WIDI - CA0629-CTA Neck

CTA Neck

Claim CME Credit

0.5 CME Credit available on completion

POINT 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.

CA0629-CTA Neck

Exam

CTA of the neck

Prior Study

CT Head
Negative study for acute arterial or venous occlusion.

There is a small completed lacunar infarct in the left caudate head.

The combination of a completed stroke and mild global atrophy and prominent basal ganglia calcificiation suggests the presence of underlying vasculopathy.

CT Perfusion
CT perfusion and CTA evidence of moyamoya disease with expected alteration of blood flow, as above.

Small completed infarct in the left caudate head.

Findings

CTA Neck

The lower neck demonstrates no intrinsic arteriopathy nor atherosclerotic disease. The common carotid artery size is normal. There is an incidental 1cm cystic adenoma in the left lobe of the thyroid; correlate clinically.

The carotid bifurcation region in within normal limits with no atherosclerotic disease, as a source for thromboemboli, since head CT demonstrated a left chronic caudate head lacune.

After the bifurcation, the right ICA becomes much smaller than the left, but without stenosis nor dissection nor intimal web, which implies the size reduction is related to signifcant downstream flow obstruction. The left ICA becomes smaller than normal in its' cavernous segment.

There is bilateral intradural ICA stenosis (in the ophthalmic ICA segment) bilaterally, right worse than the left. This is followed by prominent perforators to the basal ganglia consistent with moyamoya disease. Only partial proximal intradural ICA imaging is evident on this neck CTA.