Brain Aneurysm Coiling : Endovascular Coiling of Intracranial Aneurysms in Mumbai
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Transcript of Brain Aneurysm Coiling : Endovascular Coiling of Intracranial Aneurysms in Mumbai
BRAIN ANEURYSM COILINGDr.Saurabh Joshi, MD, FNVIR
www.VeinCenter.in
• 26 yr old male presented with sudden onset severe headache.
CLINICAL GRADING SCALES FOR SAH Grade Description
Hunt and Hess Scale
1 Asymptomatic or minimal headache and slight nuchal rigidity
2 Moderate to severe headache, nuchal rigidity, no neurological deficit other than cranial nerve palsy
3 Drowsiness, confusion, or mild focal deficit
4 Stupor, moderate to severe hemiparesis, possible early decerebrate rigidity and vegetative disturbances
5 Deep coma, decerebrate rigidity, moribund appearance
CLINICAL GRADING SCALES FOR SAH
Grade Description
World Federation of Neurological Surgeons Scale
1 GCS 15, no motor deficit
2 GCS 13 to 14, no motor deficit
3 GCS 13 to 14, with motor deficit
4 GCS 7 to 12, with or without motor deficit
5 GCS 3 to 6, with or without motor deficit
THE FISHER GRADING OF SAH AS DEMONSTRATED BY CT SCAN
Grade1
2
3
4
Description
No blood detected
A diffuse deposition or thin layer with all vertical layers of blood (interhemispheric fissure, insular cistern, ambient cistern) less than 1 mm thick)
Localized clots and/or vertical layers of blood 1 mm or greater in thickness
Diffuse or no subarachnoid blood, but with intracerebral or intraventricular clots
• Next investigation ??
• MRA / CTA / DSA ?
• CT angiography and MR angiography have limited sensitivity in the detection of small aneurysms.
• The accepted reference standard for identification of intracranial aneurysms is intra arterial digital subtraction angiography
• Elective ventilation for 12 hrs.
• Extubated coming morning / HHH protocol.
• Uneventful recovery
• F/u CT after 3 days significant resolution of the SAH.
• Discharged Day 8 after coiling.
• Dr.Saurabh Joshi is a Neuro and Vascular Interventional Radiologist practicing in a tertiary care hospital in Mumbai.
• For Appointments : +919967368256 ( Mon – Sat 9 :00 to 19:00 India Standard Time )