CT Head
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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.
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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.
CA0469-CT Head
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CA0469-CT Head
Case ReportHistory
Exam
Prior Study
Findings
CT head
There is a focal area of encephalomalacia in the left MCA-PCA watershed zone and in the P3-PCA perfusion zone along the ventrolateral aspect of the left temporal lobe consistent with prior completed infarction. There are other small lacunar defects.
There is generalized prominence of the supratentorial sulci consistent with brain atrophic changes well outside that expected in a 59 year old person. There is dense mural ICA calcification also unexpected in this age group without other comorbidity, as diabetes.
There is dense mural calcification in the intradural vertebral artery segments. There is hyper CT-density in the left intradural vertebral artery and the basilar artery consistent with hyperacute thrombosis.
The multiple separate areas of infratentorial cytogenic edema involve bilateral SCA perfusion zones, the left AICA & PICA perfusion zones, and the Rt. (deep central) cerebellar watershed zone. All areas of cytogenic edema on the CT are clearly discernable placing their likely stroke-age beyond the 8 hour treatment window. They also involve much more than 1/3 of each of all of the affected arteries.
The central left cerebellar watershed area has a discernable mass effect that is slightly CT-hyperdense consistent with a very recent intercurrent hemorrhagic conversion (with hematoma formation).
There is suggestion of cytogenic edema in the pons but beam-hardened bone artifact crosses the same area limiting conspicuity. Despite the thrombus in the distal basilar, there is no distinct thalamic or thalamogeniculate perforator infarct identified suggesting these arteries are collateralized.
There is bilateral focal cerebellar hemispheric swelling with evidence of compression of the fourth ventricle, and effacement of cerebellar sulci and effacement of the prepontine cistern. The cerebellar tonsils are minimally low, and there is clear upward transtentorial herniation of the superior vermis into the quadrigeminal plate cistern. In the context of stroke, focal mass effect can be related to very acute hemorrhage (prior to becoming CT hyperdense) and sequestered infarct. Sequestered infarction in later stages of stroke evolution develop marginal enhancement, at which time they are called tumefactive strokes, which can be confused with either primary or metastatic brain tumors.
Impression
2. There is early mass effect including compression of the 4th ventricle, effacement of prepontine cisterns, and clear evidence of early upward transtentorial herniation.
3. Focal lesion within the deep central left cerebellum is likely a site of hemorrhagic conversion with very acute hematoma.
