Case Notes
History
8 yo male with history of Tetrology of Fallot repair and known ascending aortic aneurysm. Patient developed endocarditis after strep throat. He has had recent stroke events: a relative recent (weeks earlier) left MCA stroke followed by a very recent Rt. Frontal hemorrhagic stroke. Current MR imaging was performed after the most recent stroke event.Exam
Prior Study
noneDicom
Findings
CTA/MRA/DSA Findings | Correct Answer | Your Answer |
---|---|---|
There is evidence of intracranial/extradural aneurysm: petrous canal cavernous sinus, sub clinoidal space, lower ICA ophthalmic segment, or superior hypophyseal segment. This can be any type, saccular aneurysm, arteriosclerotic giant aneurysm, or blister aneurysm. |
No | NA |
There is evidence of intracranial/intradural saccular or giant arteriosclerotic aneurysm(s): upper ophthalmic ICA segment for true ophthalmic, dorsal ophthalmic variant, or ICA apex aneurysms. |
No | NA |
There is evidence of intracranial/intradural saccular aneurysm: communicating ICA segment for P-com aneurysm. |
No | NA |
There is evidence of intracranial/intradural saccular aneurysm: choroidal ICA segment for anterior choroidal aneurysm. |
No | NA |
There is evidence of intracranial/intradural saccular aneurysm: caudal P-com/P1 PCA junction aneurysm. |
No | NA |
There is evidence of intracranial/intradural saccular aneurysm: ICA vertex, or lenticulostriate (off M1 or A1), or anterior temporopolar aneurysm (off M1/2). |
No | NA |
There is evidence of intracranial/intradural saccular aneurysm: A1-2 segment for anterior communicating aneurysm. |
No | NA |
There is evidence of intracranial/intradural saccular aneurysm: distal ACA for pericallosal aneurysm. |
No | NA |
There is evidence of intracranial/intradural saccular aneurysm: M1-2 segment for lateral frontotemporal, or MCA trifurcation aneurysm. |
No | NA |
There is evidence of intracranial/intradural saccular aneurysm: basilar apex aneurysm. |
No | NA |
There is evidence of intracranial/intradural saccular aneurysm: PCA-SCA junction aneurysm. |
No | NA |
There is evidence of intracranial/intradural saccular aneurysm: PICA origin aneurysm. |
No | NA |
There is evidence of saccular aneurysm complexities including daughter aneurysms and wide neck (vs fundal width), aneurysm neck involvement of parent artery, local dissection of parent artery. |
No | NA |
There is evidence of major vessel vasospasm (minimal, moderate, or advanced). |
No | NA |
There is evidence of a bleb/blister type aneurysm (usually off ICA ophthalmic segment or dorsal side of A-com or basilar apex). |
No | NA |
There is evidence of a major artery spontaneous distal fusiform aneurysm. |
No | NA |
There is evidence of intracranial/intradural dissecting aneurysm: vertebral or carotid dural penetration site. |
No | NA |
There is evidence of intracranial/intradural dissecting aneurysm of distal artery branches: consistent with saccular appearing dissection or mycotic source. |
No | NA |
There is evidence of a distal pial artery inflammatory tubular aneurysms, especially M2-4, P2-4 arteries. |
No | NA |
There is evidence of aneurysms associated with vascular anomalies: arterial fenestrations, trigeminal anomaly, or any other arterial anomaly. |
No | NA |
There is evidence of major vessel atherosclerotic sacculo-fusiform aneurysm. |
No | NA |
There is evidence of significant arteriosclerotic dolichoectasia. |
No | NA |
There is CT perfusion evidence of dysautoregulation (mixed vasospasm and downstream vasodilatation from collaterals). |
N/A | NA |
Other abnormalities |
No | NA |
Impression
Expert Answer
Mycotic aneurysms tend to use all or part of the parent artery lumen as the aneurysm neck. The mycotic aneurysm fundus may be patent, partly patent, or completely thrombosed. Mycotic aneurysm most often bleed into brain parenchyma.