CTA Neck
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.
CA0471-CTA Neck
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CA0471-CTA Neck
Case ReportExam
Prior Study
1. Hyperacute basilar and left intradural vertebral artery thromboses with multicentric both arterial and watershed strokes involving multiple posterior fossa arteries, as described above.
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.
CT Perfusion
1. The TTP, CBF, & CBV changes consistent with completed infarctions in both SCA’s, the left AICA, the left PICA, the right cerebellar watershed zones, and possibly the left pons.
2. Absent MTT signal (out of scale sign) indicates virtually no transcapillary blood flow to generate MTT data. This is can occur with either sequestered infarction, or hemorrhagic transformation, or both. Differentiation between these two stroke complications is best exhibited on the MR susceptibility sequence.
3. CTA head (included with our CT perfusion protocol) demonstrates patency of the left intradural vertebral artery and of the caudal basilar artery at this time, despite the CT-hyperdensity seen on the noncontrast CT head .
4. There is an old infarct with an encephalomalacic defect in the left temporal lobe (PCA-P3 segment perfusion zone).
Findings
CTA of the Neck
There is no evidence of aortic arch dissection, but there is diffuse atherosclerotic plaque with scattered shallow ulcerations, which could be a source for thromboemboli.
The brachiocephalic arteries are reasonably normal, but there is a focal 50% stenosis at the origin of the right vertebral artery and occlusion at the origin of the left vertebral artery. The left vertebral is reconstituted at C5 level by cervical collaterals. The mid and distal parts of the vertebral arteries are within normal limits including the intradural vertebral artery segments.
There is mural calcification scattered throughout the aorta and carotid arteries along with subintimal atheromatous plaque. This produces roughly a 60% stenosis (by NASCET criteria) at the bifurcation and lower segment of the ICA on the right, and roughly 50% on the left. There is no ulceration, intimal dehiscence or intraluminal soft clot at any site.
The high cervical ICA’s are within normal limits for age.
The left vertebral is dominant (embryologically) and the right vertebral is hypoplastic.
Impression
2. There is focal left ICA stenosis of 50% and a focal right ICA stenosis of 60%.
3. The proximal left vertebral artery is occluded at its’ origin, but is reconstituted at the C5 level from cervical soft tissue collaterals. The high cervical and intradural vertebral segments are within normal limits.
