CT 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.
CA0454-CT Head
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CA0454-CT Head
Case ReportHistory
Exam
Prior Study
Findings
CT head
There is both punctate area of calcification in the ICA apex plus subtle luminal hyperdensity in the ophthalmic segment of the proximal ICA (primary stem artery), and in the Lt A1 and M1 segments (secondary stem arteries consistent with acute thrombosis. No hyperdensity or other abnormality is evident in the high cervical or intracranial-extradural ICA segments to suggest dissection. There are sites of hyperdensity in distal branches of the left ACA and M3-MCA, but distinguishing mural calcification from punctate acute sites of thrombus is difficult.
There is early stroke cytogenic edema in the Lt. ACA (especially the mesial orbitofrontal cortex), and in the Lt. MCA (both superior and upper-part of inferior division perfusion zones). There is involvement of both the mesial and lateral lenticulostriate perfusion zones. The Lt. PCA perfusion zone has normal parenchymal CT-density. The relatively minimal CT-hypodensity places the stroke-age in the 4-6 hour range, possibly in the IA treatment window (i.e. 6-8 hours);
The cytogenic edema occupies more than a third of the superior division volume, and is enough to compress portions of the lateral ventricles (body and temporal horn) and effaces superficial sulci. There is a subtle left to right subfalcine shift. The cytogenic edema involves all of the mesial lenticulostriate perforator zone (off A1) and all of the lateral lenticulostriate perforator zone (off M1/2).
The loss of sulci in the left high convexity has less obvious cytogenic edema and may, in fact, represent effects of physiologic hyperemia in the collateral zone.
Remainder of exam is within NL limits for age
Impression
2. Early cytogenic edema in both Lt. ACA & MCA territories, likely stroke-age is in the 3-6 hour range.
