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.
CA0612-CT Head
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CA0612-CT Head
Case ReportHistory
Exam
Prior Study
Findings
CT Head
There is clear evidence of hyperacute intracranial CVT. There is hyperacute (CT hyperdense) thrombus within both transverse sinuses and possibly the high cervical right internal jugular vein. The thrombus within the right transverse sinus is more hyperdense on the left suggesting there may be recanalization on the left. There is apparent thickening of walls of the distal SSS and torcular herophile, which are concerning for acute thrombosis, but these findings are not conclusive.
There is evidence of acute thrombus in the apex of the straight sinus as it adjoins the vein of Galen. There is also thickening of dural sinus walls, especially in the distal SSS, consistent with mural wall collateralization ( a secondary effect of luminal thrombosis).
There is evidence of right basal vein of Rosenthal acute thrombosis.
There is evidence of right sided dorsal thalamic parenchymal edema secondary to venous congestion in the right ICV venous egress territory.
There is also reduced CT density in the superior vermis is consistent with leukomalacia in the context of advanced cerebellar atrophy. However, similar changes could represent propagation of thrombus into the superior vermian vein complex from the apparent vein of Galen thrombosis.
There is advanced chronic atrophy of the cerebellum, likely from chronic medical therapy for known seizure control.
There is no evidence of skull base aggressive infection or tumor. There is no evidence of hydrocephalus or optic hydrops to confirm elevated CSF pressure.
Impression
2. Acute venous thrombosis is evident in both of the internal cerebral veins (ICV), the vein of Galen and the right basal vein of Rosenthal. There is edema in the dorsal right thalamus, but whether this is vasogenic edema or cytogenic edema (venous stroke) is indeterminate. There is also reduced CT density within the superior vermis related to chronic leukomalacia), or whether it is related to retrograde propagation of clot from the vein of Galen into the superior vermian vein complex is indeterminate.
