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.
CA0630-CTA Head
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CA0630-CTA Head
Case ReportExam
Purpose
1. To define sites of afferent supra or infratentorial arterial thrombosis or flow-limiting high grade stenosis, or less significant luminal narrowing but tandem stenoses, or stenosis plus incomplete circle of Willis with isolated arterial circuit (presented in the Arterial stroke module).
2. To assess presence of any combination of proximal stenosis plus an incomplete circle of Willis, which together create an isolated arterial circuit with reduced potential for collateral blood flow.
3. Given there is significant afferent extradural obstruction, is there effective EC-IC collateral (presented in the Arterial stroke module).
4. Is there a watershed of shifted watershed stroke zone affecting the anastomotic arterial boundary zones (presented in the Arterial stroke module).
5. To assess status of retrograde pial collateral for any "pial collateral gap" between a proximal thrombus & the available retrograde pial collateral based on the initial (1st pass) contrast injection.
6. To identify any cortical vein or dural sinus thrombosis (presented in the Venous stroke module).
7. To recognize all the venous collateral rerouting (presented in the Venous stroke module).
8. To identify any intradural arterial vasospasm.
9. To identify any distal small vessel angiitis.
Prior Study
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.
CTA neck
Arterial vascular changes consistent with moyamoya disease.
Findings
CTA Head
There are classic features of moyamoya disease with high grade stenoses of the ophthalmic ICA segments bilaterally, but worse on the right. This accounts for the luminal collapse of the right ICA. Additionally, there are the peculiar moyamoya perforator collaterals creating the "puff of smoke" appearance bilaterally.
The circle of Willis is not intact with hypoplasia of the left P-com and possibly of the right A1 segment.
There is evidence of complex pial collateral re-routing with pial collateralization mainly form the P4-PCA arteries into the MCA and ACA distal branches bilaterally . However, the distal pial filling of the right MCA vessels on the right compared to the left, placing the right hemisphere at more risk for hypoperfusion ischemic injury.
Impression
2. There is a prior small completed lacunar stroke in the left caudate head.
3. There is delayed filling of distal MCA pial arteries on the right.
Recommendations
No recommendation
