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Venous Hypertension and Intracranial Aneurysm Rupture

Venous Hypertension and Intracranial Aneurysm Rupture. Fong Y Tsai,* Andrew Yen*, Wan-You Guo**Chin C Wu** *UC Irvine Medical Center, Orange,Ca ** Taipei Veterans General Hospital,Taipei,Taiwan. Risks of Rupture Cerebral Aneurysm. 1) Size and site:

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Venous Hypertension and Intracranial Aneurysm Rupture

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  1. Venous Hypertension and Intracranial Aneurysm Rupture Fong Y Tsai,* Andrew Yen*, Wan-You Guo**Chin C Wu** *UC Irvine Medical Center, Orange,Ca ** Taipei Veterans General Hospital,Taipei,Taiwan

  2. Risks of Rupture Cerebral Aneurysm 1) Size and site: No difference in size, posterior fossa and posterior communicating and PCA more likely rupture, 2) Configuration: lobulation 3) Smoking, hypertension 4) Wall shear stress and tension 5) Hemodynamic patterns 6) Flow patterns: hemodynamic profile

  3. Risks of ruptured Cerebral Aneurysm • Hemodynamic profiles: • 1)Flow patterns: Intraneurysmal flow • 2)Jet wave: ruptured aneurysm with small jet size • 3)Impingment region:Dome,body,neck, ruptured with small impingement zone • 4)Geometry of aneurysm

  4. Asymmetry Dural Sinus Potential factor: venous hypertension from asymmetrical dural sinus

  5. Materials:Retrospective • 193 patients: 131 females and 62 males • Age ranged from 15 to 90 in female and 26 to 81 in males • 140 had ruptured aneurysm • 87 of 140 had venous asymmetry • Females: 60 of 91 ruptured aneurysm had venous asymmetry • Males: 27 of 49 ruptured aneurysm had venous asymmetry

  6. Case Presentation Case 1 57/F presented with worse headache of life with clinical Grade 2 SAH

  7. Case Presentation Case 2 53/M presented with recurrent headache, negative neural examinations

  8. Case Presentation Case 3 37/M recurrent headache

  9. Case Presentation Case 4 66/F presented with severe headache and grade 2 clinically

  10. 66/F Severe Headache stage 2 clinically

  11. Venous Pressure Measurement By MRI • Phase Contrast • Standard fluid dynamics • Poiseuille’s Law:

  12. Pressure Measurement

  13. Right central Q1(L) Q1(R) Q2(L) Q2(R) Q1(R) Right lateral Q2(R) Left central Q1(L) Left lateral Q2(L)

  14. Flow Chart, right side

  15. Flow Chart, left side

  16. Calculation Of Pressure ΔPr/Pl=75.26%

  17. Pressure Gradient Left venous pressure is 24.76% higher than right side

  18. Conclusion • Preliminary data demonstrated association of rupture cerebral aneurysm with venous sinus asymmetry • Preliminary MR phase contrast venous pressure measurement showed pressure gradient in asymmetry of dural sinuses

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