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.
CA0569-CTA Head
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CA0569-CTA Head
Case ReportHistory
Exam
Prior Study
Focal left retrosylvian vasogenic edema matching the vein of Labbe' venous egress territory. Whether there is cytogenic edema in this area representing venous stroke remains indeterminate.There is acute thrombus in multiple branches of the left vein of Labbe' without apparent concurrent left transverse sinus thrombosis.There is no hemorrhagic conversion.
CT Perfusion
There is a focal area of reduced brain perfusion in the left retrosylvian area corresponding to oligemia resulting from thrombosis of the left vein of Labbe' (evident on the noncontrast head CT). There is both collateral zone physiologic hyperemia in the collateral zone surrounding the retrosylvian oligemic area plus evidence of re-routing of venous egress into the left superior sylvian vein complex and left lateral tentorial venous confluence. This accounts for the increased blood volumn (increased CBV) in the cavernous sinus and left transverse sinus.
CTA Neck
Negative for venous occlusion; negative for otomastoid or paranasal sinus infection/tumor. The CTA of the neck included the head with good opacification of the major dural sinuses, all of which were patent.
Findings
CTA Head
CTA of the head was obtained not CTV, hence there is limited opacification of the venous system. There is minimal opacifications of the major dural sinuses including the left transverse sinus. The cortical and deep central veins have sufficient opacification to indicate patency. The left vein of Labbe' is not evident.
Additionally, there is early filling of dilated venous pial collateral egress veins, including the left basal vein of Rosenthal, and the superior sylvian vein complex draining into the left sphenoparietal sinus. The cortical veins in the left ventrolateral aspect of the posterior temporal lobe also exhibit hyperemia and early filling. These veins drain into the left lateral tentorial venous confluence. These secondary findings are consistent with pial venous re-routing associated with the left vein of Labbe' thrombosis.
The intracranial arteries demonstrate not significant stenoses nor occlusion. There is some dilatation of the arteries in the left posterolateral thalamus compared to those on the right (i.e. physiologic hyperemia).
Impression
2. The major dural sinuses, although with limited filling based on image acquistion time, demonstrate no dural sinus thrombosis. This would imply that the left vein of Labbe' thrombosis is on a primary (de novo) cortical basis.
