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.
CA0412-MRA Head
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CA0412-MRA Head
Case ReportExam
Prior Study
Non Contrast Head CT
1. Acute thrombus in the high cervical and vertical intrapetrous segments of the left cervical ICA without evidence of acute cerebral stroke. The history of acute upper neck pain makes dissection a very likely possibility.
2. Head is negative for hyperacute stroke changes.
MRA of the Neck
1. Acute dissection of the high cervical and vertical intrapetrous ICA on the left with intraluminal thrombus producing high-grade luminal stenosis (or occlusion) leaving at best minimal residual antegrade blood flow. Patent EC-IC collateral likely provide most of the collateral.
2. Given a history of seizures, this spontaneous left ICA dissection may have been the result of a recent grand mal type of seizure. No underlying vasculopathy is evident.
3. The right carotid, both vertebral arteries, and the left common carotid including the bifurcation were normal in appearance.
Findings
MRA of the head
There is an outside CTA of the head performed 10 hours earlier which demonstrated a developmentally hypoplastic right A1 segment. The remaining intracranial arteries were normal in appearance. CTA of the neck demonstrated the short segment thrombus in the intracranial/extradural left ICA. The current MRA of the neck confirmed the same findings as the prior CTA of the neck.
The MRA of the head was performed 10 hours after the CTA. The exam has substantially changed.
There is now an acute dissection in the left high cervical and vertical intracranial/extradural (intrapetrous) ICA. There is a short segment of apparent ICA occlusion in the genu region of the left ICA. The left ICA again becomes patent in the horizontal intrapetrous segment and beyond related to functional EC-IC collaterals.
There is intracranial arterial thrombus (thromboemboli) in the origin of the right ACA just after the A-com. A second intraluminal thrombus is evident in the left M2 segment affecting both the superior and inferior MCA divisions. There is some distal arterial filling in M3, but whether this reflects some antegrade blood flow versus pial collateral is indeterminate.
Only the proximal few mms. of the left PCA are opacified, presumably from thrombus or developmental hypoplasia. This possibly puts the left thalmogeniculate perforators at ischemic risk.
The circle of Willis is incomplete with hypoplastic P-coms, absent right A1 segment, and left P1 segments. These findings reduce available collateral to the left ICA region.
Impression
2. Multiple sites of acute thromboemboli are evident (right A1/A2 junction, left M1/2 junction, and possibly the left proximal P1 segment.
