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.
CA0394-CTA Head
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CA0394-CTA Head
Case ReportExam
Prior Study
Changes consistent with hyperacute stroke in the Lt. lateral lenticulostriate and Lt. superior division MCA region. This makes the likely level of occlusion in the Lt. M1/2 level.
No intracranial hemorrhage nor hyperdense (acute) thrombotic arterial segments are evident.
CT Perfusion
Acute stroke changes with focal prolonged TTP and MTT plus moderate reduction in CBF and CBV centered in the Lt. orbitofrontal artery with some involvement of the Lt. rostral lentriculostriate, and Lt. anterior insular M3 perfusion zones. The tissue at risk is surrounded by areas of physiological hyperemia.
CTA of the Neck
Proximal right vertebral artery stenosis in the 50-60% range with no other abnormality noted in the remaining cervical arteries or veins. This accounts for the slowed flow on CT perfusion in the Rt. PICA perfusion zone.
No carotid occlusion is evident to account for the apparent left cerebral stroke.
Findings
CTA of the head
There is no primary of secondary intracranial stem artery occlusion or high grade stenosis.
There is a short stenosis at the origin of the Lt. superior division of the MCA; there is minimal post stenotic dilatation placing the stenosis in the 50-60% range; there is now reasonable antegrade blood flow and no pial collateral gap (all afferent vessels are opacified; there is no soft clot in the stenotic site. This is a likely site of prior thrombosis now with recanalization.
The Rt. intradural posterior fossa and the Lt. hemispheric arteries are NL.
There is hyperemia in the distal superior division MCA arteries with subtle evidence of BBB leak of contrast. This is evident in the frontoparietal operculum area. Findings suggests that part of the hyperemia is related to post-oligemic vascular injury with dysautoregulation and part from physiologic compensatory hyperemia. This can be resolved on the DWI sequence by determining whether the areas of hyperemia fall within positive diffusion sites or not.
There is relatively little venous opacification at this early imaging time.
Impression
2. There is subtle leak of contrast around the distal Lt. MCA arteries consistent with the minimal blood brain barrier leak associated with post ischemic arteriopathy.
