MR 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.
CA0415-MR FLAIR
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CA0415-MR FLAIR
Case ReportExam
Prior Study
There is evidence of a left high-cervical ICA dissection. There is very subtle edema in the left hippocampus.
MRA Head and Neck
There are changes consistent with left high-cervical and vertical intapetrous ICA dissection. There is a short segment with non-filling of the genu segment of the ICA likely representing occlusion. However, the left ICA becomes patent in the horizontal, intrapetrous segment and beyond reflecting patent EC-IC collateralization.
Focal areas of absent MRA signal (consistent with down-stream thromboemboli) were evident in the proximal right ACA, the proximal left PCA, and the left MCA at the M2 trunk division (affecting flow into both the superior and inferior MCA perfusion zones).
MR Diffusion
Positive diffusion in the left hippocampus consistent with post-ictal effects of a recent seizure. A grand mal seizure may have precipitated the left high-cervical ICA dissection.
Findings
MR flair
There is minimally increase FLAIR signal in the left hippocampus consistent with recent seizure event.
The remainder of the brain demonstrates no additional post ischemic abnormality.
There is positive FLAIR signal within the arterial wall (mural thrombus) of the high cervical left ICA consistent with hyperacute dissection.
There is positive FLAIR within the lumen of the intrapetrous left ICA with an abrupt transition between thrombus and patent distal ICA lumen.
The FLAIR sequence is positive for classic post ictal left hippocampus changes. This makes an epileptic event the most likely cause of the left high cervical ICA dissection. The dissection produced significant luminal narrowing and slow flow, which is the most likely cause of the intraluminal intrapetrous ICA thrombus. The intraluminal thrombus is the most likely source for the intracranial proximal arterial emboli, which have, as yet, produced no acute stroke. This which means the initial symptoms were likely post-ictal. Symptoms of a seizure are often similar to acute ischemic effects; hence, seizure is always in the stroke differential at time of presention.
Impression
Subtle, positive, FLAIR signal is evident within the left hippocampus and the left column of the fornix consistent with hyperacute post ictal edema. This again supports the idea that an epileptic event precipitated the left ICA dissection. It is also likely that the presenting symptoms were at least partly based on a post ictal state.
Recommendations
No recommendations.
