Post contrast head CT
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.
CA0631-Post contrast head CT
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CA0631-Post contrast head CT
Case ReportExam
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.
CTA head
1. Evidence of moyamoya disease vasculopathy.
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.
Findings
CT Head Post Contrast
There is virtually normal CT density within the venocapillary pool within most entire cerebrum, including the cerebral cortex and the right basal ganglia and to a lesser extent the right dorsal thalamus. The cerebral arteries on the right are more hyperemic compared to the left. The findings are consistent with physiologic hyperemia in response to the proximal ICA stenosis, which is more prominent on the right compared to the left. There are two small areas of reduced parenchymal contrast density: one is in the left caudate head and the other is in the right basifrontal white matter; these sites represent prior oligemic injuries at end-artery levels.
The CT density in the venocapillary pool is within normal limits even in the right MCA perfusion zone despite the delayed filling evident on the CTA.
There is moyamoya disease physiology with stenoses of the ophthalmic segment of the ICA's bilateral; the right is more stenotic than the left. There is also the peculiar, characteristic enlargement of the cerebral perforators (both the lenticulostriate and thalamic). Again, althoug bilateral, the "puff of smoke perforator collatersl are more prominent on the right than the left.
Impression
2. There are two small areas of persistent oligemia in the caudate head on the left and basifrontal white matter on the right. Both are likely sites of previous ischemic injury.
3. The classic features of moyamoya disease are again evident.
Recommendations
No recommendation
