Cerebrovascular Disease

Cerebral aneurysms

Arteriovenous malformations

Arteriovenous fistulae

Cerebral aneurysms

The most common form of cerebral aneurysm is called a berry aneurysm, because its shape resembles a small berry. They develop at branching points of cerebral arteries where the arterial wall tends to be thin. The aneurysm wall can thin out and leak, especially at its dome. An aneurysm may never leak, but once it does, the risk of subsequent hemorrhage increases.

Patients with leaking cerebral aneurysms typically present with the sudden onset of severe headache, often followed by nausea, vomiting, and varying degrees of altered consciousness or neurological deficit. These symptoms are caused by sudden leakage of arterial blood from the aneurysm. The degree of leakage varies from mild to severe. After the initial hemorrhage, there is risk of recurrent hemorrhage – particularly in the first 24 hours.

The treatment goal is to stabilize the patient medically, then take the steps necessary to exclude the aneurysm from the cerebrovascular circulation. There are several techniques to accomplish this including a direct surgical intervention or endovascular obliteration of the aneurysm. There may be delayed complications as a result of the hemorrhagic event, which must be managed medically while treating the aneurysm itself.

Arteriovenous malformations

Arterivenous malformations consist of an abnormal network of arteries and veins that are usually present from birth, and may enlarge over a period of years. These lesions may also produce hemorrhage, although the risk of death from a single hemorrhage is not as high as it is with cerebral aneurysms. Malformations may also cause progressive neurological deficit and seizures.

Arteriovenous malformations may be surgically excised, treated by endovascular techniques, or by a combination of endovascular and surgical management.

Arteriovenous fistulae

Arteriovenous fistulae are lesions consisting of an abnormal communication between an artery and a vein, usually around the base of the skull where the arteries and veins are in close proximity. These lesions can be present from birth, or can be acquired as a result of head trauma. They can often be managed by endovascular techniques.