MRA 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.
CA0750-MRA Head
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CA0750-MRA Head
Case ReportExam
Prior Study
Given the history of cocaine abuse and hypertension, there is substantial global brain atrophy for chronological age, plus end-artery type of completed lacunar infarctions.
MRA of the neck
Normal MRA of the neck without vascular stenoses nor dissection.
Findings
MRA of the head
The distal left MCA and left PCA pial branches do fill as far as those on the left. They also appear to have subtle evidence of luminal narrow of the type associated with distal smaller artery vasospasm. Finding are not definitive but suggestive of the type of vasospasm associated with abuse of vasoactive drugs.
The head MRA demonstrates no apparent focal proximal artery stenoses, nor arterial dissections. The circle of Willis is incomplete with hypoplastic P-com segments bilaterally and minimal right A1 hypoplasia.
There is a saccular aneurysm with relatively wide neck evident at the M1/2 bifurcation on the right. The aneurysm neck and mid fundus cross-sectional diameter is estimated at 3 mms for both; the apex to base diameter is estimated at 5mms. There is no apparent intrafundal thrombus. There is vasospasm to suggest recent SAH.
Impression
2. Suspicious evidence of distal left MCA and PCA vasospasm plus minimal delay in filling rate, which are consistent with cocaine related distal arterial vasospasm. Otherwise, negative head MRA for arterial occlusion or dissection
