Anesthetic management of patient with Neurovascular disease

The brain and the spinal cord are fragile organs and both of them are covered by three layers of meninges, the dura, arachnoid and pia matters.The brain and spinal cord are rich in blood supply, brain is supplied by the two internal carotid and the two vertebral arteries while spinal cord .is supplied by the anterior and posterior spinal arteries. Both brain and spinal cord are surrounded by CSF protecting them from potentially injurious blows.The brain has a high metabolic rate, Under resting but awake conditions, the metabolism of the brain accounts for about 15 percent of the total metabolism in the body. Also The cerebral oxygen consumption (CMRO2), averages 3–3.8 mL/100 g/min (50 mL/min) while the cerebral blood flow varys from 10–300 mL/100 g/min. Moreover, there is a blood brain barrier which is essential to maintain the constancy of the environment of the neurons in the central nervous system.There are a large variety of neurovascular disorders affecting the blood vessels present within or supplying the brain and spine specially intracranial aneurysm, AVMs and cerebrovascular stroke.. the cerebral aneurysm may be saccular, fusiform or desecting, also it may be silent for a long time or ruptures presented by SAH. Although AVMs are present from birth, onset of symptoms is most common between 10 and 30 years of age. The cerebrovascular stroke comes in one of two forms either ischemic or hemorrhagic..