MR FLAIR
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.
CA0379-MR FLAIR
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CA0379-MR FLAIR
Case ReportExam
Prior Study
1. Acute hyperdense thrombus in the distal basilar artery (last 3mm’s), and of the basilar apex.
2. No focal reduced CT density within the venocapillary pool is evident to confirm completed stroke in the rostral cerebellum, rostral brain stem, nor occipital poles.
MR Diffusion
1. Multicentric embolic-type strokes are present including the PICA perfusion zones in the caudal cerebellar hemispheres, the distal basilar perforators to the Rt. cerebral peduncle, the basilar tip perforators to the mesial thalamus, the Rt. posterior mesial choroidal artery perforators to the dorsal Rt. thalamus, and the P4 branches to both occipital polar areas.
Findings
MR flair
Most of the embolic strokes are positive on DWI & ADC and are negative on FLAIR making the very recent and likely in the hyperacute or early acute timeframe.
The larger right mesial occipital stroke is diffusion and FLAIR positive but also shows protein leak in the sulci, which usually occurs after 6 hours.
There is turbulence in the CSF surrounding the distal basilar artery increasing the FLAIR signal and making it difficult to distinquish acute clot on FLAIR alone.
