Hemorrhage - Case 9 Head CT
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.
CB1714-Hemorrhage - Case 9 Head CT
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CB1714-Hemorrhage - Case 9 Head CT
Case ReportHistory
Exam
Prior Study
Findings
CT head pre contrast
There is wide spread supra and infratentorial subarachnoid hemorrhage. The SAH clot is largest (Fisher grade 3) in the right proximal segment of the right sylvian fissure and right lateral suprasellar cistern.
There is a focal dissecting, 3 x 2.4 x 6 cm, macrohemorrhage within the infero-mesial right temporal lobe. The mesial surface of the largest inferior portion of this hematoma abuts the largest part of the extrraaxial clot in the right proximal sylvian fissure. This complex of concurrent adjacent intra and extraaxial hemorrhage is consistent with a sentinel hemorrhage where a previous SAH resulted in pial adhesions to major proximal arteries. Thus, when a saccular aneurysm (arising off these arteries) bleeds, it hemorrhages into both the subarachnoid space and into brain abutting the aneurysm simultaneously.
The intraaxial right temporal hematoma is surrounded by significant edema. There is asymmetric-right downward transtentorial herniation with compression of the right cerebral peduncle. Midline subfalcine shift is blunted by the ventriculomegaly associated with hydrocephalus. There is optic hydrops and early right papiiledema indicating raised ICP.
There is mainly right lateral and 4th ventricular acute blood products. This is associated with acute hydrocephalus (grade 1.4/4). The hydrocephalus is an external type.
Impression
2. There is minimal to moderate external hydrocephalus and early optic hydrops.
3. There is early downward uncal herniation compressing the right cerebral peduncle.
4. There is a right P-com saccular aneurysm with a relatively wide neck for fundal size. There is no vasospasm nor incorporation of the parent artery in the aneurysm neck. It has a small apical daughter aneurysm. There is a small basilar apex pre-aneurysm.
5. There is no residual aneurysm in the left MCA treatment area.
