MR T2 and 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.
CA0582-MR T2 and FLAIR
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CA0582-MR T2 and FLAIR
Case ReportExam
Prior Study
There is thrombosis of the right vein of Trolard.
There is hemorrhagic conversion of the thrombosed vein of Trolard producing local mass effects.
There are small volume subarachnoid blood products evident within vertex sulci bilaterally and in both the suprasellar and prepontine cisterns.
CT Perfusion
No imaging available
CTV/MRV of the Neck
No imaging available
MRV of the Head
There is mesial segmental occlusion of the right vein of Trolard. Focal displacement of cortical veins in the right parietal vertex is related to the parenchymal hematoma associated with the vein of Trolard thrombosis.
Anomolous, hypoplastic frontal SSS segmental hypoplasia is present as an anatomic variant.
Delayed Post Contrast CT of the Venocapillary Pool
NO imaging available
T1-W Sequences
No imaging available
MR Diffusion
Focal right vertex hemorrhage obscurs any evidence of MR diffusion positivity to confirm venous stroke.
Findings
MR T2 and FLAIR are both available
Subtle positive FLAIR signal is evident within the thrombosed segment of the vein of Trolard along the right lateral parietal vertex. Absent flow void is detectable on the T2-w sequence, but finding is subtle. The thrombosed vein is obscurred by the adjacent hemorrhage, which is located immediately below the actual thrombosed vein.
There is FLAIR positve signal representing subarachnoid blood in vertex sulci bilaterally and along the ventral surface of the pons. The SAH is not evident on the T2-w sequence
There is vasogenic edema surrounding the right parietal vertex hematoma.
There is a dilated collateralized cortical vein (best seen on the T2-w sequence) coursing around the posterior and lateral margin of the hematoma. This likely is the same pial collateral vein evident on the MRV.
There is early optic hydrops
Impression
2. Focal hematoma is evident adjacent to the right Trolard vein thrombosis. The hematoma plus the surrounding edema produces some local mass effect, but no appreciable brain herniation.
3. There is a dilated collateral pial vein adjacent to the posterior and lateral margin of the hematoma, which is secondary evidence of CVT.
