CTA 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.
CA0615-CTA Head
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CA0615-CTA Head
Case ReportExam
Prior Study
Acute to subacute thrombosis of multiple dural sinuses is evident including the transverse sinuses on both sides, and the straight sinus. 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 wihtin the superior vermis, but whether this is from prior radiation therapy (with leukomalacia) or whether it is related to retrograde propagation of clot from the vein of Galen into the superior vermian vein complex is indeterminate.
CT perfusion
There is deep central vein thrombosis producing venous congestion in the the subependymal venous system (i.e. caudate, thalamostriate, and deep medullary parenchymal vein), greater on the right than the left.
Thrombosis of the straight sinus is evident on the CTA, which is included with the CT perfusion data set, but there is no CT perfusion evidence of collateral flow in the dural sinus wall.
CTV neck
There is thrombosis (likely chronic) of the right cervical internal jugular vein and the right sigmoid/transverse sinuses.
Findings
CTA of the head
Although the exam is a CTA and not a CVT, there is filling of the superior sagittal sinus. Therefore, the nonfilling of the straight sinus, deep central venous system, right transverse/sigmoid sinuses and the right IJ is likely related to thrombosis or at least partial thrombosis. There is thrombus within the right (but not the left) channel of the torcular herophile and the straight sinus. There is limited filling of the proximal segment of the left transverse sinus consistent with recanalization, while the distal left transverse and sigmoid sinuses are patent. There is subtle evidence of increased flow in the left lateral tentorial venous confluence representing a functional venous egress collateral pathway for the left cerebrum.
There is nonopacification of the deep venous system including the thalamostriate/septal veins and vein of Galen plus the right basal vein of Rosenthal. But this exam is a CTA, and not a CTV, therefore the lack of opacification could represent a delayed filling rate. However, acute thrombus is evident is present in these veins on the CT head making the nonopacification likely acute CVT.
Although subtle, there is early opacification of the left superior sylvian vein complex and sphenoparietal sinus reflecting re-routing of venous egress, as seen on the CT perfusion.
Impression
2. There is either thrombosis or at least delayed filling of the deep central veins, the vein of Galen, and the right basal vein of Rosenthal on CTA of the head. However, there is thrombus in these veins on the CT head consistent with hyperacute CVT.
3. There is re-routing of venous egress through the left superior sylvian venous complex/sphenoparietal sinus/cavernous sinus and through the left lateral tentorial venous confluence.
