CTA Head
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.
CA0376-CTA Head
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CA0376-CTA Head
Case ReportHistory
Exam
Prior Study
There is focal hyperdensity in the distal basilar apex consistent with acute thrombus.
There is no discernable cytogenic edema, and certainly no obvious edema to confirm stroke outside the treatment window.
CT Perfusion
1. Short segment acute thrombus is evident on the included head CTA located in the distal basilar apex.
2. Delayed PCA filling (prolonged TTP) is related to retrograde PCA filling from the circle of Willis.
3. Chronic reduced CBV is evident in the caudal Rt. cerebellum, but no discernable hyperacute stroke is evident.
CTA of the Neck
There is a focal stenosis of the left vertebral artery origin. The stenosis measures >60%, however, there is no post stenotic dilatation nor distal vessel collapse.
Findings
CTA of the head
The proximal posterior fossa afferent circulation is patent. However, there is thrombus in the distal basilar artery apex. The thrombus measures approximately 3-4 mm’s in length; both PICA & AICA vessels are patent.
There is retrograde collateral filling the PCA’s derived from the circle of Willis, despite evidence that the P-com’s are small. This does account for the delayed PCA filling on CT perfusion.
There is a retrograde filling of the superior vermian arteries but not the superior cerebellar arteries leaving a pial collateral gap, at least on the 1st pass head CTA. This finding needs to be reassessed on the delayed CTA to exclude just filling delay.
The venous system is not yet opacified.
Impression
2. There is retrograde filling of the supervermic arteries, but not the superior cerebellar arteries, as yet. This is likely an effect of delay in filling. Correlate with delayed CTA.
