MR Diffusion
Claim CME CreditPOINT OF CARE INFORMATION
This CME activity consists of the student reviewing the video of the professor reviewing the case as well as the associated DICOM image set related to the case in question.
Learning Objectives
As a result of participation in this activity, participants should be able to:
- Provide improved patient care.
- Greater knowledge of the imaging characteristics of the patient's disease.
- Understand a better approach to interpretation of studies.
Faculty Disclosure
Mehmet Albayram, MD, Ivan Davis, MD, Mariam Hanna, MD, Anthony Mancuso, MD, Ronald Quisling, MD, Dhanashree Rajderkar, MD, Priya Sharma, MD, Roberta Slater, MD and Joann Stamm, MBA have disclosed that they have no relevant financial relationships. No one else is a position to control content have any financial relationship to disclose.
CME Advisory Committee Disclosure:
Conflict of interest information for the CME Advisory Committee members can be found on the following website: https://cme.ufl.edu/disclosure/.
Continuing Medical Education Credit
Accreditation: The University of Florida College of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
Credit: The University of Florida College of Medicine designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
CA0366-MR Diffusion
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CA0366-MR Diffusion
Case ReportExam
Prior Study
1. Distal segment basilar artery partially occlusive acute thrombosis is present with mainly circle of Willis collateral to distal basilar tip and PCA trunks. Thus, there is filling of all pial arteries although limited on the left.
2. There is significantly reduced CT density in the venocapillary pool in the subcortical mesial occipital white matter bilaterally (dense ischemic core). Findings are most consistent with ischemic injury associated with the initial thromboembolic event. Currently there has been significant recanalization of the distal P4 arteries (better on the right) and partial clot lysis in the distal basilar artery. The depth and duration of the initial ischemic insult resulted in deep white matter occipital stroke.
2. Limited filling the left PICA resulting in completed stroke involving the mesial (caudal) cerebellum (dense ischemic core) and lesser ischemic changes in the remaining left lateral cerebellum (likely in the ischemic penumbra).
Findings
MR diffusion
The diffusion maps (both DWI and ADC) are positive for hyperacute stroke in both mesial occipital areas (P4 PCA perfusion zones). The visual cortical areas appear to be involved in the infarct zone at least on the left and possibly on the Rt., but patient did not present with visual symptoms.
There are additional small DWI positive areas in the right occipital lobe, which again are consistent with recent secondary emboli.
The diffusion maps (both DWI and ADC) are positive for stroke in the mesial left cerebellum and left peritonsillar region corresponding to the peritonsillar and mesial hemispheric trunks of the Lt. PICA. The lateral cerebellar trunk off PICA is less involved likely reflecting ipsilateral AICA collateral. The posterior medullary perforators off PICA are not involved, however the peritonsilar arterial stroke does involve the left inferior cerebellar peduncle. The ADC is less positive than the DWI in the left PICA stroke again consistent with a recent but not hyperacute stroke timeframe.
Anterolateral and posterior medullary perforator perfusion zones to medulla and the basilar tip perforator zones are normal as are the pontine & rostral central brain stem perforators. Remaining cerebellum and superior & inferior vermis parenchyma remain normal.
Impression
2. Recent, likely late acute phase in the Lt PICA affecting the mesial cerebellar caudal cerebellar and peritonsillary trunks off the Lt PICA.
3. Embolic source is likely with the original thrombus in the left intradural vertebral artery and the occipital stroke being secondary to later embolization.
