A B C D E F G H I J K L M N O P R S T U V W

CEREBRAL ANGIOGRAPHY

Why is Cerebral Angiography performed ?

The examination is carried out because a disorder of the brain or nearby structure is suspected. It is particularly helpful in disorders of the arteries such as abnormal narrowing (stenosis) and widening (aneurysm). It is usually carried out where the simple tests have failed to give the diagnosis.

Preparations needed for Cerebral Angiography

The test is always carried out in hospital and usually means an inpatient stay of two nights. You will need to be at rest for a few days afterwards, resulting in at least a week off work. It will be another week before you will be able to return to full physical activity. The test is usually carried out under local anaesthesia.

What Happens during Cerebral Angiography

THE PRINCIPLE The test outlines the arteries and veins of the brain and nearby organs, such as the pituitary gland. An iodine-containing dye (called contrast medium ) is injected into the arteries supplying the brain through a needle or thin plastic tube (catheter), and x-ray films are taken. The arteries and veins show up on the x-ray, and any abnormality will be shown.

THE PROCEDURE The test takes about 2 hours and is carried out by a medically trained specialist (radiologist). He or she will be assisted by a small team of radiographers and nurses. Tell your doctor beforehand of any known allergies to drugs. With a general anaesthetic, you will need to have fasted for 6 hours to make sure that the stomach is empty. However, if you are being examined under local anaesthetic, you will usually be allowed a light snack 2 hours before the procedure. Arterial injections are usually given through the groin and both groins are shaved before the you are brought to the x-ray department. You are also likely to have received a sedative injection on the ward and will be feeling sleepy by the time you come to the x-ray department. Here you will be placed on an x-ray table. If you are to have a general anaesthetic, you will be given an injection into the arm or hand by the anaesthetist and will go to sleep within a few seconds. The next thing you will remember is waking up and answering simple questions. There will be a feeling of pressure on the groin at the site of the injection and this will last for at least 10 minutes. Some patients are examined under local anaesthesia. The radiologist injects the local anaesthetic into the groin until the area becomes numb. A larger needle is passed into the artery and is replaced by the arterial catheter which can be seen on the x-ray TV screen. The catheter can be guided into the arteries supplying the brain. It is usually necessary to give several injections of dye and to take x-rays at different angles. This usually takes about 1 2 hours. Some people have a sensation of flushing or heat in the face with each injection but this disappears within a few seconds and is not painful. The head may be moved into different positions for different injections. It is important to keep quite still when the x-rays are taken to avoid blurring the pictures. You will be aware of the arterial catheter being moved in the groin from time to time, but will feel no pain. The catheter is removed when all the x-ray films have been taken. Pressure is then applied to the groin for at least 10 minutes to prevent bleeding. This can be uncomfortable but it is not painful. You are then lifted from the x-ray table onto a stretcher and placed in bed. Most will be kept in bed for 12 hours afterwards, to avoid the risk of bleeding from the entry point of the catheter.

Possible Complications of Cerebral Angiography

You will have a small bruise where the injection was given. This is hardly a complication and clears within a week. Some patients develop a large bruise at the site of the injection, which is painful but not serious. Allergic reactions to sedative, painkilling and anaesthetic drugs occur rarely. Allergic reaction to the dye also occurs. This is readily controlled by drugs such as anti-histamines or cortisone-like (steroid) drugs and is rarely serious. The most serious complication is that you could develop a stroke. This is extremely rare. Even if it does occur, it usually gets better in a few days without treatment. However, it is important to point out that it can very occasionally result in long-term or even permanent disability. The artery can also be damaged at the injection site in the groin. This results in a reduced blood supply to the leg. This usually gets better without treatment, but an operation is occasionally required.

After Cerebral Angiography

If you were active before the procedure, you should be up and walking about the day afterwards. There will be some stiffness of the groin and a small bruise will be visible. Even larger bruises will clear in 2 3 weeks. You should be able to return to full physical activity 2 weeks after the procedure.

If Cerebral Angiography is not performed

If the test was not carried out, an accurate diagnosis could not be made and the treatment could not be planned. This is particularly important if an operation is being considered. However, in some circumstances CT scanning or magnetic resonance imaging may be able to be used instead.