Neurovascular or cerebrovascular disease refers to all disorders in which an area of the brain is temporarily or permanently affected by bleeding or restricted blood flow. Restrictions in blood flow may occur from vessel narrowing (stenosis), clot formation (thrombosis), blockage (embolism), or blood vessel rupture (hemorrhage). Blood travels throughout your body via arteries and veins. Arteries are responsible for carrying oxygen-rich blood from the heart to the brain, kidneys, intestines, arms, and legs. Veins carry the blood back to the heart.
Problems that arise along this elaborate network of blood vessels, called the vascular system, can cause severe disability and/or death. While there is no clear cause of neurovascular disease, individuals with diabetes, a history of heart disease, high cholesterol level, and a history of smoking, may be at a greater risk of developing it. Penn researchers are actively studying the development of neurovascular disease and finding improved methods to treat it.
Neurovascular Conditions Treated at Penn
Stroke and Transient Ischemic Attack
Penn has a comprehensive stroke center (higher than a primary center) which means our center is the largest and best-equipped facility in the area that can treat any kind of stroke or stroke complication. A stroke occurs when blood vessels in the brain are suddenly blocked or burst causing lack of blood and oxygen. Brain cells begin to die causing a wide variety of disabling symptoms and often permanent disability or death. Symptoms may include sudden weakness on one side of the body, confusion, vision problems, and trouble walking. Surgical treatment at Penn includes microsurgical procedures where we place clips at the base of the aneurysm or endovascular procedures where we place micro platinum inside the vessel.
Atherosclerosis: Carotid and Vertebral Artery Disease
Carotid and vertebral artery disease, or stenosis, occurs when the main blood vessels carrying oxygenated blood to the brain become narrowed. The narrowing of the arteries is most commonly related to atherosclerosis or "hardening of the arteries. Atherosclerosis can be either asymptomatic or symptomatic. Symptoms can include sudden weakness, clumsiness or paralysis of an arm and/or leg on one side of the body, confusion, dizziness, fainting, and/or headache, and numbness or loss of sensation in the face, arm and/or leg.
Treatment can range from modification of patient risk factors to administration of medications such as antiplatelets, statins and antihypertensives. In some cases, surgical treatment is required. Open surgery includes carotid endarterectomy (CEA) in which the narrowing is removed, or revascularization procedures that divert blood flow from other regions, such as the scalp or nearby muscles, to the oxygen-deprived region of the brain. Endovascular surgery involves carotid angioplasty, where a catheter is used to temporarily place a balloon across the narrow portion of the artery and expand it, followed by placing a stent across the narrow segment to keep the blood vessel open.
A brain aneurysm is an abnormal bulging outward of a vessel wall in one of the arteries in the brain. Most aneurysms are not symptomatic. However, the symptoms of an unruptured cerebral aneurysm can include, but are not limited to headaches, dizziness, eye pain and vision deficits. The first evidence of a cerebral aneurysm may be a subarachnoid hemorrhage (SAH), due to rupture of the aneurysm. Symptoms that occur at the time of SAH can include, but are not limited to, rapid onset of "worst headache of your life," stiff neck, nausea and vomiting, changes in mental status and loss of consciousness.
Treatment for aneurysms can include open, as well as endovascular surgery. Open surgery involves placing a clip across the aneurysm where it arises from the blood vessel to prevent blood flow from entering the aneurysm. Endovascular surgery (coiling) techniques include placing platinum coils into the aneurysm, stent-assisted coiling, and balloon remodeling, all of which help to eliminate the aneurysm.
Arteriovenous Malformation (AVM)
An AVM is a collection or tangle of abnormal blood vessels that grow in the brain. The most frequent symptoms of an AVM include intracranial hemorrhage (abrupt onset of severe headache, nausea, vomiting, collapse/loss of consciousness), seizure, motor symptoms including paralysis or sensory disturbance, stroke-like events and headache.
Treatment for an AVM may involve microsurgery, endovascular surgery, Gamma Knife radiosurgery or a combination of therapies. The goal of treatment is obliteration of the AVM. Microsurgical resection of the AVM may be used alone or in combination with endovascular surgery for complex AVMs. Endovascular surgery (embolization) delivers "glue" to the AVM to block abnormal flow into the malformation. Gamma Knife radiosurgery may be used alone or in combination with microsurgery and/or endovascular surgery.
Dural Arteriovenous Fistula/Malformation
A dural AVF/AVM is a collection or tangle of abnormal blood vessels in the dura matter, the thick covering surrounding the brain. It may occur as a result of trauma, infection or surgery. The symptoms of a dural AVF include headache, ringing in the ears, visual problems and stroke-like symptoms, including neurological deficits.
The current treatment of choice for a dural AVF is endovascular embolization, in which "glue" is delivered to the area blocking the abnormal flow into the fistula and restoring normal circulation. In some cases, microsurgical resection of the dural AVF may be required to occlude abnormal blood flow. Treatment may also involve a combination of endovascular and microsurgery to eliminate abnormal blood flow. Gamma Knife radiosurgery can also be used in specific cases.
A cavernous malformation is an abnormal collection or tangle of thin-walled blood vessels within normal brain tissue. Cavernous malformations are also known as cavernous hemangiomas or cavernomas. The decision to treat a cavernous malformation depends on the location of the malformation and whether it causes symptoms. Microsurgical techniques as well as Gamma Knife radiosurgery may be used.
Moyamoya disease is a condition in which the walls of the carotid arteries thicken and narrow, restricting blood flow to the brain. Moyamoya disease can cause episodes of weakness, paralysis in a limb or on one side of the body, headaches, dizziness, or seizures. Severe immediate problems include the risk of transient ischemic attack (TIA), stroke, or intracranial hemorrhage.
Treatment for Moyamoya disease includes surgical revascularization procedures that involve diverting blood flow from other regions, such as the scalp or nearby muscles, to the oxygen-deprived region of the brain. Moyamoya disease is a very rare disease that only highly-specialized facilities can treat.