now an alternative for treating these high-risk patients. In August 2005, the FDA approved a device called the WingspanTM Stent System to treat ICAD. Designed for the brain’s fragile vessels, the Wingspan Stent System is a system that enables appropriately trained and experienced physicians to reach and open narrowed arteries in very deep parts of brain.
Dr Farhat is highly experienced with this technique and can offer this advanced care.
MOYA MOYA DISEASE
Moya Moya Disease is a rare disorder of uncertain cause that leads to irreversible blockage of the main blood vessels to the brain as they enter into the skull. This blockage tends to cause strokes or seizures. The process of blockage (vascular occlusion) once it begins tends to continue despite any known medical management unless treated with surgery.
Once a diagnosis is suspected by CT or MRI, the next step is usually an angiogram to confirm the diagnosis and to see the anatomy of the vessels involved. Often nuclear medicine studies such as SPECT (single photon emission computerized tomography) are used to demonstrate the decreased blood and oxygen supply to areas of the brain involved with the Moya-moya disease. The next step is for the neurosurgeon to decide what type of operation is best suited for the child. Moya-moya disease treatment options.
VASOSPASM
A dangerous side effect of subarachnoid hemorrhage that irritates the blood vessels on the surface of the brain causing them to constrict erratically, cutting off blood flow. Vasospasm treatment options.
VEIN OF GALEN MALFORMATIONS (VGM)
VGM is a very rare condition affecting the blood vessels of the brain. Occurring during embryonic development, VGM’s are abnormal connections between arteries and the deep draining veins of the brain. Under normal conditions these arteries and veins are connected by capillaries that function to slow blood flow through the brain, allowing for the necessary exchange of oxygen and nutrients. VGM’s do not have capillaries, thus the blood flow can be extremely fast increasing the work of the heart. Causing excessive strain on the heart, the result can be cardiac failure, which is the most common symptom of this disease. The high flow of blood can also interfere with the normal blood drainage of the brain, which can cause the development of hydrocephalus. Hydrocephalus treatment options.
Stroke
A stroke is a condition in which vital supplies of blood and oxygen leading to the brain are suddenly interrupted. A stroke can damage brain tissue and cause loss of some of the physical and mental functions controlled by the injured area of the brain. Strokes occur when an artery or blood vessel leading to or in the brain becomes blocked or ruptures. There are two types of stroke, ischemic stroke (blocking) and hemorrhagic stroke (bleeding).
According to the National Stroke Association, approximately 750,000 Americans experience a stroke each year. Of those, approximately 21% will be fatal, making stroke the nation’s third leading single cause of death. Further information is available on the National Stroke Association website www.stroke.org.
ISCHEMIC STROKE
Ischemic Stroke occurs when an artery supplying the brain with blood becomes blocked, suddenly decreasing or stopping blood flow and ultimately causing brain cells to die and some body functions to become impaired. This kind of stroke accounts for approximately 80 percent of all strokes.
There are two types of ischemic or clot-caused strokes, thrombotic and embolic. A thrombotic stroke occurs when a blood clot forms within an artery that supplies blood to the brain. An embolic stroke occurs when a plaque fragment or blood clot travels to the brain from the heart or another artery supplying the brain. These types of blockages in the arteries may be due to atherosclerosis or hardening of the arteries caused by cholesterol or plaque build-up.
HEMORRHAGIC STROKE
Hemorrhagic Stroke occurs when a blood vessel in the brain breaks or ruptures. Long-term high blood pressure can weaken blood vessels in the brain and eventually cause a hemorrhagic stroke (cerebral hemorrhage).
Hemorrhagic strokes are divided into two types, intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH). An intracerebral hemorrhage is characterized by bleeding into the brain itself. High blood pressure may cause small blood vessels to bulge and eventually burst spilling blood into the brain. The bleeding damages brain cells and the damaged area cannot function properly. A subarachnoid hemorrhage is characterized by bleeding into the area that surrounds the brain. This type of hemorrhage has many possible causes but is usually the result of a ruptured aneurysm. Blood from a ruptured aneurysm (a weak and balloon-like bulging portion of an artery) may bleed into the space between two membranes on the surface of the brain. The bleeding can increase pressure in and on the brain, injuring brain cells and may affect brain function. A subarachnoid hemorrhage may also be caused by bleeding from a tangle of abnormal blood vessels called an arteriovenous malformation (AVM).