脑动静脉畸形.ppt
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1、CEREBRAL ARTERIOVENOUS MALFORMATIONS,AVM: a TLA for the CNS,Incidence,0.52% at autopsy Slight male preponderance (1.09 to 1.94) Congenital lesions (although rarely familial),Embryology,First half of third week of gestation epiblastic cells migrate to form mesoderm mesodermal cells differentiate to a
2、rterial and venous vessels on the surface of the embryonic nervous system,Embryology,First half of third week of gestation epiblastic cells migrate to form mesoderm mesodermal cells differentaite to arterial and venous vessels on the surface of the embryonic nervous system Seventh gestational week v
3、essels sprout branches & penetrate developing brain reach the gray-white interface, either loop back to pial surface or traverse entire neural tube, thus epicerebral & transcerebral circn eventually connect arterial and venous systems by around the twelfth week,Pathology & Pathophysiology,absence of
4、 normal capillary system,Pathology & Pathophysiology,absence of normal capillary system usual function displaced,Pathology & Pathophysiology,absence of normal capillary system usual function displaced asymptomatic at birth,Pathology & Pathophysiology,absence of normal capillary system usual function
5、 displaced asymptomatic at birth vessels change with time may develop aneurysms,parenchymal changes within and around the lesion,Pathology & Pathophysiology,absence of normal capillary system usual function displaced asymptomatic at birth vessels change with time may develop aneurysms,parenchymal ch
6、anges within and around the lesion site frequency is proportional to brain volume,Pathology & Pathophysiology,absence of normal capillary system usual function displaced asymptomatic at birth vessels change with time may develop aneurysms,Clinical presentation,95% have symptoms by age of 70 years,Cl
7、inical presentation,95% have symptoms by age of 70 years peak presentation second to fourth decade,Clinical presentation,95% have symptoms by age of 70 years peak presentation second to fourth decade high output failure, neonate, vein of Galen hydrocephalus, first decade headache, hemorrhage, seizur
8、es, 2nd & 3rd,Clinical presentation,factors contributing to symptoms vessel walls, flow and pressures,Clinical presentation,factors contributing to symptoms vessel walls, flow and pressures enlargement and encroachment,Clinical presentation,factors contributing to symptoms vessel walls, flow and pre
9、ssures enlargement and encroachment dural sinuses,Clinical presentation,factors contributing to symptoms vessel walls, flow and pressures enlargement and encroachment dural sinuses ischaemia,Clinical presentation,factors contributing to symptoms vessel walls, flow and pressures enlargement and encro
10、achment dural sinuses ischaemia cardiac output,Clinical presentation,Hemorrhage,AVM rupture not a function of size,Aneurysm rupture related to aneurysm size,Hemorrhage,AVM rupture not a function of size no marked increase with exercise, pregnancy, trauma,Aneurysm rupture related to aneurysm size inc
11、rease with trauma exercise, end pregnancy,Hemorrhage,AVM rupture not a function of size no marked increase with exercise, pregnancy, trauma arteriovenous, therefore less severe,Aneurysm rupture related to aneurysm size increase with trauma exercise, end pregnancy arterial, therefore more severe,Hemo
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- 静脉 畸形
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